[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.
______