H.R. 4157

I bet all of you got emails from non-IT people this week letting you know that H.R. 4157 was passed by Congress. Did you politely thank them, or, did you say “hey, I am on the same email lists as you”?

Anyway, I think the most substantial impact of this bill would be the fact that hospitals would be able to provide physicians with EHRs without being in violation of Stark. This will clearly benefit the largest providers and those with the most advanced technology. If you are a free-standing community hospital the pressure is getting greater to align with a larger system (as if it weren’t already unbearable).

I received two emails before H.R. 4157 went to the floor. One from CHIME encouraging me to let my congressman know we needed him to support the bill. The other was from AHIP (I am also the CIO for our HMO) encouraging me to tell my congressman to vote against the bill. I may have too many lobbying groups working on my behalf.

I think AHIP got it right. This bill originally called for interoperability standards. Theoretically it wouldn’t matter if a doctor used a particular hospital’s EHR because the interoperability standards would allow them to practice at the competing hospital and still have access to those patient’s information. As passed, HR 4157 gives large health systems ways to lock in physicians. If you are a doctor and all of your patient’s information was in one system, it would be too inconvenient to admit them where you don’t have easy access to that patient data.

AHIP is also concerned about the deadlines for the ICD-10 coding systems. That will be a lot of work.

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