Speeches & Floor Statements

Opening Statement: Alexander: Getting Electronic Health Records “Out of the Ditch” is Critical to the Future of Medical Innovation

Posted on October 31, 2017

Last December, I said that, for the second consecutive year, President Obama has signed a Christmas miracle into law. In 2015, it was the Every Student Succeeds Act, the law fixing No Child Left Behind. Last year, it was the 21st Century Cures Act, which Majority Leader McConnell called “the most important legislation” Congress passed last year.

This is the first hearing on the implementation of Cures, which this committee worked so hard on.

We hope it will help virtually every American family by taking advantage of breathtaking advances in biomedical research.

As I said when we began hearings on the Every Student Succeeds Act, a law is not worth the paper it’s printed on if it is not implemented properly. I intend to ensure Cures is also implemented properly and today is the start of that.

This hearing is focused on the health IT provisions in Cures. We will have additional implementation hearings in December on the sections dealing with the research, development, and approval of innovative treatments, cures and medical devices, and on the reforms to mental health programs.

As we worked on Cures, we learned that in order for most areas of the bill to succeed, it was essential that electronic health records systems work properly.

For example, the precision medicine initiative aims to assemble one million genomes to help doctors tailor treatment to patients. But most of that information the head of the National Institutes of Health, Dr. Francis Collins, is trying to collect, will flow through electronic health records.

And the more we looked into these systems, the more we realized our nation’s system of electronic health care records was in a ditch.

Since 2011, we have spent $37 billion incentivizing doctors and hospitals to install electronic health records systems through the Meaningful Use program in Medicare and Medicaid.

A well-respected hospital told me that Meaningful Use Stage I was helpful, Stage II was very difficult, but Stage III was terrifying. On top of that, doctors and hospitals were being asked to adjust to a new system of Medicare and Medicaid reimbursements.

So I recommended slowing down the implementation of Stage III to get it right, and working with doctors and hospitals to get it right, which the previous administration did not do.

In 2015, a family doctor in Kingsport, Tennessee explained to the New York Times the problems he and others face with electronic health records systems 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.”

The exchange of information between electronic health records systems is called interoperability. In the case of the doctor from Kingsport, and many others across the country, this exchange of information does not always happen easily, or at all.

This committee held six hearings in 2015 looking at ways to improve electronic health records and formed a bipartisan working group that made recommendations that were included in the final Cures legislation.

The goal of the health IT provisions in Cures was to make it easier for patients to access their health records and for doctors and hospitals to get the information they need to treat patients.

The law set clear deadlines for the administration to meet and today I would like to hear how implementation of these provisions is going.

Are doctors spending less time on administrative tasks and more time with patients?

Are doctors and hospitals better able to understand before purchasing an electronic health records system how well it shares information with other systems?

What has been done to discourage information blocking, which is when there is some obstacle getting in the way of health records being sent to another medical provider like one clinic refusing to send information to another or one record system not exchanging information with another?

What tools have been given to local provider networks, hospitals, and doctors to help them achieve interoperability with other health providers?

What has been done to ensure patients know they have a right to access their own health records?

What steps have been taken to help doctors ensure they are looking at the record of the patient in front of them, and not another patient’s record?

There is also a role for the private sector to play in ensuring electronic health records are working.

In a country where nearly two million people fly every day, taking for granted how easy it is to make and change flight reservations on different airlines, we should be able to use the genius of our private sector to make sure electronic health records are working.

While some regulations are useful, we should be careful to leave plenty room for the game-changing innovation in electronic health records that we’ve seen in so many other sectors of our economy.

One such effort is the Center for Medical Interoperability, a group of non-profit, for-profit, and university-based hospitals, that is headquartered in Nashville.

Their idea was, among them, they have a large enough purchasing power to tell the makers of electronic health record systems they want systems that work properly and are able to communicate with each other.

And if the systems don’t perform properly, these purchasers will find products that do.

In February of 2016, former Centers for Medicare and Medicaid Services Administrator Andy Slavitt joined me at the Center for Medical Interoperability and both of us were impressed.

I was glad to see these hospitals coming together to work out a solution in the private sector.

Electronic health records are a critical piece to the success of Cures and I look forward to hearing what steps the administration has taken to implement the provisions this committee passed.