Industry officials at a Senate panel Tuesday urged HHS to give them more time to review two proposed interoperability rules through an extension of the comment period and granting health IT and provider groups additional time for implementation.
Chairman Sen. Lamar Alexander, R-Tenn., also raised worries the government was moving too quickly. Sen. Patty Murray, D-Wash., disagreed, noting "there are real consequences if the department takes too long to implement these policies."
Other issues raised included problems matching patients to their health records and striking the proper balance between patient privacy and security and patient access, along with the standardization of application programming interfaces (APIs).
Nearly every player in the healthcare system backs moving toward interoperability, in theory, to promote better care coordination, cut costs and reduce duplicative services. By some estimates, up to 50% of healthcare spending is unnecessary.
CMS and the Office of the National Coordinator's twin proposed rules to implement provisions of the 21st Century Cures Act last month are an attempt to move toward those ends.
The HHS rules precisely define the practice of information blocking and require that by Jan. 1 insurers share a patient's personal health information with them. All health IT companies must adopt the same API two years after the rules are completed and hospitals must send a patient's doctors a notification when a patient is discharged from the hospital.
The new regulations, if implemented, would save about $3.3 billion per year, according to HHS, and grant roughly 125 million patients easier access to their records.
Panelists before the Senate's HELP panel largely agreed that, though interoperability was necessary, the new rules may be moving too quickly given the number of steps necessary for health IT vendors and providers to get in compliance over the next two years or so, including developing and certifying new EHR functions, provider adoption and customization and staff training.
"Are these the right standards? Are we correct to insist that there still be the same standard for everybody? And are we moving too fast?," Alexander asked a panel of expert witnesses.
Christopher Rehm, chief medical informatics officer at 30-state provider Lifepoint Health, proposed that following the 24 month period tech vendors have to make their systems interoperable, providers should have additional time to "work with whatever's been realized."
"Policymakers must strike a balance between their desire to make personal digital health information available and the burdens that these requirements place on health systems under proposed timelines," he said in his prepared testimony.
The health IT group Health Innovation Alliance echoed those concerns, with executive director Joel White cautioning of provider burden, including keeping doctors on the hook for the cost of technology maintenance and updates.
Lucia Savage, chief privacy and regulatory officer at San Francisco-based Omada Health and ONC chief privacy officer from 2014 to 2017 also urged ONC to consider a transition or "sunset" period to allow organizations to adapt to app-enabled health information sharing and to make sure they're compliant with the new non-data blocking strictures.
The witnesses also recommended ONC adopt the United States Postal Service address standard to help patient matching, standardize APIs with Fast Healthcare Interoperability Resources, or FHIR, standards for information exchange and patient export of data and extend the ONC information blocking penalties to entities like non-certified EHR developers and connected devices, among other suggestions.
Mary Grealy, president of the Healthcare Leadership Council, a coalition of healthcare chief executives, also requested at the hearing that CMS and ONC grant at least a 30-day extension of the comment period for the proposed rules given their complexity. The period is due to expire May 3.