On Tuesday morning, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on electronic health records, their value and implementation issues. For background, health organizations have been shifting their records from paper to computers since about the 1970s, with a large push in the past decade or so. However, the transition has not been smooth, with the EHRs adding to physician workload by not being intuitive to use, needing to use an excessive number of clicks, and not interfacing with other EHR systems at other healthcare providers.|
With this in mind, Congress passed the 21st Century Cures Act of 2016 (Cures Act), which includes provisions to improve in interoperability of health information. In other words, the Cures Act aimed to improve the way that health information computer systems exchange information, so health information that is recorded by your primary care physician can easily be transferred to and used by specialty providers or hospitals. Unfortunately, EHRs are still not as efficient as we would like them to be, and there are some concerns on data privacy.
The hearing itself focused primarily on two topics: the first is interoperability and the second health data ownership and privacy.
In terms of interoperability, the committee focused most heavily on information blocking, which is when an actor involved in the exchange of health data knowingly and unreasonably obstructs the exchange of EHRs. This includes charging fees to exchange the data, obstructionist organizational policies, and technology systems that are not standard, which decrease the ability of the system to interface with other systems. Suggestions to increase interoperability from the panel included better and more standardized demographic data standards to increase patient matching rates, increasing providers and consumer’s confidence in the system, and providing implementation oversight for the issue.
Health data ownership and privacy is another topic that was heavily discussed during the hearing. Senator Cassidy and Senator Murray in particular were concerned about who owns health data—does the patient own it, or do the insurance companies or health providers own it? In addition, who is responsible for the integrity of patient’s health record?
To expand on those questions, questions came up surrounding what health information is legitimately protected—HIPAA protects medical records, but what about other, less explicit data such as spending patterns and fitness tracker app data? The answers are relatively ambiguous: You should own your own health data, but oftentimes, it’s difficult to access. HIPAA protects information that is transferred from a device or application to a doctor’s office or insurance company, but if it does not transfer the data to an affiliated organization, it is not protected by HIPAA.
Overall, EHRs bring up many questions that simply cannot be easily answered right now, and there are operational problems that can make the system highly difficult to navigate. However, the value potential in a fully functioning EHR system will reduce healthcare costs and improve usability and outcomes.