Lawmakers focus on federal role in promoting health IT systems

One bill would charge physicians fees for using a national EMR system; another would offer incentives to join and let doctors participate at no cost.

By Dave Hansen — Posted July 2, 2007

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The lack of widespread electronic medical records is a "giant market failure," says Sen. Sheldon Whitehouse (D, R.I.). And he doesn't think physicians should pay to fix it.

The lawmaker recently introduced a bill to establish a federally chartered nonprofit organization that would set up, fund and manage an EMR system.

Health information technology shows great promise in reducing health care expenses, yet few physicians embrace it, because the money saved goes to health insurance companies, Whitehouse said.

Dumping the cost on the federal government won't happen in an era of budget deficits, Whitehouse concluded. So he took a different tack in his legislation, known as the National Health Information Technology and Privacy Advancement Act of 2007.

The federally charted corporation would design, build and operate the national health information system and set user fees for physicians, individuals and health insurance companies. The system would be interoperable with pre-existing health information technology equipment and systems.

Patient privacy would be a top priority of the corporation, which would establish transparent and accountable privacy guidelines. The organization also would appoint a chief privacy officer to protect patients' personal information from illegal use.

Whitehouse isn't alone. Reps. Dennis Moore (D, Kan.) and Paul Ryan (R, Wis.) plan to introduce similar legislation, the Independent Health Record Trust Act, in the House soon.

How trusts would work

A Moore health care staff member who asked to remain anonymous shared advance details with AMNews. The measure would create private medical record trusts regulated by the federal government with voluntary participation from patients and physicians. Doctors could simply input medical data into a Web site using a password. No special equipment would be needed, the aide explained.

Physicians also could send records directly to a trust for its staff to input, the aide said. Trusts could offset the costs of physicians whose staffs entered the data. They also could pay doctors as an incentive for joining. Revenue received by the physician would be tax free.

As a further incentive, physicians could use the entry of data to satisfy the current requirement that they submit medical records to patients within 30 days of treatment if the patient requests it, the aide explained.

Doctors would not be charged to use the system, an aide to Ryan said.

Trusts could fund the system by charging consumers a nominal fee, perhaps $5 per month, said the Moore aide. They also might collect startup money from private health care organizations, which would benefit from a national records system. Health plans could reduce the cost of premiums for patients who sign up for a medical record trust because it would reduce plans' chronic disease management costs, the aide added.

The bill, which already had at least 11 co-sponsors before its formal introduction, does not address the donation of equipment to physicians, the Ryan aide said.

Whitehouse expressed optimism that the Senate would pass his bill with bipartisan support.

But Robert Tennant, senior policy adviser for the Medical Group Management Assn., said the legislation was not likely to pass.

While Whitehouse's measure is very innovative, the Senate Health, Education, Labor and Pensions Committee likely will focus on another measure, the Wired For Health Care Quality Act. That bill, not yet introduced at press time, would establish a public-private partnership to recommend the technical aspects of a health information system to the Dept. of Health and Human Services.

The legislation also would mandate that the federal government purchase equipment conforming to those standards. This would be voluntary for private entities.

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