This post was authored by Michael J. Mirro, MD, FACC, a member of the ACC’s Informatics and Health Information Technology Task Force.

Today, I had the opportunity to testify on Capitol Hill about the important issue of health information blocking, unforeseen problems that have been created by electronic health records (EHRs), and possible solutions to help improve care during a Senate Health, Education, Labor, and Pensions (HELP) Committee hearing titled “Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions.”

This spring, Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced their aim to accomplish five items related to interoperability of EHRs, including health information blocking, by the end of the year—whether through legislative means or an administrative fix. To accomplish this goal, the Senate HELP Committee has been hard at work soliciting feedback from stakeholder organizations, including the ACC, to help them pave a path forward.

The College, with a diverse membership of cardiovascular care team members and its operation of five hospital-based, one outpatient, and two multi-specialty clinical data registries, is an expert in using data to improve patient care. Given the ACC’s vested interest in complete interoperability of health information technology (IT), the HELP Committee invited the ACC to testify.

I was honored to share cardiology’s perspective and offer recommendations during the hearing to ensure that EHRs are being used to improve patient care, not inhibit the sharing of critical medical information. With two decades of experience in health informatics, I was able to provide specific examples of how information blocking has emerged as a threat to the delivery of quality care.

I first became aware of information blocking when my colleagues in other private cardiology practices adopted EHRs and were forced to spend substantial resources to interface with their health system’s EHR. These practices would have been able to better plan financially if these costs had been disclosed at the outset.

Many EHR vendors provide the functionality needed, but require the user to purchase their health IT products to make the elements of the EHR fully interoperable. Like other products such as consumer electronics, you are able to connect, but you must buy a specific company’s products to do so with ease. The ramifications of health IT tools that are unable to communicate are serious, resulting in decreased care quality and stunting improvements in population health.

The delay of information sharing is another form of information blocking. During my testimony, I shared an experience I had with one of my patients who was admitted to the emergency room in cardiac arrest. Because of a delay in receiving his cardiac history, data critical to his care was not available in a timely fashion. The patient experienced a complication during the emergency heart procedure resulting in prolonged illness. Unfortunately, experiences like this are all too common. EHRs are supposed to facilitate the sharing of critical medical information, not inhibit it.

In order to facilitate the flow of health information, I provided the following recommendations to the Committee:

• Transparency of additional (or hidden) fees within EHR vendor contracts should be evaluated.
• Data fluidity should mean not only that information reaches the provider, but that the data is transmitted quickly and securely.
• EHR vendors’ products should be universal and connect to other EHRs offered by different companies.
• Health IT vendors and providers should be incentivized to establish networks for patients to monitor their devices, empowering them to actively participate in their health decisions. In addition, adoption of public data standards should be expected and supported in the best interest of patients.

I also echoed ACC’s recommendation that Meaningful Use Stage 3 be delayed in its entirety, especially since only 11 percent of physicians have attested to Stage 2.

Things have certainly changed since my practice first adopted an EHR before the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009. Back then, these systems had a user-centered clinical design as opposed to the software centric certified EHR systems of today. I am encouraged by Chairman Alexander and Ranking Member Murray’s dedication to examining the unintended consequences that have arisen and look forward to health IT improvements that will benefit patients, providers, practices, and the health care system as a whole.

To watch the hearing, click here. The full written testimony is available here.

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