Senate and House Mark Up HELP

June 24, 2011
As Democrats took control of Congress early this year with a long health agenda, some people saw little hope of moving a healthcare informatics

As Democrats took control of Congress early this year with a long health agenda, some people saw little hope of moving a healthcare informatics bill.

Sen. Edward Kennedy
But as Washington temperatures rose to the mid-'90s at the end of June, the Senate Committee on Health, Education, Labor and Pensions (HELP) retreated to a mark up session to work on several bills and passed a new version of "The Wired for Healthcare Quality Act."
Sen. Mike Enzi
Among other things, the bipartisan legislation would create several avenues for grants to encourage HIT and would make permanent most of the federal structure, including the HIT coordinator that the Bush administration set up.

Sen. Edward Kennedy (D-MA), chair of the HELP committee, said in a statement, "It's long past time for the nation's healthcare industry to adopt modern information technology. Such technology has revolutionized a wide array of American industries, and it holds the same promise for the healthcare industry."

Sen. Mike Enzi (R-WY), the top Republican on the committee, stated: "Doctors, hospitals, healthcare advocates, and the business community — including small business — are clamoring for Congress to take action and establish uniform health IT standards. Time is of the essence — if we do not act, our healthcare system will move forward in a highly inefficient, fragmented and disjointed way."

At the House

On the other side of Capitol Hill, the main health committees in the House of Representatives have not put forth major HIT legislation. Members there are busy, according to observers, with issues like amending Medicare so physicians will not get the looming 10 percent payment cut and with revising the State Children's Health Insurance Program (SCHIP). A staff aide for the House Energy and Commerce Committee, a major panel that would consider such legislation, said the committee was definitely interested in the topic, and will know more about whether it can schedule hearings in a few weeks.

The House does have at least a little time to come up with a bill, since the 110th Congress will not end till fall of next year.

Meantime, Michael Zamore, staff member in charge of HIT for Rep. Patrick Kennedy, cautioned that although legislation on HIT itself would be valuable, it will likely take incentives for healthcare providers on big funding bills to really get HIT moving. Pointing to the work Congress is doing to make changes in Medicare and SCHIP, he said, "We hope these two bills will not go by," without Congress creating mechanisms to motivate provider adoption of HIT.

He also pointed out that moving through Congress is a package of bills called the biggest reform of the Food and Drug Administration in decades. If Congress, for example, is gong to enhance surveillance of drugs already on the market by encouraging physicians to report problems electronically, it needs to make those systems compatible with electronic health records, he said.

Privacy is paramount

One big question hanging over any HIT legislation is how it will deal with privacy. Congress has been told repeatedly this year that there are major privacy concerns regarding any HIT efforts and the laws need to deal with it first. But the issue is so thorny that some HIT advocates hope the legislators will work with it in a separate bill, for fear that disagreements could sink any legislation it's a part of.

Several Congressional hearings have addressed the issue this spring. As late as June, the Government Accountability Office, an investigative agency under Congress, again testified, as it had previously, that the industry is having problems in protecting HIT privacy and the Department of Health and Human Services (HHS) needs to implement a more comprehensive plan for protection.

But for now, the newly fledged Senate bill is foremost a vehicle for discussion. Sponsored by Senators Hillary Clinton (D-NY) and Orrin Hatch (R-UT), in addition to Kennedy and Enzi, the bill would write into law the Office of the National Coordinator for Health Information Technology (ONCHIT), created by this Administration to push adoption of health electronics. It would also make permanent the American Health Information Community (AHIC), which is the advisory body to HHS that has guided several coordination breakthroughs in the last two years.

The AHIC provision comes at a time when HHS Secretary Michael Leavitt, who has focused hard on these issues, is trying to get AHIC to spin itself off into a public-private partnership next year.

The bill would also create a new public-private, "Partnership for Healthcare Improvement" to advise HHS on technical aspects of health information, including interoperability, standards, implementation specifications and certification criteria for electronic exchange, including reporting of quality data. The Comptroller General would appoint seven members representing different stakeholders, but there would also be one or two members appointed by leaders of the Senate, the House, and HHS.

Quality on the rise

In the quality arena the package includes grants for integrating IT into clinical education and encouraging the use of decision support software.

The bill would require designation of "a single organization to develop healthcare performance measures." That private entity would set national strategy for priorities and goals in establishing quality measures, harmonize development and testing of such measures, and endorse national consensus measures.

That organization would adopt evidence-based measures of clinical processes and outcomes, patient experience, efficiency, under use and over use, among other characteristics. Priority is to be given to measures that are most likely to improve performance and efficiency and may be rapidly implemented by group health plans, health insurers, physicians, hospitals, nursing homes, long term care providers and others.

The quality outcomes are to be publicized, says the bill: "In order to make comparative performance information, including at the provider level, available to healthcare consumers, health professionals, public health officials, oversight organizations, researchers, and other appropriate individuals and entities, the Secretary (HHS) shall work with multi-stake holder groups to provide for the dissemination, aggregation and analysis of quality measures collected."

Among a few provisions targeted at privacy, the bill would require the GAO to report on circumstances in which health plans, healthcare clearing houses and healthcare providers that transmit electronic healthcare information tell people when their information is wrongly disclosed.

It also requires HHS to develop a Health Information Technology Resource Center to provide technical assistance and best practices information. The center would "provide for establishment" of regional and local networks for interoperability across healthcare settings as well as other activities that the networks or other stakeholders feel are important for sharing best practices.

New coalition on the block

In another Washington HIT event, a coalition to advocate for HIT legislation as soon as possible announced its establishment in early June. Its 24 members include the American Academy of Nursing, the American Society of Clinical Oncology, the National Medical Association and the National Retail Federation. Former Representative Nancy Johnson and former Senator John Breaux are its co-chairs. Johnson is the former chairman of the House Ways and Means Health Subcommittee and Breaux is a former Senate Finance Committee member.

In addition to making progress in healthcare informatics, one of the coalition's goals is creating a Federal focus on consumer empowerment through patient education tools that encourage patient use of electronic health records and provider quality information.

The Senate committee HIT bill did not immediately have a bill number attached to it, but information is available on the committee's Web page,

Kathryn Foxhall is a contributing writer based in Hyattsville, Md.

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