[Congressional Record Volume 153, Number 104 (Tuesday, June 26, 2007)]
[Senate]
[Pages S8414-S8416]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KENNEDY (for himself, Mr. Enzi, Mrs. Clinton, Mr. Hatch, 
        Mr. Obama, Mr. Gregg, Mr. Alexander, Mr. Burr, Mr. Roberts, Mr. 
        Isakson):
  S. 1693. A bill to enhance the adoption of a nationwide interoperable 
health information technology system and to improve the quality and 
reduce the costs of health care in the United States; to the Committee 
on Health, Education, Labor, and Pensions.
  Mr. KENNEDY. Mr. President, it is long past time for the Nation's 
health care industry to adopt modern information technology. Such 
technology has revolutionized a wide array of American industries, and 
it holds the same promise for the health care industry. It has a clear 
capacity to increase efficiency and reduce costs at a time when the 
industry is being plagued by the alarming rise in health costs.
  Staggering inefficiencies imbedded in our health care system prevent 
patients across the country from receiving the type of care they 
deserve. Forty percent of Americans have been victims of preventable 
medical errors, and as many as 100,000 patients die each year from such 
errors. In a Nation which already spends more on health care than any 
other country, a modest investment in health IT is a small price to pay 
for a safer and less costly health care system.
  Some health facilities with resources at their disposal have already 
invested in IT systems with great success. Meanwhile, the most 
vulnerable institutions lag further and further behind in the adoption 
of necessary technology. It now costs a physician's office about 
$40,000 to implement a new IT system. Providers with financial need 
deserve access to information technology to close the health IT gap, so 
that patients across the country have access to quality health care.
  The Senate unanimously approved the Wired for Health Care Quality Act 
in the last Congress. Today, Senator Enzi, Senator Hatch, Senator 
Clinton, and I are reintroducing that bill, and we urge its swift 
passage. By setting national standards for health information 
technology and by offering funds for IT investment, the legislation 
will help providers overcome both the technical and the financial 
barriers to adopting and implementing health IT systems.
  Recognizing the financial challenges of such investments, our bill 
establishes several Federal funding mechanisms to encourage the 
adoption of this technology. The legislation authorizes Federal grants 
for providers in need and funds low interest loans in order to ease the 
burden on health care professionals who invest in new systems for 
electronic medical records and other purposes. Since the ability of 
physicians to share information is essential to ensuring effective 
treatment and eliminating wasteful spending, our bill also provides 
financial assistance to establish regional and local health IT 
networks.
  Rapid exchange of information is essential to ensuring that providers 
have complete patient information, but the adoption of such technology 
must be accompanied by strong patient privacy protection. Our bill 
specifies that the American Health Information Community will be a body 
to make recommendations to the Secretary of Health and Human Services 
on patient privacy, information security, and appropriate uses of the 
technology. In addition, the bill ensures that freestanding health 
information databases are subject to the same privacy rules as other 
health care entities and requires grant recipients to implement strong 
privacy protections themselves.
  To encourage the implementation of modern health information systems 
across the Nation, the legislation codifies the role of the National 
Coordinator for Health Information Technology in the Department of 
Health and Human Services to coordinate and expedite the adoption of 
health IT by Federal agencies. In addition, the bill establishes a 
public-private partnership, the Partnership for Health Care 
Improvement, to streamline the nationwide implementation of health 
information systems by establishing standards for interoperability that 
must be adopted by grant recipients and Federal contractors.
  Estimates indicate that the widespread adoption of electronic health 
records could save up to 30 percent in annual health spending, or more 
than $600 billion a year. Since 45 million Americans are uninsured, we 
can't delay the nationwide adoption of health IT systems any longer. 
Interoperability standards will eliminate inefficiencies caused by lack 
of uniform technology. Increased funding will reduce the widening 
health IT gap, making the advances of the information age available to 
all health facilities. The savings generated by these initiatives have 
the potential to give all Americans access to the Nation's state-of-
the-art health care industry.
  I especially commend the work of my colleagues Senator Enzi, Senator 
Clinton, and Senator Hatch in developing this needed legislation, and I 
look forward to its enactment as soon as possible.
  Mr. ENZI. Mr. President, I rise today to speak about my commitment to 
improve the quality and reduce the cost of health care in this Nation.
  Some of the most serious challenges facing health care today, medical 
errors, inconsistent quality, and rising costs, can be addressed 
through the effective application of available health information 
technology linking all elements of the health care system. Information 
sharing networks have the potential to enable decision support anywhere 
at any time, thus improving the quality of health care and reducing 
costs.
  But what does this mean for patients? Well, first of all, the 
widespread use of health IT would allow medical data to move with 
people as they move. When someone goes to the doctor's office, he or 
she won't have to take the clipboard and write down everything they can 
remember about themselves. Better use of health IT also would cut down 
on medical errors with prescriptions, instead of trying to decipher the 
doctor's handwriting, a pharmacist could access the prescription 
information electronically.
  The widespread use of health IT could also save lives. If someone is 
traveling and gets in a car wreck or gets hurt in some other way, the 
emergency room doctor would be able to find out everything he or she 
needs to know to make the right treatment decisions. If someone falls 
into a coma and can't tell a doctor or nurse about their medications, 
being able to access an electronic medical record could prevent 
dangerous drug reactions.
  Beyond saving lives and saving time, more effective use of health IT 
also could save us a lot of money. A Rand study suggested that health 
IT has the potential to save the health care system $162 billion a 
year. In order for these savings to be realized, we must create an 
infrastructure for interoperability. The bill I am introducing today is 
the first step toward building that infrastructure.
  Last Congress, the Senate unanimously passed the Wired for Health 
Care Quality Act, which I wrote with Senator Kennedy. We have worked 
with Senator Hatch and Senator Clinton and are introducing an updated 
bill today. We plan to bring this revised bill before our committee 
this Wednesday.
  This legislation addresses one of the primary barriers to widespread 
adoption of interoperable health IT, which is the lack of agreed-upon 
standards, common implementation guides, and a certification process. 
The bill directs the Secretary to establish and chair the public-
private American Health Information Collaborative, which is composed of 
representatives of the public and private sectors. The greatest 
improvements in quality of health care and cost savings will be 
realized when all elements of the health care system are electronically 
connected and speak a common technical language; that is, they are 
interoperable.
  In order to address the health information technology ``adoption 
gap'' in the U.S., the bill authorizes three grant programs that will 
carefully target financial support to health care providers and 
consortia for the purpose

[[Page S8415]]

of facilitating the adoption of interoperable health information 
technology.
  Another barrier to greater adoption is cultural. I recognize that 
many physicians and hospitals are hesitant to move from paper-based 
systems to electronic systems. Some physicians have been writing 
prescriptions by hand for many years and may resist changing to 
electronic prescribing. One way to address this cultural barrier is to 
support teaching hospitals that integrate health information technology 
in the clinical education of health care professionals. Exposing 
students and residents to effective everyday uses of health IT will 
lead to a greater adoption by these students and residents when they 
graduate and begin practicing on their own.
  The wise deployment of health IT is also critical for effective 
response in public health emergencies. Interoperable health IT systems 
will help to track infectious disease outbreaks and increase the 
Federal Government's rapid response in emergency situations.
  I am eager to work with members of the Finance Committee to ensure we 
produce a bill that will pass the Senate unanimously once again this 
Congress. This bill ensures that avenues to measure and report the 
quality of care are available through health information technology. 
Improving the quality of care provided in this country is one of my top 
legislative priorities.
  I look forward to passing this important legislation, which will help 
facilitate the widespread adoption of electronic health records to 
ultimately result in fewer mistakes, lower costs, better care, and 
greater patient participation in their health and well being. This is a 
great stride forward in the journey to improve our Nation's health care 
system. I look forward to seeing meaningful health information 
technology legislation signed into law this Congress.
  Mrs. CLINTON. Mr. President, for several years now I have been 
promoting the adoption of health information technology as a means to 
improve our health care system. Modernizing our system will improve 
quality of care and reduce costs. A RAND study found that, as a nation, 
we could save more than $77 billion annually through the widespread use 
of electronic medical records, and these savings could double with the 
addition of prevention and chronic disease management components.
  I introduced comprehensive health quality and IT legislation in 2003 
to set us on the path to creating a health IT infrastructure. 
Subsequently, the Senate unanimously passed bipartisan legislation that 
I worked on with Senators Frist, Kennedy, and Enzi. We were unable to 
reach final agreement on that bill before the adjournment of the 109th 
Congress and today are reintroducing the Wired for Healthcare Quality 
Act to bring our health care system into the 21st century.
  I am pleased to be working again on this critical effort with 
Senators Kennedy and Enzi and want to welcome Senator Hatch and thank 
him for his work and contributions to the bill we are introducing 
today.
  While there are a number of things I believe we need to do to improve 
our health care system, one of the most fundamental avenues for change 
is modernizing our system of care by developing a nationwide 
interoperable health information technology infrastructure that 
protects patient privacy. It is past time that our health care delivery 
system allow providers to easily manage their information needs and 
securely and privately manage the needs of their patients.
  We have the most advanced medical system in the world, yet patient 
safety and quality is compromised because health care providers are 
treating patients without all the information they need. It happens in 
the emergency room or when you are seeing multiple doctors who are 
unaware of treatments you are receiving from others. Harnessing the 
potential of information technology will eliminate these problems and 
help reduce errors and improve quality in our health care system.
  Interoperable health IT will also help eliminate inefficiency and 
duplication in the system. Every time patients see a doctor, they fill 
out forms, have to remember their medical history, their medications, 
immunizations, and previous test results. No wonder a study in 
California found that one out of every five lab tests and x rays were 
conducted solely because previous lab results were unavailable.
  There is no reason why people's health files--their medical history, 
test results, lab records, x rays--can't be accessed securely and 
confidentially from a doctor's office or hospital. In fact, if all 
hospitals used a computerized physician order entry system, an 
estimated 200,000 fewer adverse drug events would occur, saving roughly 
$1 billion per year.
  We should also eliminate administrative inefficiencies that drive up 
health care costs. Today, processing paper claims costs an average of 
$1.60 to $2.20 per claim. It costs 85 cents for an electronic claim.
  We can also use information technology to disseminate clinical 
research. A government study recently showed it takes 17 years from the 
time of a new medical discovery to the time clinicians actually 
incorporate that discovery into their practice at the bedside. Health 
IT will dramatically reduce this time and help drive improvements in 
care.
  The Wired for Healthcare Quality Act is designed to address these 
issues through Federal leadership to develop and adopt the technology 
standards necessary to ensure that electronic medical records are fully 
portable and confidential for patients and accessible to their health 
care providers. The legislation encourages the development of a private 
and secure nationwide interoperable health IT infrastructure through:
  Codifying the role of the National Coordinator for Health Information 
Technology in coordinating the policies of federal agencies regarding 
health IT.
  Establishing a public-private partnership known as the Partnership 
for Health Care Improvement to provide recommendations to the Secretary 
with regard to technical aspects of interoperability, standards, 
implementation specifications, and certification criteria for the 
exchange of health information.
  Requiring all Federal IT purchases to conform to the standards 
recommended by the Partnership and adopted by the President.
  Establishing the American Health Information Community as a body 
providing recommendations to the Secretary regarding policies to 
promote the development of a nationwide interoperable health 
information technology infrastructure. These include recommendations 
regarding patient privacy, information security, and appropriate uses 
of health information. A wide variety of stakeholders including 
patients, providers, insurers, employers, and experts in information 
technology, privacy, security, and quality--will have representation on 
the AHIC.
  Establishing three competitive grant programs for the adoption and 
increased utilization of qualified health information technology 
systems. The first grant program would award funding to eligible 
entities, including nonprofit hospitals, community health centers, and 
small physician practices to purchase, train, and use qualified health 
information technology systems and improve the management of chronic 
diseases. The second grant program would award funding to States to 
establish loan funds for the purchase of qualified systems, and the 
final competitive grant program would assist with the establishment of 
regional or local health information technology exchanges.
  Ensuring privacy and security by delineating the rights of 
individuals to inspect and correct their records and take action to 
address fraud, as well as requiring breach notification and audit 
trails so patients can know who has accessed their information.
  Establishing a Health Information Technology Resource Center to 
provide technical assistance and highlight best practices associated 
with the adoption, implementation and effective use of health 
information technology systems.
  I am especially pleased by the focus that this legislation places on 
ensuring that information technology will improve the quality of care 
delivered in our Nation. The Wired for Healthcare Quality Act will 
prioritize quality through the following provisions: Developing quality 
and efficiency reports at the national, regional, and, when requested, 
institutional or individual

[[Page S8416]]

provider level, that will help to improve quality and efficiency and 
enhance the ability of consumers to evaluate the quality and delivery 
of healthcare services; Establishing a process through which to develop 
evidence-based, consensus health care quality measures, through which 
to determine the quality and efficiency of care received by patients; 
and adopting the quality measures established by such process and 
providing for the integration of these measures into the nationwide 
health IT infrastructure, thus fostering uniformity in quality measures 
across our healthcare system.
  Information technology has radically changed business and other 
aspects of American life. It is time we use the power of the 
information age to improve health care. If we do, we can dramatically 
improve the quality of care we all receive. The Wired for Healthcare 
Quality Act is critical to this effort. Again I want to thank my 
colleagues, Senators Kennedy, Enzi and Hatch for their partnership on 
this legislation, and I look forward to working with them and all of my 
colleagues to enact this important bill.
  Mr. HATCH. Mr. President, I am proud to be an original cosponsor of 
S. 1693, the Wired for Healthcare Quality Act. The goal of achieving 
high quality health care is not reachable without use of information 
technology. For instance, the 21 quality measures that hospitals now 
report for Medicare must usually be manually extracted from paper 
charts. The Government Accountability Office reports that hospitals are 
near the limit of the number of quality measures that they can report 
by these antiquated techniques. Implementation of information 
technology is critical because with it there is no practical limit on 
the ability to measure quality.
  Dr. Brent James, a national quality expert from Intermountain 
Healthcare of Salt Lake City, UT, tells me that a health care provider 
who wishes to improve performance starts by defining detailed measures 
of quality health care and then builds information technology around 
the measures so that routine, automatic reporting of compliance with 
the measures becomes part of the health information technology 
platform. The Wired for Healthcare Quality Act does not just impose 
standards for interoperability of information technology it creates a 
mechanism by which quality measures are embedded in those standards.
  The legislation encourages the development of standards by codifying 
the office of the National Coordinator for Health Information 
Technology who coordinates the health information technology policies 
of Federal agencies.
  It creates a public-private partnership, the Partnership for Health 
Care Improvement to advise the Secretary on technical aspects of 
interoperability, on standards, on implementation, and on certification 
of compliance with those standards.
  The bill establishes the American Health Information Community as a 
body providing recommendations to the Secretary regarding the broad 
policy issues of implementation of technical standards created by the 
partnership. For instance, it will advise the Secretary on issues of 
patient privacy, information security, and appropriate uses of health 
information.
  The bill directs the Secretary to provide for the development and use 
of quality measures in the health information technology platform by an 
arrangement with a private entity that establishes standards for 
measurement development and coordinates and harmonizes measures so that 
providers are able to use the same set of measures, if not the same 
measures, for all their patients.
  The legislation requires that all Federal information technology 
purchases conform to the standards recommended by the Partnership and 
adopted by the President within 1 year and that all Federal agencies 
comply within 3 years. Adoption of these standards is voluntary for 
private entities except for functions they contract with the Federal 
Government.
  The legislation encourages the adoption of qualified health 
information technology by providing grants for the purchase of health 
information technology systems to providers demonstrating financial 
needs, by providing low interest loans to states to help providers 
acquire health information technology systems, and by providing grants 
to facilitate the implementation of regional or local health 
information exchanges.
  The legislation provides for the development of national reports of 
health care quality based on Federal health care data and private data 
that is publicly available. Reports are to be contracted to quality 
reporting organizations.
  The legislation assures strong privacy protections for electronic 
health information by forbidding funding under the bill to any 
information technology system that lacks strong privacy and security 
protections, by requiring recipients of funding to notify patients if 
their medical information is wrongfully disclosed and by requiring that 
the national strategy on health information technology include strong 
privacy protections.
  Before I close, I must raise a concern with the bill. Building a 
national, interoperable health care information technology platform is 
like building two houses with a common driveway. Federal programs such 
as Medicare and Medicaid are one house. Private health plans are the 
other. They both must share common standards for health information 
technology so that systems all talk with one another. They both must 
implement from a common pool of quality standards otherwise providers 
will be impossibly confused. The two houses will not look alike but 
they must share a common driveway and common building standards.
  I use this analogy to emphasize that the rules for the quality 
measures used by the Medicare Program are the jurisdiction of the 
Senate Finance Committee on which I serve as a senior member. The rules 
for quality measures in a national health information technology 
standard, and private health insurance plans, are under the 
jurisdiction of the Health, Education, Labor and Pensions Committee. We 
must be certain that these distinctions are made with clarity to avoid 
confusing ourselves and the medical community. I look forward to 
working with Senators Enzi, Kennedy, and Clinton, and my colleagues 
Chairman Max Baucus and Ranking Minority Member Chuck Grassley on the 
Finance Committee to ensure that these important distinctions are made.
  If we do not accomplish the task of integrating quality and health 
information technology standards between public and private programs, 
providers will be placed in the impossible position of having one set 
of quality and information technology standards for publicly insured 
patients and other requirements for privately insured patients. If such 
a Tower of Babel is allowed to develop, providers will simply not be 
able to implement the improvements in care that we all want to see 
through the use of health information technology. We cannot miss this 
chance.
                                 ______