Testimony
Wednesday, July 27 , 2005 Introduction
Setting the Context On July 21, 2004, during the Department’s Health IT Summit, we published the � Framework for Strategic Action: The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care,� (The Framework). The Framework outlined an approach toward nationwide implementation of interoperable EHRs and in it we identified four major goals. These goals are: 1) inform clinical practice by accelerating the use of EHRs, 2) interconnect clinicians so that they can exchange health information using advanced and secure electronic communication, 3) personalize care with consumer-based health records and better information for consumers, and 4) improve public health through advanced bio-surveillance methods and streamlined collection of data for quality measurement and research. The Framework has allowed many industry segments, sectors, interest groups, and individuals to review how health IT could transform their activity or experience, consider how to take advantage of this change, and to participate in ongoing dialogue about forthcoming efforts. My office has obtained significant additional input concerning how these four goals can best be met.
The Framework for Strategic Action and the Federal Health Architecture (FHA) are irrevocably linked in the effort to address critical health care needs. The FHA is now under the leadership of the ONC and will provide the structure or �architecture’ for collaboration and interoperability among federal health efforts as specified in the Framework for Strategic Action. Moreover, the Consolidated Health Informatics activities are now moving forward under the FHA. Building on the EO, The Framework, and this input, we have developed the clinical, business, and technical foundations for the HHS health IT strategy. Let me turn to some of those now.
The Clinical Foundation: Evidence of the Benefits of Health IT Every primary care physician knows what a recent study in the Journal of the American Medical Association (JAMA) showed: that clinical information is frequently missing at the point of care, and that this missing information can be harmful to patients. That study also showed that clinical information was less likely to be missing in practices that had full electronic records systems. Patients know this too and are taking matters into their own hands. A recent survey by the Agency for Health Care Research and Quality (AHRQ) with the Kaiser Family Foundation and the Harvard School of Public Health found that nearly 1 in 3 people say that they or a family member have created their own set of medical records to ensure that their health care providers have all of their medical information. Some researchers estimate that savings from the implementation of health IT and corresponding changes in care processes could range anywhere from 7.5 percent of health care costs (Johnston et al., 2003; Pan et al, 2004) to 30 percent (Wennberg et al., 2002; Wennberg et al., 2004; Fisher et al., 2003; Fisher et al., 2003). These estimates are based in part on the reduction of obvious errors. For example, a medical error is estimated to cost, in 2003 dollars, about $3,700 (Bates et al, 1997). However, these savings are not guaranteed through the simple acquisition of health IT. If poorly designed or implemented, health IT will not bring these benefits, and in some cases may even result in new medical errors and potential costs. Further, these are estimates which we have not yet seen realized in the health care system generally. Therefore, achieving efficiency and potential cost savings requires a much more substantial transformation of care delivery that goes beyond simple error reduction. Health IT must be combined with real process change in order to see meaningful improvements in our delivery system and systems must be standards compliant and interoperable so that patient information can be communicated to all possible points of care. It requires the industry to follow the best diagnostic and treatment practices everywhere in the nation. For example, cholesterol screenings can lead to early treatment, which in turn can reduce the risk for heart disease. Where that has been done, there have been substantial savings on cardiac expenditures. So, this is the clinical foundation for our work, which demonstrates that health IT can save lives, improve care, and improve efficiency in our health system; now let me turn to the business foundation.
The Business Foundation: The Health IT Leadership Panel Report The Leadership Panel was comprised of nine CEOs from leading companies that purchase large quantities of healthcare services for their employees and dependents and that do not operate in the healthcare business. The Leadership Panel included CEOs from FedEx Corporation, General Motors, International Paper, Johnson Controls, Target Corporation, Pepsico, Procter & Gamble, Wells Fargo, and Wal-Mart Stores. The business leaders were called upon to evaluate the need for investment in health information technology and the major roles for both the government and the private sector in achieving widespread adoption and implementation. Based upon their own experiences using IT to reengineer their individual business - and by extension, their industries - the Leadership Panel concluded that investment in interoperable health IT is urgent and vital to the broader U.S. economy due to rising health care demands and business interests. As identified by the Lewin Group, the Leadership Panel concluded:
The Leadership Panel identified as a key imperative that the Federal government should act as leader, catalyst, and convener of the nation’s health information technology effort. The Leadership Panel also emphasized that federal leverage as purchaser and provider would be needed�and welcomed by the private sector. Private sector purchasers and health care organizations can and should collaborate alongside the federal government to drive adoption of health IT. In addition, the Leadership Panel members recognized that widespread health IT adoption may not succeed without buy-in from the public as health care consumer. Panelists suggested that the national health IT vision must be communicated clearly and directly to enlist consumer support for the widespread adoption of health IT. These findings and recommendations from the Leadership Panel were published in a report released in May 2005 and laid the business foundation for the HHS health IT strategy. Now, let me turn to the technical foundation.
The Technical Foundation: Public Input Solicited on Nationwide Network We received over 500 responses to the RFI, which were reviewed by a government-wide RFI Review Task Force. This Task Force was comprised of over 100 Federal employees from 17 agencies, including the Departments of Homeland Security, Defense, Veterans Affairs, Treasury, Commerce, Health and Human Services, as well as multiple agencies within the departments. The resulting public summary document has begun to inform policy discussions inside and outside the government. We know that the RFI stimulated substantial and unprecedented discussions within and across organizations about how interoperability can really work, and we have continued to build on this. These responses have yielded one of the richest and most descriptive collections of thoughts on interoperability and health information exchange that has likely ever been assembled in the U.S. As such, it has set the foundation for actionable steps designed to meet the President’s goal. While the RFI report is an illustrative summary of the RFI responses and does not attempt to evaluate or discuss the relative merits of any one individual response over another, it does provide some key findings. Among the many opinions expressed by those supporting the development of a NHIN, the following concepts emerged:
Key Actions To address these challenges, HHS is focusing on several key actions: harmonizing health information standards; certifying health IT products to assure consistency with standards; addressing variations in privacy and security policies that might pose challenges to interoperability; and, developing an architecture for nationwide sharing of electronic health information. HHS has allocated $85 million to achieve these and other goals in FY 2005 and has requested $125 million in FY 2006. These efforts are inter-related, and they will be coordinated through the formation of a new collaborative known as the American Health Information Community.
American Health Information Community (the Community) HHS is currently soliciting nominations for people to serve on the Community and Secretary Leavitt will appoint up to 17 commission members, including himself as chairperson. It will consist of nine members from the public sector and eight members from the private sector. Public Sector members will be drawn from Department of Health and Human Services 7 (including the Office of the Secretary, the Centers for Medicare and Medicaid Services, and the Public Health Service), Department of Veterans Affairs, Department of Defense, Department of Commerce, Department of the Treasury, Office of Personnel Management, and a State government representative. The private sector membership will be drawn from purchasers, third-party payers, hospitals, physicians, nurses, ancillary services (e.g., lab or pharmacy), consumer and privacy interests, and health information technology. Nominations for membership are being accepted through August 5, 2005. The Community is expected to be convened early this fall. The Community will start by building on the vast amount of standardization already achieved inside and outside the healthcare industry. Specifically, the Community will:
The Community will be chartered for two years, with the option to renew and duration of no more than five years. The Department intends for the Community to be succeeded within five years by a private-sector health information community initiative that, among other things, would set additional needed standards, certify new health information technology, and provide long-term governance for health care transformation. In addition to the formation of the Community, the Office of the National Coordinator issued four requests for proposals (RFPs). The outputs of the contracts stemming from these RFPs will, in part, serve as inputs for the Community’s consideration. We expect to award contracts based on these RFPs in September and October 2005. Specifically, the RFPs will focus on four major areas:
Standards harmonization
Compliance certification
NHIN Architecture
Security and privacy Fraud and Abuse Study While only a small percentage of the estimated 4 billion healthcare claims submitted each year are fraudulent, the total dollars in fraudulent or improper claims is substantial. The National Health Care Anti-Fraud Association (NHCAA) estimates that healthcare fraud accounts for 3 percent of U.S. health expenditures each year, or an estimated $56.7 billion. They cite other estimates, which may include improper but not fraudulent claims, as high as 10 percent of U.S. health expenditures or $170 billion annually. At present, the contractor is working to perform two main tasks. One task is a descriptive study of the issues and the steps in the development and use of automated coding software that enhance healthcare anti-fraud activities. The second task is identifying best practices to enhance the capabilities of a nationwide interoperable health information technology infrastructure to assist in prevention, detection and prosecution, as appropriate, in cases of healthcare fraud or improper claims and billing. An expert cross-industry committee composed of senior level executives from both the private and public sectors is guiding this second task. The project’s final report is scheduled for completion in September 2005.
Conclusion Last Revised: October 14, 2005 |