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guest Guest Column by
David Blumenthal, M.D., M.P.P.

A Defining Moment for Meaningful Use

As we enter 2010, we can envision a transformation of our health system to improve health care quality, efficiency, equity, and safety through the use of health information technology (HIT), while providing the foundation for continued, measurable improvement in our nation’s health.  The adoption and meaningful use of information technology in health care is central to a necessary and overdue modernization of our health system. 

As required by the HITECH Act, the Secretary of the Department of Health and Human Services (HHS) has published an initial set of standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health information technology.  These criteria are outlined in the interim final rule (IFR) on Standards & Certification Criteria issued by the Office of the National Coordinator for Health Information Technology (ONC).  

The IFR provides details on requirements for “certified” electronic health record (EHR) systems, and the technical specifications needed to support secure, interoperable, nationwide electronic exchange and meaningful use of health information. 

In a related announcement, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) that outlines provisions governing the Medicare and Medicaid EHR incentive programs, including a proposed definition for the central concept of “meaningful use” of EHR technology.  In order for professionals and hospitals to be eligible to receive payments under the incentive programs, provided through the Recovery Act, they must be able to demonstrate meaningful use of a certified EHR system.  The proposed standards and certification criteria in the IFR are fundamentally linked to and specifically designed to support the 2011 meaningful use criteria.

Great care was taken in the development of these criteria, with input from the public and federal advisory committees every step of the way.  The resulting standards and certification criteria in the IFR are organized into four categories as recommended by the HIT Policy Committee and HIT Standards Committee:
 

  • Content Exchange Standards (i.e., standards used to share clinical information such as clinical summaries, prescriptions, and structured electronic documents);
  • Vocabulary Standards (i.e., standard nomenclature used to describe clinical problems and procedures, medications, and allergies);
  • Transport Standards (i.e., standards used to establish the communication protocol between systems); and
  • Privacy and Security Standards (e.g., authentication, access control, transmission security/encryption) which relate to and span across all of the other types of standards.


While well-defined data and technical standards are the foundation for interoperability between systems – allowing for reliable, consistent, secure, and accurate information exchange – we recognize that a high-level of nationwide interoperability will take time and will occur at varying rates.  Therefore, our approach to the adoption of standards and certification criteria is pragmatic, yet forward looking.  The criteria are designed to be supportive of the staged meaningful use requirements, but at the same time lay the foundation for future growth in information exchange and technological innovation.

An incremental approach to standards adoption requires harmonization with current and future standards to come.  We will continue to be guided by recommendations from our federal advisory committees, public comment, industry readiness, and future meaningful use goals and objectives established for the Medicare and Medicaid EHR incentive programs.  We anticipate this ongoing evolution in standards and certification criteria development as meaningful use requirements become more demanding over time and as industry continues to spur adoption through its innovative offerings.

Now, we ask for your continued input to inform the final regulations due in 2010.

Additional information on both of these regulations and how you can contribute to the open public comment periods can be found through the HHS news release and at the http://HealthIT.HHS.Gov website.

At ONC, we look forward to your continued and active participation in HITECH programming and ongoing rulemaking processes.

 

guest Guest Column by
Peggy Welch & Todd Rowland, MD

Working Together to Improve Healthcare with HIT

Health IT in Indiana has a long history of success in both academic and community settings. Heath Information Exchange is the strongest sector, with five operational HIEs serving the citizens of Indiana. State officials and the five HIEs serving Indiana are collaborating as part of a statewide effort to create a sub-national network of networks using federal standards.  There are still many hospitals, radiology centers, and laboratories that are not connected to HIE services—so there is much to be done. 

Indiana is 33rd nationally in electronic prescribing (SureScripts 2008), but is making tremendous strides in this area. Our stretch goal is to have Indiana make the biggest improvement in use of e-prescribing in 2010 and 2011.

Groups in Indiana have also applied for ARRA Regional Extension Center (REC) funding to assist ambulatory providers move to meaningful use. As an example, HealthLINC is participating in these activities and is applying its expertise to rural healthcare IT.  Educational institutions also realize they have a tremendous opportunity to help with workforce development for new HIT professionals. Members of the Indiana HIMSS board have been very proactive, implementing education programs today that will produce the medical leaders of tomorrow.  For example, Indiana University School of Informatics recently announced an informatics certificate program for clinicians that includes the St. Vincent’s family practice residency program.

In 2007, Indiana created the Indiana Health Informatics Corporation (IHIC) which embraces private sector successes and promotes statewide strategies aligned with the needs of Indiana and emerging federal plans for widespread use of HIT/HIE. IHIC includes a broad set of stakeholders that set the stage for ARRA-supported activities, including HIE statewide network of networks. This has led to the development of new state designated entity called Indiana Health Information Technology (IHIT) to directly contract with the Office of the National Coordinator. Several groups in Indiana have participated in federal level projects that have helped to establish much of the evidence base around HIT benefits.

Generally, larger hospital systems have more advanced implementations of HIT; however, there are some extraordinary successes in the rural hospitals of Indiana. Certain regions of Indiana, including Ft. Wayne, South Bend, Bloomington, Paoli, and neighboring regions have achieved very high levels of EMR adoption, ranging from 55% to as high as 73%. 

In addition to EMRs, many physician practices are participating with HIEs and using clinical electronic tools.  The benefits are improvements in speed and reliability of results delivery, care coordination, and communication within and across health care providers. Given the penetration of HIE services, physicians who use EMRs understand that an HIE data-connected system is critical to the practice of modern medicine. For example, Southern Indiana Pediatrics in Bloomington uses electronic tools to coordinate care for on-call physicians, physicians on vacation, across multiple office locations, and with pediatric specialists in central Indiana more than 50 miles to the north.

Looking at this from my nursing perspective, electronic tools are a means to an end, so we all need to remember that the target is improved value in health care.  Value is an expression of increased quality achieved in a cost-effective manner in concert with patients’ and families’ desires.  We must stay patient-centered.  I am fortunate to have skilled medical informatics professionals who share this vision with me. 

These colleagues express the natural stages as adoption, use, and eventual performance. It can take a long time to achieve performance improvements, so we must demonstrate a disciplined approach that supports our clinical colleagues in their journey. The current regulatory environment has created many unintended consequences by paying for high volume care and offering few incentives for care coordination—this is particularly true across inpatient to outpatient transitions in care.  As a legislator, I have made it my part of my job to stay tuned-in to ways that we can reduce unnecessary barriers to improvements in health care.  We are all in this together.

Peggy Welch is a registered nurse, Indiana State Representative for the 60th District (surrounding Bloomington), and Vice Chair of the House Standing Committee on Public Health.   Representative Welch also serves as the Chair of the National Conference of State Legislatures (NCSL) Health Committee.

Dr. Todd Rowland is Director of Medical Informatics at Bloomington Hospital, Executive Director of HealthLINC, and on the Adjunct Faculty at Indiana University, Bloomington.

 

guest Guest Column by
State Senator Richard Moore of Massachusetts

Health IT – A New Level of Care in the 21st Century

Health IT expansion in Massachusetts serves as a leading example for the nation as Congress continues to tackle national health reform. 

One of my first initiatives in health IT was to change Massachusetts law to permit the issuing of prescriptions and the physician’s signature electronically. For three years now, Massachusetts has ranked number one in the nation for the use of electronic prescribing.  According to the results of a nationwide audit of electronic prescriptions routed in 2008, prescribers in the Commonwealth sent more than 6.7 million prescriptions electronically, representing 20.5 percent of all eligible prescriptions in the state – as compared to 2.3 percent in 2005.

Established as part of “Health Reform II”, the Massachusetts e-Health Institute was created as a research and technological institute devoted to expanding the use of electronic prescribing and electronic medical record and health exchanges.  Part of Health Reform II included a mandate that everyone licensed to prescribe medicine must have competency in the administration of e-prescribing and other health technologies by January 1, 2015.

In addition, Massachusetts’ landmark health care reform law authorized $5 million for a pilot study of Computerized Physician Order Entry (CPOE) in three community hospitals in Massachusetts.  The pilot demonstrated that within about 18 months, the hospital could save about $2 million in reduced test ordering and medication errors. 

In addition to the creation of the Massachusetts e-Health Institute, I have played a role in the allocation of funds to the Massachusetts Technology Collaborative, which oversees the operation of the e-Health Institute, and the health information technology fund. 

Currently, the Massachusetts Technology Collaborative is in the process of applying for funds that would partially reimburse providers for their use of health IT.  The providers must prove “meaningful use” of existing technologies—including electronic medical records and prescriptions—in order to qualify for the stimulus funds.  While the funding will not be allocated towards the expansion of health IT with providers that do not currently use the technologies, existing clinicians will be allowed to expand their own practices in meaningful use, encouraging others to reap the benefits of modernized care.

I have two pieces of health IT-related legislation before the legislature this session.  The first, S 867, An Act Relative to Centers of Excellence, will study the feasibility of developing a consolidated center of excellence focused on technology, performance measurement and quality improvement in health care—which includes the expansion of health IT. The study shall include an examination of existing centers for quality, including the Health Care Quality and Cost Council, the Betsy Lehman Center, and the Massachusetts Health Quality Partners, as well as potential opportunities to increase efficiency and avoid duplication of efforts.

My second piece of legislation, S 1299, An Act Establishing a Health Care Electronic Prescribing Tax Credit, promotes the expansion of health IT by offering a tax incentive for providers.  This bill would modestly reduce the cost of implementing new health technologies, and would especially entice those that have yet to modernize their practices.

Quite simply, health information technology saves costs, and dramatically improves the quality of services offered to a patient.  Additionally, by reducing medical errors and duplication of tests, health information exchanges offer a safer alternative to traditional patient files.  Far too often do we hear of a clinician, technician, or nurse practitioner leaving behind patient files in a public setting.  Secure networks not only provide a modernized method of care, but enhance the efficiency and communication between various health care providers and insurance companies.

As we work to implement “Health Reform III” in the Commonwealth by addressing payment reform and moving away from fee for service to a global payments system, health IT will help to coordinate a new level of care in the 21st century. 

Senator Richard T. Moore is Senate Chairman of the Massachusetts Legislature’s Committee on Health Care Financing, President-Elect of the National Conference of State Legislatures, co-chair of NCSL’s Health Information Technology Champion’s (HITCh) Project, and a member of the National Governor’s Association’s State Alliance on e-Health.

 

guest Guest Column
by Vish Sankaran


“CONNECTing” Health IT Systems to Support Citizen Care

CONNECT is an open source software solution that lets health IT systems securely communicate with each other using nationally-recognized standards and guidelines. By using CONNECT, information can be shared among IT systems at doctor’s offices, federal agencies, state agencies, disability organizations, public health organizations, pharmacies, payors, labs and other health stakeholders, making it possible for information to follow patients and for caregivers to have a complete view of a patient’s health information.

The Nationwide Health Information Network (NHIN) is the emerging model for health information sharing among healthcare organizations in the U.S. The NHIN standards and governance will allow health stakeholders throughout the country to communicate reliably and securely. The CONNECT solution was originally built to meet federal agencies’ need to share health information among themselves, with other government agencies, and with the private sector using the NHIN governance and standards.

Rather than have each federal agency independently build its own NHIN-compliant gateway for health information exchange, the agencies came together through the Federal Health Architecture (FHA) E-Gov initiative to create CONNECT. Working closely with more than 20 federal agencies that participate in FHA, the CONNECT project team defined project needs, developed the solution, demonstrated its viability for connecting federal and non-federal health organizations, and made the solution publically available – all in less than a year!

The solution was officially released during the HIMSS 2009 conference, and today, the Social Security Administration and MedVirginia are in limited production and more federal agencies will go into limited production in the coming months.

Although delivering CONNECT has been an enormous undertaking with many stakeholders and evolving requirements, the result will provide the “gateway” to the future of American healthcare – a future where health records follow the patient through their healthcare experiences, doctors have relevant medical data readily available, citizens are better served through more complete public health data, and eligibility and adjudication for federal benefits can be processed more efficiently.

CONNECT was built to help make health information exchange a commonplace reality while lowering the cost and reducing the efforts required to achieve secure data exchange. Through CONNECT, we are enabling the creation of an ecosystem of vendors, end users and other stakeholders. This community will continue to evolve the product in line with market needs over the coming years. Many vendors have already begun building CONNECT into their health IT offerings to offer their clients, and end users throughout the country – both large and small – are implementing CONNECT as part of their health IT deployments.

The Viral Model: Achieving Rapid Results

Since CONNECT was released as an open source solution in early 2009, healthcare stakeholders  have adapted the solution, improved upon it, implemented it in their environments, and are getting on with the business of securely sharing health information in line with NHIN guidance.

The California eHealth Collaborative is one model of an organization taking advantage of the CONNECT solution.  Unknown to the CONNECT team, the California eHealth Collaborative successfully downloaded the free solution from the CONNECT Web site, took the solution and successfully used it to link five separate health information exchange projects in California. They connected the first two exchanges in a few weeks, and each additional exchange only took a couple of days to bring into the NHIN compliant network.

A quote from the press release about the California project sums it up well. "Our NHIN Gateway (CONNECT) is a federally-funded asset, and we can now use this resource to rapidly expand the ability to improve patient care by connecting with other health information exchanges in the state simply by using national standards," states Laura Landry, Executive Director of Long Beach Network for Health. “California needs the ability to share patient data across regions to the point of care, and we have just demonstrated how to do that using the Internet as the backbone and the NHIN standards as the on-ramp.”

Similar CONNECT projects are being initiated throughout the country, involving federal agencies, states, care providers and academia. 

The benefits of health information exchange are significant – ranging from improved continuity of care, fewer adverse drug interactions and better public health. By getting health organizations throughout the country to participate in secure data sharing to benefit patients, we will all be able to deliver a better care experience for citizens.
More information about CONNECT can be found online at www.connectopensource.org. 

Vish Sankaran is the program director for the Federal Health Architecture, the E-Gov initiative that works within the Office of the National Coordinator for Health IT to coordinate federal health IT activities.  FHA was responsible for the development and release of CONNECT.

 

guest Guest Column by
Sen. Mike Enzi (R-WY)

Government-run Health Care Not an Option for Enzi

A government-run option for healthcare is not an option for the U.S.  Last week, Health and Human Services Secretary Katherine Sebelius hinted that the Administration may be willing to look beyond a government-run option.

As I've said from the beginning, a government-run option is not an option. I voted against the Democrat plan in the Senate Health, Education, Labor and Pensions Committee last month and would do so again.  A government-run plan would increase healthcare costs, lessen service and add to our huge debt. The American people are doing a great job of getting this message across to the Administration and Congress.

Healthcare reform is urgently needed but a government takeover would make the situation worse. The “10 Steps to Transform Health Care in America” bill I introduced in the last Congress can be viewed at www.enzi.senate.gov, and other ideas put forward by both Republicans and Democrats as possible ways to make healthcare in America better.

One concept being discussed in the Senate is a non-profit health insurance cooperative where consumers could band together to seek better rates and coverage from health insurance companies.  This approach, depending on how it is written, could be similar to his small business healthcare plans, a part of his 10 Steps.

The co-op approach has potential and should be considered as long as it's not hijacked as a backdoor way to get a government-run program in place. I believe the American people have made it clear that this is not something they want. It worries them and they have rightly expressed their concerns.

If the Democrats choose to go it alone, their healthcare plan will fail because the American people will have no confidence in it. If we keep working together, we can get a bill that will work and will have broad support in Congress and from the American people.  We need to get a bill that 75 or 80 Senators can support. Unfortunately, some are determined to jam a bill through Congress that the American people do not want. The bill the majority leadership wants will drive up costs, deny patients access to their doctors and generally make health care in this country worse. This doesn't have to happen. The majority can choose to listen to what the American people are saying and let us take the time to get it right.

Sen. Mike Enzi (R-WY) is Ranking Member of the Senate Health, Education, Labor and Pensions (HELP) Committee and member of the Senate Finance Committee.

 

guest Guest Column by
Rep. Charles B. Rangel (D-NY)

Ways and Means Passes Historic Health Reform Legislation
The House Committee on Ways and Means today passed H.R. 3200, the America’s Affordable Health Choices Act of 2009, by a vote of 23-18.  According to the non-partisan Congressional Budget Office (CBO), reform provisions in the bill will cover 97 percent of Americans.  These provisions will be merged with provisions currently under consideration in the Committees on Energy and Commerce and Education and Labor for consideration by the full House of Representatives in the coming weeks. 

This is an exciting time in the history of this Committee and the Congress as we tackle the challenges of reforming America’s healthcare system.  America is ready for reform, the rising cost of healthcare has been draining the economy and the pocketbooks of American families for too long. The Committee approved legislation that will encourage competition in the health insurance marketplace, control costs and improve access to quality affordable care.  This uniquely American solution will put patients first, make critical investments in primary care and nurses, and reform the healthcare delivery system so that we can build a healthier, more productive economy.

The bill, endorsed by the American Medical Association, and supported by the AARP along with other organizations, includes important reforms such as the creation of health insurance exchange, a public health insurance option to compete with private insurers, and new rules to prohibit abusive practices by private insurers.  The bill strengthens Medicare and Medicaid, makes critical delivery system reforms and includes subsidies to make insurance more affordable for individuals and small businesses.  The bill also makes key reforms to the healthcare delivery system to help “bend the curve” and control long-term healthcare costs.

CBO has issued a preliminary estimate of the new reform provisions at a net cost of $1 trillion over ten years.  These reforms will be fully paid for through payment and delivery system reform in Medicare and Medicaid that will result in substantial cost savings, as well as a surcharge that will affect only the wealthiest one percent of households, and only four percent of small businesses.

The key principles of legislation include, among other things:

  • Increasing choice and competition. First, the bill will protect and improve consumers’ choices. If an individual likes their current plan, they will be able to keep it.  For individuals who either aren’t currently covered, or wanted to enroll in a new healthcare plan, the proposal will establish a healthcare exchange where consumers can select from a menu of affordable, quality healthcare options: either a new public health insurance option or a plan offered by private insurers. This new marketplace will reduce costs, create competition that leads to better care for every American, and keep private insurers honest. Patients and doctors will have control over decisions about their healthcare, instead of insurance companies.
  • Giving Americans peace of mind. Second, the legislation will ensure that Americans have portable, secure healthcare plans – so that they won’t lose care if their employer drops their plan or they lose their job.  Every American who receives coverage through the exchange will have a plan that includes standardized, comprehensive and quality healthcare benefits.   It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and limited age rating (2:1).  The proposal will also eliminate co-pays for preventive care, cap out-of-pocket expenses, and guarantee catastrophic coverage that protects every American from bankruptcy.
  • Improving quality of care for every American. Third, the legislation will ensure that Americans of all ages, from young children to retirees have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.  The proposal guarantees that every child in America will have healthcare coverage that includes dental and vision benefits.  It will provide better preventative and wellness care. Every healthcare plan offered through the exchange will cover preventative care. By growing the healthcare workforce, the proposal will ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.  The proposal strengthens Medicare and Medicaid so that seniors, people with disabilities and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.
  • Ensuring shared responsibility. Fourth, the bill will ensure that individuals, employers, and the federal government all share responsibility for a quality and affordable healthcare system. Employers who currently offer coverage will be able to continue offering coverage to workers. Employers who don’t currently offer coverage could choose to cover their workers or pay a penalty. All individuals would be required to get coverage, either through their employer or the exchange, or pay a penalty. The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.
  • Protecting consumers and reducing waste, fraud, and abuse. Fifth, the legislation will put the interests of consumers first, protect them from any problems in getting and keeping healthcare coverage, and reduce waste, fraud, and abuse.  The proposal provides complete transparency in plans in the health exchange so that consumers have the clear, complete information needed to select the plan that best meets their needs.

Additionally, it establishes Consumer Advocacy Offices as part of the exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.  The proposal will identify and eliminate waste, fraud, and abuse by simplifying paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.

For more information on the bill, including bill text, summary, information on revenue provisions, and fact sheets on the reform provisions in the bill, click here.

Rep. Rangel is Chairman of the House Ways and Means Committee.

guest Guest Column by
Rep. Allyson Schwartz (D-PA)

Last Friday, the U.S. House Budget Committee held a hearing examining the high cost of health care in America and the need for reform. The witness at the hearing, “The Economic Case for Health Reform,” was Christina Romer, Ph.D., Chair, President’s Council of Economic Advisers (CEA), who explained the CEA’s report on healthcare.  
  
The recent report from the CEA on the economic case for health care reform could not be more timely.  It serves as an important statement of how we cannot separate the challenges in our economy from the challenges of our health care system.  And in order to rebuild our economy, in order to enable American businesses to be more competitive, in order to set our budget and country back on the path to strong fiscal standing, we must enact a uniquely American solution to health care costs and coverage.
 
We have already begun this work.  In the first three months of this new Administration, we did more to strengthen health care than in the prior decade.  We expanded affordable health coverage to 11 million American children of working parents, took major steps to modernize medicine through health information technology, invested significantly in life-saving medical research, and ensured that American workers and their families hurt hardest by this recession continue to have access to health coverage when they lose a job.   

The three House Committees crafting comprehensive health care reform legislation released a draft of that proposal last week.  My colleagues in the Budget Committee have repeatedly heard me argue for health reform as an economic and moral imperative – our fundamental responsibility to improve health outcomes and expand access to affordable, meaningful health coverage to every American.  You have also all heard this Committee discuss the grave implications for the federal budget if we do not enact health care reforms that control the rate of growth of health care spending.
 
Health care reform that slows the growth of health costs will lower the federal deficit and promote national saving and capital formation.  Expanding health insurance coverage to all Americans will improve Americans’ health status and increase workforce productivity and free up dollars now used for benefits for increased wages, additional job growth, and other needed investments.  And perhaps, most obviously, driving down the cost of health insurance will relieve some of the burden of employee health benefits on our businesses that are struggling to compete.

guest Guest Column by
Rep. Michael Burgess (R-TX)

No Quick Fixes for Healthcare

My clinical background has left me with the overwhelming impression that, as far as medicine is concerned, Americans are ready for change.  They are frustrated with an expensive and complicated system that is not serving anyone well.  Primary care physicians don’t get paid enough, patients pay too much, many people don’t get any care at all, and everyone claims that someone else needs to change. 

In response, many people are pointing to ‘universal’ health care as the answer.  Being part of the federal government myself, I certainly don’t want Congress making medical decisions for me.  There are only 7 doctors in the House of Representatives!   Plus, any decision-making requires months of deliberation and consultation with lawyers – the process is simply too slow to be responsive to rapid advances in science and medicine.

Instead, I think medical decisions should be made by doctors and patients, and that is why I believe market-based health care would better serve Americans.  I want you to have the power to walk out of the waiting room and find care somewhere else if you feel that the staff are rude and the prices are too high. 

Health Savings Accounts (HSAs) are one way to accomplish this.  HSAs are investment-type accounts that can be established with tax free dollars and are dedicated to the account holder's medical needs.

They allow all Americans - regardless of income level - to save money for health care expenses, yet are paired with a high-deductible insurance plan to protect the individual from overwhelming medical costs.  I am a strong supporter of HSAs because they allow individuals to control their own health care dollars. 

Most Americans have a series of jobs throughout their lifetime, which means that they are repeatedly changing health insurance plans.  As they get older, the list of pre-existing conditions may grow, and patients get less value for their health insurance premium.  Patients with HSAs have portable, pre-tax health care dollars.  This money allows them to choose their own doctor and pay smaller premiums, and they don’t have to switch plans and lose benefits if they change jobs.  Most health care providers, who would normally have to wait months for an insurance company to process the claim, also like the idea. 

As the cost of medical care continues to increase, businesses are more and more reluctant to provide coverage for their employees, while the self-insured market can be cost prohibitive for most Americans. In light of these developments, the U.S. Congress must: (1) enact laws that provide a safety net for the poorest of the poor; (2) take less taxpayer dollars so they can be used to pay for the cost of a family's health coverage; and (3) provide new incentives for families and individuals to save for their health expenses.  I would like to build on prior success by making the premium payments for HSA high-deductible health insurance plans completely tax-deductible.

There are no quick fixes for American health care.  If you think universal healthcare sounds too good to be true, then it probably is.  But we do know that market-oriented reforms can give health care consumers more options (and importantly, less expensive ones) when it comes to their health needs.

Rep. Burgess will provide the opening keynote for HIMSS Virtual Conference & Expo June 9-10, 2008.

guest Guest Column by
Rep. Joe Barton (R-TX)

Market Based Approach Needed for Healthcare

Access to quality, affordable healthcare is an issue that affects every family. The US healthcare system is a complicated mix of private and public payers, using a patchwork of different providers to care for patients. In this country, we have the best trained medical professionals, the most state of the art facilities, and are the world leader in technology. The US spends more on healthcare than any other country in the world. Ensuring Americans are able to afford the healthcare they need is an important priority for me in Congress. I believe a more market based approach to healthcare will lead to greater flexibility, efficiency, and lower costs.

Medicare has been a great program that provides seniors, ages 65 and over, with healthcare. The program was most recently expanded in 2003 with the addition of the prescription drug benefit (Medicare Part D). Medicare Part D is important because many medical conditions that once led to hospital time or invasive treatments can now be managed by taking medication.  This benefit allows seniors to get the life saving drugs they need at a price they can afford. Surveys show that more than 75 percent of beneficiaries are pleased with their coverage and are saving an average of $1200 more per year than those without coverage. The Part D benefit was created based on market principles, whereby private plans compete to provide drug coverage.  Estimates show that over $96 billion in taxpayer funds is being saved as a direct result of competition.

I believe that true reform in our healthcare system will come by creating competition within our federal programs. One approach to bringing competition to Medicare was the creation of the Medicare Advantage program (MA). The MA plans were also created in 2003 along with the Part D benefit. These plans offer an alternative to traditional fee-for service Medicare. Enrollment in the MA program is at an all time high.  The Centers for Medicare and Medicaid Services (CMS), state that: “In 2007, MA plan enrollees are receiving an average of $86 in additional benefits monthly.  These benefits can include lower cost-sharing, additional benefits beyond the original Medicare benefit package (including enhanced Part D coverage), and premium reductions. 

Medicaid is facing a financial crisis.  The growing cost of this program threatens to bankrupt state budges if not reformed. Non-disabled children and adults comprise the majority of Medicaid enrollment, however, the cost of providing services to these individuals are a relatively small portion of total Medicaid expenditures.  Long-term care, is the costliest program in Medicaid, yet these services are provided to relatively few users. As our population ages, long-term care needs will increase.  We must ensure that Medicaid is not the only healthcare option for these individuals and must increase the availability and usage of private healthcare insurance.  By providing more options for individuals needing long-term care, we can ensure that Medicaid funds are available to the children and families the program was originally intended to serve.

One way to increase access to healthcare is by the use of HSAs. These savings accounts that provide a great way for people to pay for unreimbursed medical expenses. HSAs are beneficial because contributions are deductible (or excluded from income that is taxable if made by employers), withdrawals are not taxed if used for medical expenses, and account earnings are tax-exempt. Unused balances may also accumulate without limit. I strongly support the use of HSAs.

guest Guest Column by
Sen. Richard Durbin (D-IL)

Affordable, Accessible, Quality Healthcare

Over 46 million Americans are uninsured, an additional 16 million have only inadequate health care coverage, and both of those numbers are on the rise. It should be our goal to cover every American. We must support programs that help cover people with disabilities, such as the Supplemental Security Income program. When I served as a member in the House of Representatives, I cosponsored and voted for the Americans with Disabilities Act (ADA), and I will continue to support legislation to end discrimination based on disability. I support increasing the number of children with health insurance by expanding the Children's Health Insurance Program. I am also working to make private health insurance more affordable for small businesses and their employees by pooling together into one risk and purchasing pool.

Though it is important to improve our healthcare system by supporting new medical facilities, hospital beds, and physician services, the truth is that these will do very little to reduce the root causes of illness. Too many children are growing up unhealthy; as a result, they are at a higher risk for developing medical problems later in life.

Despite the extraordinary progress in health care in recent years, minority Americans continue to experience more health challenges than do American Caucasians. I am a cosponsor of legislation aimed at eliminating health disparities through education and training, healthcare quality and access, research, data collection, and leadership and collaboration. I am also an active supporter of efforts to promote freedom from hunger, and I have worked consistently over the years to preserve and strengthen federal nutrition programs including WIC, Food Stamps, and School Lunch and Breakfast Programs.

Healthcare Workforce

Over 1.5 million Illinoisans live in medically underserved areas where there aren't enough primary healthcare providers. Given the growing nursing shortage; the uncertain supply of physicians; the availability of dentists, pharmacists, and other health professionals in high need areas; and the diversity of our healthcare workforce, I am working on several fronts to improve the quality and quantity of health care workforce professionals.

I am a strong supporter of Title VII programs, and have worked to expand and strengthen programs like Centers of Excellence, the Health Careers Opportunity Programs, and Loan Repayment programs. I am advocating for nursing issues and have introduced legislation to address one of the major causes of the nationwide nursing shortage --not enough nursing school faculty-- by providing grants to nurse colleges so they can train, recruit and retain nurse educators. In addition, I have also worked with another senator to introduce legislation that would strengthen and improve the capacity of the public health workforce to respond to emerging infectious diseases, food-borne illnesses, and bioterrorism.

The health and wellness of the American people reflects the health of our nation, physically and financially. I am committed to improving the health of our country now, and in the years to come.

guest Guest Column by
Rep. Patrick Kennedy (D-RI)

The Start of a Process to Turn the Tide on Failed Policies

The final agreement of the American Reinvestment and Recovery Act of 2009 is the start of a process to turn back eight years of failed fiscal policies that have resulted in the worst economic crisis since the Great Depression. I voted in support of this legislation because it will provide the essential federal funds for healthcare information technology, to help create jobs, invest in infrastructure, and help families who are struggling each day with job losses, mortgage payments, and declining retirement accounts.

Our healthcare system must be transformed to deliver the best quality care at the lowest cost.  While many individuals like to say we have the best healthcare system in the world, the truth is that we have the best talent, medical technology, and facilities in the world but that the system itself is a mess. How else can one explain the fact that as many as 98,000 Americans die of preventable medical errors in hospitals each year, with many hundreds of thousands more injured or endangered? Or that 45% of the time, patients fail to receive care according to scientific guidelines in appropriate situations? Or that in some places, Medicare spends 60% more than in others, with worse mortality and quality of care? 

This reinvestment bill will also put Americans back to work and help improve the local economy. The final agreement also includes tax cuts for 95% of working Americans, the most expansive tax cut for low- and moderate-income people in the nation’s history. In addition to tax relief for American families, there are also substantial tax incentives for small businesses, including increased small business expensing for businesses making investments in plants and equipment in 2009 and expensing for investment in new plants and equipment. The bill also includes $3.95 billion for adult job training, dislocated working job training programs, and youth service programs.

I had hoped this bill would offer a bolder vision for the future of our economy. I feel it is imperative that as we devise solutions to the current economic situation, we must also exhibit the foresight to draft the blueprint by which our nation’s future generations will find the tools and the means to thrive for centuries to come. We can neither escape the crisis we now find ourselves, nor can we prepare America’s children to compete in a growing global economy without 21st century schools, healthcare, energy sources and transportation. All the infrastructure we need in order to remain competitive in the future can also immediately make available jobs for Americans who now find themselves out of work.

President Bush inherited a record $5.6 trillion budget surplus from the Clinton Administration. President Obama inherited a $1 trillion deficit and the worst economic recession since the Great Depression. We have to dig out of a massive hole that will take bold thinking, enormous investments, and time. This reinvestment plan is not perfect, but leading economists agree we cannot wait any longer to address these challenges. I will continue to work with Congress and President Obama to push for investments and policies that are vital to spur job growth and provide future generations of Americans with the resources they need to remain competitive in a global economy.

guestGuest Column by Guest Column by
Congressman David Wu

Creating the Jobs of the 21st Century

With efforts underway to get our economy back on track, now is the perfect time to discuss the benefits and potential of health information technology (IT) to our economy. Job creation is a central theme of the economic stimulus legislation that is currently in development, and health IT will create thousands of jobs in the years to come, while making our health care system more efficient and reducing medical errors.

Health IT has received considerable attention from Congress in recent years. Standards and interoperability, privacy, and workforce development are all aspects of health IT that have been the topic of congressional hearings and legislation. While few question the need to invest in health IT, the lack of a trained workforce may prevent its widespread implementation.

A recent study from the Oregon Health & Science University states that more than 40,000 individuals will be needed to fill health IT jobs in hospitals alone. This does not account for the thousands more that will be needed outside of our hospitals. As we continue to demand more IT in health care, more workers will be needed.

To address the workforce shortage, I have introduced the 10,000 Trained by 2010 Act (10x10), H.R. 461. This bill provides capacity-building grants to grow the workforce to meet the growing demand for health IT. In the last Congress, this was the only health IT bill that passed either chamber. While it did not become law during the 110th Congress, I reintroduced this legislation recently and its passage is one of my top priorities.

As we consider what to include in an economic stimulus package, we have found the exact right moment to invest in 10x10. President Obama has called for $50 billion to be invested in health IT. He has also called for a stimulus package that creates jobs. 10x10 is job creation. The provisions within the my legislation will help put people to work in a field that is vital to making our health care system more efficient, while providing family wage jobs. Investing in health IT will bring our health care system into the 21st century.

guestGuest Column by Guest Column by
Sen. John Kerry (D-MA)

Affordable Health Care for All

In the wealthiest nation in the world, it is inconceivable that anyone could lack access to health care. Yet there are at least 47 million Americans - including 11 million children - who are uninsured. Health care for a family of four costs more than a minimum wage worker earns in a year. That's wrong and it creates a burden on both working Americans and the hospitals and doctors who treat them. It's clear that our system isn't working, and Americans are suffering as a result.

Affordable health care should be a right, not a privilege, and it is our moral responsibility to ensure that no American has to choose between receiving the care they need and putting food on the table. Our first priority must be to cover all children, no questions asked.

My Kids First Act, which I submitted to the Senate last year, would provide health coverage for every child in America through age 21. By requiring the federal government to take over Medicaid, states would be free to expand coverage for children above the poverty line. When passed, this proposal will save Massachusetts more than $219 million dollars a year, and states across the country will save over $6 billion a year. It's not only fiscally responsible; it's morally responsible.

Every American should have access to the same type of health care plan that Congress gives itself. If it's good enough for Members of Congress, then it's good enough for average Americans, and I would provide tax credits to make it affordable for those who fall through the cracks of our current system - the working class, small business owners and employees, and people between jobs.

I know this plan sounds expensive, but it could be easily paid for by repealing President Bush's tax cuts for those earning over $200,000. It's a matter of priorities. What is more important to us - ensuring affordable, quality health care for every American, or giving another tax break to those who need it least?

Affordable health care should be a right, not a privilege, and I will continue to fight in the Senate for health care for all.

 

guestGuest Column by
U.S. Senator Max Baucus (D-MT) Chairman U.S. Senate Committee on Finance

A CALL TO ACTION . . .
It is the duty of the next President and the next Congress to reform America’s health care system.  In 2009, Congress must take up and act on meaningful health reform legislation that achieves universal coverage while also addressing the underlying problems in our health system.  The urgency of this task has become undeniable. 
In preparing to act, I led the U.S. Senate Committee on Finance in holding nine hearings on health care reform this year, and hosted a day-long health summit in June 2008 to explore in greater depth the problems plaguing our health system.  Additionally, I have spent a good deal of time talking to colleagues on both sides of the aisle and to stakeholders in the health care industry to get better perspectives on the issues that matter.

This “Call To Action” represents the next step.  It is not intended to be a legislative proposal.  Rather, it details my vision for both policy and the process in the upcoming health care reform debate.  The plan contained outlined here addresses health care coverage, quality, and cost.  Many components will require an initial investment but, over time, will vastly improve the quality of the health care Americans receive and reduce the cost of that health care, ultimately putting our system on a more sustainable path.  It is my intention that after ten years the U.S. will spend no more on health care than is currently projected, but we will spend those resources more efficiently, and will provide better-quality coverage to all Americans.

The health system is so complex that any solution will demand time and attention to make sure we get it right.  This plan is most certainly a work in progress.  But the intention of this “Call to Action” is to encourage constructive input by policymakers, stakeholders, and health policy thought leaders to move us forward.  I look forward to discussing this plan with President-Elect Obama, with my colleagues in Congress, and with stakeholders in the health care system, working collaboratively with all to enact an effective health reform law.

Americans who care deeply about the future of our health system and our economy must all take up the fight together for comprehensive health care reform.  My door will be open throughout the debate, and I will seek partners with “can do” spirits and open minds.  I believe — very strongly — that every American has a right to high-quality health care through affordable, portable, meaningful health coverage.  And I believe that Americans cannot wait any longer. 

guestGuest Column by
Rep. Pete Stark (D-CA)

HIT is the Key to Improving Healthcare System

Health information technology (HIT) is the key to improving quality, gaining efficiencies, and reducing cost in the U.S. healthcare system. That’s something that even people ranging from President Bush to Barack Obama can agree on.

There is no debate over whether we need such a HIT system in America. The debate is over the right role for government to foster the widespread adoption of such an interoperable, seamless HIT system. In this debate, it is vitally important to ensure that such a system has strong privacy protections and security requirements.  Some might say let the private sector do it. I’d respond that we’ve tried that and it’s failed. Currently only 20-30% of hospitals and 10-20% of physician’s offices have comprehensive health information systems. Even where systems are in place, they operate in silos and do not provide the aggregate data needed to improve quality of care.

One reason for this failure is that private industry has spawned the development of unique proprietary systems. These systems may work well for the doctor’s office or hospital system that purchases it, but they are unable to perform outside of their own network and therefore fail to meet the need of integrating our disparate healthcare system. This lack of progress is costing US tax payers millions of dollars. Studies have indicated that widespread adoption of HIT could reduce healthcare spending by $80 million annually. 

That’s why, in my mind, it is so important for the federal government to step into the arena of HIT. Not because I think government is better than the private sector. But, because I think that if our government has decided that a uniform, interoperable HIT system is a priority, we should step up to the plate to create the standards and help pay for its adoption. That’s precisely what the Health-e Information Technology Act that I introduced does.

With introduction of the Health-e Information Technology Act, I hope that we can move from the realm of private discussions to public endorsements. I am under no illusions that it will be easy to enact a bill like this. While the Congressional Budget Office has not yet provided a score for the legislation, we know that it will have significant costs. But down-payments are required to achieve yield on long-term investments. I am confident that a uniform HIT system will ultimately lead to dramatic improvements in the delivery system and reap great savings once it is in place.

We’ve been talking about this for decades. It is now time to act.

guestRep. John D. Dingell (D-MI)

2009 Will Bring New Opportunities for Health Reform

In many ways, our health care system is the best in the world. Yet too many Americans do not have access to quality care, and many who have access still face financial ruin due to inadequate coverage. It’s nothing short of a disgrace that here, in the world’s wealthiest country, 47 million people are without health coverage. Nearly nine million of them are children. Most adults without health insurance are working full-time, but have jobs that do not provide insurance.

Unfortunately, for nearly eight years our President has done little to help the growing pool of uninsured and underinsured Americans. And this Administration has fought nearly every effort to improve or extend coverage for our youngest, oldest, poorest and most vulnerable.

In 1993, the last time our country launched a serious reform effort, health care spending was 14 percent of our GDP. Today it’s nearly 17 percent.  Annual insurance premiums for a family of four now average more than $12,000. Half of all bankruptcies in our country are the result of medical expenses.

Our current health care system isn’t just morally indefensible, it's also economically untenable. Some of our largest corporations simply can’t compete with foreign companies based in countries with universal health care.

It’s been sixty years since President Truman issued the first call for a national health care plan. In 1942, my father, John Dingell, Sr., tried to answer Truman’s call by introducing the National Health Insurance Act in the House of Representatives. And I have carried on Pop’s work, opening each Congressional session by introducing a bill to provide every American with health insurance.

Though we have not moved forward as far or as quickly as I would have liked, we have made significant progress, chiefly by creating programs such as Medicare, Medicaid and SCHIP. These programs have allowed millions of Americans to enjoy better health and feel more financially secure.

In 2009, we must build on these efforts. Next year, there will be new opportunities for reform. Not only because we will have a new Administration, but also because support for comprehensive reform has become widespread, and a diverse group of business and health industry leaders are now calling for change.

 

guestGovernor Edward Rendell (D-PA)

The Prescription for Pennsylvania

The health care crisis is a national problem, but we can and must take responsibility for a Pennsylvania solution. To increase the competitiveness of Pennsylvania businesses and the health and well-being of our residents, we need a "Prescription for Pennsylvania" that expands access to affordable health care coverage, improves the quality of care our residents receive and gets health care costs under control for employers and employees.

The cost of inaction is far greater than what it will take to improve health care for Pennsylvanians. Charges for uncompensated care for the uninsured, additional days of hospital care due to potentially avoidable hospital acquired infections, certain medical errors, readmissions for complications and infections and avoidable hospitalizations due to inadequate care for patients with chronic diseases total $7.6 billion per year. And there are other major cost drivers such as excessive use of emergency rooms for non-emergency care and lack of control over duplicative, expensive capital expenditures. Much of this is paid for through higher health insurance premiums by Pennsylvanians and Pennsylvania businesses.

Our health care system is broken, and Pennsylvania's families and businesses are suffering the consequences. 767,000 Pennsylvania adults are forced to go without health insurance. For those who are covered, the cost of health care is rising far faster than wages. And despite the United States spending more on health care than all other developed countries and even with the extraordinary skills of Pennsylvania’s health care providers, residents of Pennsylvania are not consistently getting the quality of care they deserve.

Prescription for Pennsylvania is a realistic plan for meeting our urgent needs by:

  • Providing Access to Affordable Health Care Coverage to Every Pennsylvanian.
    Cover All Pennsylvanians (CAP) will make affordable basic health insurance available to eligible small businesses that do not presently offer health insurance to their employees and to the uninsured. This coverage will be offered through the private insurance market. In addition, more effective regulation of the insurance industry will ensure that small businesses and other consumers are not faced with skyrocketing costs for their health care coverage.
  • Expanding Access to Health Care in Appropriate Settings for the Best Cost.
    Prescription for Pennsylvania will make more health care providers available to Pennsylvanians by enabling nurses, dental hygienists and other licensed health care providers to practice to the fullest extent of their education and training. With Pennsylvanians 11% more likely than the average American to go to the emergency room - often because they do not know where else to go for their primary health care needs - the plan will promote non-emergency settings for non-emergency care. The Prescription will increase the number of care centers in shortage areas and promote incentives for health care providers who offer services in the evenings and on weekends.
  • Improving Quality by Delivering the Right Care, Right, the First Time and Promoting Wellness -- Strategies that Save Money While They Improve Lives.   Real reform requires everyone in the health care system to be accountable, including consumers, hospitals and health care providers.

Prescription for Pennsylvania will focus on patient safety by eliminating hospital-acquired infections - saving thousands of lives and billions of dollars each year - and targeting avoidable medical errors. The Prescription will promote a payment system that rewards wellness and does not pay for unnecessary or ineffective medical services. The plan will also improve the care received by the many Pennsylvanians suffering from chronic conditions such as heart disease, diabetes and asthma. And to help all Pennsylvanians stay healthy, the plan will support consumer incentives that reward healthy lifestyles.  For more information, please visit www.RXforPA.com.

 

guestRep. Phil Gingrey, MD (R-GA)

On May 7th, I introduced the Medicaid and SCHIP Abuse Prevention Act of 2008 (H.R. 5691). This legislation would eliminate the potential for individuals to fraud programs such as Medicaid and SCHIP, so that these programs can instead be used to benefit those truly in need. The Medicaid and SCHIP Abuse Prevention Act of 2008 will help ensure that these programs continue to be made available for the most vulnerable and needy in this country.

SCHIP and Medicaid were originally designed to be safety-net programs for those most in need in our society.  However, these assistance programs for low-income Americans are now being hijacked, and their funds misused.  By exploiting inadvertent loopholes in the statute, some states are allowing people to disregard significant portions of their income in order to appear poor on paper, even though their actual income is much higher.

For example, there is a state whose statutory upper limit for SCHIP is 200% of the Federal Poverty Level, which is $42,400.  However, by using income disregards, this state allows people to enroll in SCHIP with incomes up to $74,200 per year, which is 350% of the FPL. Yet, nearly 25% of this state’s children – whose families make under 200% of the FPL – are uninsured, leading many to argue that by focusing on higher income families, the state is ignoring the very people it should be helping the most.

Disregarding whole blocks of income – a practice already being employed by as many as thirteen states – for the sole purpose of making an individual eligible for a government entitlement program is an egregious practice that manipulates the very intent of these programs. In order to ensure these programs serve children and individuals who ACTUALLY qualify as “low-income,” the Medicaid and SCHIP Abuse Prevention Act of 2008 will institute a gross income cap of 250% for SCHIP and Medicaid eligibility. This legislation will limit any income disregards to a maximum of $250 per month or $3000 per year.

Placing a firm eligibility cap on SCHIP and Medicaid is the best way to ensure that federal taxpayer dollars are spent on those most in need, and will not be diverted to people who already have the ability to purchase their own health insurance plan without taxpayer-funded assistance. 

The bill’s original co-sponsors include: Rep. Feeney (R-FL), Rep. Walden (R-OR), Rep. Herger (R-CA), Rep. Bartlett (R-MD), Rep. Kingston (R-GA), Rep. Broun (R-GA), Rep. Miller (R-FL), Rep. Wilson (R-SC), Rep. Price of Georgia (R-GA), Rep. Westmoreland (R-GA), and Rep. Deal (R-GA).

 

guestArizona Governor
Janet Napolitano

'Stimulus' and the States

The states are now in a precarious position. The economy is slowing down. Tax revenues are falling. And demand for expensive services – health care, food assistance and the like – is growing.

A slowing economy is never easy. But this year, the states' fiscal crunch is being made worse. That's because misguided policies put in place by Congress and the Bush administration have either forced states to spend money or driven away tax revenue.

Before anyone in Washington seriously contemplates a second "stimulus package" aimed at reviving the economy, I would offer two succinct pieces of advice: First, take a Hippocratic Oath to do no harm to state budgets. Second, ensure that Washington "pays its bills," just as we require of everyone else.

Let's start with doing no harm. The plain fact is that the first stimulus package violated this principle, and will result in nearly $2 billion in revenue loss to states. State taxes are based on the amount of federal taxes individuals and businesses pay. So when the stimulus package cut federal business taxes, it also cut state taxes and thereby cost us revenue.

Fortunately, Congress is considering bipartisan legislation in both the House and Senate that would provide new resources to help states.

Now, let's talk about Washington paying its bills. The Bush administration has perfected the nasty habit of cost-shifting to the states. Examples are plentiful:

  • The State Child Health Insurance Program (Schip). The beauty of Schip is that it is a federal-state partnership. Yet in August 2007, President Bush stopped states from expanding Schip to cover children in families who earn more than 250% of the federal poverty level. As a result, states must now carry the additional burden of providing health care for these children.

  • Medicaid. The administration has also proposed or issued eight different regulations that alter the federal-state Medicaid partnership. In most cases, these regulations simply shift costs to states and localities. Collectively, they will reduce federal investment in Medicaid by $50 billion over the next five years. It's not as if poor people no longer need health care. Instead, these regulations are simply a maneuver to have someone else (i.e., the states) foot the bill.

  • State Criminal Alien Assistance Program. By law, the federal government must reimburse states for the cost of incarcerating illegal immigrants who break state laws. But for years, the federal government has only reimbursed a fraction of the cost.

Arizona's unpaid bill is nearing $500 million. As governor, I must enforce the law and pay to incarcerate these individuals. The federal government just shrugs its shoulders and walks away from its statutory obligation.

  • Real ID. The federal government passed Real ID so everyone would have a secure identification card. But it didn't pay states to do the work. Estimates for implementation run as high as $11 billion.

Even if you accept the Department of Homeland Security's suggestion that costs may be closer to $3.9 billion, this is a large unfunded liability. States are not in a position financially, nor inclined from a policy perspective, to bail out the federal government on Real ID.

  • Byrne-Justice Assistance Grant program (Byrne-JAG). This is the only federal, comprehensive crime-fighting program in existence. Yet, the Byrne-JAG grants were cut by 67% in the omnibus appropriations bill that was passed last year.

Grants would have funded multijurisdictional drug and gang task forces, information sharing and technology, county jails, prosecutors, drug courts, juvenile delinquency and drug treatment programs. Now, states – as well as counties and municipalities – are on their own.

There are dozens more examples. Even if the federal government paid up on only a few of its debts mentioned here, Arizona would not be in deficit this year. It's that simple.

Rest assured, states will manage their economic challenges and balance their budgets as they have before – 49 of the 50 states are legally required to have balanced budgets. But Washington's failure to meet its obligations is forcing states to cut education, health care and other vital services. The federal government should accept its responsibility, do no harm and pay its bills. Once it does, we can work together to improve the quality of life for those we are privileged to represent.

 

guestNew Hampshire
Governor John Lynch

Citizens Health Initiative to Develop Plan for Using Technology to Improve Health Care Quality, Affordability

This week I directed the Citizens Health Initiative to develop a plan for improving the state’s health information infrastructure to improve health care quality and affordability for New Hampshire citizens.  Our goal is to keep New Hampshire one of the healthiest states in the nation, and make sure more of our citizens have access to quality health care, at a more affordable cost.  Technology can help us reach that goal, by doing for the health care industry what it has done for virtually every other industry - improve quality and efficiency, which cuts down on errors and reduce costs.

As the use of healthcare technology grows, there is a risk of numerous potentially conflicting standards for health information technology in the health care community, which may make it difficult to appropriately share patient information and jeopardize the health care improvements that can come from the greater use of electronic medical records.
We want to make sure New Hampshire citizens get the maximum value from the increasing use of technology in health care.  That is why I am asking the Citizens Health Initiative to bring people together now to make sure we develop common standards.

I issued an Executive Order directing the Citizens Health Initiative to work with hospitals, providers and businesses to further develop the state’s health information technology infrastructure in a way that will encourage common standards and coordinated efforts and ensure the privacy personal medial information is protected.

In 2005, I created the Citizens Health Initiative Citizens Health Initiative bringing together lawmakers, state government officials, business leaders, health care providers, workers, and insurance experts to address the state’s health care challenges.
This Executive Order directs the Citizens Health Initiative to convene  working groups comprised of various stakeholders from across the state. The strategic plan will be delivered to the Governor by Dec. 1.

Through the work of the Citizens Health Initiative, New Hampshire has set the goal of being the first state in the nation to ensure all physicians have the ability to prescribe medications electronically, which will help lower costs and reduce errors.

The Citizens Health Initiative has worked with insurance companies to develop criteria for “pay-for-performance” standards putting the focus on preventative healthcare. The Initiative also has a Web site, www.nhhealthinfo.org, that allows employers to get the information they need to make informed decisions about employee health benefits.

 

guestRep. Patrick Kennedy (D-RI)

New Legislation Expands Federal Neurotechnology Research and Development

I recently introduced legislation designed to unite and expand federal neurotechnology research and development efforts under a National Neurotechnology Initiative (NNTI).  Using targeted funding increases, totaling less than 4 percent of the total brain and central nervous system research budget, the National Neurotechnology Initiative Act will ease bottlenecks, increase coordination, and result in critical treatments reaching patients faster. 
The passage of mental health parity legislation in the House was an important step towards bringing greater attention to brain-related illness.  It is important that we continue taking steps to better understand and ultimately develop treatments for all the various illnesses of the human brain.  Key provisions of the legislation are outlined below (FY09 Authorization levels are in parentheses): 

  • Coordinates Interagency Neurotechnology Research and Development
  • Creates a National Neurotechnology Initiative that supports and coordinates NIH and interagency neurotechnology research and development, including partnerships with small businesses and coordination with the FDA. 
  • Establishes a National Neurotechnology Coordinating Office within the Department of Health and Human Services to implement the NNTI, help agencies such as the VA, Defense Department, and HHS plan joint and complementary research strategies, and serve as the unified voice of federal neurotechnology efforts ($5 million).
  • Creates an advisory panel of experts from industry, academic institutions, and non-profit organizations to inform the NNTI on issues including R&D priorities, technology transfer, commercial applications, and ethical, legal, and social issues.  
  • Supports Inter-Institute NIH Neurotechnology Research and Development
  • Authorizes the ongoing NIH Blueprint for Neuroscience Research, a collaboration between the 16 NIH Institutes involved in brain and nervous system research.
  • Provides a steady source of sufficient funding for the Blueprint ($80 million).  
  • Accelerates NIH Partnerships with Innovative Neurotechnology Small Businesses
  • Increases NIH funding for SBIR and STTR programs, with an emphasis on translational neurotechnologies ($75 million).  
  • Increases Neuroscience Staff and Training at the Food and Drug Administration
  • Provides funding for the FDA to increase neuroscience-related staff, provide funds for training and to develop workshops to improve the timelines and safety of the neurotech review process ($30 million).  
  • Examines of Ethical, Legal, and Social Issues
  • Provides for a research center to conduct studies on the ethical, legal and social implications of neurotechnology, addressing issues such as its appropriate use in the criminal justice system, or enhancement of soldier and civilian mental capabilities ($10 million).

The brain is the most important component of the human body, and with so many Americans suffering from brain-related illnesses, it is crucial for us as a society to maximize our efforts and continue learning about the many facets of the brain, leading to a healthier life for all Americans. 

guestU. S. Senator
Debbie Stabenow (D-MI)

Senate Budget Places Priority on Veterans Health Care Needs

As a member of the Senate Budget Committee, earlier this month I announced the Senate passage of the Fiscal Year 2009 Budget Resolution, which for the second year in a row, will fully-fund veterans’ health care in order to make sure that our country keeps its promises to those who have served our country and will include two of my amendments that put veterans first. One amendment prevents the Bush Administration from doubling the cost of prescription drugs co-payments and implementing enrollment fees for our veterans.

The other amendment helps lay the groundwork to make the Department of Defense and Veterans Administration’s health record systems compatible, which means lower costs and improved care for those transitioning from active duty to veterans’ service.

Michigan is home to over 760,000 men and women who have worn the uniform in defense of our country.  Our veterans have always been there for us and our country needs to be there for them. Providing the necessary funding for our veterans has been a long, hard fight, and the Senate’s Budget is a major step towards our goal. No one who has put their life on the line for their country should ever be forced to pay more for health care or fall through the cracks because there is a lack of resources.

My amendment rejects the Administration’s proposed increase in health care costs for veterans.  Currently, many veterans have an $8 per prescription co-pay for each 30 day prescription.  As of October 1, 2008, the President's Budget would increase the co-pay to $15.  Veterans, who make more than $28,429 dollars but less than 80% of the community’s median income, would be subject to co-payment increases as well as enrollment fees.  My amendment will help ensure that the brave men and women that have put their lives on the line in service to our country are not strapped with additional health care costs.

My Health IT amendment, included in the budget, will help pave the way to fund the Department of Defense and Veterans Administration's effort to make their electronic health records compatible.  The Wounded Warrior Act, which passed last year, requires that these systems be compatible. This will help ensure that soldiers returning home from Iraq and Afghanistan do not fall through the cracks.

As a member of the Budget Committee, I have been an advocate for the needs of our nation’s veterans.  Last year, veterans from across the country looked to Democrats to make their health care needs a priority, and we delivered.  While the current administration has consistently under-funded the Veterans Administration, I have fought at every turn for full funding of veterans health care and to eliminate the year-to-year uncertainties in funding the needs of our nation’s heroes.

 

guestU.S. Senator Edward Kennedy (D-MA)

Our Nation Depends on a Strong Primary Care System

The number of primary care physicians and other health professionals trained in the United States is shrinking, according to Government Accountability Office findings announced during a Senate Health, Education, Labor and Pensions Committee hearing last month.  The nonpartisan research arm of Congress was asked to assess the state of primary care training in the United States. 

The health of our nation depends on a strong primary care system. There are too many communities that lack affordable, quality primary care services.  We must take the necessary steps to make sure that all Americans have access to primary care physicians and other providers. I look forward to working with my colleagues on this issue in our committee this year.

The number of U.S. medical school graduates enrolled in primary care residency programs -- such as family medicine, internal medicine and pediatrics -- fell to 22,146 in 2006 from 23,801 in 1995, according to the findings presented to the HELP Committee. Although the number of foreign-trained, primary care physicians went up.   

In presenting the findings to the Committee, GAO Health Care Director A. Bruce Steinwald testified that there is “a growing recognition that greater use of primary care services and less reliance on specialty services can lead to better health outcomes at lower cost.”

 

guestU.S. Senator Michael Enzi (R-WY)

Addressing Healthcare Workforce Issues for the Future

In my home state of Wyoming, one of our biggest challenges is providing timely access to health care providers.  That kind of access has been hampered because Wyoming is currently facing a shortage of health care professionals – and I am not referring only to specialists.  Clearly, that is a problem that needs to be addressed on more than one level.

To begin with, to have access to more health care professionals, we need more than a new, more effective grant program to increase their numbers.  We need real reform of our medical system as a whole.  I have introduced a Ten Step bill that will, when it is adopted, will greatly reduce the health professional crisis we are already seeing in states like Wyoming, Vermont, Alaska and Massachusetts.

We will be focusing on the training of health professionals, today, but I want to make it clear that work-force issues also include affordable medical insurance for patients, health information technology, better telehealth capabilities, and a liability environment for health care providers.   Together, these foundations will help to make people feel more satisfied with their career choice, more fulfilled by the work they do, and ultimately attracted to not only begin, but pursue the call of medicine for many, many years.
 
That is necessary because Wyoming has a long list of health care needs.  We do not have enough primary care physicians, dentists, physician assistants and nurse practitioners.  That is in addition to our shortage of subspecialists. 

Title VII of the Public Health Service Act is an important component of training our nation’s health care providers.  Loan repayment, underrepresented minority programs, faculty training, and various other education programs are important programs that need to be continued.  At the same time, we must coordinate the goals of the programs with the outcomes that we measure.  We need to improve these programs and our health care delivery system.  A few small tweaks are likely not sufficient.  That would be like adding a new heel to an old shoe that we would be better off replacing with a new pair. 

It seems to me it is also important that we may need to broaden training sites to include more ambulatory care sites in rural areas.  Recent experience in Wyoming shows that with concentrated effort almost 2/3 of the family practice physicians who train in Wyoming will stay in Wyoming.
 
We need to establish a National Health Work Force Commission so that we can start addressing the shortages.  I look forward to continuing the dialogue on this important topic and working with my colleagues on solutions that will place good and affordable health care within the reach of all Americans.

 

guestNew Jersey Assemblyman
Herb Conaway, MD

Health Information Technology Would Improve Quality of Health Care, Access to Patient Information

Governor Jon S. Corzine recently signed into law legislation I drafted to enhance the quality of health care delivered to New Jersey residents through a health information technology (HIT) system.

Improving access to health records for patients and medical practitioners would ensure that every patient receives the best care each and every time they seek medical attention.  Our paramount goal should be to do all that we can to reduce medical errors that can threaten the health and safety of New Jersey medical patients.  This health information sharing network will better coordinate the care of a patient among hospitals, emergency rooms, clinics, nursing homes, pharmacies, and health care professionals.

The “New Jersey Health Information Technology Promotion Act” (A-4044) will establish the state’s first electronic medical records infrastructure and create a Health Information Technology Commission to oversee the development, implementation and oversight of the program.  The new law will advance the quality of health care for all New Jersey residents through a secure and integrated medical records system.  The result is a comprehensive network to improve patient care, health policies and efficiency in research while cutting administrative costs and increasing our state’s emergency preparedness. 

Health Information Technology can save New Jersey over three-quarters of a billion dollars.  Electronic medical records also have the potential to cut-down on fraud and the misuse of New Jersey’s health care resources.

Thomas Edison State College released a 1994 healthcare information networks and technology study that showed that New Jersey could save as much as $760 million by migrating from paper-based systems to an electronic network.

The 19-member Health Information Technology Commission will be established within the Department of Health and Senior Services to oversee the creation and functions of a state-wide health information technology plan, with the assistance of the Department of Banking and Insurance, which will institute an Office for the Development, Implementation and Deployment of Electronic Health Information Technology, which shall be known as the “Office for e-HIT”.  The commission would be charged with promoting the use of national standards for the state’s HIT system including security, privacy, data content, format, vocabulary and information transfer standards.

The commission will include:

  • The commissioner or a representative from the state departments of Health and Senior Services, Banking and Insurance, Human Services and Treasury;
  • 19 members of the public, including representatives from professional health care organizations from across the state including,  one general practitioner physician, one physician who represents an acute care teaching hospital, and one physician from a non-teaching acute care hospital.   

The commission also would have access to assistance and services from any state agency as needed. The “New Jersey Health Information Technology Promotion Act” will take effect 180 days from the date of the Governor’s signing, January 13, 2008.

Assemblyman Herb Conaway (D-Burlington/Camden) is a practicing physician and Chairman of the Health and Senior Services Committee.

 

guestRep. Steny Hoyer (D-MD)

Working with Our Nation’s Providers

In almost every public poll that asks Americans what domestic issue most concerns them, health care is almost always listed among in the top three.  As a matter of public policy, health care dominates the debate, both in the state of Maryland and in Washington.

There is much more that must be done to improve the way our nation provides health care services to its citizens. One of the greatest challenges before us is decreasing the massive rolls of the uninsured. Currently, there are more than 45 million Americans without health insurance coverage, 9 million of which are children.  Quite simply, this is a national scandal.
 
It is simply unacceptable that in a country as prosperous as ours, 9 million children - one out of nine children - lack any covered access to health care services, while more than 20 million more who rely on Medicaid and the State Children's Health Insurance Program (SCHIP) endure considerable limitations to care.
 
Earlier this year, for example, a 12-year old boy from Prince George's County – Deamonte Driver – died from a brain infection caused by an abscessed tooth.  His Medicaid coverage had lapsed and he was denied access to basic dental services.
 
Cases like Deamonte's are precisely why the 110th Congress has made reauthorization of the State Children's Health Insurance Program (SCHIP) a top priority. Unfortunately, President Bush's budget request for SCHIP failed to keep pace with inflation, preventing millions of children from getting coverage and putting even greater strain on states' coffers.
 
Clearly, Maryland's doctors are the on the front line in the effort to ensure the health and well-being of our residents, particularly our elderly.  That is why I am committed to working with physician groups to ensure that Medicare fairly reimburses physicians for their services.  Some data show that Maryland ranks in the bottom quartile for reimbursement payments to doctors and health care providers. And, since 2002 the "sustainable growth rate" (SGR) that governs annual updates in Medicare has called for reductions in payment rates.  Cuts of 40 percent are anticipated over the next eight years.
 
Certainly, we must reexamine the SGR, but doing so will require significant investments, which must be balanced with other national priorities.  But as we work to get our fiscal house back in order at the federal level and reverse years of irresponsible budget and tax decisions, we must take steps to ensure that physicians can afford to serve our nation's elderly and needy.
 
The key point to remember as we look to make improvements in our health care system is that investing a few dollars up front will save many more later on.  Investments for immunizations, obesity prevention, smoking cessation, and research - just to name a few - will help us reduce patient care and hospital costs and prevent the government from having to spend more later on mandatory costs in Medicaid and Medicare.
 
Unfortunately, the Bush Administration has pushed spending levels over the years that have eroded our health care safety net. For example, the Administration proposed only a 1.6 percent increase in discretionary health programs for Fiscal Year 2008.
 
Surely, in the days and months ahead, Congress will work to make improvements to our health care system so that you - our front-line providers of health services – can provide quality care to all those in need.
 
I look forward to working with the medical community to implement necessary reforms, so that the United States – which has the most professional, dedicated and knowledgeable providers in the world – can address our shortcomings and fulfill our promise to the American people.
 
Congressman Steny H. Hoyer represents Maryland's 5th Congressional District and serves as the House Majority Leader in the 110th Congress

 

guestHouse Speaker Nancy Pelosi (D-CA)

Affordable Health Care is Critical

Access to quality, affordable health care is critical to the well being of America, today and in the future.  Central to this is addressing the needs of the 46 million uninsured Americans, strengthening the Medicare system, providing health insurance to our low-income children, funding cutting-edge research into cures for diseases, and giving patients the clout to challenge the decisions of health insurers. Only through action on these critical issues can we meet the pressing health care concerns of our nation.

A top priority of the new Democratic-led Congress is providing health care for our nation’s children. On September 25th, the House voted overwhelmingly to pass the final agreement reauthorizing the successful Children’s Health Insurance Program (SCHIP) for five years.  The Children’s Health Insurance Program provides health coverage to American children whose parents do not qualify for Medicaid, but can not afford private insurance. This bill will bring health coverage to approximately ten million children in need – preserving coverage for all 6.6 million children currently covered by SCHIP, and reaching millions more low-income, uninsured American children in the next five years.

On October 3rd, President Bush vetoed this legislation. On October 18th, House Republicans sustained President Bush’s veto of the Children’s Health Insurance Program Reauthorization Act of 2007, H.R. 976.  House Democrats will continue to insist on insuring the full 10 million children covered by this bill.

Eighty-six percent of children covered by the SCHIP program are in working families that are unable to obtain or afford private health insurance for their children. The program is crucial for both our children in our country’s rural and urban areas. In rural areas, one in three children has health care coverage through SCHIP or Medicaid. In urban areas, it is one in four. SCHIP has also had a dramatic effect in reducing the number of uninsured minority children. After SCHIP was enacted, the number of uninsured African American children dropped from 20 percent to 12 percent; the number of uninsured Latino children dropped from 30 percent to 21 percent, and the number of uninsured Asian American children dropped from 18 percent to 8 percent. Additionally, health care through SCHIP is cost effective. It costs only $3.34 dollars a day to cover a child under SCHIP, according to the Congressional Budget Office.

The passage of the SCHIP reauthorization is a bipartisan victory for America’s families and children. The reauthorization of SCHIP program presents an historic opportunity to put an end to the morally unacceptable fact that nine million American children live every day without insurance.


Medicare for Seniors

Congress is working to maintain Medicare’s commitment to insure our seniors and reverse harmful cuts proposed by the Bush Administration. We are working to prevent the scheduled 10 percent cut to physician payments, and create a path to a better payment system for physicians. Unless Congress acts with updates to reflect the increasing cost of running a medical practice, physicians in Medicare will receive a 10 percent reduction in fees and an estimated 5 percent patient reduction each year.

Congress will also enhance Medicare benefits for vulnerable populations, strengthening programs that provide financial assistance to low-income Medicare beneficiaries for premiums, cost-sharing, and prescription drug costs. Enhancing and simplifying eligibility and enrollment in these programs will help more beneficiaries afford health care services without being forced to choose between food and medical care. Our health care legislation will additionally invest in rural health care. Currently, rural patients and doctors face real problems with Medicare Advantage private plans. Rural doctors often receive far lower rates in these plans as compared to traditional Medicare. Investing in traditional fee-for-service Medicare is the top priority for rural America.  
 
Expanding Health Care for the Uninsured

It is a disgrace that there are 46.6 million Americans without health insurance. In July, Congress is considering legislation that takes steps to address this problem—funding several initiatives that would provide access to health care for more than 2 million uninsured Americans. The legislation provides $200 million, or 10 percent more than 2007 and the President’s request for community health centers, enabling these centers to serve an additional 1 million uninsured Americans.  It also provides $75 million for a new initiative of state health access grants—providing start-up grants to states that are ready with plans to expand health care coverage to targeted groups.  It also includes $50 million for an initiative to assist states in providing high-risk insurance pools to support affordable insurance for almost 200,000 people who are medically high-risk.

Strengthening Life-Saving Medical Research

Medical research at National Institutes of Health offers hope to millions of American families—with groundbreaking research into diseases such as cancer, diabetes, Alzheimer’s, and Parkinson’s. And yet the Republican-led Congress has been shortchanging NIH for years. Between 2003 and 2006, the number of new and competing research grants that NIH could support actually dropped by 12 percent.  For Fiscal Year 2008, the President proposed a cut of $279 million below 2007.  Instead, this Democratic legislation being considered in July provides an increase of $750 million over 2007 and $1 billion over the President—allowing NIH to support another 545 new and competing research grants. 

Military and Veterans’ Health Care

As part of the Emergency Supplemental funding measure signed into law in May, Congress is expanding and improving health care for the brave men and women who have given their all to keeping our country safe and secure. They deserve the best possible treatment. The legislation includes funding for Post Traumatic Stress Disorder and Traumatic Brain Injury care and research, for preventing health care fee increases for our troops, and for addressing the problems at Walter Reed Hospital. It will address the backlog in maintaining VA health care facilities, allow hiring of additional personnel for the administration of the VA health care system, fund mental health care for veterans, and speed up the processing of claims of veterans returning from Iraq and Afghanistan.

 

guestRep. Lois Capps, RN (D-CA)

Appropriate Nurse Staffing Levels Improve Patient Care

For the sake of our patients and our nurses we have to do a better job of ensuring there are enough nurses on staff to provide quality patient care.  It comes as no surprise that when there aren’t enough nurses on the job there is an increased chance of medical errors.  The Registered Nurse Safe Staffing Act (HR 4138) would require health care facilities to work with nursing staff to implement a system that ensures appropriate nurse staffing levels are present to promote quality patient care.  

The strain on overworked nurses leads to burnout, greater stress on the job and more nurses leaving the profession.  We all want patients to have the best possible care and nurse staffing practices that promote a safe and healthy work environment are a key element in reaching that goal.  This legislation encourages nurses and hospitals to work together to make sure the right number of nurses are there to provide the excellent care that each and every patient deserves. 

A study published in the New England Journal of Medicine in May of 2002 found that higher levels of nursing care correlate with better patient care and outcomes in hospitals. Another study in 2002 by the Joint Commission on the Accreditation of Healthcare Organization (JCAHO) found that nearly one‑quarter of all unanticipated events that result in death, injury or permanent loss of function result from inadequate nurse staffing levels.  And research published in the October 23, 2002 Journal of the American Medical Association concluded that a patient's overall risk of death rose roughly 7 percent for each additional patient above four on a nurse’s workload.

Appropriate staffing is the number one concern of nurses today and is critical to the delivery of quality patient care.  Proper staffing levels allow nurses the time they need to make patient assessments, complete nursing tasks, respond to health care emergencies, and provide the level of care that their patients deserve.  Proper staffing levels also increase nurse satisfaction and reduce staff turnover, an important priority given today’s nursing shortage and the projected shortfalls in the future.

 

guestMaryland Governor Martin O’Malley

Last week, I announced a new healthcare proposal that would extend medical coverage to more than 100,000 uninsured Marylanders – including poor adults and children.  Maryland currently has almost 800,000 residents who are uninsured, and ranks among the lowest states in Medicaid eligibility.  As members of the General Assembly come together to address the fiscal challenges of our State, I hope they will also focus on what is possible to improve the quality, access, and affordability of healthcare in our State.

Right now, in Maryland there are almost 800,000 people living without health insurance.  In many cases, healthcare is too expensive and out of reach for Maryland families, and when its available healthcare quality is not what it should be.   We can and must do better. 

My healthcare proposal which was introduced during the special session this week, would:

  • Help small businesses to provide health insurance to their employees;
  • Provide healthcare insurance to low income families and adults by expanding Medicaid to parents with incomes below $20,000 for a family of three – or 116 % of the federal poverty level, and;

Encourage wellness and prevention by lowering out-of-pocket costs in exchange for enrollees’ commitment of personal responsibility.

I also signed an Executive Order establishing the Maryland Health Quality and Cost Council to coordinate best practices of the private and public sector to improve healthcare in our State.  The Maryland Health Quality and Cost Council will be chaired by Lieutenant Governor Anthony Brown, and shall:  

  • Coordinate and facilitate collaboration on healthcare quality improvement and cost containment initiatives,
  • Make recommendations on healthcare quality and cost containment initiatives and priorities to policy makers, State and local governmental entities, professional boards, the Maryland Patient Safety Center, industry groups, consumers, and other stakeholders.
  • Develop a chronic care management plan to improve the quality and cost-effectiveness of care for individuals with, or at risk for, chronic disease,
  • Facilitate the integration of health information technology in healthcare systems; and
  • Examine and make recommendations regarding other issues relating generally to the Council’s mission to improve healthcare quality and reduce costs in the State.

I have also asked the Maryland Healthcare Commission to move forward as quickly as possible to create a Health Information Exchange that allows patients and providers to share vital information on a real time basis.  Information technology has tremendous potential for improving quality of care and eliminating many unnecessary costs. 

 

guestKansas Gov. Kathleen Sebelius

Healthcare: Make Your Voice Heard

Health care affects people more directly than any issue I've worked on during my time in public service.  We are all patients at some point in our lives, and we all know people who have benefited from the amazing medical treatments that are available today.

But we also all likely have friends or family members who fought endless battles with an insurance company, or neighbors who have no insurance at all and who were brought to the brink of financial ruin by a health problem.

Now, Kansans have two opportunities to make their voices heard in the national discussion on the health care crisis and how to solve it.  The first involves comprehensive health care reform in Kansas. The Kansas Health Policy Authority – a bipartisan group created to oversee health care in our state – is touring Kansas, listening to the stories of patients, providers, families and business leaders.

You can be a part of this discussion by going to www.khpa.ks.gov and offering your stories or your suggestions for how to improve health care in Kansas. Your input will help shape the reform plan that is presented to me and the Legislature later this year, and which will set us on the path to coverage for all Kansans.

At the same time, I also hope you'll contribute to a national debate on health care for children – a debate that's taking place right now.

Congress needs to take action soon in order to continue a program that provides health insurance to tens of thousands of Kansas children. As part of this debate, there are proposals being offered that would expand the number of low-income children who receive health care, and therefore have a healthier start on life.

I am joining other governors across the country in urging our congressional delegation to support an expansion in health insurance for children. We know that if a child is healthy, they will have a better start towards a successful life. I encourage you to contact Senators Brownback and Roberts, and your Congressional representative to add your voice to the discussion.

We can solve the health care crisis, but only if you make your opinions known to the people elected to represent you.
 
Together, we can create a future where every Kansan has access to affordable, quality health care, and I look forward to working with you to make that future a reality.

 

guestRep. Anna G. Eshoo (D-CA)

New House Legislation Accelerates the Adoption of HIT

We live in the Information Age, but healthcare, one of the most information-intensive segments of our economy remains mired in a pen-and-paper past. We can buy airline tickets online, we can check our bank accounts from anywhere in the world, and
we send pictures of new babies and grandchildren to friends and family via e-mail or instant messages. The healthcare industry, however, remains dangerously disconnected. Patients' medical histories are largely disaggregated among the various physicians who have treated them, and are often inaccessible to a new doctor or even to the patients themselves.

Such an inefficient healthcare information system creates unnecessary risks and costs. It's time to look at healthcare in a new way, focusing on overall health and not simply disease. We need to move toward a model of integrated care by providing ways for a patient's physicians to coordinate their care, and promote the modernization of our nation's healthcare system.

Health information technology (HIT) promises to revolutionize the healthcare delivery system and have a powerful effect on enhancing patient safety, reducing medical errors, improving the quality of care, and reducing healthcare costs. The deployment of HIT and the adoption of important patient tools such as electronic health records (EHRs) have been slow and have not kept pace with the advances of technology in nearly every other aspect of our lives.

To accelerate the adoption of HIT and create market conditions and incentives which will encourage investment in this critical technology, I'm introducing the Promotion of Health Information Technology Act. This legislation builds on the excellent work of Senators Kennedy and Enzi and will promote HIT in the federal government and throughout the healthcare sector.

Any meaningful HIT legislation must establish a process for the rapid formulation and implementation of standards to facilitate the exchange of interoperable health data and create incentives to ensure that these technologies are actually adopted. The Promotion of Health Information Technology Act establishes a streamlined process for the adoption of HIT interoperability standards and requires the federal government to abide by the standards it sets.

The legislation establishes a permanent position within HHS with broad responsibility to facilitate the exchange of interoperable health information and coordination of the government's own health IT activities and procurement. It also creates a permanent public-private advisory body to recommend or endorse appropriate HIT interoperability standards with definitive timeframes for adoption and updates. Broadly accepted interoperability standards are vital to the development of IT systems that can communicate and share information.

Under my legislation all federal HIT procurement must comply with the standards endorsed by the interoperability standards body. In addition, all agencies that collect health data electronically for purposes of quality reporting, health surveillance and other purposes must comply with endorsed standards. For HIT to gain a foothold in the healthcare marketplace, it is essential for the federal government to utilize its purchasing power in healthcare to ensure the United States is rapidly adopting these innovative technologies.

The Promotion of Health Information Technology Act also provides important protections for patients and their sensitive medical information. The bill establishes an ongoing system for certification of Electronic Health Records products by third-party entities and guarantees that individuals will have the right to inspect and obtain a copy of their EHRs and amend any inaccurate or fraudulent information. It also clarifies that operators of health information electronic databases like Google Health, Revolution Health, and WebMD are deemed to be covered entities under HIPAA. The use of non-identifiable health data for public health and research purposes is permitted with appropriate patient approval.

The bill establishes a process for the development of reports by ``Health Quality Organizations'' on federal healthcare data to advance healthcare research, enhance consumer education and awareness, and provide the public with reports on national, regional, and provider-and supplier-specific performance.

Finally, to provide resources for the adoption of HIT nationwide the Promotion of Health Information Technology Act authorizes funding for grant programs to assist state and local governments adopt HIT and promote adoption within their states. It also establishes a grant program for regional health information exchanges and a competitive grant program for private sector healthcare providers, with a preference for providers that use the ``Medical Home'' patient care model, which allows patients to have a single point of care and a medical provider to coordinate care through the use of HIT. The legislation also provides incentives for utilizing broadband to deliver HIT in underserved areas and funding of academic curricula to train qualified Health IT professionals.

The power of HIT to transform American healthcare is clear, but without aggressive action by the Congress to promote and adopt HIT, we will not see the benefits of these innovative technologies for years to come. The Promotion of Health Information
Technology Act will ensure that the federal government fosters the development and implementation of advanced Health IT networks and technologies in our country.

 

guestMaine Governor
John Baldacci

Health care is a basic human right, and universal health insurance coverage is my goal for every man, woman and child in Maine.

This is a great challenge. Health care is an issue so important and complicated that to truly provide universal insurance, a national solution is needed.

But as we just learned in the latest Census data released last month, the rate of the uninsured in the nation has climbed, this includes more children who are without health insurance.

Absent a national solution, with health care costs continuing to climb, states have had to go it alone. But Maine has led the way.

In the latest Census data, Maine tied for first in the nation in health insurance coverage. Through Dirigo Health Reforms, we are addressing underlying costs in the health care system while working to improve the quality of care and providing more insurance options in the health care marketplace.

We announced this week that DirigoChoice will now be offered through Harvard Pilgrim, a nonprofit insurance company. This new partnership is a better financial arrangement for Dirigo and helps bring competition back to the health insurance marketplace in Maine.

We have expanded coverage through Medicaid and through innovative efforts that ensure people don’t go without the health care they need, but that they get it by better managing and tightening the controls in the Medicaid program.

Also, in the recent State Legislative session, we achieved legislation to require insurers and allow employers to extend a child’s insurance coverage on a parent’s plan until the age of 25, regardless of whether or not the child is in school.

Much of our success in keeping our rate of uninsured low has been through the use of the tool known as the State Children’s Health Insurance Plan (SCHIP).  I was very pleased to be part of its creation at the federal-state partnership, being established in 1997. I was in my second term as a 2nd District Congressman from Maine.

This program has lived up to its promise. It is a unique program providing states with precious funding, and with the flexibility to craft their own effective programs.
Maine’s program is one of the most successful in the country.

In fact, 93% of children in Maine have health insurance. Even when talking about the hardest group of kids to insure – the poor and near-poor, children of working families – the very group designed for Children’s Health Insurance to cover – Maine’s has reached a successful coverage rate of 88%.

More than 13,000 Maine children have health care because of this program. But now, Maine and other states’ good faith efforts to extend affordable insurance to children are being threatened.

As I expressed in a letter to President Bush almost a year ago, pulling back coverage to our children is unacceptable.  Funding for this program is one of the best investments we can make to ensure that our children grow and develop healthy, reduce chronic disease instances and costs, and attend school better equipped to learn.

Simply put, future success of Maine’s efforts to provide quality affordable health care to Maine children depends on the federal government continuing to meet its responsibility to this program.  Luckily, Congress is moving in to reauthorize the Children’s Health Insurance Program in a way that keeps the promise made ten years ago.Both the current House and Senate versions of the reauthorization would enable Maine to continue the health insurance program for children.

Both bills would give Maine and other states the tools to expand that coverage. I want to extend my thanks to our Congressional Delegation: to Senator Snowe and Senator Collins; Congressman Allen and Congressman Michaud – for their strong support of Children’s Health Insurance Programs.  Their voices have been loud and clear through this debate.

Working with my Administration and other governors, they have rejected the White House’s attempts to curtail insurance to low and moderate income families.  Along with our Delegation in Washington, D.C., Children’s Health Insurance Programs has strong support in Maine from the Maine Legislature, the Maine Children's Alliance, Maine Equal Justice Partners, Maine hospitals, Maine physicians, among many others in the State of Maine, because they all know there’s nothing more important than protecting the health and welfare of the children of the State of Maine.

 

guestGovernor Joe Manchin III
West Virginia

Technology Will Help Control Costs and Improve Health Care

I am very excited about the promise that information technology holds for improving the health of West Virginians. In just as much as modern information technology has made it easier for us to bank online, conduct research, find a phone number or get the biography of our local council members, or to purchase items from around the globe, it can revolutionize the way we provide quality health care to our residents.

By more effectively using technology, such as electronic medical records, the health care community can directly improve the quality of care it provides its patients and can save millions of dollars and countless hours that free up valuable time and resources that could be better used to improve patient care. 

Soon after I took office, I challenged state government and the health care community to work together to make West Virginia a national model for implementing health information technology and adopting electronic medical records. I’m pleased to say that since then, we’ve put in place a leadership team that is making real headway not just in West Virginia, but that’s also drawing attention on a national level.

In 2006, I introduced and signed Senate Bill 170, which created the West Virginia Health Information Network (WVHIN). The network is a public-private partnership of consumers, physicians, medical facilities and business leaders, led by WVU School of Medicine neurosurgeon Dr. Julian Bailes. The WVHIN board is making plans for appropriate statewide sharing of medical information and resources for doctors and consumers. Of course, maintaining privacy will be paramount.

The WVHIN is looking at how our state’s various electronic medical records systems are set up, and how we can plan and build a robust, interoperable and affordable system. This work will take strong partnerships so that together we can understand our needs, maintain high quality and control costs. The result: better and more efficient health care for our citizens.

I’m really proud of the progress the network is making, including applying for federal funding and grants that, among other accomplishments, will make us part of the national health information network. The network is competing in two national projects and going after others. Their efforts are garnering national attention and West Virginia is being called a leader in this field.

We want to become a nationwide model for health information exchange and I applaud everyone involved for their efforts toward that goal. It’s important for us to realize the impact information technology has had on productivity and efficiency in other businesses. If we make the right investments in information technology for health care in West Virginia, we can make great advancements in medical quality, safety, health promotion and savings right here in the Mountain State.

 

guestU.S. Rep. Jesse Jackson, Jr. (D-IL)

Mending the Health Care Breach

Shamefully, the health care system in this country is broken, leaving too many Americans stranded and trapped in the cracks.  I introduced The Minority Health Improvement and Health Disparity Elimination Act, which amends many of the breaches in the system.

The bill provides education and training, increases healthcare quality and access, expands research and data collection and improves leadership and collaboration within the federal government.  Among its specific aims, the legislation reauthorizes and strengthens the National Center for Minority Health and Health Disparities at the National Institutes of Health (NIH); establishes an internet clearinghouse at the Office of Minority Health to provide culturally appropriate resources; establishes grants to promote positive health behaviors as well as to improve access to care; provides scholarships to minorities who make a mid-career change to a health profession; and requires the development and implementation of a national action plan to improve minority health and eliminate health disparities. 

Too many racial and ethnic minorities have less access and fewer options in health care.  And, when they do receive care, it is often infrequent, inadequate or inferior.  To eliminate the disparity, this legislation directs the attention, summons the resources, and implements a plan within our government.  It makes important steps to ensuring that all Americans have an opportunity to see a doctor and get a clean bill of health.

The bill was introduced with 56 original co-sponsors, with an equal number of Democrats and Republicans signing on to it.  The legislation also is supported by leading national organizations and institutions, including the American Heart Association, American Public Health Association, Harvard Medical School, Meharry Medical College, National Association of Community Health Centers, Campaign for Tobacco Free Kids, National Council of La Raza, NAACP and the National Medical Association.  In June, Senator Edward Kennedy introduced the companion bill in the U.S. Senate.

I am committed to improving and extending access to health care in our country.  I believe that health care is a human right, to which all Americans should be entitled under the U.S. Constitution.

 

guestGuest Column by
U.S. Senator Ben Cardin (D-MD)

Healthcare is a Basic Right for All Americans

All Americans, regardless of age, ethnicity, or background, deserve access to affordable health care. More than 46 million Americans, including 9 million children, are without health insurance and must rely on hospitals and clinics to provide their basic health care needs. Millions more have inadequate insurance and face rising health care costs. As a nation, we must ensure that access to health insurance is a basic right for all by instituting a universal requirement for health insurance with the federal government providing options to individuals and assistance to those who cannot afford adequate coverage.

I introduced a universal health care bill that would require all Americans to enroll in a health care plan.  The legislation builds on our current health care system, but would require individuals who do not have coverage to enroll in a “qualified” health plan. The measure is similar to many state laws that require motorists to purchase auto insurance.

The Universal Health Coverage Act would require Americans to have “qualified health coverage” such as Medicare, Medicaid, SCHIP, veterans’ health care, federal health employee benefits, Indian Health Service or any other qualified health coverage as defined by their state of residence. 

This legislation provides a simple, straight-forward solution that will ensure that all Americans have health insurance.   It directs the Secretary of Health and Human Services to work with the National Association of Insurance Commissioners (NAIC) to develop three low-cost options for individuals below 400% of federal poverty level (FPL).  The FPL is currently defined as approximately $20,000 a year for a family of four.  That standard was selected because the vast majority of working families with incomes above that level have access to employer-based health insurance.

Those who fail to enroll for any coverage for a continuous period greater than 60 days would be required to pay a tax equal to the average monthly premium amount for qualified coverage as defined by the state in which they reside. Funds collected by this tax would then be used to automatically enroll them in a state-approved plan.

The proposal is based on the principle of personal responsibility: namely, that those who have the financial ability to afford health insurance must be required to have it.  It also maintains the current employer-based system and protects government-sponsored health programs.

As a member of the Senate Small Business Committee, I am working to help small businesses provide affordable health insurance for their employees. On the Senate Budget Committee, I have worked to ensure that critical health care programs such as Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) are priorities in the federal budget.

Children are our greatest resource and we have a special obligation to take care of them. I am an original cosponsor of the Keep Children Covered Act, S. 401, to increase funding for SCHIP which provides millions of American children with health insurance. I have also cosponsored the Children's Dental Health Improvement Act, S. 739, to require states to include dental health coverage for children in their SCHIP programs.

Medicare is a critical element in providing health coverage for seniors and the disabled. I have introduced the Preserving Medicare for All Act, S. 137, to guarantee a universally available, defined prescription drug benefit plan for seniors through Medicare. The bill also would fix Medicare Part D drug coverage and allow the federal government to negotiate lower prices for prescription drugs.

We must continue to fund research for new treatments and actively encourage people to get preventative health care and testing. Stem cells hold the promise of great advances in medicine. I have cosponsored the Stem Cell Research Enhancement, S. 5, and consistently have voted to allocate more federal funds for embryonic stem cell research.

In the House, I successfully fought to expand Medicare to provide coverage for cancer patients so they could enroll in clinical trials. As the lead Democratic sponsor of the Medicare Cancer Clinical Trial Coverage Act, I was able to establish a project whereby Medicare beneficiaries with cancer would be covered for patient care costs, including hospital and physician fees.

Great advances have been made in women's health and we must now build on this success and ensure that women are able to get the care they need. I have cosponsored the Prevention First Act, S.21, a comprehensive bill designed to increase access to reproductive health services, with an emphasis on education and prevention of unintended pregnancies.  We have the most sophisticated health care in the world, but our system lacks adequate access.

 

guestGuest Column by
U.S. Rep. Stephanie Tubbs Jones (D-OH)

Eliminating Health Disparities

For the past few Congresses, the Congressional Black Caucus (CBC) has made confronting health disparities one of its major initiatives. We have been champions for access to affordable healthcare, meaningful coverage for prescription medications for every American, and increased representation of African Americans across all health care professions.

The healthcare statistics are staggering in the African American community.

  • While African Americans comprised approximately 12% of the U.S. population in 2000, they represented 19.6% of the uninsured.
  • The African American AIDS diagnosis rate was 11 times the White diagnosis rate (23 times more for women and 9 times more for men) 
  • African Americans are two times more likely to have diabetes than Whites, four times more likely to see their diabetes progress to end-stage renal disease and four times more likely to have a stroke; and
  • African Americans are only 2.9% of doctors, 9.2% of nurses, 1.5% of dentists and 0.4% of health care administrators, yet African Americans comprise 12% of the population.

These problems are just the tip of the iceberg. Today, 50 million Americans have no health insurance, including more than 8 million children. Eight out of 10 uninsured Americans either work or are in working families. Sadly, many of those that are uninsured and underinsured are African American.

Being uninsured means going without needed care. It means minor illnesses become major ones because care is delayed. Tragically, it also means that one significant medical expense can wipe out a family's life savings. There are millions of working, uninsured Americans who go to bed every night worrying what will happen to them and their families if a major illness or injury strikes.

In my home state of Ohio there are currently 1,362,000 uninsured an increase of 18,000 people since 2003. We have also seen the strain on many of the local hospitals in my district when people are forced to use emergency rooms as their source of primary care.

The problem is getting worse. As the price of health care continues to rise, fewer individuals and families can afford to pay for coverage. Fewer small businesses are able to provide coverage for their employees, and those that do are struggling to hold on to the coverage they offer. It is a problem that affects all of us and we cannot sit idly by while the people of this country continue to go without health insurance.

We must begin to move forward on a bipartisan basis to expand access to affordable, quality and reliable health coverage for America’s families. Additionally, members of the CBC are putting forth legislation that addresses specific health issues that affect the African American community.

Earlier this year, I introduced the Uterine Fibroid Research and Education Act, which would double federal funding for uterine fibroid research and fund a public education campaign on the condition. Senator Barbara Mikulski (D-MD) introduced companion legislation in the Senate.  Congresswoman Tubbs Jones and Senator Mikulski introduced identical legislation in the 109th Congress, but neither received a floor vote.

Uterine fibroids are non-cancerous tumors that form within a woman’s uterine lining.  It is estimated that three in every four American women have uterine fibroids, with one in four women seeking medical care for the condition. African American women are three to nine times more likely to develop uterine fibroids.  Historically, hysterectomy has been one of the few treatments available.

Right now, hysterectomy is the most common treatment for uterine fibroids, accounting for 200,000, or 30percent of all hysterectomies in the United States. This legislation will help us develop new and better ways to treat or even cure uterine fibroids. 

This is just one of the many pieces of health legislation that the CBC is working on. I encourage you to contact your member of Congress and ask them to support these pieces a legislation. Our society must be one that seeks to bridge the divide between the Haves and the Have-Nots and ensure that all Americans have an equal opportunity to live a healthy and happy life.

guestGuest Column by
Rep. Pete Stark (D-CA)

Reliable, Unbiased Comparative Information
Can Control Health Spending

All too often physicians and patients struggle to understand when a new product, diagnostic test or surgical procedure will be most helpful, or how to choose among existing courses of treatment. Comparative clinical effectiveness means comparing the relative value of different clinical treatments, including drugs, devices, tests, procedures, bandages, pills and anything else you want to take and try to get a comparative ranking.

Given the dearth of good information on comparative clinical
effectiveness, it’s hardly surprising that GAO and MedPAC find dramatic variation in the use of medical services across regions, providers and specialties. Even worse, researchers find that areas with the highest use of some services aren’t necessarily linked to higher quality care or better outcomes. To the contrary, beneficiaries may be put at greater risk when they are subjected to more -- and more complicated -- tests and treatments.

As Medicare’s Board of Directors, Congress needs to ensure that Medicare resources are being used effectively and efficiently to provide high quality care and achieve the best possible outcomes. Getting reliable, unbiased comparative information is our best shot at controlling health spending while improving care and access. Even if Dr.Orszag won’t give us savings immediately for our efforts, we can
identify ways we can get the information we need to achieve this
important goal, and lay the groundwork for a more efficient, effective system.

Health policy experts across the political spectrum advocate that
comparative information is sorely needed for the public good. They argue that greater investment in comparative effectiveness research is critical to assuring high-quality care and reducing unnecessary
expenditures. Better information about the relative strengths and weaknesses of various products, procedures and services will help physicians and patients make wise decisions and will help public and private payers equitably manage rising health care costs.

Many countries have already made major investments to provide this information to physicians, patients, and policy makers. It’s high time that we do the same!

Many of my colleagues urge that we should “pay for performance.” We already do that – providers perform, and we pay. It’s just that we pay the same whether the service is done on the right people at the right time -- or the wrong people at the wrong time! We really have to know what the effective and appropriate services are before we can know how to reward the care that achieves the best outcomes.

Various authorities both within and outside government have called for a substantial national investment in comparative effectiveness information, and have identified issues and options to help us determine optimal financing and governance for this activity. My personal preference is to move toward a system that is accountable, yet independent, and free from both industry and political influence. Let me repeat that, free from both industry and political influence. Both clinicians and patients need to be confident that this work has been done in the best interest of the patient. To me that points to a government-led effort.



guestGarth N. Graham, MD, MPH
Deputy Assistant Secretary for Minority Health

Office of Minority Health: Using E-learning Tools to Improve the Health Status of Minority Populations

The United States is acknowledged worldwide for leading medical technologies.  But, even with the greatest technologies, we are not able to serve the needs of our patients if we are unable to communicate effectively with them.

Nearly one in five Americans speaks a language other than English in their home.  If we cannot accurately diagnose or treat a patient due to a lack of language/cultural understanding, we run the risk of misdiagnosis, losing valuable time in the fight to maintain health.  A national dialogue about the minority healthcare divide speaks to these issues and how we can improve healthcare for all Americans.

At the Office of Minority Health, U.S. Department of Health and Human Services, we have leveraged e-learning as a powerful tool (www.thinkculturalhealth.org) to improve the healthcare of minority populations of the nation and promote cultural competence. Our distance learning courses are based on streaming multimedia clinical vignettes that reflect clinical practices and illustrate clinical encounters in a readily understandable format.   

With the growing popularity of these courses, we leverage content delivery networks and content management systems to insure effective delivery of the rich instructional content based on the latest research in the field of cultural competence. Our learners benefit from accredited online testing and certification, as well as content updates made possible by the flexibility of the web. 

We have made it part of our mission to make use of materials and approaches that appeal to the healthcare provider by providing content that is relevant to their particular specialty as well as being available ‘anywhere, anytime’ using the web as well as DVDs, streaming media, and other technologies which lessen the burden associated with maintaining knowledge and gaining new skills.  In addition, we are anticipating more healthcare providers’ use of mobile devices such as smart phones and iPods- and we are working to provide content in formats that are compatible with these devices which can be used in concert with desktops – so that education can be accessible through the most convenient combination of devices.  In the near future, as videoconferencing through the cell phone and interpretation services may arrive at the bedside, our efforts can be used to augment these solutions as well – providing a cultural context for medical decision making and communications between patients and their providers.

Techniques such as viral marketing have been very successful in spreading the word about cultural competency.  Our user statistics indicate that 32% of our 11,500 users found out about our on-line courses through email invitations from their peers who had experienced the online materials.  We also have made use of organic search engine placement, e-mail notifications, and links to the latest resources and legislative information to insure the highest levels of relevancy and credibility to our audiences. 

With the increased interest in cultural competency, and rapidly growing number of users, we have transitioned from the limitations of in person training to mass training with very little cost associated with distribution.  Our educational programs have been endorsed by the Centers for Medicare and Medicaid Services’ Quality Improvement Organizations, the American Nurses Association, and United Healthcare.

As with any successful e-learning initiative, we need to provide learner support services, such as automated help desk functionality.  We also need to enable adaptive methods for individuals and institutions to participate in the course work. 

With organizations such as the Healthcare Information Management Systems Society (HIMSS), catalyzing needed healthcare information technology infrastructure, we can provide critical ongoing education using innovative on-demand media.  With greater availability of portable digital media devices, new web technologies can provide us with the opportunity to personalize content for individuals and institutions, as well as, multi-lingual dynamic, digital signage in public spaces.  With audio and video conferencing now commonplace, mobile phones can facilitate the availability of interpreters 24/7 at the bedside. And, we can continue to further leverage all of these technologies to facilitate behavior change, improve healthcare, and enhance health outcomes of racially and ethnically diverse populations.

 

guestRep. Bart Gordon (D-TN)
Chairman
U.S. House Committee on Science and Technology

Putting the Technical Standards in Place to Usher in a Comprehensive EHR System

There is common agreement that the widespread use of Electronic Healthcare Records (EHRs) would improve patient care and decrease costs. Nonetheless, the ubiquitous use of information technology (such as in the case of EHRs) in the healthcare industry lags behind other sectors such as financial, manufacturing, and retail. There are a number of reasons why the widespread use of IT within the healthcare sector lags. However, one important component has been the lack of interoperable EHR systems that also ensure privacy and data security.

I believe that unless the technical standards are developed to ensure the interoperability, privacy, and security of EHRs, little will happen. Since assuming the chairmanship, I have held a series of roundtables with outside groups on what is slowing the adoption of EHRs. There was uniform consensus that interoperability, privacy, and security issues must be addressed if we wish to see the widespread usage of EHRs. While work on the development of technical standards has been initiated by the National Health Information Technology Coordinator, I am concerned about the pace and the scope of the work. As a result, I introduced H.R. 2406 to establish a Healthcare Information Enterprise Integration Initiative.

H.R. 2406 has three components: 1) to strengthen and reinforce ongoing technical standards work for EHRs; 2) to ensure that Federal agencies set a gold standard in the adoption, deployment and use of EHRs; and 3) to establish a research program to anticipate the next generation of information technologies. The provisions of the bill are based on the roundtables I held as well as recommendations made by the President's Information Technology Committee (PITAC) in their report, "Revolutionary Healthcare through Information Technology," and the National Academies report, "Building a Better Delivery System: A New Engineering/Healthcare Partnership."

One major element of this legislation is to provide a greater role for the National Institute of Standards and Technology (NIST) to work with the appropriate parties to develop standards and guidelines for EHRs. Why NIST? For more than 100 years, NIST has worked cooperatively with the standards-setting community and the private sector in the development of standards and measurement tools. In the IT field, NIST has worked cooperatively with the financial and banking sector, the e-business sector, and the manufacturing sector to ensure the interoperability, security, and integrity of their IT systems.  In addition, NIST currently develops Federal Information Processing Standards (FIPS) for use by Federal agencies.  Current FIPS address interoperability, data integrity, data security and privacy. Many of the challenges faced by those industries are similar to the ones faced by the healthcare sector. NIST is currently assisting the Department of Health and Human Services (HHS) in their health IT efforts. However, given NIST's successful track record in IT interoperability, privacy and security, they should play a leading role in any Federal efforts related to the technical aspects of EHRs. H.R. 2406 ensures this.

H.R. 2406 has three sections:

Healthcare Information Enterprise Integration Initiative - Builds upon the work already underway at NIST on electronic healthcare records and is complementary to the work underway at the Office of the National Coordinator for Health Information Technology.  This section provides NIST with greater authority to work with both the user community and the technology community to develop the standards and tests required to ensure that a fully interoperable EHR system is developed.  Building upon NIST expertise in information technology privacy and security, NIST will also address these important components in EHRs as well.  The technical components of the program include standards and interoperability analysis; conformance testing and certification; security and privacy issues; management of electronic healthcare records; and usability and access to EHR information.

Federal Healthcare Information Technology Systems Infrastructure - Requires NIST to work with Federal agencies and the private sector to develop an interoperable system between agencies and their transaction partners.  Elements of the program include development of guidelines for use by Federal agencies; development of testing procedures for conformance assessment; guidance for the protection of privacy of patient information and data security; and establishing a minimum level of interoperability criteria for transactions between Federal agencies.  The Federal government currently operates the largest EHR system at the Department of Defense, the Veterans Administration and the Bureau of Indian Affairs.  We need to ensure that Federal agencies serve as the gold standard for an interoperable, secure and private EHR system.

Research and Development Programs - Establishes a research program to anticipate the next generation of technologies.  This section establishes industry/university partnerships to perform multi-disciplinary research in fields such as wireless networking of medical systems, voice recognition systems, and healthcare information management.

The goal of this legislation is to build upon and strengthen existing EHR efforts.  Every month and year that goes by without a workable Electronic Healthcare Record system compromises patient care and increases healthcare costs.  This legislation does not address all aspects of the complicated healthcare IT issue.  However, it does address one critical element - the technical standards that would allow a comprehensive EHR system to be developed and used by the healthcare community.

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guestU.S. Senator Sheldon
Whitehouse(D-RI)

I have heard from countless Rhode Islanders who have struggled to pay for their health care and who live in fear of losing coverage on which they and their families depend. I have met nurses frustrated and heartbroken that they must spend so much time coping with the paperwork and so little time caring for patients. I have talked with families whose lives and health were shaken by terrifying medical errors, lost paperwork, missed diagnoses that should have been totally avoided.

I believe our current health care system is too complex and costs so much, yet so often does not provide patients with the quality of care they should have. It does not have to be this way. I have seen firsthand that we can make the system work better for everyone, we can cut costs, save lives, and improve the quality of the health care we receive, a critical step toward ensuring that all Americans have health care they can afford.

In Rhode Island, we have been working and experimenting for years to find solutions to many of these challenges. I have been privileged to be part of much of that work, most directly when I founded the Rhode Island Quality Institute to focus on quality reforms in health care.

The subject today is the issue of how the system itself runs, how it operates, put bluntly, how badly in America it runs. If we can reduce the cost of the underlying system by improving its performance, it will make solutions easier for financing our health care system and for finding a way to make sure every American gets health care coverage. Our health care system is a mess. The number of uninsured Americans is climbing and will soon reach 50 million. The annual cost of the system exceeds $2 trillion every year, and that number is expected soon to double. We spend more of our gross domestic product on health care than any other industrialized country in the world, 16 percent. That is double the European Union average.

There is today more health care in Ford cars than there is steel. There is more health care in Starbucks coffee than there are coffee beans. Worse still, for all this money we spend, we get a mediocre product. We have the best doctors, the best nurses, the best procedures and equipment, the best medical education in the world. Yet the system produces mediocre results. As many as 100,000 Americans are killed every year by unnecessary and avoidable medical errors. That is just the fatalities. Think how many people have to stay longer in the hospital and run up costs.

Life expectancy, obesity rates, and infant mortality rates are much worse than they should be in a country such as ours. We fail by most international measures. The system itself does not work. Hospitals are going broke. Doctors are furious, and paperwork chokes the system.

Quarrels between the providers and the payers drive up costs, while potential savings in billions of dollars are left lying on the table. More American families are bankrupted by health care costs than any other cause. It is a system in crisis.

I trust market forces and I believe in market forces, but I see it as our job in Government to create the environment in which market forces operate in a healthy way to serve the public interest. That is our job. It always has been. Where that healthy environment for market forces does not exist--which is the case right now in our health care system--Government must act.

The market failure in health care has three core components: One, the American health care system does not optimize investment in quality of care, even where--indeed, particularly where--that quality investment in improving care would also lower costs; two, the system does not have the information technology infrastructure to support the improvements we need; three, the way we pay for health care sends perverse price signals that steer us away from the public interest.

These problems can each be fixed, but fixing each in isolation will not yield the change we need. Similar to three climbers roped together for an ascent, the three solutions need to track with each other, not necessarily in lockstep but staying close because each one reinforces the other.

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guestU.S. Senator
Debbie Stabenow (D-MI)

 

Health Information Technology: Cutting Costs, Saving Lives

Former Health and Human Services Secretary Tommy Thompson once said, “The most incredible feature of this 21st century medicine is that we hold it together with nineteenth century paperwork. This is just inexcusable. And it has to change.”

We may have had our disagreements, but this is one instance where I completely agree with Secretary Thompson.  Nearly a decade into the 21st century, too many health care providers still rely on hand-written notes for communication and record keeping.

American families feel the consequences of not having a fully-wired health care system.  I met Renae Wallace, a small business owner in Kingsley, Michigan.  At that time, Renae’s son Randall was just turning eight.  But unlike a typical eight year-old, Randall had seen the inside of a surgery room more often than most people see in a lifetime because he was born with complex heart and lung defects.

The Wallaces visit specialists hundreds of miles apart in Traverse City, Grand Rapids, and Ann Arbor.  But because there is no easy way for Randall’s doctors to talk to each other, Renae carries around a file of Randall’s medical records—X-rays, MRI scans, surgical notes— in the trunk of her car.  Otherwise, the specialists may not know the results of Randall’s previous treatments. 

It would make a lot more sense if the doctors, nurses, hospitals, and everyone treating Randall had that information readily available without Renae having to haul her son’s medical records back and forth herself.

Nowhere is the high cost of health care of more concern than in my home state of Michigan – where our automakers and manufacturers are struggling to shoulder the crippling costs of health insurance for workers.  Increased health care costs make American businesses less competitive in the global marketplace, and that threatens American jobs.    

The result of using 19th century technology in a 21st century health care system is higher costs, increased errors and decreased quality of care. In its report, To Err Is Human, the Institute of Medicine estimates that 44,000 to 98,000 Americans die each year not from their medical conditions but from preventable medical errors.  In the United States, 31 cents of every health care dollar pays for administrative costs – nearly twice the rate in other countries.  But even more importantly, we will save money by reducing duplicative tests and ensuring patients get the care they need when they need it.  A study by the RAND Corporation suggested savings as high as $81 billion a year through effective use of electronic medical records. 

With all of America’s resources, we must not continue to let paperwork drive up costs and drag down quality of care.  Electronic health records will help providers pick up errors such as potentially life-threatening drug interactions and incorrect drugs and dosages.

But doctors’ offices and hospitals can’t do this alone.  High start-up costs often discourage or delay conversion to computerized health IT systems.  Congress must provide incentives and meaningful resources so health care providers can obtain the hardware and software they need.  Health care providers already are struggling to keep up with the rising costs of doing business while experiencing cuts in Medicare and Medicaid payments, which makes it difficult to invest in new IT.

I am planning to reintroduce my Health Information Technology Act, or the “HealthTech Act,” again with Senator Olympia Snowe (R-ME).  This bill would provide federal seed money that would be available to hospitals, skilled nursing facilities, community health centers and physicians to offset the costs of investing in new technology, technical support services or IT training for staff.  At least 20 percent of the funds would be available to rural areas or regions with a shortage of health care professionals. 

The HealthTech Act would accelerate depreciation of health IT equipment expenses and increase Medicare payments to providers who use health IT to improve the quality and accuracy of clinical decision making for patients with chronic conditions.

The result will be substantially lower costs and improved quality – without sacrificing the quality of health care or asking people to pay more for it. It’s the smart way to reduce health care costs.  Federal investments in health IT will result in lower Medicare, Medicaid and SCHIP spending, reduced medical errors, and greater quality and efficiency in our health care system.

America is the greatest nation in the world. It’s long past time that we began to use technology to make health care accessible and affordable for every American business.  Every day that we delay investments in health IT, people like Renae and Randall Wallace pay the price.

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guestU.S. Senator
Edward M. Kennedy (D-MA)


HEALTH IT IS ESSENTIAL TO PROVIDING HEALTH CARE FOR ALL  

Every American deserves a health care system where accurate and complete information is instantly accessible to patients and doctors, when it is needed and where it is needed.  Today, we are far from that ideal.

One out of every 7 primary care visits is affected by missing medical information. More than 40 percent of Americans have been affected by a medical error, either personally or through a friend or relative.  In this era of medical miracles and advanced health technology, there’s no excuse for lagging so far behind.

Recently, I introduced the Medicare for All Act of 2007, which will make Medicare available to every American who wants to enroll in it. Administrative costs are low, patient satisfaction is high, and patients have the right to choose any doctor and hospital they think is best. An essential part of providing quality health care for all Americans is a solid health information technology infrastructure with strong privacy and security protections.

The United States spends more per person by far on health care than any other nation.  Yet we consistently rank in the middle of the pack in terms of the quality of care provided.  A large part of the problem is our inexplicable continuing reliance on outdated paper records instead of using modern electronic technology effectively, as other professions do.  

Thousands of lives are lost every year to preventable medical errors.  This unacceptably high toll can be dramatically reduced through wider use of electronic records and error prevention software that warns a doctor or nurse when a medication is likely to injure a patient or when an urgently needed test has not been performed.  

Health information technology can increase health coverage for the 46 million Americans who lack health insurance, by freeing up funds now used for overhead.  It places control over health care in the individual’s own hands, through personalized electronic health records and secure online medical consultations between physicians and their patients.  

Industries as diverse as telecommunications, tourism, and financial services have already been transformed by IT.  Yet the health care sector—the industry that saves lives and promotes well-being—has been left behind.  The IT gap is making it more and more difficult for smaller hospitals, clinics and doctors’ offices to keep up with the costs of advanced technology.  It costs a physician’s office about $40,000 to implement a new IT system, and many can’t afford the upfront investment, adopt new computer systems, or re-train their staff.  

In 2004, our health care spending reached $1.9 trillion, a record 16 percent of our economy. Over $600 billion was spent on administrative costs alone, representing a third of the total spent on health.  Widespread adoption of electronic health records could save more than $160 billion each year, according to a study by the RAND Corporation.  It makes no sense not to adopt this cost-saving technology.

America faces growing challenges in a competitive global marketplace. We can no longer afford a health care system rife with inefficiencies and burdened with paperwork.

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guestU.S. Senator
Hillary Rodham Clinton (D-NY)

Few issues touch all of our lives more closely or cause us more anxiety than healthcare. While Americans receive some of the best care in the world, unfortunately our healthcare system has some serious flaws. We see it in the increasing cost of health care and health insurance premiums, the rising number of people who lack coverage or have limited coverage, and lack of access to needed services. And despite the fact that the United States spends more per capita on health care than any other industrialized nation, we still rank far below other countries on key quality indicators such as life span and infant mortality.

Clearly, we must address these problems so that we can strengthen our health care system and prevent it from collapse.  The United States currently has 46 million uninsured individuals, almost 3 million of whom live in New York. Many of these individuals cannot afford to purchase private health insurance due to annual double-digit increases in insurance premiums.

One critical first step is to bring our health care system into the 21st century. Right now, technology exists that would allow primary care physicians to push a button and send prescriptions to your pharmacy. It is conceivable that emergency room attendants could access your medical files with handheld computers in the blink of an eye. And, the capability exists to have the latest research in the hands of your doctor in days – rather than years. All these things can be done while protecting patient privacy and in the process save time, money and lives. But the information technology infrastructure simply is not there.

Last year, I worked with Senators Frist, Kennedy and Enzi to introduce the Wired for Health Care Quality Act, which will allow us to use information technology to develop a nationwide, interoperable health information infrastructure to streamline our healthcare system, improve quality, reduce errors, and lower costs. Reducing the administrative costs of our medical system, which currently account for about one in four of our healthcare dollars, will allow us to redirect our scarce resources to more efficiently address other problems in our healthcare system, such covering the uninsured. I am committed to working with my colleagues to enact health IT legislation in the 110th Congress.

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guestCongressman
Dennis Moore

Independent Health Record Trusts

Information technology has significantly changed the way we live and do business, making it easier to communicate with others, manage our personal finances, or even track a package we shipped across the country.

Unfortunately, the healthcare industry lags far behind other sectors in its utilization of information technology.  The inefficiencies and redundancies that result from this lack of automation costs the industry billions of dollars a year, but more importantly, it costs lives and reduces quality of care.

A 2005 study performed by the RAND Corporation found that nationwide use of electronic medical records could result in potential annual savings of $162 billion: $81 in increased prevention and chronic disease management, $77 billion in increased efficiency, and $4 billion in increased safety standards.  By comparison, the cost of maintaining an electronic medical records system is only $10 billion per year, resulting in more than $150 billion in net savings.

At this point, national efforts to spur adoption of health information technology have largely focused on getting doctors and hospitals to adopt electronic medical records.  While these efforts have yielded some results, we still only have somewhere between 17-25% of physicians utilizing health information technology, and a much smaller percentage of those physicians are actually utilizing these systems at the point of care with their patient. 

As Congress considers healthcare reform proposals, strategic focus should be given to system changes providing patients with more choices, more convenience, and more control over their healthcare.  For this reason, I will soon introduce bipartisan legislation to establish a modern, market-driven approach to building a National Health Information Network through the establishment of federally certified organizations called independent health record trusts.  Individuals would have the option of signing up for an account to be managed by a health record trust, similar to the way banks offer and maintain credit card accounts. 

The account would give consumers control over who has access to their health records and would let them check for any unauthorized use of their information.  Doctors and other health professionals whom patients authorize would have real-time access to patient health records, giving them the information they need to make better-informed medical decisions, reducing medical errors and improving the overall quality of healthcare. In emergency situations, healthcare providers could see a pre-authorized, limited data set from the account. 

Medical records travel with the individual throughout their lifetime, no matter where they go for treatment, giving patients the convenience and peace of mind that their health records are a keystroke away from themselves and their doctors.

Electronic recordkeeping by doctors should remain the long-term goal to achieve full savings from health information technology.  My proposal, however, will produce immediate benefits and help spur the transition to electronic medical records for doctors.

Our healthcare system is plagued by rising costs and declining quality of care.  Investing in health care information technology is a solution we can take to improve the quality of care, improve effectiveness and efficiency, and reduce overall health care costs.  Putting patients at the center of this transformation is not only the right thing to do; it's the smart thing to do.

Congressman Dennis Moore represents the Third District of Kansas and is currently serving his fifth term in Congress.  Moore serves on the Budget and Financial Services Committees and is the Policy Co-Chair for the fiscally conservative Democratic Blue Dog Coalition.

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guestCongressman
Charles A. Gonzalez

Democratic and Republican lawmakers agree – the benefits of full-scale adoption of health information technology (HIT) will significantly transform how we deliver healthcare in America.  But without adequate incentives for HIT adoption, smaller physician practices will be left behind the technological curve, and as a result, patients will fail to benefit from the quality of care electronic health records provide. 

Congress needs to do all in its power to help these smaller practices, where most patient care is received, and the most effective way to do so is to provide financial incentives for such practices to adopt and implement HIT.  This will ensure that smaller practices are encouraged to purchase and implement HIT while simultaneously protecting them from the financial burden of government regulations and mandates.

It’s well known that HIT benefits are vast and wide reaching.  Practices fortunate enough to already have access to this technology know the technology reduces healthcare costs, improves administrative efficiency, and reduces paperwork.  This leads to improved safety and quality, and ultimately, increased access to affordable healthcare. 

Seventy-eight percent of physicians in the United States practice in groups of 8 or fewer.  In addition, studies show that most patients, including a significant majority of Medicare patients, receive outpatient care from smaller practices.  These very practices, unfortunately, simply can’t afford the costs associated with acquiring these vital technologies.  This results in patients missing opportunities to benefit from a more efficient system that will improve the quality and affordability of care in America. 

Since it is well documented that the biggest obstacle facing these practices is the cost associated with this technology, Congress ought to act immediately to provide financial incentives and resources that helps smaller practices speed up the adoption of HIT.  These resources include tax incentives, grants, and subsidized loans, all of which are vital pieces of a practical solution for this problem.  That’s why in the next few weeks, I will be re-introducing legislation from last year that directly addresses the needs of these small practices.  By providing financial assistance to these practices that need it the most, we’ll take an important step forward in transforming how we deliver healthcare in America.    

Modern technology’s benefits are felt across the country in our day to day lives.  From the impact they’ve had on our children in our schools to the advances we’ve made in the fields of science and research, we’ve already learned that the sky is the limit when it comes to enhancing our everyday lives. 

It is now time for our healthcare system to catch up.  We have a historic opportunity to give a much needed helping hand to small healthcare practices that desperately need financial incentives and resources to get up to speed with HIT, and Congress should do all in its power to take appropriate action.  That starts by passing this year’s version of HR 747 which I will re-introduce to the United States House of Representatives. 

Congressman Charles A. Gonzalez has represented the 20th Congressional District in Texas since being elected in 1998. He serves on the House Committee on Small Business and Chairs its Subcommittee on Regulation, Healthcare and Trade.  He also serves on the House Committee on Energy and Commerce. 

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guestU.S. Representative
Edolphus "Ed" Towns (D-NY)

HIMSS Can Help Provide Real Solutions to Health Disparities

The regulation of health care in the U.S. has become a bewildering array of federal and state laws and regulations that affect the quality, cost and reimbursement of health care.  Within this environment, and perhaps because of it, medically underserved communities experience a wide range of health disparities.   In these communities, difficulties in accessing quality care are often made worse by the fragmentation in state and local health care delivery. 

Predictably progress toward eliminating these health disparities has been slow, especially for a nation with the resources of the U.S.  Now we must tackle the implementation of health information technology (HIT).  My fear is that we will create further divisions in service delivery for medically underserved communities if we don't include these communities in both the national dialogue and in the implementation of HIT.  In this regard, I want to urge HIMSS to work with me to create what I call "Health Information Technology Empowerment Zones," areas in which best practices for HIT will be achieved for medically underserved communities.  Your great wealth of experience and information is critical to helping make this work.
 
As you know, in July 2006, the U.S. House of Representatives passed H.R. 4157, “The Better Health Information System Act of 2006”. This bill, though flawed and stalled in the Senate, would have begun the process by setting guidelines for interoperability, system standards and security and through my amendments, set up at least some baseline grants to improve the coordination of HIT for the uninsured, underinsured and medically underserved.
 
My amendments would have also required the Secretary of HHS to conduct a study of HIT best practices related to medically underserved communities, community health information exchanges, state security and confidentiality laws, and other provisions related to the promotion of telehealth services.

My new legislation will wrap these amendments into one bill that I hope HIMSS and its members will inform and support.  In addition, I will continue to work with federal agencies to find ways to develop strategies and practical methods to implement health information technology in medically underserved communities, both urban and rural.  This includes working with the Secretary for Health and Human Services, the Centers for Medicare and Medicaid Services, the Agency for Health Resources and Quality and other federal agencies, to carry out their mandates to perform and improve population-based chronic care management to advance clinical outcomes and patient satisfaction. 

I applaud HIMSS for taking steps to include the reduction of health disparities in its efforts to achieve outcomes for the development of our nation's health information technology infrastructure.  I want to urge you to continue to work with myself and others in Congress to fully connect federal policies and private sector efforts for the development of HIT with reducing health disparities and meeting the needs of medically underserved communities.  I urge you to contact my senior health policy advisor, Rick Blake, who is working on these efforts.

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guestU.S. Congressman
Phil Gingrey, M.D.
February 8, 2007


Health Information Technology: Saving Time, Money and Lives

Modern technology allows us to access critical information, anywhere in the world.  Last year, I traveled to Antarctica and could access my bank account information from the local ATM without a glitch. But had I fallen ill on my trip, the hospitals in Antarctica would have no idea what medications I take, or anything about my medical history.

That’s because our bank records are currently more advanced than our medical records.  To close this gap, we need wider adoption of health information technology, like electronic health records and e-prescribing. A 2005 RAND study estimates health IT could save the U.S. $162 billion annually – nearly 10 percent of our nation’s total healthcare spending.

But the benefits of health IT go far beyond monetary savings. This new technology can reduce medical errors, eliminate duplicative and unnecessary tests, help patients become more informed healthcare consumers, quickly detect population threats, and ultimately save lives.

While the benefits of health IT would revolutionize the healthcare industry, the adoption won’t happen on its own.  These programs can be expensive, and the industry currently lacks concrete guidelines, making many physicians reluctant to invest in the new technology.

There are two important ways Congress can help get critical health information technology into physician offices – and into the lives of American patients.

First, we must address the cost.  I plan to introduce congressional legislation that uses the tax code as an incentive for physicians to adopt health information technology.  My bill would allow increased tax deductions under the small business section of the tax code by more than doubling the first year write-off for healthcare providers who purchase new health IT systems.  Additionally, the legislation would greatly increase the yearly maximum purchase costs for qualifying equipment, allowing physicians to buy both health IT systems and other medical necessities in the same year.  

As a physician myself, I know doctor offices are small businesses, and these tax incentives will help ease the financial burden of purchasing a new system.

Second, we must give physicians the confidence to know their health IT systems will be secure, interoperable, HIPAA compliant and a good investment for the future.  To achieve this, the government should provide guidelines physicians can use when shopping for health IT systems.  Guidelines will give medical professionals the confidence to invest in new technology without worrying they are purchasing inadequate products.   

The sooner we encourage physicians to adopt health IT, the sooner patients across America will benefit.  According to a study by the University of Minnesota, 12 percent of U.S. physician practices have fully implemented electronic health records. Another 13 percent have started the implementation process.   

We can dramatically increase these numbers by passing common sense legislation to help doctors, patients and communities reap the benefits of health IT.  The results will help doctors deliver higher-quality care to their patients, and help patients take control of their own well-being.  With the right incentives and industry standards, health IT will soon be saving the healthcare industry time, money and most importantly, lives.

U.S. Congressman Phil Gingrey, M.D. represents the 11th District of Georgia. Before coming to Congress, Gingrey practiced medicine as an OB-GYN for nearly 30 years.

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guestRep. Patrick Kennedy (D-RI)
Guest Column
for HIMSS Pulse on Public Policy
January 25, 2007

We’ve got a health care system heading for a cliff.  The status quo will not remain an option.  We’ll either change our health care system … or our health care system will change itself. 

I don’t need to relate the horrible statistics – the number of Americans who aren’t getting the necessary care, the businesses being priced out of offering benefits, the uneven quality, the growing toll chronic diseases are putting on the system.  Even without statistics, we all know in our guts that the system is not in good shape. 

It’s as simple as this: our health care system will unravel unless we figure out how to build a real system around value.  How do we get to a twenty-first century health care that delivers the best possible health care at the lowest possible cost?

Twenty-first century health care means redesigned primary care, with active care management of our growing population of chronic disease patients.  It means moving away from episodic care towards a continuous relationship between doctor and patient.

Twenty-first century health care means untethering care from the doctor’s office to weave health care and disease management into people’s lives.  It’s empowering consumers to be active participants in their care rather than passive recipients.

Twenty-first century health care means building a payment system around quality and efficiency, and mining data to catch the next Vioxx before it kills thousands, and having a complete health record for individuals even when disasters like Hurricane Katrina strike.  It means not duplicating tests because information is at hand and preventing inevitable human errors. 

None of this can happen without information technology. 

There are so many ways that I.T. can give us a higher value health care system.  It’s not the silver bullet, but it is fundamental to any effort to transform health care. 

This is no longer a news flash of course.  But as much as health I.T. is the flavor of the month in health care, it’s proving a pretty stubborn challenge to digitize our health information.

The good news is that health I.T. is finally on the Congressional radar screen.  Now the challenge is to finally pass legislation that really accelerates the use of technology to change health care.

There is much Congress can do to reinforce the private sector and Administration efforts underway, but several are critical:

  • Tap the power of consumer demand by creating incentives for doctors and patients to use consumer controlled, web-based personal health records.
  • Ensure that new health information networks are designed with strong patient privacy protections that give individuals control over who sees their health information and for what purposes.
  • Guarantee timely adoption of interoperability data standards.
  • And get Medicare and Medicaid, the biggest health care stakeholders out there, off the sidelines when it comes to supporting adoption of health I.T. by providers and development of local infrastructure for health information sharing.

Without at least these steps, it is difficult to envision the sort of rapid adoption of technology that is so desperately needed in health care.

Our health care system must and will change.  The only question is whether we change the system, or it changes us.  Moving health care into the Information Age is the critical first step to building a sustainable, high performing 21st century health care system.  Let’s make 2007 the year Congress commits to that future.

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What's Next for Patient Safety Policy

HIMSS Vice President of Government Relations Dave Roberts' article, What's Next for Patient Safety Policy, appears in Patient Safety and Quality Healthcare Magazine's November/December 2006 issue.  Roberts states, “As the 109th Congress slowly draws to a close, there’s no doubt that enormous opportunities still exist for transforming healthcare with health information technology (HIT), regardless of partisan issues and politics. Democrats and Republicans alike have introduced 62 separate pieces of legislation to address HIT as well as healthcare quality and patient safety-related issues.”

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View from Capitol Hill

HIMSS Vice President of Government Relations Dave Roberts monthly column, View from Capitol Hill, in the Medical News is now online.  Roberts states, “America’s healthcare system is in intensive care and has been for far too long. The question is how long can we tolerate the hemorrhaging costs and its almost comatose state. Imagine nurses, physicians, and surgeons working in an intensive care unit (ICU) without any healthcare information technology (HIT). A patient should not have to be in ICU to have access to the best HIT the industry has to offer. Not only is it costly but it also makes no common sense. Moreover, it is counterproductive to business and accounting decisions as well as any regulations or laws enacted by federal and state governments. What is Congress’ role in ameliorating this healthcare ICU?”

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A Good Year for HIT

HIMSS VP of Government Relations Dave Roberts' column, A Good Year for HIT, in Patient Safety and Quality Healthcare magazine, September/October 2006.

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Op-Ed by HIMSS EVP Carla Smith Featured in Government Health IT Magazine

An op-ed by HIMSS Executive Vice President Carla Smith  entitled, Around-the-Clock Access to Health Info: Why Is it So Hard,” is featured in Government Health IT magazine’s August 2006 issue.  “Remember how we used to have to run to the bank before closing time to cash a check?,” Smith writes.  “Then — seemingly overnight — a magical machine began giving us money. With nearly a half-million automated teller machines in the United States, access to our money is just inside the nearest convenience store. Why can’t health information be accessed that easily? There are two reasons: First, because what appears to be a rapid shift in the banking industry was actually 50-plus years in the making. Second, because what makes ATMs function — a complex dance of transactions — is simple compared with health information.”

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Patient Safety and Quality Healthcare Magazine Features a Special Report by HIMSS VP Dave Roberts

A Special Report by HIMSS Vice President of Government Relations Dave Roberts is featured on Patient Safety and Quality Healthcare magazine’s web site. In the report, HIT Legislation on the Horizon, Roberts states "President Bush may become only the second U.S. president in history to sign major health information technology (HIT) legislation; the first being President Clinton, who signed the HIPAA legislation in 1996.

"The stage is set. However, we need healthcare professionals to call their members of Congress now and request their support of H.R. 4157. While there is no such thing as perfect legislation, this is a start. This is an opportunity to make healthcare information technology part of the federal dialogue in Washington. It's a matter of working with Congress now to pass legislation or waiting another 4, or possibly 8 years, until the stage is set again.”

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"Paper Kills" Should Be Healthcare's Mantra

In a column for Patient Safety & Quality Healthcare magazine, HIMSS Vice President of Government Relations Dave Roberts evokes importance of healthcare IT.

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