    [Public Papers of the Presidents of the United States: George W. Bush (2004, Book I)]
    [May 27, 2004]
    [Pages 933-940]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks in a Discussion at Vanderbilt University Medical Center in
    Nashville, Tennessee
    May 27, 2004

        The President. Thank you all for coming. Please be seated.
    Tommy, thanks for the kind introduction.
    You can keep your job for a while. [Laughter] I put him in my Cabinet
    because I knew how effective he was as a Governor. He was the Governor
    of Wisconsin. [Applause] And I knew when I asked him to--don't go
    overboard for Wisconsin, please. [Laughter] I knew when I asked him to
    join my Cabinet that he would reform programs that needed reform, focus
    resources on programs that needed resources, and would do a great job.
    He really has. He's been a remarkable Secretary of Health and Human
    Services, and I'm proud he came here today.
        We're going to talk about an interesting subject, and it's one that
    has got a chance to change our country for the better. As you can see,
    I've surrounded myself with people who probably can--not probably--will
    be able to explain the subject better than me.
        But before we get talking about health care and how to make sure the
    costs are reasonable and health care is affordable and medical errors
    are reduced by using information technology, I do want to thank the good
    folks here at the Vanderbilt University Medical Center for your
    hospitality. I particularly want to thank Harry Jacobson for welcoming us, for allowing us to use this facility to
    talk about health care. No better place to talk about health care than
    at a place that delivers excellent health care, right here at
    Vanderbilt. Thanks for having us.
        Neal Patel is with us. Where are you, doc?
    There he is. Neal showed us the new children's hospital, some of the
    parts of the children's hospital. It's an impressive facility. Thank you
    for being a doctor. Thank you for caring about America's kids, and thank
    you for giving us a tour. I want to thank Jim Shmerling, who is the CEO; Bill Stead, who is the chief information officer. Thank you all for
    coming.
        This is a--the reason we're here is because this hospital knows how
    to use information technology for the benefit of patients and docs.
    That's why we're here. You're ahead of the country in using technology
    to your advantage, and we'll talk about that here in a second.
        I want to thank my friend Senator Bill Frist
    for joining us today. Senator, you're doing a heck of a job. You cut
    your eye teeth here, right? That's where you started practicing? That's
    good. He married a Texas girl, I want you to know. [Laughter]
    Karyn is with us, a west Texas girl, just like
    me. We both married above ourselves, didn't we, Senator? [Laughter] But
    Karyn, thank you for coming. I'm proud you're here.
        I want to thank Members of the Congress who are here with us today.
    First, Congressman Jim Cooper from this district.
    Thanks for coming, Congressman, proud you're here. Jimmy Duncan is with us, Jimmy. And you brought your son
    John, I see. Thank you for being here. I know Zach Wamp and Kim are here. Thank you all for
    coming. Appreciate you being here. And Marsha Blackburn is with us today. Marsha, thanks for coming.
        I know the mayor is here. Mr. Mayor, I appreciate you coming. Thanks for being here. Fill the
    potholes, that's the only advice I can give you. [Laughter] I'm sure you
    are.
        Today when I landed, I met Phuong Le. Phuong,
    please stand up for a second, will you? Thanks for coming. I'll tell you
    why I wanted to introduce Phuong. She is a soldier in the army of
    compassion. That's why I want you to hear about her. She is a person who
    just graduated from high

    [[Page 934]]

    school, like a week ago, right, Phuong? Yes, a week ago. For 6 years,
    she has been volunteering at the Siloam Family Health Center to not only
    help people who can't speak English communicate with the caregivers
    there but to help provide love for those who hurt. That's what she's
    there for. The reason I bring up Phuong is because I want to remind you
    that the strength of this country is in the hearts and souls of our
    citizens. We're a mighty military power. We will stay that way to make
    the world more free and more peaceful. We've got a mighty economy. We
    are a wealthy nation compared to other nations, but our strength is in
    the hearts and souls of our citizens. That's our true strength. Our
    strength is found when people take time out of their life, like Phuong
    has done, to help somebody who hurts.
        See, the great hope for America is neighbor loving neighbor. The
    hope for this country is when somebody who is hungry or needs shelter or
    needs love can find it when a fellow citizen says, ``What can I do to
    make your life better?'' I appreciate, Phuong, you
    serving as such a great example for the folks here in this community. I
    call on others to love your neighbor just like you'd like to be loved
    yourself. And you can join the army of compassion, which is changing
    America for the better one heart, one soul at a time. Thanks for coming.
        One of the important subjects in America is how do we make sure
    health care is affordable and available. Part of making sure health care
    is available is for medicine to use information technology, and that's
    what we're here to discuss.
        I want to talk real quick about some other ways we can help with
    health care. One, we've modernized the Medicare system. Senator, thank
    you. Members of the House who voted for the plan, I want to thank you
    for your vote.
        The modern Medicare system begins with making sure seniors have got
    drug discount cards, and they're now being passed out. And seniors are
    going to be able to save between 15 to 30 percent off the retail price
    of most brand drugs and more for generic drugs. As well there is going
    to be a $600 credit for poor seniors. This is the beginning of a reform
    package that will affect seniors' lives in a very positive way, by
    making sure our drugs are more affordable.
        And the cards are out. They're heading out right now. Unlike most
    Government programs where they say, ``The check's in the mail,''
    actually, the cards are in the mail--[laughter]--and people will be able
    to use those cards to their benefit. They'll also be able to get on the
    Internet and comparatively shop for drugs. In other words, you can get
    on the Internet, put in your ZIP Code, and you'll be able to see the
    price of retail drugs in drug stores close to you and in your community.
    And that in itself will serve as a way to put pressure, downward
    pressure through the market, not through Government edict or Government
    declarations but through the market, for the benefit of consumers. This
    is a major--the beginning of a major reform to the benefit of our
    seniors.
        We've also got in the--inherent in that bill, what's called health
    savings accounts. You can put in after-tax money. You can earn interest
    after tax. You can take out money after tax--put it in tax-free, earn it
    tax-free, take it out tax-free in order to pay for not only medical
    costs but also catastrophic care. These are called health savings
    accounts, which will be a really good vehicle to help control costs and
    to make sure patient and doctors are the center of the decisionmaking
    process in health care.
        We're working with Congress to expand what's called association
    health care plans, which will allow small businesses to pool risk so--
    just like big businesses do to get better prices for their health care
    plans for their employees.
        We've also got to make sure that we continue to expand community
    health centers--again, appreciate the Members of

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    Congress here. Community health centers are a really effective use of
    taxpayers' money, in my judgment. They provide primary care and
    preventative care for people who need help with medicine, and it takes
    the pressure off the emergency rooms. The most expensive place to find
    health care is an emergency room.
        These community centers are being expanded all across America. They
    want to open up--or expand 1,200 community health centers. That's on top
    of the 3,000 that exist. We want to see to it that 16 million Americans
    are taken care of in these community health centers. In other words,
    it's a safety net for people. I recognize people aren't covered by
    insurance. We'd like more people covered by insurance. Until they are
    covered by insurance, here's a way for people to get good, cost-
    effective health care, cost-effective for them and, as importantly,
    cost-effective for the taxpayers.
        And finally, in order to make sure that we've got available and
    affordable health care, the United States Congress needs to pass medical
    liability reform. Our doctors--if you get sued all the time, you're
    going to practice defensive medicine. And when you practice defensive
    medicine, it means somebody's cost is going to go up. In other words,
    you're worried about winning a lawsuit, and therefore, you're going to
    do more procedures than might be necessary just to protect yourself. And
    these lawyers are filing suit after suit after suit, and you know what
    I'm talking about. That's just the way it is. People ought to have their
    day in court. But frivolous lawsuits are running up the cost of
    medicine, and they're running docs out of business. Just talk to docs.
    Just talk to people in rural America what it's like to try to keep a
    professional--a group of docs around when these junk lawsuits are making
    it hard for them to stay in business.
        When I got to Washington, I said, ``We'll just let the States take
    care of it,'' and then I saw what the cost of defensive medicine and
    increased premiums are doing to our budgets. The cost of Medicare goes
    up with all these junk lawsuits. The cost of Medicaid goes up with all
    these lawsuits. The cost of veteran health care goes up for all these
    lawsuits. It's time for the United States Congress to pass national
    medical liability reform. It's out of the House of Representatives. You
    don't have to worry about your United States Senators from Tennessee. They're on
    board. I appreciate you. We've just got to convince some other ones.
        These are all ways to affect cost and to make sure the doctor-
    patient relationship is central in medicine. What we can't afford to
    have happen in America is for the Federal Government to decide to run it
    all. That will not work. America has got--is on the leading edge of
    medicine for the whole world. We've got the best research and
    development. We've got great docs. We've got fantastic hospitals. The
    Federal Government cannot run the system as well as docs, professionals,
    administrators, and patients can.
        Another way to save money is to introduce information technology
    into the health care world. One of the amazing discrepancies in American
    society today is, we're literally changing how medicine is delivered in
    incredibly positive ways. And yet, docs are still spending a lot of time
    writing things on paper, and sometimes it's hard to read their
    handwriting--[laughter]--and therefore, sometimes it's difficult to have
    the spread of accurate information so that doctors can make good
    decisions.
        The idea of making sure we use information technology starts with
    setting this goal: Within 10 years, we want most Americans to have
    electronic health care records. That means your records. And what--
    you'll hear us talking about it here today. I'll try not--I'll try to
    give it my best shot. Your records are on--in a digital form that can be
    transformed--transferred over the Internet, so that if you happen to be
    traveling somewhere and you get in a wreck, a doctor

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    or emergency physician in Texas can call up the information or ask for
    information or seek information not only off the card but to your home
    doctor's office, and they'll be able to know what's wrong with you or
    right with you, what has been wrong with you, and how to treat you.
        You can imagine what kind of system that will do. It will cut down
    the cost of paperwork. It will also cut down on medical errors, which,
    if you're going to be a patient, that's something you really hope
    happens. [Laughter] Sometimes information gets lost. Sometimes people
    inadvertently prescribe the wrong drug because the information isn't
    correct. And so the fundamental question is: How do we use technology--
    how do we modernize health care? That's what we're here to talk about.
    How do we, you know, do the same thing that is happening in other
    industries to health care?
        And we believe we can change how health care uses IT, and it starts
    with the Federal Government. Listen, the VA is doing a fabulous job for
    using information technology. This hospital is doing a fabulous job for
    using information technology, which we will talk about. And so, one of
    the first things we're going to talk about is what can the Federal
    Government do to help.
        Now, we hired a guy named David Brailer. David's right here to my right. David's an expert on
    information technology and how it is applied to medicine and to health
    care. Tommy hired him, see--yes, he's got
    a pretty good title, the National Health Information Technology
    Coordinator. [Laughter] The way I look at it, his job is to use the
    Federal Government's abilities and our Medicare law and our VA and other
    assets we have to spread this fantastic opportunity throughout America.
        And I just want to say one other thing before I turn it over to
    David. Privacy is really an important part
    of, in my judgment, of an American system that works well. I don't want
    some people looking at my records. Of course, my line of work, everybody
    gets to look at my records. [Laughter] It's too late for me. [Laughter]
    It's not too late for you, and therefore, as you hear the idea of moving
    your information across the Internet, you've just got to know it's got
    to be with your permission. These are your records. It's your health,
    and you can decide whether or not people can use your records. This is
    important for people to understand that, that those of us in Government
    who talk about spreading information also, first and foremost, keep your
    privacy in mind.
        Now with that, David is the
    Coordinator, named on May the 6th, and here he is sitting with the
    President right here in Vanderbilt talking about his job. But David,
    tell us what you do, why you do it, and when you're going to finish it.
    [Laughter]
        David J. Brailer. What time is it?
        The President. Yes, exactly.
        Dr. Brailer. Well, thank you, Mr.
    President. And first, let me just say thank you from American medicine
    for your historic leadership in information technology.
        The President. Thank you very much. Thanks.

    [At this point, Dr. Brailer, National Health Information Technology
    Coordinator, Department of Health and Human Services, made brief
    remarks.]

        The President. Good. Let me ask you a couple of questions. One of
    the interesting challenges--evidently the medical lingo varies. In other
    words, part of your challenge has been to standardize as well as develop
    a common vocabulary. Would you explain that so--obviously I can't. Would
    you explain it, please, so people can understand it better?
        Dr. Brailer. We have a different
    vocabulary. Sure, when a physician sees a patient, we write down a
    problem list, which is the list of issues that's active with that
    person. We create a label called a diagnosis, which is the formal name
    that you know. We do procedures, the things that we do

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    to people's bodies whenever they have to have treatments. We make
    estimations of what is happening with someone, and all of these things
    are codified in language.
        And traditionally in medicine the language has been informal. It's
    been variable by physician. I might call something hypertension; someone
    would call it high blood pressure. I might say you have a high
    temperature; someone says you have a fever. And there are over 50,000
    language terms that are in medicine that cover, and the point of
    standardization is to make it one vocabulary. This is very hard, not
    just in terms of what the vocabulary is but being able to make this part
    of the normal daily activities of physicians' days.
        The President. Yes, see, that's part of the challenge. I'm sure you
    can envision it. If people call the same disease or symptoms by
    different names, obviously there needs to be a standardization process.
    The Federal Government can help. As I understand it, we're quite far
    down the road in terms of developing the standards.
        Dr. Brailer. Mr. President, the Federal
    Government has had an extremely positive effect in the last 2 years.
    Secretary Thompson set up an effort to take the standards that are being
    developed in the private sector--the Federal Government hasn't developed
    the standards, but it's taken those and put them into Government
    procurement, into the contracting arms of Health and Human Services and
    elsewhere. So they go from being on paper into real systems that are
    used everyday. And we have a lot more that can be done.
        The President. Good. I imagine they say ``scraped your chin when you
    fell off the bicycle'' the same in Tennessee as they do in Texas,
    though. [Laughter] What do you think?
        Okay, thanks. Good job.
        Jim N. Jirjis is with us. Jim, thanks for
    coming. He is the assistant chief medical officer here at Vanderbilt
    University Medical Center. Appreciate you coming.
        Jim Jirjis. My pleasure.
        The President. Here's your chance. [Laughter]

    [Dr. Jirjis made brief remarks.]

        The President. You helped set up the electronic records here at the
    hospital?
        Dr. Jirjis. Correct.
        The President. So what does that entail?
        Dr. Jirjis. Well, I have the funnest--
    second funnest job in the world. [Laughter] Vanderbilt is a wonderful
    sandbox, I like to say. Harry Jacobson, Bill Stead are visionary
    leaders, and they have developed an infrastructure that allows guys like
    me and Neal, whose passion--you know, I was the guy in high school
    behind the computer. I was also an athlete too; don't make any mistake
    about it. [Laughter] But when I came to medicine and computers, who
    knew, at Vanderbilt, I would have a sandbox.

    [Dr. Jirjis made further remarks.]

        The President. Yes, and one final question along these lines. You do
    prescribe prescription drugs over the--through the Internet yet?
        Dr. Jirjis. Most of the prescriptions
    through the Internet, we can't interact with the pharmacies yet, though
    there's a lot of work going on nationally to try to arrive at that.
        The President. Yes.
        Dr. Jirjis. In our hospital, 100 percent
    of our prescriptions are done in the computer.
        The President. Which is important.
        Dr. Jirjis. If I try to order the wrong
    thing, Bill Stead--even if it's 1 a.m., a little ``beep'' comes up,
    says, ``You're going to hurt this patient.''
        The President. See, that's really important for people to
    understand. The ability to make sure that we prescribe the right drug
    and the right dosage can be controlled by proper use of medical records,
    which is really important. And it's cost effective.

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        I hope you're getting a sense for what we're talking about here.
    It's a really exciting opportunity. Again, I repeat, we're at Vanderbilt
    for a reason. It's because this hospital is--and system is innovative
    and different. And it's on the leading edge of change. It benefits a lot
    of patients, obviously, in your illustrious career here, one of whom is
    Bob McNeilly. He's a patient, Bob. He's, like,
    your patient, right?
        Dr. Jirjis. Yes, he is.
        The President. Bob, welcome.
        Bob McNeilly. Thank you.
        The President. Tell us how electronic records affected you.

    [Mr. McNeilly, patient, Vanderbilt University Medical Center, made brief
    remarks.]

        The President. How does that work? I mean, you say it communicates
    with you.
        Mr. McNeilly. Well, I've got e-mail.
    [Laughter]
        The President. Yes, there you go. [Laughter] There you go. You look
    like an e-mailing kind of guy.
        Mr. McNeilly. Absolutely. [Laughter] Give
    me your address, and I'll send you one. [Laughter] There's another
    advantage also. I've got more than one doctor here at Vanderbilt. I've
    got, as a matter of fact, two other doctors who are both cardiologists.
    One calls himself my plumber and one my electrician. [Laughter] They
    prescribe medications, and I want to make sure that Jim Jirjis knows
    exactly what they have prescribed and what changes are in my medication.
    And they, in turn, need to know anything that he's prescribed. This
    system takes care of that automatically.
        The President. Yes, that's fantastic. If you're beginning to get the
    drift here, it not only helps the docs make right decisions; it helps
    the patients as well. It helps the patients--keeps the patients on a
    timetable. It reminds patients about patient responsibility, but it also
    has got--give you peace of mind to know that you're getting the very
    best care all the time.
        Mr. McNeilly. Absolutely. I really have a
    great deal more confidence in the system. Although, I'm looking forward
    to the next step, which is to have access to my own medical records,
    which are computerized now, which really enables me to take charge of my
    health care even more than I do now.
        The President. Absolutely. Gosh, thanks. I'm glad you're here. I
    appreciate you coming.
        Mr. McNeilly. Thank you. I'm glad I'm still
    here. [Laughter]
        The President. All right, we've got J.T. Finnell with us. He's an emergency medicine physician right
    out of Indianapolis, Indiana. You're probably wondering why we asked
    somebody from Indianapolis to come. And one of the reasons why is the
    health care system in Indianapolis has done a fantastic job of
    implementing and employing information technology.
        Is that an accurate description, J.T.?
        John ``J.T.'' Finnell. That's
    correct.
        The President. All right, well, tell us why you're here.
        Dr. Finnell. Well, it's race week.
        The President. Get out of town, huh?
        Dr. Finnell. That's right.
    [Laughter]

    [Dr. Finnell, emergency medicine physician, Wishard Memorial Hospital,
    Indianapolis, IN, made brief remarks.]

        The President. Let me stop you, one question. One of the interesting
    things that--the reason why Indianapolis is farther down the road, if
    you notice, hospitals can talk to hospitals, which hasn't happened in
    many communities. In other words, it's easier to talk intra-hospital
    system than it is inter-hospital system. And part of the challenge is
    and the reason we standardize language is so that when a--one emergency
    room can talk to another emergency room or a State facility.
    Indianapolis has done a good job of integrating the capacity to talk
    amongst different facilities. I think that's an accurate statement.
        Dr. Finnell. That is accurate.

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        The President. Yes, and so the challenge is, by the way, is to do
    that within a community and then is to get communities hooked up with
    communities so that the whole--there's a whole nationwide network.
    That's the real challenge we're going to face in America. Step one was
    to get the language standardized so words can travel and be understood
    on a more common basis. Go ahead. Examples.

    [Dr. Finnell made further remarks.]

        The President. Information saves lives, and it saves money. That's
    what we're here talking about, and we've got a strategy to encourage
    information--the spread of information technology throughout the entire
    health care industry to help control the costs and raise the quality of
    health care. That's what we're here to talk about.
        And somebody who can testify--I think you can----
        Jennifer Queen. I hope so.
        The President. You will--is Jennifer Queen. She's here as a mom. Tell us about Courtney, your daughter.

    [Ms. Queen, mother of a Vanderbilt University Medical Center patient,
    made brief remarks.]

        The President. Thank you for sharing that. That's a great--you know,
    a great story. I saw Courtney. You're right,
    she's strong. She's doing great.
        Ms. Queen. Yes, she's our little
    beautiful angel.
        The President. She is your beautiful
    angel.
        Ms. Queen. We have two little angels, and
    they're doing real well.
        The President. That's good. Listen, I hope that story helps you
    understand--listen, if you're having to tote around written records, not
    only is it cost ineffective, there's a chance there's going to be
    errors. And as the system evolves, it puts these records on the
    computers, on disks. They can move information at lightning speed. You
    not only save money; you improve the quality of care through the spread
    of good information. It lets these docs do their jobs. It eases the
    minds of the patients. They can take Courtney's records with her if she were to go down to Crawford,
    for example. [Laughter] And you can take the records with you.
        And it's--we're changing medicine. Medicine's changing. That's what
    we're talking about. It's changing for the better. We're here because
    this little center of excellence is on the leading edge of change. And
    the goal for our country is that most everybody--medical records are
    digitized, and every health care system can talk to each other, every
    office can talk to each other to share information in a better way, to
    make sure America's health care system remains the best in the world.
        That's what we want. We want only one thing: We want the best health
    care system in the world for our patients at the best possible price. It
    can be--it will be achieved. That's what I'm here to tell you. It's
    going to be achieved. One of the ways we do so is to properly use
    information technology. I want to thank our panelists for sharing your
    stories and your information. I want to thank you all for coming to
    listen. I hope you have found this as interesting as I have.
        Let me conclude by telling you, we're lucky to live in the greatest
    country in the face of the Earth. God bless. Thanks for coming.

    Note: The President spoke at 1:43 p.m. in the Langford Auditorium. In
    his remarks, he referred to Harry R. Jacobson, vice-chancellor for
    health affairs, Neal R. Patel, assistant professor of pediatrics and
    anesthesia, James E. Shmerling, chief executive officer, Children's
    Hospital, and William W. Stead, associate vice-chancellor for health
    affairs and director, Informatics Center, Vanderbilt University Medical
    Center; Karyn Frist, wife of Senator Bill Frist; Kim Wamp, wife of
    Representative Zach Wamp; and Mayor Bill Purcell of Nashville, TN.

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