Congressional EHR interest brings both opportunity and risk
Look at at all of the attention that congress is lavishing on electronic health records.
More than 30 bills aimed directly at EHR use have been introduced since the new session began in January. They cover a lot of ground, including bills to:
- Ease the pain of the Meaningful Use program by creating two new exceptions and softening other requirements
- Expand the Meaningful Use incentive program to safety net clinics
- Impose strict time limits on interoperability of EHR data between the U.S. Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA)
- Increase congressional scrutiny of the DoD/VA joint EHR
- Exclude pathologists from the Meaningful Use program (HR 1309)
- Create a prize program for the development of an iEHR (HR 2055)
- Extend Meaningful Use eligibility to some physician assistants (HR 1790)
- Use EHRs as part of coverage of voluntary advance care planning (HR 1173)
- Use EHRs when caring for newborns (HR 1281), mothers and babies (S 425)
- Provide loan guarantees for small providers who wish to purchase health IT (HR 28)
In addition, while not a proposed bill, you've got lawmakers asking the U.S. Department of Health & Human Services Office of Inspector General to extend the legal protections allowing EHR donation programs, which otherwise would sunset at the end of this year.
And this doesn't even count the ongoing attention being given to the beleaguered Meaningful Use Incentive Program, with Republication lawmakers calling for a reboot, freeze or a pause of the initiative.
What's going on with congress and EHRs in 2013?
My hypothesis: The increased legislative activity corresponds to the increase in EHR activity and visibility.
This may be one of the best indicators by far of the acceptance--or at least acquiescence--of EHRs into the mainstream.
It's as if EHRs, which in their own way have flown under the radar, now are more of a front burner item.
However, this uptick in congressional interest is not without its risks.
For one, not everyone may be in favor of this increase in governmental interest in EHRs. It's one thing to suggest that pathologists be excluded from the Meaningful Use requirements. It's another to require DoD and VA get their iEHR act together in only one year; they've been trying for years to accomplish that. Simply telling them to speed it up might not be that effective.
There's also a risk that the subject will become even more partisan. I hope we don't start seeing repeated votes to repeal the Meaningful Use program, the way the House continues to vote to repeal the Affordable Care Act.
At the same time, perhaps this is a great opportunity for congress to step in take some positive steps to improve EHR use.
For instance, I'd like to see legislation that bars EHR vendors from jeopardizing patient safety by freezing out providers from their own EHRs whenever there's a billing dispute or contract termination. There must be some middle ground that can be found--setting reasonable access fees, putting money into escrow, allowing patient access to their own records, perhaps.
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