Health IT bill gets nod from doctor groups

Several physician groups are throwing their support behind a federal health care information technology bill that promotes the adoption of electronic medical records and seeks to create regional networks and uniform operating standards for information systems.

The American Academy of Family Physicians and the American College of Physicians, among others, have endorsed the "21st Century Health Information Act of 2005," which has bipartisan backing on Capitol Hill. The bill's goal is to put electronic medical records and e-prescribing technology in every physician's hands and to ensure a seamless flow of data, which its sponsors say will improve patient safety and decrease costs.

The AAFP "wholeheartedly supports this critical and life-saving measure because it takes into account small- and medium-sized practices that are essential for a successful interoperable system," said David C. Kibbe, MD, director of AAFP's Center for Health Information Technology.

At press time, the AMA had not reviewed the bill. It has been supportive of efforts to create an affordable, standards-based electronic health record.

The bill, sponsored in the U.S. House by Reps. Tim Murphy (R, Pa.) and Patrick J. Kennedy (D, R.I.), has seemed to draw more attention than past efforts to implement health care information technology, both because of its content and its support. Political opponents Sen. Hillary Rodham Clinton (D, N.Y.) and Republican former House Speaker Newt Gingrich appeared together at a press conference last month to endorse the measure.

Legislative efforts in previous years have included similar provisions, but the support of these political heavyweights "provides a little cachet," said Chet Speed, vice president of public policy for the American Medical Group Assn.

Clinton said she was working with Senate Majority Leader Bill Frist, MD (R, Tenn.), on a Senate version. "We have the most advanced medical system in the world, yet patient safety is compromised every day due to medical errors, duplication and other inefficiencies. Harnessing the potential of information technology will help reduce errors and improve quality in our health system."

Sufficient funds?

But for all the buzz surrounding the bill, questions remain about how physicians will be able to afford a system that can communicate properly with a regional network.

"There isn't a lot of money discussed in the bill," said Robert Tennant, senior policy adviser for the Medical Group Management Assn. "For a national infrastructure, it's really not much. It's not going to work without a lot more money."

The legislation earmarks $50 million in 2006 to fund 20 three-year grants for regional organizations to develop and implement electronic health record systems. The bill also proposes to offer federal 10-year loans to organizations that need help meeting initial costs associated with implementing this technology.

But to put that funding into perspective, one large practice in New York will spend $140 million alone on its information technology system, Tennant said. With an uncertain reimbursement climate, doctors simply don't have much money to invest in these systems, he added.

"This has to spring from an environment where physicians are comfortable investing in IT," he said. "The only way this bill will succeed is if physician offices have technology, but it has to come after the Medicare payment issue is settled."

Another problem with the measure's funding plan is that it does nothing to help physician groups that have been ahead of the curve, Speed said. Many of AMGA's members "have made multimillion-dollar investments in IT systems, and they should be acknowledged," either through financial means or involvement in discussions about setting system standards, he said.

While the bill might not lay out a perfect financial path, it does include provisions to help physicians in other ways. Perhaps most important, according to the AAFP, is the proposed establishment of a national technical assistance center. This will help small physician groups in their efforts to "acquire and use appropriate IT," Dr. Kibbe said.

The legislation would reward physicians for their involvement by offering an increase in Medicare reimbursement to those doctors who participate in regional information networks. It also proposes to carve out exceptions to Stark self-referral and anti-kickback laws. These provisions would allow hospitals to help fund physicians' adoption of information technology systems within a community plan.

The laws "currently bar local hospitals from equipping community doctors with the IT infrastructure needed to electronically exchange patient information," said Gingrich, who is founder of the Washington, D.C.-based Center for Health Transformation, a member organization dedicated to creating an electronically based, quality-driven health system. "Breaking down these barriers is vital to rapid adoption of [health information technology]," he added.

In a letter to the bill's sponsors, several physician organizations, including the ACP and American College of Emergency Physicians, as well as more than a dozen health care technology companies, supported the provisions, especially the idea of financially rewarding physicians who participate in a network.

"The importance of reforming Medicare is hard to overstate," the letter reads. "With so many of the sickest Americans in this one program, creating a relationship between payment and quality in Medicare will have a lifesaving impact for patients throughout the country."

Uniform standards for systems

Protecting patients is the prime goal of the bill, supporters say. Not only will electronic health records reduce medical errors, but they also will encourage the use of best practices and make it easier to report quality data, they said.

The ability to transfer data seamlessly is another important aim of the bill, which proposes uniformity and interoperability requirements to make communication between networks easier.

Regional networks would have minimum design requirements under the legislation, and organizations only would be able to use the federal funds to purchase systems that have been certified as meeting basic interoperability standards.

Interoperability is certainly an ambitious goal, but the means of getting there are financial, Tennant said. "If there's no money to buy the infrastructure, then interoperability is irrelevant," he said.