Will interoperability undo Cures bill?

'I’m happy to serve as the lightning rod for this discussion'
By Bernie Monegain
08:19 AM
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Interoperability

The House Energy and Commerce Committee gave the 21st Century Cures bill a unanimous sendoff Thursday, voting 51-0 to approve. If Committee Chairman Fred Upton, R-Mich., has his way, the bill would be enacted by the full House by the end of June.

How quickly it moves through Congress remains to be seen, however. The bill, which would provide $10 billion to the National Institutes of Health to find cures for the thousands of diseases that are without remedy, has garnered many champions. But it has also drawn forceful critics, among them John Halamka, MD, chief information officer of Boston's Beth Israel Deaconess Medical Center and vice chairman of the federal Health IT Standards Committee.

In a May 21st blog post, Halamka writes that while others might be reluctant to publicly criticize the bill, he was willing to point out its flaws. And he does.

"I’m happy to serve as the lightning rod for this discussion, pointing out the assumptions that are unlikely to be helpful and most likely to be hurtful," he writes.

Halamka's concerns relate to the parts of the bill that address standards and interoperability, which he writes, make no sense.

[Read Halamka's recommendations here.]

In their comments to the committee earlier this year, both HIMSS and CHIME raised red flags concerning the interoperability piece of the bill, essentially warning the panel that interoperability is complicated.

[See also: 21st Century Cures bill set for markup.]

"Interoperability and standardization of data and transmission rules, leading to successful exchange and re-use of health information and efficient and safe clinical workflows, requires the regular updating of standards, implementation guides, regulations, and operating rules," wrote Paul Kleeberg, MD, chair of the HIMSS board of directors, and HIMSS CEO H. Stephen Lieber in the their letter to Upton and DeGette. "The importance of 'adoption and implementation' of the standards is essential to fully realize interoperability."

"CHIME members wish to highlight the enormously difficult socio-technical challenge of making technology systems interoperable; not only does it require harmonizing complex technology systems, but complex systems of policies, processes and people must also align to achieve interoperability," wrote CHIME CEO Russell Branzell and CHIME Board Chairman Charles Christian in their letter to the House committee. "We stress the need for simplicity as an overarching goal of future drafts, but we also caution against any notion that interoperability will come easily or cheaply."

Privacy advocate Deborah Peel, MD, has a warning of her own for the panel.

"This bill will massively expand the hidden US health data broker industry---it's about CURES for REVENUE DEFICITS not cures for patients," Peel wrote in a comment she posted on the website of Healthcare IT News.

[See also: Privacy advocates blast 21st Century Cures bill.]

When the House committee presented the bill – more than a year in the making – the members called it "nonpartisan legislation." It would help to modernize and personalize healthcare, encourage greater innovation, support research, and streamline the system to deliver better, faster cures to more patients."

"This historic day marks a big bipartisan step forward on our path to cures," Upton said in his remarks before the committee on Thursday. “We have all said too many early good-byes to people we love and treasure. Every single person has a common goal: We want more time with those we love. In this, the greatest country in the world, Americans deserve a system second to none. We can and must do better. The time for 21st Century Cures is now.”

The bill, H.R. 6, the 21st Century Cures Act, has garnered praise from many quarters.

On Thursday, Premier's Blair Childs added his approval on behalf of the organization.

Premier thanked Upton and Degette "for their leadership to advance interoperability standards as part of the landmark 21st Century Cures legislation," Childs said in a statement. "With today’s vote, the vision for a fully interoperable health information technology ecosystem is one step closer to becoming a reality.

Track the bill here.