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Senate Committee Seeks EHR Interoperability Investigation

Bipartisan Senate Appropriations Committee wants an investigation into poor interoperability, possible "information blocking" in electronic health records.

talking about the money that was spent on the health information exchange program, which would facilitate finding key patient information when it is needed," he said. "I hope any oversight looks at [whether] so-called information blocking has impacted the use of that money."

Records also should be accessible, regardless of vendor software, through each state's health information exchange (HIX), said Mansur Hasib, author and longtime healthcare CIO. While states such as Maryland and Delaware lead the way, others' HIX adoption lags, damaging patients and providers, he told InformationWeek.

"All these health information exchanges that are being built were supposed to really help with this interoperability. All the states do not have working health information exchanges and that's a big problem. Is that a federal government issue? I don't think so," said Hasib. "Blaming the federal government for this is really not going to be fair because they don't control the state governments. The only thing they can do is provide the money -- and they have provided the money."

Next steps
In its comments, the Senate Appropriations Committee outlined several steps the ONC should take. These include:

  • Using ONC's authority to "certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange."
  • Decertify products that proactively block information sharing.
  • Provide the committee with a detailed report on the extent of information blocking within EHRs, including the number of vendors, hospitals, and providers involved, and ways to address the issue.
  • Within 12 months of enactment of the act, ONC should submit a report to the Senate Committees on Appropriations and Health, Education, Labor, and Pensions on the challenges and barriers to interoperability. It should address technical issues, operational impediments, financial hurdles, the role of certification, and any other obstructions.

If there is any truth to the allegations of information blocking, the ONC should not lead this investigation because it only runs the EHR certification program and the department has limited responsibilities by law, said Bialick.

"What I took away from the hearing is that this practice of information blocking is using taxpayer dollars to further a business practice that undermines congressional intent. If that is the case, then this should be investigated, very publicly, by the Energy & Commerce Committee in its Oversight capacity," he said. "Keep in mind that the technologies doing this supposed blocking are totally in compliance with the regulations set out by the HHS. It is contracting and business agreements that are blocking the data; this is to say that ONC likely does not have the legal mandate to address this issue."

If blocking is part of EHR development, participants are seriously damaging patients and providers. Doctors cannot trust they're seeing an entire patient record, for example, Bialick said. Patients might unnecessarily repeat expensive or dangerous tests, he added.

"The patient safety movement believes that device and EHR interoperability is key to developing patient safety systems that can aid healthcare professionals in their clinical decision making to stop threats to patient safety before they happen," Bialick said.

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