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The Ups And Downs Of Health IT
by Danielle Belopotosky
As Congress ponders its next step toward boosting health information technology, the Health and Human Services Department is working to ensure access to electronic health records, and its leaders are winning kudos for their work.
HHS Secretary Michael Leavitt and David Brailer, the national coordinator for health IT, in particular are being praised. Under their leadership, said Kara Calvert, director of government relations at the Information Technology Industry Council, the department has "taken the bull by the horns" on health IT this year.
Progress At The Health Department
When Leavitt took office Jan. 26, he propelled the work of Brailer's office, which was established by executive order in 2004. Under Brailer, HHS set a decade-long plan to drive health IT and provided $139 million in regional grants. Leavitt proposed standards for electronic prescriptions to coincide with Medicare's rollout of a new drug benefit beginning in 2006.
Since then, the department has formally codified Brailer's office and set a formal organizational structure. Leavitt announced and established an advisory board comprised of 16 insurers, health providers, consumer advocates, government officials and technology companies. Naming the members of the American Health Information Community and making health IT a priority "has made [the movement] a reality for people," Calvert said.
HHS has awarded four contracts worth $36.1 million to advance a nationwide health IT infrastructure. The first went to the American National Standards Institute, which ultimately will develop a prototype for health IT software standards, primarily electronic health records.
A second contract will establish certification standards for e-health records software, and the third aims to harmonize state and federal privacy and security practices. The final award was granted to four consortia to develop prototypes for the national health information network infrastructure.
In October, Leavitt announced proposals to remove legal barriers for e-prescriptions. He also moved to loosen restrictions for health entities to donate hardware and software so doctors have access to the tools and knowledge necessary to reduce medical errors and improve health care.
"Leavitt as secretary ... has done more in his brief tenure," said Scott Wallace, president of the National Alliance for Health Information Technology. "He has remained on message and on theme" since he walked in the door.
Janet Marchibroda, CEO of the eHealth Initiative and executive director of the eHealth Initiative Foundation, also noted in an e-mail that there has been "an enormous increase in maturation in states, regions and communities across America who are building multi-stakeholder collaboration around mobilizing health information in our region." The foundation helps build regional health collaborations while focusing on improving the quality, safety and efficiency of health care. Today, more than 200 regional projects are underway.
The Slow Pace In Congress
The progress in Congress is not so obvious, however. ITI has urged Congress to enact a national standards-based health network, to fully fund Brailer's office and to provide financial incentives to foster the uptake of health IT, but little action on health IT has occurred.
While Wallace said lawmakers have publicly stated the need for Congress to step up to the plate on health IT, "people [on Capitol Hill] are still looking for the plate." There was early enthusiasm that Congress would act, he said, but now people are asking, "What can Congress do?"
Lawmakers started this year with great momentum, introducing about 20 bills with health IT components, including those that aim to overhaul payment systems through incentives for improved care. The Senate has passed one bill, S. 1418. In addition to supporting the work in progress at HHS, the measure would authorize competitive grants and loans through the state matching-grant programs.
The House has been slower to act, Calvert said. But momentum is likely to increase with the introduction of a bill by Connecticut Republican Nancy Johnson, who chairs the House Ways and Means Health Subcommittee. The legislation, H.R. 4157, has 41 sponsors, including two Democrats -- Anna Eshoo of California, who sits on the House Energy and Commerce Health Subcommittee, and Sheila Jackson-Lee of Texas. Action is expected early in 2006.
Still, key members like House Ways and Means Chairman William Thomas, R-Calif., have yet join the push for health IT. Thomas needs to be active, Calvert said, because there are funding and grant mechanisms in the Senate bill that require his committee to act. Thomas has yet to co-sponsor health IT legislation.
Furthermore, Congress has not met Bush's fiscal 2006 budget request to foster health IT. In the conference report for the Labor, HHS and Education appropriations bill, H.R. 3010, Congress agreed to authorize $61.7 million, which would be $13.3 million shy of Bush's request. The bill also would limit funds for health research and quality projects to $50 million in fiscal 2006.
In October, Eric Dishman, Intel's general manager and global director of health research and innovation, said at a Markle Foundation conference that the government's slow adoption of health IT is not a technology problem. Instead, it stems from a bureaucratic shuffle on the Hill. "It is a political challenge," he said.
Hurricane Katrina offered evidence to prove that point. Within a week after the storm hit, HHS, with the Markle Foundation, pharmacies and tech companies, culled together medication records of Louisiana evacuees because the technology already was in place. The business processes, governmental policies and privacy rules slowed the turnaround time. "Katrina plays a good role in bringing the focus to the need of electronic health records," Calvert said.
A Process, Not A Destination
Still, health IT advocates do not think Congress has lost its desire to act on health IT issues. "It was a tough year for Congress, given budgetary pressures, the war, Hurricane Katrina," Marchibroda said, but health IT stayed on the agenda.
Wallace said Congress can make its mark by filling some gaps. Certain "regulatory issues may require a congressional fix," including the pre-emption of state privacy laws "to ensure privacy on the national level is an appropriate role," he said. Congress also can provide incentives for rural areas, funding and a standard for patient authentication within the health information network.
HHS and Brailer's office "need to deliver" on the contracts it awarded, Marchibroda said. "It is critical that we execute and execute well on those contracts." Meanwhile, the payment system must be realigned with incentives to reward higher quality care, which has a health IT component, she added.
"I think one of the things that is important in looking at all of this is that it is a process and not a destination," Wallace said.
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