Health IT Bill: Boon or Boondoggle?

Published September 1, 2006

A bill pending in Congress would create a framework for a national interoperable network for storage and transmission of individual health care records. The measure has sparked debate as to whether it could significantly cut the industry’s enormous administrative costs.

The Health Information Technology Promotion Act of 2006 (H.R. 4157) passed the House at the end of July. At press time, the U.S. Senate was considering the bill.

The Health IT Act would direct the National Coordinator for Health Information Technology (an existing position within the U.S. Department of Health and Human Services) to create a plan for implementing a “nationwide interoperable health information technology infrastructure.”

Leaving its particulars undefined, the bill suggests such an infrastructure will deliver myriad benefits, from better patient care and medical decision-making to lower costs and a more competitive health care system. To achieve those ends, the National Coordinator is to develop key technical guidelines for “electronically accessing and exchanging health information.”

Portable Electronic Records

Most health care industry players agree digitally collecting and disseminating clinical data–the sort physicians, other caregivers, and diagnostic machines gather during examinations and treatment–would lead to an improved health care system.

The goal of portable electronic records is to enable physicians to access detailed patient data at any point of care so they can quickly make well-informed decisions. Such records could reduce duplicate testing and medical errors. Also, when stripped of personally identifiable information, the data within such records could help evaluate the quality of care a particular physician or hospital offers, enabling patients to be better-informed consumers.

The obstacles to developing such records have been cost, the logistics of gathering data from systems and caregivers, and security issues. How well H.R. 4157 would address those obstacles is debatable.

Surveying States

The bill could help create a nationwide health network providing privacy-protected access to an electronic health record, said Diana M. Ernst, public policy fellow in health care studies at the Pacific Research Institute.

A key mechanism to that end, said Ernst, is the bill’s call for a survey of state health information and confidentiality laws and regulations. That survey would help determine whether variations in these laws are slowing the electronic exchange of health information among states, the federal government, and other public as well as private entities.

If the survey finds issues exist, H.R. 4157 calls for the introduction of a bill “to provide the commonality” required among state and federal governments for the “secure, timely, and confidential” exchange of health data.

“It’s a viable study,” said Ernst, noting it could help lay a foundation for a national network and identify where health care systems could be more cost effective. It makes sense to involve the federal government, she said, because it is a major player in the health care industry.

Government Part of the Problem

But government has been part of the health care problem, mainly by insulating patients from health care’s true costs so they’ve had little incentive to demand or accept electronic health records, said Michael F. Cannon, director of health policy studies for the Cato Institute.

Cannon said the $40 million in grants H.R. 4157 would offer to health care systems and small physician practices to adopt or expand use of technology is wasteful. “The solution to every problem is to throw money at it,” Cannon said. “It’s what the Republicans have been doing with health care since 1996.”

Another question is whether federal “promotion” of electronic health records simply duplicates efforts. Health care providers have a tradition of strong software user groups and peer group information-sharing. And the industry has been using standardized datasets for a host of administrative and certain clinical data for more than a decade.

While H.R. 4157 includes some “safe harbors” from antitrust and anti-kickback laws that would make it easier for hospitals to share technology with physicians, and for insurance companies to install and train caregivers on technology, it’s not clear these provisions will do much to stimulate electronic health records.

Data Gathering Complexities

A lack of computer systems is not the major technological problem in creating electronic records. The real challenge is gathering data from the wide range of disparate systems that most hospitals and physicians have, and then presenting it in a coherent fashion wherever the patient shows up for treatment.

GE Medical Systems, Epic, and Cerner are among the vendors tackling this issue. Microsoft Corp.’s new health care industry initiative is based on a highly effective records system developed by a Washington, DC-based nonprofit health care network–illustrating the industry has a track record for developing solutions on its own.

H.R. 4157 touts the benefits of electronic health records but is vague on how to achieve or even promote adoption of the technology. One hope is that the bill’s vagueness will permit the industry to have a strong voice in treating itself, instead of finding itself forced to swallow federal technology prescriptions.

Sharon J. Watson ([email protected]) is a freelance writer specializing in IT issues. Steven Titch ([email protected]) is senior fellow for IT and telecom at The Heartland Institute and managing editor of IT&T News.