[Congressional Record Volume 165, Number 80 (Tuesday, May 14, 2019)]
[Senate]
[Page S2809]
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. Reid Blackwelder is a family physician with 
     three clinics in the Tri-Cities area of East Tennessee.
       A few years ago, he talked to the New York Times about the 
     electric health records that were supposed to make his life 
     easier, saying, ``We have electronic records at our clinic, 
     but the hospital, which I can see from my window, has a 
     separate system from a different vendor. The two don't 
     communicate. When I admit patients to the hospital, I have to 
     print out my notes and send a copy to the hospital so they 
     can be incorporated into the hospital's electronic records.''
       Dr. Blackwelder could pay for his patients' hospital 
     records to be electronically sent from his system to the 
     hospital's system--but it would cost him $26,400 every 
     month--or $316,800 a year. For Dr. Blackwelder, and so many 
     other doctors, record keeping is now more expensive and 
     burdensome.
       In 1991, the National Academy of Medicine released a report 
     urging the ``prompt development and implementation'' of what 
     were then called computer-based patient records. The report 
     said these systems, ``have a unique potential to improve the 
     care of both individual patients and . . . to reduce waste 
     through continuous quality improvement.'' Electronic health 
     records got a boost in 2009 when the federal government began 
     the Meaningful Use program, spending over $36 billion in 
     grants to incentivize doctors and hospitals to use these 
     systems.
       As was the prediction in the 1991 report, the hope was 
     electronic records would improve patient care and reduce 
     unnecessary health care spending. This is important because, 
     at a hearing last summer, Dr. Brent James, from the National 
     Academies, testified that up to 50 percent of what we spend 
     on health care is unnecessary.
       There is a bipartisan focus both in Congress and in the 
     Administration on reducing health care costs. One way to 
     reduce what we spend on administrative tasks and unnecessary 
     care is by having electronic health records that talk to one 
     another--we call that interoperability.
       But in 2015--six years after the Meaningful Use program 
     started--as this Committee worked on the 21st Century Cures 
     Act, we realized that, in many cases, electronic health 
     records added to administrative burden and increased 
     unnecessary health care spending.
       A major reason for that is that the records are not 
     interoperable. One barrier to interoperability is information 
     blocking--which is when some obstacle is in the way of a 
     patient's information being sent from one doctor to another.
       So, in 2015, this committee held six bipartisan hearings 
     and formed a working group to find ways to fix the 
     interoperability of electronic health records. These hearings 
     led to a bipartisan group of HELP Committee members working 
     together to include a provision in the 21st Century Cures Act 
     to stop information blocking and encourage interoperability.
       Today's hearing is about two new rules the Department of 
     Health and Human Services has proposed to implement this 
     provision in the 21st Century Cures Act. These two rules are 
     complicated, but I'd like to highlight a few ways that they 
     lay out a path toward interoperability:
       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;
       Third, all electronic health records must adopt the same 
     standards for data elements, known as an Application 
     Programming Interface, or API, two years after these rules 
     are completed.
       Fourth, hospitals are required to send electronic 
     notifications to a patient's doctors, immediately, when that 
     patient is admitted to, discharged from, or transferred from 
     the hospital.
       According to the Department of Health and Human Services, 
     these two new rules should give more than 125 million 
     patients easier access to their own records in an electronic 
     format. This will be a huge relief to any of us who have 
     spent hours tracking down paper copies of our records and 
     carting them back and forth to different doctors' offices.
       The rules will reduce administrative burden on doctors so 
     they can spend more time with patients. A recent study from 
     Kaiser found that emergency room doctors, in order to use 
     electronic health records systems, make up to 4,000 mouse 
     clicks per shift. If electronic health records data was truly 
     interoperable, it would greatly reduce how many clicks 
     doctors have to make. According to HHS, spending less time on 
     these administrative tasks will improve efficiency and 
     therefore could save $3.3 billion a year. And because doctors 
     can see patients' full medical history, they can avoid 
     ordering unnecessary tests and procedures.
       I also want to be aware of unintended consequences from 
     these rules: Are these rules moving too fast? In 2015, I 
     urged the Obama Administration to slow down the Meaningful 
     Use program, which they did not do, and looking back, the 
     results would have been better if they had.
       Are the standards for data elements too rigid? Is the door 
     still open for bad actors to game the system and continue to 
     information block? And how can we ensure patient privacy as 
     patients gain more access and control over their personal 
     health information. And how do we help them keep it secure?
       I want to ensure these rules will make the problem of 
     information blocking better, not worse. I look forward to any 
     specific suggestions to improve these rules from those who 
     use electronic health records systems.
       Electronic health records that work can give patients 
     better outcomes and better experiences at a lower cost.

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