In the past year, lawmakers have struggled in their efforts to pass health information technology legislation. The Senate and House each passed a bill that they sent to conference committee by early fall, but the prospects for creating a framework for a National Health Information Network died without ever being presented for a full vote in either chamber.
“We all worked so hard, so we were extremely disappointed that Congress threw away all the progress that had been made over the past two years — when there was real opportunity to pass a good bill,” said David Merritt, a project director at the Center for Health Transformation, a health policy think tank that former House Speaker Newt Gingrich founded. “It’s not like this was Social Security or Medicare reform. This was a bipartisan issue.”
Now it’s the Democrats’ turn, and the new majority party appears to be committed to tackling health care. Health IT advocates are optimistic the new leadership will make health IT a priority, build on the progress of the past two years and create a better, more comprehensive legislative framework.
Ticia Gerber, vice president of public policy and international programs at the eHealth Initiative, said the Democrats’ focus on health care could result in a completely different approach to health IT. She said she thinks IT is likely to be included as a subset of many larger health care issues Democrats want to tackle, including stem cell research, Medicare and children’s health insurance.
“I can see where a lot of these bigger goals have the potential to have health IT and quality measures,” she said. “A bill for improving access for the uninsured, for example, might include ways that health IT can be used to better serve the underserved more efficiently and effectively.”
Meanwhile, IT is likely to remain a strongly bipartisan issue — some even refer to it as nonpartisan. “We’re talking about shades of a color, not different colors,” said Scott Wallace, president and chief executive officer of the National Alliance for Health IT.
But no one believes that the Democrats will address health IT in the same way that the Republicans did. Observers say several prominent themes are likely to dominate this year’s debate. Privacy Privacy advocates were nearly in despair last summer after the House passed its bill without including any privacy protections and the Senate bill relied only on existing Health Insurance Portability and Accountability Act language. Now that the Democrats are in charge, “we’re ecstatic,” said Dr. Deborah Peel, executive director of the Patient Privacy Rights Foundation.
House Democrats in particular have a recent history of fervent concern for privacy, Merritt said, having countered the House bill last summer with an amendment that included a menu of privacy safeguards, including the right to consent to data disclosure, the right to opt in and opt out of electronic databases, a right to audit trails and a private right of action if and when privacy breaches occur.
Democrats are likely to debate the privacy topic more vigorously and call for committee hearings, Peel said. They’ll likely include explicit protections for electronic medical information.
Michael Zamore, a senior policy adviser to Rep. Patrick Kennedy (D-R.I.) said the inclusion of strong privacy provisions will be critical to the passage of any health IT bill because many Democratic lawmakers believe that without strong privacy protections, health IT will fail in the long term.
“Success in transforming health care through information technology is predicated on a level of acceptance and trust by consumers,” Zamore said. “If that trust level isn’t there, then the whole IT enterprise will be set back. There’s nothing that could undo the years of effort toward a digital health information system faster than one or more highly publicized breaches that compromise patient privacy.”
Merritt said he believes that strong privacy protections have a good chance of making it into a health IT package, as long as they aren’t unreasonable. “If [industry finds] it to be a mandate with an unnecessary or unreasonable deadline or an administrative burden, then that’s where you’ll run into opposition,” he said.
Funding Democrats are expected to put a lot more money behind health IT than Republicans were willing to do last year, said Gerber, who expects not only competitive grants but also a broad range of funding vehicles to be proposed.
But Wallace said he doesn’t think Democrats will deliver one giant blank health IT check. “I think Democrats will look to provide funding in specific targeted niches where the IT adoption gap is growing and the implementations of that adoption gap is detrimental to the broader scale of medicine,” he said. “The debate will likely address: How do we use our resources to drive this into smaller practices and underserved communities?”
Dave Roberts, vice president of government relations for the Healthcare Information and Management Systems Society, said House Democrats may have hampered themselves by committing to pay-as-you-go budgeting rules. This requires legislators to pull funding from existing programs or raise taxes to pay for any new proposed initiatives.
“That’s going to be a real trick,” he said, adding that health IT will need to compete for dollars with a number of existing and critical health care issues, including finding a fix for scheduled Medicare physician reimbursement cuts.
Quality The quality movement got a big boost in late 2006 when Congress included a quality measurement incentive provision in the Tax Relief and Health Care Act of 2006. Among other things, the new law awards Medicare providers a 1.5 percent bonus if they report certain quality measures.
“It’s a start for legislative action this year,” Gerber said, adding that President Bush also pushed the movement along last fall with an executive order requiring federal health care organizations to use quality measures. “I think it all portends really good things for this year.”
Last year’s Senate bill included quality reporting provisions for health care organizations in general and tied it to funding. The House bill did not address the issue.
Wallace predicts that Congress will put a major emphasis this year on linking quality measurements and IT. “Right now, there’s a big focus on figuring out: How do we measure quality?” he said. “And the answer is through good information systems. So I think the legislative focus is going to be on: How do we align the IT movement and the quality measurement and the pay-for-performance and transparency movement?”
Personal health records Some Democrats see personal health records as a tipping point for health IT, Roberts said. “If they can get consumers bought into electronic health care, they believe that there will be more of a transformation, so I think there will be a lot of focus on personal health records and how they might be legislated,” Roberts said.
Last fall, for example, Kennedy, introduced the Personal Health Information Act, which aimed to support the rapid use and adoption of personal records, and he will likely introduce a similar measure this year or try to get the main provisions incorporated into a larger health IT bill. “Just the way banking was radically remade by consumer demand for ATM machines and online banking, we need consumers as part of the equation here,” Zamore said.
Odds and ends Meanwhile, a few issues that were included in the House and Senate bills last year are likely to be revisited but not necessarily with the same results. Mandating a move to International Classification of Diseases-10 coding is not likely to get passed under this Congress, and it may not even get proposed, Wallace said.
If Congress takes up the issue of Stark Act and anti-kickback exemptions for health IT, it could be just to undo the decision by the Department of Health and Human Services last summer to relax the rule. And there is likely to be a stronger push for setting interoperability standards that everyone can agree on.
Government Health IT presents Liesa Jo Jenkins, executive director of CareSpark, in this recent eSeminar, where she shared her experiences and insight into building a health information exchange that enhances community health, rewards regional collaboration and drives economic progress.
