Key Takeaways
- •Thomas Keane (Assistant Secretary for Technology Policy and National Coordinator for Health Information Technology, U.S. Department of Health and Human Services) announced HHS is issuing notices of potential non-conformity to penalize entities for illegal health information blocking.
- •Keane testified that the Trusted Exchange Framework and Common Agreement now supports 500 million record exchanges, facilitating "data liquidity" to ensure medical records follow patients across different providers.
- •Sen. Marshall (R-KS) challenged Keane on insurance companies using prior authorization to delay care, leading Keane to highlight new standards for real-time electronic approvals at the point of care.
- •Sen. Cassidy (R-LA) criticized previous enforcement failures regarding data hoarding, while Sen. Alsobrooks (D-MD) raised concerns about maintaining centralized oversight and patient safety guardrails during the transition to AI.
- •This hearing underscores a shift toward aggressive enforcement of interoperability standards and the need for updated cybersecurity frameworks to protect rural hospitals from increasing ransomware threats.
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Hearing Analysis
Overview
HEARING PURPOSE The Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing on March 5, 2026, titled "Transforming Health Care with Data." Chaired by Sen. Bill Cassidy (R-LA), the hearing examined the progress of the U.S. healthcare system’s transition to a fully digital infrastructure. The primary focus was the work of the Office of the National Coordinator for Health Information Technology (ONC), recently elevated to the Assistant Secretary for Technology Policy (ASTP), in implementing the 21st Century Cures Act, promoting interoperability through the Trusted Exchange Framework and Common Agreement (TEFCA), and addressing the persistent issue of "information blocking."
Key Testimony
KEY TESTIMONY Dr. Thomas Keane, Assistant Secretary for Technology Policy and National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services (HHS), served as the sole witness. Dr. Keane emphasized "data liquidity" as his top priority, arguing that technology must enable a patient-centered system where medical records follow the individual. He reported that TEFCA now connects over 70,000 locations and has facilitated the exchange of nearly 500 million health records.
Organizations & Entities
Dr. Keane highlighted the HTI-4 final rule (July 2025), which provides clinicians with real-time access to prescription drug costs at the point of care, and the HTI-2 proposed rule, which aims to streamline certification criteria for Electronic Health Records (EHR) to focus on modern interoperability standards. He also addressed enforcement, noting that his office has begun issuing "notices of potential non-conformity" to entities suspected of information blocking, working in tandem with the HHS Office of Inspector General (OIG).
Overview
POLICY PROPOSALS Several legislative efforts were discussed: - The Improving Seniors' Timely Access to Care Act: Focused on automating prior authorization in Medicare Advantage. - The Health Information Privacy Reform Act: Introduced by Sen. Cassidy (R-LA) to modernize patient data protections. - The Healthcare Cybersecurity and Resiliency Act: A bipartisan bill recently passed by the committee to address cyber threats. - The Improving Data in Public Health Act: Proposed by Sen. Tim Kaine (D-VA) to establish standards for sharing public health data with the CDC. - The Patients Deserve Price Tags Act: A bipartisan bill from Sen. John Hickenlooper (D-CO) and Sen. Roger Marshall (R-KS) to mandate the publication of real healthcare prices. - The Rural Hospital Cybersecurity Enhancement Act: Introduced by Sen. Josh Hawley (R-MO) to develop a workforce strategy for rural hospital defense.
INDUSTRY & SECTOR IMPACT The hearing identified significant impacts on EHR vendors, who face new certification requirements and potential penalties for information blocking. Health insurers, particularly those managing Medicare Advantage plans, are being pressured to adopt real-time prior authorization standards. Rural hospitals and tribal health providers (via the Indian Health Service) were identified as sectors needing targeted support for digital modernization and cybersecurity. The emerging AI sector in healthcare also faces potential new regulatory frameworks regarding data privacy and clinical decision support.
Policy Proposals
ORGANIZATIONS & ENTITIES - United States Department of Health and Human Services (HHS): The parent agency for ONC/ASTP, leading the "data liquidity" and enforcement initiatives. - Office of the National Coordinator for Health Information Technology (ONC) / Assistant Secretary for Technology Policy (ASTP): The primary office discussed regarding health IT standards, TEFCA management, and information blocking enforcement. - Indian Health Service (IHS): Discussed regarding its health IT modernization efforts and its status as the first government organization to join TEFCA. - Centers for Medicare & Medicaid Services (CMS): Referenced regarding its role in prior authorization pledges and the "access model" for health apps. - Office of Inspector General (OIG): Mentioned as the investigative partner for information blocking complaints. - Food and Drug Administration (FDA): Identified as the primary regulator for AI-driven clinical decision support tools. - United States Department of Veterans Affairs (VA) and Department of Defense (DOD): Discussed regarding the ongoing challenges of achieving interoperability between their EHR systems and the private sector. - Centers for Disease Control and Prevention (CDC): Referenced in the context of public health data sharing standards. - St. Margaret's Health: Cited by Sen. Hawley (R-MO) as a rural hospital that closed following a ransomware attack. - Banner Health: Mentioned by Dr. Keane and Sen. Hickenlooper (D-CO) as a provider system in Colorado. - UnitedHealthcare and Cigna Group: Referenced by Sen. Hickenlooper (D-CO) regarding the lack of price transparency in large employer contracts. - Change Healthcare: Mentioned by Sen. Angela Alsobrooks (D-MD) as the site of a massive 2024 data breach that influenced policy. - American Medical Association (AMA): Cited regarding statistics on healthcare spending and administrative waste. - Cybersecurity and Infrastructure Security Agency (CISA) and Federal Bureau of Investigation (FBI): Identified as partners in responding to healthcare cyberattacks.
Overview
PARTISAN DYNAMICS The committee showed a high degree of bipartisan consensus on the need for better cybersecurity and the elimination of information blocking. Republicans, led by Sen. Cassidy (R-LA) and Sen. Marshall (R-KS), focused heavily on market competition, price transparency, and reducing regulatory burdens. Democrats, including Sen. Kaine (D-VA) and Sen. Alsobrooks (D-MD), emphasized the need for federal standards in public health reporting and expressed concern about maintaining a centralized policy framework within HHS to protect patient safety.
Partisan Dynamics
NOTABLE EXCHANGES Sen. Cassidy (R-LA) questioned Dr. Keane on the privacy gap for AI platforms. He noted that while EHRs are covered by HIPAA, a patient who voluntarily uploads data to a non-covered AI chatbot loses those protections. Dr. Keane admitted that ASTP cannot regulate data once a patient consents to its release to a third party, leading Sen. Cassidy to suggest a need for new consumer safeguards.
Sen. Marshall (R-KS) expressed frustration over the lack of true interoperability, comparing EHR vendors to "Ford and Chevy" systems that refuse to talk to each other. Dr. Keane responded that the department is now using "notices of non-conformity" to force compliance.
Overview
NEXT STEPS Chairman Cassidy (R-LA) announced that questions for the record are due by 5:00 PM on Thursday, March 19, 2026. The committee is expected to move toward a markup of the Patients Deserve Price Tags Act in the near future.
Transcript
The Senate Committee on Health, Education, Labor, and Pensions will please come to order. Increasingly, patient care happens outside the exam room. Any of us can pull up our health records, make an appointment, refill a prescription on our phones, and that is a huge advantage to patients and doctors, saying that as a person who is a doctor and who has been a patient. And so digital access to our health records allows doctors and hospitals to share a patient's information so quickly. And it's at least convenient and in some circumstances life-saving. Whether you're out of town and need to go to the emergency room, or maybe you want a second opinion or to see a specialist, having easy digital access to health information makes the process work better. In 2009, Congress established the Office of the National Coordinator, ONC, to transition the health care system to a fully digital system. Today we'll hear from ONC on their work to standardize health information sharing and put patients in the driver's seat. We've made a lot of progress on this, but there is more to do. There continues to be the issue of information blocking, which I think our witness will speak to, where one party blocks another from sharing data, even with the patient's consent. Now, frankly, on that, I'm looking forward to hear what you have to say, because hospitals tell me that they are transferring back and forth. And patients will tell me sometimes not the case. And doctors will tell me sometimes not the case. And so I don't know if it's something which is improving, what the relative balance of, but I look forward to your kind of illuminating that. I'll note that the Biden administration did not respond to a single case of information blocking. So maybe that means there's absolutely none of it going on, or maybe it just wasn't enforced. But again, I'm hearing different things. Now, I practiced medicine for over 25 years. Ideally, you have all the information you can get to treat the patient well, and that's why I and others led efforts to outlaw information blocking in the 21st Century Cures Act, and I thank the Trump administration for acting upon this. Dr. Keane, who's here today, is working with HHS Secretary Robert Kennedy to investigate allegations of information blocking and taking appropriate action. We must also consider how Congress can continue to modernize patient access to information. ONC created the Trusted Exchange Framework and Common Agreement, or TEFCA, to standardize health information sharing and to give the patient the power of access. Just last month, almost 500 million health records were exchanged through TEFCA in a secure and protected manner. Improving ways to exchange information is pro-patient and delivers better care. So we must redouble efforts to make sure that bad actors don't use TEFCA for their own goals. Now, for all of us, for I as a physician, patients are the priority. We're living in a digital age. For that, there are advantages and disadvantages. This committee should expand those advantages and to limit the disadvantages with the goal of putting the patient first. That's why I introduced the Health Information Privacy Reform Act. The committee also last week passed on a bipartisan basis my Healthcare Cybersecurity and Resiliency Act to respond to continuing threats of cyberattacks. Protecting patient information is bipartisan and essential to deliver modern care. I look forward to discussing how we can do that. Senator Kaine, are you going to make a statement for...
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