Doctor organizations' concerns put brakes on health IT bill

Washington -- An attempt to quickly pass a Senate health information technology bill was derailed after medical groups raised concerns about its quality measurement, patient privacy and funding provisions.

Senators in mid-November considered but could not agree on "hotlining" the bill, a term for passing it by unanimous consent without formal floor debate, said Senate Health, Education, Labor and Pensions Committee spokesman Michael Mahaffey.

Mahaffey declined to specify the disagreements but said the most serious was whether the bill, the Wired for Health Care Quality Act, contained adequate patient privacy protections. The delay occurred after the American Medical Association and 35 other physician organizations sent a Nov. 9 letter expressing their concerns to the legislation's main sponsors, Sens. Hillary Clinton (D, N.Y.), Edward Kennedy (D, Mass.), Mike Enzi (R, Wyo.) and Judd Gregg (R, N.H.).

The legislation would establish a board to determine HIT interoperability standards and require federal agencies to adopt them. It would give the Health and Human Services secretary the authority to create quality measures and doctor-specific reports on performance on the measures.

Quality measures should be developed in a transparent process that involves physicians and other stakeholders, the physician organizations wrote.

"The [HHS] secretary and federal government are not equipped to unilaterally mandate the practice of medicine," the letter stated. Without adequate stakeholder input, "there is a significant risk that the measures will not be appropriate or valid for the services that are to be measured, and, therefore, will not be useful to patients or could even harm patients."

The organizations also questioned whether the amount of funding in the bill would be enough. The legislation calls for up to $278 million in grants to physicians for purchasing new technology.

Financial support is essential, the groups stated. "Adequate funding should be provided to physicians investing in HIT to ensure the success of an undertaking of this magnitude, with due consideration for the constraints already faced by solo or small physician practices ... and those who practice in rural, inner-city and medically underserved areas."

The grant application process outlined in the bill is too lengthy and detailed, the letter also stated. "The process is not well-suited for small medical practices or solo practitioners, who have limited resources."

The dispute probably means that the Senate will not vote on the bill this year, said Robert Tennant, Medical Group Management Assn. senior policy adviser. "The letter strongly encouraged them to work with the physician community to ensure any legislation will be supported by us," he said. "I hope they take that to heart. As providers, we are the ones who will implement HIT, so I hope we will be consulted when they develop legislation."

At press time in late November, Mahaffey said Senate Health, Education, Labor and Pensions Committee negotiators were meeting with various physician groups to try to win their support.