Sunday, February 10, 2008

Budget Discussed on the Hill

Key hill staffers, a leading HIT administration official, and the Vice President for eHI, spoke to a packed room at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics lunch session on February 6th. The speakers focused on the President’s FY 2009 HIT-related budget and future legislative possibilities.

According to P. Jon White, MD, Health IT Director, the health IT budget at AHRQ for FY 2009 is $44.8 million the same as FY 2008 with $7.5 million in grants. Dr. White explained that AHRQ’s four broad goals are to improve medical management, provide engineered clinical knowledge, deliver patient-centered care, and enable quality measurements.

Some of these goals are accomplished through grants and contracts. For example, the National Resource Centers for Health IT are helping the healthcare community deal with the information age. The Centers provide direct technical assistance and consulting services to AHRQ projects.

AHRQ awarded 5 contracts in 6 states to support State and Regional Demonstration projects. These projects are in place to support statewide data sharing and interoperability activities on a state or regional level.

AHRQ’s report to Congress included information on a joint CMS and AHRQ electronic pilot program to support the adoption of new electronic prescribing standards. The pilot was conducted in 5 sites in 8 states to test initial standards to see if the standards were ready to be adopted. As reported to Congress, the pilot program showed that the initial standards were already capable of supporting e-prescribing.

Christine Bechtel, Vice President of Public Policy, eHealth Initiative presented an overview of the FY 2009 Budget request. The request for $66 million for the Office of the National Coordinator for Health IT is an increase of $5 million over FY 2008 but still significantly less than last year’s administration request for $114 million. Overall, the HHS budget would decrease by 2.1% under the President’s budget proposal.

The proposed ONC budget would establish a successor to AHIC, develop standards and implementation for health IT through HITSP, make efforts to ensure appropriate Federal privacy and security protections for electronic health information, support state consensus efforts to address patient protections, develop the NHIN at $26 million, and certify Health IT products through CCHIT.

On the Senate side, Dana Halverson, Health Legislative Assistant for Senator Kent Conrad (D-ND) Chairman of the Senate Budget Committee, started by telling the attendees that the Senator wants to thank Neal Neuberger for the time and effort he has spent over the past 16 years to coordinate and develop the sessions and technology demonstrations for the Steering Committee.

Looking ahead, she said, although the legislation “Wired for Health Care Quality Act” to establish an interoperable health IT system did not pass in 2007, the goal in 2008 is to bring the legislation up again and to deal with the privacy issues.

Katie Oppenheim, Health Legislative Assistant for Senator Mike Crapo (R-ID,) said the Senator is very involved in telehealth and wants to see the program Telehealth Idaho broaden and expand resources to keep helping the people in the rural areas in the state to improve their access to healthcare.

Jordanna Levinson, Health Legislative Assistant for Senator Sheldon Whitehouse (D-RI), reported that DEA has made progress on regulations lifting the federal prohibition against electronic prescriptions for certain medications classified as scheduled drugs.

According information released by her office, the Senator is happy to see DEA acknowledge the need to move forward with new rules and is going to watch the situation closely over the next several months to make sure that this process stays on track. However, the officials at DEA report that they can’t predict how long the approval process will take since both OMB and the Department of Justice are required to review the proposed rule.

She also mentioned that the Senator is very actively involved in other HIT issues. Three bills (S 1451, S 1455, and S 1471) were introduced last year. The Senator wants to see the establishment of a public corporation to advance HIT that would spin off into the private sector, a bill to fund quality grants, and another bill to deal with reimbursement reform.

On February 7th, Senator Whitehouse (D-RI) spoke on the Senate floor concerning HIT issues and reported that the RAND Corporation estimates that a national interoperable HIT system could save $81 billion per year. He believes that we must not only develop a national interoperable secure HIT infrastructure, but we must also invest properly in quality and prevention, and at the same time, address how we will pay for this system.

He emphasized that health IT adoption alone will not stop our huge healthcare costs but we have to do something because more American families are bankrupted by healthcare, doctors are furious, and the paperwork is choking the system.

The Rhode Island Quality Institute has made a great effort to reduce the number of hospital-acquired infections. Similar efforts are ongoing in Washington State and in Utah. The Senator said “we need to get behind all of these state and local efforts.”

The Senator explained that when his state started the ICU reform, he talked to the Hospital Association. They estimated a $400,000 cost per intensive care unit but as much as $8 million could result in savings, a 20 to 1 payback. The Senator said the problem is that all the savings go to the insurers, so as a result, reform is very much an uphill battle.

On the House side, Mike Quear, Staff Director, House Science and Technology Subcommittee on Technology and Innovation, was very pleased to see the science workforce bill (HR 1467) pass the house but wants to see the bill move through the Senate. He said several changes have to be made to get healthcare professionals to embrace health IT. One of the barriers is the lack of trained workers in the field, and secondly, software developers work alone and don’t always design the appropriate needed healthcare systems. Quear emphasized that Congressman David Wu wants to see practitioners not only trained to use technology but also to develop products that fit the needs.

In another legislative effort, Chairman Bart Gordon (D-TN) of the House Science and Technology Committee introduced (HR 2406) on October 2007 to authorize NIST to increase efforts to support the integration of the healthcare information enterprise. Quear said, “NIST would still support AHIC and not circumvent AHIC 2.0.” Efforts are also underway to work on additional targeted bills to deal with privacy and the payment system.

Nandan Kenkeremath, Professional Staff, House Energy and Commerce Committee, raised some concerns as to how providers and patients should deal with specific information in electronic medical records. One of the questions is how will providers deal with genetic information in their actual practices? Will providers need prior patient consent in order to use genetic information in every case? Using genetic information is a very complicated issue. One of the solutions is to separate out specific medical information, but if the information is separated out and moved around in electronic records, then more medical errors may result.

Information in records that can help researchers also presents problems to providers. Medical researchers sometimes find that non-identifiable information can be vital for their use in their studies. However, is it always necessary to get a release for non-identifiable data? If the consent is needed, how do we inform patients on the need for the research so that they will give their consent?

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

The next session at noon on Wednesday March 5th, will discuss “HIT Projects to Improve Access for Low Income Persons and the Uninsured: Safety Net Providers Step up to the Plate”. The briefing will take place in the Senate Russell Building, Room 385. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email