The U.S. Senate’s Committee on Health Education Labor & Pensions (HELP) held a hearing this week on the effectiveness of the meaningful use program, with many senators expressing concern over the lack of usable, interoperable electronic health record (EHR) systems.
The Committee, chaired by Senator Lamar Alexander (R-TN), asked questions to four panelists who represented various facets of the industry. Julia Adler-Milstein, Ph.D. assistant professor of Health Management and Policy at the University of Michigan’s School of Public Health represented the research side; Robert L. Wergin, M.D. president of the American Academy of Family Physicians (AAFP) represented the provider side; Peter DeVault, director of interoperability at Epic Systems Corporation represented vendors; and Angela Kennedy, Ed.D. head of the Department of Health Informatics and Information Management and College of Applied and Natural Sciences at Louisiana Tech University represented consumers and health IT professionals.
Whereas the House of Representatives’ Energy and Commerce Committee’s Subcommittee on Health’s hearing on ICD-10 had a clear division, the various industry stakeholders and politicians involved in this one seemed to find more common ground. Specifically, there was a sense that the lack of interoperable, usable EHR systems was holding back the technology’s potential to impact healthcare.
“The interoperability barriers that exist between providers are driven by a lack of incentives. EHR vendors do not have a business case for seamless, affordable interoperability across vendor platforms, and provider organizations find it an expense that they often can’t justify,” Dr. Adler-Milstein said in her testimony.
Later in response to a question from Sen. Elizabeth Warren (D-MA), Adler-Milstein added that it was hard for providers to justify the high-cost of interoperability and that competitive markets were less likely to share data. She also noted that the problem of interoperability was a global one, calling it a common problem across the world no matter how a country pays for its healthcare. “There is no silver bullet,” she said.
Dr. Kennedy said in her testimony: “If we continue with a narrow focus on technology and without a focus on information governance processes and principles, the US will continue to experience daunting challenges related to health information exchange and sharing, patient identification, and privacy/security.”
Epic’s DeVault, who at times during the hearing adamantly defended his company against perceived criticisms, noted that widespread interoperability is a significant distance away. “No single network attempts to address all interoperability use cases and scenarios, and no single technical platform operated by a single provider can meet the needs of all the diverse players in healthcare. Just as ATMs and cell phones rely on multiple, interconnected networks, healthcare must connect its interoperability networks to achieve universal connectivity,” he said in his testimony.
Led by Sen. Alexander, those in Congress were not shy in their criticism of the meaningful use program’s fault in the industry’s lack of interoperable, usable EHRs. In his opening statement, Alexander said EHRs “should have been a really good idea,” but the meaningful use program has failed for many because the government mandated rather than encouraged. He cited statistics which said 70 percent of physicians said that EHRs have not been worth it.
Sen. Sheldon Whitehouse (D-RI) was even firmer in his critiques of the program. He said meaningful use should be completely rebooted, and in the next version, it has to include long-term care and behavioral health facilities. In a similar vein, Dr. Wergin from the AAFP asked the Committee that documentation requirements for meaningful use should be completely overhauled and redone to not be as time-consuming for physicians. He also asked them to remove penalties associated with noncompliance.
Adler-Milstein wasn’t as certain that removing the penalties would be a good idea. She said market pressure has to be maintained to ensure the status quo isn’t accepted.
Sens. Tammy Baldwin (D-WI) and Bill Cassidy, M.D. (R-LA) focused their questioning on Epic’s DeVault. Dr. Cassidy asked him questions on the system’s interface, calling it “1990” in the way it looks and peppered him with costs associated with data exchange. Baldwin, who introduced DeVault, asked him why Epic wasn’t a member of CommonWell, the nonprofit trade group made up of many of Epic’s EHR vendor competitors aiming to create a national patient identifier.
DeVault said that joining CommonWell, which he called an “aspiring” network, would have cost millions and they would have had to sign a non-disclosure agreement (NDA), which he suggested meant they planned on selling data downstream. Instead, he vouched for CareEquality, another interoperability effort from a nonprofit group.
The hearing ended on a positive note. Sens. Alexander and Whitehouse separately suggested the Committee setup continuous meetings on how to improve meaningful use and enable providers to adopt EHRs. He asked the panelists how they would do enable this adoption.
Adler-Milstein focused on transparency and urged the creation of tools that better understands what elements of EHRs are useful for frontline physicians. DeVault and Wergin asked for the end of “data dumps” and decried artificial incentives, instead asking for focus on patient outcomes. Kennedy said the industry has to stop leveraging profits at the expense of care.
Other Senators, including Sens. Al Franken (D-MN) and Patty Murray (D-WA), were quick to praise the meaningful use program for leading to a significant increase in the adoption of EHRs in the U.S. “In 2001, only 18 percent of physicians used electronic health records—and today, 78 percent do. That’s a real transformation. And I’m proud the HITECH Act we passed in 2009 was a big part of that,” Murray said in her opening statement.