Push continues for electronic health records

Washington -- Another key senator has joined the ranks of influential lawmakers who have backed the notion of electronic health records.

Sen. Edward Kennedy (D, Mass.) introduced legislation in May that could foster the development of electronic records and provide financial incentives for their use.

Health care information technology is one of the few health issues on which Republicans and Democrats seem to agree, but continued wrangling over last year's Medicare Modernization Act and looming elections have cut that momentum to foundation-building for next year.

Kennedy's bill would require standards for interoperability of electronic health records to be finalized by Jan. 1, 2006, and would provide grants, loans and loan guarantees to help health care practitioners implement the technology. The legislation also would offer larger reimbursements to hospitals and other facilities that implement these types of information systems.

Under the measure, health care information technology would be used to improve quality of care by tracking performance on clinical measures and requiring both public and private payers to cut payments to practitioners who fail to meet quality standards.

"The legislation is an effective way to modernize and improve the health care system by using modern information technology, by paying for value and results and not simply for procedures performed or patients admitted to hospitals, and by focusing on improving quality and preventing disease," Kennedy said.

A Kennedy spokesman said the senator had not sought co-sponsors for the bill but introduced the legislation as a starting point. Kennedy is the ranking Democrat on the Senate Committee on Health, Education, Labor and Pensions. The panel's chair, Sen. Judd Gregg (R, N.H.), has introduced a bill that would implement President Bush's electronic health records plan, announced earlier this year. Sen. Hillary Clinton (D, N.Y.) and Reps. Nancy Johnson (R, Conn.) and Patrick Kennedy (D, R.I.) also have proposed health care IT bills.

Who will pay?

Physician groups, including the American Medical Association, have backed the drive for electronic health records, but they remain concerned about who would foot the bill for the new technology.

"We're not sure where the money is going to come from," said AMA Trustee Joseph M. Heyman, MD. "It may come from health insurers that may provide financial incentives to accomplish something like this. It may come from the government. We just aren't sure, and that's a big concern for us."

In his proposed fiscal 2005 budget, Bush asked for a doubling of the funds available for electronic records grants and demonstration projects to $100 million, an amount considered by experts as more a symbolic stake in the ground than adequate funding. The Centers for Medicare & Medicaid Services also has issued a proposed rule that would provide an exemption to anti-kickback laws for hospitals and insurance companies to provide electronic record systems to physicians.

Private insurers are increasingly interested in the quality and efficiency gains that electronic systems can provide. Kaiser Foundation Health Plan recently implemented a records system in two of its regions and saw outpatient visits drop by 7%.

"That was a function of providers having the information at the time of the visit to adequately care for the patient, not having to have repeat visits, [and] being able to handle issues over the phone which prevented a visit," said Robert Crane, Kaiser senior vice president for research and policy development.

Crane said studies had shown that up to one-third of the time in inpatient settings and up to half the time in outpatient settings, physicians often do not have a paper record or test results at hand when they need to make an informed judgment about care.

"Our paper-based system is increasingly non-viable," he said. "[But] providers have been unwilling to make investments, not knowing that the infrastructure was solid, that standards are in place to allow this interoperability to take place."