[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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