View From the Hill: Hope Springs Eternal
January / February 2005
View From the Hill
Hope Springs Eternal
Happy New Year, everybody! 2005 sure has started off with a bang. President Bush has been inaugurated for a second term, we have a new secretary of Health and Human Services, and the new 109th Congress has been seated with at least 46 new members.
There is much hope for 2005 as far as improving patient safety and quality health is concerned, but it is hard to let go of the major disappointment that resulted at the end of 2004. I thought this might be a good opportunity to look back at 2004 to see what happened to dampen our enthusiasm as we prepare for new success in 2005.
One of the key events last year occurred on April 27, 2004, when President Bush signed an Executive Order creating the Office of the National Coordinator for Health Information Technology (ONCHIT) in the Department of Health and Human Services (HHS). The goal of this office was to promote widespread usage of health information technology (IT) so that most Americans would have an electronic health record (EHR) within 10 years. The healthcare industry cheered when Dr. David Brailer was selected as the first national coordinator for HIT.
To begin to achieve this goal, the president promised to put some seed money into this initiative, and in the FY 2005 President’s Budget, he included $50 million for Agency for Healthcare Research and Quality (AHRQ) grants, $4 million for Health Resources and Services Administration (HRSA) grants, and $50 million for health information technology in the General Departmental Management account within the office of the secretary of HHS. These management funds would be used to put in place the infrastructure necessary for widespread adoption of EHRs, and to ensure that the anticipated wave of investment in this technology will result in both dollar savings and improved healthcare quality.
Specifically, according to the Office of the National HIT Coordinator, this investment was to be used to accomplish the following:
- Formally define a regional health information organization (RHIO), and assist aspiring communities in establishing such organizations, in order to facilitate the sharing of healthcare data.
- Begin the development and coordination of private sector entities to construct a national health information network (NHIN), which will establish the technical design and codification of industry standards needed for both local data sharing by healthcare communities and nationwide sharing of clinical data.
Unfortunately, the $50 million management funding was not approved by the Congress for FY 2005. A key Capitol Hill contact told me that in an election year, there is always more interest in funding projects back home in the Congress members’ districts rather than in good government ideas in D.C. Even though funding for ONCHIT staffing would continue in FY 2005 and there would be funding for HIT demonstrations in AHRQ and in HRSA project earmarks, there would be no congressional funding this year for ONCHIT beyond the basic level of funding.
Former House Speaker Newt Gingrich (R-GA) called the denial of this funding request a “disgrace.” He added, “Congress, in its infinite wisdom, zeroed out David Brailer’s office. They couldn’t find $50 million to signal that David Brailer has a real job and what he’s doing is important.”
Brailer stated in an interview that “the money is important,” adding that the omission of healthcare IT funding from the final FY 2005 appropriations bill “was a bad bounce, and it shows how big our education challenge is.” However, Brailer added, “I have absolute confidence that the president is totally behind what we are doing, and it is far more than a rhetorical commitment. And I’ve been given assurances that the momentum we’ve built up will not be lost.”
So, hope does spring eternal, and the initiative to improve healthcare using technology continues to progress, in my opinion, based on the following activities:
- Even though the Strategic Framework for adopting Health IT — which the secretary presented to the president in July 2004 — will be stalled, and milestones for demonstration projects, the establishment of RHIOs, etc., will be delayed, the overall initiative will continue.
- The Department of HHS is looking for other sources of internal FY 2005 funding to help this effort.
- The department has continued with its request for information (RFI) to plan how to proceed with an NHIN, and industry has positively responded.
- FY 2006 budgets are being finalized for Congress to promote these initiatives, and hearings will soon be under way.
In a white paper to congressional leaders, Brailer concluded: “This is a critical window of time for healthcare information technology in the U.S., when industry, government at all levels, healthcare payers and providers, consumers, and all other stakeholders are united in intent.” Therefore, substantial federal investment in the formation of local and regional projects to accelerate the adoption of Health IT, the development of technologies and public private cooperatives for technology delivery, incentives to encourage clinician adoption and use of IT, and the stimulation of market forces is critical to achieving the president’s goal.
There is still hope that we will see progress this year. Many members of Congress are promoting legislation to improve patient safety, and many associations are beginning more substantial education campaigns to advocate for federal funding for ONCHIT. In future columns, we will look at the progress and possibly suggest some ideas for how you can personally get involved. Until then, keep the faith and keep the pressure on your elected officials to do what is right for all Americans.
Dave Roberts, MPA, FHIMSS, is director of public policy for the Healthcare Information Management Systems Society (HIMSS). Formerly a professional staff member for both the U.S. House Appropriations Committee and the U.S. Senate Health Subcommittee on the Handicapped, and a civilian financial analyst for the U.S. Air Force, Roberts now resides with his family in Solana Beach, California, where he is an elected member of the City Council, and maintains a HIMSS office in Alexandria, Virginia.