21st Century Cures Act May Reduce HIT Regulatory Burden

Legislation on its way to the U.S. Senate offers a possible path toward solving the patient ID problem.

Last week's passage of the 21st Century Cures Act in the U.S. House of Representatives may result in reduced regulatory burdens for providers struggling to comply with meaningful use and other health IT-related requirements.

The bipartisan legislation is expected to pass the Senate this week and head to President Obama's desk for a promised approval.

It directs the Department of Health and Human Services to create a report outlining how the department could reduce regulatory and administrative burdens, says Leslie Krigstein, vice president of congressional affairs at College of Healthcare Information Management Executives (CHIME).

Grab Bag Of Goodies In 21st Century Cures Act

"It wasn't a direct relaxation [of regulations], but hopefully their findings could result in some harmonization across all of the different reporting programs, even just within CMS," Krigstein says. "That would be exceptionally helpful."

Effects on Patients
Then there is the patient ID aspect.

According to Krigstein, the 21st Century Cures legislation gives the U.S. Government Accountability Office two years to report back to Congress on a number of tech-related topics: the impact of IT on patient safety, on health IT security, and, of particular note, improvements in matching patient records, reducing errors, and duplicating records.

Each year since HIPAA passed in 1996, Congress has inserted language into the HHS appropriations bill (or its continuing resolution equivalent) that prohibits HHS from spending money on developing a unique health identifier for individuals. CHIME and other organizations have lobbied, with little effect until now, for Congress to relax this prohibition, which arose out of privacy concerns.

In preparing the report required by the 21st Century Cures bill, HHS's Office of the National Coordinator could define additional data elements that move toward a universal patient identifier, Krigstein says.

Krigstein cautions that the way previous Congressional language reads, such an identifier might not be created until a separate act of Congress authorizes it, essentially lifting the 20-year-old ban.

Infrastructure for Data Exchange
Yet another element of the bill defines a new federal advisory committee to replace the existing ONC Health IT Standards and Health IT Policy committees, Krigstein says.

The charter of the new advisory committee is "to articulate the infrastructure that will facilitate national and local electronic access exchange and use of information," she says. "That includes technology that can accurately match patient information to the correct patient and that avoids duplicate records. So that's huge."

Due to the bipartisan support the 21st Century Cures Act has received, Krigstein does not expect the Trump administration to overturn its elements in any sweeping health reform which may be in the cards.

"There are bits and pieces that were priorities of the Democrats as well as the Republicans both in the House and Senate," she says.

Several other provisions in the version of the House bill that passed are of interest to HIT leaders:

• No enforcement of information blocking practices or conduct occurring prior to 30 days after the date of enactment can occur.
   
• The new HHS Secretary is required to submit a report to the new advisory committee on attestations within six months of enactment.
   
• The National Coordinator shall convene appropriate stakeholders to develop or support a trusted exchange framework for trust policies and practices and for a common agreement for exchange between health information networks.

This last point is particularly interesting, as it speaks to the shortcomings of MACRA's information blocking. Several sources report that the lack of common rules of the road among various health information networks is the main stumbling block keeping those networks from reaching agreements.

Perhaps the new administration can do what the present one failed to do: Get all these stakeholders in a room, and don't let them leave until they agree to open up their trust frameworks and health information silos and share data with each other.