People in Washington had high hopes for legislation on health information technology last year, even though few bills of substance were getting through Congress and attempts to build a compromise from the separate House and Senate bills floundered. Now it's a new world in Congress, with the Democrats in charge and leading every committee, including those fashioning health legislation.
Nevertheless, several observers say the starting point for new discussion of HIT legislation may be the Senate bill which was left on the table last year. It was a bipartisan effort, with Democrats active in writing the legislation, points out a spokesperson for Senator Edward Kennedy (D-Mass.), now chair of the Senate Health, Education, Labor and Pensions Committee.
That bill would have put into place various federal grants to encourage HIT adoption, including money to purchase systems for providers who demonstrate significant financial need. Not-for-profit hospitals and individual and group practices were mentioned specifically. It would also have provided grants for regional or local health information plans and for demonstration projects to integrate HIT into health professional education. The top potential for funding would have been $155 million for fiscal year 2007, an average of a little more than $3 million per state.
One question this year is whether the Democrats are willing to put more muscle into funding such efforts.
The Senate bill also would have written into law the structure the Administration has set related to the "HIT Czar," including the public-private advisor group known as the American Health Information Community. The legislation would have required that group to make recommendations for HIT standards and mandated that federal agencies comply with those standards.
The sticking point that stopped the legislation last year, say people close to the process, was Senate disagreement with the House proposal to further loosen anti-fraud rules (referred to as Stark/Anti-kickback rules) in order to encourage donations of HIT items and services. Although the Department of Health and Human Services issued new rules in August that would make barriers against such donations far less onerous, the legislation that passed the House would have opened up the process even more.
House Democrats objected last year that the bill would go too far in undermining fraud and abuse laws. This year Democrats, say their staff members, are likely to be content to let the new HHS rules work for a while and see what happens.
Observers also predict that privacy will be much more of an issue in upcoming legislation. That discussion has been put on the table by last year's House bill proposal to pre-empt state privacy laws, say staff members.
Rep. John Dingell (D-Mich.) is the new chair of the House Energy and Commerce Committee, a key avenue for health-related bills. He objected to the House bill last year, because he said it made, "No progress towards protecting the privacy and security of health information." Dingell also indicated that the House bill should have contained more federal funding for HIT.
Others point out that the Medicare and Medicaid programs could be up for changes which might provide avenues for influencing HIT adoption, much more so than legislation focused specifically on HIT.
Last fall saw the introduction of a bill by Patrick Kennedy (D-R.I.) for the promotion of interactive personal health records, which are consumer-controlled electronic records that can be shared with physicians and other healthcare entities. Many say that might get more attention this year, particularly since health plans and employers recently announced major efforts in that area (see PHR trend story, page 44).
Kathryn Foxhall is a contributing writer based in Hyattsville, Md.