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AHA Voices Concerns With 21st Century Cures Act’s Interoperability Provisions

July 13, 2015
by Rajiv Leventhal
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The passing of the 21st Century Cures Act in the U.S. House of Representatives was praised by several health IT associations, but the AHA is one organization that still has concerns regarding the bill’s interoperability provisions.

On July 10, the 21st Century Cures Act, H.R. 6, passed by a vote of 344-77 in the House, sending it to the U.S. Senate. The main focus of the legislation is an attempt to remove regulatory roadblocks in the review process for new pharmaceuticals and medical devices on the part of the Food and Drug Administration (FDA). In addition, according to Congress.gov, the federal government’s official legislation tracking service, “Requirements are established [in the bill] for interoperability and certification of health information technology. Practices that discourage the exchange of electronic health information are prohibited.”

After the House’s passage of the bill, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) released a statement attributed to Leslie Krigstein, interim vice president of public policy, praising the bill’s focus on interoperability. Additional praise for the House of Representatives’ passage of the bill came from the Charlotte-based Premier healthcare alliance.

Nonetheless, in a letter to leaders on the Committee of Energy and Commerce, American Hospital Association (AHA) executive vice president Rick Pollack said, “While we appreciate the positive changes made to the interoperability provisions and elsewhere in this legislation, the enforcement provisions in Section 3001 still rely on fraud and abuse mechanisms that will result in unfair sanctions to hospitals and other providers. The bill also includes an overly broad definition of “information blocking” that would result in penalties for providers’ reasonable business practices and beneficial modifications to information technology (IT) systems that improve patient care.”

Regarding information blocking sanctions, AHA said it said it strongly opposes any sanctions on providers beyond the existing electronic health record (EHR) Incentive Programs. “For hospitals and other care providers, Medicare fraud and abuse mechanisms, such as OIG investigations or imposition of civil monetary penalties, to address concerns about ‘information blocking’ are unnecessary and duplicative,” AHA said.

According to the letter, “The AHA recommends the use of the existing structures of the Medicare and Medicaid EHR Incentive Programs to promote information sharing. The programs already include specific requirements for providers to share health information. In addition, current law includes provisions requiring healthcare providers to make an affirmative attestation to the government that they have not taken steps to limit the interoperability of their EHRs as part of the requirements of meaningful use. Penalties for failing to meet meaningful use are significant, and grow larger over time. We do not believe the penalties contained in H.R. 6 are needed,” it said.

Regarding the “broad definition of “information blocking,” AHA said that Section 3001 applies the same definition of “information blocking” to both providers and vendors.  “At its core, the definition encompasses ‘business, technical and organizational practices’ that ‘prevent or materially discourage the access, exchange, or use of electronic health information,’” AHA said. “Such practices describe virtually every aspect of a provider’s information sharing activity. Instead of this broad definition applied to all parties, the AHA recommends that vendors and providers have separate definitions of ‘information blocking’ because their roles in information sharing are unique,” the letter read.

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