The Senate Health, Education, Labor and Pension Committee Chair Lamar Alexander (R-Tenn.) announced that the panel will recommend that HHS delay Stage 3 of the meaningful use program, Modern Healthcare reports.

Alexander's announcement followed a HELP committee hearing on information blocking and electronic health record interoperability (Dickson, Modern Healthcare, 7/23).

Background

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

In March, HHS released a proposed rule for Stage 3 of the meaningful use program.

Under the proposal, all eligible professionals beginning in 2018 would report on Stage 3 of the meaningful use program regardless of their previous participation. Providers would have the option to move to Stage 3 starting in 2017 (iHealthBeat, 5/28).

Push for Delay

According to EHR Intelligence, many stakeholders have criticized the Stage 3 proposed rule for being too ambitious.

During the hearing, Alexander said, "[A] hospital told me that Stage 1 and Stage 2 worked 'okay,' but they were 'terrified' by Stage 3" (Bresnick, EHR Intelligence, 7/23). He added, "We might want to slow down the implementation of Stage 3, not with the idea of backing up on it, but with the idea of saying, 'Let's get this right'" (Slabodkin [1], Health Data Management, 7/24).

According to Clinical Innovation & Technology, postponing Stage 3 of the meaningful use program will be one of several recommendations the Senate committee plans to make to the Obama administration (Walsh, Clinical Innovation & Technology, 7/23).

Other recommendations likely will focus on:

• Achieving interoperability;
• Creating standards to clarify patients' ownership of their health data;
• Developing more user-friendly EHRs; and
• Implementing stronger security requirements for patient data.

Alexander said the recommendations will be crafted as regulations that HHS can implement via rulemaking rather than through legislation (Modern Healthcare, 7/23).

Meanwhile, Rep. Renee Ellmers (R-N.C.) on Wednesday announced a bill that would delay the Stage 3 rulemaking until 2017, meaning Stage 3 would not go into effect until 2019 or 2020, Politico's "Morning eHealth" reports (Allen et al., "Morning eHealth," Politico, 7/24).

Details of Senate Hearing on Interoperability, Information Blocking

During Thursday's hearing, experts told the HELP committee that current information blocking practices make it impossible for the health care industry to achieve full interoperability, Health Data Management reports.

Committee members heard testimony from:

• Paul Black, president and CEO of EHR vendor Allscripts;
• David Kendrick, chair of the Department of Medical Informatics at the University of Oklahoma and CEO of MyHealth Access Network;
• David Kibbe, president and CEO of DirectTrust and a senior adviser at the American Academy of Family Physicians; and
• Michael Mirro, chief academic research officer at the Parkview Mirro Center for Research and Innovation (Slabodkin [2], Health Data Management, 7/24).

In his opening remarks, Alexander said, "Information blocking is one obstacle to interoperability, and I'm interested in hearing today from the witnesses the extent to which this is a problem -- and the extent to which the government may share in the blame."

Alexander cited an Office of the National Coordinator for Health IT report that found that some health IT vendors and health care providers are intentionally blocking the sharing of patient information and that congressional action might be necessary to address the practices (Murphy, EHR Intelligence, 7/23).

In his testimony, Kendrick said that there are "so many specific experiences with inappropriate data blocking and sub-standard data quality that we've created a nomenclature to classify six common types," the most common of which is "the high price charged by vendors to implement and maintain interfaces."

Meanwhile, Mirro noted that many EHR vendors include gag clauses in their contracts that bar providers from publicly addressing issues with their EHR system or unfair pricing.

He said, "Many EHR vendors provide the functionality needed [to connect with other systems], but require the user to purchase their health IT products to make the elements of the EHR interoperable."

Kibbe said the federal government should play a role in incentivizing interoperability (Slabodkin [2], Health Data Management, 7/24). Kibbe recommended several actions the federal government could take, including:

• Continuing to expose information blocking issues and working with stakeholders to set expectations for interoperability;
• Developing an improved EHR certification process;
• Encouraging federal agencies to use standards-based interoperable health information exchange with providers; and
• Tying in the use of certified EHR technology with value-based purchasing models (Murphy, EHR Intelligence, 7/23).

Kibbe argued that ultimately "the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, not the EHR vendors and not the government (Bresnick, Health IT Analytics, 7/23).

However, Black disagreed, arguing that federal government action is key to ending information blocking.

Black argued that such practices are the result of the "lack of a strong business case or a true market driver for interoperability" among providers. He added that the "current payment system simply does not provide appropriate financial motivation for providers to truly be invested in creating an interoperable health care environment."

As such, Black said CMS could produce better results by "creating a direct relationship between payment and data exchange" (Slabodkin [2], Health Data Management, 7/24).