TMA Testimony by Joseph Schneider, MD, MBA
House Public Health
House Public Health Hearing
Wednesday, Sept. 24, 2014
Charge: Identify strategies to support the efficient exchange of electronic health information with Texas Health and Human Services enterprise agencies. Examine legal and technical issues around the accessibility of information held in registries maintained by state agencies to authorized health care providers. Identify issues related to health information exchange and providers’ liability, as well as concerns related to transitioning patient data in cases where a provider selects a new electronic health record vendor.
Good morning, Chairwoman Kolkhorst and members of the committee. My name is Joseph Schneider. I am the past chair of the Texas Medical Association (TMA) Committee on Health Information Technology, a Dallas pediatrician, and a chief medical information officer of Baylor Scott and White. I am here on behalf of TMA, which represents more than 47,000 physicians and medical student members. I want to thank the chair and committee members for the opportunity to testify about the electronic exchange of health information. The two areas where I will focus are improving accessibility to information in state registries and transitioning patient data when a physician or hospital selects a new electronic health record (EHR) vendor. Both subjects have the common thread of what’s called “interoperability” or the ability to exchange information meaningfully.
As background, I want to emphasize that electronic health information exchange starts with the use of electronic health records, and if this isn’t done well, then exchange is meaningless. So the foundation of good interoperability is a strong focus on improving the quality and efficiency of EHRs. TMA is committed to this.
Regarding the first topic, improving accessibility to information in state registries, I happened to be in a meeting this weekend where I learned that we do hearing screening on more than 98 percent of babies born in Texas each year. But we lose track of more than 75 percent of them in the coming years. A significant portion of this loss probably stems from a lack of data interoperability. There are websites and ways by which pediatricians and others can find out information about the hospital testing of these children, but it’s in a format totally separate from that of the EHRs the physicians use. Even if the first pediatrician who sees the baby post-hospital receives the information, the moment the family moves to another pediatrician, the information can easily be lost. There is no standard place for the information to live in our EHRs and no standard way to send this information to the next place of care. So the child’s screening is “lost” to follow-up.
Hearing screening isn’t the only place where this occurs. Even our most widely known state, ImmTrac, is a system separate from the EHR of many physicians and hospitals, and accessing the information in ImmTrac is therefore a challenge. So this sytem is not used nearly as often as it should be. The same is true with newborn screening and many other state databases.
What physicians want and need to achieve high-quality care in this electronic age is a single pipeline for submitting data to and getting information from government, not multiple pipelines, and websites.
Let me next address concerns related to transitioning patient data in cases where a physician or hospital selects a new electronic health record vendor. First let me explain that the clinical reason for a medical record is that it’s a tool created by the physician to aid in the provision of medical care. It allows for documentation and communication of my observations, thoughts, and analyses. Under current Texas Medical Board rules, Texas physicians are required to maintain medical records for a minimum of seven years from the date of last treatment. If the patient is younger than 18 when last treated by the physician, then his or her doctor must maintain the medical record until the patient reaches the age of 21 or for seven years from the date of last treatment, whichever is longer.
Texas’ medical record retention requirements do not differentiate between electronic records and paper records. In the world of paper records, this is a fairly straightforward process. There are solid, well-established procedures for preserving the full medical record in paper form.
With each passing year, more and more physicians and hospitals are adopting EHRs. There are many reasons to go electronic, as a well-designed and well-implemented EHR can do great things. Increasingly, however, data show that EHRs are not well-designed and sometimes not well-implemented. This is leading to broad dissatisfaction and to EHR switches among many. Other times, switches are not by choice when the EHR vendor goes out of business or the EHR is eliminated through acquisition by another company.
In other industries, the answer to a system that is not meeting your needs is simply to change systems. Unfortunately, due to a lack of foresight in federal meaningful use program requirements, there is no simple way to do this with an EHR because the data are in a proprietary format. In fact, some cloud-based vendors have refused to provide electronic copies of data for moving to another EHR. So when EHR switches occur, significant pieces of the patient’s records can be lost due to the difficulty of moving the patient’s complete medical record.
TMA understands and supports the importance of preserving medical records under state and federal law, regardless of whether the medical record is in electronic or paper form. Maintenance of the medical record is important for continuity of care, as well as to provide patients access to their medical history.
However, for the reasons stated above, it must be recognized that maintenance of medical records as part of an EHR is far more complex than with paper, particularly in the instance of transitioning data. TMA, therefore, recommends the Legislature study: (1) the proprietary nature of recordkeeping used by EHRs and whether standardized data tagging could ease transmission between systems. We believe this is possible and have lobbied the federal government with little success to date; and (2) the number of patients affected by EHR data transitions in Texas.
We appreciate the opportunity to testify on this important subject and your interest in this topic. If there are any questions, I’m happy to try to answer them.
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