    [Public Papers of the Presidents of the United States: George W. Bush (2004, Book I)]
    [April 27, 2004]
    [Pages 680-686]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion on the Benefits of Health Care Information
    Technology in Baltimore, Maryland
    April 27, 2004

        The President. Thanks a lot. Thanks for coming. Please be seated.
    Thanks for the hospitality. I'm really pleased to be here in the great
    city of Baltimore. Governor, I'm
    proud you're here. Thanks for greeting us at the airport--I mean, at the
    heliport. Thanks for bringing the first lady.
    Thanks for bringing the Lieutenant Governor as well. I'm proud you all are here.
        I'm also proud to be with--in the presence of a man I still call
    Governor, Governor Schaefer. I'm proud
    you're here, Governor. He said he didn't care a whit about seeing me. He
    just wanted to make sure I gave his best to Mother. [Laughter] Still a
    plain-spoken fellow, aren't you?
        But Governor, thanks, you're doing a great job for the State of
    Maryland, and congratulations on the newest Ehrlich.
        Dutch Ruppersberger is with us
    today. Congressman, where are you? Oh, thanks for coming. Listen, I'm--
    here's the thing about the Congressman: He cares deeply about the people
    who wear the Nation's uniform. He's very much involved with programs to
    kind of lighten the load for our troops who are sacrificing and are
    working for a free world. Dutch, I'm proud of the job you've done. I
    know you've recently received the USO Merit Award. Well deserved, and
    congratulations. Thank you for doing that.
        I want to thank George Owings and Larry
    Kimble, who are veterans affairs folks
    here for the State of Maryland. One is incoming. One is outgoing. Both
    care deeply about the veterans of this State. I appreciate so very much
    Nelson Sabatini, who is department of
    health and human services

    [[Page 681]]

    here in Maryland, for caring about the health delivery systems of your
    State.
        We're going to talk about some interesting opportunities today for
    our health care system to be modern, to deliver--help it deliver quality
    service at lower cost. This is going to be--I think you'll find it an
    interesting dialog. I'm certainly looking forward to it.
        Before we begin, though, I want to thank the people who work here at
    this hospital, work for the VA. I appreciate your service to our
    country. I appreciate your care for those who have worn the Nation's
    uniform. I see we've got folks here who have worn and are wearing the
    Nation's uniform. For those who have worn the Nation's uniform, thank
    you for setting such a good example for the brave men and women. For
    those who are wearing the Nation's uniform, I appreciate so very much
    your service.
        We're changing the world. We have an obligation and a duty to
    protect our country. And in so doing, we're changing the world for the
    better. We understand that freedom is the deepest need of every human
    heart and that free societies are peaceful societies. And a peaceful
    society in the heart of a region that has fostered terror and hatred is
    in our short-term and long-term interest. And for those who wear the
    uniform, thanks for what you're doing. You have stepped up at this
    historic time. And the country is more secure for it, and the world will
    be more peaceful for your service.
        Yesterday I talked about ways for us to make sure America stays on
    the--stays a leader in the world, particularly when it comes to
    technology and innovation. That's what we want. We want to lead. We're
    not interested in following. America is a nation where the
    entrepreneurial spirit is strong, where the focus of the Government, in
    my judgment, is right. We're willing to spend research money. I see
    Elias Zerhouni is with us, who's head of
    the NIH. Elias, thanks for coming. I'm confident that when you spend
    research money at the NIH, we're laying the groundwork for what will be
    a better tomorrow.
        Yesterday I talked about energy. One way for us to stay on the
    leading edge of an innovative society is to introduce ideas like a
    hydrogen-powered automobile, put money behind it and research behind it
    so someday, Governor, we're able to
    drive around with water as the byproduct, as opposed to that which is
    currently coming out of the tailpipes in America. It'll make us less
    dependent on foreign sources of energy when this technology comes to be,
    which is vital to make sure America is on the leading edge of technology
    and innovation. It'll help improve the environment.
        I talked about the need for us to spread broadband technology
    throughout our entire society if we want to stay competitive and
    innovative, that we've got to have broadband in every household in
    America by the year 2007. And there's ways to do that with the
    Government having to provide all the capital. We ought not to tax access
    to broadband. If you want something to flourish, don't tax it.
        As well we've got to make sure that regulatory policy in Washington
    is conducive for the spread of broadband. For example, one of the things
    that's probably going to need to be done is they're going to need to
    build towers on Federal lands in order for over-the-air Internet
    services to work out into the remote regions of our country. They don't
    need a bunch of paperwork and hassle in order to build the tower on
    Federal lands. There's a lot of things we can do to reduce the
    bureaucratic hurdles necessary to make sure that broadband is plentiful,
    and not only plentiful but there's competition so that you get better
    quality and better price.
        But today we're going to talk about a third avenue that's--to make
    sure America is innovative and is a leader in the world, and that is how
    to make sure our health care system works better. And there are some
    fantastic ideas as to how to do that.

    [[Page 682]]

        The way I like to kind of try to describe health care is, on the
    research side, we're the best. We're coming up with more innovative ways
    to save lives and to treat patients. Except when you think about the
    provider's side, we're kind of still in the buggy era. I told a story
    yesterday of a guy in Kalamazoo, Michigan. His
    young daughter has a case of leukemia, and
    he had to--she had to see a lot of specialists. But he had to carry her
    files around every time she saw a specialist in order to expedite care,
    to make sure she was getting the best care.
        And the health care industry is missing an opportunity if patients,
    in order to make sure they get quality care, have to carry files from
    one specialist to the next. It's like IT, information technology, hasn't
    shown up in health care yet. But it has in one place, in one department
    that you're about to hear from, and that's the Veterans Department.
        So here's what we're here to talk about. We're here to talk about
    how to make sure the Government helps the health care industry become
    modern in order to enhance the quality of service, in order to reduce
    the cost of medicine, in order to make sure the patient, the customer is
    the center of the health care decisionmaking process.
        And we've made great progress. There's a role for the Federal
    Government. One thing is, the Federal Government has got to make sure
    the privacy rules are strong. You're going to hear us talk about
    electronic medical records, and that's exciting. But it's not so
    exciting if you're a patient who thinks somebody could snoop on your
    records, to put it bluntly. I'm not interested in having my--well, it's
    too late for me. [Laughter] My medical records are pretty well known.
        But for those people--there's a lot of people in America who say,
    ``Good. I want there to be good information technology in the health
    care field. I just don't want somebody looking at my records unless I
    give them permission to do so.'' And I fully understand that. No, your
    records are private if that's the way you want them to be, but there's
    the ways to address this, the privacy issue. And there's the ways to
    make sure that the Federal Government's role is helpful in expanding
    information technology, and that's what we're going to talk about.
        Tommy Thompson is the head of the--the
    Secretary of Health and Human Services--is a strong advocate about the
    spread of IT throughout the health care industry. I think he's got--I
    know he's got the proper perspective of the role of the Federal
    Government in encouraging not only the Federal agencies but the private
    sector to adopt these strategies in a way that is positive for the
    American consumer and cost-beneficial for society.
        You'll hear him talk about standards.
    I told him when he starts talking about standards, ``Make sure it's the
    kind of language we all understand.'' See, that's part of the problem.
    The medical terminology is really different from English, and it's
    different from one office to the next. And so when Tommy is talking
    about standards, I think he'll help you understand how we can help with
    standards.
        At any rate, we're doing some smart things at the Federal
    Government, and the Federal Government can lead because we're spending a
    lot of money in health care. We're a large consumer on behalf of the
    American people. Think about it: Medicare, Medicaid, veterans' benefits,
    Federal employee health insurance plans. I mean, there's a lot of money
    going through the Federal Government, and therefore it provides a good
    opportunity for the Federal Government to be on the leading edge of
    proper reform and change.
        Tommy, thanks for your service. Let
    her go.

    [At this point, Secretary of Health and Human Services Tommy G. Thompson
    made brief remarks.]

    [[Page 683]]

        The President. Thanks, T, good job.
    It's estimated that they spend $8,000 per worker on information
    technology in most industries in America, and $1,000 per worker in the
    health care industry. And there's a lot of talk about productivity gains
    in our society, and that's because companies and industries have
    properly used information technology. If properly used, it is an
    industry-changer for the good. It enables there to be a better cost
    structure and better quality care delivered, in this case in the health
    field.
        And yet the health care industry hasn't touched it, except for
    certain areas. And one area that has is the Veterans Administration.
    You're about to hear an example from our Secretary and the administrator of this hospital and the assets here in Baltimore about forward thinking by
    people who care about the patients they serve. I know the veterans who
    are here are going to be proud to hear that the Veterans Administration
    is on the leading edge of change. That's what we expect. The taxpayers'
    money is being well spent.
        And one of the reasons why the Veterans Administration is doing so
    well in changing, kind of, behavior, as well as making sure the backlog
    for veterans cases has been reduced, is because of our Secretary, a
    Vietnam vet, a really decent guy, and who is doing a fabulous job, Tony
    Principi.

    [Secretary of Veterans Affairs Anthony J. Principi made brief remarks.]

        The President. Thanks. I'm real proud of the job that you're doing
    here. Our job is to set the strategy. Smith's job here is to make sure they put it in place. [Laughter]
    Dennis Smith, as I've told you, runs the show here. Tell us how this
    happened. I mean, first of all, how long have you been working for the
    Veterans Administration?
        Dennis Smith. Thirty-one years.
        The President. Thirty-one years?
        Mr. Smith. Yes, sir.
        The President. You don't look that old. [Laughter]
        Mr. Smith. Thank you.
        The President. Maybe because you don't spend a lot of time in
    Washington. [Laughter] Explain your job, explain what this means--if you
    can possibly share some stories with us. You're doing a great job, by
    the way.

    [Mr. Smith, director, VA Maryland Health Care System, made brief
    remarks.]

        The President. I presume it's cost effective?
        Mr. Smith. It is.
        The President. I mean, think about a system where you had to take
    each individual x-ray and put it in a shelf and get somebody to take it
    out of the shelf and put it back in the shelf and probably had to
    duplicate it just in case somebody wouldn't lose it. So when you hear
    him talk about cost-effectiveness and productivity increases, this is
    what we're talking about. This system, when it gets advanced beyond the
    VA, will save American consumers a lot of money. If we're wise about how
    we use technology, we can save money.
        Anyway, sorry to interrupt. [Laughter]
        Mr. Smith. That's quite all right.
    [Laughter]
        The President. The man knows the chain
    of command. [Laughter]

    [Mr. Smith made further remarks.]

        The President. Let me ask you, was it hard to get all the records
    computerized in the first place? I mean, somebody is listening out there
    who is running a hospital in Dallas, Texas. Are they going to say,
    ``Gosh, this is such an overpowering startup that it makes no sense to
    do so?''
        Mr. Smith. Well, with the VA, we kind of
    started years ago with this. We started with physician-order entry. And
    we had packages. We had a lab package. So we brought lab on board, where
    the physicians would order their lab work, and that would be automated.
    And then we went to various

    [[Page 684]]

    other systems. So it was gradual that we did it. It is a daunting task
    for the hospital sector to bring in a computerized medical record all at
    one time. So no doubt, but it has to be done, Mr. President. We have to
    do it.
        The President. The goal I set is, most people ought to be covered
    within a 10-year period. It's not like in 10 days or 10 months. This is
    something that is going to take time to get there.
        Tell me about the pharmaceuticals, the distribution of drugs, the
    barcoding and how that affects----

    [Mr. Smith made further remarks.]

        The President. How do you deal with the privacy issue? In other
    words, there's some suspicious character around that doesn't----
        Mr. Smith. Well, the nurses all have
    codes to get into the system, so you have to have a security code to get
    in. So before--you can't just go up to a computer. We have these on
    medication cards, laptops, so they have to type in a code to get into
    it. So we know--the system knows that, if I was a nurse, Dennis Smith is
    in the system. And I'm visiting Mr. Principi in his room and click on,
    it will know that I'm administering the drug and who the patient is. It
    brings all that up. It's a very secure system. We've built security into
    this.
        The President. Good. You're doing a great job.
        Mr. Smith. Thank you, Mr. President.
        The President. Thanks a lot. One of the things that's interesting,
    one of the challenges we face in our society--Governor Ehrlich understands this--is we've got to make sure we
    train people in the health care field who understand what they're doing
    when it comes to computers and information technology. There's a lot of
    jobs available in the health care field, and the community college
    system turns out to be a great laboratory for enhancing people's skills.
    And I appreciate your support of the community colleges here in
    Maryland, giving people a chance to learn a new skill to meet the
    challenges of the--when I say, ``challenges of the 21st century,''
    here's one: Figure out how to use IT in a constructive way to save costs
    and improve quality care and to save lives. I suspect 20 years ago
    people who were in the health care field simply could not envision the
    use of computers and broadband and the Internet to make the field
    modern. And our education system has got to reflect that, Governor. I
    appreciate your understanding.
        So far you've only heard from the public sector. It probably makes
    sense to hear from the private sector today as well, since the delivery
    of health care in the private sector is equally if not greater part of
    people's--the quality of medicine here in the country.
        Johns Hopkins is one of the really great hospital university systems
    in America. It's world renowned, and it's quality care. With us today is
    Marlene Miller--Dr. Marlene Miller, I
    might add. She is in charge of the office of quality and safety
    initiatives at Hopkins. Tell us what that means, and just give us a
    sense of the challenges you face and the challenges we face in
    encouraging the spread of information technology to the private sector.
    Is Hopkins involved with any of this, or anything else you want to say?

    [Marlene Miller, director, Quality and Safety Initiatives, Johns Hopkins
    Children's Center, made brief remarks.]

        The President. Yes, see, the VA has got an advantage because all the
    administrators work for the same outfit, the same organization. Hopkins
    stands alone. I suspect Hopkins doesn't do a very good job of conversing
    with M.D. Anderson in Houston. Two different languages--no, anyway.
    [Laughter]
        And so the real challenge in the private sector is to take what the
    Johns Hopkins people have done intrahospital and have it be able to
    converse with both large and

    [[Page 685]]

    rural hospitals all across America. And that's where the Federal
    Government can help, like the development of standards. I guess you
    support the development of standards when it comes to talking over the
    Internet?
        Dr. Miller. Absolutely.
        The President. What other challenges do you see?

    [Dr. Miller made further remarks.]

        The President. Let me ask you something. Are you saying that these
    systems are able to build in a kind of a safety valve--in other words,
    automatically kick out a prescription if it doesn't meet the logic of
    the computer program?
        Dr. Miller. One aspect of an ideal
    system, in my mind, is if I prescribe you 50 milligrams of something,
    but the 10 prior visits I prescribed you 5, I should get a warning flag,
    and say, ``Look, do you really mean this?''
        The President. But what you said about the weight, something----
        Dr. Miller. Well, it's the same issue
    in children.
        The President. If you've got small children, it is illogical to
    prescribe this much dosage.
        Dr. Miller. Yes, the prescription I
    talked to you about was an adult-sized dose. No one, had they looked in
    any textbook, would have ever given that child that dose.
        The President. Pretty good. That's why you've got to get the
    standards right, Tommy.

    [Secretary Thompson and Secretary Principi made brief remarks.]

        The President. This is a big challenge for us here in the country.
    Think of what we're talking about. We're just talking about how
    hospitals talk to each other. Then we've got to get it so the docs are
    able to talk to each other, and they've got to buy into this.
        And so the reason why we've started this process now is we want to
    encourage insurance companies and State governments, doctors
    organizations, AMA, and others to understand the great benefit for the
    American people by implementing information technology in the health
    care field.
        By introducing information technology, health care will be better,
    the cost will go down, the quality will go up, and there's no telling
    whether other benefits will inure to our society. In other words, when
    we get this done--and we will, because America is a land of doers and
    entrepreneurs; our job is to set the goal and then to encourage and
    incent people to achieve the goal--but when we get this implemented,
    America will remain on the leading edge of technological change. This is
    the kind of innovation that's practical and makes sense, that will keep
    us to be the leader in the world.
        And when we're the leader of the world, it means our people have a
    chance to make a better living. See, when you're the leader,
    particularly when it comes to innovation and technology, your society
    improves a lot. The quality of life goes up. People's pay goes up.
    People in America are more likely to realize the American Dream. It's
    essential that we be in a society of innovators and change, and this is
    an area where there is a huge opportunity.
        And I look forward to working with people to achieve this objective.
    I want to thank those up here who are doing a good job. Tony, you all have made us proud. I'm giving Tony the
    credit, but you deserve it. [Laughter]
        Marlene, thank you for your vision. We
    look forward to working with Johns Hopkins as to how--to better learn
    how to encourage implementation of this opportunity. And when we get it
    done--we will--we will--this is America, after all. [Laughter] And when
    we get it done, we'll all be able to say, ``We've done our duty, job
    well done. Now we go on to the next issue after this.'' But let's get
    this one right.
        Thank you all for coming. We've enjoyed it. I hope you found it as
    interesting as

    [[Page 686]]

    I have to listen to the great opportunities in front of us, some of the
    challenges that have been overcome, and recognizing that we've got other
    challenges to overcome. But our spirits are high. Our spirits are high
    because this country can overcome any challenge in our way.
        God bless. Thank the healers who are here. God bless the veterans as
    well.

    Note: The President spoke at 1:50 p.m. at the Department of Veterans
    Affairs Medical Center. In his remarks, he referred to Gov. Robert L.
    Ehrlich of Maryland, his wife, Kendel, and their newborn son, Joshua;
    former Gov. William Donald Schaefer of Maryland; George W. Owings,
    secretary-nominee, and Lawrence J. Kimble, acting secretary, Maryland
    Department of Veterans Affairs; and Nelson J. Sabatini, secretary,
    Maryland Department of Health and Mental Hygiene. The related Executive
    order of April 27 on incentives for the use of health information
    technology and establishing the position of the National Health
    Information Technology Coordinator is listed in Appendix D at the end of
    this volume.