In a hearing on Meaningful Use Stage 3, interoperability and patient access to data, Sen. Lamar Alexander (R-Tenn.) cut right to the heart of the problem.
"To put it bluntly, physicians and hospitals have said to me that they are literally terrified of the next implementation stage ... because of the complexity and because of the fines that will be levied," he said.
Alexander (pictured) spoke at a Senate Committee on Health, Education, Labor and Pensions hearing today; one in a series the committee set up to seek ways to improve electronic health record exchange and interoperability of health IT systems.
The committee chairman said he wants the group to find ways to work with hospitals and said the Obama administration must get the program back on track to make it something healthcare professionals will find useful--not dreadful.
Thomas Payne, M.D., of the American Medical Informatics Association, said during the hearing that the association wants to ensure that the Centers for Medicare and Medicaid Services does not rush to the next stage of Meaningful Use. Last month, the AMIA outlined recommendations for the future direction of EHRs.
However, Christine Bechtel, president and CEO of Bechtel Health Advisory Group, said delaying Stage 3 would hurt patient engagement. A technical fix that would help unlock data siloed in patient portals would also be hampered, she added.
"Wholesale delay of Stage 3 should be very thoughtfully considered," she said.
When it comes to the government's role in EHR adoption and record interoperability, one panelist said it must come in from a governance perspective to encourage the development of rules and standards.
There should be a multi-disciplinary team of payers, patients, vendors and providers who get together and develop the standards, but the industry will need regulation to define timelines and the rules of the road, said Craig Richardville, chief information officer for Carolinas HealthCare System.
The hearing also touched on barriers to health information exchange and systems interoperability.
When Republican Sen. Richard Burr (N.C.) asked why exchange and interoperability of data is so difficult, Richardville pointed to the technical issues that arise because of the varying systems used in the industry--as well the industry's health IT priorities.
"It was not one of the top incentives, so when you have limited resources ... those are things that fall more to the bottom of the list," he said.
Another issue is the lack of a national patient identifier system, Neal Patterson, co-founder and chief executive officer of EHR vendor Cerner, added. It's a problem that can be solved, he said, but one that currently has prohibited interoperability. He also pointed to providers' fears of letting records out, especially because of the possibility of penalties through HIPAA.
Patterson also testified that business models and market competition can deter information exchange.
In response, Sen. Cassidy (R-La.), brought up CommonWell--and noted that Epic was the only major player that doesn't participate in that organization.
"I feel like Epic's the elephant in the room," Cassidy said to Patterson. "It was implied in your testimony that a business practice which does not allow sharing somehow furthers their business model--if you want to share data with another Epic hospital you have to have Epic, and they have such a market share that people will migrate. Is that a fair opinion? Is that defensible?"
Patterson said his experience would be that Epic does use that "as a marketing technique." However, he said he hopes Epic will join CommonWell and they can work together as an industry.
However, Cassidy pressed the issue.
Congress allotted billions of dollars, he said, "and now a major player is not participating in a common effort to create structured data … that is a problem."
He asked how Congress could solve such an issue. Moving toward reimbursement and value and quality would be a big drive toward interoperability, Payne answered.