[Weekly Compilation of Presidential Documents Volume 40, Number 22 (Monday, May 31, 2004)]
[Pages 957-963]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
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

[[Page 958]]

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 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 modernize 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.

[[Page 959]]

    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 Congress here. 
Community health centers are a really effective use of tax payers' 
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.

[[Page 960]]

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 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 with 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 name 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]
    Dr. 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.

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

[[Page 961]]

    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 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 has 
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.
    Dr. Jim Jirjis is with us. Jim, thanks for coming. He is the 
assistant chief medical officer here at Vanderbilt University Medical 
Center. Appreciate you coming.
    Dr. 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

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and the right dosage can be controlled by proper use of medical records, 
which is really important. And it's cost effective.
    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.
    Mr. 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 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. John ``J.T.'' 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.
    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

[[Page 963]]

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.

[Jennifer 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.