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OPPORTUNITIES AND CHALLENGES IN ADVANCING 

HEALTH INFORMATION TECHNOLOGY 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON 

INFORMATION TECHNOLOGY 

AND THE

SUBCOMMITTEE ON HEALTH CARE, 

BENEFITS AND ADMINISTRATIVE RULES 

OF THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

MARCH 22, 2016 

Serial No. 114–109 

Printed for the use of the Committee on Oversight and Government Reform 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://www.house.gov/reform 


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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM 

JASON CHAFFETZ, Utah, Chairman 

JOHN L. MICA, Florida 

MICHAEL R. TURNER, Ohio 

JOHN J. DUNCAN, JR., Tennessee 

JIM JORDAN, Ohio 

TIM WALBERG, Michigan 

JUSTIN AMASH, Michigan 

PAUL A. GOSAR, Arizona 

SCOTT DESJARLAIS, Tennessee 

TREY GOWDY, South Carolina 

BLAKE FARENTHOLD, Texas 

CYNTHIA M. LUMMIS, Wyoming 

THOMAS MASSIE, Kentucky 

MARK MEADOWS, North Carolina 

RON DESANTIS, Florida 

MICK, MULVANEY, South Carolina 

KEN BUCK, Colorado 

MARK WALKER, North Carolina 

ROD BLUM, Iowa 

JODY B. HICE, Georgia 

STEVE RUSSELL, Oklahoma 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

GLENN GROTHMAN, Wisconsin 

WILL HURD, Texas 

GARY J. PALMER, Alabama 

ELIJAH E. CUMMINGS, Maryland, Ranking 

Minority Member 

CAROLYN B. MALONEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

WM. LACY CLAY, Missouri 

STEPHEN F. LYNCH, Massachusetts 

JIM COOPER, Tennessee 

GERALD E. CONNOLLY, Virginia 

MATT CARTWRIGHT, Pennsylvania 

TAMMY DUCKWORTH, Illinois 

ROBIN L. KELLY, Illinois 

BRENDA L. LAWRENCE, Michigan 

TED LIEU, California 

BONNIE WATSON COLEMAN, New Jersey 

STACEY E. PLASKETT, Virgin Islands 

MARK DESAULNIER, California 

BRENDAN F. BOYLE, Pennsylvania 

PETER WELCH, Vermont 

MICHELLE LUJAN GRISHAM, New Mexico 

JENNIFER HEMINGWAY, Staff Director 

DAVID RAPALLO, Minority Staff Director 

TROY STOCK, Subcommittee on Information Technology Staff Director 

CHRISTINA HINKLE, Counsel 

WILLIE MARX, Clerk 


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SUBCOMMITTEE ON INFORMATION TECHNOLOGY

WILL HURD, Texas, Chairman 

BLAKE FARENTHOLD, Texas, Vice Chair 

MARK WALKER, North Carolina 

ROD BLUM, Iowa 

PAUL A. GOSAR, Arizona 

ROBIN L. KELLY, Illinois, Ranking Member 

GERALD E. CONNOLLY, Virginia 

TAMMY DUCKWORTH, Illinois 

TED LIEU, California 

SUBCOMMITTEE ON HEALTH CARE, BENEFITS AND ADMINISTRATIVE RULES

JIM JORDAN, Ohio, Chairman 

TIM WALBERG, Michigan 

SCOTT DESJARLAIS, Tennessee 

TREY GOWDY, South Carolina 

CYNTHIA M. LUMMIS, Wyoming 

MARK MEADOWS, North Carolina 

RON DESANTIS, Florida 

MICK MULVANEY, South Carolina, Vice 

Chair 

MARK WALKER, North Carolina 

JODY B, HICE, Georgia 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

MATT CARTWRIGHT, Pennsylvania, 

Ranking Member 

ELEANOR HOLMES NORTON, Distict of 

Columbia 

BONNIE WATSON COLEMAN, New Jersey 

MARK DESAULNIER, California 

BRENDAN F. BOYLE, Pennsylvania 

JIM COOPER, Tennessee 

MICHELLE LUJAN GRISHAM, New Mexico 

Vacancy 


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C O N T E N T S 

Page 

Hearing held on March 22, 2016 ............................................................................ 1 

WITNESSES 

Karen DeSalvo, M.D., National Coordinator for Health Information Technology, U.S. Department of Health and Human Services 

Oral Statement ................................................................................................. 5 

Written Statement ............................................................................................ 8 

Ms. Jessica Rich, Director, Bureau of Consumer Protection, U.S. Federal 

Trade Commission 

Oral Statement ................................................................................................. 13 

Written Statement ............................................................................................ 15 

Mr. Matthew Quinn, Federal Managing Director, Intel Healthcare and Life 

Sciences 

Oral Statement ................................................................................................. 24 

Written Statement ............................................................................................ 27 

Mr. Neil DeCrescenzo, Member, Executive Committee, Healthcare Leadership 

Council 

Oral Statement ................................................................................................. 44 

Written Statement ............................................................................................ 46 

Mr. Mark Savage, Director of Health IT Policy and Programs, National Partnership for Women and Families 

Oral Statement ................................................................................................. 126 

Written Statement ............................................................................................ 128 

APPENDIX 

An April 1, 2016 letter from the National Partnership for Women & Families 

to Chairman Will Hurd, Chairman Jim Jordan, Ranking Member Robin 

Kelly, and Ranking Member Matthew Cartwright, Entered by Chairman 

Will Hurd .............................................................................................................. 152 

A December 2014 report from the National Partnership for Women & Families titled, ‘‘Engaging Patients and Families: How Consumers Value and 

Use Health IT’’, Entered by Representative Matt Cartwright. A copy of 

the report can be found online here: http//www.nationalpartnership.org/ 

research-library/health-care/HIT/engaging-patients-and-families.pdf 


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OPPORTUNITIES AND CHALLENGES IN ADVANCING HEALTH INFORMATION TECHNOLOGY 

Tuesday, March 22, 2016 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON INFORMATION TECHNOLOGY, JOINT

WITH THE SUBCOMMITTEE ON HEALTH CARE, BENEFITS, 

AND ADMINISTRATIVE RULES, 

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, 

Washington, D.C. 

The subcommittees met, pursuant to call, at 2:06 p.m., in Room 

2154, Rayburn House Office Building, Hon. William Hurd [chairman of the Subcommittee on Information Technology] presiding. 

Present from Subcommittee on Information Technology: Representatives Hurd, Walker, Blum, Connolly, and Lieu. 

Present from Subcommittee on Health Care, Benefits, and Administrative Rules: Representatives Walberg, Gowdy, DeSantis, 

DeSaulnier, Cartwright, and Lujan Grisham. 

Mr. HURD. The Subcommittee on Information Technology and the 

Subcommittee on Health Care, Benefits, and Administrative Rules 

will come to order. Without objection, the chair is authorized to declare a recess at any time. 

We are expecting votes fairly soon, so I am hoping we can get 

through opening remarks, go do our vote series, and come back and 

finish the hearing. 

Good afternoon. I appreciate your being here today. You all know 

that heart disease is a leading cause of death in the United States, 

according to the CDC. More than 600,000 Americans die from heart 

disease each year. 

The American Medical Association recommends walking as the 

simplest positive change you can make to improve your heart 

health. Walking 30 minutes day, or around 10,000 steps, lowers 

blood pressure, improves movement and mobility, and increases energy. Simply increasing the number of steps you take per day can 

significantly reduce your risk of coronary heart disease and stroke. 

Many of you could glance right now at your smart phones, 

wearables, or other devices and report your number of steps and 

calories burned for the same period of time. For most of us, I will 

bet that number is probably higher than before we had the app or 

device and we were tracking our steps. 

It would not be an extreme exaggeration to say that the proliferation of wearable devices and smart phone apps that track 


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steps and the accompanying increases in the number of steps some 

people are taking on a daily basis has saved lives. 

This is just one example of the benefits technology has brought 

to health and health care, and we have barely scratched the surface. We are on the cusp of being able to use technology to truly 

revolutionize health care and health care delivery. 

Leveraging the power of the cloud will enable us to move more 

health care tasks online, including consultations and data storage 

and retrieval. 

Sensors will make it easier for people to take care of themselves 

before they get sick. Constituents in rural parts of Texas 23rd, my 

district, will be able to speak directly with their primary care providers instead of commuting hours each way. 

As more devices are connected and more data is generated, medicine will become customized and personalized. Preventative medicine and healthy living practices will increase, costs will decline, 

and the prevalence of chronic diseases will decrease substantially. 

But this will only happen if researchers, hospitals, entrepreneurs, regulators, health care professionals, patient advocates, 

and lawmakers come together to update antiquated laws and reform outdated institutions. 

Right now, old and unclear privacy laws hinder interoperability 

between health IT systems and devices. Right now, the sheer number of Federal agencies, and often conflicting rules one must navigate to invest in the space, chills investment and entrepreneurship. 

And right now, a fragmented and bureaucratic system places the 

patient at the fringe of the process, rather than at the center. 

In today’s hearing, I hope to hear specifically what laws or regulations need to be changed or updated, and how they should be 

changed or updated or abandoned. 

Health IT is an exciting, innovative field, but to get this right, 

we must collaborate. We must destroy silos. I am committed to 

doing so. I know my friend and ranking member, Ms. Kelly, and 

Ted Lieu are as well. 

And I want to thank the witnesses for being here today, and I 

look forward to their testimony. 

Now I would like to recognize Mr. Cartwright for his opening 

statement. 

Mr. CARTWRIGHT. Thank you, Chairman Hurd. I would like to 

thank you both for calling this hearing so we can hear about how 

the Federal Government and private industry are working together, and for your interest and efforts at creating the next generation of health information technology. 

I represent largely a rural district in northeastern Pennsylvania, 

and I know quite well how health IT can bring affordable medical 

care to those who might not otherwise be able to receive it. 

In fact, that is why I cosponsored the Medicare Telehealth Parity 

Act of 2015, the 21st Century Cures Act, and also the TELE–MED 

Act. Bills like these help medical professionals provide patients 

with the best health care available anywhere and at any time. 

But even with the undeniable benefits technology brings, patient 

safety must remain our foremost consideration. Technology brings 

opportunity, but it can also bring unforeseen challenges, and I hope 

we can talk about that a little today. 


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As a career courtroom attorney, I have seen too many medical 

malpractice lawsuits where carelessness caused injuries and death, 

and where doctors have made grave and avoidable mistakes. Too 

often these mistakes were due to failures in communication that 

left physicians and nurses without all of the patient’s information 

that they needed to complete proper assessment and treatment. 

We worry that different computer system standards and methods 

of tracking medical history often mean doctors, nurses, lab technicians, and others involved in the treatment process cannot get a 

complete understanding of the illness in front of them and the 

treatment that is needed. 

That is why it is so important that technologies like electronic 

health records, which contain the complete medical and treatment 

history of a patient quickly and efficiently give providers insight 

and a comprehensive view into what is going on and all the facts 

of the case. Standardized, industry-accepted technologies can make 

that happen, in my view. 

In the field of health IT, private industry has a critical role in 

the process doing what it does best: drive innovation and keep 

America at the leading edge in medical technology. 

The Federal Government also has a role to play, making sure 

these new technologies meet health care needs without compromising patient safety. 

I am looking forward to today’s hearing, to the testimony of all 

of you. I am glad that industry and government are working together to bring about the kinds of technological advances that will 

improve health care in this country, make it safer, and make it 

more available to people in all corners and all pockets of this Nation. 

I thank you again, Chairman Hurd, and I yield back. 

Mr. HURD. Thank you. 

I am going to hold the record open for 5 legislative days for any 

members who would like to submit a written statement. 

Ranking Member Lieu is here, and if he is ready, we will have 

him give his opening remarks. 

Mr. Lieu from California is recognized for 5 minutes. 

Mr. LIEU. Thank you, Mr. Chairman. 

Thank you to the witnesses who will be presenting today. 

Today, we are here to learn more about how to make the primary 

health technology laws work smarter and better. Laws and regulations should be there to protect the public, but done incorrectly, 

they can hinder innovation, and the same holds true in the health 

IT space. 

The Health Insurance Portability and Accountability Act, 

HIPAA, contains provisions to create universal electronic medical 

records and protect patient privacy. The Health Information Technology for Economic and Clinical Health, HITECH, contains provisions to protect consumer privacy and give notice in case of data 

breach. The Affordable Care Act also contains provisions to improve the quality and efficiency of patient care with EHRs. 

However, these laws and regulations were enacted before key 

technological advances that we now take for granted. HIPAA was 

passed in 1996 before broad adoption of the mobile revolution. 


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HITECH was passed in 2009, before much of cloud computing existed. 

Some might suggest that rolling back regulations is the answer. 

While I agree that government regulation is not as nimble as technology, we still need some combination of regulations and enforceable guidance to protect the public. 

For instance, last month, the IT system at Hollywood Presbyterian Hospital in Southern California was held hostage by 

ransomware denying patients and providers access to their medical 

records. The HITECH law has cybersecurity requirements that require notifications for data breaches, but the law says nothing 

about notification for data that was frozen or held hostage where 

it is stored. 

I note that today the press reports that two more hospitals in 

Southern California were hit with malware attacks. 

Technology is moving very quickly. Telemedicine and text messaging and mobile smart phone exposure requires that HHS and 

FTC keep up with technology changes, update guidance reliably, 

and keep rules and regulations flexible to encourage innovation. 

Regulation done wrong or too little regulation makes it difficult 

to protect the public and ensure that data flows freely. Regulation 

done right spurs innovation and improves quality of care and protects the public. 

I look forward to hearing from the witnesses today about what 

we can do to encourage innovation and cooperation, and continue 

to bring government health care into a more modern era of service. 

With that, I yield back. 

Mr. HURD. Thank you, Mr. Lieu. 

If Chairman Jordan joins us and is interested in giving opening 

remarks, we will let him do that as he arrives. 

Again, I would like to thank the witnesses. I would like to recognize you all now. I am pleased to welcome Dr. Karen DeSalvo, national coordinator for health information technology at the U.S. Department of Health and Human Services. Thank you for being 

here. Ms. Jessica Rich, director of the Bureau of Consumer Protection at the U.S. at the Federal Trade Commission; Mr. Matthew 

Quinn, Federal managing director at Intel Healthcare and Life 

Sciences; Mr. Neil DeCrescenzo, member of the executive committee at the Healthcare Leadership Council; and Mr. Mark Savage, director of health IT policy and programs at the National Partnership for Women and Families. 

Welcome to you all. Pursuant to committee rules, all witnesses 

will be sworn in before you testify. 

Please rise and raise your right hands. 

Do you solemnly swear or affirm that the testimony you are 

about to give will be the truth, the whole truth, and nothing but 

the truth? 

Thank you. Please be seated. 

Let the record reflect that the witnesses answered in the affirmative. 

In order to allow time for discussion, please limit your testimony 

to 5 minutes. Your entire written statement will be part of the 

record. 


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We are going to go through as many opening remarks as we can 

before we get called to votes. If the bells go off while you are in 

your remarks, go ahead and continue. We will finish after your remarks. 

Now I would like to recognize Ms. DeSalvo for your opening remarks. 

WITNESS STATEMENTS 

STATEMENT OF KAREN DeSALVO, M.D. 

Dr. DESALVO. Thank you, Chairman Hurd, and Ranking Members Lieu and Cartwright, and distinguished members of the subcommittees. Thank you all for the opportunity to appear here 

today. 

I am Dr. Karen DeSalvo, and I have the honor of serving as the 

national coordinator for health information technology at the U.S. 

Department of Health and Human Services for the past 2 years. 

I’m proud to be here today representing the remarkable team at 

the Office of National Coordinator and share with you the current 

State of health information technology in our Nation and how we 

are working with others to see that these systems realize their full 

potential. 

The Office of the National Coordinator for Health Information 

Technology has a strong, bipartisan history. It was established in 

2004 by executive order and charged with the mission of giving 

every American access to their electronic health information. In 

2009, it was statutorily established by the Health Information 

Technology for Economic and Clinical Health Act, or HITECH, 

which provided the resources and infrastructure needed to foster 

the rapid nationwide adoption and use of health IT. 

In the 7 years since HITECH was enacted, we have seen dramatic progress. Today, nearly all hospitals and more than threequarters of physicians report using a certified electronic health 

record. This tripling in rates of adoption puts us as a Nation well 

ahead of our peer countries, giving us a significant competitive advantage in health care innovation and scientific advancement. And 

it is working in so many communities across this country. 

But I also note that we haven’t realized the full potential of 

health IT for every person in this country. 

And this is not just an abstract policy idea to me. It is personal. 

It is why I came to ONC 2 years ago, because I knew as a doctor 

the promise of health IT, of having information available for me 

when I was on call in the evening not at the hospital, such a leap 

from the days in the early 1990s when I was a medical school student at Charity Hospital and had to physically go up to a lab and 

pull a lab slip with handwritten results from a wooden box, so that 

I would understand more about my patients and how to care for 

them. 

Today, that is all available electronically to me and other doctors, 

and not just to us but to our patients, to really see that they can 

be empowered and have the information they need to self-care. It 

is a rapid and remarkable transformation in a very short period of 

time. But the pace has come with challenges. 


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Like others, I have been frustrated by the lack of interoperability, by the usability of the systems, and by how hard it can be 

to select the right system to buy. I hear about these challenges 

from my colleagues whether at listening sessions but also from consumers and other stakeholders. 

We all want to move ahead with technology, but we want it to 

work better. That is what I came to Washington to do. 

Since I’ve been the national coordinator, we have been focused on 

fixing those challenges in an urgent fashion to meet the expectations of the people that I serve, the American people. ONC does 

this in a variety of ways. 

For example, we can leverage our electronic health record certification program. We also serve as a coordinator across the Federal 

Government to see that agencies have shared policy and technology 

approaches and will send clear signals to the private sector. 

We have also worked with the private sector on setting a clear 

path ahead for our nationwide interoperability. This roadmap that 

we produced last year lays out who should do what by when to 

achieve interoperability in the near term to see that electronic 

health information is available when and where it matters to consumers and clinicians. 

ONC and others have been meeting our deliverables from this 

plan and are advancing drivers of interoperability like payment reform, publishing clear standards, working with States and others 

on harmonizing privacy and security expectations. The plan has 

been publicly endorsed by our Federal partners, by the private sector, and we have been so pleased with everyone’s willingness to 

step up and lead where appropriate, to see that we can innovate 

and accelerate interoperability. Indeed, working with the private 

sector is how ONC operates. 

As another example, we recently convened stakeholders to ask 

them to make a series of commitments to ensure that electronic 

health information works better for patients and providers. It is a 

really tremendous opportunity for the private sector to lead. 

So last month, we were able to announce that companies that 

provide electronic health records for 90 percent of hospitals in this 

country, and health care systems with facilities in 46 States, including the States for all the members of these two subcommittees, 

and over a dozen professional associations and stakeholder groups 

like the AMA and the American Hospital Association, all have 

agreed to implement three commitments that will help make sure 

health information flows. 

The commitments are that consumers will have access to their 

electronic health information, that entities will not engage in 

health information-blocking, and that we will move to federally recognized national standards so that all these different systems will 

speak the same language. 

ONC and our partners in the Federal space and the private sector are working together each and every day to see that we can 

move this future vision to an immediate reality. And Congress has 

been one of the great partners in health IT, and I look forward to 

continuing to work with you all to realize the full potential of 

health IT for this country. 


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Thank you for having me here today, and I look forward to your 

questions. 

[Prepared statement of Dr. DeSalvo follows:] 


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Mr. HURD. Thank you, Dr. DeSalvo. 

Now, Ms. Rich, you are recognized for 5 minutes. 

STATEMENT OF JESSICA RICH 

Ms. RICH. Chairman Hurd, Ranking Members Lieu and Cartwright, and members of the subcommittees, I am Jessica Rich, director of the Bureau of Consumer Protection at the Federal Trade 

Commission. I appreciate this opportunity to present the commission’s testimony. 

Consumers are increasingly taking an active role in managing 

their health data, and there has been an explosion of new products 

and services to help them. These range from wearable fitness devices like Fitbit or Jawbone, to dieting apps like My Fitness Pal 

and Calorie Counter, and to Web sites like WebMD where consumers can get health advice and information. 

These products and services offer enormous benefits to consumers, but they raise privacy and security concerns, too. Who has 

access to all of this data? And is it being stored securely? 

Much of this activity now happens outside of the doctor’s office 

and other traditional health care contexts. As a result, it is not protected under HIPAA, which only applies to health data held or generated by covered entities, such as health care providers and health 

plans. In most instances, however, this activity is covered by the 

Federal Trade Commission Act, which prohibits unfair or deceptive 

practices across the marketplace, including in the area of health 

privacy. 

As the primary Federal agency charged with protecting consumer 

privacy, the FTC has made it a priority to protect consumer-sensitive health information. Our efforts include civil law enforcement, 

policy initiatives, and consumer and business education. 

Three recent FTC cases illustrate the challenges we face in protecting consumer health data and how the FTC is addressing them. 

PaymentsMD is a medical billing company that offered an online 

portal where consumers could pay their bills. The FTC charged 

that the company misled thousands of consumers who signed up by 

failing to tell them that it would also seek their highly detailed 

medical data from pharmacies, medical labs, and insurance companies. 

Henry Schein provided office equipment software for dental practices. We charged this company with misrepresenting to clients 

that its software provided industry-standard encryption of sensitive 

patient information as required by HIPAA. In fact, we alleged the 

software used a weaker method of data masking that didn’t meet 

HIPAA standards. 

A third example is our settlement with GMR, a medical transcription service. We charged that GMR assured its clients that its 

services were secure but outsourced them to a third-party service 

provider without adequately checking its security measures. As a 

result, consumers found doctors’ notes of their physical examinations freely available on the Internet. 

Besides enforcement, the commission engages in policy initiatives 

to encourage stronger protection for health information. Last year, 

we hosted a public workshop on consumer health data to examine 


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the products and services consumers are using to generate and control their data and how this data is protected. 

We also released a staff report on the Internet of Things, which, 

among other topics, examined the privacy and security issues 

raised by connected medical devices and health and fitness products. Of greatest concern, panelists discussed the unique risks if 

health devices like pacemakers and insulin pumps are not secure 

and are vulnerable to hackers. 

Finally, the commission promotes stronger data protections 

through consumer education and business guidance. For example, 

our new IdentityTheft.gov Web site provides customized advice to 

consumers who have been victims of medical identity theft. 

And last year, the FTC launched its Start with Security campaign to educate small businesses around the country about how 

to develop an effective data security program. 

In addition, working with HHS and with FDA, the FTC is currently developing business guidance for health app developers to 

help them understand which legal requirements apply to them. 

The FTC shares the subcommittees’ concerns about the need to 

protect the privacy and security of consumer health data. Although 

we now use a variety of tools to protect consumers in this area, additional tools would enhance our ability to do so. 

To this end, the commission reiterates its longstanding bipartisan call for Federal data security and breach legislation that 

would allow us to seek civil penalties to deter unlawful conduct and 

give us jurisdiction over nonprofit entities. 

In closing, the FTC remains committed to protecting consumer 

health data and looks forward to our continued work with Congress 

on this critical issue. Thanks again for the opportunity to provide 

the commission’s views today. 

[Prepared statement of Ms. Rich follows:] 


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Mr. HURD. Thank you, Ms. Rich. 

Mr. Quinn, you are recognized now for 5 minutes. 

STATEMENT OF MATTHEW QUINN 

Mr. QUINN. Good afternoon, Chairman Hurd and other esteemed 

members of the House Oversight and Government Reform Committee. Thank you for the opportunity to testify today on behalf of 

Intel Corporation. 

In my written testimony, I provide some tangible examples of 

how Intel is working to make good on the promise of today’s health 

technologies and to pave the way toward tomorrow’s. Today, I 

would like to frame my comments in the context of recent personal 

experiences. 

Two Fridays ago, I received a call that no one wants. My sister 

in Ohio said that dad had just taken a bad fall. He had just left 

his doctor’s office where he was in for a checkup after a recent hospitalization. 

Things had gone well, and they stopped by a favorite restaurant 

for breakfast. As my dad climbed the curb, he became lightheaded, 

fell to the ground, and tumbled back into the parking lot. As we 

soon found out, he broke his clavicle, pelvis, and deeply cut his 

elbow. 

To say that my dad is a complex patient would be an understatement. He is the poster child for needing all of his providers and 

caregivers to be on the same sheet of music and have the whole 

picture of his health and health care. 

Let’s begin by thinking of the constellation of my dad’s health 

data. Most familiar are the clinical and claims data captured at 

clinics, hospitals, and the like. Secondly, there is diagnostic data 

captured by medical devices and imaging. Adding to this is consumer-generated data. And finally, there is ’omics, vast amounts of 

information in his genome. 

Personal precision medicine in the 21st century will need to 

make sense of all of this. 

The U.S. has made great strides to ensure that each person has 

an electronic health record. Yet the goal of point-of-care and personal access to comprehensive health information has not yet been 

achieved. 

There are three recurring barriers that often limit data-sharing. 

First, medical institutions using privacy and security policies and 

laws like HIPAA as excuses for why they can’t share; next, medical 

professionals lacking easy, affordable tools to share data, especially 

because vendors fail to use or consistently implement standards; 

and finally, payment reforms that don’t reimburse for new care 

models like telehealth. 

Back to my dad’s experience, when he arrived at the ER, the 

same hospital where he had received his most recent treatment, 

they pieced together his health history, partly from the EHR and 

partly from my parents. 

I fear that if he was brought to a different hospital, it would’ve 

been basically starting from scratch. There exists a local health information exchange, but evidently, this hospital and my dad’s 

nephrologist don’t participate. My mom is our de facto health information exchange. 


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My dad would definitely enjoy the kind of secure, standardsbased data-sharing that Intel’s own Connected Care program 

makes available for over 33,000 of its employees. As we have 

shown, it is all quite possible today, just not as widespread as it 

could be. 

We need to think about interoperability in much broader terms 

than merely exchange of electronic health record data. That will 

change as the Internet of Things takes hold and we connect smart 

devices to the Internet in ways that generate data that can be 

turned into valuable insights. 

How would this affect my dad? Well, first of all, it would allow 

him to get some sleep. Because the devices monitoring him in the 

ICU don’t talk to each other and his vitals tend to bounce around, 

there are endless, nearly always false alarms. 

What if devices even from different vendors could talk to each 

other? Innovators could create smart alarms from the new combined data streams and save countless hours of nursing time, 

countless lives, and just let my dad sleep. The data from all the 

medical devices could automatically feed the EHR, millions more 

nursing hours saved. 

But let’s think bigger. What if when my dad was discharged that 

he was outfitted with sensors or an app that constantly detected 

whether his gait was making him prone to falls? Or what if instead 

of having to drive across town to visit his doctor, he could do so 

from his home via telemedicine, and his blood and vitals could be 

automatically analyzed via his home dialysis unit? What if his 

caregivers could track his progress in getting back up on his feet 

as he rehabs? 

I think we have come up with a half-dozen ideas for new businesses, but all of this relies on there being a solid foundation for 

the Internet of Things to blossom: security from the sensor to the 

cloud; connectivity, allowing devices to communicate their status to 

the system; data normalization to allow devices to speak the same 

language; and actionable analytics. 

So to close, how do we believe Congress can help seize the opportunities and overcome the challenges? 

First, sustain momentum toward standards and interoperability 

for today and for tomorrow. As Intel’s Connected Care program 

demonstrates, a rigorous standard-based approach enables quicker 

and more rapid efficient deployments today. And to rapidly move 

forward toward the Internet of Things, Intel invites active Federal 

participation in industry-led initiatives such as the IIC, OCF, ICE 

alliance, and Continua. 

Second, encourage patient engagement by removing obstacles for 

patients to access and share their data. Intel invites policymakers 

to partner with industry to pursue a standardized, machine-readable consent form to allow patients to easily donate their data to 

ongoing research. 

And last but not least, continue to push towards value-based 

care. We support the HHS goal to move half of care to alternative 

payment models by 2018. When incentives are aligned to valuebased care, the demand for information-sharing goes up. Congress 

can further drive innovation by providing reimbursement for remote patient monitoring and other promising technologies. 


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Thank you, and I look forward to your questions. 

[Prepared statement of Mr. Quinn follows:] 


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Mr. HURD. Mr. Quinn, I appreciate your opening remarks. 

Now Mr. DeCrescenzo is recognized for 5 minutes. 

STATEMENT OF NEIL DeCRESCENZO 

Mr. DECRESCENZO. Thank you. Mr. Chairman, members of the 

committee, it is a privilege to be here today. 

My name is Neil DeCrescenzo. I am the president and CEO of 

Change Healthcare. Perhaps our name says it all. 

Change Healthcare is headquartered in Nashville, Tennessee, 

provides its services in all 50 States, and has over 50 offices nationwide. We are a leading provider of software and analytics, network 

solutions, and technology-enabled services that optimize communications, payments, actionable insights that enable smarter health 

care. 

By leveraging our Intelligent Healthcare Network, which is one 

of the largest financial and administrative networks in the United 

States health care system, payers, providers, and pharmacies are 

able to more effectively manage complex workflows that support 

value-based health care. 

While I am proud to represent the nearly 7,000 people of Change 

Healthcare, I am testifying today in my role as a member of the 

executive committee of the Healthcare Leadership Council, a coalition of leading companies and organizations from virtually every 

sector of American health care. In that role, I would like to share 

a few thoughts on the role and capability of health information 

technology to transform our Nation’s health care system for the 

better. 

As increasingly is the case in most fields, health care improvement today is driven by data. If our health care system is not improving at the pace any of us would like, this is in large part due 

to barriers standing in the way of access to data, the ability to 

share information, and the utility of this information for consumers, providers, payers across the health care continuum. 

Our HLC member companies know from firsthand experience 

that data interoperability can strengthen care coordination, enabling providers, payers, pharmacists, laboratories, and others, to be 

on the same page when treating a patient. It can boost progress toward an outcome-driven, value-based payment system to replace 

the outdated and inefficient fee-for-service status quo while also 

improving our quality measurement capabilities. 

With interoperability and access to clinical and claims data, we 

can accelerate medical research and give hospitals and physician 

offices real-time access to comparative effectiveness findings. An 

interoperable system can improve care to rural and underserved 

areas of the country through improved telehealth and remote patient monitoring. Wellness and prevention will also be enhanced 

through the better use of patient-generated data. 

This future is promising, exciting, and imminently obtainable, 

once we address some of the obstacles standing in our way. 

Last year, HLC, under the auspices of its National Dialogue for 

Healthcare Innovation initiative, brought together leaders from 

over 70 organizations representing government, industry, patients, 

employers, and academia. There we built consensus on how we can 

move closer to this desirable data-driven future. 


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Last month, we announced the consensus recommendations 

emerging from this effort, a number of which are relevant to today’s discussion. 

On data interoperability, we believe that a firm date of December 

31, 2018, should be established by which health information is 

widely shared among electronic health record systems nationwide. 

We have the capability to reach this goal in the near term, not a 

decade from now. Progress toward this nationwide data infrastructure should be driven by private sector innovation, with emphasis 

placed on secure data-sharing to protect patient privacy, common 

standards and governance, and a ban on data-blocking. 

In addition, we believe that Congress and the administration 

must address physician health referral laws and Federal anti-kickback statutes, as well as civil monetary penalty laws. 

These fraud and abuse protections were built for a fee-for-service 

world, but today, they often stand as barriers to the kind of collaboration and information-sharing that is essential for value-based 

health care approaches and for improving patient care. 

Another barrier to data-sharing is the multitude of diverse and 

often contradictory Federal and State laws regulating health information that exist alongside the Federal HIPAA regulations. We believe these national and State privacy laws and regulations should 

be harmonized to facilitate greater information-sharing for the benefit of patients while still protecting their confidentiality. 

Members of the committee, I would like to close by applauding 

you for conducting this hearing and your focus on the issues that 

can genuinely transform and improve health care for every American. 

We can move faster. We can move more collaboratively across the 

spectrum of U.S. health care. And we can help more Americans 

maintain or improve their health better than we do today through 

data, information, and insights. 

We look forward to working with you toward our shared goals, 

and I will be happy to take your questions. Thank you. 

[Prepared statement of Mr. DeCrescenzo follows:] 


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Mr. HURD. Thank you, sir. 

Mr. Savage, you are recognized for 5 minutes. 

STATEMENT OF MARK SAVAGE 

Mr. SAVAGE. Good afternoon, Chairman Hurd, Ranking Members 

Lieu and Cartwright, and distinguished committee members. 

Thank you for the opportunity to testify today. 

I am Mark Savage, director of health IT at the National Partnership for Women and Families, a nonprofit, nonpartisan organization that for 45 years has worked to improve the lives of women 

and families. We are deeply invested in improving the value and 

experience of health care and ensuring that new models of delivery 

and payment help make consumers partners in their care with access to the right care at the right time. 

I am delighted to be able to share today the values, experiences, 

and needs of patients and consumers who are using health information technology, such as online access and electronic data-sharing with doctors to improve their health and care. 

The national partnership leads the Consumer Partnership for 

eHealth coalition and can speak broadly to the great opportunities 

that health IT presents and the obstacles that still make it difficult 

to realize its full potential. 

Health IT is the essential infrastructure for improving quality, 

care coordination, and value in our health care system today. 

It is a critical tool for engaging consumers who clearly recognize 

its value, according to a national survey we commissioned in 2014. 

We found that nearly 9 in 10 patients with online access to their 

health information use it. Notably, people who use online access 

frequently are much more likely than infrequent users to report 

that health IT motivates them to improve their health. 

Patients recognize that health IT is essential to improving their 

access to care, as well as their access to their health information. 

They know what we know, that health IT helps patients and family 

caregivers communicate with their health care providers, share information and manage their care; improves patients’ knowledge of 

their health and empowers them to take charge of their care plans; 

allows patients to correct errors or outdated information in their 

medical records, such as a missing drug allergy; enables patients 

to share treatment outcomes, such as pain levels, functional status, 

and whether their health improved after the office visit; helps 

health care providers answer questions from patients by secure 

email and provide care with telehealth and see the patients who 

need the most; gives patients more control over how much personal 

medical information is shared and how it is used; and much, much 

more. 

Like electronic access in so many other parts of our lives, such 

as banking and retail, health IT enables real-time access to care 

and information, and provides individuals with the convenience 

and control they need and expect in the 21st century. Health IT 

can also enhance patient trust and the privacy and security of patient data through encryption and other means. 

The country has seen a rapid increase in health care providers’ 

adoption and use of health IT in recent years, but much work remains before the potential benefits reach all patients. We have an 


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urgent imperative to break down barriers and continue the 

progress. 

First, that begins with removing barriers to health information. 

The national partnership runs the Get My Health Data campaign, 

and, through it, we have learned that many patients continue to 

face astonishing barriers to getting their digital health records 

from their health care providers. We need to change that by advancing policies and programs that promote patients’ online access 

to and use of their health information. 

Second, we need to clarify privacy and security requirements for 

sharing health data, because confusion persists about patient access rights. That means, for example, adding proactive education 

initiatives about what HIPAA requires and what it does not, and 

encouraging mobile app developers and technology vendors to post 

their privacy policies and data-sharing practices in standardized 

ways. 

Third, we need to enhance the usability of health information so 

that when patients access their medical data, they can understand 

and use it. For example, innovative apps could help patients organize their health information in ways that they find most useful. 

And fourth, we need to bridge existing digital divides to help 

identify and reduce disparities in care. That means, for example, 

promoting online access to health information across diverse communities, and innovation in mobile apps can help. 

In sum, patients and consumers applaud the progress to date 

and they need more. Patients have a unique vantage point for they 

are at the center of the health care and information-sharing we are 

all working to improve. 

Our goal must be to leverage health IT so it helps patients become real partners in their care and health. Only if we do that will 

we realize the full promise of health information technology. Thank 

you very much. 

[Prepared statement of Mr. Savage follows:] 


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Mr. HURD. Thank you, Mr. Savage. 

We are going to keep going. We are expecting votes in about 10 

to 15 minutes, so we will try to get through as many members’ 

questions as we can. 

To kick us off this afternoon is the distinguished gentleman from 

North Carolina, Mr. Walker. 

Mr. WALKER. I thank you, Mr. Chairman. 

I appreciate the panel being here today and taking your time and 

being really a valuable resource for us. 

I married into the medical community. My wife is a family nurse 

practitioner at Wake Forest Baptist Medical Health Center. Every 

time I feel like I have, by osmosis, learned more medical knowledge, after 23 years, she reminds me that I don’t really have a good 

base of understanding. 

But this is something that concerns. I remember even as a minister for 2 decades sometimes trying to get information about a patient to family members or to others, and trying to figure out how 

we can meet those needs. Sometimes there were problems to do 

that, even good laws. 

I also want to paint a picture here of some friends. I recently 

tagged along with a surgeon there in Moses Cone Hospital in 

Greensboro that has been so burdened with some of the software 

and some of the regulation. It has impacted him negatively, as well 

as other physicians who have talked about this. 

So I want to address a couple of these issues. Maybe, Mr. 

DeCrescenzo, if I could start with you, you both mentioned in your 

testimony obstacles. You also mentioned the word ‘‘barriers.’’ Talk 

to me for just a minute, if you would, about what specifically are 

the obstacles and barriers to getting where this needs to go. 

Mr. DECRESCENZO. I think some of the barriers and obstacles, 

Representative, are some of the things that I mentioned and some 

of the other folks here on the panel. 

First of all, there is a lot of activity underway around collaboration in the industry, but it is one that we think needs to be supported broadly. We have both private sector and combined private 

sector and government initiatives, things like the CommonWell Alliance, the Sequoia Project. There are technical standards from 

committees like HL7 that are trying to push the ball forward to 

make these systems talk to themselves, to each other, a lot more 

adeptly and easily than they have historically. 

I think support for that, as exhibited by the ONC report that 

came out last year, to push us down a roadmap where those efforts 

can be channeled into a way that they ultimately come to a harmonized approach between the State regulations and laws and 

standards, Federal, State, Federal laws, regulations, and standards, and private sector initiative, really is one of the ways that we 

can make the most against some of the obstacles and barriers that 

exist today where the systems don’t have those standards to make 

it easier for them to talk to one another. 

Mr. WALKER. Thank you for responding to that. Are you familiar 

with the Press Ganey scores? 

Mr. DECRESCENZO. The patient satisfaction scores. 

Mr. WALKER. Exactly right. I want to make sure that we are also 

being an advocate for the health care providers, that we don’t put 


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these guys in a bind. In fact, earlier this morning, we had a very 

passionate hearing—compassionate, I should say as well—as far as 

the heroin and opioids. And we know sometimes patients can be 

very manipulative in this process. 

Can you take a moment, Dr. DeSalvo, and speak to that to make 

sure, as we move forward with this, we are not putting our providers in a more vulnerable position? 

Dr. DESALVO. Thank you for the question, Congressman. 

As a doctor, I know full well the challenges of making sure that 

you are being compassionate but also being evidence-based in the 

practice of medicine. 

I wanted to touch on the patient access piece, because you mentioned it, and it is so critically important. The electronic health information is theirs. They have the right to access it. And we have 

worked with the private sector to see that we are creating innovative ways that they have more ready access to that information, so 

they can make their own care decisions, but also it can be available 

in the care setting. 

As an example, just in the last few months, working with the Office of Civil Rights, who has the primary responsibility for HIPAA 

access, put out some guidance directed at consumers, so that they 

would know what they have the right to access. This is a common 

refrain that we hear from consumers but also from docs who want 

to make sure that the information is getting out. 

In the space of opioids, as an example, we certainly want to 

make sure that we are doing everything to support clinicians on 

the frontlines. 

My husband is an emergency medicine doctor, so this is a very 

everyday occurrence for him. The tools like PDMPs, the prescription drug monitoring programs that are electronic in many States 

and have really made it easier for us to access information to make 

sure that we are appropriately giving opioids to people who have 

pain, are needed, but also trying to help folks stay out of trouble. 

We have been working with SAMHSA and with States and with 

the industry to see that those become more aligned within electronic health records, so you don’t have to go to another place and 

sign on. That’s an added burden. 

Mr. WALKER. Before my time expires, let me also look at this. 

Health care certainly is very important as we move forward in having the right perspective. As a Member of Congress, we also have 

a financial fiscal responsibility as well. We spend more than $2,000 

per patient than any other country in the world. 

Can we make a case out of this that is something that can drive 

us to be more health care cost conscience as well? 

Mr. QUINN OR MS. Rich, would one of you like to address that? 

Mr. QUINN. I will use as an example Intel’s Connected Care program. Where Intel, as a large purchaser of health care on behalf 

of its 53,000 employees in the U.S., said how can we make our employees the healthiest in the country, retain them, and also try to 

save some money doing it? 

We have been very successful in the first two. The third has been 

more challenging, although there has been a great progress there. 

The key to it, I would say, and this is also the key potentially 

for driving data-sharing and information-sharing in our broader 


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health care system, is focusing on value-based care, rather than 

fee-for-service. That was the engine that drove this, and we have 

seen a massive amount of actual use of this health information exchange because, of course, the technical pieces are there with the 

Sequoia Project and building this, but also the incentives for using 

it are there for the health care providers. 

Mr. WALKER. Thank you, Mr. Quinn. 

I yield back, Mr. Chairman. 

Mr. HURD. The plan is to go to Mr. Connolly, and then we will 

go into recess to get to votes. 

I now recognize the gentleman from Virginia, Mr. Connolly, for 

5 minutes. 

Mr. CONNOLLY. I thank the chair. 

And I thank Mr. Lieu and Mr. Cartwright for their gracious consideration. Thank you so much. I have seven hearings in a day and 

half, so I’m running back and forth. 

Mr. Quinn, thank you for sharing your story. Boy, could I relate 

to that. Both of my parents are in their 80s, and I have witnessed 

scenes where one is in the hospital in the emergency room, and the 

other one is being asked to give the history, the medical history. 

I’m thinking, what could go wrong with this scenario? Thank God 

they are both alert and have mental acuity, but you know, memory 

sometimes fails us in moments of stress. 

It is hardly an ideal system, and surely technology exists that 

would allow us to have a comprehensive picture of the patient in 

question without relying on human memory and such. 

So I really related to what you had to say, and I hope your dad 

is doing well. 

Dr. DeSalvo, picking up on Mr. Quinn’s narrative, according to 

HHS’s 2016 report to Congress on the adoption of health IT, your 

agency found that 97 percent of hospitals and 74 percent of physicians possessed a certified electronic health record system. But only 

76 percent of hospitals and 42 percent of physicians with electronic 

health record systems were sharing the information for the coordination of care. Why that big gap? 

Dr. DESALVO. Well, thank you for the question. I certainly identified with Mr. Quinn also, both as a doctor who takes care of those 

kinds of patients but also because of family members as well. So 

as I said in my opening, it is pretty personal to all of us to see that 

the data is moving. 

The good news story in the data that you present is that, over 

the course of the last many years, we have dramatically increased 

not just adoption but the opportunity to move and share data. So 

those are snapshot numbers. But if you look back at the trajectory, 

every year it improves both for doctor offices and hospitals. We are 

not where we want to be yet, but we are making progress. 

There are areas like the national capital region where health information exchanges like CRISP make that data available, such 

that if somebody arrives in an emergency room, their primary care 

doc will get a ping and be able to have the opportunity to send that 

med list or problem list, so that we will actually know more about 

the person in the ER. 

There are even more exciting advances happening, like in Mississippi, where the State of Mississippi has been working with local 


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vendors to see that all of long-term data from their Medicaid program is available to the doctors in the University of Mississippi 

Medical Center, so that when somebody arrives, you have a picture 

like you mentioned. 

Mr. CONNOLLY. You mentioned CRISP, but doesn’t that require 

a voluntary decision to participate? 

Dr. DESALVO. You are touching on the challenge that has 

emerged since we have been adopting electronic health records and 

moving to a digitized system, and that is that State laws vary, and 

so there is a need to harmonize that. 

Mr. CONNOLLY. Right. That is a particular challenge here in the 

national capital region, since we have three jurisdictions with three 

different political cultures and sets of laws and so forth. 

I have actually encountered that, where Maryland has one set of 

standards on this kind of communication and Virginia has another, 

and we are not always talking, which what could go wrong with 

that for someone’s health? I mean, you could jeopardize someone’s 

health without intending to. 

Now, do we need, from your point of view, and I welcome Ms. 

Rich as well, or anyone else, but is this a case where, frankly, we 

do need to look at some Federal legislation? 

We regulate blood supply for safety. Well, electronic recordkeeping is not just a nice thing to have. In the digital age, it may 

be very critical to someone’s health and the care they get, especially in an emergent situation. 

Dr. DESALVO. In the short run, we have been working, the Office 

of National Coordinator, with the National Governors Association 

on developing a toolkit so States themselves can harmonize their 

privacy expectations, so that won’t be an unnatural impediment to 

information flow. 

Over the long term, clearly, the health IT landscape has changed 

a lot since HITECH was passed in 2009. We were on iOS 3 then 

and now we are up to 6, just as one example. But apps and cloud 

computing have really evolved. 

So we certainly are leveraging all the opportunities that we have 

at ONC and our partners, the Office of Civil Rights and other agencies, to see that we are protecting consumers and that data is going 

to flow. But there are areas where we know that there may be 

some opportunity, like information-blocking, where we would need 

some additional support. 

Mr. CONNOLLY. Thank you so much for this fascinating conversation. 

Again, Mr. Chairman, thank you. 

Mr. HURD. Sure. 

Votes have been called. The committee stands in recess until immediately following votes. 

[Recess.] 

Mr. HURD. The Committee on Oversight and Government Reform 

Subcommittees on Information Technology and Health Care, Benefits, and Administrative Rules will get started again. 

I appreciate our witnesses’ and guests’ patience as we went to go 

vote. We shouldn’t be interrupted. 

To get us restarted is my friend from California, Mr. Lieu. You 

are recognized for 5 minutes. 


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Mr. LIEU. Thank you, Mr. Chair. 

Dr. DeSalvo, in your opening statement, you mentioned datablocking. Can you explain what that is and how it works? 

Dr. DESALVO. Yes, certainly, Mr. Lieu. Thank you for the question. 

Congress asked us to provide a report on health informationblocking, which we did last April. We thank you for that, because 

it generated a national conversation and set into motion some actions that we have been taking in partnership, for example, with 

the Office of Inspector General, also with the Office of Civil Rights, 

to see that we unblock data that has been collected in electronic 

health records. 

This is a new challenge we wouldn’t have had years ago when 

we did not have a digitized system. It has emerged since 2009 

when the HITECH Act put ONC and our authorities into place. 

An example of it would be that I’m in a health system and my 

patient records have been collected or digitized, and a patient ends 

up in the emergency room at another hospital across the street, 

and for whatever reason I’m not sure I can share it, because I don’t 

understand HIPAA, or maybe I don’t have a business associate degree that I think you need to have to share data. And so when that 

patient shows up across the street literally, the data is not moving. 

And it is just because of a lack of understanding. 

So that would be sort of an unknowing example. And by educating about HIPAA, which is something we have been actively 

doing, we hope to unblock that sort of data. 

Sometimes it is more around business practices. People want to 

hold onto patients or hold onto data and don’t share it. 

So we have asked and gotten pledges from the health IT industry 

to say they won’t block data. Now we are acting on making sure 

that we can put some teeth to it. 

But if I may, Congressman, it is an area where, since 2009, the 

world has really evolved. That is why in our budget request, we did 

put forward a proposal asking for some more opportunities for us 

to be able to address blocking, and to see that, where data could 

move, that it would. 

We really welcome the chance to talk with you more about the 

ways that we think we could have more opportunities to address 

it. 

Mr. LIEU. Just so I understand, sometimes you have data-blocking because the doctor or hospital may not have interpreted HIPAA 

correctly. Are there times where, in your opinion, they are intentionally doing it to gain a competitive advantage? 

Dr. DESALVO. We certainly heard plenty of reports about the use 

of it to gain a competitive advantage. 

Mr. LIEU. What about vendors? Do vendors sometimes do that as 

well? 

Dr. DESALVO. Occasionally. The way that will occur with vendors 

is they will require added fees, unexpected fees, to create the interfaces, and that is a form of lack of transparency but can also be 

a form of blocking. 

Mr. LIEU. And in the HITECH law, do you believe there are gaps 

that could address this? What can this committee or Congress do 

to help on data-blocking? 


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Dr. DESALVO. Yes, sir. 

What we have asked for as part of our budget request are some 

additional opportunities around defining it and giving us an opportunity to require that vendors, for example, can’t use gag clauses 

to prevent providers from talking about some of the contractual elements. Those are just a couple of the examples that we’ve asked 

for. 

So, yes, we do believe that, since the world has evolved, there is 

a new need for us to have some additional opportunities to protect 

the people who are using the systems and, more importantly, to 

protect the data of the consumers. 

Mr. LIEU. Let me switch to cybersecurity. 

Hollywood Presbyterian Hospital in Southern California had 

been attacked with malware. They had to give a ransom to get 

their data essentially unencrypted, unblocked. Two more hospitals, 

it was disclosed, were recently attacked in Southern California. 

What do you think we can do to help prevent those attacks? 

And my understanding is that it is the Office of Civil Rights that 

does cybersecurity? 

Dr. DESALVO. That’s correct. 

Mr. LIEU. And do you think that would be the appropriate office 

or not? 

Dr. DESALVO. The Office of Civil Rights does have the primary 

responsibility for privacy and security, and for security breach investigations. We work with them in a variety of ways to see that 

we are educating providers, clinicians, and others to make sure 

that the functionalities, the capabilities in electronic health records 

that we require to keep the data secure, are actually used in the 

field. 

We all know that there is a mix of both physical and 

cybersecurity expectations, so tools like our security risk assessment tool is a way that we educate providers to know in a simple 

way how they can protect the data that is in there. So there are 

some opportunities that we leverage, but we work largely in partnership with the Office of Civil Rights. 

Mr. LIEU. And does that office have a team of computer folks 

that deal with cybersecurity issues? 

Dr. DESALVO. It is very tight partnership. They certainly have 

experts in the area of HIPAA and cybersecurity and privacy, and 

we work very hand in hand with them. 

We, for example, recently released some additional guidance for 

providers but also for consumers about access and security, and 

have posted a series of joint blogs to make sure there is a shared 

understanding of what security expectations there are. 

You all, for example, asked the department to put together a 

cybersecurity task force, and we have been working along with others across the department to see that we put together that task 

force. It just met for the first time last week, so we thank you guys 

for raising that issue. 

Mr. LIEU. Thank you. I yield back. 

Mr. HURD. I would like to pick up where Mr. Lieu left off. So in 

OCR, they have lawyers so they understand HIPAA. Do they have 

technical folks that can actually help with a breach or the next 

ransomware attack? 


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Dr. DESALVO. Congressman, I would not want to speak specifically to the skill sets of their staff. What I can share with you is 

that the Office of the National Coordinator, which has technical 

staff, partners very tightly with the Office of Civil Rights, just like 

we do with other agencies, to make sure that we are bringing that 

talent to the table if it is necessary. 

Part of this task force as an example, which is with the private 

sector, is to bring together the best minds in cybersecurity and to 

work with not only ONC but OCR to see that we are helping to 

advance the health care marketplace to adjust to any new changes 

they need to in cybersecurity. 

Mr. HURD. Ms. Rich, why is there so much confusion around 

HIPAA? 

Ms. RICH. I can’t speak to why there is confusion around HIPAA, 

but I do know that there are many entities that are outside of 

HIPAA that are under our jurisdiction, and that includes all the 

health apps and the Web sites that take in consumer-generated information, and that consumers may be confused about whether 

there is a regulation that protects their privacy in those areas, 

which is one of the reasons why we think there ought to be a regulation that protects the privacy and data security for the information collected by those entities directly from consumers. 

Mr. HURD. Does FDA have responsibility in some type of regulation in this space? 

Ms. RICH. The FDA regulates medical devices, and that includes 

some health apps. But generally, they are looking at safety issues 

surrounding whether the app does what it says it does. The privacy 

and data security issues of such entities is generally in our care. 

And we have been working in this area for over 15 years, and we 

have an extensive program to look at the data security of these entities and take action—well, educate them to start with and then 

also take action in appropriate instances. 

Mr. HURD. So if it is a HIPAA violation, that is OCR’s jurisdiction. If it is generally something else, it may be you, it may be 

FDA, it may be SAMHSA, or the PPACA. There are so many of 

these different regulatory bodies, and my fear is that it is hurting 

innovation. It is hurting the proverbial two guys or two gals in a 

garage from creating something that can change the way that we 

deliver health care. 

Ms. Rich, I will get back to you on another question. 

I wanted to ask Messrs. Quinn, DeCrescenzo, and Savage, and 

then, Ms. DeSalvo, you answer after them, meaningful use, this is 

a term that I have been hearing a lot over the last 16 months that 

I have been in Congress and how it was originally designed to kind 

of spur companies from participating in EHR programs. But what 

I am hearing is that it is actually getting in the way of innovation. 

I would like for you three gentlemen to comment on your opinions on meaningful use. And, Ms. DeSalvo, I will let you be the 

cleanup batter. 

Mr. Quinn? 

Mr. QUINN. So meaningful use was quite successful in driving 

adoption of electronic health records. Without meaningful use, we 

wouldn’t have the rates of adoption today that we see. 


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As is the case with my dad’s example, that each individual 

health care organization has an electronic health record and may 

be beginning to exchange data doesn’t mean that the net result of 

it is the coordinated care, the shared health information, that we 

all need. And the prescriptiveness of this led some vendors and 

health care organizations to play to the test. 

What we need is to think ahead about the next generation of 

technology that is needed to embrace, for example, the Internet of 

Things, consumer-generated health data, the data that is being unearthed with the genome, and these other sources, and incorporate 

them into this so that we are not just thinking about this program 

as an end unto itself, but as an enabler of new technologies, new 

care models, et cetera. 

Mr. HURD. Thank you. 

Mr. DECRESCENZO. Thank you, Mr. Chairman. I would certainly 

second Mr. Quinn’s opinion that meaningful use as it has been affected in the last few years to dramatically increase use of the 

EHRs, as Dr. DeSalvo mentioned earlier, in addition to some of the 

new technologies that you mentioned, need now to be considered, 

and also suggest that over the last 4 or 5 years under meaningful 

use, we have learned a lot about how technology is used and what 

are some of the other process and incentive issues, including things 

like reimbursement mechanisms that may or may not incent further use of electronic medical records and other types of electronic 

digitization of health information in a sharing around that. 

So going forward, we believe that we need to be thoughtful about 

what we have learned over the last 4 or 5 years, as we look at additional regulation or requirements for expanding the use of electronic medical records and allied technologies. 

Mr. HURD. Mr. Savage? 

Mr. SAVAGE. We agree that the meaningful use program has 

been a major catalyst for improved adoption and use of health IT. 

Patients have been seeing a lot of the benefit of that. As I said in 

my testimony, there are still obstacles to overcome, and more needs 

to be done. 

But with the meaningful use program in our surveys, we saw a 

doubling of online access from 2011 to 2014, from 26 percent of patients with online access to 50 percent. 

We see them using it for the kinds of things that are really critical for delivery system reform that is coming. So the access is important, but the meaningful use program is also in 2017 to 2018 

to provide much more robust functions around patients sharing 

data with their providers, nonclinical data that is nonetheless relevant to care, better correction of errors, wearables, remote monitoring. And it will, indeed, stimulate the kind of innovation that we 

are all looking for. 

The version that is coming up also has APIs. We have tech developers who are writing apps for using those APIs. 

So important catalyst. Critical things are coming for patients and 

family caregivers to help them with their care planning. 

Dr. DESALVO. Thanks to these folks, I’m just going to talk about 

going forward, because the health IT landscape and health care has 

absolutely been changing and evolving. We are looking to go forward after listening to providers, after seeing where the health IT 


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landscape is, to take the opportunity that was made from the doc 

fix or the MACRA legislation and make this program going forward 

more flexible, much more focused on clinical outcomes and on interoperability. 

Mr. HURD. Thank you. 

Mr. Cartwright, you are recognized for 5 minutes. 

Mr. CARTWRIGHT. Thank you, Chairman Hurd. 

I want to follow up that discussion with Mr. Savage a little bit. 

I think a cornerstone of the health IT field are the electronic health 

records, the digital version of a patient’s paper chart containing not 

just the patient’s current condition but also his or her medical history. 

I have here, it looks like a Harris poll that NPWF commissioned. 

Is that correct, Mr. Savage? 

Mr. SAVAGE. That is correct. 

Mr. CARTWRIGHT. So this is entitled, ‘‘Engaging Patients and 

Families: How Consumers Value and Use Health IT.’’ 

I will ask that this be made a part of the record, Mr. Chairman. 

Mr. HURD. So moved. 

Mr. CARTWRIGHT. It is a result of the Harris poll. I cannot imagine how long this poll went, Mr. Savage, but it’s pretty hefty. 

It was done in the spring of 2014, correct? 

Mr. SAVAGE. Correct. 

Mr. CARTWRIGHT. Toward the end of it, there is a global summary. And it showed that more than 50 percent of patients want 

the ability to review their treatment plans, right? 

Mr. SAVAGE. Correct. 

Mr. CARTWRIGHT. And that nearly 60 percent wanted to see their 

doctors’ notes, and that fully 75 percent of patients wanted access 

to their test results electronically. 

Have I got that correct, Mr. Savage? 

Mr. SAVAGE. Yes, we found great interest in all of those. 

Mr. CARTWRIGHT. So that is the sort of information that would 

be available in an electronic health record, correct? 

Mr. SAVAGE. Yes. 

Mr. CARTWRIGHT. Okay. Is it easy for patients to get access to 

their electronic health records right now? 

Mr. SAVAGE. The survey that you are referencing does identify 

increased numbers of access, doubling from 26 percent to 50 percent. For those who have it, it has become easier, but the national 

partnership has also done work with the Get My Health Data campaign, which has found that there are also people without the access that they need and that there are some barriers. 

So I can either talk about on the survey side, or I can share with 

you some of the barriers we found with the Get My Health Data 

side. 

Mr. CARTWRIGHT. The barriers I’m interested in. 

Mr. SAVAGE. We have tracers, volunteers who report to us their 

experience with trying to get data, and everybody’s story is unique. 

But we do find some commonalities among those stories. 

So some of the significant barriers are a very complex, time-consuming process in order to get access. So you and I, in order to get 

access to our banking records, we just go down to an ATM or access 


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it through the Internet. That is not a time-consuming process, for 

the norm. 

But for access to health records, yes, it has been very time-consuming for these individuals. 

Records provided in a format that is not useful. You may ask for 

it in an electronic format. You get a piece of paper by snail mail. 

Misunderstanding of what patient’s rights to access are. 

And perhaps one of the things that we’ve discovered most recently is the use of unreasonable fees in order to—before you can 

get access to your records. That may take the form of you have 

asked for your information and, sure, here’s the copy and here’s the 

bill, and it is a bill that you never expected. Surprise. Or you are 

charged a per page fee when it is an electronic record. 

So there’s actually been—the Get My Health Data campaign has 

recommended that there be some comprehensive education initiatives to try to help providers and patients alike understand the requirements better. 

And the OCR guidance that recently came out provides some examples of the kind of innovative education efforts that we really do 

need to see. 

Mr. CARTWRIGHT. Dr. DeSalvo, pick up from there. What kind of 

examples? 

Dr. DESALVO. So consumers have more access to their information than they did previously, though it is not where we think it 

needs to be. And as Mr. Savage mentioned in his earlier comments, 

we have been pushing through the meaningful use program and 

through other ways to get increased consumer access. 

We, in fact, just put out a challenge grant through the Office of 

National Coordinator calling on the private sector to take advantage of this API expectation that we put in electronic health 

records to create very consumer-friendly apps that would be on a 

smart phone and allow somebody, any patient, to be able to access 

their health information and have more opportunity to control it. 

So we are really excited to see what the private sector is going to 

develop in the next few months to make it easier to get more access. 

The kinds of examples that get in the way of that, technology 

certainly Mr. Savage mentioned, but they are sometimes just a 

misunderstanding of HIPAA. The Congressman had asked earlier 

why doctors don’t understand HIPAA, and part of it is we are not 

really well-trained in it in medical school. 

This is, I think, a really important opportunity that the medical 

education field has along the way to see that we understand what 

HIPAA is and is not, and do not let it get in the way. Also, the 

way sometimes it is enacted gets in the way of consumers having 

access to their information. 

It is, in essence, a form of blocking. 

So, again, back to this comment of, the world has really evolved 

and now there is data to be free, data to move. And the primary 

concern is to see that it is there for that clinical moment when you 

need it. 

There are also many other important uses, so we are leveraging 

all the tools we have, whether that is education or clarity on rules 

and regs, but there’s probably also some additional needed attenVerDate Nov 24 2008 10:43 Feb 16, 2017 Jkt 000000 PO 00000 Frm 00149 Fmt 6633 Sfmt 6633 H:\23444.TXT APRIL

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tion and maybe some additional support to see that blocking is 

never a reason that people do not get their data. 

Mr. CARTWRIGHT. So last question, my sense of it is that the better access patients have to their medical records, the better we all 

are in terms of patient safety. 

Does anybody disagree with that? Let the record reflect they are 

all shaking their head no, Mr. Chairman, and I yield back. 

Mr. HURD. Thank you, sir. 

I would now like to recognize Ms. Lujan Grisham for 5 minutes. 

Ms. LUJAN GRISHAM. Thank you, Mr. Chairman. I think I probably want to take off from where my colleague was leading you all, 

Mr. Cartwright. 

I actually think in addition to the blocking and misunderstanding that we have seen two principles in HIPAA be determined—and as an attorney, I feel bad about this—but sort of a 

legal opinion that you have two mutually exclusive premises. One, 

patient protection, and the other would be the portability of that 

information, and they err on the side they are absolutely in their 

minds mutually exclusive, so they go to privacy. 

I just had this happen with a very large, very recently, health 

care provider who argued with me—and HIPAA, I spent a lot of 

time dealing with HIPAA, so it wasn’t—I won, because the CEO of 

the health care company refused to provide the patient information 

from provider to provider. 

Actually, I was trying to do them a favor, right? I have labs that 

are 45 days out. I get a patient who calls my office as a constituent 

and says I have to have them because my specialist can’t do what 

they need to do without the records from this other provider. I said, 

let me just call, because I know I don’t need really anything else, 

provider to provider, just do it. And basically I’m helping you, because God forbid we find something in those labs that indicate to 

your lawyers that you have a real liability. 

And then second, they wouldn’t do it, because HIPAA prevents 

that, as you all know it absolutely does not. For the audience, it 

does not prevent that. It explicitly provides for that. 

Then in addition, to make it easy for them, I was willing to get 

the patient on the phone, with plenty of patient identifiers. And 

HIPAA, according to this provider, also explicitly prohibits not having someone where you have really restrictive proof that that is the 

patient. I said that is nowhere in there. That is your own system, 

which gets to that it is proprietary, it is not interoperable, and that 

while we are to doing I think great strides to make this information available, that unless we deal with that, you can’t really create 

a patient record. 

I have to have apps for, right now, let’s see, I’m old, that would 

work with about 47 different providers. Now that I am lucky 

enough to have this job, I have to have to add all the providers that 

are in D.C. that I guarantee you do not speak to any of my providers in Albuquerque. 

So that was a typical-for-me, long-winded statement that our intentions here and meaningful use and all the incentives and including many of the accountability mechanisms really haven’t gotten us 

to what we really want, which is very effective patient records, because if we want patients to be part of problem-solving, and you 


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do. If I get access to my record, I find all kinds of stuff that my 

docs didn’t see because they are busy. I feel bad about that. I love 

them. They are my docs, so I really like them, or my practitioners. 

But they do not have the time to search through stuff, which is 

why every time you go, they have to do a whole new history because they have to ask me, because it is much faster. But what 

happens when about 20 years from now, I can’t remember for a 

whole variety of reasons? 

So what additional incentives can we use? And you sort of floated 

around many, right? 

But I also want a milestone check, because I have also been 

working on telehealth for more than 2 decades. Quite frankly, the 

reimbursement issues and the other barriers really simply have not 

made it available in the places where the technology, not only in 

juxtaposition to physician consultations or physician-to-patient consultations, but now you have the ability to do incredible online 

diagnostics. And yet, we aren’t really doing it. 

So what are some really great milestones and mechanisms that 

this committee can help you achieve, to that end? 

Anyone? All of you? Everyone? 

Ms. RICH. I would just like to comment that I do think an obstacle to uptake on the part of consumers is concern about privacy, an 

obstacle to uptake of use of electronic records. 

Regardless of what a lot of consumers think about privacy in 

other contexts, we do know that they care a lot about privacy when 

it comes to their health records, which can reveal truly personal information. So from the perspective of somebody that is talking 

about privacy, we would like to see stronger protections that make 

sense. Yes, it is a balance. Stronger protections for data —— 

Ms. LUJAN GRISHAM. Where do you see the balance? And nobody 

I think on this committee is making any sort of statement that we 

should reduce privacy protections. But when they become an obstacle—that does not diminish the protection of privacy, we have a 

really big problem here. 

I gave you one illustration. There are many. But what is a milestone to not diminish the protections that we are all interested in, 

but to get us to real patient records, serious interoperability, not 

just provider to provider because of proprietary, but as you mentioned in an earlier meeting, within our hospital equipment, which 

creates huge patient outcome issues, that is not a privacy issue, 

and gets us to telehealth, all the different kinds of things I know 

that you all are promoting? 

I don’t know if the chairman is going to let me keep going. What 

a good guy. 

Mr. HURD. Mr. Quinn can answer that question. 

Mr. QUINN. I would say a wonderful milestone is getting to 50 

percent alternate payment models by 2018, as HHS has proposed, 

and that Intel, eating our own dog food or, as my colleague says, 

drinking our own champagne, including in Albuquerque, where we 

have a huge facility —— 

Ms. LUJAN GRISHAM. We would like that to be bigger. 

Mr. QUINN. Thirty-three-thousand employees are today participating in our Connected Care program. The real enabler of this is, 

of course, that there is something called the Sequoia Project that 


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makes interoperability possible in connecting 150 different EHRs, 

but more importantly, that we are directly contracting with the 

providers in that area and we have purchasing power. 

We are doing this in Albuquerque. We are doing it in Portland. 

We are doing it in Arizona. 

Intel is a big purchaser, and we said you are going to participate 

as part of this, and we are going to collect these metrics. 

The same is happening on this national basis, this 50 percent. 

Fifty percent I think is a real tipping point, because you can’t live 

in two different worlds. You can’t live in the fee-for-service world 

and the alternate-payment world. 

The sooner we can get there, the better. We can’t let up on the 

accelerator. 

Ms. LUJAN GRISHAM. Okay, thank you. 

Mr. HURD. Thank you, Mr. Quinn. 

Raise your hand if you have suggestions on how to harmonize 

privacy laws, and which privacy laws and regulations need to be 

harmonized? 

Mr. Savage, your organizations don’t have opinions? 

Mr. SAVAGE. We do. We don’t look at them as harmonization. We 

look at them as protecting privacy for patients in all the different 

States. 

Mr. HURD. So I would like all of you all to submit those ideas, 

those white papers, to the committee for the record, so we can review those and see if that can be an area that we look at. 

I would be remiss if I don’t ask a cybersecurity question. 

Ms. Rich, this is for you, and I am not interested in any particular company or something like that. What do you think is the 

biggest threat right now to health information and our citizens’ 

health data? 

Ms. RICH. There are a few. One is failure by companies still to 

take this as seriously as they should. There has been a lot of 

progress in recent years, but we are still seeing not enough attention focused on this issue. 

Congressman Lieu also mentioned ransomware, which is something that is on the rise and is particularly on the rise when sensitive information is collected, because of the great interest in protecting that information, so the ransomware tactics are more likely 

to succeed. 

We are seeing that more and more in our cases, and we are looking at this issue ourselves, and maybe doing something publicly on 

that. 

But the number one issue is still the failure to pay enough attention to this issue, among many, many companies. 

Mr. HURD. Mr. DeCrescenzo? 

Mr. DECRESCENZO. Obviously, Ms. Rich has her perspective, 

what I think at the HLC, we are taking this very seriously. And 

we see across providers, payers, pharmacies, everybody who is part 

of HLC, an enormous amount of investment and forward-thinking 

on what to do about the problems that you described, for example, 

at Hollywood. 

I think one of the challenges everyone needs to recognize is that 

we are also trying to constrain costs as much as practicable in the 

U.S. health care system. And all these things come at a cost. And 


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there is not necessarily as much freedom, or maybe should there 

be, to be able to capture reimbursement in order to reflect those 

costs. 

So I think it is a very difficult barrier when you think of the resources that are applied anywhere from telecommunications to 

banking to other industries around cybersecurity, the fact that we 

have all described the importance of personal health information, 

and recognizing that many of these institutions, including many 

hospitals I’m sure in your districts, are already struggling to deal 

with a number of other aspects of successfully providing patient 

care. 

So I think we certainly see people taking it very seriously. As I’m 

sure you’re aware, many people go into the medical profession because they have that commitment to patients, their data, and privacy. 

So I think one of the things we need to consider is how well is 

reimbursement reflecting the cost of doing a good job at it. 

Mr. HURD. Ms. Rich, what has been the biggest fine that FTC 

has issued on a private company for violating our privacy? We don’t 

need to know the situation, just what is the dollar amount? And 

can you describe the situation? 

Ms. RICH. We actually, in the initial instance, don’t have fining 

authority in the data security area in general. We do when it involves kids’ information or consumer credit data. But in the general 

data security work we do, we do not have the authority to obtain 

any penalties. 

That is, I think, something that we seriously need in order to 

create different incentives here. 

Mr. HURD. If a private company would have lost the information 

on 23 million records, what would FTC have done? 

Ms. RICH. In the abstract, it is hard to say. Each violation, if we 

had civil penalty authority, just borrowing from the authority that 

we have in other areas, every violation could amount to a $16,000 

penalty. So if you add that up over millions of consumers, it’s potentially infinite. But, of course, we take the ability to pay, et 

cetera, into account. 

But the fines could be quite high for a company that had very 

serious violations and injured a lot of consumers. 

Mr. HURD. Thank you. 

Now to close this out, Mr. Blum, you are recognized for 5 minutes. 

Mr. BLUM. Thank you, Chairman Hurd, for holding this most important hearing. 

And thank you to all the panelists today for your insights. I appreciate it very much. 

Telehealth, telemedicine, has absolutely intrigued me since I 

have been in office the last 15 months. When we talk about rising 

health care costs in the country, I know many citizens want a silver bullet, one answer, one thing that is going to solve the increasing health care costs. 

I kind of believe, pardon my pun, I believe it has been death by 

1,000 cuts, the increase in health care costs. It has been a lot of 

small things. And I think one piece of the puzzle, the solution to 

keeping health care costs in line, is telehealth or telemedicine, and 


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particularly in our veterans’ care system with the psychiatric care, 

PTSD. 

I know in Iowa, it is rural, so we don’t have a lot—in all the outpatient clinics for vets, we don’t have a psychologist or psychiatrist 

on staff. So telemedicine is a great application there. 

I would like to ask all the panelists, what policy changes do you 

think are necessary so there is 100 percent—100 percent—telehealth participation by providers and by hospitals? I see it as critically important to saving the government money and also improving the outcomes of our patients. 

So whoever would like to take that, jump on it, please. 

Dr. DESALVO. Congressman, perhaps I will begin and say that I 

share your enthusiasm for telehealth. As a doctor, I have had the 

opportunity to use that, particularly for access to psychiatric care 

in my home community of New Orleans after Katrina, when we 

had really a lack of services. As a rural State, we have been able 

to leverage that as well. 

So as a care delivery model, very well-received, and can also save 

people money, because they don’t have to take off of work and find 

health care, et cetera, to go to the sites. It is less of a technology 

issue and more of, I think, an opportunity as we move to alternative payment models. 

So as the VA has been able to show and the private sector, and 

certainly through some of the work that the department has done 

with these models in the Center for Medicare and Medicaid Services, we have been working to advance that as an administration, 

in partnership with the private sector. 

I think it is something that we see as a department an opportunity in the delivery system reform work that is moving to alternative payment models, such as in the MACRA legislation that is 

required for docs. It is going to give us a lot of opportunity to really 

enable and support new kinds of care models. 

So from our standpoint, we believe that, with the department, we 

really believe that we are moving forward into this world and that 

the MACRA legislation for docs, in particular, is going to be helpful. 

Mr. BLUM. You are a medical doctor, correct? 

Dr. DESALVO. Yes. 

Mr. BLUM. I know you cannot speak for the medical community, 

but what is your impression or your opinion of the medical community’s opinion of telemedicine? Is it a good one? Or do they say this 

isn’t that good? 

Dr. DESALVO. So I can’t speak for the medical community, so I 

will speak for myself and my peers, that there are some real benefits to it. 

Speaking purely as a doctor, I think one of the challenges is 

there is a lot that you gain from being in the room with a patient, 

you can touch them, you can listen to them in a way you can’t necessarily through technology. So a mix of kinds of interaction is typically what we want. We wouldn’t want it to all to be remote, because you also gain something from that touch in that exam room. 

Mr. BLUM. Absolutely. 

Others? Yes, sir? 


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Mr. DECRESCENZO. Congressman, one other thing I would mention is harmonization of standards across the States. 

Obviously, with telemedicine, as you described, it is something 

that brings the ability to provide care across distance. And, of 

course, many of the States are quite large, so it is urban to rural 

and various other ways. It certainly would facilitate the growth of 

telemedicine in a very important fashion. 

But in addition, there is quite a patchwork of regulations and 

standards on a State basis across the country, so the ability to leverage perhaps highly specialized care outside the State is often 

more difficult for somebody looking to put together a national network or even nationally focused providers like Cleveland Clinic and 

others who have a very large footprint across the country. 

Mr. BLUM. And what would the solution to that be? Is there an 

easy one? I like easy solutions. 

Mr. DECRESCENZO. Well, we have 50 States, so I doubt there is 

an easy one. 

But I think there is increasing, I would say, similarity between 

the regulations of different States as they become more familiar 

with this. And perhaps like a lot of the work ONC and others have 

done around harmonization of technology standards, we would 

hope there would also be a similar effort to harmonize the standards and regulations around telemedicine. 

Mr. BLUM. Yes, ma’am? 

Ms. RICH. The FTC in the competition area, which I don’t personally work, but we have done a good deal of work on breaking down 

barriers to competition that may hold back certain alternative 

forms of medicine. 

For example, we have commented to States that may have laws 

that favor certain medical techniques over others in a way that 

interferes with competition through State laws. So competition is 

very important in this area. 

Mr. BLUM. Do I have time for one more question, Mr. Chairman? 

Mr. HURD. Thirty-nine seconds. 

Mr. BLUM. One of the major barriers preventing a focus on homebased health care versus expensive hospitalization—another area I 

am very interested in, is keeping that person in their home as long 

as we possibly can or getting them back to their home as quick as 

we can. Thoughts on that? 

Mr. SAVAGE. I would jump in and say that is a good illustration 

of perhaps an interoperability issue. We want to make sure that 

the patient’s home is connected with the system. 

So you want access. You want the patient to be able to send remote monitoring information to the doctor’s clinical record. These 

are things that are actually in the process of being developed on 

a national level. 

That kind of two-way communication between the home and the 

doctor’s system also contributes to care planning, so that you actually have working together to manage the care and to move from 

care to health. 

Mr. BLUM. This could apply to nursing homes as well, correct? 

Mr. SAVAGE. That’s correct. 

Mr. QUINN. I would say that one of the things that really is lacking today is ensuring that those home-based applications have a 


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market. So today without the reimbursement for many of those 

things, the market hasn’t blossomed the way that it could. Many 

of the applications and the tools aren’t necessarily designed for a 

78-year-old or maybe somebody with disabilities who is at home. 

Ensuring that that, frankly, consumer marketplace with the 

technology that is rigorous enough to be trusted and incorporated 

into the health care system is built and that there is a marketplace 

for it, because there is reimbursement, there is a path for investors 

to say there is something here. 

Mr. BLUM. That’s a good point. Thank you very much for your 

input. I appreciate very much. 

With that, I yield the time that I do not have. 

Mr. HURD. I would like to thank Mr. Lieu and Mr. Cartwright 

for the bipartisan nature in working on this topic. It is important 

for an exchange of information. 

And I appreciate our witnesses taking the time to appear before 

us today and for your patience. 

If there’s no further business, without objection, the subcommittees stand adjourned. 

[Whereupon, at 4:22 p.m., the subcommittees were adjourned.] 


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