View from the Hill: Plenty of Action, but No Results


January / February 2008

View from the Hill

Plenty of Action, but No Results

As I ponder the first session of the 110th Congress, a number of words come to mind. The most appropriate is probably “déjà vu.” Multiple bills were introduced, but none were signed into law. The U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) is fully operational but lacks codification, which means it can be closed at any time, with or without funding.

Congress busily introduced more than 90 pieces of legislation pertaining to healthcare information technology (HIT) during the 1st Session. However, despite hearings, briefings, hundreds of meetings with members of Congress, and the second annual National Health IT Week, neither the House nor Senate voted on one healthcare IT bill.

Could it be the majority of members of Congress are still not convinced that HIT can help transform healthcare? Despite the fact that IT has transformed every industry, except healthcare, we still need the patience of Job to make HIT a cost- and life-saving enabler for healthcare.

A recent HIMSS survey of healthcare IT professionals on the impact of federal initiatives on the adoption of HIT was published in the December 2007 issue of Vantage Point and contained some interesting insights.

HIMSS Survey Raises Questions
Over recent months, the federal government has taken several steps to support the adoption of health information technology. In general, survey respondents raised concern that these efforts would have limited impact because they did not include funding that could truly drive adoption.

In October 2007, the House Science and Technology Committee passed by voice vote legislation (HR 2406) that would provide $16 million to the National Institute of Standards and Technology (NIST) to increase its efforts to create a national database for patient records. One component of this bill requires NIST, in consultation with the National Science Foundation, to establish a task force of federal agency and industry group representatives to create a strategy for developing common terminologies and classifications for use in HIT systems.

More than half of the survey respondents indicated that this legislation would have little impact on the adoption of HIT. However, nearly one-third saw this legislation as having a substantial impact on promoting the adoption of HIT.

HHS Secretary Mike Leavitt unveiled a 5-year plan by HHS and the Centers for Medicare and Medicaid Services (CMS) to provide 1,200 physicians with bonus payments for quality reporting associated with the use of electronic health record (EHR) systems. Two-thirds of respondents indicated they believed that the impact of these bonus payments would have only a limited impact on accelerating the adoption of EHRs in the physician community.

The HIMSS survey also included Homeland Security Presidential Directive 21, which orders HHS to create a national biosurveillance system to detect public health threats, relying on electronic health systems where possible. These systems should be “predicated on state, regional, and community-level capabilities and create a networked system to allow for two-way information flow between and among federal, state, and local government public health authorities, and clinical health care providers.”

Very few respondents believed that this Directive will have a substantial impact on the adoption of HIT. Instead, one-third of respondents suggested that the effectiveness of this system would be based on the amount of funding attached to the Directive. Another third were concerned about the impact due to the current implementation rates of EHRs.

These are alarming numbers from industry professionals. HIT professionals believe in what they do, but unfortunately, they are not convinced that government efforts — congressional or federal — will foster the adoption of HIT.

The question we must consider at this juncture is clear. What are the probabilities for change if we as an industry do not believe we can, must, and will demand that Congress and the federal government not only address HIT as an issue but foster and fund its adoption nationally? I venture to say it’s highly unlikely. We must be determined to explain the benefits of HIT while believing that it can and will be done in due time and season.

We have the research, studies, the use cases, as well as national and international evidence to prove our case. However, the defendants must stand up and be willing to convince every Congressional, state, and local legislator, policymaker, and regulator. Other industries are examples of what IT can do to save money and lives. Why should healthcare be any different? It is not.

We must convince ourselves and others that what we do matters and tell everyone one of America’s biggest secrets — HIT can transform healthcare!

Dave Roberts is vice president of government relations for the Healthcare Information and Management Systems Society (HIMSS) and senior executive of HIMSS’ Office of Advocacy & Public Policy in Arlington, Virginia. 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 deputy mayor. He is a member of the Editorial Advisory Board for Patient Safety and Quality Healthcare and may be contacted at