Some Senators Urge Caution, Some Carp at Pace of Healthcare EHR Adoption

ONC was asked to consider slowing down the two-year implementation window, but one committee member blasted a 'dysfunctional' healthcare system as technology laggards.

A Senate committee during a status update Tuesday on the proposed rules for electronic health records under the 21^st Century Cures Act offered mixed messages to policymakers charged with implementing those provisions.

Sen. Lamar Alexander (R-Tenn.) chairman of the Senate Health, Education, Labor and Pensions Committee, repeatedly raised concerns about past mistakes with HIT adoption under the Meaningful Use initiatives and warned that the pace of implementation under the 21^st Century Cures Act was too hasty. He urged policymakers to proceed with caution.

"My major concern is to give the administration the advice my piano teacher used to give me before a recital," Alexander told officials from the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology.

"She would say 'Lamar, play it a little slower than you can play it. You're less likely to make a mistake.' That's pretty good advice," he said. "We don’t need to set a record time to get there with an unrealistic time line."

The Centers for Medicare & Medicaid Services in February proposed that Medicaid, Medicare, and other government-funded healthcare programs provide enrollees with immediate electronic access to medical claims and other health information by 2020.

Alexander suggested that ONC slow down the two-year implementation window with "a more phased approach" that starts with U.S. core data for interoperability, "do that well within those first two years, and then take a second step."

"You had a common clinical data set that set in 2015 and many people still haven’t been able to comply with that. Now you're having an updated data set. You're not only asking for that information. You're asking for all of the other information within a two-year period," Alexander said.

Don Rucker, MD, ONC's national coordinator for HIT, told the committee "the difference between the U.S. core data of interoperability and the common data set is we are adding in clinical notes and what is called metadata."

"All the core technical provisions and the testing about the core data for interoperability, that is the part that is computable," Rucker said. "We have evidence that the vast majority or providers, both hospitals and physicians, have access to that software today."

Following up on Alexander's remarks, Committee Ranking Member Patty Murray (D-Wash.) asked Rucker about the consequences of delaying provisions of the Act that dealt with information blocking.

"The main risk, fundamentally, to the extent this delayed or prevented, the American public is not in charge of their healthcare," Rucker said. "They're paying more for their care. They're not getting as good care as they could get, and fundamentally they're not in control of their care."

Sen. Mike Braun (R-Ind.) used his five minutes to rail against a "dysfunctional" healthcare system that has to be goaded by the government to adopt technologies that other sectors of the economy have been using for decades.

"Most industries would not be having hearings because there is transparency and there is competition and there is embracing of the technology," Braun told the committee. "I hated to hear that within the medical sector it's the only place where we see neutral or maybe negative annual gains in the use of technology. It begs the question: What is wrong with the industry itself?"

Braun, who referred to himself as a "Main Street conservative," said the problem is not with the government, but with the private sector.

"I lay the burden not here in the Senate, but on the shoulders of the industry itself," he said. "If you are cloaking and making this so difficult to get simple things like interoperability, we're hearing about blocking information, that is so far out of the mainstream from all other industries."

"I want the industry to hear what I've been saying all along. Get with it or you are going to be changed radically with all kinds of approaches that are based on frustration," he said.