Public Policy – View from the Hill: Patient Safety and the 108th Congress


October / December 2004

Public Policy

View from the Hill: Patient Safety and the 108th Congress

I remember one of my first boyhood visits to Washington, D.C., in the 1960s, with my grandfather, the late state Representative Lawrence H. Roberts (R-CT). On one such visit, Grandpa Roberts told me that when French architect Pierre L’Enfant first began designing our nation’s capital, the U.S. Congress was concerned that they would not be viewed on equal footing with the president. Therefore, a group of congressmen convinced L’Enfant to position the Capitol at the opposite end of Pennsylvania Avenue high on a hill known as Jenkin’s Hill. That way, so my grandfather’s story goes, the U.S. Congress would be able to look down on the president’s house and convince the entire world that they were equally important to the president. President George Washington dismissed L’Enfant in 1792 because of his insistence on complete control of the design project. I remember my grandfather winking and telling me that he always wondered if the old president was just upset with L’Enfant for giving the U.S. Capitol building such prominence.

I share this story for two reasons. First, because this is my first column focused on public policy for this publication, and I wanted to provide you with some of my past experience and background to help you understand my perspective. I come from a very politically active family that has been involved in public policy work for generations. More important, I share this story because it has direct relevance to what I see happening in Washington, D.C., as I write this column in early September, as the president, his opponent John Kerry (D-MA), and the U.S. Congress all jockey for a place of prominence heading into the November elections.

We are currently in the second session of the 108th Congress. Each session of Congress has two sessions or two one-year periods. As the second session of the 108th Congress heads for closure this fall, it is a good time to review what steps this Congress has taken to improve patient safety for all Americans and assess if any more progress will be made this year.

The 108th Congress began with much fanfare. A medical doctor was leading the U.S. Senate, and the president’s team was actively promoting healthcare improvement. Everybody seemed to realize that the country is pretty evenly divided and that new groups of supporters needed to be found. One newly recognized group of potential supporters was technology-savvy healthcare professionals. At the same time, a majority of members in the U.S. House of Representatives, the U.S. Senate, and the president were all from the same party, and the American people were finally focusing on patient safety because of the Institute of Medicine’s clarion call that up to 98,000 individuals die each year as a result of medical errors. Everyone believed that progress was at hand.

Momentum and Slow Progress
Momentum has begun. But, progress does take time. Any time you have 435 members of one team, 100 members of another team, and a third one-person team trying to compete for action, the results can be hard to follow, so let’s see if we can track the progress. You must remember that during each session of Congress, over 8,000 separate pieces of legislation can be introduced. So keeping track of all these legislative proposals is quite daunting. (Author’s Note: To track the progress of legislation yourself, go to the HIMSS Legislative Action Center at center.)

One of the first bills introduced in 2003 into the 108th session of Congress was H.R. 877, the Patient Safety Improvement Act of 2003. This legislation proposed to establish an Office of the National Healthcare Infrastructure reporting directly to the secretary of Health and Human Services (HHS), whose primary duty would be to provide national leadership in the development of a national healthcare information infrastructure (NHII). This bill never made it into law, but in April 2004, in an Executive Order, President Bush created this new office and shortly thereafter named Dr. David Brailer as the first National Coordinator for Health Information Technology. There are still bills proposed in both the House (H.R. 2915) and Senate (S. 2710) to legislatively create this new NHII position so that progress is not deterred by political elections.

Next, two companion pieces of legislation were introduced to improve patient safety and reduce the incidence of events that adversely affect patient safety: H.R. 663 (Patient Safety and Quality Improvement Act) was introduced to the House of Representatives by Rep. Michael Bilirakis (R-FL), and S. 720 (Patient Safety and Quality Improvement Act) was introduced to the Senate by Senator James Jeffords (I-VT). Progress was made on this bill up until the August summer recess. In late July, Senate conferees Judd Gregg (R-NH), Bill Frist (R-TN), Mike Enzi (R-WY), Lamar Alexander (R-TN), Ted Kennedy (D-MA), Chris Dodd (D-CT), and Jim Jeffords (I-VT) were appointed to work with House conferees to resolve differences to get this bill passed and to the president for signature. I hope that I will have some progress to report on this legislation in my next column.

HIMSS is currently tracking five other major pieces of patient safety legislation, which I have summarized below and attempted to provide you with the latest status:

H.R. 3035 — The Medication Errors Reduction Act of 2003 was proposed by Reps. Amo Houghton (R-NY) and Earl Pomeroy (D-ND) in September 2003 to establish an informatics grant program for hospitals and skilled nursing facilities in order to encourage healthcare providers to make major information technology advances. This bill was referred to both the House Energy and Commerce Subcommittee on Health and House Ways and Means Committee for action. There has been no action since September 2003.

H.R. 4880 — The Josie King Act of 2004 (also know as the Quality, Efficiency, Standards, and Technology for Health Care Transformation Act of 2004 or QUEST) was introduced in July 2004 by Rep. Patrick Kennedy (D-RI) to improve the quality, efficiency, standards, and technology of healthcare. This legislation was also referred to both the House Energy and Commerce Subcommittee on Health and House Ways and Means Committee for action. There has been no action since July.

S. 2003 — The Health Information for Quality Improvement Act was introduced in December 2003 by Senator Hillary Clinton (D-NY) to promote higher quality healthcare and better health by strengthening health information, information infrastructure, and the use of health information by providers and patients. This legislation was referred to the Senate Finance Committee, and no action has occurred since last December.

S. 2421 — The Health Care Modernization, Cost Reduction, and Quality Improvement Act was introduced in May 2004 by Senator Ted Kennedy (D-MA) to modernize the healthcare system through the use of information technology and to reduce costs, improve quality, and provide a new focus on prevention with respect to healthcare. This legislation was referred to the Senate Health, Education, Labor and Pensions Committee, and there has been no action since May.

S. 2570 — The Health Care Assurance Act of 2004 was introduced in June 2004 by Senators Arlen Specter (R-PA) and Tom Harkin (D-IA) to assist in the development by the private sector of needed technology standards and to examine the use of information technology as well as coordinate actions by the federal government to ensure that investments will further the national health information infrastructure. This legislation was referred to the Senate Finance Committee, and there has been no action since June.

There are only a few legislative days left during this session of Congress. The political conventions are over, and the race is on for selecting our next president, all members of the U.S. House of Representatives, and one-third of the U.S. Senate seats. Everybody is scrambling for a winning advantage. There is still hope that at least one of these pieces of patient safety legislation may pass during this session of Congress. If not, there is always next year.

Dave Roberts, MPA, FHIMSS, is HIMSS Director of Public Policy. Formerly a professional staff member for both the U.S House Appropriations Committee and the U.S. Senate Health Sub-committee on the Handicapped, and a civilian financial analyst for the U.S. Air Force, Roberts now resides with his family in Solana Beach, California, and maintains a HIMSS office in Alexandria, Virginia.