Alexander: Committee Working to Identify Immediate Solutions to Electronic Health Records Program that has Physicians “Terrified”

Says improvements need to be made quickly, as 257,000 physicians have already begun losing 1 percent of Medicare payments as penalty under federal program

Posted on June 10, 2015

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 “My goal is that before that phase is implemented, we can work with physicians and hospitals and the administration to get the system back on track and make it a tool that hospitals and physicians can look forward to using to help their patients instead of something they dread.”– Lamar Alexander 

WASHINGTON, D.C., June 10 – Senate health committee chairman Lamar Alexander (R-Tenn.) today chaired the first in a series of hearings intended to solve problems with the federal government’s six-year-old, $30 billion program meant to encourage adoption of electronic health records at doctor’s offices and hospitals.

Alexander said the Centers for Medicare and Medicaid Services announced in December that already a quarter of a million physicians have not been able to comply with the program’s second phase and have begun losing 1 percent of their Medicare payments. The final rule for the next stage is expected by early fall.

“To put it bluntly, physicians and doctors have said to me that they are literally "terrified" on the next implementation stage of electronic health records, called Meaningful Use Stage 3, because of its complexity and because of the fines that will be levied,” Alexander said. 

He added: “My goal is that before that phase is implemented, we can work with physicians and hospitals and the administration to get the system back on track and make it a tool that hospitals and physicians can look forward to using to help their patients instead of something they dread.”

The senator’s prepared remarks follow:

We’re here today to outline our plans to conduct an intensive review of electronic health records.

There is a great deal of bipartisan interest in this on the committee. My staff and Sen. Murray’s staff have been meeting with experts every day, the staff of each of our committee members have been meeting once a week, and Sen Murray and myself have been speaking with the administration regularly as well.

The administration understands our level of interest and is working with us to improve these records.

Here’s what we’re talking about:

The Meaningful Use Program began in 2009 to encourage the 491,000 physicians who serve Medicaid and Medicare patients and almost 4,500 hospitals who serve those patients to begin to adopt and use electronic health records systems.

Of those 491,000 physicians, 456,000 have received some sort of Medicare or Medicaid incentive payment from the Meaningful Use Program. All hospitals and most physicians that tried were able to meet the first stage requirements. For those who met the requirements, the government paid incentive payments in the form of higher Medicare reimbursements. It has so far paid out $30 billion in incentive payments.

But the program’s stage 2 requirements are so complex that only about 11 percent of eligible physicians have been able to comply so far, and just about 42 percent of eligible hospitals have been able to comply.

The next step in the program is penalties for doctors and hospitals that don’t comply. This year, 257,000 physicians have already begun losing 1 percent of their Medicare reimbursements and 200 hospitals may be losing even more than that.

Our goal is to identify the 5 or 6 steps we can take to improve electronic health records – a technology that has great promise, but has, through bad policy and bad incentives, run off track.

To put it bluntly, physicians and doctors have said to me that they are literally "terrified" on the next implementation stage of electronic health records, called Meaningful Use Stage 3, because of its complexity and because of the fines that will be levied.    

My goal is that before that phase is implemented, we can work with physicians and hospitals and the administration to get the system back on track and make it a tool that hospitals and physicians can look forward to using to help their patients instead of something they dread.

Today will mark the start of a series of hearings we will hold this summer to address various possible solutions.

Senator Murray and I are today announcing the next two hearings in the series, which will be chaired by different members of our committee to examine solutions to the problems we identify.

The first hearing is on the burden physicians face with these systems, and I have asked Sen. Cassidy, who is a physician himself, to chair that hearing.

The second hearing is on the question of whether you and I control information about our health, and I have asked Sen. Collins to chair that hearing.

On March 17, we held our first hearing to identify the problems with electronic health records, and the government’s Meaningful Use Program.

At today’s hearing, we will set the table for this series of hearings by discussing how we can solve those problems and improve electronic health records. 

I was in Nashville at Vanderbilt University two weeks ago for a public workshop of the National Institutes of Health Precision Medicine Working Group, which is working out the details of the president’s precision medicine initiative. That will involve creating a collection of 1 million sequenced genomes that researchers and scientists and doctors nationwide can consult in treating patients and curing diseases.

It’s cutting edge medicine that has the potential to change the way we treat everything from diabetes to cancer.

But it will only work the way it’s supposed to if electronic health records systems work the way they are supposed to.

Number one, electronic health records can help to assemble and understand the genomes of the one million individuals. And, second, if we want to make genetic information useful, being able to exchange information will help doctors when they write a prescription for you.

So that’s just one important medical breakthrough initiative that will rely on a big improvement to electronic health records.

This committee is interested not least because the government has invested $30 billion to encourage doctors and hospitals to install these expensive systems.

The program has increased adoption. According to the Centers for Medicare and Medicaid Services (CMS), since 2009, the percentage of physicians with a basic electronic health record system has grown from 22 percent to 48 percent. And the percentage of hospitals with a basic records system has grown from 12 percent to 59 percent.  But the program hasn’t done enough to make the systems easy to use or interoperable—meaning able to communicate with one another—or really achieved much beyond adoption. 

According to a Medical Economics survey nearly 70 percent of physicians say their electronic health record systems have not been worth it. They are spending more time taking notes than taking care of patients, and they are spending a lot of their own money on systems that have to comply with government requirements, not satisfying their own needs to serve patients with the latest in cutting edge medicine that could be accessed with the kind of technology Health IT is supposed to promise.

Or as the conservative columnist Charles Krauthammer, a doctor himself, wrote recently: “The EHR technology, being in its infancy, is hopelessly inefficient. Hospital physicians will tell you endless tales about the wastefulness of the data collection and how the lack of interoperability defeats the very purpose of data sharing.”

Today we have invited experts representing various perspectives:

medical informatics, the profession focused on what information to use and how to use it to improve care,

a records system vendor, one of the companies tasked with building the records systems,

a health system chief information officer, the expert in charge of implementing Health IT for a hospital’s many different types of care providers across many different types of care settings,

and the perspective of the patient so that we can hear recommendations on how improvements in Health IT can improve the patient experience and patient involvement in their own care. 

I am especially interested to hear from our witnesses their recommendations to improve the exchange of health information, which has been a glaring failure of the current state of electronic health records. 

Patients will receive better care if we can improve the exchange of information so that a patient’s health record can be accessed by physicians and pharmacists in an efficient and reliable way, the term industry experts use for this exchange of information is interoperability.

We’re fortunate that a report was published May 28, 2015, by the American Medical Informatics Association offering immediate strategies to the challenges in electronic health records that I’ve been detailing.  The report was written by a task force of experts from all aspects of Health IT: physicians, researchers, vendors, patient advocates, and others. 

We know that improvements need to be made to these programs, and they need to be done quickly.  One of the things I like about this report is that the recommendations are targeted for the next 6 to 12 months and could make improvements quickly. 

The report makes recommendations in these five areas:

  1. Simplify and speed documentation – that means using technology to help doctors spend less time taking notes and more time taking care of patients.
  2. Refocus regulation—that means the government requirements should be clear, simple, and streamlined towards better patient care.
  3. Increase transparency and streamline certification, such as using detailed tests for records systems to receive certification, so purchasers can easily judge performance and compare products
  4. Foster innovation – The brilliant minds working in Information Technology should be allowed to innovate new ideas, not just react to satisfying government ideas for Health IT.  Standards are important, but they should support and enable innovations—not stifle them.
  5. And “support person-centered care delivery” –Today, with a click of a mouse or a swipe on a smart phone, one can see the prices for airplane tickets from competing airlines or, mortgage rates from hundreds of banks.  But, in health care, Information Technology has not made much difference to the patient experience.  Patients still fill out paper forms with clipboards at every doctor appointment, call multiple offices to make appointments, and piece together their health information one doctor office and one hospital visit at a time. Electronic health records could change that experience for all of us so that when an individual visits a doctor, his care team can access his information no matter where the patient has been or which doctors he’s seen in the past and deliver more accurate and higher quality care for the patient.

I look forward to hearing our witnesses’ recommendations, their thoughts on this report, and also advice on how we can make improvements as quickly as possible. 

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