[Congressional Record Volume 161, Number 93 (Thursday, June 11, 2015)]
[Senate]
[Pages S4100-S4101]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 HEALTH INFORMATION EXCHANGE: A PATH TOWARDS IMPROVING THE QUALITY AND 
                   VALUE OF HEALTH CARE FOR PATIENTS

  Mr. ALEXANDER. Mr. President, I ask unanimous consent to have printed 
in the Record a copy of my remarks at the Senate Health, Education, 
Labor and Pensions Committee hearing earlier this week.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 Health Information Exchange: A Path Towards Improving the Quality and 
                   Value of Health Care for Patients

       We're here today to outline our plans to conduct an 
     intensive review of electronic health records.
       There is a great deal of bipartisan interest in this on the 
     committee. My staff and Sen. Murray's staff have been meeting 
     with experts every day, the staff of each of our committee 
     members have been meeting once a week, and Sen Murray and 
     myself have been speaking with the administration regularly 
     as well.
       The administration understands our level of interest and is 
     working with us to improve these records.
       Here's what we're talking about:
       The Meaningful Use Program began in 2009 to encourage the 
     491,000 physicians who serve Medicaid and Medicare patients 
     and almost 4,500 hospitals who serve those patients to begin 
     to adopt and use electronic health records systems.
       Of those 491,000 physicians, 456,000 have received some 
     sort of Medicare or Medicaid incentive payment from the 
     Meaningful Use Program. All hospitals and most physicians 
     that tried were able to meet the first stage requirements. 
     For those who met the requirements, the government paid 
     incentive payments in the form of higher Medicare 
     reimbursements. It has so far paid out $30 billion in 
     incentive payments.
       But the program's stage 2 requirements are so complex that 
     only about 11 percent of eligible physicians have been able 
     to comply so far, and just about 42 percent of eligible 
     hospitals have been able to comply.
       The next step in the program is penalties for doctors and 
     hospitals that don't comply. This year, 257,000 physicians 
     have already begun losing 1 percent of their Medicare 
     reimbursements and 200 hospitals may be losing even more than 
     that.
       Our goal is to identify the 5 or 6 steps we can take to 
     improve electronic health records--a technology that has 
     great promise, but has, through bad policy and bad 
     incentives, run off track.
       To put it bluntly, physicians and doctors have said to me 
     that they are literally ``terrified'' on the next 
     implementation stage of electronic health records, called 
     Meaningful Use Stage 3, because of its complexity and because 
     of the fines that will be levied.
       My goal is that before that phase is implemented, we can 
     work with physicians and hospitals and the administration to 
     get the system back on track and make it a tool that 
     hospitals and physicians can look forward to using to help 
     their patients instead of something they dread.
       Today will mark the start of a series of hearings we will 
     hold this summer to address various possible solutions.
       Senator Murray and I are today announcing the next two 
     hearings in the series, which will be chaired by different 
     members of our committee to examine solutions to the problems 
     we identify.
       The first hearing is on the burden physicians face with 
     these systems, and I have asked Senator Cassidy, who is a 
     physician himself, to chair that hearing.
       The second hearing is on the question of whether you and I 
     control information about our health, and I have asked 
     Senator Collins to chair that hearing.
       On March 17, we held our first hearing to identify the 
     problems with electronic health records, and the government's 
     Meaningful Use Program.
       At today's hearing, we will set the table for this series 
     of hearings by discussing how we can solve those problems and 
     improve electronic health records.
       I was in Nashville at Vanderbilt University two weeks ago 
     for a public workshop of the National Institutes of Health 
     Precision Medicine Working Group, which is working out the 
     details of the president's precision medicine initiative. 
     That will involve creating a collection of 1 million 
     sequenced genomes

[[Page S4101]]

     that researchers and scientists and doctors nationwide can 
     consult in treating patients and curing diseases.
       It's cutting edge medicine that has the potential to change 
     the way we treat everything from diabetes to cancer.
       But it will only work the way it's supposed to if 
     electronic health records systems work the way they are 
     supposed to.
       Number one, electronic health records can help to assemble 
     and understand the genomes of the one million individuals. 
     And, second, if we want to make genetic information useful, 
     being able to exchange information will help doctors when 
     they write a prescription for you.
       So that's just one important medical breakthrough 
     initiative that will rely on a big improvement to electronic 
     health records.
       This committee is interested not least because the 
     government has invested $30 billion to encourage doctors and 
     hospitals to install these expensive systems.
       The program has increased adoption. According to the 
     Centers for Medicare and Medicaid Services (CMS), since 2009, 
     the percentage of physicians with a basic electronic health 
     record system has grown from 22 percent to 48 percent. And 
     the percentage of hospitals with a basic records system has 
     grown from 12 percent to 59 percent. But the program hasn't 
     done enough to make the systems easy to use or 
     interoperable--meaning able to communicate with one another--
     or really achieved much beyond adoption.
       According to a Medical Economics survey nearly 70 percent 
     of physicians say their electronic health record systems have 
     not been worth it. They are spending more time taking notes 
     than taking care of patients, and they are spending a lot of 
     their own money on systems that have to comply with 
     government requirements, not satisfying their own needs to 
     serve patients with the latest in cutting edge medicine that 
     could be accessed with the kind of technology Health IT is 
     supposed to promise.
       Or as the conservative columnist Charles Krauthammer, a 
     doctor himself, wrote recently: ``The EHR technology, being 
     in its infancy, is hopelessly inefficient. Hospital 
     physicians will tell you endless tales about the wastefulness 
     of the data collection and how the lack of interoperability 
     defeats the very purpose of data sharing.''
       Today we have invited experts representing various 
     perspectives:
       Medical informatics, the profession focused on what 
     information to use and how to use it to improve care; a 
     records system vendor, one of the companies tasked with 
     building the records systems; a health system chief 
     information officer, the expert in charge of implementing 
     Health IT for a hospital's many different types of care 
     providers across many different types of care settings; and 
     the perspective of the patient so that we can hear 
     recommendations on how improvements in Health IT can improve 
     the patient experience and patient involvement in their own 
     care.
       I am especially interested to hear from our witnesses their 
     recommendations to improve the exchange of health 
     information, which has been a glaring failure of the current 
     state of electronic health records.
       Patients will receive better care if we can improve the 
     exchange of information so that a patient's health record can 
     be accessed by physicians and pharmacists in an efficient and 
     reliable way, the term industry experts use for this exchange 
     of information is interoperability.
       We're fortunate that a report was published May 28, 2015, 
     by the American Medical Informatics Association offering 
     immediate strategies to the challenges in electronic health 
     records that I've been detailing. The report was written by a 
     task force of experts from all aspects of Health IT: 
     physicians, researchers, vendors, patient advocates, and 
     others.
       We know that improvements need to be made to these 
     programs, and they need to be done quickly. One of the things 
     I like about this report is that the recommendations are 
     targeted for the next 6 to 12 months and could make 
     improvements quickly.
       The report makes recommendations in these five areas:
       Simplify and speed documentation--that means using 
     technology to help doctors spend less time taking notes and 
     more time taking care of patients.
       Refocus regulation--that means the government requirements 
     should be clear, simple, and streamlined towards better 
     patient care.
       Increase transparency and streamline certification, such as 
     using detailed tests for records systems to receive 
     certification, so purchasers can easily judge performance and 
     compare products.
       Foster innovation--The brilliant minds working in 
     Information Technology should be allowed to innovate new 
     ideas, not just react to satisfying government ideas for 
     Health IT. Standards are important, but they should support 
     and enable innovations--not stifle them.
       And ``support person-centered care delivery''--Today, with 
     a click of a mouse or a swipe on a smart phone, one can see 
     the prices for airplane tickets from competing airlines or, 
     mortgage rates from hundreds of banks. But, in health care, 
     Information Technology has not made much difference to the 
     patient experience. Patients still fill out paper forms with 
     clipboards at every doctor appointment, call multiple offices 
     to make appointments, and piece together their health 
     information one doctor office and one hospital visit at a 
     time. Electronic health records could change that experience 
     for all of us so that when an individual visits a doctor, his 
     care team can access his information no matter where the 
     patient has been or which doctors he's seen in the past and 
     deliver more accurate and higher quality care for the 
     patient.
       I look forward to hearing our witnesses' recommendations, 
     their thoughts on this report, and also advice on how we can 
     make improvements as quickly as possible.

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