[Congressional Record Volume 140, Number 80 (Wednesday, June 22, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 22, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                E X T E N S I O N   O F   R E M A R K S


              NATIONAL HEALTH CARE INFORMATION TECHNOLOGY

                                 ______


                          HON. LESLIE L. BYRNE

                              of virginia

                    in the house of representatives

                        Wednesday, June 22, 1994

  Mrs. BYRNE. Mr. Speaker, I rise today to call attention to the 
importance of ensuring that information technology is included in any 
solution that results from the national debate on health care reform.
  Information technology is a vitally important industry to the 
constituents of my district, to all northern Virginia, and to our 
Nation. Recently, I had the pleasure and opportunity to host a 
roundtable discussion with key information technology executives and 
Vice President Al Gore to share common concerns and issues relating to 
the future of this strategic industry.
  Out of this discussion came many helpful suggestions and 
recommendations. We learned that the future success of reforming our 
Nation's health care problems may be closely tied to using available 
information technology.
  One participant prepared a concept paper on his vision of why our 
Nation needs to initiate a national health care information and 
telecommunications testbed now. I would like to share this concept 
paper with all my colleagues in the House and encourage them to 
consider the possibilities that already exist to both expand accessible 
and quality health care by using resources already developed, tested, 
and approved by the Federal Government.

      Why Our Nation Needs A National Health Care Information and 
                       Telecommunications Testbed

                       (By Dr. John Warner, Jr.)

       President Clinton and Vice President Gore have proposed 
     three major national initiatives which are interdependent in 
     the health care information and telecommunications technology 
     areas. The three initiatives are the Health Security Act of 
     1993, the National Information Infrastructure (NII) and the 
     National Performance Review (NPR). The establishment of a 
     national health care information and telecommunications 
     testbed using the Department of Defense (DoD) health care 
     system would address all three simultaneously and do so with 
     DoD's strength in these key technologies. This national 
     testbed represents a unique opportunity for DoD to be an 
     important and visible contributor to these executive 
     initiatives through efforts on improving health care 
     information and telecommunications, efforts similar to what 
     DoD has ongoing already and which must be continued anyway in 
     order to improve health care quality and cost control in the 
     large DoD health care system.
       The Health Security Act of 1993 depends on the use of 
     health care information and telecommunications technologies 
     to achieve a number of its important objectives. It includes 
     efforts with increased focus on clinical systems and on 
     establishing practice guidelines, computerized patient 
     records, outcomes management, managed care, regionalization, 
     smart cards, patient information security and privacy, as 
     well as on many other areas which depend on these 
     technologies. It also has efforts which will require a 
     reduction in administrative paperwork with standardized forms 
     and systems, as well as electronic transfer of information. 
     As present, the Department of Defense leads the nation in 
     many of these areas, particularly in the clinical information 
     area as a result of the ongoing full deployment of the 
     Composite Health Care System (CHCS) and other initiatives. 
     The GAO agrees and many members of Congress see the 
     tremendous benefits of these initiatives.
       It is important to note that many of the alternative health 
     reform proposals under consideration also have recognized the 
     importance of better utilization of information and 
     telecommunications technologies to achieve increased access, 
     improved quality and improved control of health care costs. 
     As a result, though the health care reform debates and 
     eventual compromises will evolve, a national health care 
     information and telecommunications testbed using the DoD 
     health care system would have general applicability. 
     Additionally, health reform would not be delayed by the 
     existence of a testbed. Other issues dominate this reform. 
     The testbed addresses key health care information and 
     telecommunications technologies and provides a means for 
     structured tests, feedback and continuous improvement in 
     these important areas to provide both short term and long 
     term benefits to our nation.
       A key to improved health care is to get accurate and timely 
     clinical information on the patient to the health care 
     providers at the time of key decisions both to improve the 
     effectiveness of health care provider teams and to help 
     control the growth in costs. DoD has programs to do this now 
     for their own health care system. This system continues to 
     consume an increasing share of the DoD budget (approximately 
     5.5% in FY 1994) because health care costs are increasing as 
     the DoD budget is decreasing. There is the opportunity for 
     DoD to continue these programs while playing a much larger 
     role in supporting national health reform initiatives with a 
     national health care information and telecommunications 
     testbed. This can be done with a relatively small additional 
     investment. Also, if started now, and if based on current DoD 
     programs, initial results could become available within a 
     year. Simultaneously, a longer term program could be 
     established. The testbed also would have obvious benefits to 
     DoD personnel because its implementation would have 
     greatest benefit to the active and retired military 
     personnel and their dependents. It would improve DoD 
     health care. Furthermore, large testbeds have been very 
     useful in DoD in the past to explore very complex problems 
     and health reform certainly is a complex problem.
       A DoD national health care information and 
     telecommunications testbed offers many advantages because: 
     (1) DoD has the second largest medical system in the U.S. 
     with about 9 million beneficiaries, (2) DoD controls the 
     facilities, the providers and many of the beneficiaries, (3) 
     DoD beneficiary demographics are close to the national 
     demographics, (4) DoD is well along in key information and 
     telecommunications technologies already and is implementing 
     CHCS as a standard, centrally controlled, fully integrated 
     medical information system which applies across all services, 
     (5) DoD has many computer literate health care professionals 
     who can contribute to the testbed in a very positive fashion, 
     (6) DoD has the management experience to make such a testbed 
     a success, (7) the DoD health care system has many 
     similarities to a civilian staff model HMO and (8) DoD must 
     invest in these areas anyway.
       Obviously, various parts of the DoD health care system 
     could be used in a testbed fashion for various objectives. 
     However, with CHCS currently in the full deployment phase, 
     over 140 DoD hospitals and their associated clinics will have 
     CHCS by the end of the current fiscal year, and these 
     hospitals provide care to about 7 million beneficiaries. CHCS 
     is also presently used at the White House Physician's Office. 
     Therefore, with comprehensive, standard format data being 
     collected on various health care problems for such a large 
     population, there is the opportunity for significant directed 
     efforts within CHCS such as in the areas of computerized 
     patient records, outcomes management, regionalization and 
     management care.
       The increased electronic networking capabilities associated 
     with a national testbed has one other important advantage to 
     the DoD. As the DoD base closure process continues, 
     electronic networking in health care will have increasing 
     importance for providing care to beneficiaries in areas where 
     health care facilities are closed. This applies not only to 
     direct care but also through managed care support contracts. 
     Areas with prototype, regional networks would benefit in this 
     manner if some facility closures were to occur in these 
     areas.
       Eventually, once the testbed was expanded with automated 
     health care information available in very large regions, 
     there would be an opportunity to aggregate the results 
     applicable not only for the nation but also for specific 
     states with high DoD beneficiary populations. For example, 
     nine states have DoD beneficiary populations of about 200,000 
     or greater. These states are California (1,144,000), Colorado 
     (196,000), Florida (635,000), Georgia (349,000), Maryland 
     (279,000), North Carolina (387,000), South Carolina 
     (239,000), Texas (690,000) and Virginia (622,000). 
     Furthermore, although having smaller DoD beneficiary 
     populations, some states have significant percentages of 
     their state populations as DoD beneficiaries. These include 
     Alaska (14.9%), Hawaii (14.3%), Washington (6.1%), New Mexico 
     (5.5%), Nevada (5.5%) and North Dakota (5.3%). As a result 
     there is the potential for testbed evolution to very 
     cooperative, beneficial testbed efforts in all of these 
     states.
       This type of testbed effort also supports the NII 
     initiative. Although much of NII is focused on efforts for 
     industrial initiatives, it still is a technology driven 
     effort. Health care is a key concern. Efforts on the part of 
     DoD, through a national health care information and 
     telecommunications testbed, could be very beneficial to the 
     NII, particularly if they include the areas of electronic 
     transfer of medical records, telemedicine (e.g, image 
     transfer such as X-rays, color videos of patients and patient 
     problems, etc.) and patient information security and privacy. 
     Efforts on the part of DoD in these areas could play a strong 
     role in NII initiatives while demonstrating technology key to 
     the national health reform for areas such as rural health 
     care. For example, telemedicine (e.g., teleradiology, 
     teleconsulting for diagnosis and surgery, telepathology, 
     etc.) will be critical to improve health care in rural and 
     disadvantaged urban areas because of the difficulty in 
     providing a sufficient number of health care professionals in 
     these areas. Telemedicine also is an important future 
     capability for DoD, not only for the regional type of 
     networks discussed previously, but also for medical 
     consultation with deployed air, land and sea forces. There 
     are some initial DoD prototypes already ongoing in this 
     latter area (e.g., Walter Reed with Somalia and Macedonia, 
     Tripler with the Pacific area). Prototype, regional 
     networks could include such capabilities to prove 
     important concepts in telemedicine within regions and 
     extending to deployed forces.
       Finally, there is the National Performance Review 
     initiative. One NPR initiative subset is NPR Code DoD 09 
     which is to maximize the efficiency of DoD health care 
     operations. This initiative proposes the use of emerging 
     technologies to upgrade care at DoD health care facilities. 
     It includes efforts to maximize automation and 
     telecommunications, to optimize administrative support and to 
     move to paperless records. Therefore, testbed efforts to 
     support improvement in DoD health care simultaneously 
     supports national health care reform, the NII and the NPR.
       A national information and telecommunications testbed based 
     on the DoD health care system also would be beneficial to 
     other Federal Departments, such as Veterans' Affairs (VA) and 
     Health and Human Services (HHS). For example, prototype, 
     regional networks might be expanded to include VA medical 
     facilities. CHCS started with modifications to the VA 
     hospital information system. This facilitates increased VA/
     DoD information sharing because with the recent advent of 
     gateways, the two systems can be allowed to transfer data 
     relatively easily. There are obvious potential benefits from 
     increased VA/DoD information sharing in the medical area. The 
     Indian Health Service (IHS) in HHS is slated for expanded 
     roles in the Health Security Act of 1993 and can benefit from 
     DoD information and telecommunications technologies. IHS 
     utilizes versions of the VA hospital information system. HHS 
     also will need to develop practice guidelines, outcomes 
     management concepts and information standards. Such efforts 
     could receive valuable support from a national health care 
     information and telecommunications testbed. There also is the 
     potential for some very productive interactions between 
     Federal Departments to support health reform initiatives with 
     DoD playing a strong role.
       The above presents the reasons why the nation has an 
     opportunity to leverage what the Department of Defense must 
     do anyway for its own benefit and simultaneously become a 
     stronger contributor for key aspects of the President's 
     health care reform initiative, the NII, the NPR and other 
     health reform initiatives. This would be accomplished with a 
     national health care information and telecommunications 
     testbed utilizing the DoD health care system. Furthermore, 
     DoD's efforts would also support other Federal Departments, 
     as well as the more important broader national and specific 
     state interests as the information obtained from a national 
     health care information and telecommunications testbed is 
     collected, analyzed and distributed.
       Now is the time to seize the initiative and establish a 
     National Health Care Information and Telecommunications 
     Testbed. Our nation demands no less.

                          ____________________