[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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