[Congressional Record Volume 141, Number 93 (Thursday, June 8, 1995)]
[Extensions of Remarks]
[Page E1176]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



[[Page E1176]]

          THE HEALTH INFORMATION MODERNIZATION AND SECURITY ACT

                                 ______


                          HON. DAVID L. HOBSON

                                of ohio

                    in the house of representatives

                         Wednesday, June 7, 1995
  Mr. HOBSON. Mr. Speaker, today I am introducing the Health 
Information Modernization and Security Act with Mr. Sawyer. In the 
Senate, Mr. Bond and Mr. Lieberman introduced the same bill as S. 872. 
Our bipartisan, bicameral bill was developed over several years in an 
open, cooperative effort between the private and public sectors. Our 
purpose is to reduce excessive paperwork and administrative waste in 
the health care system by facilitating the development of an electronic 
health information network.
  Health information systems are on the verge of a dramatic 
transformation. Today, financial and administrative information 
commonly is keyed into a computer, printed in paper form, and then 
mailed or transmitted to another person who rekeys the information into 
another computer. The constant demand for more information in less time 
is pushing the current system toward electronic data interchange [EDI], 
the computer-to-computer exchange of information in a standard format.
  The technology exists today to move away from a paperwork system and 
toward an electronic health information network. Although many 
institutions have internally automated health information systems, 
there are barriers to sharing information externally, among 
institutions. First, no single entity in the health care industry has 
the market power to move the industry toward a common standard. Second, 
antiquated State licensing laws make computerized medical records 
technically illegal in 12 States and legally ambiguous in 16 others. 
Third, there are privacy concerns related to the degree of access to 
health information.
  The Health Information Modernization and Security Act removes the 
barriers that block the modernization and simplification of health 
information networks. Once these barriers come down, the private sector 
will be able to reduce unnecessary paperwork, which adds nearly 10 
cents to every health care dollar; expose fraud in ways that are 
impossible under the confusing, disjointed paperwork system we have 
today; protect patient privacy and the confidentiality of health 
information; and provide consumers with the data they need to compare 
the value of insurance plans and health services.
  Basically, our bill sets up a process that moves the health care 
industry toward a common electronic language for sharing information. 
The Secretary of the U.S. Department of Health and Human Services is 
required to adopt standards for health information, but only if those 
standards already are in use and generally accepted. The Secretary is 
required to adopt financial and administrative data standards, security 
standards, privacy standards for individually identifiable health 
information, and special rules for coordination of benefits, code sets, 
electronic signature, and unique health identifiers for individuals, 
employers, health plans, and health care providers.
  The Secretary is not required to adopt standards for clinical data or 
information in the patient medical record. Financial and administrative 
data often is handled electronically today, and there is general 
agreement on the type of standards that should be adopted. Clinical 
information, in contrast, is more complicated and there is little 
consensus on the quantity or content of the data that should be 
standardized. Further, adopting clinical standards involves complex 
privacy requirements and a debate about whether or not data should be 
centralized. However, after 4 years, but sooner than 6 years, the 
Secretary must recommend to Congress a plan for developing and 
implementing uniform, electronic data standards for information in the 
patient medical record.
  Within 2 years after the Secretary adopts the standards, health plans 
are required to comply. The mandate is on the payer, not the provider. 
Providers are required to comply with the standards for any business 
they do with Medicare. Payers and providers may deviate from the 
standards by mutual agreement. For example, a payer may agree to accept 
information on paper claims, but they are not required to accept that 
information if it is not in the standard format adopted by the 
Secretary. Similarly, a provider may agree to provide additional 
information requested by the payer, but they do not have to provide 
that information if it is not among the standards adopted by the 
Secretary. This creates the market-oriented leverage necessary to 
converge on a single industry standard.
  To conclude my remarks, I want to credit the work and commitment of 
the people behind this legislation. In 1991, Secretary of Health and 
Human Services Louis Sullivan articulated a vision of a health care 
information system. Mr. Bond first introduced legislation to achieve 
that vision in 1992, updated that work in 1993--Mr. Sawyer and I were 
the House sponsors--and now we introduce the final product of our 
continuing efforts here today--the Health Information Modernization and 
Security Act.


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