Alexander: Information Blocking is Standing in the Way of Patients, Promise of Electronic Health Records

Asks witnesses at Senate hearing to detail scope of problem and whether government, through electronic health records program, shares in blame

Posted on July 23, 2015

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 “If I found myself suddenly at the Vanderbilt University Medical Center emergency room and the doctors there wanted to get my paperwork from the hospital and doctors I usually use —information blocking means that there is some obstacle getting in the way of my personal health information getting sent to them.”– Lamar Alexander 

WASHINGTON, D.C., July 23 – Senate health committee Chairman Lamar Alexander (R-Tenn.) today chaired a hearing on the practice of “information blocking”—when something or someone creates an obstacle to the electronic sharing of a person’s health information—and raised the question of whether the federal government, through its program to encourage adoption of electronic health records, played a role in encouraging the practice.

“If I found myself suddenly at the Vanderbilt University Medical Center emergency room and the doctors there wanted to get my paperwork from the hospital and doctors I usually use —information blocking means that there is some obstacle getting in the way of my personal health information getting sent to them,” Alexander said. “This could happen a few different ways: My usual hospital refuses to share my information. The electronic systems at both hospitals don’t talk to each other. My usual hospital says it will charge Vanderbilt a huge fee to send my electronic records. My usual hospital says it can’t share them for privacy reasons. Or, my usual hospital won’t send them because they cite concerns about data security.”

He added: “Since 2009, the American taxpayer has spent $30 billion to spur doctors and hospitals to install electronic health records systems—through incentive payments to Medicare and Medicaid providers.”

“But interoperability—this communication between systems that is so critical to the success of electronic health records—has been difficult to achieve. Information blocking is one obstacle to interoperability, and I’m interested in hearing today from the witnesses the extent to which this is a problem – and the extent to which the government may share in the blame.”

This is the committee’s fourth 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.

Staff for the chairman and Ranking Member Patty Murray (D-Wash.) have been meeting with committee members’ staff weekly and meeting regularly with experts and administration officials to build legislation to improve the program.

The chairman’s full prepared remarks follow:

Today’s hearing is on information blocking. What does that mean?

Here’s an example: If I found myself suddenly at the Vanderbilt University Medical Center emergency room and the doctors there wanted to get my paperwork from the hospital and doctors I usually use —information blocking means that there is some obstacle getting in the way of my personal health information getting sent to them. This could happen a few different ways:

·       My usual hospital refuses to share my information.

·       The electronic systems at both hospitals don’t talk to each other.

·       My usual hospital says it will charge Vanderbilt a huge fee to send my electronic records.

·       My usual hospital says it can’t share them for privacy reasons.

·       Or, my usual hospital won’t send them because they cite concerns about data security.

Since 2009, the American taxpayer has spent $30 billion to spur doctors and hospitals to install electronic health records systems—through incentive payments to Medicare and Medicaid providers.

One of the chief goals of this effort was to improve the electronic exchange of a patient’s health information between physicians’ offices and urgent care centers and hospitals and pharmacies – by encouraging these practitioners to adopt these systems, and by encouraging manufacturers of the systems to make them able to communicate with one another—we call that “interoperability” of systems.

That way, for example, I could have my physician send my records easily to a specialist, who could have my entire medical history right in front of her before I even have my first appointment.

No more printing out of papers that I have to go and pick up and bring to my appointment and have added to a paper file and then re-entered in the specialist’s computer.

The federal government even went so far as to certify certain systems, so physicians and hospitals generally expected that the certified systems would enable them to transfer records.

But interoperability—this communication between systems that is so critical to the success of electronic health records—has been difficult to achieve.

Information blocking is one obstacle to interoperability, and I’m interested in hearing today from the witnesses the extent to which this is a problem – and the extent to which the government may share in the blame.

Information blocking could loosely be defined as something or someone intentionally interfering with access to my personal electronic health information.

As Reid Blackwelder, a family physician in Kingsport, Tennessee, told the New York Times earlier this year: “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.”

Last year I worked with the Appropriations committee to require a report from the Office of the National Coordinator for Health Information Technology on information blocking.

We received their report on information blocking in April.  Dr. Karen DeSalvo and her team did a good job in describing various kinds of information blocking. Media covered it extensively.

The usefulness of this report is a good example of the kind of service the government ought to provide.

The report described the sorts of information blocking scenarios I outlined—it might be physicians and hospitals blocking patient information from being shared with competing physicians and hospitals to keep patients.  Or it might be electronic health records vendors blocking information so they can increase their market share. 

The report concluded that “successful strategies to prevent information blocking will likely require congressional intervention.” 

But this is not the only view of the practice -- some view information blocking as rational competitive practice by for-profit businesses in a competitive health care industry.

In other words, why would a hospital and physician network make it easy for a patient to go out of their network when that is against their business interests?

Senator Murray and I are hard at work on trying to find a way to deliver on the promise of electronic health records.

And so, as I said, I’d like to hear from the witnesses today the extent to which information blocking is a problem—and the extent to which government shares in the blame.

I look forward to our witnesses’ insights and perspective.

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