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Interoperable Health Records and 21st Century Cures

May 4, 2018

When I was still a practicing physician, I knew not to worry about seeing a patient until at least 15 minutes after the scheduled appointment time. People were sometimes late. Nurses had to do preliminary examinations. But mostly, I had to shift the schedule because of the forms.

On the other side of the partition, speaking as a patient, I have memories of sitting in waiting rooms struggling to recall the address of my last doctor and the exact dosages of my medications. This is, however, more than simply an administrative annoyance. Asking every patient to accurately recall their medical autobiography every time they visit a new doctor is simply not viable. Mistakes are inevitably made, information is omitted, and patients end up paying the cost either in time or medical mistakes.

Once in Congress, I became a strong champion of finding a technological fix to the records dilemma. Mike Leavitt, George W. Bush’s HHS Secretary, clearly set out the facts of the matter and what could be done about it.

In terms of solutions, we came to agree that the key idea is interoperability.

This long word simply means that patients’ records should be digital and accessible to all their health care providers. Instead of recreating vital information with every new doctor, specialist or clinic, a patient would instead have a permanent file that different health care providers could view and update. The viewing of these secure electronic health records (EHR) would be strictly confidential, limited to medical professionals, and subject to the serious restrictions and safeguards provided under HIPAA.

In addition to the benefit for providers, interoperability would also revolutionize the patient experience. It would allow patients to view their medical history and examination and testing results.

To mandate the adoption of interoperable health records, Congress enacted Meaningful Use – which tied government incentives for health care institutions to the implementation of interoperability. However, Meaningful Use did not live up to its billing.

Facing strong pushback from providers from the outset, Meaningful Use was watered down. CMS Administrator, Seema Verma, recently announced that Meaningful Use will be changed to Promoting Interoperability.

Specifically, the agency seeks to:

  • make the program more flexible and less burdensome
  • emphasize measures that require the exchange of health information between providers and patients
  • incentivize providers to make it easier for patients to obtain their medical records electronically

I am encouraged by this development so long as it results in the goal – sharing of medical records between providers and providing access for patients themselves. I also was encouraged by the passage in 2016 of the 21st Century Cures Act (Cures). Cures tasks the Office of the National Coordinator for Health Information Technology to work with public-private partnerships to create a trusted network for the exchange of information.

It also mandates a Draconian penalty of $1 million for every time a health care institution engages in “data-blocking.”

But, we should be careful that hospitals and other providers are not caught between HIPPA and a hard place. Nevertheless, if Congress makes any refinements to Cures, it should be careful not to do anything to further water down Meaningful Use and the drive to achieve interoperable health records.

Many dollars and ultimately lives depend on us getting this right.