[Congressional Record Volume 150, Number 102 (Wednesday, July 21, 2004)]
[Extensions of Remarks]
[Pages E1441-E1442]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  INTRODUCTION OF THE QUALITY, EFFICIENCY, SAFETY, AND TECHNOLOGY FOR 
                     HEALTHCARE TRANSFORMATION ACT

                                 ______
                                 

                        HON. PATRICK J. KENNEDY

                            of rhode island

                    in the house of representatives

                        Wednesday, July 21, 2004

  Mr. KENNEDY of Rhode Island. Mr. Speaker, I rise today for Josie 
King. Josie was a vibrant eighteen-month-old who suffered a terrible 
accident and, thanks to the incredible advances in medicine, was saved 
and preparing to go home from the hospital.
  Before she could, though, the same health system that saved her then 
took her life. That sweet little girl was lost to a series of entirely 
preventable mistakes in one of the finest hospitals in the nation, if 
not the world.
  Politicians like to say that the United States has the best 
healthcare system in the world. But we don't. What we have is the best 
medical talent in the world, the best medical technology in the world, 
the best facilities in the world.
  But the system itself is a mess.
  The best healthcare system in the world would not allow nearly 
100,000 people like Josie King to die in hospitals of preventable 
medical errors.
  The best system in the world would not leave the United States ranked 
28th in the world for infant mortality, in the company of Cuba, 
Hungary, and Slovakia.
  The best system would not leave almost 75 million people--nearly one 
in three people under 65--without health insurance at some point over a 
2 year period, especially when the National Academy of Sciences has 
documented that people without insurance have worse health and die 
sooner.
  The best system wouldn't waste 30 cents on the dollar, or 1,400 
dollars per employee per year, on care that does nothing to improve 
clinical outcomes. That's a 2 billion dollar tax on employers and 
taxpayers in my home state of Rhode Island in 2004, and an estimated 
77.44 trillion dollars for the nation over the next decade.
  And, one thing I know for certain, Mr. Speaker, the best healthcare 
system would

[[Page E1442]]

not give patients barely a coin-flip's chance whether they receive 
evidence-based, scientifically accepted care in appropriate situations.
  Mr. Speaker, I rise today to introduce legislation because our health 
care system is not the best in the world. Our health care system 
produces great medicine but it produces great medicine unevenly and 
with massive inefficiencies and frequent mistakes. We can do better.
  There's a saying: ``Every system is perfectly designed to produce the 
results it gets.'' We need to redesign the health care system to 
produce better outcomes at a better value. We need nothing short of a 
transformation so that delivering the highest quality health 
care becomes not only the overriding goal of the professionals within 
the system, but of the system itself.

  How do we get there? Today, I am introducing a bill called the Josie 
King Act to put in place three pillars of a transformed system: A fully 
electronic, integrated, paperless healthcare system; a new emphasis on 
improving the science of better care, from the evidence base underlying 
medical treatments to the creation of a new cadre of health quality 
experts; and new methods of measuring the quality of care and new 
payment practices so that providers are compensated for the quality of 
care they provide, not just the quantity.
  We're in the information age, and nowhere is information more 
important than in health care. Yet we ask doctors to practice medicine 
in the dark.
  Our healthcare system is made up of thousands upon thousands of 
independent providers, each with its own records and no way to 
communicate with each other. Patients see multiple doctors, very rarely 
with anybody other than the patient as the traffic cop.
  Since the right hand doesn't know what the left hand is doing, it's 
no wonder that 54 percent of serious chronic disease patients say they 
have been sent for duplicate tests or procedures within the last year.
  In fact, it is estimated that 20 percent of labs and x-rays are 
ordered because the previous results can't be found. One in seven 
hospitalizations occurs as a precaution because patient information is 
unavailable.
  Handwriting errors and other human mistakes cause deaths and 
injuries. The chances of being administered the wrong drug or the wrong 
dose in the hospital is around seven percent. Adherence to evidence-
based medicine is shockingly low--barely 50 percent.
  Why? It's not because the doctors and nurses and other health care 
personnel aren't skilled or committed or careful. It's because we 
practice 21st century medicine on a 20th century platform. Right now, 
less than five percent of doctors' offices use electronic medical 
records there's no way for even those doctors to easily share 
information.
  The information revolution has transformed financial services, 
manufacturing, retail. Even hide-bound politicians are adapting 
campaigns and elections to the new tools. We need I.T. to transform 
medicine as well.
  Making our health care system fully electronic, with networks to 
share all information that patients choose to share, will create new 
tools for doctors and nurses to let them use their skills more 
effectively.
  Each provider would have a complete record for the patient, so there 
would be no more duplication of tests and procedures.
  Computerized decision support systems would catch possible errors and 
help remind health professionals of new advances in evidence-based 
practice guidelines.
  Patients would have access to important health information in a way 
that can allow them to be active participants in their own care.
  A national health information infrastructure will also be a critical 
public health tool, helping the CDC and other public health agencies 
quickly pick up on and respond to outbreaks and acts of bioterrorism.
  As we build these health information networks, security and privacy 
must be paramount. In fact, we can and should make a new information 
infrastructure safer than the status quo, with paper records that can 
be read by anybody and are easily accessible.
  Not only could creation of this health information infrastructure 
dramatically improve patient care, it could save us billions of 
dollars--dollars our health care system can scarcely afford to waste. 
The independent Center for Information Technology Leadership prepared a 
report for the Department of Health and Human Services estimating the 
savings at $87 billion per year as we eliminate duplicate tests, 
unnecessary hospitalizations, and the many errors that plague our 
system today.
  If electronic health systems are so terrific, you would think we'd 
have them by now. But here's the trouble. Most providers, especially 
physicians in small practices, have little financial incentive or 
wherewithal to make substantial I.T. investments.
  In order to fix that, we need to recognize that putting in the 
information technology we need is a community-wide, infrastructure 
challenge. The benefits of achieving a widespread health information 
network for the community as a whole are tremendous, easily providing 
enough return on investment for all to gain.
  But to get there, all of the health care stakeholders will have to 
work together to figure out how they're going to divide up the costs 
and the savings of putting electronic systems in every provider's 
office and of establishing the network. It needs to be a community-wide 
approach.
  The model is being built in Rhode Island. Work is underway to pilot 
the development of a comprehensive health information network, and when 
it is in place, Rhode Island will be showing the future to the rest of 
the nation.
  Building on this model, the Josie King Act lays out a phased process 
that will provide seed money and leadership to get the process rolling 
across the country and help every state and region build its 
infrastructure. With this proposal, we can get virtually the entire 
healthcare system networked in a decade.
  When we have an electronic health information system, all kinds of 
other possibilities for transformation become possible. The Josie King 
Act not only would put I.T. in place, but would help establish new 
systems to take advantage of it.
  Information systems create new opportunities for developing and using 
the evidence base. The Josie King Act would promote research into the 
comparative effectiveness and value of drugs, treatments, and 
technologies so doctors will have more and better information.
  But as we expand our understanding about what constitutes good 
medicine in a given situation, we need to improve how that knowledge is 
used. How would we react, Mr. Speaker, if the airline lost half of our 
bags? Or if every other computer in our offices had to be returned to 
the manufacturer due to defects?
  Well that's what we have in medicine--a defect rate approaching 50 
percent in many cases, according to research from the RAND Corporation. 
We need to challenge the culture and systems that we have, because they 
are simply not good enough.
  Information technologies can be powerful tools to drive out errors 
and improve efficiencies, as we have seen throughout our economy. But 
they are the tools, the means not the end. We also need leaders 
committed to redesigning health care delivery. The Josie King Act would 
begin training this new cadre of health care leaders with scholarships 
for graduate study in health care quality and efficiency.
  To improve quality and efficiency, we also must be able to accurately 
measure quality and efficiency. The Josie King Act will help 
standardize performance measurement and use the new electronic clinical 
data so that, for the first time, consumers and payers can have a 
single source for an apples-to-apples comparison of all providers' 
quality, efficiency, and patient satisfaction.
  Over time, these performance measurements can help us redesign 
payment practices so that doctors and hospitals are rewarded, not 
penalized, for improving patient outcomes.
  The status quo is just not a sustainable option. We deserve a health 
care system that is as good as the quality of the medicine it can 
provide. That means thinking critically and creatively about what kind 
of health care system we want and how we build it.
  Mr. Speaker, I would be remiss if I did not take a moment to 
acknowledge the great leadership and commitment on this issue of the 
former Speaker of this House, Newt Gingrich. There is nobody thinking 
more critically and more creatively about health care delivery than he 
is. Speaker Gingrich has been a terrific teacher and partner tome in 
this effort, and it is the great fortune of this nation that he has 
turned his prodigious talents to fixing what ails our health care 
system.
  We can transform the health care system. It's an ambitious goal, but 
our reimbursement rates are too low, our premiums are too high, and our 
health outcomes are too uneven for us not to meet this challenge. We 
owe it to Josie King and her family to make sure that our health care 
system follows the Hippocratic Oath: first do no harm.
  I look forward to working with my colleagues on both sides of the 
aisle on the Josie King Act, and I hope that we can do the hard work to 
build a health care system that's every bit as good as the 
extraordinary medicine it can produce.

                          ____________________