Electronic Health Reporter

Testifying before the Senate Committee on Health, Education, Labor & Pensions (HELP), DirectTrust president and CEO David C. Kibbe, MD MBA, urged the federal government to take action to help overcome the problems impeding the sharing of health information between and among parties authorized to access electronic health data, commonly referred to as “information blocking.”

“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” testified Dr. Kibbe, one of the nation’s foremost authorities on health information exchange security issues.  Dr. Kibbe’s organization, DirectTrust, is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable exchange of health information.

Dr. Kibbe testified at a full Senate HELP committee hearing titled “Achieving the Promise of Health Information Technology:  Information Blocking and Potential Solutions. During his testimony, Dr. Kibbe enumerated the problems with information blocking and offered suggestions to help improve upon the current situation in the near-term. Among the many actions Dr. Kibbe suggests the government take to help overcome information blocking include:

• Continue to shed light on these problems, and work with trade groups, standards and policies organizations, and others to set expectations for interoperability of EHRs and other applications certified as interoperable, especially those that have been federally subsidized within the meaningful use programs.

• Bring better and improved EHR certification processes forward beyond the testing laboratory so that the utility and usability of interoperability features of ONC certified EHR products in the field becomes part of the public record, and can be used in purchasing decisions. Collaboration and partnership with non-profit trade groups to achieve this goal would be advisable.

• Accelerate federal agency use of and demand for open, standards-based interoperable HIE (health information exchange) with private sector providers and provider organizations, thereby removing reliance on paper-based mail, fax, e-fax and courier for these federal programs.

  Examples include Veterans Health Administration referrals to and from private sector medical practices and hospitals; Veterans Benefits Administration health information exchanges with private sector medical practices and hospitals; the use by Medicare, Medicaid, and state agencies of interoperable HIE for communications with private sector providers and provider organizations for limitation of fraud, payment adjudication, claims attachments requests, and other administrative transactions now done via fax and mail.

• Continue to tie more robust ONC EHR certification and use of certified EHR technology to participation in value-based purchasing programs, wherein interoperability and collaboration across multiple organizations in multiple-vendor environments is financially rewarding to providers and their health IT vendors. Demand for collaboration and interoperability is best driven by underlying business models and business cases supported by regulation and oversight.

In closing his testimony, Dr. Kibbe said, “Attempts to redress the root causes of information blocking must address the unwillingness of some providers and their EHR partners to share and exchange data, and not just the specific problems that may be encountered in making exchanges run smoothly and reliably. In my opinion, this unwillingness originates in the current business models of some health care provider organizations, and the health care industry in general, wherein fee-for-service payment creates disincentives for sharing of health information and rewards information hoarding, or at least the delay of timely information exchanges. Changes to these payment incentives could do much to reward business models where collaboration and interoperability are highly valued, and where the technological capabilities, standards, and infrastructure for interoperable health information exchange now in place would be put to much better use.”

Dr. Kibbe’s complete testimony can be found here.