Congress calls for paperless health records
Both the Senate and House are edging toward a new set of regulations pushing health care providers to embrace IT.
"Greater use of IT has the potential to dramatically improve the safety and quality of health care for Americans," Rep. Nancy Johnson, R-Conn., said at a hearing convened by the House of Representatives' Ways and Means Committee's health subcommitee.
But widespread adoption of electronic health records has been "disappointingly slow," said Johnson, who chairs the subcommittee and is currently drafting legislation aimed at accelerating the process.
Rep. Pete Stark, D-Calif., also criticized the lag time, pointing to news that Medicare is slated next month to begin offering doctors free software for managing electronic records. The Department of Veterans Affairs already runs the product. "It's beyond me why we're having all these therapy sessions when we could get started and install the software," he said at the hearing.
In his State of the Union address earlier this year, President Bush reiterated his call for change, and the U.S. Department of Health and Human Services has spent the last year investigating ways to deliver the new technology.
Proponents of computerized records say they allow doctors to share information more easily and efficiently, prevent duplicate tests, and furnish health care providers and consumers more readily with information they need to make health decisions. The HHS estimates that making the switch could ultimately save the health care industry approximately $140 billion per year in administrative costs.
But the change needs to be "market based" and "non-regulatory," said Dr. David Brailer, who has served as national health information technology coordinator for HHS since an executive order created the position in spring 2004. It's up to the government to act as "a leader, a catalyst and a convener," he told the committee.
"We want uniform widespread adoption of standards, and yet we want to remain current over time," Brailer said. "The approach we're taking is to develop these by contracting with the private sector" before turning those ideas over to a federal advisory committee.
Brailer suggested that two major obstacles remain: a lack of incentives for physicians to make the switch and a lack of standards for the information systems themselves, "which makes implementation very risky and very difficult."
Privacy perils
Others at the hearing raised a medley of concerns to address before making the shift.
Existing privacy laws under the federal Health Insurance Portability and Accountability Act, or HIPPA, aren't broad enough to mesh with a widespread computerized system, said Joy Pritts, an assistant research professor at Georgetown University's Health Policy Institute. They don't cover entities that do not engage in insurance transactions, she said, noting as an example "those who provide (health care) services over the Internet and accept credit cards."
What's more important is creating a federal uniform privacy standard that would pre-empt state laws, some of which are stricter than HIPAA's base guidelines, countered Mary Grealy, president of the Healthcare Leadership Council. Failure to do so "will make the creation of an effective health information network, one that crosses state bounds, virtually impossible," she said.
Congress must also move quickly to adopt new code sets for classifying patient data, such as diagnoses and conditions, said Linda Kloss, chief executive officer of the American Health Information Management Association. Record-keepers are currently working off a 30-year-old set of codes that include obsolete terms and lack specificity, Kloss said.
Last week, the U.S. Senate Health, Education, Labor and Pensions Committee approved the Wired for Health Care Quality Act, which blended bills offered up by Sen. Mike Enzi, R-Wyo., and by Sen. Bill Frist, R-Tenn., and Sen. Hillary Clinton, D-N.Y.
Light on regulatory language, the measure would put into law an Office of National Health Information Technology, which would "carry out programs and activities to develop a nationwide interoperable health information technology infrastructure." A presidentially appointed "national coordinator" reporting directly to the HHS secretary would head the office.
Under the bill, the American Health Information Community, an advisory board composed of nine representatives from the public sector and eight from the private sector, would become part of federal statute. A week before the Senate committee action, HHS Secretary Michael Leavitt announced the community's formation and called for nominations for the two-year posts.
The Senate measure would permit qualified entities to apply for grants or loans to use for installing the technology. It would also establish a "Center for Best Practices" to assist in the transition and extend HIPAA regulations to include "any health information stored or transmitted in an electronic format" after the law takes effect.
Rhett Dawson, CEO of the Information Technology Industry Council, which represents 32 high-tech companies, praised the Senate's action in a press release: "Bringing new technology to our hospitals isn't just about having the latest gadgets. It's about cutting health care costs, reducing errors and saving lives."