Medical Device Daily Washington Editor

WASHINGTON – The economic crisis has fed demands for more federal spending on healthcare information technology (HIT), a call that both the incoming Obama administration and the Democrat-led Congress have repeatedly promised to answer.

However, yesterday's meeting of an HIT working group of the Senate Health, Education, Labor and Pensions (HELP) Committee failed to make clear whether Congress will mandate that the Department of Health and Human Services commit to a standard for interoperability before the spending begins.

Sen. Barbara Mikulski (D-Maryland), who chaired the first meeting of the HELP Committee's HIT working group, declined to take questions at the end of the hearing, and her staffers were unable to say how much appreciation there is on Capitol Hill to ensure that standards are published in time to influence HIT spending over the next two years, the term proposed for an economic stimulus package that Congress and the President-elect are forging.

The lack of a standard raises the possibility that HIT infrastructure could increase substantially without reducing the digital balkanization that plagues the current installed base of technology.

Rachel MacKnight, Mikulski's director of communication, said for the record that Mikulski "understands the value of HIT and the importance of standards for interoperability," but she was unable to discuss whether the Senate's intent is to prod HHS into committing to a standard within a given time frame.

Mikulski led yesterday's hearing by noting that HIT is an essential ingredient in reforms needed "for saving lives and saving money," and echoed other promises by the Democratic Party majority to work with their GOP counterparts.

"In the spirit of both our President-elect and the Democratic Party, we want to reach out to our Republican colleagues" to ensure that the bipartisanship established by the HELP Committee's chair and ranking member, Sen. Ted Kennedy (D-Massachusetts) and Mike Enzi (R-Wyoming). She said Democrats want any such bill "to pass if not unanimously, to pass in a robust way." Mikulski also noted that the HELP Committee has formed two other working groups, which will address coverage and prevention.

Mikulski hinted that HIT is no panacea for healthcare reform. "Everybody sees it as a silver bullet," she said, but lamented wasted investments in times gone by, stating, "we don't want another techno boondoggle.

"We ended up spending over a billion dollars and it wasn't worth a bucket of warm spit," Mikulski cracked. "Our challenge is to develop it, fund it, and promote its use and keep it fresh and contemporary," she added.

The first witness to speak at the working group's inaugural hearing, John Cochran, MD, executive director of the Permanente Foundation (Menlo Park, California), briefly discussed the experiences of the various Kaiser Permanente plans in their shift toward an electronic healthcare system. He said KP Health Connect, the company's electronic portal, started in 2003 and that "today, KP Health Connect securely connects 8.3 million patients with their physicians."

Cochran warned, however, that system implementation "is disruptive. You should expect reductions in productivity for the first few months," he said. His written testimony indicated that Kaiser units experienced a productivity drop of 20% in the first three to six months as providers inserted the new mechanism into their workflows. He also reiterated the long-standing proviso that "physician leadership is essential" for adoption.

As for the Kaiser electronic portal, he noted that, "patients greatly value" the interaction, but only about 2 million Kaiser enrollees use the portal to construct personal health records.

Cochran also noted that incentives matter. "Rather than rewarding physicians for simply purchasing" HIT systems, he asserted, payers must reward for actual use. He said "done well, an electronic decision support system can ... provide more time with patients and less time with traditional paperwork."

Janet Corrigan, president/CEO of the National Quality Forum (NQF, Washington), said that a standardized reporting system is a core element for a successful HIT system and that federal funding "is an essential foundation for improving safety, quality and affordability." However, she cautioned that HIT "investments and incentives should be tied to the effective use ... not just having the technology in place."

Among the elements of HIT that funding should emphasize are data on prescriptions, lab tests and imaging procedures, but she said such a system should also help develop evidence "on the safety and efficacy of treatments." Federal funding "will only result in improvement in care" if it encourages these features, she said.

Mary Greely, president of the Healthcare Leadership Council (Washington), echoed many of the other comments about the urgent need for federal monies for HIT, but sounded a note of caution about sacrificing progress in the name of a fully functioning system. The most important focus of HIT, she said, is "critical data rather than the whole enchilada," including imaging data. "We would like to see loans and grants" to encourage roll-out, Greely said, but she also noted, "we need to do [more] work on standards," but not rewrite existing standards.

Valerie Melvin, director of human capital and management information systems at the Government Accountability Office, seemed to urge caution in fleshing out interoperability and other features. She said, "The most important aspect ... is a comprehensive approach" and made the case that "this is not something you want to do very quickly." Melvin said, "an incremental approach would allow opportunities to ... assess what works."

At press time, calls to the Healthcare Information and Management Systems Society (Chicago) for comments regarding the hearing were not returned.