Speeches & Floor Statements

Hearing Statement: Implementing The 21st Century Cures Act

Posted on March 26, 2019

The Senate Committee on Health, Education, Labor and Pensions will please come to order.
Senator Murray and I will each have an opening statement, and then we will introduce the witnesses. After the witnesses' testimony, senators will each have 5 minutes of questions.
Reid Blackwelder is a family physician with three clinics in the Tri-Cities area of East Tennessee.
A few years ago, he talked to the New York Times about the electric health records that were supposed to make his life easier, saying, “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."
Dr. Blackwelder could pay for his patients’ hospital records to be electronically sent from his system to the hospital’s system– but it would cost him $26,400 every month – or $316,800 a year.
For Dr. Blackwelder, and so many other doctors, record keeping is now more expensive and burdensome.
In 1991, the National Academy of Medicine released a report urging the “prompt development and implementation” of what were then called computer-based patient records.
The report said these systems, “have a unique potential to improve the care of both individual patients and…to reduce waste through continuous quality improvement.”
Electronic health records got a boost in 2009 when the federal government began the Meaningful Use program, spending over $36 billion in grants to incentivize doctors and hospitals to use these systems.
As was the prediction in the 1991 report, the hope was electronic records would improve patient care and reduce unnecessary health care spending.
This is important because, at a hearing last summer, Dr. Brent James, from the National Academies, testified that up to 50 percent of what we spend on health care is unnecessary.
There is a bipartisan focus both in Congress and in the Administration on reducing health care costs.
One way to reduce what we spend on administrative tasks and unnecessary care is by having electronic health records that talk to one another – we call that interoperability.
But in 2015 – six years after the Meaningful Use program started – as this Committee worked on the 21st Century Cures Act, we realized that, in many cases, electronic health records added to administrative burden and increased unnecessary health care spending.
A major reason for that is that the records are not interoperable.
One barrier to interoperability is information blocking – which is when some obstacle is in the way of a patient’s information being sent from one doctor to another.
So, in 2015, this committee held six bipartisan hearings and formed a working group to find ways to fix the interoperability of electronic health records.
These hearings led to a bipartisan group of HELP Committee members working together to include a provision in the 21st Century Cures Act to stop information blocking and encourage interoperability.
Today’s hearing is about two new rules the Department of Health and Human Services has proposed to implement this provision in the 21st Century Cures Act.
These two rules are complicated, but I’d like to highlight a few ways that they lay out a path toward interoperability:
First the rules define information blocking – so it is more precisely clear what we mean when one system, hospital, doctor, vendor, or insurer is purposefully not sharing information with another;
Second, the rules require that by January 1, 2020, for the first time, insurers must share a patient’s health care data with the patient so their health information follows them as they see different doctors;  
Third, all electronic health records must adopt the same standards for data elements, known as an Application Programming Interface, or API, two years after these rules are completed.
Fourth, hospitals are required to send electronic notifications to a patient’s doctors, immediately, when that patient is admitted to, discharged from, or transferred from the hospital.
According to the Department of Health and Human Services, these two new rules should give more than 125 million patients easier access to their own records in an electronic format.
This will be a huge relief to any of us who have spent hours tracking down paper copies of our records and carting them back and forth to different doctors’ offices.
The rules will reduce administrative burden on doctors so they can spend more time with patients. 
A recent study from Kaiser found that emergency room doctors, in order to use electronic health records systems, make up to 4,000 mouse clicks per shift.
If electronic health records data was truly interoperable, it would greatly reduce how many clicks doctors have to make.  
According to HHS, spending less time on these administrative tasks will improve efficiency and therefore could save $3.3 billion a year.
And because doctors can see patients’ full medical history, they can avoid ordering unnecessary tests and procedures.
I also want to be aware of unintended consequences from these rules:
Are these rules moving too fast?
In 2015, I urged the Obama Administration to slow down the Meaningful Use program, which they did not do, and looking back, the results would have been better if they had.
Are the standards for data elements too rigid?
Is the door still open for bad actors to game the system and continue to information block?
And how can we ensure patient privacy as patients gain more access and control over their personal health information. And how do we help them keep it secure?
I want to ensure these rules will make the problem of information blocking better, not worse.
I look forward to any specific suggestions to improve these rules from those who use electronic health records systems.
Electronic health records that work can give patients better outcomes and better experiences at a lower cost.