[Congressional Record Volume 152, Number 108 (Wednesday, September 6, 2006)]
[Senate]
[Pages S9043-S9045]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARPER (for himself and Mr. Voinovich):
  S. 3846. A bill to provide for the establishment and maintenance of 
electronic personal health records for individuals and family members 
enrolled in Federal employee health benefits plans under chapter 89 of 
title 5, United States Code, and for other purposes; to the Committee 
on Homeland Security and Governmental Affairs.
  Mr. CARPER. Mr. President, I rise today to announce the introduction 
of a piece of legislation that Senator Voinovich of Ohio and I have 
worked on for a while. It is called the Federal Employees Electronic 
Personal Health Records Act of 2006. This bill makes available--or 
would make available--electronic personal health records for every 
enrollee of a Federal health benefits plan who wishes to have one. That 
is, potentially, as many as 8 million people. That includes those of us 
who work in Federal agencies, large and small, across the country and, 
actually, around the world. It includes their families and includes 
Federal retirees and their families as well.
  Our health care sector is the most innovative in the world, but it 
has not kept up with the information age. Our excessive reliance on 
paper record keeping makes our health care system less efficient, more 
costly, and more prone to mistakes. Expanding the use of health 
information technology shows promise as a way to improve both the cost 
and the quality of health care in our country.

[[Page S9044]]

  In 2004, the United States spent some $1.9 trillion on health care 
costs.
  That is more than any other industrialized country on this planet. In 
2005, health care premiums continued their upward trend, increasing by 
an average, I am told, of some 9 percent. We are literally spending 
trillions of dollars on health care, but I am sorry to say we are not 
getting the gold standard of treatment or results.
  A 2005 survey conducted by the Commonwealth Fund, a private 
foundation that focuses on improving health care, found that medical 
error reports rates in the United States far exceed those of western 
countries. In that survey, one in three Americans reported getting the 
wrong dosage of medication, incorrect test results, mistakes in 
treatment, or late notification of test results. That is nearly 15 
percent higher than similar results in Britain and Germany.
  I believe some of the problems--though certainly not all of them--can 
be blamed on the fact that health care providers don't have full and 
real-time access to patients' medical records. Doctors in this country 
wait days sometimes for couriers to deliver lab tests or x rays. They 
diagnose patients without knowing their full medical history, what they 
are allergic to, what kinds of surgeries they have had, or whether they 
have complained about similar symptoms before.
  Time constraints, or medical necessity, often force doctors to 
perform a quick diagnosis. Sometimes that diagnosis wrong. Sometimes 
those errors prove to be costly. The widespread use of health 
information technology, the ability to immediately access one's full 
medical history from a computer, can help doctors and nurses provide 
better care less expensively. It has the potential to dramatically 
transform the way we provide health care in America--saving lives, 
saving costs.
  If we are looking for success stories on how health care 
professionals have integrated the use of electronic health care records 
into their daily routines, we don't have to look any further than our 
own Department of Defense and our Department of Veterans Affairs.
  Times have changed since I retired from the Navy some 15 years ago. I 
remember that as an ensign I used to carry my medical health records in 
a brown manila folder from duty station to duty station--from the time 
I left Ohio State, on to Pensacola, Corpus Christi Naval Air Station, 
out to California, across the seas and back again, and, finally, 
getting off of active duty and coming to Delaware to enroll in graduate 
school, on the GI bill, at the University of Delaware in the business 
school. I went up the road to the VA hospital. I still had my folder 
with the records. I turned them in and asked: What kind of benefits am 
I eligible for?
  Over a decade ago, the Department of Defense and VA decided there was 
a better way, and the results have been nothing short of phenomenal. 
Today, when a patient enrolls in the Department of Defense's military 
health system, they no longer need the kind of brown manila folder I 
carried all those years. Instead, we have electronic health care 
records to keep track of the medical histories of those who serve our 
country in the military. This health record is managed electronically, 
and you don't have to remember to pack it up on your next tour of duty, 
whether it is in Southeast Asia, or Iraq, or Afghanistan.
  Instead, one's electronic health care record follows them wherever 
they go--both during the time they are in the military and when they 
leave and join our veterans community as a veteran.
  The result is that the Department of Defense and VA have been 
impressive, especially when you consider that they have only used these 
electronic health records for about a decade or so.
  The VA health system has transformed itself from a troubled, 
sometimes bloated and inefficient operation to one of the best health 
care operations in the country.
  Researchers and doctors now laud the VA for having the foresight to 
use electronic health records to improve patient care.
  What is the cost? That is a good question. It is about $78 per 
patient. That is roughly the cost of not repeating one blood test. In 
other words, it is money well spent.
  The VA now regularly outperforms Medicare and other private health 
plans when it comes to providing patient care for diabetes, high blood 
pressure, and heart attack victims.
  In January, the National Quality Research Center concluded that for 
the sixth consecutive year, the VA health care system outranks the 
private sector for customer satisfaction.
  I have witnessed that new-found satisfaction in my own backyard, at 
the Veterans Medical Center in Elsmere, DE. That is the place I went in 
1973 fresh out of the Navy. Veterans from neighboring States are now 
coming to our hospital in Elsmere to seek care instead of going to 
regular civilian hospitals near them.
  In 2004, the Elsmere facility, as well as popular satellite clinics 
in Millsboro and Seaford, DE, served more than 22,000 veterans and had 
more than 150,000 outpatient visits. Both totals are about 20 percent 
higher than just 4 years ago.

  Normally, you would think the busier a hospital is, the less 
satisfied customers are because of longer waits and other hassles. But 
it turned out that the opposite is true. As the workload has climbed, 
so has patient satisfaction. I might add, so has the satisfaction of 
those providing the care to the patients.
  More than 85 percent of Delaware's VA outpatients said they were 
``highly satisfied'' with the care they received. Planning is now 
underway to open a third outpatient clinic for veterans in Kent County 
next spring--probably in Dover where we have another 15,000 veterans.
  What is keeping the rest of our Nation's health care system from 
following the lead of the Department of Defense and the VA? The answer 
is the high cost of implementing the latest information technologies, 
as well as the lack of uniformity among various technology products.
  A physician can spend up to $30,000 implementing an electronic health 
records system. A hospital can spend up to five times that amount. If 
that weren't enough of a reason to say no thanks, there is one more 
reason; that is, we don't have a set of national standards in place to 
make sure that once health care providers have made the switch, their 
new system can communicate with the hospital or doctor on the other 
side of town. The result: Only 15 percent of doctors and about 30 
percent of hospitals have fully functional electronic health care 
systems today.
  A new study by a number of health care scholars estimates there will 
be another 20 years before the majority of physicians are using an 
electronic health care system.
  Let me say this. Our Presiding Officer is from Louisiana where they 
went through a terrible situation a year ago with Katrina. The folks 
who happened to be civilians and were in hospitals or nursing homes, 
for the most part, they had paper health records and they were 
destroyed. The veterans who were on the gulf coast when Katrina 
struck--either in nursing homes, VA nursing homes, or VA hospitals--
were evacuated from the area as civilians were; but when the veterans 
got to another VA facility inland, or a nursing home, or a VA hospital, 
their electronic health records were available immediately, and whoever 
provided care for them had access to the records and were able to 
provide excellent care.
  I am sorry to say that the same wasn't true for the civilians whose 
paper records were largely destroyed at the time of the evacuation.
  As a nation, we cannot afford to rely solely on health care providers 
to bring the health care industry into the 21st century. We must think 
outside of the box and build on the health information technology 
issues already underway in other areas of our health care industry.
  The Federal Employee Electronic Personal Health Records Act of 2006--
the legislation Senator Voinovich and I introduce today--does just 
that. How? By requiring all carriers that contract with the Federal 
Employees Health Benefits Program to make available an electronic 
personal health record for those of us who are enrolled in that 
program. As I said earlier, it is some 8 million people.
  Electronic personal health records will provide enrollees with a tool 
to better access and control their health information. Via the 
Internet, an enrollee will be able to log on to their

[[Page S9045]]

electronic personal health record to keep track of such things as their 
medications, cholesterol, glucose levels, allergies, and immunization 
records.
  An enrollee will also be able to review a comprehensive, easily 
understood listing of their health care claims. Health care providers, 
payers, and enrollees will be able to add this information onto the 
electronic personal health record. Enrollees will benefit, I believe, 
significantly from such a tool.
  An enrollee can easily share sections of the electronic personal 
health record with their health care provider, ensuring that their 
provider has the most up-to-date and accurate health information when 
making clinical decisions.
  In the case of an emergency, an enrollee can also grant others the 
ability to access their electronic personal health record. Again, it is 
the decision of the patient, the enrollee in the Federal Employee 
Health Benefits Program, to decide what kind of access to grant to a 
provider or a member of the family or another person in the wake of an 
emergency.
  Having health information readily available will increase the 
efficiency and safety of health care for enrollees by eliminating 
unwarranted tests, procedures, and prescriptions.
  Most important, the legislation ensures that the electronic personal 
health records provided for through this act are kept private and 
secure.
  The electronic personal health records are required to include a 
number of security features. They include, among other things, user 
authentication and audit trails.
  The legislation also requires that carriers comply with all privacy 
and security regulations outlined in the Health Insurance Portability 
and Accountability Act, which we call HIPAA.
  Mr. President, what Senator Voinovich and I are introducing today 
will help demonstrate the importance and utility of health information 
technology--not just the importance of the technology but the 
importance of harnessing the technology--in the delivery of health care 
in this country today. In this case, the potential is as many as 8 
million additional Americans.
  This bill is designed to jumpstart this new technology by requiring 
some of the largest health insurance companies to offer these 
electronic personal health records, which many are beginning to do 
today. As more insurance companies, health care providers, and 
consumers use this new technology, I am convinced that more people will 
recognize its advantages, and we can more quickly move America's health 
care industry into the 21st century.
  We view this initiative as the next necessary step for the Nation's 
largest employer-sponsored health insurance program that prides itself 
on being a model for best practices in health care.
  I invite my colleagues to join Senator Voinovich and me as we 
introduce this legislation. We look forward to talking with our 
colleagues about it. With luck, maybe we will have a hearing. Senator 
Voinovich may hold one in his subcommittee this month.
  Mr. VOINOVICH. Mr. President, I rise to speak about a bill my 
colleague Senator Carper and I introduced today, the Electronic 
Personal Health Records Act. The purpose of this legislation is to 
provide for the establishment and maintenance of electronic personal 
health records for individuals and family members enrolled in the 
Federal Employee Health Benefits Plan, FEHBP.
  The widespread adoption of health information technology, such as 
electronic health record, (EHR), will revolutionize the health care 
profession. In fact, the Institute of Medicine, the National Committee 
on Vital and Health Statistics, and other expert panels have identified 
information technology as one of the most powerful tools in reducing 
medical errors and improving the quality of care. Unfortunately, our 
country's health care industry lags far behind other sectors of the 
economy in its investment in IT.
  The Institute of Medicine estimates that there are nearly 98,000 
deaths each year resulting from medical errors. Many of these deaths 
can be directly attributed to the inherent imperfections of our current 
paper-based health care system. This statistic is startling and one 
that I hope will motivate my colleagues to take a close look at the 
goals of our legislation.
  The voluntary EHRs that would be established through the Electronic 
Personal Health Records Act will provide clinicians with real-time 
access to their patient's health history. Each EHR would contain claims 
data, contact information for providers of health care services, and 
other useful information for diagnosis and treatment. The records will 
be available cost-free to FEHBP participants and will maintain strict 
adherence to HIPAA.
  Under the bill, the Office of Personnel Management, OPM, would be 
required to ensure that all carriers who participate in FEHBP educate 
their members about the implementation of the EHR, as well as give 
timely notice of the establishment of the record and an opportunity for 
each individual to elect not to participate in the program.
  OPM, through their carriers, would also have to ensure that all 
records would be available for electronic access through Internet, fax, 
or printed method for the use of the individual, and that to the extent 
possible, records could be transferred from one plan to another. The 
bill would require EHRs to be made available two years after the 
passage of the legislation or earlier at the discretion of OPM in 
consultation with the Office of the National Coordinator for Health 
Information Technology within HHS.
  Not only can EHRs save lives and improve the quality of health care, 
they also have the potential to reduce the cost of the delivery of 
health care. According to Rand Corporation, the health care delivery 
system in the United States could save approximately $160 billion 
annually with the widespread use of electronic medical records. As a 
result, the private market is already moving toward implementing 
electronic medical records.
  This bill, simply encourages the health care industry to continue in 
that direction and take their use of technology in the delivery of care 
to the next step. I urge my colleagues to consider not only the benefit 
it will provide to the eight million individuals who receive their 
health care through the FEHBP, but also to our Nation's overall health 
care system.
                                 ______