AHA raises concerns about interoperability provisions in 21st Century Cures Act

The American Hospital Association (AHA) expressed concerns about the interoperability provisions in the 21st Century Cures legislation in a letter sent to Rep. Fred Upton (R-Mich.) chairman of the House Committee on Energy and Commerce.

"We are concerned that the heavy-handed and duplicative enforcement mechanisms contemplated for providers could have significant unintended consequences, including undermining new models of care and setting up an environment where well-intentioned providers face significant penalties for small mistakes," writes Rick Pollack, AHA executive vice president.

Pollack points to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which requires that providers attest that they are not limiting interoperability of their electronic health records (EHRs) as part of the requirements of Meaningful Use. At the same time, the 21st Century Cures Act also would require such an attestation, which the AHA sees as duplicative and unnecessary.

While the organization backs efforts to hold vendors accountable for creating interoperable products, it's concerned about the effect that vendor decertification could have on hospitals and physicians. The AHA urges the Federal Trade Commission to conduct a study of anti-competitive behavior by EHR vendors, but also to protect providers against Meaningful Use penalties if their EHR systems are later decertified. Since replacing an EHR system can take a year or more, AHA seeks protections that last more than one year.

Thirdly, it sees the definition of information blocking in the legislation as overly broad, creating the potential that reasonable business practices or software system customizations could lead to charges of Medicare fraud.

"We look forward to working with you to refine that definition in a way that prevents true information blocking without criminalizing actions that are needed to establish a solid information system to support good care and new models of care," Pollack writes.

House leaders in late April unveiled an updated draft of the 21st Century Cures Act, which aims to bring new drugs and treatments to the market more quickly. That version did not contain interoperability language, which was added in a mid-May version. It calls for hardship exemptions to Meaningful Use penalties of no less than 12 months and no more than five years, to be determined by the Department of Health and Human Services on a "case-by-case basis."

The new version requires that EHRs be interoperable by Jan. 1, 2018.

To learn more:
- read the letter (.pdf)