[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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