- The American Hospital Association (AHA) has reservations about the health IT interoperability provisions of the 21st Century Cures Act.
In a letter to Representative Fred Upton (R-MI), Chairman of the House Committee on Energy & Committee, AHA voiced its concerns concerning three areas of the current draft bill that could have negative consequences for its members: enforcement mechanisms, decertifications of EHR systems, and the definition of information blocking.
The association believes that the 21st Century Cures Act would impose attestation and auditing procedures that are redundant and therefore burdensome to providers.
"We recommend that you use the existing structures of the meaningful use program to promote information sharing," writes AHA Executive Vice President Rick Pollack. "On the provider side, we believe that the use of Medicare fraud and abuse mechanisms, such as investigations by the Office of the Inspector General, imposition of civil monetary penalties or exclusion from the Medicare program, is unnecessary and inappropriate to address the concerns that the legislation seeks to remedy."
While AHA supports the draft bill's intent "to hold vendors accountable for the design and marketing of interoperable products," the association contends that EHR decertification could prove a disruption to hospitals and physicians.
"Decertification would be disruptive to hospitals and physicians that have invested in and deployed an EHR that is later decertified," Pollack continues. "However, the inclusion of provider protections against meaningful use penalties if their EHR is decertified makes it more reasonable."
What's more, AHA leadership argues that the proposed duration of these protections — one to two years — is likely to be insufficient in some cases. "For complex hospital information systems, this process can take two or three years," Pollack adds.
Lastly, the letter calls into question the breadth of the draft bill's definition for information blocking because it "could result in reasonable business practices or customization of software systems leading to charges of Medicare fraud."
In addition to these three areas, AHA is reminding Congress of the complex regulatory environment hospitals and health systems are operating within:
They must meet the requirements of the meaningful use program, build new approaches to care delivery, and respond to growing consumer expectations that their health information will follow them through the health system and be available to access online. However, we still lack significant technical capabilities and infrastructure to support efficient and effective health information exchange. We believe that there are positive steps that would further our shared goals, such as more robust testing of health information technology products and greater commitment to developing and maturing data standards.
The AHA's remarks echo those of the Healthcare Information and Management Systems Society (HIMSS) and College of Healthcare Information Management Executives (CHIME), which likewise focused on the complexity of advancing health IT interoperability.
Others, such as CIO of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, have criticized the draft bill's proposal of a new charter organization to spearhead many of the provisions in the 21st Century Cures Act.
"It does not make sense to officially sanction a 'charter organization' and seed it with $10 million, creating yet another player in an already crowded field of groups working on interoperability," John Halamka, MD, MS, writes on his blog Life as a Healthcare CIO. "I agree that coordinating the standards development organizations makes a lot of sense -- why not just direct ONC to create a permanent Task Force that reports to the HIT Standards Committee, and let ONC support it out of existing resources?"
Halamka's concerns also include the standards that will be used to measure interoperability, the criteria for determining information blocking, and the meaning of decertification.