Government
House bill seeks to speed up adoption of health IT systems
■ The legislation offers grants and loans for doctors and hospitals to buy information technology. But some experts say the proposed funding levels fall short.
By Beth Wilson amednews correspondent — Posted July 28, 2008
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A new bill moving through the U.S. House of Representatives aims to speed development of a nationwide electronic health record infrastructure, but some critics say the measure lacks the necessary funding and patient-privacy protections.
The House Energy and Commerce Committee plans to vote on the $575 million legislation this summer. A subcommittee approved the measure by voice vote in late June.
The bipartisan bill, sponsored by the committee's leaders, calls for $115 million in federal grants and loans each fiscal year from 2009 to 2013. Physicians and hospitals could compete for funds to purchase certified health information technology. Applicants would be required to demonstrate financial need and contribute $1 for each $3 given by the government. Small practices and hospitals, and those in underserved areas, would get preference.
Also included are grants to states to develop loan programs for health IT purchases, and to entities creating local or regional interoperable information technology networks. Other provisions would make permanent a national health IT coordination office at the Dept. of Health and Human Services and encourage the universal use of electronic health records by 2014.
The American Medical Association has not endorsed the bill, but it believes the measure takes several important steps toward the goal of broad adoption of health IT. Overall, the AMA supports provisions that recognize the importance of moving toward an interoperable, nationwide health IT infrastructure and the federal government's role in accelerating this process.
The Association also advocates providing financial assistance to physicians and expanding the Health Insurance Portability and Accountability Act's privacy rule to cover all parties involved in an electronic exchange. This includes workers' compensation carriers, researchers, life insurance issuers, employers and marketing firms.
The Denver, Colo.-based Medical Group Management Assn. is pleased that the House has taken up the issue, said Robert M. Tennant, the organization's senior policy adviser in Washington, D.C. "But the bill falls short in terms of what really needs to be done to adopt HIT. The main barrier is still the cost," he said.
The equipment is extremely expensive to purchase, he said, especially in these economically tough times when "health care costs are up and reimbursements are down." Often physicians are not the ones to see the financial benefit. Others such as insurance companies do, he said. Another obstacle is doctors' confusion about which system to buy.
In spite of these factors, physicians recognize the value in such systems and see their potential to improve patient care, Tennant said.
"We're looking for legislation that really jump-starts this process," he said. "We're hopeful [lawmakers] can come together with a bill we can support. As it's written now, we have a lot of concerns."
AMA Board of Trustees Member Steven J. Stack, MD, while addressing the health subcommittee of the House Energy and Commerce Committee on June 4, noted that health IT adoption rates among doctors remain low.
About 20% of physicians in practices employing 21 or more doctors have health IT, while 12% to 13% of practices with five or fewer physicians do, Dr. Stack said. "Significant adoption barriers remain. These include lack of financial incentives, training and technical support."
Dr. Stack cited a study that found initial health IT costs were approximately $44,000 per full-time-equivalent physician per year and ongoing costs were about $8,500 per FTE physician per year.
Privacy an issue
In addition to cost, Tennant said, physicians are concerned about protecting patients' privacy. At the same time, however, some requirements under discussion would "prove to be quite onerous," he said.
The bill's mandate that patients receive notification within 60 days of any breach in privacy may be too much to ask, he said. "In some instances it's feasible, but it's a little bit of an unnecessary burden, especially to a small practice."
Deborah C. Peel, MD, founder and chair of the Patient Privacy Rights Foundation, an advocacy group based in Austin, Texas, hopes the legislation as it stands does not pass. "This bill falls short of what it will take for the public to trust these systems."
Dr. Peel, who also testified before the subcommittee in early June, said she would rather see the effort fail than create a flawed system. "We want the [electronic health system] to be built in a way that's successful."
She wants the bill to contain a clear definition of privacy, meaningful penalties for privacy violations, an audit trail of every time a record is accessed, patients' right to segment sensitive information and privacy protections severely limiting which people have access to the records.
"It's difficult to layer privacy in later," she said, adding that "health IT has abysmal security overall."
Sometimes lawmakers confuse security with privacy, she said. "If you build an office where all the doors have strong locks, you may think it's secure -- but if you give 500 people the security key, it's worthless."
Regarding the bill, Dr. Peel said, "We think the locks on the doors will be installed. We're concerned about everyone and their dog having a master key."
She applauded the bill's requirement that patients be notified of breaches in a timely manner. But, she added, "It's a security issue. It's after the fact."