[Congressional Record Volume 149, Number 143 (Tuesday, October 14, 2003)]
[Senate]
[Pages S12544-S12546]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM of Florida (for himself and Ms. Snowe):
  S. 1729. A bill to establish an informatics grant program for 
hospitals and skilled nursing facilities in order to encourage health 
care providers to make major information technology advances; to the 
Committee on Finance.
  Mr. GRAHAM of Florida. Mr. President, I am very pleased to introduce 
the Medication Errors Reduction Act of 2003 with my friend and 
colleague Senator Olympia Snowe.
  In recent years we've heard much about the consequences of medication 
errors. What we haven't heard as much about are the root causes for the 
medication errors, or the solutions that are available to us to reduce 
errors, save lives, prevent injuries, and reduce costs. Simply put, our 
legislation is necessary because as a nation we face a serious patient-
safety problem. The good news is that we have a solution to the 
problem: we have the technological ability to dramatically reduce 
medication errors and thus save lives.
  The bad news is that the start-up costs and a lack of awareness have 
to this point been preventing us from reaping the benefits of the new 
technologies. The solution is right in front of us, but has been just 
out of reach.
  The legislation we are introducing today would bring the solution 
within our reach. It would address the causes of medication errors--
which are systems breakdowns--and the solutions--use of clinical 
computerized information systems that can save lives.
  We are here today to lend a helping hand, not to point a finger. We 
all share the goal of improving patient safety, and our bill will do 
that in a very simple, straightforward manner. The legislation 
establishes a voluntary grant program to encourage hospitals and 
skilled nursing facilities to become the pioneers of new, life-saving 
technologies. It does that by assisting with the often prohibitive 
start-up costs associated with purchasing and implementing information 
systems--systems that are designed to reduce medication errors and 
improve patient safety.
  I want to stress the goal of this legislation: to help build a safer 
medication-delivery system. The great successes of our health care 
system are largely due to our highly committed and talented doctors, 
nurses, pharmacists, hospitals, nursing homes and other health care 
providers. The problem we are addressing today is not theirs, but is a 
problem with the system they rely on to provide inpatient care.
  The Institute of Medicine report that kicked off much of this 
discussion 4 years ago tells us that we must address the ``systems 
problems'' and design systems that will prevent errors--just as cars 
are designed so that drivers cannot start them while in reverse helps 
prevent automobile accidents.
  The systems we want to fund would improve the medication-delivery 
system at many stages.
  We leave it up to the hospitals and nursing homes to determine 
exactly what types of technology would best fit their institutions and 
their needs. The grants could be used to purchase or improve computer 
software and hardware, purchase or lease communications capabilities, 
or provide education and training staff on computer patient safety 
programs.
  The grants could be used to improve patient safety at every stage of 
the medication delivery process. For example, a hospital or nursing 
home could use the funds to implement 1. electronic prescribing systems 
that can intercept errors at the time medications are ordered, 2. 
electronic medical records to alert doctors to possible drug 
interactions and complications related to the patient's medical 
history, 3. automated pharmacy dispensing to make sure the nurse 
receives the correct medication in the correct dosage for the correct 
patient, and 4. bedside verification--using bar codes on patient 
wristbands and the medications to ensure that the right medication is 
administered to the right patient at the right time.
  We could only have dreamed about clinical computerized information 
systems when the Medicare program was implemented. Today, we have them 
at our disposal. The sooner we get them into our hospitals and nursing 
homes, the sooner we start saving lives.
  The Medication Errors Reduction Act is supported by the Florida 
Hospital Association, National Rural Health Association, National 
Association of Children's Hospitals, Healthcare Leadership Council, 
AFSCME, Federation of American Hospitals, Catholic Health Association 
of the United States, Association of American Medical Colleges, 
Premier, Inc., the American Society of Heath-System Pharmacists, 
McKesson Corporation, IBM, VHA, Inc., Vanderbilt University Medical 
Center, New York Presbyterian Hospital, Aetna, Siemens, 
AmerisourceBergen Corporation, American Health Packaging, AutoMed, 
Choice Systems, Inc., Pharmacy Healthcare Solutions, Telepharmacy 
Solutions, Verizon, Becton Dickinson, American Health Care Association, 
AFL-CIO, Cardinal Health, and the eHealth Initiative.
  I ask their letters of support to be included for the Record. With 
their help, this bill will become law and we will be well on our way to 
improving patient safety.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
                                                 October 13, 2003.
     Hon. Robert Graham,
     U.S. Senate,

     Hon. Olympia Snowe,
     U.S. Senate,

     Hon. Amo Houghton,
     House of Representatives,

     Hon. Earl Pomeroy,
     House of Representatives,
     Washington, DC.
       Dear Senators Graham and Snowe and Representatives Houghton 
     and Pomery: Long engaged in efforts to improve patient 
     safety, the undersigned organizations strongly support the 
     ``Medication Errors Reduction Act of 2003.'' This critical 
     legislation would fund efforts to improve our nation's 
     clinical safety systems. Since the release of the 1999 
     Institute of Medicine report, to Err is Human, we have 
     collectively embraced a more vigorous commitment to the 
     advancement of patient safety in our healthcare system.
       Concern over improving the quality of our nation's health 
     care extends far beyond the provider community. The business 
     community, consumers, and Labor have an equally vested 
     interest. While the issues surrounding the improvement of 
     patient safety are numerous and complex, we agree that the 
     facilitated deployment of new technologies to certain 
     providers would be of immense benefit. Further, we believe 
     that clinical healthcare informatics systems designed to 
     reduce the incidence of adverse events and complications 
     stemming from medication errors great promise.
       New and evolving technologies like computer physician 
     order-entry (CPOE), bedside verification, and automated 
     pharmacy dispensing could prove particularly beneficial to 
     many healthcare providers. Still, sizable barriers to 
     acquisition and deployment exist. The inability to finance 
     such systems in perhaps the most insurmountable--but the 
     easiest to address, as well. This legislation would permit 
     providers and their patients to reap the rewards of these 
     critical patient safety improvement technology tools.
       Again, we thank you for having introduced the ``Medication 
     Errors Reduction Act of 2003,'' and look forward to working 
     with you toward enactment.
           Sincerely,
         Premier, Inc.;
         IBM;
         VHA, Inc.;
         Vanderbilt University Medical Center;
         New York Presbyterian Hospital;
         Aetna;
         McKession Corporation;
         Siemens;
         AmerisourceBergen Corporation;
         American Health Packaging;
         AutoMed;
         Choice Systems, Inc.;
         Pharmacy Healthcare Solutions;
         Telepharmacy Solutions;
         National Rural Health Association;
         National Association of Children's Hospitals;
         Verizon;
         Becton Dickenson;
         Federation of American Hospitals;
         American Health Care Association;
         AFL-CIO;
         Cardinal Health;

[[Page S12545]]

         American Society of Health-System Pharmacists;
         Healthcare Leadership Council;
         eHealth Initiative;
         Catholic Health Association of the United States;
         Association of American Medical Colleges; and
         AFSCME.
                                  ____



                                             Premier Advocacy,

                                               September 12, 2003.
     Hon. Robert Graham,
     U.S. Senate,

     Hon. Olympia Snowe,
     U.S. Senate,

     Hon. Amo Houghton,
     House of Representatives,

     Hon. Earl Pomeroy,
     House of Representatives,
     Washington, DC.
       Dear Senators Graham and Snowe and Representatives Houghton 
     and Pomeroy:
       On behalf of the more than 1,500 leading not-for-profit 
     hospitals and health systems allied in Premier, Inc., and the 
     millions of patients whose healthcare needs they serve, we 
     extend our vigorous support for the Medication Errors 
     Reduction Act of 2003.
       This innovative legislation would provide grants to 
     hospitals and nursing facilities to offset the prohibitively 
     high costs of developing and implementing new patient safety 
     and information technologies to reduce medical errors and 
     adverse events. As such, the measure would undoubtedly 
     contribute to the sustained improvement of quality health 
     care in America.
       The legislation's establishment of a ten-year, $1 billion 
     grant program would effectively mitigate the most formidable 
     barrier to hospitals' implementation of new, life-saving 
     technologies--namely, cost. In this way, the efforts of early 
     adopters of new technologies are simultaneously rewarded and 
     facilitated.
       As you know, Premier is a long-standing champion of patient 
     safety and quality improvement. At present, we are hosting a 
     series of collaborative meetings designed to help members 
     implement and adopt computerized physician order entry 
     (CPOE). Participation by hospital executives, including CIOs, 
     CMOs and CEOs, as well as their CPOE project leaders, 
     facilitate and energize the exchange of knowledge and 
     experience, which are invaluable to the advancement of CPOE 
     adoption. In addition, Premier has long championed industry 
     adoption of the bar code for drug, biological, and 
     appropriate medical device labeling to reduce the incidence 
     of adverse events, and improve patient safety overall.
       Premier and its member hospitals believe that the 
     Medication Errors Reduction Act represents a significant step 
     on the path to improved patient care. We applaud your 
     efforts, and look forward to working with you toward passage 
     of this critical legislation.
           Sincerely,
                                                        Herb Kuhn,
     Corporate Vice President.
                                  ____



                                         McKesson Corporation,

                            San Francisco, CA, September 12, 2003.
     Hon. Bob Graham,
     U.S. Senate,

     Hon. Olympia Snowe,
     U.S. Senate, Washington, DC.
       Dear Senators Graham and Snowe: On behalf of McKesson 
     Corporation, I would like to thank you for authorizing the 
     Medication Errors Reduction Act of 2003. We strongly support 
     this legislation and applaud your leadership in identifying 
     ways to help reduce medication errors and improve the quality 
     of health care in our nation.
       As the world's largest healthcare services company, 
     McKesson provides automation, information systems, and 
     pharmacy services that enable medication management accuracy. 
     We have pioneered advances in medication management 
     technology by providing hospitals, retail pharmacies and 
     other clinical settings with unique robotic pharmaceutical 
     dispensing and bedside bar-coding technologies to ensure that 
     the right drug, in the appropriate dosage, is administered to 
     the right patient via the right route at the right time. In 
     addition, McKesson provides computerized physician order 
     systems, pharmacy information systems, and clinical 
     consulting services designed to improve the quality and 
     delivery of health care.
       As early as 1993, the University of Wisconsin Hospitals and 
     Clinics (UWHC) embraced McKesson's automation and bar code 
     solutions for pharmaceutical distribution. Building on this 
     system, they have implemented point-of-care bar code scanning 
     at the bedside. In partnership with McKesson on clinical 
     programs and adverse drug event tracking, UWHC has 
     demonstrated a significant reduction in medication errors, 
     enhanced efficiency, increased clinician satisfaction, and 
     improved medication documentation. As an example of these 
     successes,they have achieved an 89 percent reduction in 
     medication administration errors due to point-of-care bar 
     code scanning, as well as a reduction in dispensing errors 
     from 1.43 percent to 0.13 percent. UWHC also realized a 
     return on investment in two years.
       We commend you for recognizing the need for economic 
     incentives to accelerate the adoption of innovative 
     technology so critically needed in today's health care 
     environment. By providing grants to hospitals and skilled 
     nursing facilities, your legislation will facilitate the 
     widespread use of technology designed to prevent medication 
     errors and enhance patient safety. We stand ready to work 
     with you and your staff to support passage of this 
     legislation.
           Sincerely,
                                            Ann Richardson Berkey,
      Vice President, Public Affairs.
                                  ____

                                               American Society of


                                    Health-System Pharmacists,

                                 Bethesda, MD, September 17, 2003.
     Hon. Robert Graham,
     U.S. Senate, Washington, DC.
     Hon. Olympia Snowe,
     U.S. Senate, Washington, DC.
     Hon. Amo Houghton,
     House of Representatives,
     Washington, DC.
     Hon. Earl Pomeroy,
     House of Representatives,
     Washington, DC.
       Dear Senators Graham and Snowe and Representatives Houghton 
     and Pomeroy: The American Society of Health-System 
     Pharmacists (ASHP), the 30,000-member national professional 
     association that represents pharmacists who practice in 
     hospitals, health maintenance organizations, long-term care 
     facilities, home care, and other components of health care 
     systems, would like to commend you on introduction of the 
     ``Medication Errors Reduction Act of 2003.''
       The Institute of Medicine (IOM) report, To Err is Human: 
     Building a Safer Health System, pointed out as many as 98,000 
     patients die annually as the result of medical errors, 7,000 
     of which are the direct result of medication-related 
     complications. Handwritten clinical data, incomplete, 
     outdated, or improperly implemented information technology 
     within our nation's health system contributes to the high 
     number of adverse events or health care complications due to 
     medication use.
       Research demonstrates that information technology 
     enhancements, when appropriately implemented, enhance the 
     appropriate, accurate, and timely distribution of 
     medications, and improve the quality of patient care.
       The voluntary grant program for which your legislation 
     provides would allow early adopters of new technology to meet 
     the high price tag associated with this technology as well as 
     the necessary and important expense of properly educating and 
     training staff on the correct use of the information system.
       ASHP hopes to foster a fail-safe medication process. Your 
     legislation helps move toward that goal and we look forward 
     to a continued partnership to make this a reality. For more 
     information, please contact Kathleen M. Cantwell, Director, 
     Federal Legislative Affairs and Government Affairs Counsel, 
     at 301/657-3000, ext. 1326.
           Sincerely,

                                        Henri R. Manasse, Jr.,

                                      Executive Vice President and
     Chief Executive Officer.
                                  ____



                                 Florida Hospital Association,

                                                 October 14, 2003.
     Hon. Bob Graham,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Graham: On behalf of the more than 230 members 
     of the Florida Hospital Association, I want to commend you 
     for introducing legislation to provide financial assistance 
     to help hospitals take patient safety to the next level. Your 
     bill, the ``Medication Errors Reduction Act of 2003,'' 
     represents a significant step toward assisting hospitals in 
     Florida and throughout the country in their continuous 
     efforts to improve their clinical safety systems.
       Your initiative recognizes that our commitment to patient 
     safety requires more financial resources than are currently 
     available to hospitals, which continue to experience 
     extraordinary financial pressures. You are a realist--
     matching resources in support of a great need.
       The FHA will encourage other members of the Florida 
     Congressional Delegation to support your bill--a measure that 
     targets our desire to improve patient safety. It will be 
     important for the bill to retain its clear focus, and not 
     become weighted down with extraneous legislative baggage that 
     could change its focus.
       Thank you for moving so swiftly to help us protect patients 
     while protecting the integrity of the Hospital Trust Fund.
           Sincerely yours,
                                                    Wayne NeSmith,
                                                        President.

  Ms. SNOWE. Mr. President, I rise today to join my colleague, Senator 
Bob Graham of Florida, in reintroducing the Medication Errors Reduction 
Act, which will serve to improve the quality of health care delivered 
in hospitals and skilled nursing facilities by reducing medical errors. 
The lack of quality assurances in America's health care system has been 
documented many times. We believe this bill is the first step in the 
process to correct this troubling circumstance and to ensure that the 
American health system is the world's safest.
  We first began development of this legislation in 2001, following the 
release of the Institute of Medicine's (IOM) report ``To Err Is Human: 
Building a Safer Health System.'' We were prompted by the startling 
revelations contained in the report that showed up

[[Page S12546]]

to 98,000 people per year lose their lives because of a medical error 
and the annual financial impact that results from these mistakes is 
believed to be as high as $29 billion.
  As you might imagine, a medical error can be many things, but the 
Institute defines it as ``the failure of a planned action to be 
completed as intended or the use of a wrong plan to achieve an aim.'' 
The Institute sites among the problems that commonly occur during the 
course of providing health care--adverse drug events and improper 
transfusions, surgical injuries and wrong-site surgery, suicides, 
restraint-related injuries or death, falls, burns, pressure ulcers and 
mistaken patient identities. All of these can have tragic endings, but 
all are preventable.
  In developing the solution, we looked to incentives that would prompt 
hospitals and skilled nursing facilities to utilize technology to 
identify inaccuracies and prevent medical errors before they happen. 
Senator Graham and I developed a proposal that provides Federal 
matching funds to hospitals and skilled nursing facilities that 
integrate into their medical systems technology that can prevent 
medical errors. Technology exists, as never before, that can help 
identify errors before they happen, and save lives. But this technology 
is rendered useless if it is not being utilized. That is why the 
Federal Government must step forward and provide the necessary 
incentives to prompt innovation.
  In taking this step, we believe it is imperative that the Federal 
Government invest time and funding in not just identifying the 
solution, but to provide the means to implement the solution. It is the 
role of the Federal Government to lead, and I believe that providing 
grant funding to hospitals and skilled nursing facilities to integrate 
technology into their health care delivery systems will in fact provide 
the necessary leadership to see this idea become a reality.
  More specifically, the grants provided by this legislation can be 
used to purchase or improve computer software and hardware, and provide 
education and training to staff on computer patient safety programs. 
They also may be used to improve patient safety at every stage of the 
medication delivery process through: electronic prescribing systems 
that can intercept errors at the time medications are ordered; 
electronic medical records to alert doctors to possible drug 
interactions and complications related to the patient's medical 
history; automated pharmacy dispensing to make sure the nurse receives 
the correct medication in the correct dosage for the correct patient; 
and bedside verification--using bar codes on patient wristbands and the 
medications to ensure that the right medication is administered to the 
right patient at the right time.
  Further, we direct the funding to hospitals that serve predominately 
patients who receive insurance coverage through Medicare, Medicaid and 
S-CHIP. And to ensure that all hospitals, especially those in rural 
communities that have smaller operating margins, can afford to utilize 
this innovative new program, we set aside 20 percent of the funding for 
rural hospitals. I believe this is an important and necessary step to 
protect our rural communities and provide families with the highest 
quality care.
  I hope my colleagues will join us in support of this legislation so 
we soon will be able to reduce the number of Americans who are harmed 
by medical errors.
                                 ______