The e-Health Revolution | Time | 6.20.05
It’s medicine that the health-care system needs desperately. Backed by the Bush Administration, prodded by employers and under pressure to contain costs and improve service, the medical community is finally–and rapidly–plugging into the new world of electronic health records, in which your personal health information shows up wherever you do–at your doctor’s office, the emergency room, the MRI machine, even your home. “Resistance is at an all-time low,” says Neal Patterson, CEO of Cerner, an e-health company based in Kansas City, Mo. Cerner and Allscripts are racking up quarter after quarter of double-digit sales growth.
Underscoring the new urgency to shift to e-health was the joint press conference held in Washington last week by Senators Hillary Clinton and Bill Frist, two potential presidential candidates who otherwise rarely get near enough to pass a communicable disease. They’ve got together, however, to introduce legislation that would provide seed money for local health networks and eliminate the biggest hurdle to beaming medical records to where they are needed: the lack of interoperability among the myriad systems now in use. Medical record keeping in the U.S. is in the “Dark Ages,” Clinton complained. “We need to have the information easily accessible.”
The U.S. government is leading this charge into the medical information age–robustly and, by most accounts, effectively–because it pays 46% of the nation’s medical bills. Dr. Mark McClellan, former head of the FDA and now director of the Centers for Medicare and Medicaid Services, is making paperless medicine mandatory for physicians who want to participate in the agency’s potentially remunerative pay-for-performance scheme.…
The bottom line is that better health care may not happen in the U.S. without better health-care information technology. Sooner or later all of us will probably be carrying around our medical history in a key-ring device or an ATM-type card or maybe even a surgically implanted chip. The benefits could be extraordinary. IBM sees opportunities to apply massive computing power to help doctors make diagnoses and treatment decisions. New standard practices could be communicated to doctors within months rather than 15 years, the current lag between discovery and practice. Pharmaceutical companies with access to anonymous health data could improve and speed up drug development. There may even be a buck or two in it for consumers from what has been called information liquidity: If you want access to my data, pay me. Best of all, we could finally throw away those damned clipboards.
Clinton press release
Frist press release (PDF)
The Health TEQ Act
Section by Section Summary
June 16, 2005Part I — Health Information Technology Infrastructure Development
Section 1 — Establishment of National Coordinator; Recommendation, Adoption and Implementation of Health Information Electronic Exchange Standards
This section creates a new title within the Public Health Service Act (PHSA) for the coordination and oversight of health information technology activities at the Department of Health and Human Services (HHS). It establishes, in statute, the Office of the National Coordinator of Health Information Technology (ONCHIT), which was announced by the Administration in April 2004. Among other duties, the National Coordinator is directed to carry out a range of activities to help develop a nationwide interoperable health information technology infrastructure that reduces health care costs, improves quality, facilitates health care research and the reporting of public health information, and ensures that patient health information is secure and protected.
This section also establishes a collaborative public-private process for the recommendation and adoption of standards for the electronic exchange of health information in conjunction with the National Institute for Standards and Technology (NIST).
It also directs the Secretary of Health and Human Services (Secretary) and ONCHIT to designate a private entity or entities that will certify and assist with the implementation of both mandatory public and voluntary private standards. This section of the legislation also ensures that the Secretary and ONCHIT coordinate spending across agencies of the federal government, including HHS, to facilitate the electronic exchange of health information.
Section 2 — Encouraging Secure Exchange of Health Information Among States
This section directs the Secretary to conduct a study of privacy laws and practices to determine how the variation among such state laws and practices may impact the electronic exchange of health information among states, between states and the federal government, and among private entities. Based on the findings of the study, the Secretary is required to make recommendations on harmonizing state laws to promote the secure electronic exchange of health information nationwide. It also authorizes the Secretary to award grants to states to develop and implement policies that will facilitate the electronic exchange of health information with a priority in awarding grants to reducing barriers related to privacy, confidentiality, and the security of health information.
This section of the legislation also directs the Secretary to conduct a study of laws relating to licensure of medical professionals and how the variation of state licensure laws may impact the electronic exchange of health information. It also reauthorizes Section 330L(b) of the PHSA to continue grants to states to develop and modify licensure laws to address remote treatment utilizing health information that is exchanged electronically. Finally, this section clarifies that the privacy, confidentiality and security protections included in the Health Insurance Portability and Accountability Act of 1996 extend to health information exchanged electronically under the provisions of this Act.
Part II — Encouraging the Implementation of Interoperable Electronic Health Information Systems
Section 1 — Grants for the Implementation of Regional or Local Health Information Technology Plans
This section allows the Secretary, in consultation with ONCHIT, to award competitive grants to implement regional or local health information plans that improve healthcare quality and efficiency through the use of interoperable heath information technology consistent with standards. To receive a grant, eligible entities must be comprised of a consortium of community stakeholders and adopt policies that demonstrate a commitment to open and fair participation. This section authorizes $125 million per year for five years for this purpose.
Section 2 — Safe Harbor for the Provision of Permitted Support
This section creates a narrow statutory safe harbor from the federal “Stark” self-referral and Antikickback laws for standard compliant hardware, software and support services. The safe harbor applies to physicians and other health care providers as long as these tools are used to exchange health information as part of a system designed to improve health care quality and safety, reduce medical errors, reduce health care costs, improve care coordination, simplify administrative processes, and promote transparency and competition.
Section 3 — Safe Harbor for Group Purchasing
This Section directs the Secretary to establish a narrow safe harbor from federal antitrust laws to allow providers to collectively purchase standard compliant hardware, software and support services for the electronic exchange of health information.
Section 4 — Permissible Arrangements between Health Plans and Providers
This section directs the Secretary to establish guidelines to permit arrangements between health plans and providers where savings from the implementation and utilization of health information technology systems that may accrue to the plans are shared with providers, provided the arrangements are designed to improve health care quality and safety, reduce medical errors, reduce health care costs, improve care coordination, simplify administrative processes, and promote transparency and competition.
Part III — Adoption, Implementation and Use of Quality Measures
Section 1 — Standardized Measures
This section directs the Secretary, Secretary of Defense, Secretary of Veterans Affairs and the heads of other relevant federal agencies to adopt uniform health care quality measures to assess the effectiveness, timeliness, patient centeredness, efficiency and safety of care delivered across federal healthcare programs, including Medicare, Medicaid and the State Children’s Health Insurance Program (S-CHIP). It also requires reporting of quality measures by providers participating in federal healthcare programs and allows the Secretaries to aggregate, analyze and disseminate quality data for the purposes of providing information to consumers, professionals, officials and researchers.
Section 2 — Value Based Purchasing Programs; Sense of the Senate
This section directs the Secretary to establish a value-based purchasing pilot program under Medicare to encourage the reporting of health care quality data and facilitate the payment of providers based on performance. After two years, the Secretary may expand the program and implement it nationwide. This section also provides that it is the Sense of the Senate that any modifications to the Medicare fee schedule for physician services should include provisions to encourage the adoption of health information technology standards and the reporting of standardized quality measures.
It also directs the Secretary to conduct a value-based purchasing program to encourage the electronic collection and exchange of quality measure data reports within the Medicaid program. Finally, it directs the Secretary to aggregate and share information with providers under the Medicare program regarding resource utilization.
Section 3 — Quality Improvement Organization Assistance
This section permits the Secretary to direct Quality Improvement Organizations under contract through the Medicare program, to assist healthcare providers in implementing systems for the electronic exchange of health information.