Transforming Health Care for Americans with Health Information Technology
Remarks by the President in a Conversation on Health Care Information Technology
Vanderbilt University Medical Center
Nashville, Tennessee
1:43 P.M. CDT
THE PRESIDENT: Thank you all for coming. Please be seated.
Tommy, thanks for the kind introduction. You can keep your job for a
while. (Laughter.) I put him in my Cabinet because I knew how
effective he was as a governor. He was the Governor of Wisconsin.
AUDIENCE MEMBER: (Applause.)
THE PRESIDENT: And I knew when I asked him to -- don't go
overboard for Wisconsin, please. (Laughter.) I knew when I asked him
to join my Cabinet, that he would reform programs that needed reform,
focus resources on programs that needed resources, and would do a great
job. He really has. He's been a remarkable Secretary of Health and
Human Services, and I'm proud he came here today.
We're going to talk about an interesting subject, and it's one that
has got a chance to change our country for the better. As you can see,
I've surrounded myself with people who probably can -- not probably,
will be able to explain the subject better than me.
But before we get talking about health care and how to make sure
the costs are reasonable and health care is affordable and medical
errors are reduced by using information technology, I do want to thank
the good folks here at the Vanderbilt University Medical Center for
your hospitality. I particularly want to thank Harry Jacobson for
welcoming us, for allowing us to use this facility to talk about health
care. No better place to talk about health care than at a place that
delivers excellent health care, right here at Vanderbilt. Thanks for
having us. (Applause.)
Neal Patel is with us. Where are you, doc? There he is. Neal
showed us the new children's hospital, some of the parts of the
children's hospital. It's an impressive facility. Thank you for being
a doctor. Thank you for caring about America's kids, and thank you for
giving us a tour. I want to thank Jim Shmerling, who is the CEO; Bill
Stead, who is the Chief Information officer.
Thank you all for coming. This is a -- the reason we're here is
because this hospital knows how to use information technology for the
benefit of patients and docs. That's why we're here. You're ahead of
the country in using technology to your advantage. And we'll talk
about that here in a second.
I want to thank my friend, Senator Bill Frist, for joining us
today. (Applause.) You're doing a heck of a job. You cut your teeth
here, right? That's where you started practicing? That's good. He
married a Texas girl, I want you to know. (Laughter.) Karyn is with
us. A West Texas girl, just like me. We both married above ourselves,
didn't we, Senator? (Laughter.) But Karyn, thank you for coming. I'm
proud you're here.
I want to thank members of the Congress who are here with us
today. First, Congressman Jim Cooper from this district. Thanks for
coming, Congressman. Proud you're here. Jimmy Duncan is with us,
Jimmy. And you brought your son, John, I see. Thank you for being
here. (Applause.) I know Zach Wamp and Kim are here. Thank you all
for coming. (Applause.) Appreciate you being here. And Marsha
Blackburn is with us today. Marsha, thanks for coming. (Applause.)
I know the mayor is here. Mr. Mayor, I appreciate you coming.
Thanks for being here. (Applause.) Fill the potholes, that's the only
advice I can give you. (Laughter and applause.) I'm sure you are.
Today, when I landed, I met Phuong Le. Phuong, please stand up for
a second, will you? Thanks for coming. I'll tell you why I wanted to
introduce Phuong. She is a soldier in the army of compassion. That's
why I want you to hear about her. She is a person who just graduated
from high school, like a week ago, right, Phuong? Yes, a week ago.
For six years, she has been volunteering at the Siloam Family Health
Center, to not only help people who can't speak English, communicate
with the care-givers there, but to help provide love for those who
hurt. That's what she's there for. The reason I bring up Phuong is
because I want to remind you that the strength of this country is in
the hearts and souls of our citizens. We're a mighty military power.
We will stay that way to make the world more free and more peaceful.
We've got a mighty economy. We are a wealthy nation compared to other
nations. But our strength is in the hearts and souls of our citizens.
That's our true strength. Our strength is found when people take time
out of their life, like Phuong has done, to help somebody who hurts.
See, the great hope for America is neighbor loving neighbor. The
hope for this country is when somebody who is hungry, or needs shelter,
or needs love can find it when a fellow citizen says, what can I do to
make your life better. I appreciate, Phuong, you serving as such a
great example for the folks here in this community. I call on others
to love your neighbor just like you'd like to be loved yourself. And
you can join the army of compassion, which is changing America for the
better one heart, one soul at a time. Thanks for coming. (Applause.)
One of the important subjects in America is, how do we make sure
health care is affordable and available. Part of making sure health
care is available is for medicine to use information technology. And
that's what we're here to discuss.
I want to talk real quick about some other ways we can help with
health care. One, we've modernize the Medicare system. Senator, thank
you. Members of the House who voted for the plan, I want to thank you
for your vote.
The modern Medicare system begins with making sure seniors have got
drug discount cards, and they're now being passed out. And seniors are
going to be able to save between 15 to 30 percent off the retail price
of most brand drugs and more for generic drugs. As well, there is
going to be a $600 credit for poor seniors. This is the beginning of a
reform package that will affect seniors' lives in a very positive way,
by making sure our drugs are more affordable.
And the cards are out. They're heading out right now. Unlike most
government programs where they say, the check's in the mail, actually,
the cards are in the mail -- (laughter) -- and people will be able to
use those cards to their benefit. They'll also be able to get on the
Internet and comparatively shop for drugs. In other words, you can get
on the Internet, put in your zip code, and you'll be able to see the
price of retail drugs in drug stores close to you and in your
community. And that in itself will serve as a -- as a way to put
pressure, downward pressure through the market, not through government
edict, or government declarations, but through the market for the
benefit of consumers. This is a major -- the beginning of a major
reform to the benefit of our seniors.
We've also got -- inherent in that bill, what's called health
savings accounts. You can put in after-tax money; you can earn
interest after tax; you can take out money after tax. Put it in
tax-free, earn it tax-free, take it out tax-free, in order to pay for
not only medical costs, but also catastrophic care. These are called
health savings accounts, which will be a really good vehicle to help
control costs and to make sure patient and doctors are the center of
the decision-making process in health care.
We're working with Congress to expand what's called
association health care plans, which will allow small businesses to
pool risk, so just like big businesses do to get better prices for
their health care plans for their employees.
We've also got to make sure that we continue to expand community
health centers -- again, appreciate the members of Congress here.
Community health centers are a really effective use of tax payers'
money, in my judgment. They provide primary care and preventative care
for people who need help with medicine. And it takes the pressure off
the emergency rooms. The most expensive place to find health care is
an emergency room.
These community centers are being expanded all across America.
They want to open up -- or expand 1,200 community health centers.
That's on top of the 3,000 that exist. We want to see to it that 16
million Americans are taken care of in these community health centers.
In other words, it's a safety net for people. I recognize people
aren't covered by insurance. We'd like more people covered by
insurance. Until they are covered by insurance, here's a way for
people to get good, cost-effective health care, cost-effective for
them, and as importantly, cost-effective for the taxpayers.
And finally, in order to make sure that we've got available and
affordable health care, the United States Congress needs to pass
medical liability reform. Our doctors -- (Applause.) If you get sued
all the time, you're going to practice defensive medicine. And when
you practice defensive medicine, it means somebody's cost is going to
go up. In other words, you're worried about winning a lawsuit, and
therefore, you're going to do more procedures than might be necessary
just to protect yourself. And these lawyers are filing suit after suit
after suit, and you know what I'm talking about. That's just the way
it is. People ought to have their day in court. But frivolous
lawsuits are running up the cost of medicine and they're running docs
out of business. Just talk to docs. Just talk to people in rural
America what it's like to try to keep a professional -- a group of docs
around when these junk lawsuits are making it hard for them to stay in
business.
When I got to Washington, I said, we'll just let the states take
care of it and then I saw what the cost of defensive medicine and
increased premiums are doing to our budgets. The cost of Medicare goes
up with all these junk lawsuits. The cost of Medicaid goes up with all
these lawsuits. The cost of veteran health care goes up for all these
lawsuits. It's time for the United States Congress to pass national
medical liability reform. (Applause.) It's out of the House of
Representatives. You don't have to worry about your United States
Senators from Tennessee, they're on board. I appreciate you.
(Applause.) We've just got to convince some other ones.
These are all ways to affect cost and to make sure the
doctor-patient relationship is central in medicine. What we can't
afford to have happen in America is for the federal government to
decide to run it all. That will not work. America has got -- is on
the leading edge of medicine for the whole world. We've got the best
research and development, we've got great docs, we've got fantastic
hospitals. The federal government just cannot run the system as well
as docs, professionals, administrators and patients can. (Applause.)
Another way to save money is to introduce information technology
into the health care world. One of the amazing discrepancies in
American society today is, we're literally changing how medicine is
delivered in incredibly positive ways. And yet, docs are still
spending a lot of time writing things on paper, and sometimes it's hard
to read their handwriting -- (laughter) -- and therefore, sometimes
it's difficult to have the spread of accurate information so that
doctors can make good decisions.
The idea of making sure we use information technology starts with
setting this goal: within 10 years, we want most Americans to have
electronic health care records. That means your records. And you'll
hear us talking about it here today, I'll try not -- I'll try to give
it my best shot. Your records are on -- in a digital form that can be
transformed, transferred over the Internet, so that if you happen to be
traveling somewhere and you get in a wreck, a doctor or emergency
physician in Texas can call up the information or ask for information
or seek information, not only off the card, but to your home doctor's
office and they'll be able to know what's wrong with you or right with
you, what has been wrong with you and how to treat you.
You can imagine what kind of system that will do. It will cut down
the cost of paperwork. It will also cut down on medical errors, which,
if you're going to be a patient, that's something you really hope
happens. (Laughter.) Sometimes information gets lost. Sometimes
people inadvertently prescribe the wrong drug because the information
isn't correct. And so the fundamental question is, how do we use
technology, how do we modernize health care? That's what we're here to
talk about. How do we, you know, do the same thing that is happening
in other industries to health care? And we believe we can change how
health care uses IT. And it starts with the federal government.
Listen, the VA is doing a fabulous job with using information
technology. This hospital is doing a fabulous job for using
information technology, which we will talk about.
And so, one of the first things we're going to talk about is what
can the federal government do to help. Now, we hired a guy name David
Brailer. David's right here to my right. David's an expert on
information technology and how it is applied to medicine and to health
care. Tommy hired him, see -- yes, he's got a pretty good title: the
National Health Information Technology Coordinator. (Laughter.) The
way I look at it, his job is to use the federal government's abilities
and our Medicare law and our VA and other assets we have to spread this
fantastic opportunity throughout America.
And I just want to say one other thing before I turn it over to
David. Privacy is really an important part of, in my judgment, of an
American system that works well. I don't want some people looking at
my records. Of course, my line of work, everybody gets to look at my
records. (Laughter.) It's too late for me. (Laughter.) It's not too
late for you, and therefore, as you hear the idea of moving your
information across the Internet, you've just got to know it's got to be
with your permission. These are your records, it's your health, and
you can decide whether or not people can use your records. This is
important for people to understand that, that those of us in government
who talk about spreading information also, first and foremost, keep
your privacy in mind.
Now with that -- David is the coordinator named on May the 6th.
And here he is sitting with the President right here in Vanderbilt
talking about his job. But David, tell us what you do, why you do it,
and when you're going to finish it. (Laughter.)
MR. BRAILER: What time is it?
THE PRESIDENT: Yes, exactly.
MR. BRAILER: Well, thank you, Mr. President. And first, let me
just say thank you to American Medicine for your historic leadership in
information technology. (Applause.)
THE PRESIDENT: Thank you very much. Thanks.
* * * * *
THE PRESIDENT: Let me ask you a couple of questions. One of the
interesting challenges -- evidently the medical lingo varies. In other
words, part of your challenge has been to standardize, as well as
develop a common vocabulary. Would you explain that, so -- obviously I
can't. Would you explain it, please, so people can understand it
better?
MR. BRAILER: We have a different vocabulary. When a physician
sees a patient, we write down a problem list, which is the list of
issues that's active with that person. We create a label, called a
diagnosis, which is the formal name that you know. We do procedures,
the things that we do to people's bodies whenever they have to have
treatments. We make estimations of what is happening with someone.
And all of these things are codified in language.
And traditionally in medicine the language has been informal. It's
been variable by physician. I might call something hypertension;
someone would call it high blood pressure. I might say you have a high
temperature; someone says you have a fever. And there are over 50,000
language terms that are in medicine that cover. And the point of
standardization is to make it one vocabulary. This is very hard, not
just in terms of what the vocabulary is, but being able to make this
part of the normal daily activities of physician's days.
THE PRESIDENT: Yes, see, that's part of the challenge. I'm sure
you can envision it. If people call the same disease or symptoms by
different names, obviously there needs to be a standardization
process. The federal government can help. As I understand it, we're
quite far down the road in terms of developing the standards.
DR. BRAILER: Mr. President, the federal government has had an
extremely positive effect in the last two years. Secretary Thompson
set up an effort to take the standards that are being developed in the
private sector -- the federal government hasn't developed the standards
-- but has taken those and put them into government procurement, into
the contracting arms of the Health and Human Services and elsewhere.
So they go from being on paper into real systems that are used
everyday. And we have a lot more that can be done.
THE PRESIDENT: Good. I imagine they say, scrape your chin when
you fell of the bicycle the same in Tennessee as they do in Texas,
though. (Laughter.) What do you think? (Applause.)
Okay, thanks. Good job.
Dr. Jim Jirjis is with us. Jim, thanks for coming. He is the
Assistant Chief Medical Officer here at Vanderbilt University Medical
Center. Appreciate you coming.
DR. JIRJIS: My pleasure.
THE PRESIDENT: Here's your chance. (Laughter.)
* * * * *
THE PRESIDENT: You helped set up the electronic records here at
the hospital?
DR. JIRJIS: Correct.
THE PRESIDENT: So what does that entail?
DR. JIRJIS: Well, I have the funnest -- second funnest job in the
world. (Laughter and applause.) Vanderbilt is a wonderful sandbox, I
like to say. Harry Jacobson and Bill Stead are visionary leaders and
they have developed an infrastructure that allows guys like me and
Neil, whose passion -- you know, I was the guy in high school behind
the computer -- I was also an athlete, too, don't make any mistake
about it. (Laughter.) But when I came to medicine and computers, who
knew, at Vanderbilt, I would have a sandbox.
* * * * *
THE PRESIDENT: Yes, and one final question along these lines. You
do prescribe prescription drugs over the -- through the internet yet?
DR. JIRJIS: Most of the prescriptions through the internet, we
can't interact with the pharmacies yet, though there's a lot of work
going on nationally to try to arrive at that.
THE PRESIDENT: Yes.
DR. JIRJIS: In our hospital, 100 percent of our prescriptions are
done in the computer.
THE PRESIDENT: Which is important.
DR. JIRJIS: If I try to order the wrong thing, Bill Stead, if you
try to order the wrong thing, even if it's 1 a.m., a little, "beep"
comes up, says, you're going to hurt this patient.
THE PRESIDENT: See, that's really important for people to
understand. The ability to make sure that we prescribe the right drug
and the right dosage can be controlled by proper use of medical
records, which is really important. And it's cost effective.
I hope you're getting a sense for what we're talking about here.
It's a really exciting opportunity. Again, I repeat, we're at
Vanderbilt for a reason. It's because this hospital is -- and system
is innovative and different. And it's on the leading edge of change.
It benefits a lot of patients, obviously, in your illustrious career
here, one of whom is Bob -- Bob McNeilly. He's a patient, Bob. He's
like your patient, right?
DR. JIRJIS: Yes, he is.
THE PRESIDENT: Bob, welcome.
MR. MCNEILLY: Thank you.
THE PRESIDENT: Tell us how electronic records affected you.
* * * * *
THE PRESIDENT: How does that work? You say it communicates with
you.
MR. MCNEILLY: Well, I've got -- I've got email. (Laughter.)
THE PRESIDENT: Yes, there you go. (Laughter.) There you go. You
look like an emailing kind of guy.
MR. MCNEILLY: Absolutely. (Laughter.) Give me your address and
I'll send you one. (Laughter and applause.) There's another
advantage, also. I've got more than one doctor here at Vanderbilt.
I've got, as a matter of fact, two other doctors who are both
cardiologists. One calls himself my plumber, and one my electrician.
(Laughter.) They prescribe medications, and I want to make sure Jim
Jirjis knows exactly what they have prescribed and what changes are in
my medication. And they, in turn, need to know anything that he's
prescribed. This system takes care of that automatically.
THE PRESIDENT: Yes, that's fantastic. If you're beginning to get
the drift here, it not only helps the docs make right decisions, it
helps the patients, as well. It helps the patients -- keeps the
patients on a timetable; it reminds patients about patient
responsibility; but it also has got -- give you peace of mind to know
that you're getting the very best care all the time.
MR. MCNEILLY: Absolutely. I really have a great deal more
confidence in the system. Although, I'm looking forward to the next
step, which is to have access to my own medical records, which are
computerized now, which really enables me to take charge of my health
care even more than I do now.
THE PRESIDENT: Absolutely. Gosh, thanks. I'm glad you're here.
I appreciate you coming.
MR. MCNEILLY: Thank you. I'm glad I'm still here. (Laughter and
applause.)
THE PRESIDENT: All right, we've got J.T. Finnell with us. He's an
Emergency Medicine Physician right out of Indianapolis, Indiana.
You're probably wondering why we asked somebody from Indianapolis to
come. And one of the reasons why is the health care system in
Indianapolis has done a fantastic job of implementing and employing
information technology.
Is that an accurate description, J.T.?
DR. FINNELL: That's correct.
THE PRESIDENT: All right, well, tell us why you're here.
DR. FINNELL: Well, it's race week.
THE PRESIDENT: Get out of town, huh?
DR. FINNELL: That's right. (Laughter.)
* * * * *
THE PRESIDENT: Let me stop you, one question. One of the
interesting things that -- the reason why Indianapolis is farther down
the road, if you notice, hospitals can talk to hospitals, which hasn't
happened in many communities. In other words, it's easier to talk
intra-hospital system than it is inter-hospital system. And part of
the challenge is, and the reason we standardize language, is so that
when a -- one emergency room can talk to another emergency room or a
state facility. Indianapolis has done a good job of integrating the
capacity to talk amongst different facilities. I think that's an
accurate statement.
DR. FINNELL: That is accurate.
THE PRESIDENT: Yeah. And so the challenge is, by the way, is to
do that within a community and then is to get communities hooked up
with communities so that the whole -- there's a whole nationwide
network. That's the real challenge we're going to face in America.
Step one was to get the language standardized so words can travel and
be understood on a more common basis. Go ahead. Examples.
* * * * *
THE PRESIDENT: Information saves lives, and it saves money.
That's what we're here talking about. And we've got a strategy to
encourage information -- the spread of information technology
throughout the entire health care industry to help control the costs
and raise the quality of health care. That's what we're here to talk
about.
And somebody who can testify -- I think you can --
MS. QUEEN: I hope so.
THE PRESIDENT: You will -- is Jennifer Queen. She's here as a
mom. Tell us about Courtney, your daughter.
* * * * *
THE PRESIDENT: Thank you for sharing that. That's a great -- you
know, a great story. I saw Courtney. You're right, she's strong.
She's doing great.
MS. QUEEN: She's our little beautiful angel.
THE PRESIDENT: She is your beautiful angel.
MS. QUEEN: We have two little angels. And they're doing real
well.
THE PRESIDENT: That's good. Listen, I hope that story helps you
understand -- listen, if you're having to tote around written records,
not only is it cost ineffective, there's a chance there's going to be
errors. And as the system evolves, it puts these records on the
computers, on disks, they can move information at lightning speed. You
not only save money, you improve the quality of care through the spread
of good information. It lets these docs do their jobs; it eases the
minds of the patients. They can take Courtney's records with her if
she were to go down to Crawford, for example. (Laughter.) And you can
take the records with you.
And it's -- we're changing medicine -- medicine's changing. That's
what we're talking about. It's changing for the better. We're here
because this little center of excellence is on the leading edge of
change. And the goal for our country is that, most everybody --
medical records are digitized, and every health care system can talk to
each other, every office can talk to each other to share information in
a better way, to make sure America's health care system remains the
best in the world.
That's what we want. We want only one thing. We want the best
health care system in the world for our patients at the best possible
price. It can be -- it will be achieved. That's what I'm here to tell
you. It's going to be achieved. One of the ways we do so is to
properly use information technology. I want to thank our panelists for
sharing your stories and your information. I want to thank you all for
coming to listen. I hope you have found this as interesting as I
have.
Let me conclude by telling you, we're lucky to live in the greatest
country in the face of the Earth. God bless. Thanks for coming.
(Applause.)