Five years and $28.1 billion of federal dollars later, and the promise of better patient care and lower costs through electronic health records still hasn't come to fruition. Congress needs to take swift action to create a more accountable regulatory framework that gets electronic health records (EHRs) fully implemented and operating properly.
The nation's EHRs are supposed to talk to each other, or in technical terms, be interoperable. Ten years ago, it was estimated that a widely adopted and effective interoperable EHR system could save the U.S. $81 billion annually through improved efficiency and enhanced patient safety.
But so far, most of the nation's EHRs are not communicating, and that is costing taxpayers.
In 2009, the American Recovery and Reinvestment Act offered federal incentives in the form of Medicare and Medicaid payments to hospitals and medical providers to adopt EHR technology into their systems through the Health Information Technology for Economic and Clinical Health Act (HITECH). The EHRs at these facilities were expected to meet meaningful use benchmarks, including interoperability, through three different stages to be completed by 2016. Under HITECH, the Office of the National Coordinator for Health and Information Technology (ONC) was charged with overseeing a certification process for EHR technology vendors. Overall, the spirit of HITECH and the meaningful use program was to create interoperability with the goal of greater health system efficiency.
Today, although 80 percent of U.S. hospitals have a basic EHR system, less than half have met the meaningful use criteria, according to a 2014 RAND Health research report. Hospitals and doctors with inadequate EHRs will be penalized with reductions in Medicare reimbursements each year for failing to fully integrate and use EHRs. Instead of widespread efficiency across the nation's healthcare system, the result has been finger pointing between hospitals, medical providers, vendors and the ONC regarding what went wrong along the way.
Doctors have lamented that too many existing EHR systems were designed to meet meaningful use compliance instead of physician and patient needs. For example, some systems don't allow medical providers to leverage in a useful manner the patient data they have collected. Hospitals and healthcare facilities report that some EHR vendors have contractually locked them into systems that don't work as promised or cannot communicate with other EHR systems, or the vendors have tried to charge extra for features that add functionality. This has led to some lawsuits and multimillion-dollar settlements. Meanwhile, the system still is failing the patients and providers who need to use it.
Since the beginning of this year, there have been some positive steps toward interoperability. Interoperability was called a "national objective" in the Medicaid Access and CHIP reauthorization Act (MACRA), which was signed into law last April. It requires the secretary of Health and Human Services to establish interoperability metrics by July 1, 2016 with a deadline for full interoperability by the end of 2018.
Although MACRA covered some general interoperability issues, unfortunately there was no mechanism included for enforcement. In July, the U.S. House passed the 21st Century Cures Act, which included penalties for information blocking that are "business, technical and organizational practices" which "prevent or materially discourage the access, exchange, or use of electronic health information." Penalties include EHR decertification and civil monetary fines on healthcare providers. This bill is now in the hands of the Senate Health, Education, Labor and Pensions Committee and absent any further action on it, all that stands are the vague and unenforceable interoperability goals in MACRA.
Meanwhile, the House is considering legislation this month that would allow healthcare providers and hospitals to request a hardship exception and not lose any Medicare funding for failing to meet EHR standards for 2017. The ONC has also drawn up another 10-year nationwide interoperability road map that goes through 2024. But the record for success doesn't bode well for the future: The ONC has already had five years and spent billions of taxpayer dollars on the nation's EHR system.
It's clear that the ONC needs help from Congress. I urge Congress to keep pressing forward on provisions of the 21st Century Cures Act to create an environment with necessary enforceable requirements to accomplish the mission of nationwide EHR interoperability. Health information technology holds so much promise for improving healthcare and reducing costs. The nation's patients and the healthcare providers who serve them can't afford more delays in full EHR implementation any longer.
Gingrey, M.D., is a senior adviser at the District Policy Group, a boutique policy and lobbying practice within Drinker Biddle & Reath. Gingrey is a former U.S. congressman who served Georgia's 11th congressional district from 2003 to 2015. The views expressed are the author's own and are not an endorsement of the legislation mentioned.