Testimony
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Statement by
David J. Brailer, M.D., Ph.D.
National Coordinator for Health Information Technology
Office of the Secretary, U.S. Department of Health and Human Services
on
Hearing: Health Information Technology
before the
Subcommittee on Health, Committee on Ways and Means
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June 17, 2004
Chairwoman Johnson, Representative Stark, distinguished members of
the Committee: I thank you for inviting me here today to
discuss the Administration’s efforts to increase the use of
information technology throughout the health care industry.
As you know this is a high priority for the President and Secretary
Thompson. The priority has been further accelerated by the
President’s call to make electronic health records (EHR)
available to most Americans in the next 10 years and by the
creation of my position to achieve this goal. Your thoughtful
leadership and that of your subcommittee toward achieving this goal
has been widely recognized and demonstrated through the
e-prescribing and other health information technology (HIT) related
provisions in Medicare Prescription Drug, Improvement and
Modernization Act of 2003.
As a result of the President and the Secretary’s strong
commitment to this issue, the Office of the National Coordinator
for Health Information Technology has been established to meet the
goals of the Executive Order announced earlier this spring.
In my new role as National Coordinator for Health Information
Technology, I will be working with the Administration, Congress and
the private sector to bring together the resources and talent to
drive the adoption of HIT in the health care system. There is
unprecedented enthusiasm and commitment for changing the day-to-day
world of health care with HIT from leadership across sectors, and
my goal in the next year is to focus this into a well-developed
plan and a set of coordinated actions to accelerate the widespread
adoption of electronic health records and e-prescribing.
The Administration has already made significant progress in this
area. Specifically,
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Last year, we licensed SNOMED (Systematized Nomenclature of
Medicine, a comprehensive set of clinical terminologies) to make
it available without charge to everyone in the United States.
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As part of the Federal Health Architecture, we adopted clinical
terminology standards across federal agencies through the
Consolidated Health Informatics (CHI) initiative. The
Department of Health and Human Services (HHS), Department of
Defense (DoD), Department of Veterans Affairs (VA), and other
Executive Branch agencies have endorsed 20 sets of standards,
such as standards for medications, labs, and
immunizations. These standards will make it easier for
information to be shared across agencies and could serve as a
model for the private sector.
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The Secretary created the Council on the Application of Health
Information Technology (CAHIT), which has been the coordinating
and internal advisory body for HHS. CAHIT has served as the
primary forum for identifying and evaluating activities and
investments that promote and/or complement evolving private
sector initiatives and strategies.
The Executive Order of April 27th not only created my
position within the new Office, but it also required the
Departments and agencies of the Executive Branch of the federal
government to work together to develop and align policies and
programs that will achieve our common goal of using HIT to improve
the safety, quality and efficiency of health care in every area of
this country. I have also been given the responsibility to
direct the HHS HIT programs, and to coordinate these with those of
other Executive Branch Departments and agencies. Specifically, HHS
will coordinate with other Executive Branch Departments and
agencies to develop and implement a strategic plan for and to use
resources to accelerate HIT adoption in the private sector. Both
the DoD and VA have surpassed the private sector in successfully
incorporating HIT into the delivery of health care, and will play a
central role in adoption efforts. The Office of Personnel
Management (OPM), as the purchaser of healthcare for federal
employees, has a unique role and the ability to encourage the use
of electronic health records through the Federal Employee Health
Benefits Program. It can join other purchasers who are
developing programs that support adoption of HIT by physicians and
hospitals, and its use in improving and rewarding quality. In
addition to collaboration with federal agencies and Departments, I
will also coordinate outreach and consultation by the federal
government with interested public and private organizations,
groups, and companies. We will coordinate with the National
Committee on Vital and Health Statistics and other advisory
committees to do this, and will enhance relationships with
public-private collaboratives that are advancing HIT
adoption.
The President’s vision is to develop a nationwide HIT
infrastructure that ensures appropriate information is available at
the time and place of care, resulting in improved health care
quality, fewer medical errors and may even reduce health care
costs. This new infrastructure will help to connect physicians,
hospitals and consumers in every location of our country.
This would give consumers and clinicians secure and controlled
access to all the important information they need to make informed
decisions about their health and health care, while ensuring
individually identifiable information is confidential and
protected. Designed and implemented correctly, health
information exchange organizations could promote a more efficient
health care delivery system. They will also help to improve
coordination of care through the secure exchange of information
among hospitals, labs, physician offices, and other health care
providers.
Health information exchange networks could be privately operated
and governed by many State, regional or community level health
information exchange authorities. These authorities would have
responsibility for protecting information and ensuring that data is
used to advance the public interest, and used in compliance with
applicable State and federal laws. Regional health
information exchange networks could keep indexes of where
patients were treated and could intercommunicate, butnot
create a national database. A set of standards and secure networks
would allow information – such as lab results, x-rays and
medical history as well as clinical guidelines, drug labeling and
current research findings – to move to where needed,
immediately and securely. Information would only be
accessible to authorized users and aggregated at the individual
patient level for the time that it is needed, without being stored
in a database. The purpose of this information exchange would be to
personalize care in such a way that each patient could be diagnosed
and treated as an individual rather than a disease type. For
example, the national availability of patient health
information could allow a Medicare beneficiary with multiple
chronic conditions to receive the same high quality care at home or
while traveling, without needing to carry their information or fear
that new findings or treatments may not be known to all possible
health care providers. Many patients take multiple drugs or
have histories of drug reactions, but decentralized paper records
often do not reveal this fully. Regardless of where a
beneficiary is receiving care, health information exchange networks
would allow for information about medication history and
potentially serious drug interactions to be available in real-time,
along with out of pocket costs and therapeutic alternatives, before
the physician transmits a prescription to a pharmacy.
The national availability of de-identified patient health
information will also enable research on health outcomes that could
more rapidly identify the most effective diagnostic and treatment
options for clinicians and patients and will accelerate the
translation of new research into clinical practice. Across
HHS, there are several inter-related HIT programs that are aimed at
improving the delivery of health care and enhancing public health
surveillance. I will highlight the key initiatives that are
critical to meeting our goal of making electronic health records
available for all Americans. These initiatives fall into three
categories: 1) automating clinical practice, 2) interconnecting
care, and 3) improving population health.
Clinical Practice
Our efforts to automate practice have been focused on identifying
and implementing tools to accelerate the adoption and use of
electronic health records and e-prescribing. At President
Bush's direction, in the Executive Order, HHS is preparing a
report on options to create incentives in Medicare or other HHS
programs to encourage the adoption of interoperable electronic
health records and e-prescribing, and OPM will report on similar
options for encouraging the adoption of such technology through the
Federal Employee Health Benefit Program. As you know, HHS is also
implementing the provisions in the recently enacted Medicare
Modernization Act to encourage electronic prescribing by physicians
participating in Medicare through the use of standards and
incentives. The National Committee on Vital and Health Statistics
has already conducted two hearings and is expected to provide
recommendations on standards to the Secretary before September
2005, the date specified in the new law. The Food and Drug
Administration’s recently promulgated requirement for bar
coding will also enable e-prescribing in hospitals and will reduce
the incidence of some forms of medication delivery errors.
Additional provisions of the Medicare Modernization Act support
demonstrations providing incentives for physician practices to
improve the quality and safety of care for Medicare beneficiaries
through effective implementation of selected HIT systems, in up to
four States.
In addition, HHS' Indian Health Service (IHS), with the help of
other HHS agencies, is developing an enhanced EHR system, a version
of the VA’s VistA product, which can be used in IHS and
tribal health care facilities. The enhanced system will improve
care for patients by allowing appropriate information to be
available whenever and wherever they seek care within the IHS
system.
This year, the Agency for Healthcare Research and Quality (AHRQ)
will spend $50 million on health information technology research
and demonstration projects aimed at improving the safety, quality,
efficiency and effectiveness of care. Using a portion of
these resources, AHRQ will establish a Health Information
Technology Resource Center, a much-needed resource that will
provide technical assistance, expert health information technology
support, educational services and other services to HHS grantees to
support the implementation of HIT into clinical practice. President
Bush's fiscal year 2005 budget request includes an additional
$50 million to expand health information technology demonstration
projects, particularly targeted to health data exchange by
providers. This request would double federal investments in
this area.
We are also examining how to address regulatory barriers to HIT
adoption. HHS recently created a new regulatory exception to
the physician self-referral (“Stark”) prohibition,
Section 1877 of the Social Security Act, which will allow provider
organizations to furnish health information technology items or
services to physicians if certain criteria are satisfied. This new
exception will facilitate adoption of HIT and participation in
local health information exchange networks by assuring hospitals
and doctors that they can work together to finance the acquisition
of community-wide health information systems
Interconnecting Care
Beyond fostering the adoption of electronic health records, it is
critical for HHS to support the appropriate exchange of health
information across settings of care as needed. Fundamental to
information sharing in nearly every form is the use of standards to
allow caregivers to easily share and use patient information. At
HHS' request, the international standards-setting organization
known as Health Level 7 (HL-7) has established a draft standard
defining the set of functions of an electronic medical record. HHS
will continue to work with HL-7 and others to define standards for
transmitting complete electronic health records.
HHS has already adopted strong national privacy and security
standards for health plans, health care providers and others
covered by the Health Insurance Portability and Accountability Act
of 1996 (HIPAA). These standards, which are carefully
balanced to ensure individuals’ access to quality care, will
guide the development of a national health information
infrastructure and form the basis of the safeguards to protect the
privacy and confidentiality of personal health information.
As both the President and Secretary Thompson have made clear,
maintaining privacy and security protections for individually
identifiable health information is a primary concern as health
information exchange organizations are developed across the
country.
In addition to the important work and progress we have made in the
development and adoption of clinical and technical standards, we
have also taken significant steps recently to facilitate
interconnecting care through the support of health information
exchange networks. Over the next few months, AHRQ will fund five
State-level HIT projects. This project will build on nascent health
information exchange networks and current State-level planning
activities by providing crucial funding, technical assistance and
coordination. In fiscal year 2005, HHS and AHRQ will continue
to complement and expand these initiatives with up to $50 million
to support the development of health information exchange networks.
Improving Population Health
HHS has new HIT programs underway to advance the use of electronic
medical records nationally. This effort should also benefit
population health activities and improve preparedness.
President Bush’s fiscal year 2005 budget proposes $130
million at CDC for a new biosurveillance initiative to tap
information technology to improve the nation’s capabilities
to detect and quantify public health outbreaks and bioterrorism, as
part of a coordinated multi-departmental effort. Key to this
effort is BioSense, which will allow CDC to collect and analyze
existing health-care data quickly to identify potential outbreaks
or health hazards and respond accordingly. Information then
could be shared quickly with other federal agencies and State and
local health officials to promote more effective coordination. CDC
also supports the National Electronic Disease Surveillance System,
which promotes the use of standards to advance development of
efficient, integrated and interoperable surveillance systems at
federal, State, and local levels.
In addition to these activities, HHS is taking a leadership role in
promoting and supporting the widespread adoption of HIT through:
(a) providing a national vision; (b) leading by example; (c)
developing a framework for strategic action; and (d) planning
initiatives to promote competition and innovation. The
strategic plan that HHS will develop in collaboration with DoD, VA,
and OPM, to accelerate HIT adoption in the private sector, will be
grounded in key guiding principles including: 1) personalization of
care, 2) market-based solutions, 3) shared public and private
investment, and 4) individually controlled information as a common
good for public health and research.
We will coordinate with the private sector to develop market
institutions that will enable the widespread use of EHRs and
sustainable health information exchange networks to improve
delivery of care and health outcomes. For example, we are
exploring how to support physicians and other purchasers of HIT so
that they can choose technology that meets their needs and assess
costs and benefits. Also, we are looking at how the private
sector can measure and report the conformance of specific products
to a defined set of benchmarks. These and other market
institutions will make our national investment in HIT effective and
sustainable and will ensure ongoing investment in product research
and development.
We are aware that every day, Americans are dying of medical errors
and are not always getting the best treatments. We need results
that will change care delivery and that will last. The
Secretary and the President are firmly committed to improving the
safety and efficacy of health care by increasing the use of
information technology throughout the health care industry. The
Administration has already made significant progress in this area,
and we will continue to work diligently to meet the
President’s goal for most Americans to have electronic health
records within 10 years.
On July 21, 2004, we will hold the Secretary’s Second HIT
Summit, where we will report on the progress of the HIT Strategic
Plan ordered by the President and obtain input from those in the
private sector who will actually develop and use the HIT systems.
Leaders from the government and the health care and information
technology industries will convene and work together to identify
specific actions that will lead to rapid progress.
Overwhelming support from leaders in the public and the private
sector presents an unprecedented opportunity to improve both the
delivery of health care and population health through effective use
of HIT.
Members of the Committee, I am firmly committed to contributing
what I can to helping you and others make our health care industry
a national treasure. I thank you again for the opportunity to
address you on this important health care matter. I look forward to
your continued support and leadership that will further enable the
Executive Branch and private sector leadership to transform our
paper based health care system into an electronic, quality-based
system that we all can count on.
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