Government

HIT budget plan criticized as insufficient

Health IT coordinator's office would see an increase, but funding would be flat for the agency that tests technology's potential for patient care.

By Dave Hansen — Posted March 3, 2008

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Funding levels for health information technology programs in President Bush's fiscal 2009 budget have come under fire in recent weeks from some analysts and Democratic lawmakers. They say the proposed investment isn't enough to advance the administration's goal of widespread electronic health record use by 2014.

The $3.1 trillion budget plan would boost spending for the Office of the National Coordinator for Health Information Technology by 9%, or $5.5 million, to $66.1 million. It also proposed keeping HIT funding for the Agency for Healthcare Research and Quality at last year's level of $44.8 million. AHRQ uses these funds to test HIT systems and recommend best practices. The agency would continue focusing resources on information technology investments that enhance patient safety.

At a Feb. 14 Senate Budget Committee hearing on HIT funding, Sen. Sheldon Whitehouse (D, R.I.) criticized Bush for allocating so little money to the technology coordinator's office. Widespread adoption of HIT could save $81 billion, he said, yet the president is proposing much less to achieve it. "If you could make $81 billion and get a 100% payback, that gives you an idea of how off we are in magnitude.

"Despite positive rhetoric and small steps forward, President Bush has largely squandered the opportunity to make meaningful progress on the development and implementation of a nationwide information technology system," he added.

Sen. Kent Conrad (D, N.D.) identified widespread adoption of HIT as a critical way to control health care costs. The U.S. spends 16% of its gross domestic product on health care, a figure which is expected to rise to 37% by 2050. The private sector will be overwhelmed by health care costs if they are not contained, Conrad said.

The lone Republican at the hearing, Sen. Judd Gregg (R, N.H.), did not comment on the president's HIT budget but noted the difficulty posed by the lack of interoperable electronic medical records. Gregg said he had to request federal funding for an interoperable system at a New Hampshire hospital where the systems were so complicated that the staff could not communicate from one department to another.

A Government Accountability Office report released at the hearing concluded that while the Dept. of Health and Human Services has made progress pursuing Bush's 2014 goal, it has not developed a national strategy to reach it. "Given the many activities to be coordinated, such a national strategy is essential," noted Valerie C. Melvin, GAO's director of human capital and management information systems issues, in written testimony at the hearing. Melvin noted that the federal health technology office has prepared a draft health IT strategic plan and expects to release it this spring.

Bush budget documents say HHS concluded that it missed its fiscal 2007 goal of having 18% of physicians adopt minimally functional electronic medical records. According to the department, only 14% did so.

Analysts debate commitment to HIT

HIT experts projected different views about the significance of the budget.

Although the funding level could be higher, Bush's proposal is a good sign that he counts on the next president continuing the technology office's work, said Don Asmonga, director of government affairs for the American Health Information Management Assn.

Bush could have recommended zeroing out the office, he said, but the fact that he proposed to fund it through 2009 and into another administration shows his commitment. The office's proposed budget is adequate for current programs, he added.

"It's more of a continued push for coordination to build the infrastructure and standards for future implementation," Asmonga said.

But Laura Adams, president and CEO of the Rhode Island Quality Institute, said the proposed funding level for the HIT office is disappointing. The institute is a public-private initiative to build a health care information exchange in the state. "Five million is woefully inadequate for the promise of what HIT can bring," she said.

The increase should be four or five times higher, given what the return on investment could be, Adams explained. Extra money could fund more research and development projects at the local level.

"It's hard for us to set up a nationwide HIT system if we don't know how to do it at the local level," she said. "There are a lot of local and state HIT projects that struggle to find funding and shouldn't be."

AHRQ's budget should have been tripled, Adams added. The extra money could have been spent on understanding how new technology can be applied at the point of care and developed so every patient receives it.

In the HIT office's budget, Bush proposes a $7.7 million increase, to $21.5 million, for standards harmonization so IT systems can exchange data across different health care settings. The extra money would support the American Health Information Community, the federal advisory board established in 2005 to recommend ways for accelerating technology adoption. The funds also would launch a successor to it once AHIC makes a planned change to become a private-sector organization this fall.

The budget also would increase funding for the Nationwide Health Information Network by $6.8 million, to $26 million. The program will fund nine health information exchanges across the U.S. and develop the best way for consumers to access electronic medical data in a health information exchange. HHS intends to test these entities in September on their ability to work with each other and federal agencies.

But the proposed budget would cut funding for privacy and security programs by $7.6 million, to $10.6 million, because the national coordinator's office will shift away from funding projects addressing barriers to exchanging HIT across states to evaluating such initiatives. The financial blueprint also would cut spending for operations by $1.4 million, to $8 million, through more efficient use of contractors.

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ADDITIONAL INFORMATION

Boost for HIT office

After three years of static funding for the Office of the National Coordinator for Health Information Technology, President Bush proposes a 9% increase.

FY 2006 $61.2 million
FY 2007 $61.3 million
FY 2008 $60.5 million
FY 2009 $66.1 million

Note: FY 2009 is proposed amount

Source: Dept. of Health and Human Services

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