In the past few weeks, a flurry of health care IT bills have been introduced in Congress.
Rep. Bart Gordon (D-Tenn.), chair of the House Committee on Science and Technology, introduced HR 2406, which would authorize "the National Institute of Standards and Technology to establish guidelines and mechanisms to promote the integration of the health care information enterprise in the United States."
Sen. Sheldon Whitehouse (D-R.I.) introduced a package of three bills:
- S 1415, the Quality Reform Expansion and Savings Act of 2007, would create two-year federal grants for local organizations pursuing health quality reform in areas ranging from electronic record-keeping, to early prevention and detection of illness. The grants also could go toward efforts to expand health care coverage.
- S 1455, the National Health IT and Privacy Advancement Act of 2007, would establish a private, non-for-profit corporation tasked with developing a national, interoperable, secure health IT system.
- S 1471, the Improved Medical Decision Incentive Act of 2007, would refocus the health care reimbursement system on quality by allowing states to establish "best-practice" guidelines for treating illnesses or conditions.
- Rep. David Wu (D-Ore.) introduced HR 1467, which recently was passed by the House. It would address the shortfall in health informaticists by developing a health care informatics curriculum for undergraduate and master's degree programs, as well as certificate programs. It also would create programs to train current medical professionals, such as physicians, nurses and medical administrators, in the area of health care informatics.
A Bill with PotentialSo, lots of legislation. Not doubt there's more to come. Perhaps the most promising is the Wired for Healthcare Quality Act (S 1693). An earlier version of the bill unanimously passed the Senate last session, which could bode well for the latest version. Given the powerhouse of sponsors -- Sens. Edward Kennedy (D-Mass.), chair of the Senate Health Education Labor and Pensions committee; Mike Enzi (R-Wyo.), ranking Republican member of the HELP committee; Hillary Rodham Clinton (D-N.Y.); and Orrin Hatch (R-Utah) -- and its track record, my bet is on the Wired bill as the main and most significant health IT legislative vehicle in the 110th Congress. There's a lot about the bill to like, plus a few things that I think need to be revisited.
The Wired bill would:
- Make the National Coordinator for Health IT a more permanent structure in the federal government than what is currently permitted under the executive order creating the position;
- Establish a public-private group called the Partnership for Health Care Improvements, which would recommend standards for interoperability, implementation specifications and certification criteria;
- Require all federal health IT purchases to conform to federally adopted health IT standards;
- Strengthen privacy protections; and
- Provide grants for the purchase of health IT system for providers demonstrating financial need for states to establish low-interest loan programs for providers to purchase health IT; and to facilitate implementation of local and regional health information exchanges.
Codifying the post and office of the national coordinator is a good thing, and it's overdue. The responsibilities of the office are simply too important at this point to have them based only on an executive order. If anything, the bill needs to go further. Instead of being appointed by the HHS secretary and being based in that department, the national coordinator should have governmentwide authority. Health IT issues and funding are found in agencies throughout the federal government. Absent governmentwide authority, non-HHS agencies are likely to reflexively cast off in their own directions, guided by their own priorities and politics. It's the nature of any bureaucracy, public or private.
Making Sense of the LegislationI think I get the idea behind the partnership. This public-private body would be the one entity to coordinate development of various standards, criteria and specifications, as well as recommend to the HHS secretary which of those to adopt. Now, in some ways this makes an awful lot of sense. The current Health IT Standards Panel, which is responsible for recommending interoperable standards to the national coordinator, needs a more permanent home.
There is good sense to having the standards development and certification criteria processes closely linked. If we were starting from scratch, that might well be the way to do.
But we're not starting from scratch. By all accounts, the Certification Commission for Health IT has been a smashing success. It should be noted that CCHIT is a client of my law firm. More than 90 ambulatory electronic health record systems have been certified, and CCHIT will begin certifying inpatient EHRs this year. Perhaps most importantly, CCHIT is proving to be a trusted validator of functionality for health IT purchasers, a critical element in achieving a functioning market in health IT. So that old Washington adage should apply here: "If it ain't broke, don't fix it."
Policymakers and others have long discussed how to use the federal government's purchasing power to propel digitization of the health care system. The Wired bill would require federal health IT purchasers to buy only systems that conform to and are certified to meet federally adopted standards -- a provision that truly could be powerful.
The bill's grant program for health care providers who can't afford to make health IT capital expenditures is long overdue. Something akin to the Hill-Burton program, which allowed for hospital construction in economically depressed communities in the 1960s, is essential if disproportionate share providers and physicians are to be able to bring the power of digital medicine to their patients.
One thing the bill lacks is a way to address the growing shortage of health IT workers. As large systems and medical groups accelerate the installation of health IT systems, it is becoming painfully obvious that there are insufficient numbers of well-trained health IT technicians to install these systems and maintain and support them. Wu's bill makes an important start in that direction.
The Wired bill seems like it should move ahead swiftly, as long as it's revised to address the issues I've identified, as well as a few others.
Before we get too excited by the prospects of successful health IT legislation, let's take a hard look in the mirror and admit that we, the health IT community, have done a poor job in advocating for health IT policy. Notwithstanding what appeared to be good progress on health IT bills in the last Congress, lawmakers approved not a single health IT bill. Congress routinely reduces federal funding for the Office of the National Coordinator from what the president requests. Just last month, the House and Senate Appropriations subcommittees approved health IT spending totaling more than 40% below what President Bush requested.
If bills are to be enacted and programs are to be funded, health IT organizations are going to have to engage more effectively in the policymaking process than they have to date. Organizations will have to put aside the natural competitiveness that exists among them, agree to a common agenda and execute a coordinated advocacy strategy. Without concerted action, I fear we will have yet another Congress that teases us with health IT bills and the prospect of spending but fails to deliver in the end.