Medical Device Daily Washington Editor

WASHINGTON — The topic of healthcare information technology (HIT) is not usually the stuff of political trench warfare, and yesterday’s hearing in the Senate Budget Committee was a relatively non-partisan effort at figuring out how to implement HIT broadly for the U.S. healthcare system, and not do it wastefully.

In yesterday’s hearing, Committee Chairman Ken Conrad (D-North Dakota), said, “we are spending far more on health expenditures as a percentage of GDP than any other nation in the Organization for Economic Cooperation and Development” (OECD).

He cited several other well-known and largely dismal metrics concerning U.S. healthcare and said that whatever reforms are adopted, “I think we should acknowledge that some of these ... have up-front costs.”

Sen. Judd Gregg (R-New Hampshire), the ranking minority member, said “we know that healthcare is extremely complex,” and no single answer exists to solve it. He mentioned a bill that he sponsored, the Medicare Quality Enhancement Act, “the purpose of which is to make available [quality] information that already exists” for payers and patients as an alternative to any current legislation.

Valerie Melvin, director of human capital management information systems issues at the Government Accountability Office (GAO) — the first witness at the hearing — said HIT “has great potential to improve the quality of healthcare” and “reducing medical errors and streamlining administrative functions,” both of which should trim costs. Melvin submitted a report on the HIT effort at the Department of Health and Human Services as part of her testimony.

Melvin said HHS and Office of the National Coordinator for Healthcare Information Technology (ONCHIT) have forged ahead with a substantial number of initiatives, including those dealing with interoperability standards. But “even though HHS has been pursuing these initiatives, it has been doing so without a national strategy,” she said.

“To his credit, the national coordinator has acknowledged the importance” of a strategic plan, Melvin said, but until HHS delivers that plan, “progress ...will be uncertain.”

Laura Adams, president/CEO of the Rhode Island Quality Institute (RIQI; Providence), said those at the institute are “under no illusions” about the difficulty of forging a national HIT system, and are aware that any such efforts can become “a festival of waste” if not properly deployed. RIQI is a consortium of public and private groups working on standards for inter-hospital HIT interoperability in that state.

Adams depicted HIT as the sine qua non of healthcare reform, pointing out that while exhaustive reform calls for medical homes, fraud and abuse detection and improved care standards, all these need HIT in order to make any difference.

“It would be a mistake to see HIT as just another good idea in a sea of ideas. I applaud the efforts of HHS and ONCHIT,” she said, but “our collective approach to funding these initiatives almost guarantees failure.”

She added: “We respectfully urge Congress to place more trust and higher levels of aggregated resources in organizations like the RIQI and a number of similar organizations.”

Mary Grealy, president of the Healthcare Leadership Council (Washington), said the “issues are neither abstract nor theoretical” and that “the closer we get to connectivity, the more we’ll improve the quality and efficiency” of healthcare.

HIT is not healthcare reform, she said, but “you cannot have reform without HIT.”

HIT “can significantly reduce medication errors that cost the system $76 billion a year,” and said. And she estimated that eliminating redundant diagnostic tests could trim $400 billion a year from the national healthcare budget.

“The future is exciting and is already happening” in the form of some of the work done under the HHS initiatives, Grealy said.

Still, a recent Rand study says only one in four hospitals and a small percentage of doctor’s practices have migrated to HIT. She made reference to “creative [financing] options that should be discussed,” including loans, grants and exceptions to Stark and anti-trust laws.

As for the question of arriving at standards of interoperability, Grealy said, “we believe that congressional action to mandate a standard is vital.”

Regarding the Wired for Healthcare Quality Act, Gregg said that it is “about to pass” in the Senate Health, Education, Labor and Pensions Committee, but that interoperability is “still a huge issue.”

One hospital in his state approached him, he said, to earmark a grant for that would provide interoperability for that hospital alone.

If “just getting interoperability within a hospital is huge,” Gregg asked Adams, “how successful are you in doing local [inter-]hospital interoperability?”

She replied that her group’s effort is in developing standards rather than delving into specific systems operations, but she pointed out that vendors are not always compelled to pursue this.

In response to a question on how HIT can encourage public reporting, when hospitals are so afraid of adverse publicity, Adams said that “it’s a difficult science to do the measurement, and it can induce interesting behavior.”

Public reporting, she said, can be an incentive for doctors to refuse difficult cases, but all providers will eventually participate, she said. And the Internet can serve as a conduit for such information to patients and providers, a medium she characterized as “word of mouth on steroids.”

Whitehouse told Medical Device Daily that he has heard from constituent hospitals that providers are interested in a statutory change to Stark and anti-trust laws before trying to share HIT resources with doctor’s offices, but he declined to characterize what sort of changes they have discussed.

He said of ONCHIT’s budget that a reasonable sum might be derived from “the lowest end of the Rand study numbers of savings” to be derived from HIT. He depicted that range as between $180 billion and $340 billion a year.

There was more controversy on the subject during a hearing of the Senate Budget Committee last week.

Sen. Sheldon Whitehouse (D-Rhode Island) gave OMB director Jim Nussle a thorough grilling over the White House’s proposed budget for the ONCHIT, which the White House has pegged at $66 million.

Nussle, who chaired the House Appropriations Committee in the 109th Congress, rebutted with the assertion that the White House’s proposed funding for ONCHIT for FY08 was more than $160 million, but that Congress hacked that sum to less than half that amount.