Proposed rules to promote electronic health record (EHR) interoperability across the health care system would place excessive burdens and costs on physicians, while making it more difficult for patients to access their electronic health information (EHI). That’s the thrust of a pair of letters the Texas Medical Association wrote to two federal health agencies last week.
In letters to the Centers for Medicare & Medicaid Services (CMS), and its health IT-focused agency, the Office of the National Coordinator (ONC), TMA applauded the agencies for working to improve interoperability, but cautioned the proposals have unintended consequences that could hurt patient care – specifically, that physicians will be forced to bear the cost of additional EHR services or functionality.
“CMS should prohibit payers from using these proposals to place additional contractual demands on physicians,” TMA’s letter to CMS Administrator Seema Verma said. “We believe CMS should focus … more on increasing the value of the electronic protected health information (ePHI) exchange such that it becomes a business and clinical imperative to participate in such exchanges.”
The proposed regulations, which were published in the Federal Register in March, touch on multiple aspects of EHR interoperability, including:
- Patient identifiers;
- Privacy and security;
- Drug benefit data;
- Information-sharing between payers, and between physicians and payers; and
- Public reporting of missing digital contact information.
Among TMA’s concerns: Vendors will require physicians to pay for EHR functionality if they want to receive their complete patient data when switching to a new system.
“TMA implores ONC to not allow vendors to use transitioning as an opportunity to create another revenue stream,” TMA wrote to ONC’s chief, Don Rucker, MD. “Physicians already pay hefty fees to purchase or lease the software in addition to annual licensing fees.”
In its letter to Administrator Verma, TMA expressed concern that payers might punish physicians with contracts that require physicians to provide patient data to the payers.
“While TMA agrees that CMS correctly places much responsibility on the payer community to provide information to patients, there is concern that payers, through coercive contracts, will place additional responsibility on network physicians,” TMA’s letter says.
Additionally, TMA called on CMS to stop “information blocking” in light of reports from Texas physicians who have had difficulty receiving medical records from hospitals when a patient sees a specialist for follow-up care.
TMA also strongly recommended that CMS not publish the names of physicians who publicly attested that they did not share information.
Ultimately, both agencies should work to promote EHR systems so that they become an integral part of the overall health care system, TMA said.
"Physicians spend more than half of their workday interacting with the EHR and performing administrative work. This is time taken away from direct patient care," TMA wrote. "CMS and ONC should use policy levers to release this burden on physicians by considering the impact of each new proposal. Physician time with the patient will result in higher quality care and better outcomes."
Once the final rules are posted, TMA will review them and inform members about any practice changes necessary for compliance.