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Johnson Plans 'Simple, Streamlined' Approach to Health IT

JULY 27, 2005 -- House Ways and Means Health Subcommittee Chairwoman Nancy Johnson said Wednesday her staff is drafting legislation that would take a "simple, streamlined" approach to increasing the use of health information technology (IT).

Witnesses at a hearing before her panel Wednesday supported the idea of broadening the use of health care information technology. But they differed over whether states should be forced to meet uniform privacy standards and whether a national information network could be established without uniform laws.

A House aide said Johnson's bill will stick to four main objectives, one of which would permit hospitals to give information technology to doctor's offices without running afoul of laws to prevent hospitals from inducing physicians to make unwarranted referrals. The bill also will seek to create common standards for protecting the privacy of medical data.

The legislation will make the existence of the office of the National Health Information Technology Coordinator a statutory requirement, the aide said. And it will take steps to further the use of a new generation of billing codes called ICD-10 codes. But unlike Senate proposals, it will not authorize federal grant programs to further IT.

Another health IT bill offered by Reps. Patrick J. Kennedy, D-Mass., and Tim Murphy, R-Pa., is the focus of efforts by Speaker J. Dennis Hastert, R-Ill., to develop a leadership bill on IT, former House Speaker Newt Gingrich said last week. But the House aide said Johnson also is working with GOP leadership on her bill. (The Kennedy-Murphy bill was to be considered during a hearing of the House Government Reform Committee on Wednesday.)

Privacy Brouhaha
Georgetown University researcher Joy L. Pritts warned against trying to achieve uniform privacy standards by preventing states from applying stricter requirements than those in the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA does not provide adequate protection and state laws with stricter standards should remain in place, Pritts said.

But Mary Grealy of the Healthcare Leadership Council said in written testimony that it would be "potentially impossible" for industry to take part in a national health information network speeding the exchange of medical data if varying federal and state privacy standards remain in effect.

A national network subject to varying state requirements "will provide only a fraction of the speed and efficiency necessary to improve patient outcomes," Grealy said.

Johnson's bill will require a study of existing federal and state privacy laws, with a report back to Congress with recommendations on how to harmonize the standards, according to another House aide.

If Congress doesn't enact legislation based on the results of the study within three years, the HHS secretary can propose a single set of federal standards. In doing so, the secretary will have the ability to modify the existing HIPAA regulations based on the study. "It is not accurate to say that her bill just does a straight preemption of existing state law with existing federal standards," the aide said.

Mixed Reviews for Bush Administration
During the hearing, Johnson lauded the efforts of the Bush administration to further the use of IT. The administration has convened a public-private commission to spur the adoption of common standards that will allow various types of computer systems to function together effectively, among other initiatives.

Although the industry will not be required to comply with the standards, they will be mandatory for federal programs and those doing business with those programs.

But the panel's top Democrat, Pete Stark of California, said the administration is doing too much talking about IT. Stark laid into National Health Information Technology Coordinator David Brailer saying, "We are going to hear from our lead witness about more meetings and conferences than one would think possible."

Stark did praise a step the administration is reportedly going to take next week, making the "VISTA" electronic health records system developed by the Veterans Administration for small medical practices available free of charge.

The Veterans Health Information Systems and Technology Architecture system "offers a complete electronic record covering all aspects of patient care, including reminders for preventive health care, electronic entry of pharmaceutical orders, display of laboratory results, consultation requests, x-rays, and pathology slides," VA said in a July 2004 press release.

"It's basically the system that we could start with tomorrow," Stark said. "Why don't we get started? It's beyond me why we're having all these therapy sessions."

Stark also demanded that Brailer explain why the federal government sees fit to use its purchasing clout to enforce common standards in IT but not to negotiate lower drug prices for Medicare beneficiaries.

The difference, he suggested, is that Republicans are getting bigger campaign donations from drug companies than from IT vendors. When Johnson tried to object, Stark said, "You're interrupting," adding that "it's my time"—that Johnson was intruding on his time for questioning Brailer.

After questioning Brailer about the administration's drug negotiating policy, Stark also challenged him on his credentials to comment on marketplace economics and concluded by telling him "you're a useless witness."

Brailer got much gentler treatment from Rep. James McCrery, but the Louisiana Republican voiced his own concerns about government involvement in the marketplace. McCrery wondered if release of the VISTA system wouldn't in effect be a declaration that "that's going to be the platform forevermore." Brailer responded that VISTA would be just one of many choices of electronic health record systems for doctors.

Brailer emphatically denied VISTA would become the de facto platform, calling it "a good solution" for "particular practice settings" but "not transformative" for health information technology adoption.

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