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Washington Debrief: “Information Blocking” Subject of Congressional Hearing This Week

July 21, 2015
by Leslie Kriegstein, Interim Vice President of Public Policy, CHIME
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Federal Affairs

Health IT Safety Center Roadmap Released

Key Takeaway: Last week ONC approved the release a roadmap for the proposed Health IT Safety Center, which was developed by a taskforce of public-private stakeholders.

Why It Matters: The roadmap released last week reveals the proposed National Health IT Safety Center will focus on two core objectives: using health IT to make care safer, and continuously improving the safety of health IT. The Center would not directly investigate, gather data or oversee health IT safety. Further, it would not be vested with any regulatory or enforcement powers.

In September 2014, the Office of the National Coordinator for Health Information Technology (ONC) initiated a process to produce a roadmap to guide the development and implementation of a proposed national Health IT Safety Center. ONC contracted with RTI International to convene a task force of health IT safety experts, patient advocates, clinician users, health IT developers, healthcare organizations, and others to rely upon their insights in crafting this roadmap.

The new Center is envisioned as a public-private entity that focuses on using evidence and collaboration to develop and share solutions to pressing health IT safety issues. The proposed Center envisions active involvement from both private and public sector representatives to share learning and build upon current health IT safety efforts to improve the safety and safe use of health IT.

The roadmap suggests the Center should have an Executive Director and Advisory Board, suggesting funding between $17.8 and $20.6 million will be necessary for optimal functionality.

“The need for a national Health IT Safety Center—to promote sustained cooperation and collaboration among private sector stakeholders, with appropriate Federal involvement—is also apparent in research and evidence on the role of health IT in patient safety events,” states the roadmap.

AHRQ Report Evaluates Health IT in Small Practices

Key Takeaway: In a report released by the Agency for Healthcare Research and Quality (AHRQ) last week looking at three kinds of information sharing technology, providers expressed concern that using some forms of health information technology could result in the missed information necessary for patient care.

Why It Matters: The AHRQ report found that three key patient-to-provider information sharing tools were barriers to patient and provider workflows. According to the report, patients especially found applications difficult to use at times, and staff had to teach patients how to use them.

The report analyzed how ambulatory patients electronically share self-reported data, such as medical histories, symptoms for illness and results of self-tests, with their clinicians, and the impact of the information on workflows. Three types of information sharing technology were evaluated—secure messaging, e-forms and patient portals.

The report entitled, “Using Health Information Technology in Practice Redesign: Impact of Health Information Technology on Workflow” focused on three questions:

  1.  How does the use of health IT to capture and use patient-reported information support or hinder the workflow from the viewpoints of clinicians, clinic staff and patients?
  2.  How does the sociotechnical context influence workflow related to the capture and use of patient-reported information?
  3. How do clinics (clinic staff and providers) redesign their workflows to incorporate the capture and use of patient-reported information?

The AHRQ study was conducted across six ambulatory care practices from two participating health care organizations, with a mix of rural, urban, primary care and specialty practices. Each of the clinics had an electronic health record system, but were at different stages of implementing it.

Results showed that secure messaging capabilities improve patient satisfaction, citing increased access to information and greater communication with providers. However, providers and nurses noted the secure messaging capabilities may result in the loss of key information, such as auditory or visual cues from patients that they could gather from in-person or phone consultations.

Overall patient portals were found to increase information flow and communication between patients and providers, yet not all patients knew about the technology, according to the report.

Congressional Affairs

“Information Blocking” Subject of Congressional Hearing This Week

Key Takeaway: Congressional attention to health IT and EHR issues continues this week with another hearing in the Senate Committee on Health, Education, Labor and Pensions (HELP).

Why It Matters: A key Senate Committee will evaluate “information blocking” and other solutions for to widespread interoperability in a hearing this week.

The HELP Committee will hold a hearing this Thursday, July 23, 2015, on “information blocking and potential solutions.” This will be the fourth hearing as part of the Committee’s focus on EHRs.

The Committee will hear from four witnesses:

  • David C. Kendrick, M.D., MPH, Chair, Department of Medical Informatics, University of Oklahoma/ CEO, MyHealth Access Network, Tulsa, OK
  • Michael J. Mirro, M.D., FACC, FAHA, FACP, Past Chair, Medical Informatics Committee, American College of Cardiology, Chief Academic / Research Officer, Parkview Mirro Center for Research and Innovation, Fort Wayne, IN
  • David C. Kibbe, M.D. MBA, President and CEO, DirectTrust, Senior Advisor, American Academy of Family Physicians, Washington, DC
  • Paul M. Black, President, Chief Executive Officer and Director, Allscripts, Chicago, IL

The Committee’s Chairman, Lamar Alexander (R-TN), has previously indicated that the Committee would hold three more hearings devoted to health IT this year, with at least one focused on the patient’s perspective to be led by Senators Susan Collins (R-ME) and Elizabeth Warren (D-MA).

CHIME submitted recommendations for the Committee’s consideration earlier this month, offering suggestions from the CIO perspective to mitigate the ongoing usability and workflow concerns surrounding the use of EHRs.

Telemedicine Bill Would Remove State Licensure Barrier for Medicare Patients

Key Takeaway: Last week, legislation was introduced into the House and Senate bills removing Medicare's interstate licensing restrictions on telehealth services.

Why It Matters: The legislation, the Telemedicine for Medicare (Tele-Med) Act of 2015, would allow Medicare providers to offer telehealth services to patients in states other than where they are licensed. Current Medicare policies restrict how doctors are reimbursed for telehealth services, including requiring providers to have a license in both the state where they are practicing and the state where the patient is located during a telehealth visit. The legislation does not address reimbursement parity for services offered.

The Senate bill, S. 1778, was introduced by Senator Mazie Hirono (D-HI) and Joni Ernst (R-IA). The House version, HR 3081, has 17 original co-sponsors, including sponsors Devin Nunes (R-CA) and Frank Pallone Jr. (D-NJ). Both bills were introduced July 15th.

The Tele-Med Act was last introduced in 2013 by Representatives Nunes and Pallone. While it garnered 64 co-sponsors, it was never formally considered by House committees.

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