The potential for electronic health records (EHRs) to transform health care remains constrained by the lack of effective health information exchange (HIE) technology, TMA says in a letter to U.S. House Ways and Means Committee Chair Kevin Brady (R-The Woodlands).
Matt Murray, MD, chair of TMA's Ad Hoc Committee on Health Information Technology, writes that EHRs have failed to transform health care "primarily because most patient health information is still 'locked' inside the physician's office." TMA's top concerns are lack of EHR interoperability and data security and liability.
Committee Chair Brady requested TMA's assessment to help his committee draft needed reforms.
Dr. Murray explains to Congressman Brady that interoperability problems are due to "the actual movement of data between systems (i.e., an interface)." Interfaces are typically implemented through:
- Connecting multiple EHRs to a single HIE organization (e.g., the Houston or San Antonio HIE);
- Making a direct connection between the computers of two organizations without an HIE (e.g., a laboratory interface to a hospital);
- Sending information one episode at a time through secure email (e.g., the DIRECT system);
- Retrieving single pieces of information through a special query (e.g., using the Fast Healthcare Interoperability Resources [FHIR] standard, which is in development and can be useful in some cases where specific information is needed); or
- Using the "Blue Button" or the equivalent to provide patients a copy of their own data and allowing them to provide it to the next physician/care location. This is rare and sometimes is supported by an HIE or by using the DIRECT email system.
In terms of data security and liability concerns, TMA's letter states: "Physicians are concerned about the security of health information exchange and need protections to avoid being inappropriately penalized or held financially liable for breaches and other problems that are inherent with electronic data exchange between health care entities."
Until these problems are addressed, the letter concludes, "TMA feels it is not appropriate to penalize physicians who do not participate in health information exchange because of these concerns."
Action, March 1, 2017