John Halamka, M.D., vice chair of the Health IT Standards Committee (HITSC), and CIO of the Beth Israel Deaconess Medical Center in Boston, led off the May 20 HITSC meeting with some biting comments about some bills currently in Congress, including the 21st Century Cures Act and the Burgess Bill.
Halamka noted that he had just posted a blog post about the legislation, calling it flawed, dangerous and harmful. As his blog post explains, the interoperability language to be included in the 21st Century Cures Act would sunset the Health IT Standards Committee while a new “charter organization” would help define the standards of interoperability.
“It does not make sense to officially sanction a ‘charter organization’ and seed it with $10 million, creating yet another player in an already crowded field of groups working on interoperability,” he wrote in the blog post. “I agree that coordinating the standards development organizations makes a lot of sense -- why not just direct ONC to create a permanent Task Force that reports to the HIT Standards Committee, and let ONC support it out of existing resources?”
Speaking to the Standards Committee, Halamka said: “What you have is some well-meaning people writing some of these pieces of legislation who don’t really understand the issues." He said information blocking is like the Lock Ness monster — often talked about but seldom seen. He said people writing the active legislation believe that they will use a hammer of decertify vendors that engage in information blocking. If that happens, he said, “we are going to have a free-for-all of vendors making claims against other vendors to the FTC, OIG and through other means every time they lose a deal in a region. It is going to be a mess.”
The legislation also suggested the creation of standards to measure interoperability. “I would love to know what is a standard that measures interoperability,” Halamka said. “I know: we’ll send CCDAs and count the number you send. That will achieve a good result,” he said sarcastically. “Look at meaningful use, Stage 2, and the number of folks who sent CCDAs to themselves, or to what I am going to call ‘electronic garbage cans’ as opposed to measuring care coordination or closed-loop referrals or some other positive outcome.”
In the blog post and his talk to the committee, Halamka enumerated some of the things that would be true enablers of interoperability: policies that could be standardized across states; some reconsideration of barriers like 2 CFR Part 2 and the challenges that creates in sharing data; and enabling infrastructure. “What if CMS decided to host a provider directory for the country that was FHIR-enabled and queryable by any EHR. Would that help us? Or a record locator service with a voluntary opt-in national identifier? While admitting that these are controversial points, he said they are the kinds of things that would truly increase capacity to exchange data in a meaningful way, not decertification, penalties for information blocking or the blunt instrument of legislation. “I know this is controversial, but somebody had to say it,” he said. If we find that there is legislation for which the emperor has no clothes, somebody has to say that.”
In his blog post, Halamka also wrote that he believes that the CMS and ONC Notices of Proposed Rulemaking for Meaningful Use Stage 3, both need to be “radically pared down,” and he stressed that ONC needs a full-time leader once Karen DeSalvo is confirmed as Assistant Secretary of Health.