Electronic Health Records Rating Bill Introduced in Senate

Ken Terry

October 09, 2015

United States Senators Sheldon Whitehouse (D-RI) and Bill Cassidy (R-LA) introduced a bill this week that would establish a national rating system for electronic health records (EHRs). According to a news release from Whitehouse's office, the measure would allow consumers" — presumably, healthcare providers — to compare different EHRs on their performance in security, usability, and interoperability.

The legislation, dubbed the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT), would require health information technology (IT) vendors to report on the performance of their products every 2 years. They could be fined if they didn't report or didn't improve a product's substandard performance. In some cases, their systems would be decertified by the Office of the National Coordinator for Health IT (ONC).

Physician practices that had to purchase a new EHR because of the decertification of their existing system would receive money from a revolving user compensation fund to offset the cost of those purchases. The money in the fund would come from the fines levied on EHR vendors. In addition, physicians and hospitals that had to switch EHRs would be exempt from meaningful use requirements for 1 year.

ONC's program for certified EHR technology would be expanded to require products to meet certain security requirements, incorporate "user-centered design," and achieve interoperability. ONC would make publicly available information, such as summaries, screen shots, or video demonstrations, to show how certified products meet the new certification requirements.

No Information Blocking

In addition, the bill would require health IT vendors to attest that they do not engage in "information blocking" activities, including nondisclosure clauses in their contracts with physicians, as a condition of certification.

The Inspector General of the Department of Health and Human Services would be authorized to investigate claims of information blocking and could assess civil monetary penalties on any person or entity that engaged in that activity. The fines could range up to $10,000 per act of information blocking.

Last spring, ONC released a report saying there was credible evidence that some health IT vendors and providers had erected barriers to the free flow of information between entities that used disparate EHRs.

Health IT vendors would also be required to attest, beginning 1 year after the enactment of the TRUST IT Act, that the data in their EHRs "may be exchanged, accessed and used through the use of application programming interfaces and other standards without special effort, as authorized under current law," according to the bill.

Meanwhile, on the very day that the TRUST IT Act was unveiled, ONC finalized its latest interoperability roadmap. According to Healthcare IT News, the roadmap's key themes include "giving consumers the ability to access and share their health data, ceasing all intentional or inadvertent information blocking, and adopting federally-recognized interoperability standards." In a conference call with reporters, MedCity News reported, ONC official Erica Galvez said the goal was to have true, standards-based interoperability by 2017.

Before being acted on by the Senate, the TRUST IT Act must clear the US Senate Committee on Health, Education, Labor and Pensions (HELP), chaired by Senator Lamar Alexander (R-TN), who has been a major supporter of interoperability. Whitehouse and Cassidy, who is a physician, hope to have their bill included in legislation on medical innovation that the HELP Committee is expected to mark up later this year.

900 Products

The Health Information and Management Systems Society (HIMSS) EHR Association (EHRA), which represents the leading vendors, said it preferred a market approach to a regulatory approach for improving the quality and usability of EHRs. "We will review the draft language [of the bill] in detail with an eye towards meeting the needs of patients, providers, developers, and the federal government," commented Leigh Burchell, EHRA chair and vice president, policy and government affairs, for Allscripts, in a prepared statement.

Mark Anderson, a veteran health IT consultant in Montgomery, Texas, said he liked the idea of providing public comparisons among EHRs. The government's EHR certification program just shows that products have met "minimal" requirements, he told Medscape Medical News. "Today, there's no way to evaluate the 900 products that are out there. Physicians have no way to evaluate those."

In Anderson's view, EHR vendors could provide true interoperability if they wanted to, but there's no incentive for them to do that. They could work out a way to exchange the 32 elements in standard-care summaries, or at least the basic information, such as diagnoses, medications, and lab codes, by using the standardized codes associated with that information, he said.

Anderson suggested that the bill's authors add two components that would benefit doctors: 1) If an EHR proved unusable or couldn't be used to meet meaningful use criteria, physicians should be able to get out of their contracts with vendors; and 2) if doctors switched to another EHR, vendors should be required to give physicians their data back.


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