Testimony

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

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,

  • 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.
  • 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.
  • 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.

Last Revised: June 21, 2004