House bill aims to spur adoption of electronic medical records

The proposed statute would require notification when personal health information is breached.

Issue: September 25, 2008

ByMatt Hasson

The U.S. House of Representatives is considering bipartisan legislation that is intended to tighten electronic health record security. The bill also calls for financial incentives for physician providers who adopt electronic medical record systems.

In interviews with Ocular Surgery News, two experts expressed concern that strict security provisions may inhibit, not promote, adoption of EMRs. They also voiced support for the financial incentives, particularly in light of the downturn in the U.S. economy.

Also known as electronic health records (EHRs), EMRs are designed to improve health care efficiency, safety and quality by minimizing or eliminating paper records, proponents say.

The Committee on Energy and Commerce approved HR 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act, in July. The full House had not voted on the bill before adjourning for the summer recess.

Nicole Liffrig Molife

Nicole Liffrig Molife, JD, an attorney with the Washington, D.C.-based law firm Arnold & Porter, and Lloyd Hildebrand, MD, chairman of the American Academy of Ophthalmology’s Medical Information Technology Committee, discussed the bill’s pros and cons.

“The bill was a good step in the right direction,” Ms. Liffrig Molife said. “I think it is evident in the bipartisan support of the bill that there is almost universal support for moving toward widespread adoption of electronic medical records.”

Dr. Hildebrand touted the bill as a badly needed shot in the arm for EMR adoption.

“The movement toward EHRs seemed to need some re-energizing, and this appears to be a good move in that direction,” he said.

Security provisions and incentives

The bill would require notification when personal health information is breached and extend federal privacy laws to organizations that conduct business with providers. It would also require providers to receive patient consent to use or disclose protected information, according to a committee news release.

An amendment to the bill would require health information exchanges and other entities to comply with security rules included in the Health Insurance Portability and Accountability Act (HIPAA) of 1996, in addition to the privacy rules included in the legislation, according to a summary of revisions to the bill.

Ms. Liffrig Molife stressed the need for any EMR legislation to be integrated with HIPAA regulations.

“We need to make sure that whatever we do with electronic health records is building on the existing infrastructure already in place,” she said.

At a July 24 hearing, House Ways and Means Health Subcommittee members called for a separate bill that would allow individuals to file suit in the event of a data security breach.

“Physician providers are already facing, rightfully or wrongly, medical malpractice lawsuits, and now here’s another way patients can sue them,” Ms. Liffrig Molife said. “I think it would be a real concern for practices if they would face these additional lawsuits for breaches of privacy. I think it is very much a disincentive.”

Dr. Hildebrand called for penalties that do not create technical headaches and deter EMR use.

“Penalties for breaches should be significant enough to deter inappropriate use, but we need to be careful that they don’t inhibit appropriate use by creating unnecessary operational overhead, especially at the end-user level,” he said. “It is a difficult area to regulate, given that many of the security solutions are not simply technical, they are operational issues that encumber end-users appropriately accessing records.”

HR 6357 would provide $560 million in grants and loans to health care providers, particularly those in rural areas and medically underserved areas to purchase EMR systems.

“I think that we need to continue to look at ways to provide financial incentives for providers to adopt [electronic health records],” Ms. Liffrig Molife said. “We need to continue to explore options like that, since small physician practices in particular continue to financially struggle.”

Dr. Hildebrand also praised the economic incentives, saying they are realistic in terms of covering the expense of setting up an EMR.

Electronic medical record pilot program set to launch this fall

Physician recruitment for a 5-year Medicare electronic medical record pilot demonstration is scheduled to begin this fall, according to the Department of Health and Human Services.

HHS selected 12 communities to participate in the program, which is designed to encourage physicians to use EMR systems, according to an HHS news release.

The communities include county, state and multistate initiatives. Four of the 12 communities are scheduled to start recruiting this fall. Recruitment is scheduled to begin in four more communities in fall 2009, the HHS release said.

The chosen sites are in Alabama; Delaware; Jacksonville, Fla. (multicounty); Georgia; Maine; Louisiana; Maryland/Washington, D.C.; Oklahoma; Pittsburgh (multicounty); South Dakota (multistate); Virginia; and Madison, Wis. (multicounty), according to the release.

Up to 1,200 primary care practices in the chosen communities will receive financial incentives for using EMRs to improve care quality, based on clinical quality measures. Also, bonus payments will be based on the number of EMR functions a physician group has incorporated into its practice. Total payments may reach $58,000 per physician or $290,000 per practice, the release said.

Payments will be based on basic EMR functions such as clinical documentation, ordering lab tests, recording lab tests and ordering prescriptions. More sophisticated functions include facilitating care management activities and sharing medical records among care providers, the release said.

The pilot demonstration is one of several federal initiatives intended to promote the use of EMRs and build a national health information network. The Centers for Medicare and Medicaid Services is offering financial incentives for participating physicians to adopt electronic prescribing, a key component of health information technology.

For more information:

Lloyd Hildebrand, MD, can be reached at 1000 Standon L. Young Blvd., Suite 390, Oklahoma City, OK 73104; 405-271-1096; fax: 405-271-1226; e-mail: lloyd-hildebrand@ouhsc.edu.

Nicole Liffrig Molife, JD, can be reached at Arnold & Porter LLP, 555 12th St. NW, Washington, DC 20004-1206; 202-942-6611; fax: 202-942-5999; e-mail: nicole.liffrig@aporter.com.

Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.