HISTORY

As Congress, the administration, and the health care industry have worked together to improve patient safety, solid support has developed for the adoption of widespread interoperable health care information technology (HIT) systems to improve quality of care. HIT offers many benefits: more efficiencies in health care delivery, cost savings, safer and better patient care, and clinical and business process improvements. All told, HIT yields significant benefits for patients, providers, and payers. 
President Bush, in 2004, called for adoption of interoperable electronic health records within 10 years for most Americans and established a new, HHS subcabinet level position of national health information technology coordinator.  The national HIT coordinator immediately drafted and released the “Framework for Strategic Action.” The report outlined four goals and 12 strategies to encourage HIT and further the development of a national HIT infrastructure. 

On September 13, 2005, HHS Secretary Michael Leavitt announced the membership for the American Health Information Community (the Community or AHIC). The Community is a federally chartered commission charged with providing input and recommendations to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected.

Given the bipartisan support for HIT adoption, both chambers have been anxious to move a HIT bill in the 110th Congress.  In June, the Senate HELP Committee passed legislation, the "Wired for Health Quality Act," (S. 1693) to facilitate widespread HIT adoption. The bill codifies HHS offices such as ONCHIT, AHIC, and a new office that would establish standards, implementation specifications, and criteria for certifying interoperability. The bill also provides for grants to health care providers, states, and localities to implement HIT and electronic data exchange.  Though broad support exists for the Senate legislation, progress has been held up due to concerns related to a proposed amendment related to privacy offered by Judiciary Committee Chairman Patrick Leahy (D-VT). 

On October 10, Rep. Anna Eshoo (D-CA) introduced the “Promoting Health Information Technology Act” (H.R. 3800) in the House with language virtually identical to the Senate’s version. The House has not yet taken action on HIT; nevertheless, additional action on HIT is expected early in 2008.

On May 21, Representative Bart Gordon (D-TN), chairman of the House Science and Technology Committee, introduced a bill (H.R. 2406) to assign responsibility for establishing standards to achieve HIT interoperability to the National Institute of Science and Technology (NIST). On October 24, the committee marked up a revised bill and reported it favorably to the full House. Several amendments were adopted to clarify NIST’s role, including an amendment that would require NIST, the National Science Foundation, and other federal agencies and stakeholders to form a task force to develop a strategic plan and recommendations related to HIT standards setting.  The legislation was not considered by the House of Representatives before adjourning in December; it remains unclear whether the full House might take up the bill in 2008 when considering HIT legislation.

Some funding for HIT was passed in 2007. The "Consolidated Appropriations Act,” (P.L. 110-161), enacted in December 2007, appropriated $42 million for the Office of Health Information Technology (ONCHIT) to include grants, contracts, and cooperative agreements for the development and advancement of an interoperable national health information technology infrastructure. In addition, the bill provided $19 million through the Public Health Service Act to carry out health information technology network development.  The report included with the appropriations act also directed the secretary of HHS to develop and make available for public comment a privacy and security framework to govern all efforts to advance electronic health information exchange.  The secretary is directed to report to the Appropriations Committee on the development and implementation of the framework and any recommended congressional or executive action no later than June 30, 2008. After appropriate public comment, the committee requests that the secretary issue regulations as necessary to assure implementation of the framework.

In 2006, significant action on HIT occurred on the legislative front.  In the House, a modified version of legislation to facilitate HIT, introduced by Ways and Means Subcommittee Chairman Nancy Johnson (R-CT) and Energy and Commerce Subcommittee Chairman Nathan Deal (R-GA), was approved by the House of Representatives on July 27, 2006.  The “Health Information Technology Promotion Act of 2005” (H.R. 4157) would have codified the Office of the National Coordinator for Health Information Technology (ONCHIT), provided an exception to the antikickback and physician self-referral rules for HIT, and required the HHS secretary to study the impact of the variation of state and federal privacy laws on the timely provision of health care services.  The bill also authorized $20 million in funds for FY 2007 and 2008 for grants to small physician practices and integrated health systems using HIT to provide care for the uninsured.

House and Senate negotiators were unable to resolve the differences between the House-passed bill and a version approved by the Senate in November 2005, S. 1418, the “Wired for Health Quality Act,” before the Congress adjourned for the year in December.

The administration also has promoted the use of HIT. In November 2007, the Federal Communications Commission (FCC) announced it will provide up to $400 million from its Universal Service Fund to subsidize telemedicine networks that use broadband backbones for connectivity.  The networks may use the funds to support other HIT initiatives, such as EHR and RHIO initiatives. 

AHIC continues its advisory work.  Most recently, HHS issued a final white paper describing the vision for and attributes of a successor to the AHIC.  CMS outlined that the AHIC successor will have representation from the public and private sectors and that the successor will adopt a business model that accelerates HIT interoperability through a collaborative based in the private sector.   In December, a Notice of Funding Availability was reissued to select an entity to establish the AHIC successor by Spring 2008. HHS had indicated that the grant would be awarded before January 15, 2008.

The Institute of Medicine (IOM) in November released a report calling for the Office of the National Coordinator for Health Information Technology (ONCHIT) to develop and implement a strategic plan for the national HIT agenda, echoing similar conclusions reached separately by the Government Accountability Office (GAO) and the Office of Management and Budget (OMB).

The National Committee on Vital Health Statistics (NCVHS) issued a final report to HHS entitled, "Enhanced Protections for Uses of Health Data: A Stewardship Framework for Secondary Uses of Electronically Collected and Transmitted Health Data." The report provides recommendations to HHS on a data stewardship framework to enable optimal uses of health data while respecting the privacy of individuals who are the sources of the data. 

Progress has also been made on an important initiative contained in the Medicare Modernization Act (MMA). HHS is moving forward with a proposed rule on the initial national electronic prescribing standards as required by MMA. A proposed e-prescribing rule was published on January 27, 2005. Standards for e-prescribing were pilot tested during 2006.   In 2007, CMS proposed a rule to adopt new standards to advance the use of e-prescribing for formulary, benefit, and medication history transactions used under the Medicare prescription drug benefit. The secretary will adopt final uniform standards by 2008.  In addition, CMS released a proposed rule to increase adoption of electronic prescribing by eliminating an exemption for computer-generated faxes by January 1, 2008. 

In 2006, the president signed an executive order requiring that as federal agencies implement, acquire, or upgrade health information technology systems they utilize, where available, health information technology systems and products that meet recognized interoperability standards.  The executive order also requires agencies in their agreements or contracts with health care providers, health plans, or health insurers, to specify that as each provider, plan, or issuer implements, acquires, or upgrades health information technology systems, it utilize, where available, health information technology systems and products that meet recognized interoperability standards.  In addition, the executive order requires agencies to provide beneficiaries and enrollees information about the pricing of health services and to develop and identify approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care. Agencies were required to be in compliance with the executive order by January 1, 2007.

Private sector groups such as the National Alliance for Health Information Technology (NAHIT) and the eHealth Initiative continue to work with a wide variety of health care industry groups to help standardize industry technology for bar coding, connectivity, automated entry systems, electronic patient records, and other emerging health care administrative technologies.

THE FUTURE

Widespread agreement on the importance of health information technology to the continued improvement of patient care suggests that progress on HIT initiatives will continue in 2008. The Senate has already begun work on HIT; the House is expected to consider legislation during this session of Congress. However, controversy over the potential addition of supplemental privacy restrictions may slow congressional progress on the issue as this already prevented Senate passage at the close of 2007.

Even if legislation to facilitate HIT is not enacted in 2008, the coming election bodes well for HIT adoption.  All of the presidential candidates support HIT investment, with leading Democrat candidates outlining a significant $3-10 billion federal contribution. 
HIT is a key component of patient safety and health care quality improvement.  Congress, the administration, and the health care industry must resolve to work together to assure facilitation of HIT. Congress should assist providers and encourage interoperability by funding HIT, providing incentives to encourage HIT adoption, and establishing uniform federal privacy and health information security standards.