[Congressional Record Volume 165, Number 75 (Tuesday, May 7, 2019)]
[Senate]
[Page S2680]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





                       ELECTRONIC HEALTH RECORDS

  Mr. ALEXANDER. Madam President, I ask unanimous consent that a copy 
of my opening statement at the Senate Health Education, Labor, and 
Pensions Committee be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                       Electronic Health Records

       Mr. ALEXANDER. In 1991, the National Academies urged the 
     adoption of electronic health records to improve patients' 
     care. However, for many patients and for many doctors, 
     electronic health records have made care more complicated.
       No one knows this better than Dr. Kelly Aldrich, who is the 
     Chief Clinical Transformation Officer at the Center for 
     Medical Interoperability in Nashville and whose husband, 
     Eric, experienced a life-threatening emergency that could 
     have been prevented if his electronic health records had been 
     interoperable.
       Eric woke up one morning with a splitting headache and went 
     to see his primary care doctor, who sent Eric to the hospital 
     for a CT scan, the results of which prompted an MRI. Usually, 
     the hospital's electronic medical records system sends the 
     results of the MRI directly to Eric's primary care doctor.
       But in this case the results were never sent, so 12 hours 
     after the test, Eric's doctor called the hospital and learned 
     that Eric had a tumor so large it was causing his brain to 
     swell and shift, putting him at risk of seizures, permanent 
     brain damage, and possibly death.
       Eric, however, assuming no news was good news, was already 
     500 miles away, on his way to a fishing trip in Louisiana. 
     Eric went to Tulane Medical Center, which had to do another 
     MRI because they could not obtain Eric's original test 
     results because the two hospitals used different electronic 
     medical records systems. Eric flew back to Nashville, where 
     he had to have yet another MRI before entering surgery. Eric 
     later spent several weeks recovering in the ICU.
       At multiple points during this traumatic experience, a lack 
     of interoperability between electronic health records caused 
     a life threatening delay of care, redundant tests, higher 
     costs, and additional pain.
       This is the second hearing on the proposed rules 
     implementing the electronic health information provisions in 
     the 21st Century Cures Act. Improving electronic health 
     records is important to this committee.
       In 2015, while working on Cures, we realized that our 
     electronic health records system was in a ditch.
       This committee held six bipartisan hearings on how to 
     improve interoperability, and formed a working group that 
     recommended provisions in Cures to ban information blocking--
     which is when some obstacle is in the way of a patient's 
     information being sent from one doctor to another.
       And this year, this committee is working on legislation to 
     lower the cost of health care.
       50 percent of what we spend on health care is unnecessary, 
     according to Dr. Brent James of the National Academics. 
     Electronic health records that are interoperable can prevent 
     duplicative tests --like Eric's repeated MRIs--and reduce 
     what doctors and hospitals spend on administrative tasks.
       In March, the Office of the National Coordinator and the 
     Centers for Medicare and Medicaid Services issued two rules 
     to implement the electronic health records provisions in 
     Cures:
       First the rules define information blocking--so it is more 
     precisely clear what we mean when one system, hospital, 
     doctor, vendor, or insurer is purposefully not sharing 
     information with another;
       Second, the rules require that by January 1, 2020, for the 
     first time, insurers must share a patient's health care data 
     with the patient so their health information follows them as 
     they see different doctors; and
       Third, all electronic health records must adopt publicly 
     available standards for data elements, known as Application 
     Programming Interfaces, or APIs, two years after these rules 
     are completed.
       Last month, we heard from those who use electronic health 
     records, and here is what they have to say about the rules. 
     First, I asked our witnesses if these were good rules--and 
     all four said yes, the intent and the goal of the rules were 
     correct.
       Mary Grealy, president of the Healthcare Leadership Council 
     said: ``Interoperability is not simply desirable, it is 
     absolutely necessary . . . These rules represent an important 
     and perhaps groundbreaking first step for true national 
     interoperability.''
       I also asked our witnesses what one change they would make 
     to improve these rules. Mary cautioned about not rushing 
     implementation, saying, ``We don't want to prevent moving 
     ahead, or progress, but I think we also have to be very 
     cognizant of the challenges that providers and others are 
     facing trying to do this complex work.''
       In 2015, I urged the Obama Administration to slow down 
     Stage 3 of the Meaningful Use program, which incentivized 
     doctors and hospitals to adopt electronic health records. The 
     Obama Administration did not slow down implementation, and 
     looking back, the results would have been better if they had.
       The best way to get to where you want to go is not by going 
     too far, too fast.
       I want to make sure we learn lessons from implementing 
     Meaningful Use Stage 3, which was, in the words of one major 
     hospital, ``terrifying.''
       I am especially interested in getting where we want to go 
     with the involvement of doctors, hospitals, vendors, and 
     insurers, with the fewest possible mistakes and the least 
     confusion.
       We don't need to set a record time to get there with an 
     unrealistic timeline. Because these are complex rules, I 
     asked CMS and ONC to extend the comment period, and I am glad 
     to see they have done so and want to thank our witnesses for 
     allowing more time for comment.
       We also heard concerns about ensuring patient privacy. lf 
     the 21st Century Cures Act is successfully implemented, 
     patients should be able to get their own health data more 
     easily and send it to their health care providers.
       Patients may also choose to send that data to third 
     parties--like an exercise tracking app on their smart phone--
     but this raises new questions about privacy. Lucia Savage, 
     Chief Privacy and Regulatory Officer at Omada Health said, 
     ``I think the committee . . . is rightfully concerned about 
     privacy and security . . . None of this will matter if the 
     consumers don't have confidence, and their doctors don't have 
     confidence that the consumers have confidence.''
       Dr. Christopher Rehm, Chief Medical Informatics Officer at 
     Lifepoint Health in Brentwood, Tennessee reminded us at the 
     hearing that these rules are ``not about the technology, it's 
     about the patient, their care and their outcomes.''
       I am looking forward to hearing from the Administration 
     today about how they plan to implement these rules.

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