Senate HELP Hearing on the CMS and ONC Proposed Rules, Interoperability, Patient Access to Data, and Physician Burden

On March 26, 2019,  witnesses testified in front of the Senate’s Health, Education, Labor, and Pensions (HELP) Committee regarding the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT’s (ONC) proposed rules, as well as the underlying challenges of interoperability, patient access to data, and physician burden. You can see information about the witnesses and their testimony here.

 

The biggest concerns from the committee members were focused on patient privacy and security, which data types are covered by HIPAA and therefore accessible by the patient, and how sufficient the proposed rules will be for preventing information blocking and increasing interoperability. The HELP Chairman, Senator Lamar Alexander, was also concerned with ensuring that major changes are implemented on a timeline that allows for meaningful compliance and implementation.

 

The witnesses raised several issues that should be considered more carefully as CMS and ONC finalize the rules.

1. Patient matching. Ben Moskovitch, of Pew Charitable Trusts, noted that standardization of data elements within the healthcare industry could lead to better patient matching. For example, based on a Pew report, he proposed that the United States Postal Service (USPS) standardized address protocol could improve address inputs, which would greatly improve the reliability of that element. We hope to see the federal government encourage this protocol for use in other human services technology applications, since patient matching across multiple human services IT systems could yield more meaningful analysis related to addressing Social Determinants of Health (SDoH) and improved outcomes-based reimbursement models.
2. Several witnesses, especially privacy expert Lucia Savage, raised concerns about the privacy and security of certain types of data that may fall outside of HIPAA rules, which could allow this data to be bought and sold by other entities. Savage pointed out that consumers are in the habit of quickly agreeing to terms of service for third-party application developers without reading or understanding them. She noted that this may lead initially to confusion, then distrust, if this is not better regulated.
3. Christopher Rehm, of Lifepoint Health in Tennessee, also suggested that the electronic health record (EHR) vendors should pursue more real-world testing and development before implementing changes that disrupt workflow and may not entirely address the needs of their customers.
4. Attached to the testimony of Mary Grealy, the President of the Healthcare Leadership Council (HLC), is a report from February 2019 titled: “Advancing Interoperability, Information Sharing, and Data Access: Improving Health and Healthcare for Americans”. HLC worked with the Bipartisan Policy Center and the University of California at San Francisco to interview stakeholders and make recommendations to improve the issues underlying the hearing. In the HELP hearing, Grealy acknowledged that the CMS and ONC proposed rules mostly aligned nicely with the recommendations from the report. However, she suggested that CMS and ONC extend the comment period by an additional 30 days to allow stakeholders more time to meaningfully develop comments to the proposals.

Comments on the proposed rules are currently due on May 3, 2019. You can submit comments to these proposed rules here and here.