WASHINGTON -- Tuesday's House (IT) interoperability was marked by bipartisan frustration from members of Congress about how little has gotten done.
Michael Burgess, MD (R-Texas), chair of the House Energy & Commerce Health Subcommittee, which held the hearing, set the tone with his opening statement. He noted that a rule prohibiting "information blocking" -- the practice of electronic health record (EHR) vendors blocking access to patient records as a way to stifle competition -- had yet to be released.
"I am extremely disappointed that 2 years after the passage of the [21st Century Cures Act], we still do not have the regulations necessary to implement these [anti-information-blocking] provisions," Burgess said. "It is hard to explain to people that Congress provided the tools necessary for doctors and patients to better coordinate their care through the sharing of patient data, and nothing has changed."
"I would think that we would be farther along than we are in these areas," said Rep. Diana DeGette (D-Colo.). She asked the hearing's lone witness, Donald Rucker, MD, the National Coordinator for Health Information Technology, to talk about the biggest impediments to greater interoperability.
"I wish I could tell you that the [proposed] rule had been passed through clearance," said Rucker, who explained that the proposed rule was currently being evaluated by the Office of Management and Budget, which is required to look at all proposed regulations.
As to why healthcare is behind the curve on interoperability compared to other areas, such as banking, "it frankly starts with the raw complexity of human biology," he said. "Unlike financial transactions, where there's a dollar sum and a destination and maybe a few other pieces of data to describe that... human biology [is complex]. Just think about the thousands of lab tests and all the different modalities of imaging. It's immensely complicated and most of it is not standardized, it's not really structured data, so there is a complexity there."
DeGette asked whether there was anything Congress needed to do to overcome these issues, but Rucker didn't think so. "I feel confident in what has already passed," he said.
Rep. Buddy Carter (R-Ga.) also asked for an update on the progress of the rule. "I wish I could give you specifics; they're looking at it. I believe we are close on that. I'm not aware of any insurmountable difficulties or challenges," Rucker replied. "I share your frustration."
Other aspects of the proposed rule also drew committee scrutiny. Rep. Markwayne Mullin (R-Okla.) asked about ways to make it easier to disclose patients' mental health and substance abuse diagnoses in order to get them the proper treatment. Mullin is the sponsor of the "," which would align Section 2 of 42 CFR [Code of Federal Regulations] with the privacy rules in the Health Insurance Portability and Accountability Act (HIPAA) to make release of such information easier, for example, in the case of a medical emergency.
"[My bill] helps, in my opinion, with the provider getting the information they need," said Mullin. "There is obviously a need for doctors to get more adequate information about the patient... Do you feel that 42 CFR Part 2 with it being realigned outside of HIPAA, do you think that hinders the provider from getting adequate information about that individual?"
"As you know, this is very controversial," Rucker answered. "We've had people come to lobby us on both sides of that coin." He deferred to his colleagues at the Substance Abuse and Mental Health Administration.
But Mullin persisted. "In your opinion, is it right that we separate individuals with mental illness or substance abuse disorders separate from anybody else's care?" "Well, I think there's an overall goal to get those things integrated into holistic care," Rucker said, but didn't go further.
Mullin noted that providers have to ask the patient for permission to release this information, and he wondered what would happen if a substance use disorder patient were unconscious and unable to provide permission. He added that there have already been some deaths related to CFR 42's restrictions on releasing healthcare information.
"As a practical matter, in the emergency department... we will assume, in many cases, that there is an opioid [involved] and a standard part of that treatment is to administer Narcan on the possibility that that might be the cause," said Rucker, an emergency physician. He agreed that it would be helpful if HIPAA and CFR 42 were aligned.
Burgess, the subcommittee chairman, agreed and interjected, "The answer to the gentleman's question [about alignment] is 'Yes.'" "If only the Senate would see it that way," Mullin said under his breath.
There was some good news to report, however, in the area of reducing documentation. Rucker mentioned that, in a , both agencies agreed that if the patient's own medical history or their family history hasn't changed since the last visit, the doctor won't need to re-enter it. And "if you have a resident or medical student who spends a lot of energy getting a history, you don't have to re-document all that and wade through that much more text." The two agencies also talked about prior authorization and working on technology to make that a lot simpler, he added.