The Senate Health, Education, Labor and Pensions (HELP) Committee today unanimously passed the Improving Health Information Technology Act as well as six other biomedical innovation bills with bipartisan support.
The 51-page Improving Health IT Act legislation aims at making electronic health records (EHRs) more interoperable and has a number of goals including establishing an unbiased rating system for health IT products to help providers better choose those products and addresses information blocking by giving the Department of Health and Human Services (HHS) Office of the Inspector General the authority to investigate and establish deterrents to information blocking practices.
The section of the bill that establishes a star-rating system for EHRs based on security, usability and interoperability was a provision of the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 by Sen. Bill Cassidy (R-La.) and Sheldon Whitehouse (D-R.I.).
As previously reported by Healthcare Informatics, the Improving Health IT draft legislation released on Jan. 20 was the product of a bipartisan, full committee health information technology working group announced by Senate health committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) in April—as well as a series of bipartisan hearings in the committee held throughout 2015. Those hearings had the intent to solve problems with the federal government’s six-year-old, $30 billion program meant to encourage EHR adoption.
Commenting on the Improving Health IT Act during the hearing, Alexander said, “This was not a subject that we intended to spend this much time on last year, but the more we got into it, the more I saw that the program was in a ditch, and that we might have an opportunity to help get it out of a ditch.”
Alexander also said that the committee’s legislative work in this area was necessary given a number of new federal initiatives, including President Obama’s precision medicine initiative and ongoing payment reform efforts, that depend on the success of EHRs and other health IT systems. He also applauded the cooperative efforts of HHS Secretary Sylvia Mathews Burwell, National Coordinator for Health IT Karen DeSalvo and Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt.
However, at the same time, Alexander reiterated that he thought federal officials should have delayed Stage 3 of the meaningful use program for a year. “We could have used that time to work with physicians to reduce unnecessary documentation. …The physicians would have appreciated that and would begin to see EHRs as more of an aid than something they dread.”
The bill approved in a 22-0 vote included a number of revisions from the draft legislation, including the deletion of a proposal to combine the HIT Policy Committee and HIT Standards Committee into the HIT Advisory Committee as well as the deletion of a section that mandated certified EHRs be able to conduct “trusted exchange with multiple other EHR products.”
Alexander said, “The House has completed its work on the 21st Century Cures Act. The president has announced his support for a precision medicine initiative and a cancer ‘moon shot.’ We have worked for a year to produce 50 different bipartisan legislative proposals. Senate Majority Leader Mitch McConnell told me even though it’s a presidential election year, he’s looking for important ideas that have bipartisan support, that help many Americans and that the president will sign. I can’t think of a single piece of legislation in 2016 that fits into those criteria better than this one.”
Commenting on the bill at the hearing, Sen. Whitehouse praised the legislation, but noted that more work needs to be done, specifically flagging three concerns. “First, we have to provide more support for health information exchanges rather than just continuing with meaningful use. Two, we’ve got to address privacy issues that are bedeviling these systems. …And we need to do something for behavioral health and for nursing homes that are outside of meaningful use parameters. We have taken an important step forward and it’s a first step.”
Senator Elizabeth Warren (D-Mass.) said during the hearing that the bills being voted on represent “smaller targeted changes” rather than the bigger changes needed to strengthen the U.S. Food and Drug Administration (FDA) and increase funding for the National Institutes of Health (NIH).
“A handful of smaller targeted changes that we are voting on today won’t get us where we need to be. Democrats and Republicans have been working together for a year to develop packaging to strengthen the FDA and boost funding for NIH, the twin pillars for advancing real medical innovation. We can’t punt this to a vague promise to add funding later on. This committee can and must include mandatory funding in any innovations bill,” she said.
At the beginning of the hearing, Alexander addressed the topic of supporting mandatory funding by suggesting what he called an “innovations projects fund” for a limited number of high priority projects, such as precision medicine and the cancer “moon shot.”
“So I propose that we deal with this innovation fund and decide what programs we want and how to pay for them when it comes to the [Senate] floor,” he said.
In summary, the Improving Health IT Act includes:
1) Assisting doctors and hospitals in improving quality of care for patients by:
- Reducing documentation burdens by convening public and private stakeholders to develop goals, a strategy, and recommendations to minimize the documentation burden on providers while maintaining quality.
- Allowing and encouraging health professionals to practice at the top of their license, allowing non-physician members of the care team to document on behalf of physicians.
- Encouraging the certification of health information technology (HIT) for specialty providers and sites of service, like pediatric care, where more specialized technology is needed.
2) Includes provisions of the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act:
- Establishes an unbiased rating system for HIT products to help providers better choose HIT products.
- Allows HIT users to share feedback on the user experience of specific HIT products related to security, usability, and interoperability, among other concerns.
3) Addresses information blocking by:
- Giving the Department of Health and Human Services (HHS) Office of the Inspector General the authority to investigate and establish deterrents to information blocking practices that interfere with appropriate sharing of electronic health information.
4) Furthers interoperability by:
- Convening existing data sharing networks to develop a voluntary model framework and common agreement for the secure exchange of health information across existing networks to help foster bridging between networks.
- Creating a digital provider directory to both facilitate exchange and allow users to verify the correct recipient.
- Requiring that HHS give deference to standards developed in the private sector.
5) Leverages health IT to improve patient care by:
- Requiring that certified HIT exchange data with registries if registries are certified to use standards endorsed by the Office of the National Coordinator (ONC).
- Include vendors in Patient Safety Organizations to allow for improvements in the safety and effectiveness of HIT.
6) Empowers patients and improves patient access to their electronic health information by:
- Supporting the certification and development of patient-centered health record technology so that patients can access their health information through secure and user-friendly software that may update automatically.
7) Directs the Governmental Accountability Office (GAO) to conduct a study to review methods for securely matching patient records to the correct patient.
The other bills passed at the hearing include: S. 2030, The Advancing Targeted Therapies for Rare Diseases Act of 2015; S. 1622, The FDA Device Accountability Act of 2015; S. 2014, Next Generation Researchers Act; S. 800, The Enhancing the Stature and Visibility of Medical Rehabilitation Research at NIH Act; S. 849, Advancing Research for Neurological Diseases Act of 2015 and S.2503, Preventing Superbugs and Protecting Patients Act.