[Congressional Record Volume 154, Number 146 (Monday, September 15, 2008)]
[Extensions of Remarks]
[Page E1790]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            THE HEALTH-E INFORMATION TECHNOLOGY ACT OF 2008

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Monday, September 15, 2008

  Mr. STARK. Madam Speaker, I rise to introduce the Health-e 
Information Technology Act of 2008, a bill to stimulate the development 
of a uniform, interoperable health information technology system for 
America. Such a system would enable every hospital and doctor to input 
a patient's information and pull up their medical record--all on-line 
and readily available. It would also make data available to researchers 
so that we could improve the practice of medicine.
  Health Information Technology (HIT) is the key to improving quality, 
gaining efficiencies, and reducing cost in the U.S. health care system. 
That's something that even people ranging from President Bush to Barack 
Obama can agree on.
  If the United States had such a system, we would be able to provide 
the right care, to the patient, at the right time. A nationwide HIT 
system would:
  Ensure that every hospital could access an emergency room patient's 
medical record to appropriately treat them.
  Reduce duplicative lab tests. One study found that 9 percent of all 
lab tests were redundant and that physicians canceled 69 percent of lab 
tests when their HIT systems alerted them to the redundancy.
  More quickly eradicate outbreaks of disease because the HIT system 
would allow us to analyze where people were sick and what they had in 
common.
  More effectively conduct post-market surveillance on drugs approved 
by the FDA to ensure that they really are safe and effective once they 
are on the market. According to the FDA, Vioxx may have contributed to 
27,785 heart attacks and sudden cardiac deaths between 1999 and 2003. 
Providers with health IT systems were able to closely monitor their 
Vioxx patients and take them off Vioxx at the first sign of harm.
  Dramatically reduce the use of paper records which--on top of being 
cumbersome and environmentally unfriendly--also cause medical errors 
because of difficulty interpreting handwriting and an inability to 
easily detect orders that are inappropriate for the patient, given 
their age, allergies, health conditions, and other drugs they may be 
taking. One study found that 1.4 percent of hospital admissions were 
caused by adverse drug events, 28 percent of which were preventable, 
and at a cost of $10,000 per preventable event.
  There is no debate over whether we need such a HIT system in America. 
The debate is over the right role for government to foster the 
widespread adoption of such an interoperable, seamless HIT system. In 
this debate, it is vitally important to ensure that such a system has 
strong privacy protections and security requirements.
  Some might say let the private sector do it. I'd respond that we've 
tried that and it's failed. Currently only 20-30 percent of hospitals 
and 10-20 percent of physicians' offices have comprehensive health 
information systems. Even where systems are in place, they operate in 
silos and do not provide the aggregate data needed to improve quality 
of care. One reason for this failure is that private industry has 
spawned the development of unique proprietary systems. These systems 
may work well for the doctor's office or hospital system that purchases 
it, but they are unable to perform outside of their own network and 
therefore fail to meet the need of integrating our disparate health 
care system. This lack of progress is costing U.S. taxpayers millions 
of dollars. Studies have indicated that widespread adoption of HIT 
could reduce health care spending by $80 million annually.
  Just last week at a hearing before the Ways and Means Health 
Subcommittee, a representative for the California Association of 
Physician Groups (which represents large physician group practices in 
California) acknowledged that, while each of their member groups had 
adopted HIT, those systems were unable to talk to each other. The 
groups had each spent millions of dollars and suffered through reduced 
productivity during the transition, but their systems still cannot 
advance the practice of medicine in the United States or engage in 
other activities to achieve broader system efficiencies and quality 
improvements.
  That's why, in my mind, it is so important for the Federal Government 
to step into the arena of HIT. Not because I think Government is better 
than the private sector. But, because I think that if our Government 
has decided that a uniform, interoperable HIT system is a priority, we 
should step up to the plate to create the standards and help pay for 
its adoption. That's precisely what the Health-e Information Technology 
Act does.
  The Health-e Information Technology Act would codify the Office of 
the National Coordinator for Health Information Technology within the 
Department of Health and Human Services. The National Coordinator--with 
the assistance of an advisory committee representing private 
stakeholders and other appropriate public agencies--would be 
responsible for establishing and implementing a plan to achieve 
widespread adoption and use of interoperable, secure, and clinically 
useful electronic health records. In addition, the Coordinator would 
develop an open source health information technology system that is 
certified to meet the standards and would be available to health care 
providers at little or no cost in 2012, after the standards are 
established in 2011. Private vendors would be part of the process and 
would be encouraged to ensure that their products meet the new federal 
standards as well.

  The bill would utilize the strength and size of the Medicare program 
as a tool to assure the adoption of these standards. Starting by 2013, 
Medicare would provide supplementary payments to doctors and hospitals 
(each up to a capped amount) to help offset the cost of purchasing new 
HIT equipment, transitioning to its use, and training personnel. These 
incentive payments would phase-out on a sliding scale over a four or 
five year period, for hospitals and doctors respectively. After that 
timeframe, if doctors or hospitals failed to use an HIT system that 
meets the defined standards, they would be penalized by a reduction in 
their Medicare reimbursements. As not all health care providers are 
reimbursed by Medicare, there are grant programs to assure assistance 
to them as well.
  Maintaining the privacy and security of people's electronic health 
records is of vital importance. The Health-e Information Technology Act 
takes the protections afforded by the Health Insurance Portability and 
Accountability Act (HIPAA) of 1996, and updates them for the 21st 
century. It provides for protections to reach new entities in the e-
health environment that were not envisaged by HIPAA, such as e-
prescribing gateways and regional health information organizations, and 
addresses the increased migration of personal health information out of 
the traditional medical system through business associates. It shuts 
down the secondary market that has emerged around the sale and mining 
of patient health information by prohibiting the sale of patient 
information and applying stiff penalties to any individual or entity 
that uses or discloses health information in an unauthorized way. The 
bill also develops a culture of privacy protection through tough 
enforcement. To date, the Secretary has not levied a single penalty 
against a HIPAA covered entity, despite numerous privacy and security 
violations. This bill strengthens the enforcement of privacy and 
security protections by increasing the amount of civil monetary 
penalties that may be levied, requiring the Secretary to levy penalties 
in cases where violations rise to the level of willful neglect, and 
holding the Secretary accountable for actively enforcing the provisions 
through period audits and reports.
  I recently sat down with the chairman of a major medical association, 
the head of a physician group practice organization, and two former 
Medicare and Medicaid administrators--one for a Democratic president 
and the other for a Republican president. All four of them agreed that 
without a date certain in law by which a uniform, interoperable HIT 
system must be used by all of America's doctors and hospitals, it 
simply won't happen. They also agreed that, while it won't be easy, it 
is vital that we form consensus around such legislation. They, too, 
acknowledged that a system that provides financial incentives for 
adoption, with eventual penalties for failure to adopt, is a sensible 
way to proceed.
  With introduction of the Health-e Information Technology Act, I hope 
that we can move from the realm of private discussions to public 
endorsements. I am under no illusions that it will be easy to enact a 
bill like this. While the Congressional Budget Office has not yet 
provided a score for the legislation, we know that it will have 
significant costs. But down-payments are required to achieve yield on 
long-term investments. I am confident that a uniform HIT system will 
ultimately lead to dramatic improvements in the delivery system and 
reap great savings once it is in place.
  I look forward to working with my colleagues on both sides of the 
aisle, as well as physician and hospital organizations, to enact 
legislation to require the development and adoption of a uniform HIT 
system. We've been talking about this for decades. It is now time to 
act.




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