The Role of Legislators and EHR Interoperability Optimization

Editor’s Note: The following article is a Guest Column from Ron Vatalaro, a health informatics author who works at Bisk Education with USF Health Morsani College of Medicine at the University of South Florida and Jacksonville University. You can contact Ron on Twitter @RonJVMedia. To learn more about submitting a Guest Column, Click Here.

The future of healthcare belongs to the digital domain.

But for six years, the issue of EHRs, a critical component of the HITECH Act, has been mired in false starts, the expenditure of millions of dollars in meaningful use incentives, and little progress on establishing a portal for healthcare providers to share patient records securely, discreetly and successfully.

When the U.S. Senate HELP Committee convened in March 2015, the issues taking center stage ranged from compliance to the exchange of data, which has eluded lawmakers and healthcare professionals since HITECH was passed in 2009.

Healthcare IT News, the media arm of HIMSS, reported that legislators touched on the current Medicare and Medicaid Electronic Health Care Record Incentive Program, which has provided nearly $30 billion to date to eligible healthcare professionals, hospitals and critical access hospitals to adopt, implement and begin using EHR technology.

This effort, meant to spur meaningful use of the new technology to improve patient care, has been stymied by healthcare providers failing to adequately initiate EHR as well as regulatory efforts meant to prompt HER implementation by penalizing noncompliant providers.

According to the U.S. Centers for Disease Control and Prevention, as of 2013, an estimated 78% of office-based physicians were using some type of EHR system, an increase of 60% from 2001. But compliance numbers continue to vary widely between states. For example, as of 2013, 75.5% of physicians in Minnesota had EHR systems in place that met government criteria compared to just 21.2% of physicians in New Jersey.

The hurdle of interoperability also remains. During the Senate hearing in March, Dr. Robert Wergin, president of the American Academy of Family Physicians, told legislators that successfully sharing EHRs between providers was one of the most complex challenges facing the industry. Wergin urged government officials to increase certification requirements and withhold penalties for non-compliant providers so that interoperability could be achieved.

Others argued that backing off penalties could create a vacuum whereby no progress was made.

Interoperability is a critical issue for EHR because patient data must be capable of being shared between different patient providers, such as doctors, hospitals and pharmacies, and it must be exchanged in a way that allows all recipients to properly interpret the data. Without interoperability, patient care for both individuals and communities is at risk.

Electronic health records and the creation of a national system to share data is just one of the healthcare issues currently being reviewed by Congress. There are many bills and/or amendments that could directly impact the individual care, treatment options and approval of benefits claims for patients and communities across the country.

21st Century Cures Act

Introduced in the U.S. House of Representatives in May 2015, this act would promote the development and expedited approval of new drugs and devices. Advocates say the bill would enhance access to and development of new and needed treatment options. Critics, however, fear that speeding approval could limit access to valuable information about the safety and efficacy of new drugs and medical devices by allowing the federal Food and Drug Administration to consider nontraditional means as valid support, such as shorter clinical trials conducted on a smaller sample of subjects. As of July 13, 2015, the bill had received House approval and was received in the U.S. Senate before being referred to the Committee on Health, Education, Labor and Pensions.

National Defense Authorization Act for Fiscal Year 2016

Among the many components of this bill are several sections specifically related to EHR and the digital sharing of medical records. One provision of the bill dealing with the TRICARE health care program of the U.S. Department of Defense Military Health System would allow automatic electronic transfer of vital information, such as enrollment and claims, between contractors in TRICARE as it relates to covered beneficiaries. Another provision calls for the Secretary of Defense and Secretary of Veterans Affairs to set forth a timeline for interoperability of EHRs between the two agencies within a year of the act being approved, as well as the creation of security and transmission standards for the exchange of medical information between the Department of Defense and the Department of Veterans Affairs. As of June 18, 2015, the act had received passage from both the Senate and the House. Multiple sections of the act are currently being reviewed prior to the act being submitted to President Obama.

21st Century Veterans Benefits Delivery Act

This act would help improve the processing of benefit claims to the Department of Veterans Affairs in part by allowing veterans more choices for participating in a claims hearing, mandating an audit of claims processing at regional VA offices, and improving communication between the VA, case workers and veterans service organizations. The act also requires the federal Department of Defense and Department of Veterans Affairs to establish a timeline for achieving interoperability between the two departments’ EHR systems. As of July 22, 2015, the Senate Veterans’ Affairs committee ordered the act to be reported with an amendment “in the nature of a substitute favorably.”

Flex-IT 2 Act

The Flex-IT 2 Act would delay Stage 3 of Meaningful Use, which includes criteria for eligible healthcare providers to qualify for Medicare and Medicaid EHR incentive payments, until 2017 at the earliest to allow for a reprieve from penalties. The act also would streamline requirements from the Centers for Medicare and Medicaid Services to remove duplicative measurements, mandate an annual 90-day reporting period for all providers regardless of their experience with the program, and speed interoperability among EHRs. As of July 31, 2015, the act was referred to the U.S. House of Representatives’ Subcommittee on Health.

SGR Repeal and Medicare Provider Payment Modernization Act of 2015

This act would amend Title XVIII of the Social Security Act as it relates to specific criteria for provider service payments and establish a merit-based incentive payment system. The act also calls for a national objective of achieving widespread sharing of health information through interoperability of EHRs by no later than Dec. 31, 2018. As of March 31, 2015, this was referred to the U.S. House of Representatives’ Subcommittee on the Constitution and Civil Justice.

Staying Informed:

The continued enhancement of healthcare in the United States, including the exchange of medical records, participation of providers and improvements to patient care, is a vital issue.

Interested citizens who want to remain up to date on the progress of these and other healthcare-related bills and amendments, as well as contact their respective legislative representatives, can access information through the website The website includes individual sections on committees, hearings, reports and legislation, as well as information on how to locate and contact specific lawmakers.

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Ron Vatalaro

Ron Vatalaro works at Bisk Education with USF Health Morsani College of Medicine at the University of South Florida and Jacksonville University. He writes about health informatics. Ron holds an advanced degree in Business Administration with a concentration in technology.

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