<DOC>
[109th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:26715.wais]
HEALTHIER FEDS AND FAMILIES: INTRODUCING INFORMATION TECHNOLOGY INTO
THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
=======================================================================
HEARING
before the
SUBCOMMITTEE ON THE FEDERAL WORKFORCE
AND AGENCY ORGANIZATION
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
ON
H.R. 4859
TO AMEND CHAPTER 89 OF TITLE 5, UNITED STATES CODE, TO PROVIDE FOR THE
IMPLEMENTATION OF A SYSTEM OF ELECTRONIC HEALTH RECORDS UNDER THE
FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
__________
MARCH 15, 2006
__________
Serial No. 109-130
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
http://www.house.gov/reform
_____
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26-715 PDF
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COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
CHRISTOPHER SHAYS, Connecticut HENRY A. WAXMAN, California
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
GIL GUTKNECHT, Minnesota CAROLYN B. MALONEY, New York
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
TODD RUSSELL PLATTS, Pennsylvania DANNY K. DAVIS, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
JOHN J. DUNCAN, Jr., Tennessee DIANE E. WATSON, California
CANDICE S. MILLER, Michigan STEPHEN F. LYNCH, Massachusetts
MICHAEL R. TURNER, Ohio CHRIS VAN HOLLEN, Maryland
DARRELL E. ISSA, California LINDA T. SANCHEZ, California
JON C. PORTER, Nevada C.A. DUTCH RUPPERSBERGER, Maryland
KENNY MARCHANT, Texas BRIAN HIGGINS, New York
LYNN A. WESTMORELAND, Georgia ELEANOR HOLMES NORTON, District of
PATRICK T. McHENRY, North Carolina Columbia
CHARLES W. DENT, Pennsylvania ------
VIRGINIA FOXX, North Carolina BERNARD SANDERS, Vermont
JEAN SCHMIDT, Ohio (Independent)
------ ------
David Marin, Staff Director
Teresa Austin, Chief Clerk
Phil Barnett, Minority Chief of Staff/Chief Counsel
Subcommittee on the Federal Workforce and Agency Organization
JON C. PORTER, Nevada, Chairman
JOHN L. MICA, Florida DANNY K. DAVIS, Illinois
TOM DAVIS, Virginia MAJOR R. OWENS, New York
DARRELL E. ISSA, California ELEANOR HOLMES NORTON, District of
KENNY MARCHANT, Texas Columbia
PATRICK T. McHENRY, North Carolina ELIJAH E. CUMMINGS, Maryland
JEAN SCHMIDT, Ohio CHRIS VAN HOLLEN, Maryland
Ex Officio
HENRY A. WAXMAN, California
Ron Martinson, Staff Director
Chad Bungard, Deputy Staff Director
Chad Christofferson, Legislative Assistant
Mark Stephenson, Minority Professional Staff Member
C O N T E N T S
----------
Page
Hearing held on March 15, 2006................................... 1
Text of H.R. 4859................................................ 10
Statement of:
Gingrich, Hon. Newt, former Speaker of the House............. 26
Powner, David A., Director, Information Technology Management
Issues, U.S. Government Accountability Office; Jane F.
Barlow, M.D., MPH, MBA, IBM Well-Being Director, Global
Well-Being Services and Health Benefits, the IBM Corp.;
David St. Clair, founder and chief executive officer,
MEDECISION, Inc.; Paul B. Handel, M.D., vice president and
chief medical director, Blue CrossBlue Shield of Texas (a
Division of Health Care Service Corp.); Jeannine M. Rivet,
executive vice president, UnitedHealth Group; and Malik M.
Hasan, M.D., chief executive officer, Healthview, retired
chief executive officer, Health Net........................ 57
Barlow, Jane F., M.D..................................... 80
Handel, Paul B., M.D..................................... 114
Hasan, Malik M., M.D..................................... 132
Powner, David A.......................................... 57
Rivet, Jeannine M........................................ 119
St. Clair, David......................................... 93
Letters, statements, etc., submitted for the record by:
Barlow, Jane F., M.D., MPH, MBA, IBM well-being director,
Global Well-Being Services and Health Benefits, the IBM
Corp., prepared statement of............................... 82
Clay, Hon. Wm. Lacy, a Representative in Congress from the
State of Missouri, prepared statement of................... 154
Cummings, Hon. Elijah E., a Representative in Congress from
the State of Maryland, prepared statement of............... 156
Ewen, Dr. Edward, Jr., prepared statement of................. 146
Gingrich, Hon. Newt, former Speaker of the House, prepared
statement of............................................... 30
Handel, Paul B., M.D., vice president and chief medical
director, Blue CrossBlue Shield of Texas (a Division of
Health Care Service Corp.), prepared statement of.......... 116
Hasan, Malik M., M.D., chief executive officer, Healthview,
retired chief executive officer, Health Net , prepared
statement of............................................... 134
Porter, Hon. Jon C., a Representative in Congress from the
State of Nevada, prepared statement of..................... 6
Powner, David A., Director, Information Technology Management
Issues, U.S. Government Accountability Office, prepared
statement of............................................... 60
Rivet, Jeannine M., executive vice president, UnitedHealth
Group, prepared statement of............................... 122
St. Clair, David, founder and chief executive officer,
MEDECISION, Inc., prepared statement of.................... 96
HEALTHIER FEDS AND FAMILIES: INTRODUCING INFORMATION TECHNOLOGY INTO
THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
----------
WEDNESDAY, MARCH 15, 2006
House of Representatives,
Subcommittee on Federal Workforce and Agency
Organization,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 3:18 p.m., in
room 2154, Rayburn House Office Building, Hon. Jon C. Porter
(chairman of the subcommittee) presiding.
Present: Representatives Porter, Norton, Cummings, Van
Hollen, and Clay.
Staff present: Ronald Martinson, staff director; Chad
Bungard, deputy staff director/chief counsel; Chad
Christofferson and Alex Cooper, legislative assistants; Patrick
Jennings, OPM detailee/senior counsel; Mark Stephenson, Tania
Shand, and Adam Bordes, minority professional staff members;
and Teresa Coufal, minority assistant clerk.
Mr. Porter. Good afternoon. I would like to bring the
meeting to order, and I certainly appreciate all of you being
here today. A quorum being present, the Subcommittee on the
Federal Workforce and Agency Organization will come to order.
This will be the first of two hearings that focus on a bill
that I and Representative Lacy Clay from Missouri have
introduced, namely, H.R. 4859, the Federal Family Health
Information Technology Act. In the past decade, information
technology has exploded onto the scene and revolutionized the
way we do business in every industry. Companies from every
sector of the marketplace have made huge investments in
technology development and are reaping the benefits tenfold.
For example, last month, General Motors announced that it
would be awarding a $15 billion contract for information
technology development. Analysts are saying that this is the
single largest information technology contract ever awarded
through a bidding process. If information technology is so
pervasive in every industry from automotive to financial
services, why has it seemingly bypassed one of the largest
industries in the United States--health care? The answers to
that question are many, but the good news is that the barriers
blocking health information technology from growing are rapidly
crumbling. People are working harder than ever to see that
health information technology is not simply something that a
few companies are using, but is a reality for all Americans.
As health information technology systems are developed, I
believe that not only will the quality of health care delivery
improve dramatically, but so will the quality of health care
overall. Some have estimated that over 90 percent of the
activity spent on delivering health care depends on the
exchange of information. Information flows constantly from
patients to doctors to carriers to pharmacies and others, yet
we are still using the processes of yesterday. With health
information technology, we will not only decrease the amount of
time it takes to exchange this information, but we will greatly
increase the accuracy of the information that we exchange.
One of the sad realities in the industry today is that
medical errors are a major problem. The Institute of Medicine
estimates that medical errors account for approximately 45,000
to 98,000 deaths each year in the United States and over
770,000 injuries due to adverse drug events, many of which
could have been prevented through the use of information
technology. If listed among deadly diseases, medical errors
would be considered among the leading causes of death, even
outpacing highway accidents, breast cancer, and AIDS. This is
no slight to our medical professionals, who are the best in the
world, but rather is an indictment of the antiquated technology
they rely on.
The use of technology will reduce medical errors by making
health information more accessible to both patients and
providers no matter where the patient is receiving the care.
For example, the Boston Globe recently reported a senseless
preventable death of a 79-year-old retired chemist who died
after doctors at Massachusetts General Hospital treated him for
a stroke when he really was having an insulin reaction. It is
easy to see how an electronic medical record could have
assisted the physicians in correctly diagnosing this patient.
In a world where our cars, our pets, and our checking accounts
have their own computerized record, it is time for every
American to benefit from the same technology.
Back home in Nevada, I spend a lot of time with foster
kids. Unfortunately, health records for these children are
scarce, which leads to needless multiple tetanus shots and
other inoculations and multiple exams, and putting these
children at risk for encountering a medical error because their
prior medical histories are not always known. With the
technological advances that we have made, this is unacceptable.
And as you know, technology today is in dog years. For every 1
year, it is 7. Technology is changing rapidly, becoming more
and more efficient and more and more accessible.
As chairman of this subcommittee, I have been working
closely with leaders from government and industry to develop
legislation to bring health information technology to the
health plans the Federal Government offers to its own
employees. We have a wonderful opportunity to improve the
quality and delivery of health care for the over 8 million
participants in the Federal Employees Health Benefits Program
and at the same time serve as a model to effect change
elsewhere. Passing this up would be a huge mistake--a mistake
we cannot afford since many lives would be unnecessarily placed
at risk, especially since the solution is literally at our
fingertips.
The bill that I have introduced is based on very successful
demonstration projects around the country, and we will hear
from several individuals who were involved in those
demonstrations this afternoon. The bill does recognize that
there are three basic components of a complete electronic
health record: No. 1, the carrier-based electronic health
record; No. 2, the personal electronic health record; and, No.
3, the provider-based electronic health record. And recognizing
this, the bill will establish a carrier-based electronic health
record and personal electronic health record and provides
incentives for creating a provider-based electronic health
record.
The first component of the bill will require all carriers
participating in the Federal plan to create a carrier-based
electronic health record for each of the participants. This
piece of electronic health record will provide each participant
and his or her providers with the information maintained by the
member's carrier in a format useful for diagnosis and
treatment. This claim-based component of the electronic health
record can provide valuable information by leveraging the data,
technology, and capabilities of health plans to improve health
care decisions by patients and providers. This information is
already there, and to ignore it would cause innocent people to
unnecessarily suffer injury or death.
Hurricanes Katrina and Rita serve as stark examples of the
value of carrier-based electronic health records. When
Hurricane Katrina hit, many medical records were destroyed or
were not immediately available for patients, potentially
putting some patients at great risk. Hoping to avoid the
medical disasters associated with Hurricane Katrina, Blue
CrossBlue Shield of Texas extracted data on its members who
lived in the areas that were evacuated before Hurricane Rita
hit. To help physicians care for Hurricane Rita evacuees, Blue
Cross took its carrier based data for 830,000 members and
converted it into an electronic health record available to any
treating provider and did it in 4 days--830,000 members were
converted into an electronic health record in 4 days. Those
records contain historic and current data such as lab results,
pharmacy information, and basic medical history.
The second component of the bill requires a carrier to
create a personal electronic health record at the request of an
individual and would allow each individual to participate in
his or her own health care by enabling the individual to input
information into the electronic health record, such as personal
health history, family health history, symptoms, over-the-
counter medication, living will information, diet, exercise, or
other relevant information and activities. As our guest today,
Speaker Newt Gingrich, will mention, it will provide for
ownership for health care, for individuals to have ownership
over their own information and their health care.
The third major component of the bill provides for a
creative mechanism for individual providers to obtain funding
for health information systems in their offices. Specifically,
the funding would be available to providers to implement an
interoperable electronic provider-based records system. The
bill would establish a trust fund at the Office of Personnel
Management that would accept private contributions. OPM will
then issue grants from the fund to participating carriers to be
distributed as performance incentives to their contracting
health care providers to implement the provider-based
electronic health records. Now, to tie all these components
together, the bill will require that within 5 years of passage,
each participant will have his or her own electronic health
record contained on a portable digital medium.
I would also like to quickly address three additional
issues surrounding the bill. First is privacy. Privacy is
always at the top of the list of concerns, and for the many
groups that I met with, it was always the No. 1 issue that was
brought forward, so rightfully so, it needs to be taken care
of. There is nothing more personal and private than a person's
medical information. Under my bill, we will ensure that
participants' medical information is kept private and secure by
requiring compliance with the Health Insurance Portability and
Accounting Act. In addition, there are some great minds at the
Department of Health and Human Services thinking long and hard
about this important issue, particularly through the work of
the Health Information Security and Privacy Collaboration.
Second, I would also like to address interoperability. The
administration has gathered the Nation's leading experts in
this area to develop standards that everyone can work under.
The bill that I will be introducing will follow the standards
being developed by the Department of Health and Human Services.
I am not interested in creating a system of electronic health
records that will be obsolete or incompatible with other
systems.
Third, and finally, we must deal with the issue of cost.
Under the bill, the Federal Employees Health Benefits Program
rates should not increase and insurance carriers will not be
burdened with paying the administrative costs to implement the
requirements in the bill. The bill includes provisions to
ensure that electronic health records are implemented over a
number of years and that participating insurance carriers can
tap into existing funds dedicated for administrative purposes
being held by OPM during the implementation stages.
Additionally, there are significant savings that can be
seen with the implementation of health information technology
in the Federal Employees Health Benefits Program. In my own
State of Nevada, Health Plan of Nevada has done a tremendous
job of implementing the HIT system. Their transition from paper
records to electronic records has saved them nearly $1.7
million, resulting from a more than 50 percent reduction in
medical records, staff, and paperwork, and certainly the
errors. The think tank Rand Corp. estimated that, in addition
to the saving of lives, the U.S. health care system could save
as much as $162 billion annually with the widespread use of
health care information technology.
Making electronic health records available for patients is
the SMART thing to do, and SMART serves as a perfect acronym to
demonstrate the strengths of the health information system.
``S'' is very simple; it stands for Significantly reducing
medical errors. ``M'' stands for Making prescription errors
extinct. ``A'' represents the prevention of Adverse effects
from conflicting course of treatment. And the ``R'' stands for
Reducing redundancy of testing and paperwork. And ``T'' stands
for recognizing that it is Time to improve the quality and the
delivery of health care in the United States for every American
citizen.
The bottom line is simple: the technology is there to save
lives and improve the quality of health care. It would be a
colossal error to not take advantage of using technology to
turn valuable claims data, for instance, into electronic health
records. There are many, many successful HIT demonstration
projects throughout the country that have shown us that this
can be done. The Federal Employees Health Benefits Program
cannot afford to wait any longer.
I look forward to the discussions today from our experts
and from all the witnesses.
[The prepared statement of Hon. Jon C. Porter and the text
of H.R. 4859 follows:]
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Mr. Porter. I would now like to recognize Eleanor Holmes
Norton. Would you like to----
Ms. Norton. Thank you, Mr. Chairman. I am pleased to speak
for this side.
I want to thank you for this initiative. This is a very
important initiative because you are getting into some of the
really important issues if one is serious about this matter. I
want to thank my good friend and former Speaker of the House,
Newt Gingrich, and welcome him back and recall our fond days of
working together. The former Speaker and I worked together
closely on many projects affecting the District of Columbia and
always on a win-win basis. We did not agree on many subjects,
so we got together and figured out how to do it on a basis that
we could agree. And in that spirit, I think we should approach
this matter because, Mr. Chairman, if I may say so, the one
thing I don't think we have to do is to convince people of the
necessity of finally applying technology to the medical sector.
Indeed, the medical sector is well nigh primitive as compared
with virtually every other major sector in American life, and I
really don't think it is because the various components of that
sector are ignorant of the advantages of technology.
As I say, one has to live in the technology age perhaps a
few hours, only a few hours, considering how far we have come
to understand what the advantages would be. And, therefore, as
with any intriguing issue like this, the way to approach it is
only, frankly, with respect to the hard questions. The easy
ones are settled as far as I am concerned.
It is not what to do. It is how to do it that has received
so little, if you will forgive me, of the gray matter that it
will take to finally bring the medical sector into the same
part of the 21st century that the rest of America is in. And
considering how much of our resources they eat up, we better
figure out how to do that.
I certainly believe it is quite appropriate, Mr. Chairman,
that the Federal sector, even Federal employees, should always
lead the way. We ought to be the best sector when it comes to
health care. Would that we were, we ought to be the best sector
when it comes to showing the private sector how to do it so we
are all on the same page.
I may have a little disagreement with some who speak first
and foremost--as you do not, Mr. Chairman--about the importance
of technology in the medical field as saving money. So I think
we ought to put that aside. Sure, it will save money over
years. But as with everything, we ought to say to everybody
there are up-front costs of investment and you have to
understand that if you want the advantages. And some of the
advantages you cannot do without. We should not play that down,
and those up-front costs cannot come from the cost of health
care, which is already in such great ascendancy that nobody can
find it. And if I may say so, Mr. Chairman, I think it has
something to do with the reluctance of the medical sector to
bite off this issue at all. So you have wisely tried to find a
way to deal with that matter.
It is not, frankly, costs and I would never try to sell it
to the American people and certainly not to this Congress this
way. Neither the American people nor the Congress of the United
States believes in the notion that you invest and the more you
invest and the more wisely you invest, you get a yield. We are
a country that believes in instant yield. You invest a little
and you get a whole lot out. So you invest a little in
education and everybody comes out, you know, going to college
and you are at the top of the list instead of at the bottom.
Not in the private sector. We understand that you do not get a
benefit for a long time. You do not look at how a company is
doing by finding whether there is a profit yet, if it goes for
years and years without a profit, you understand that.
In selling this, we have to make clear people understand
what they do get out of it, that they are going to have to
invest, and that gradually this will pay off. What will pay off
almost immediately, if we do it right, it seems to me, is the
terrible price we pay in mistakes in the health care system in
an utterly mobile country, in not even knowing or remembering
who the health care providers were, what the medications were,
forgetting perhaps or having no paper trail to vital
information that affects your health, a world in which
pharmaceuticals are able to do more and more for you, but you
got to have a lot of information before they do what they are
supposed to do. No question in my mind we got to do that. The
more advanced medical science gets, the more we need medical
technology to help us matriculate through all that is now
available to us.
This issue raises profound problems. The way in which you
propose to fund this matter, Mr. Chairman, would probably raise
some problems for lots of folks. The notion of the use of
reserves in any way would have to be looked at very carefully.
I take no opinion on it now, but I do note that even some of
the private sector carriers have raised questions about that
kind of use.
Questions of liability go, of course, to privacy, but well
beyond that, carriers themselves begin to raise the notion that
even if you get the kind of security that most people do not
trust, frankly, the technology system to give us, with
firewalls and everything else you can talk about, whether or
not they want to be responsible for having the medical records
of everybody in there, you know, Members of Congress, people
with security clearances, people whose identity is not supposed
to be known at all--I mean, it is the hard questions that
interest me, not whether or not, you know, my next-door
neighbor and I can go in and I cannot get his and he cannot get
mine. It is the hard questions. And it is some of the questions
that technology has not even now begun to deal with in the
ordinary course.
I am the last one to say they cannot deal with it. This may
be the way in which there is a real incentive to deal with
these questions. But they have to be dealt with.
I will not say anything about privacy except this one
thing, Mr. Chairman. I think that the Federal work force is an
appropriate guinea pig to experiment on--that is to say, if, in
fact, you have willing guinea pigs. Now, if you are going to
put people's medical records out there in the great cyberspace
beyond, just let me say right here don't go to--as your
counsel, as the one who went to law school----
Mr. Porter. Actually, you are my Congresswoman. Remember, I
live in your district here part-time. [Laughter.]
Ms. Norton. As your Congresswoman for the period during
which you are in Washington, as your counsel, do not even
consider everybody is in it and you have to opt out. You cannot
start with even a small pool of people are in it unless you opt
out--not when you are dealing with people's medical records,
not when you are dealing with that one group of records that
people most fear getting beyond whom they want to get--not when
even if your doctor gets it and it is online or your doctor or
the hospital that you move to, you don't now if it is the clerk
there, if it is somebody else, other than the professional who
gets it. You have to deal with the hard questions, I say.
Let me leave you, Mr. Chairman, with this one phrase:
``Medicare prescription drug program.'' If you keep that in
your head the whole time and all of the glitches that came from
throwing all those people out--and, by the way, we told the
poor people, you all are in so you do not even have to worry
about it, until all over the country people said that we cannot
find the names.
If we are going to do this--and I would very much
countenance our doing it--we should take a very small pool of
the willing and test it. They will be all around us. There will
be the computer nuts who want to be in this small group. There
will be people who are intrigued and want their records in the
same place. They may live in the same place. There are a whole
bunch of them. We have 3 million folks who work for the Federal
Government. It would be lovely if they could all be in the same
kind of unit. And part of the art of this will be figuring out
who should try it out, making sure that they are willing, and
again, as your counsel, I say make sure they sign that they
have been willing. And then let us go for it and see what we
can find out, just as I expect to find out much from hearing
from our witnesses today.
Thank you again, Mr. Chairman.
Mr. Porter. Thank you, Congresswoman. I appreciate your
comments.
Next I would like to introduce my cosponsor, Mr. Clay.
Mr. Clay. Thank you. Thank you, Mr. Chairman, and
especially for calling today's hearing on ways we can improve
the use of information technology in our health care delivery
system, and also thank you for inviting me to sit on the panel
today on the Federal Workforce and Agency Organization
Subcommittee. I appreciate that.
I especially want to express my gratitude to you for our
mutual efforts in developing health IT legislation that can
benefit our public health infrastructure for generations to
come. And as you mentioned earlier, the Rand Corp. recently
estimated that the implementation of a nationwide health care
information network that is utilized by 90 percent of providers
will produce an annual savings of approximately $162 billion
while reducing the number of adverse patient drug reactions in
hospitals by more than 2 million per year.
The only way to achieve these outcomes, however, is through
the leadership of the Federal Government, and I am a proud
cosponsor of Chairman Porter's Federal Family Health
Information Technology Act of 2006. This bill utilizes the
market power of the Federal Government by establishing a
process for the development of electronic health records for
all Federal employees by utilizing our Federal Employees Health
Benefits Program for EHR purposes. We are creating a model for
consumers, employers, and insurers to build comprehensive
electronic health records for all individuals.
In addition, I have recently introduced H.R. 4832, the
Electronic Health Information Technology Act of 2006, along
with Chairman Porter. H.R. 4832 seeks to accomplish two major
goals: first, it will codify the office of Dr. Brailer and
strengthen his role as the leading health information
technology standard-setting authority in the Federal
Government; and, second, the bill seeks to partner with the
private sector through grants and a direct loan program that
will provide key economic assistance for institutions seeking
to expand their EHR capabilities.
If we continue our pursuit of utilizing IT through the
health care delivery system, we are sure to experience shorter
hospital stays, improved management of chronic disease, and a
reduction in the number of needless tests and examinations
administered over time. The creation of such a network will
prove far more efficient in both economic and human terms.
This concludes my remarks, Mr. Chairman, and I ask that
they be included in the record.
Mr. Porter. Without objection.
Mr. Clay. Thank you.
Mr. Porter. We have some procedural matters, and I ask that
we have unanimous consent that all Members have 5 legislative
days to submit written statements and questions for the hearing
record; that any answers to the written questions provided by
the witnesses also be included in the record. Without
objection, so ordered.
I also ask unanimous consent that all exhibits, documents,
and the materials referred to by Members and the witnesses may
be included in the hearing record; that all Members be
permitted to revise and extend their remarks. And without
objection, it is so ordered.
It is also the practice of this subcommittee to administer
the oath to all witnesses, so if you would all please stand, I
would like to administer the oath, and please raise your right
hands.
[Witnesses sworn.]
Mr. Porter. Let the record reflect that the witnesses have
answered in the affirmative. Please be seated.
We are honored today to have a very special guest who is a
leader in many areas of our country on many issues, but one in
recent history, in combination with, I believe, Senator
Clinton, he has become a champion on moving health information
technology forward.
Mr. Gingrich, Honorable Newt Gingrich, understands that
health care is only as good as its weakest link, and a weak
link is that of information flow and some of the current
technology. I believe that Mr. Gingrich also understands that
we have some of the best doctors and health care professionals
in the world, but we need additional information technology
available.
So, Mr. Gingrich, we welcome you today and look forward to
your comments, and you are now recognized for 5 minutes.
STATEMENT OF HON. NEWT GINGRICH, FORMER SPEAKER OF THE HOUSE
Mr. Gingrich. Well, thank you very much for inviting me to
this very important hearing, and I am delighted to see a
bipartisan effort such as this by Chairman Porter and by
Congressman Clay, and it is something I very strongly support
as a general direction. I am also delighted to be back with my
good friend, Congresswoman Norton, who has done just a
tremendous job representing the city, and under very difficult
circumstances at times, and has been stunningly effective.
I also want to note that you have a very, very good series
of panels. Dr. Malik Hasan, who has been a pioneer for many
years in this area and who at HealthTrio has developed a
SNOMED-based language approach that is very sophisticated and
the next generation, Dr. Jane Barlow of IBM, and others are all
going to be, I think, very helpful to you.
I do think bipartisan efforts in this area are useful. That
is why Senator Clinton and I actually met launching a House
bill. Congressman Tim Murphy and Congressman Patrick Kennedy
introduced a bill in this general area, and we shocked
everybody by showing up together to say we were for it. But I
think this is an area where we can save lives and that is very
important.
I start with a very simple premise. Paper kills. Paper
prescriptions increase medication error; 8,000 to 9,000
Americans a year die from medication error. Paper records in
hospitals make it much harder to have accurate, quality
systems; 44,000 to 98,000 Americans a year die from errors in
hospitals. If we had a pandemic, whether it was the avian flu
or an engineered biological attack, the losses because of the
absence of personal electronic health records could be in the
millions.
I would also point out that personal health records are not
a radical new idea. The Veterans Administration, an area where
Government has truly pioneered, has been a leader and now has
over 13 million electronic health records. PeaceHealth in
Oregon, Washington, and Alaska has about 1,400,000 people with
electronic health records. The Mayo Clinic in Jacksonville has
been paper-free since 1996. Kaiser Permanente has about 13
million people with electronic health records. And TRICARE, the
Defense Department health system, is beginning to roll out an
electronic health record. So the capability is real.
We at the Center for Health Transformation believe that the
Federal Government can dramatically improve the health of all
Federal workers with personal health records, and I agree with
Congresswoman Norton's observation that it is better to get
into this by volunteerism and incentives than it is to try to
coerce everybody. But let me just point out that 93 percent of
the country believes they should have the right to quality and
cost information before making a health decision; 90 percent of
the country believes you should mandate electronic prescribing
in order to avoid medication error. There is a huge potential
market that will sign up for this if given a chance, and it has
an impact both in saving lives and in saving money.
The Indiana Heart Hospital, for example, reported an 85-
percent reduction in medication error by going to electronic
records. PeaceHealth in a pilot project in Eugene, Oregon,
using a GE Healthsystem model, indicated an 83-percent
reduction in medication error, a 40-percent improvement in
diabetes control, and a 100-percent improvement in LDL control
for cholesterol. So these are important things.
I would urge--and I believe your bill captures this--
individuals should own their own personal health record. This
is about their life. Doctors can keep a copy for legal and
administrative and medical reasons. Hospitals or labs can keep
a copy. But the core universal document should belong to the
individual, and current privacy laws protecting personal health
information clearly apply to electronic data as well.
Let me go a step further and say you should in passing
recommend to your friends on the appropriate subcommittee that
Medicaid needs to change its law so when people leave Medicaid,
the information could actually be transferred to their job or
business. It currently is not. It is technically blocked. And
it strikes me as an anachronistic and actually a destructive
provision.
The individual's right to know, I would urge the committee
to look at myfloridarx.com and floridacomparecare.gov. These
are two Web sites developed by Governor Jeb Bush, and the
Federal Employees Health Benefits Plan should offer exactly the
same service nationally for all Federal employees.
Myfloridarx.com, you can actually go online, put in your Zip
code, the drug you want to purchase, and every drug store in
your area shows up with its price. And it turns out in one
neighborhood within 2 miles, there is a 100-percent difference
to buy a particular drug. At one drug store it is $101. In
another drug store, it was $203. And as you can imagine, people
rapidly talk to each other when that price differential is that
big, and so it is a big, powerful tool to give citizens the
power to make choice to save their own money to lower costs.
The floridacomparecare.gov actually lists number of
procedures done by a hospital, quality of the outcome, and
price, and is already having a substantial effect in informing
Floridians.
I would also suggest you look at the Humana and Blue
CrossBlue Shield of Florida joint venture called Availity,
where they are now going to connect at least a third of the
State, and if they add Medicaid, over half of Florida will
begin to have medication and other records online.
I would also point out, as Congressman Clay noted, I think
with legitimate pride, that in addition to the work you are
doing, which is exactly right, there is effort underway with
Congressman Clay's H.R. 4832, with the bill that Chairwoman
Johnson and Chairman Deal introduced, H.R. 4157, with
Congressman Gingrey's H.R. 4641 creating a tax deduction for
doctors who want to buy equipment. I would strongly urge you to
encourage your associates to reform Stark and anti-kickback law
so that hospitals can provide electronic health records,
because if you combine that with this bill, you won't have to
have any kind of trust fund. The fact is if you modify Stark
and anti-kickback rules, the hospitals of this country will
save so much money by having electronic transfer of information
rather than paper transfer that they will provide virtually
every doctor in the country with an electronic health record
capability at no cost. They are today blocked from that by an
essentially obsolete law.
Let me also suggest that we need an accurate scoring
caucus. Fred Smith of FedEx was the first person who got me to
think about this because he pointed out that he could never
have invented FedEx with Congressional Budget Office scoring,
because they cannot distinguish investment from cost and they
do not understand market effects. You are about to see this
with Medicare because the market effect of the new drug benefit
is going to come at least 30 percent under the projection in
cost because it turns out competition is driving down the cost,
and we are actually driving down the cost of prescription drugs
for America's senior citizens.
Central Utah Multi-Specialty Clinic invested in electronic
health records. They believe they will save $14 million over 5
years. I do not believe the Congressional Budget Office would
score a penny.
The Henry Ford Health System in Detroit has introduced
electronic prescribing. They believe for a $1 million
investment they saved $3.5 million the first year in the cost
of drugs as doctors prescribe less expensive medication, and
they believe they are saving 3 hours a week per nurse for not
having to sit online talking to a pharmacist. I do not believe
the Congressional Budget Office would score a penny.
If we could take the $4.4 billion a year in waste that the
New York Times estimates for New York State Medicaid alone, if
you could take the fraud and waste out of the current system,
and if you could take the inaccuracy and paper out of the
current system, I think we could afford to cover with a very
large tax credit every single citizen and have a 300-million
payer system.
I give you this as background because you cannot get there
as long as the Congressional Budget Office has an obsolete,
reactionary, bureaucratic model of scoring that denies the
power of the market and denies factual evidence from the
private sector. That is important for this project because one
of the things I want to suggest to you is that you consider
introducing as part of this--and I like your bill very, very
much. But consider something we did to get hospital quality
reporting. In the Medicare bill, we said hospitals that report
quality will get 0.1 percent more from Medicare, and hospitals
that fail to report quality will get 0.1 percent less. That
happened to score out at zero under CBO rules.
I would urge you to consider that by the 3rd year the
Government will pay more if you have an electronic health
record and less if you have a paper model. And the analogy I
will give you is electronic ticketing. Electronic ticketing for
airlines is not more expensive. It is cheaper. And it is so
much cheaper that Continental Airlines 2 years ago announced
that for 1 year they would give you a paper ticket but charge
you $50 for the paper ticket, and at the end of 1 year they
would never give you a paper ticket. You could print out your
own at home, but they were simply never again going to deal
with having to have paper.
Now, this is the direction of the future. I very strongly
support this bill, and I will close with this observation
because I think this is a very intelligent bill moving in
exactly the right direction. And I particularly like, Chairman
Porter, your point that this would not--as I understand your
interpretation, this would not have OPM creating an entire new
pattern of standards but, rather, would have OPM looking to HHS
to adopt and follow the leadership of Secretary Leavitt, who I
think is doing an extraordinary job in this general area.
The reason I really like your bill so much is that you are
the first folks I have seen who are directly using the power of
the Government as a purchaser--not as a regulator, not as a
controller, but just simply saying, look, if you want to come
and provide insurance for the largest single private purchasing
of insurance in the world, which is the Federal Employees
Health Benefits Plan, terrific; we just want you to migrate
toward making sure that any Federal employee that wants it can
have an electronic health record for themselves and their
family.
Using the Federal Government's purchasing power will change
the health system faster than any possible regulatory regime,
and I think this bill is a very, very important step in the
right direction, and we would certainly do anything we could--I
would personally--to try to be helpful in making sure that this
bill gets a full hearing, and I would only hope it is signed
into law this year.
[The prepared statement of Hon. Newt Gingrich follows:]
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Mr. Porter. Thank you very much for your kind comments and
certainly the insights.
You know, a challenge is the provider side. I am old enough
to remember my doctor that carried the little bag and actually
made house calls. And the doctors of today are under a lot of
pressure, a lot of challenges, from Federal regulations, you
know, the file cabinet police that they are concerned that they
are going to be put out of business, privacy, also medical
liability. And I would like to ask you a question about the
providers, but also add a comment to that.
A companion to this bill I am going to be proposing is a
medical liability insurance incentive for the providers that
take part in using appropriate technology, that there be an
incentive to reduce some of their costs. Because you know
medical liability cost are literally putting health care
professionals out of business. We have had signs in Nevada at
OB/GYNs on their buildings that say ``For Rent'' because they
are concerned about liability, the point being that we have had
some improvements in Nevada as of late, but the medical
liability is not in my jurisdiction, Mr. Speaker. Of course, it
is a different committee. But my plan is to add that as another
part of this to make sure that providers have another
incentive, because it will save lives and reduce the cost of
insurance.
But to my question: Do you have any other thoughts on
encouraging the doctors--and the doctors, bless them, are not
necessarily always good business people, do not always get
along with each other because they are very independent, and
they are specialists. Do you have any additional ideas?
Mr. Gingrich. Well, let me make three points about this.
You have put your finger on a very key reason, and I think this
is part of what Congresswoman Norton was saying when she was
saying lots of people tell us where we need to go, but they
don't necessarily tell us how to get there. And it is the how
to get there sometimes that stops us, even when we are all in
agreement. So I want to say three quick things.
First of all, I want to go back to a line I started with.
Paper kills. Any major purchaser who is allowing the system to
continue to deal with the people that they care about with
paper is risking the lives of those people. We know technically
this is true, so I would start by saying any doctor or any
hospital that is not migrating to health information technology
is, in fact, saying that they are not seriously concerned about
killing people. It is literally that direct.
Second, the University of South Florida has a program they
are developing that I would commend to you where, if you use
the electronic health record, it includes an entire section on
informed consent, and they designed this to meet your point,
which is how do I get my doctors to think this is worth their
while. And what they figured out was if they could design,
working with both trial lawyers and defense attorneys, an ideal
model of informed consent so that the doctor knew they had the
minimum liability risk, the doctor would suddenly have a very
direct interest in having that as part of their health record.
And so I would strongly recommend the University of South
Florida program as something you would want to look into.
Third, you might have to add this on the floor because of
committee jurisdiction again, but I just want to go back to
what I said earlier both about Congressman Clay's bill, about
the earlier work that was done by Congressman Murphy and
Congressman Kennedy and by the very important bill introduced
by Congresswoman Johnson and Congressman Deal, and that is, you
should provide somewhere that providers, whether hospital or
doctors, who are engaged in serving Federal employees ought to
have Stark and anti-kickback waived for the purpose of allowing
the hospitals to provide the electronic health records. This is
an enormous savings for the system. It allows us to avoid the
Federal Government getting in the middle of it, and our
estimate is that you would have virtually 100 percent coverage
of doctors. But if you added that provision in, I think you
would find that most of the electronic health record problems
would disappear within 2 or 3 years.
Mr. Porter. Thank you.
Congresswoman, questions?
Ms. Norton. Thank you, Mr. Chairman, and thank you again,
Mr. Speaker.
I wanted to--I am reading your testimony. I wondered if we
may be talking past each other. Maybe, because I haven't seen
the wording of the bill, on page 16, the way the bill is
worded, you indicate in your testimony on page 16 that--of
course, the standards have to come from the industry. What in
the hell do we know--excuse me. What in the world does OPM or
anybody in Government know? You say, ``The data standards
embedded into any personal health record through the FEHBP
should be determined by health information technology experts,
not health benefits experts.''
I have to assume that H.R. 4859, to which you refer, which
gives responsibility on data standards for interoperability to
OPM, simply means that the Government does not say that the
private sector can do anything it wants to do without anybody
on our side looking to see whether it basically conforms to
status. You know, to use an analogy, the Government puts, you
know, contracts out. One of the great--although this obviously
is a huge contract, but I will give you what is more typical.
It has a gazillion contracts out. Nobody monitors the
contracts. And so, you know, you are on your own, contractors.
Well, this, of course, is something very special, and
somebody in Government--I am not sure who--would have to have
some final say if FEHBP is involved over what those who have
the expertise design as standards.
So I wonder if this is even a matter of disagreement here,
but the way in which you pose it in your testimony makes it
look as though it may be.
Mr. Gingrich. Well, let me say first of all, I may have not
been clear, and I apologize to the gentlelady if I was not
clear. I strongly believe that the Department of Health and
Human Services, which is a Government agency, has a primary
role in helping develop standards for interoperability in terms
of health records nationwide. And Secretary Leavitt has
organized an American Health Information Community, which has
been meeting regularly, and I think Secretary Leavitt is moving
in that direction. My only observation--I think it was
conforming with what the chairman said in his opening remarks--
is I think OPM is better directed to follow the lead of HHS and
allow HHS to be the primary standard setter for the whole
country rather than to have a second electronic health record
standard program being developed at OPM, which I think would be
redundant and, frankly, not nearly technically as competent.
But within that framework, you and I are on the same road.
I am a Theodore Roosevelt Republican. Theodore Roosevelt
decided, after reading Upton Sinclair's ``The Jungle,'' which
has a scene in which a man falls in a vat and gets turned into
sausage, which he supposed read shortly after breakfast, and he
sent up the Food and Drug Act of 1903 as a consequence. I like
the idea that any free market restaurant I go into anywhere in
America has drinkable water. I like the Government guaranteeing
that minimum. Now, they can compete on price and quality and
food, but they have to get up to drinkable water before they
get to play. They have to get up to edible food.
So I agree with you. There are certain standards--and I
mention in here, for example, I think the Government should
make clear that electronic health records are ultimately the
property of the patient. They are not the property of the
insurance company. They are not the property of the doctor or
the lab. They belong to the person about whom they are
developed. It is a very important distinction from where we
have been in the past. And so I agree, Congresswoman Norton, I
think your point there is well taken. And my only observation
was to not have redundancy between two Government agencies.
Ms. Norton. We do not need to be regulators here. We need
to just make sure the standards are what they say they are.
On page 12 of your testimony, first of all, let me say I am
pleased to see that you agree that the guinea pigs should all
be willing. We are both enough of libertarians to understand
that, that we do not want to get into new controversy when we
are trying to get out of it with this--when we begin this.
I would like your views, frankly, Mr. Speaker, on how this
should be begun. I mean, I agree with you, here is a group of--
a rather closed group at that--people who use the same
insurance companies and the rest. You know, it is a very large
group, very varied group. They are a group of very high
political and educational consciousness, and they all work for
the Federal Government.
If you wanted to begin with the Federal Government, have
you given any thought to how you would approach the notion of
getting employees of the Federal Government to be those who
first cast out this notion with their own health care plans?
Mr. Gingrich. Well, let me say first of all that I think if
you look at what the Veterans Administration is experiencing,
they will tell you that they are very, very excited and happy
with the electronic system they have. They want to improve it
and upgrade it, but they really do believe it has been a
remarkable breakthrough, and it is a place where the Federal
Government has been a real leader in creating the technology--
--
Ms. Norton. But those are the veterans, not the employees,
I take it.
Mr. Gingrich. Right. But I think everybody who works with
it who is a Federal employee would tell you, they are for
having that kind of record. They have seen the power of that
kind of a record system. I think at TRICARE--and these are
Federal employees--Defense Department employees are now going
to have a, everyone eligible for TRICARE is going to end up
with an electronic health record. That is happening.
So in a sense, what you are doing is extending into the
private sector and into the private market for the civilian
Federal employees, something which is absolutely happening for
the Defense Department, for those people who are eligible for
TRICARE.
Third----
Ms. Norton. But many of those are veterans and their
families, right?
Mr. Gingrich. That provides active duty military,
reservists and retirees.
Ms. Norton. They always can make you do what they want to
do, but when you are dealing with a civilian work force where--
--
Mr. Gingrich. No. My only point is that these--again, I
agree with your point. I would certainly be inclined at this
stage to make it available, not make it mandatory. But I think
because the Federal employee work force is actually a pretty
smart work force, you are going to see an amazing number who
say, ``Yes, I want that,'' particularly when they look at 83
percent reduction in medication error. I mean the Federal work
force is not stupid. And they look at, OK, I can improve my
chance of not getting the wrong medicine by 83 percent. I can
improve my chance of managing my diabetes by 40 percent. I can
improve my change of managing my cholesterol by 100 percent. I
mean these are numbers from real studies in real medical
facilities around the country. So I think you will see a very
rapid migration in this direction.
I would hope that looking at this hearing, and looking at
conversations that I know that the Director of the Office of
Health Information Technology at HHS, Dr. Brailer, has had with
OPM, I would hope that when OPM issues their letter, I think
April 15th or so, asking for next year's bids, that they will
have provisions that are very parallel with this bill, that
they will be following carefully the leadership of Chairman
Porter and Congressman Clay in looking at how to make the--and
I would certainly hope they will take your advice,
Congresswoman, and do it in a positive way.
My experience has been, when I talk to people in the
consumer care area who are in the private sector, that
somewhere between a third and 90 percent of the work force in
blue collar factories choose electronic health records once
they understand the option, and that it grows very rapidly as
people talk to each other about why it is an advantage.
Maybe I am too optimistic, but as you know, that has always
been one of my weaknesses. But I am very happy to make it
voluntarily initially, make it incentivized, encourage them to
do it, and I think it will grow much faster than people expect.
Ms. Norton. I couldn't agree with you more. I don't think
you are being overly optimistic. I think you would have a
confluence of the young people in the work force, and the older
people in the Federal work force, for very different reasons,
and if anything, you would have more people perhaps than any
pilot of this kind could use.
Finally, let me say that I very much agree with you that if
we can find a way to deal in a bipartisan way, take the privacy
matters, take the technology matters, and feel comfortable with
them, that they--and Stark and anti-kickback laws removed or
considerably reformed, would do exactly what you say they would
do. From the point of view of the hospital, now having to
communicate with physicians in ways that hark back to the early
part of the 20th century, I do believe that the incentive for
them would be greater than the incentive for us.
So I thank you very much for all of the hard thinking you
have done in this area. It is typical of you, Mr. Speaker.
Mr. Porter. Mr. Clay.
Mr. Clay. Thank you, Mr. Chairman.
Let me echo too what my colleague has said. I appreciate
Speaker Gingrich's efforts and leadership in a national health
IT infrastructure, and helping to make that a reality.
Let me ask you about the Federal Government. Since we
administer the Medicare and Medicaid programs, what lessons can
be learned by the entire health care industry in terms of
improving the quality and efficiency of care provided to the
general population? Are we becoming more effective in
implementing programs that demonstrate positive results in both
public and private health care settings? And you also mentioned
to Delegate Norton that the VA has a model program as far as IT
and electronic health records. Maybe you want to expound on
that a little.
Mr. Gingrich. That is a very good question. Let me say that
probably the two largest pioneers at personal health records
were the Veterans Administration and Kaiser Permanente. Both of
them have very sophisticated systems. The VA system is now
based on a relatively old software, and so is the Kaiser
Permanent system, about a 15-year-old software. But there is no
question that it has worked and that it has provided a dramatic
improvement in quality of care.
The biggest lesson I think you learn out of this is that
when you can gather--two things happen--when you can gather
data about individuals, you can provide them much better
prevention, a much better chronic disease management, and they
take better care of themselves because they know their status
better, and the doctor can take care of them better.
Second, when you gather enough data on a depersonalized
level, you begin to see patterns. There is no accident that it
was the electronic health record at Kaiser Permanente that
first indicated Vioxx was a problem because they saw enough
different records simultaneously electronically that their
expert systems could say, wait a second, we have more people
showing up with heart problems than should be. So you suddenly
had them saying, wait a second, here is an early warning, that
in a paper-based system might have taken 3 extra years.
So it is the combination of more accurate information about
you personally and a better ability to survey the whole system
that really leads to these dramatic improvements. And I do
think, as a conservative who is often very critical of
Government, I do think you have to give the Veterans
Administration a lot of credit for dramatic pioneering in an
area that is very, very important.
Mr. Clay. Are we in a position today to quickly detect and
respond to major public health emergencies such as SARS and
cases of bioterrorism, given the challenges that remain in
health IT, and have the standards established through Dr.
Brailer's office brought better response capabilities to those
utilizing electronic health information systems and records?
Mr. Gingrich. I am probably more adamant about this than
almost anything we talk about, and I appreciate you asking the
question. I believe, if you look at the disaster of Katrina,
and the failure of the city of New Orleans and the failure of
the State of Louisiana, and the failure of the U.S. Government,
all three of which failed the people of that area--I say this
as a graduate of Tulane and my younger daughter was born in New
Orleans--I believe that there is no reason to believe that the
Federal Government today, or the State and local governments
today, are any better prepared for a major catastrophe of a
biological nature, an avian flu pandemic or an engineered
biological attack than they were prepared after Katrina.
I think that people are kidding themselves. Every day that
we don't have a 21st century virtual public health service that
ties together 55,000 drug stores electronically, every
veterinarian in the country, every dentist in the country,
every nursing home in the country, every doctor, every
hospital, and every retired doctor, nurse, pharmacist,
veterinarian and dentist, because if you had a real crisis you
would have to surge all of those assets in real time, and every
day you failed people would die.
Second, after you look at a 1,100,000 paper records--I
spoke to the American College of Cardiology on Monday in
Atlanta at their annual meeting. And they got a briefing about
New Orleans. We lost 1,100,000 paper records in the Gulf Coast,
1,100,000. Now, somebody who is getting chemotherapy for their
cancer suddenly had no records. And the fact that we are
sitting here a half year later and do not have a Federal bill
to create as a national security matter--remember, in 1955,
President Eisenhower said we needed a National Defense Highway
Act so we could build interstates so if we had a nuclear war
people could evacuate the cities. It is a dual use system.
Middle class people travel all over America. Trucks use it
every day, but it was originally designed as a national defense
matter.
The fact that we do not have today a national defense
health information infrastructure act, I think is an enormous
mistake. And if we get unlucky, we will lose several million
Americans for not having built the system. So I appreciate you
asking me that question.
Mr. Clay. Let me, just in closing, Mr. Chairman, out of
curiosity, if we eliminate all of this paper, what kind of
pushback do you think we will get from the paper mill industry
and logging industry? [Laughter.]
Mr. Gingrich. I have a number of friends in the paper
industry, and I want to assure you that they are confident that
the Government of the United States will find enough new ways
to generate paper. [Laughter.]
That none of them think they are going to become endangered
by the elimination of medical records. But I appreciate your
concern for them.
Mr. Clay. Thank you, Mr. Speaker.
Mr. Porter. Thank you.
Mr. Cummings, do you have any comments or questions?
Mr. Cummings. First of all, good afternoon, Mr. Speaker,
good seeing you again. I was just listening to you talk about
Katrina, and I thought about the will to do something like
this, the will to do this. You talk about the highways. It
sounds like this is a good start to do something that is very
positive, but I think what happens--and maybe you can help me
with this--is do you think the Congress does not have the will
to do these make-sense kinds of things that--I mean when we
look at Katrina and we see how bad off our emergency systems
were and are, when we consider September 11th and I guess we
all pretty much assumed that we were in a better position than
we were on September 11th, and we really don't see much
improvement since September 11th. And this is in no way
knocking Republicans or Democrats. I am just throwing this out
as a general concept. It just seems to me that we--somebody
told me, I will never forget, when I first ran for office, he
says--I was down like 15 or 20 points within 3 weeks of the
election, and this guy told me, he said, ``Look, I'm not the
campaign manager.'' He says, ``Most people know what to do to
win, but they don't have the will to do it, and they don't do
it.''
I think we know what we need to do, the things we need to
do, but it just seems like there is so much going on that
distract us--just like we were able to build a highway system,
probably some folks said full sped ahead, and got it done. I am
wondering, you know, how much faith do you have even if we put
something like this on the books, that it would happen?
Mr. Gingrich. Let me say first of all, I appreciate that
question more than you can imagine. I think it is very
thoughtful and I think it captures the great difficulty that I
had the 20 years I was serving actively. I think every
Government class in the country ought to read what you just
said, because you just captured the dilemma of the American
system. Let me break it into a couple parts.
First of all, the Founding Fathers wanted to avoid
dictatorship, and so they consciously designed a machine so
inefficient that no dictator could force it to work.
[Laughter.]
They did such a brilliant job we can barely get it to work
voluntarily, and they would look down and say, ``That is
exactly right.'' This is part of--days when I am about to go
crazy, I just laugh and remind myself, Washington and Franklin
and Madison and all those guys are really happy because this is
really hard.
Second, we are at one of the great turning points in
American history, and you nailed it just now. And I would
immodestly suggest if you go to my personal Web site, Newt.org,
there are two papers there. One is on 21st century
entrepreneurial public management, and the other is on
transforming the legislative branch. The point I make there is
exactly your point at a core level. The system is broken. I
describe it as that we have inherited this box, and this box is
an 1880 male clerk sitting on a wooden stool with a quill pen
and an open ink well. That is the Civil Service Act. It is 125-
years-old. Modified by a 1935 New Deal bureaucracy, where you
use a manual typewriter with carbon paper.
I was telling the administration just last summer--because
I developed this model originally looking at Iraq and the
global war on terror, and I was going around before Katrina
saying, ``We are going to have a catastrophe,'' because this
box doesn't work.
I would say to you, if you look at FEMA's total failure,
you look at the current SBA problems, and you look at the Corps
of Engineers, the fact that the Congress is not doing
aggressive oversight--and let me say this as a Republican--I
don't care if we have a Republican President, our Constitution
is designed to have very aggressive oversight by the
legislative branch because it is the only way the system works,
just as, by the way, I think the President should occasionally
veto things because it is the only way you retain balance. The
system is designed for this conflict. But you all should be
right now taking apart FEMA and rebuilding it. You should be
taking apart the Small Business Administration and rebuilding
it. You should be taking apart the Corps of Engineers and
rebuilding it, because, I mean, how much more evidence do you
need than the last 6 months? So I think you and I are close
together.
What I am intrigued with is these things take time.
Remember, I cited the Eisenhower 1955 proposal for an
interstate highway system. Eisenhower wrote a book called ``At
Ease: Stories I Tell My Friends,'' and in one of the stories he
had in that book, he said in 1919 he led the Army's first
transcontinental truck expedition. And he remembers sitting
on--actually in your State, Congressman Porter--he remembered
sitting under the stars in Nevada, having crossed a stream,
imagining to himself what it would be like to have highways
that connected the whole country. 36 years later, as President,
he proposed that system.
These things sometimes take time. I am up here, cheerfully
optimistic, because I think with your leadership we are going
to get electronic health records for Federal employees, and
that is going to be a major break in the system. And by the
way, by the time you take care of the hospitals and doctors and
take care of Federal employees, you just took care of 50
percent of the doctors and hospitals in the country, and from
the standpoint that legitimately I would hope a number of you
have for the disparities and outcomes, you get to an electronic
health record--and we worked very closely with Morehouse
Medical School and Dr. David Sacher, Dr. Elizabeth Ofili on
this. We are going to dramatically reduce the disparities and
outcomes if we have electronic health records. I mean these are
a big breakthrough.
So what you are doing may be a building block toward a
dramatically bigger future, but that was a great question and a
great observation, and you put your finger on a big deal.
I will say one last thing. I had a great honor yesterday.
The State of Florida, the House of Representatives down there--
they only have a 9-week session--they took an entire day off to
have a workshop for all their members on transforming health in
Florida, and it was very interesting how they did it. It was a
very powerful moment of everybody stopping, you know, no packed
fundraiser, no running off to constituents, no 205 other
assignments. And we had a ton of members of the Florida
Legislature deeply engaged in learning and talking and
thinking. It was a very encouraging moment.
Mr. Cummings. Thank you.
Mr. Porter. Mr. Van Hollen.
Mr. Van Hollen. Thank you, Mr. Chairman. First, let me
thank you, Mr. Chairman, for introducing this piece of
legislation because I do think it is a very important
conversation to start. The conversation has begun, but this is
an example of something we can maybe move forward on as an
example from the Federal Government. As I told you yesterday, I
think using the Federal program to begin to push others in the
country in the right direction is a good idea, and, obviously,
the details need to be worked out and there are a lot of
important details to be worked out.
Let me also thank you, Mr. Gingrich, for your many ideas
you have had in the area of health care recently. I don't
always agree with every one, but I have to tell you, the more
ideas that are churning out there, the better off we will be as
a Nation, because I think this is an area, as I know you have
said, where we can have dramatic improvements going forward. I
agree that Congress needs to be more aggressive in its
oversight in a whole range of areas, and I think the question
of competence is something that the American people are going
to come to value even more highly than they already do, and as
a Government, whether it is Republican or Democrat, we owe them
a higher degree of competence than we have seen in many recent
instances.
Let me ask you, with respect to just some of the--and I
don't know if you have had an opportunity to look at the
details of the bill--but one of the issues is whether or not
you are going to allow people to voluntarily opt into this
system, or whether you are going to set it up so they are
required to automatically be enrolled, and given the fact that
the Federal Government is launching an experiment in this area,
and the fact that a lot of people are concerned about the
privacy implications of electronic records, do you have a view
on that question?
Mr. Gingrich. I was earlier associating myself with
Congresswoman Norton's position because--and I say this at a
practical level--if we try to impose, and we arouse all the
privacy advocates and we arouse all of the Federal employee
unions, that will slow this bill down so much, that if we can
get it to be voluntary in Phase I, I think we will actually
have more people signed up in the length of time it would take
to fight the bill through if you have a lot of opposition. So I
would rather make it a voluntary system. I did suggest the
incentive of saying to the plans we would pay slightly more in
the 3rd, 4th and 5th year if it is an electronic record and
slightly less if it is a paper record, and that would
incentivize the plans to encourage people to join.
But I think you are going to get--if you look at e-
ticketing nowadays at airports, you know, Americans aren't
stupid. As Americans learn--and I said it earlier, examples of
83 and 85 percent reduction in medication error, that saves
your life; 40 percent improvement in diabetes management, that
saves your life; 100 percent improvement in cholesterol
management. These are case studies in places that have used
these records. Federal employees are smarter. They are a very
smart group collectively, as you know, and I think they will
talk to each other. Within 3 or 4 years it will be in the high
90's. And I think, frankly, if the last 3 percent would rather
have paper and risk dying, that is their prerogative as a free
people.
Mr. Van Hollen. Thank you. I think you are right. I think
the amount of resistance you are going to get is not worth the
effort, and I think that people will see this as a good thing
and voluntarily do it.
We don't have a lot of time. What is going on--and I
apologize, Mr. Chairman for being late. We had a briefing in
the Judiciary Committee.
But in the private sector, to what extent is there
movement? How rapid is the movement in this area, and where do
you predict that going, and how important do you think it is to
move forward in this area in order to get the rest of the
market to move?
Mr. Gingrich. You are asking the right question. First of
all, there is enormous movement in this area. There is a
tremendous new program at the University of South Florida,
which I was just getting briefed on yesterday in Tallahassee.
There is a big project by Humana and Blue CrossBlue Shield of
Florida called Availity, which will cover a third of the people
of Florida, and if they had Medicaid will be over half the
people of Florida. Kaiser Permanente has 13 million health
records nationwide that are electronic. The Veterans
Administration has about 13 million health records that are
electronic. As you go around the country, Peace Health in
Oregon, Washington State and Alaska, has about 1,400,000 health
records that are electronic. So as you go around the country
you just see the momentum beginning to build in that direction.
One of the things I am passionate about is modifying Stark
and anti-kickback so that hospitals can provide free health
information technology equipment to doctors they are legally
barred today from doing. They can't even provide it to each
other. So, for example, the largest hospital in western
Michigan would probably provide health information technology
to all the small rural hospitals in the upper peninsula, but it
is currently illegal under Stark and anti-kickback. Well, that
is utterly irrational.
The Federal Government, unfortunately, is not going to pay
for it. As a national security matter I would have the Feds pay
for it and get it done in 2 years. If they are not going to pay
for it, the easiest source of sophisticated capital is the
hospitals. They actually save enough money, if patients are
transferring in electronically rather than in paper, they save
a lot of money on unnecessary labs that don't need to be taken.
So I would encourage you to look at that as a major component
of this.
Mr. Porter. Thank you very much. Mr. Speaker, we appreciate
you being here. Once again, it was an honor to have you here.
We look forward to working with you. Thank you.
Mr. Gingrich. Thank you.
Mr. Porter. In the element of time I am going to combine
actually the second and third panel, so if both panels will
come forward, please, we will have a chance to get the table
set up.
We will start with Mr. David Powner, who is Director of
Information Technology Management Issues, Government
Accountability Office. We will then have Dr. Jane Barlow, Well-
being Director, Health Benefits Operations with IBM; then have
Mr. David St. Clair, founder and CEO of MEDecision, Inc. Dr.
Edward Ewen, Jr. was going to be with us, but had to take care
of a patient. Dr. Paul Handel will be next, who is vice
president and chief medical officer, Texas Division, HCSC;
Jeannine Rivet, executive vice president of United Health Group
and then Dr. Malik Hasan, who is CEO, Health View, retired CEO
of Health Net. So we will start with Mr. Powner.
STATEMENTS OF DAVID A. POWNER, DIRECTOR, INFORMATION TECHNOLOGY
MANAGEMENT ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE; JANE
F. BARLOW, M.D., MPH, MBA, IBM WELL-BEING DIRECTOR, GLOBAL
WELL-BEING SERVICES AND HEALTH BENEFITS, THE IBM CORP.; DAVID
ST. CLAIR, FOUNDER AND CHIEF EXECUTIVE OFFICER, MEDECISION,
INC.; PAUL B. HANDEL, M.D., VICE PRESIDENT AND CHIEF MEDICAL
DIRECTOR, BLUE CROSS BLUE SHIELD OF TEXAS (A DIVISION OF HEALTH
CARE SERVICE CORP.); JEANNINE M. RIVET, EXECUTIVE VICE
PRESIDENT, UNITEDHEALTH GROUP; AND MALIK M. HASAN, M.D., CHIEF
EXECUTIVE OFFICER, HEALTHVIEW, RETIRED CHIEF EXECUTIVE OFFICER,
HEALTH NET
STATEMENT OF DAVID A. POWNER
Mr. Powner. Chairman Porter and members of the
subcommittee, we appreciate the opportunity to testify on
health care information technology. As we have highlighted in
several recent reports completed for Chairman Davis of the full
committee, significant opportunities exist to use technology to
improve the delivery of care, reduce administrative costs, and
to improve our Nation's ability to respond to public health
emergencies. This afternoon I will briefly describe the
importance of information technology to the health care
industry, discuss key Federal leadership efforts to bolster the
adoption of IT, and highlight key aspects of your proposed
legislation, Mr. Chairman, that are critical to achieve the
President's goal of a nationwide implementation of
interoperable health care systems.
Information technology can lead to many benefits in the
health care industry that we have reported on over the past
several years. For example, using bar code technologies and
wireless scanners to verify the identities of patients and
their correct medications can and has reduced medical errors.
In addition, surveillance systems can facilitate the timely
collection and analysis of disease-related information to
better respond to public health emergencies. Its standards-
driven electronic health records have the potential to provide
complete and consistent medical information necessary for
optimal care.
Just last month, the Select Committee that investigated
Hurricane Katrina concluded that the lack of electronic health
records contributed to difficulties and delays in medical
treatments to evacuees. Fortunately, several efforts led to the
development of a Web-based portal to access prescription
information for these evacuees. This highlights the importance
of electronic records with even limited information, which was
made possible when commercial pharmacies, health insurance
programs and others made accessible key prescription data.
Several major Federal health care programs, including
Medicare, Medicaid and OPM's Federal Employees Health Benefits
Program provide health care services to over 100 million
Americans. Given the Federal Government's influence over this
industry, Federal leadership can lead to significant change,
including the adoption of IT. Given this, in April 2004,
President Bush called for the widespread adoption of
interoperable electronic health records within 10 years, and
established the position of the National Coordinator for Health
IT.
Although the coordinator has issued a framework,
established working groups of industry experts and awarded
contracts to define a future direction, we have testified and
recommended that the National Coordinator: one, establish
detailed plans and milestones to carry out the President's call
for interoperable health care records; two, complete detailed
plans with private sector input for defining standards to
enable interoperability of data and systems; and three, to
fully leverage the Federal Government as a purchaser and
provider of health care.
Turning to your proposed legislation, Mr. Chairman, I would
like to commend your action to leverage the Office of Personnel
Management as one of the largest purchasers of electronic
health benefits to advance the creation of electronic health
records. The Federal Employees Health Benefits Program has over
8 million beneficiaries and advancing electronic health records
to this critical mass would be significant. Your focus on
electronic health records is critical since they are a central
component of an integrated health information system. In
addition, they have the potential to reduce duplicative tests
and treatments, and could lead to reductions in medical errors.
Another key aspect of your proposed legislation, Mr.
Chairman, is its focus on adopting standards that are
consistent with the National Coordinator's efforts. IT
standards are critical to enable interoperability of data and
systems, and it will be especially important if carrier-based
records are to be interoperable with provider-based
information.
We remain concerned about the development of such standards
and highlighted these concerns before Chairman Davis at a full
committee hearing last fall. Although the identification of
standards continues to be one of the major focus areas for the
National Coordinator, to date, the standard-setting processes
have resulted in conflicting and incomplete standards, and the
consensus on the definition and use of standards remains a work
in progress.
Hopefully, the standard-setting initiatives will gain
momentum in the near future so that provisions of your bill
calling for these standards can be carried out.
In summary, Mr. Chairman, efforts like your proposed
legislation that provide tangible solutions to jump start
adoption rates of electronic health records, and that leverage
Federal programs and resources are critical to carrying out the
President's goal.
This concludes my statement. Thank you, Mr. Chairman, for
your leadership in driving this much-needed technology.
[The prepared statement of Mr. Powner follows:]
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Mr. Porter. Thank you very much.
For those who are here for the first time at a
congressional hearing, understand that Members will come and go
for different committee hearings happening at the same time. We
may even be called to vote on the floor here at some point. But
know that your testimony is very valuable and is a part of the
record being scrutinized by a lot of folks. So we appreciate
you being here. The number of people here today is not a
reflection of the importance of this issue. It is just the
process with multiple committees happening at the same time.
Dr. Barlow, welcome.
STATEMENT OF JANE F. BARLOW, M.D.
Dr. Barlow. My name is Jane Barlow. As well as being
Director for IBM's Health Benefits Operations, I am responsible
for the delivery of $1.7 billion in health care to over 500,000
IBM beneficiaries in the United States each year. I appreciate
the opportunity to testify on behalf of IBM in support of this
important legislation.
IBM's strategy in health benefits is simple. We focus on
health people for high performance. This strategy underscores
investment in health to realize the productivity and innovative
potential of our employees. The personal health record is
critical to achieving this goal.
In 2005, IBM announced that it would provide personal
health records to its entire U.S. work force. To set up the
records, employees enter information in a secure Web site. They
input such things as medical conditions, family history,
medications and allergies. Later this year, their personal
health record will automatically import their medical and
prescription drugs claims history. The ultimate goal is to
enable all types of health information to flow into the record
to form a comprehensive portable portrait that the patient can
access when they desire and share with their provider when they
choose.
Since we rolled out personal health records late last year,
over 45,000 IBM employees have signed up. It is important to
note we are not creating new information. The carriers have
always collected claims data. It is how they pay bills. But the
personal health record will allow our employees to look at
their comprehensive claims history, many for the first time. I
believe electronic health records will drive two changes in
health care. First, they will increasingly make health care
organize around the patient; and second, electronic health
records and their related systems will improve our employees'
interaction with their doctor.
Let me explain. The personal health record empowers
consumers with the information they need to actively manage
their health and health care. As a result of the personal
health record, our employees are asking more questions about
cost and quality. With this broader personal health history,
they are able to have a collaborative relationship with their
physician that extends beyond the day's illness to address the
most important health needs for that individual. This informed
relationship with their provider is critical to improving
health care quality and reducing costs.
With the aid of electronic health records and the tools to
support them, providers will have all the information about a
patient and can focus on the most important health issues for
that patient across the continuum of care.
Let me give you an example of feedback I received from a
happy employee. This employee reported suffering depression for
most of her adult life. As a result of participating in our
disease management program, she was able for the first time, to
work with a provider who had a comprehensive view of her
medical history and other personal factors. They were able to
identify a successful treatment plan for her, and she reported
that this had totally changed her life, and for the first time
in 18 years she felt fully alive and productive.
My hope is that the personal health record will afford this
opportunity for every patient.
Provider adoption of personal health records is key. While
the legislation establishes some incentives, reforms and
reimbursement and additional sources of funding will have a
dramatic impact on the adoption and value of the electronic
health records created by the act. Finally, this bill will help
lead the critical transition to digital health care by allowing
the exchange of health information in standard electronic
formats.
IBM strongly supports the use of standards. We believe
standards are critical and necessary to ensure providers and
patients have the information they need.
In summary, personal health records will drive a more
innovative and efficient patient-centric system. Personal
health records are the foundation of a standardized
infrastructure for the electronic exchange of health care
information, one that enhances the ability of providers to
deliver high-quality care.
Finally, improving the health and wellness of a work force,
whether at IBM or across the Federal Government, is a strategic
investment that can pay substantial dividends, promoting
greater economic competitiveness and capacity to innovate.
Thank you.
[The prepared statement of Dr. Barlow follows:]
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Mr. Porter. Thank you, Dr. Barlow.
Next we will have Mr. St. Clair, founder and CEO of
MEDecisions.
STATEMENT OF DAVID ST. CLAIR
Mr. St. Clair. Good afternoon, Mr. Chairman. Thank you for
inviting me to testify before this subcommittee today on what
we consider to be a very important topic.
As you said, I am David St. Clair, Founder and CEO of
MEDecision. We are the recognized market leader in
collaborative care management solutions for the health care
industry. Our clinical systems are used nationwide to help
coordinate care for about one in every six insured people in
this country, including millions of Federal employees and their
families.
I am here today representing two other organizations as
well. I am here on behalf of HIMSS, the largest trade
association for health information technology, and I am here as
the spokesman for the CollaboraCare Consortium, an alliance of
16 innovators in the emerging regional health information
market.
We believe that electronic health records will really
improve the way health care is delivered in this country. Using
technology to facilitate collaboration among health care
stakeholders will result in the right information reaching the
right people at the right time, which can improve lives,
indeed, save lives, and make health care more affordable in the
process.
We need not wait until physicians and other providers fully
embrace the use of electronic medical record systems in their
practices. Sharing information that already exists within payer
repositories, with individuals and their care team can improve
health care outcomes.
For these reasons, MEDecision, HIMSS and the CollaboraCare
Consortium, enthusiastically endorse the Federal Family Health
Information Technology Act of 2006.
There are just a few points I would like to emphasize in my
testimony today, and as you will hear, many of them really
speak to the notion that of the things that are called for in
the proposed legislation are already well under way in the
private sector.
My first point is, our success at creating and deploying
carrier based health records, which we call the payer-based
health record [PBHR], has already demonstrated the value of
those records at the point of care. In his written testimony,
Dr. Ed Ewen, a practicing physician with the Christiana Care
Health System in Delaware, and their head of Clinical
Informatics, underlines his belief that the information in the
Blue Cross Blue Shield of Delaware PBHRs, being used in the
Christiana Care Level 1 Trauma Center, has, one, improved the
quality of care being delivered to patients in need. For
instance, they found that the PBHR gave them substantially
more--their quotes--medication information 48 percent of the
time than they had through any other means. And two, that
effort has decreased the cost of that higher quality care.
The key to understanding the value of carrier-based health
records is illustrated in the graph on my left. We have laid
out the population. This data is from the 3.7 million health
records we created last month for the Blue Cross Blue Shield of
Illinois population. We have laid them out based on their
relative burden of illness. As you can see on the left, the
sickest 5 percent of the population, which represents, by the
way, over 40 percent of the total health care spent for this
population, have, on average, 11 different medical conditions,
including three chronic care conditions, and those individuals
have taken 13 different classes of medications and seen 9
different providers of care within the past year.
This population, more than any other, is in need of
assistance in bridging the information gaps or the information
chasms evident in the medical community today. Just one of
these patients generates raw claims data that fills 60 pages
that I have in my hand here today. What we have as a technology
challenge and clinical challenge is to reduce that to the four-
page summary that we are using today in the State of Delaware,
and soon in the State of Illinois.
My second point, the technology we use have been creating
valuable information from payer data for over 10 years. In 2001
we started using the PBHR to support case and disease managers
as they worked with those individuals with the chronic
diseases. For instance, Blue Cross Blue Shield of Massachusetts
uses the payer based health record to drive their disease
management programs both through telephone contact and tailored
correspondence.
Third, if you direct your attention to the second graphic
here, our belief, since I started the company 18 years ago, is
that we need to be able to share a composite view of a
patient's history with all members of the care team, the
patient themselves to help with their own decisionmaking, with
the clinical staff who are actually treating the patient, and
with the care managers, the case managers and disease managers
who are helping coordinate their care. While there will still
be decisions to make and perhaps disagreements, at least we are
all starting with the same basic information.
Fourth, last year, in anticipation of the destruction of
Hurricane Katrina, we partnered with Blue Cross Blue Shield of
Texas, and created 830,000 payer-based health records for the
potential evacuees along the Texas Gulf Coast in 4 days. When
Rita stormed ashore, Blue Cross Blue Shield of Texas was ready.
This year we have created 3.7 million payer-based health
records for the membership of Blue Cross Blue Shield of
Illinois in 4 weeks. We will be extending that capability
across the populations for Blue Cross Blue Shield of Texas, New
Mexico and Oklahoma, all for their parent company, Health Care
Services Corp.
We and the physician executives of HCSC--and you will be
hearing from Dr. Handel in a few minutes--will be working with
the provider communities and consumer advocates to roll out
secure access to these records by the members and by the
physicians who treat them. Our success with the project in
Delaware we replicated on a much broader scale with 10 million
records available nationally. I want to point out that
represents 3.3 percent of the U.S. population who will have
electronic records available from one payer in 1 year.
Finally, that brings me to the last point, access and cost.
The PBHR, whether enhanced by PHR data or not, will improve the
quality and safety of health care for virtually everyone who
participates. We strictly adhere to HIPAA privacy and security
regulations and allow individuals to opt out of the program if
they have privacy concerns. In addition, we implement data
filters that respect State law, prohibiting the sharing of
certain classes of information. The key for adding a voluntary
PHR--and we have five such partners in the CollaboraCare
Consortium--is it will allow consumers who wish to share all
their data, some of their data, or none of their data to
control that process at a granular level.
The technology and delivery infrastructure is very
inexpensive when used across a broad population. Based on our
experience in Delaware, we would project that the PBHR and PHR
programs being called for in the legislation will cost well
under $1 per member per month for that coverage, which
represents a very small fraction of the monthly premium for
those particular individuals.
Thank you very much for the opportunity to testify before
the subcommittee today. I am prepared to take any questions you
may have.
[The prepared statement of Mr. St. Clair follows:]
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Mr. Porter. Thank you very much.
Next we have Dr. Paul Handel, who is the vice president and
chief medical officer Texas Division, HCSC. Welcome.
STATEMENT OF PAUL B. HANDEL, M.D.
Dr. Handel. Chairman Porter, thank you very much for
inviting Health Care Service Corp. to submit formal testimony
on the electronic health record.
I am Paul Handel. I am a doctor with approximately 40 years
of clinical experience in caring for and caring about patients.
At the present time I am vice president and chief medical
officer, Blue CrossBlue Shield of Texas, a division of Health
Care Service Corp. My testimony today will reflect the position
of Health Care Service Corp. I am not representing the Blue
Cross Blue Shield system in any fashion.
HCSC is a non-investor owned company that operates through
four divisions in Illinois, Texas, New Mexico and Oklahoma. We
cover approximately 10 million lives, and we are now the fourth
largest carrier in the country. We firmly believe that
electronic health records can benefit health care in the United
States by increasing the accessibility to quality care and
making health care more affordable.
The record, the electronic health record, as your own
experience that you related about your mom, and David talked
about a few moments ago, really looks toward our elderly
population and the sickest part of our population, which
consumes the vast majority of our health care resources. These
people are invariably unable to give concise histories because
of either age, underlying conditions or perhaps even their
medications. They also have a team of physicians that are
caring for them. They have multiple ancillary providers that
are involved, and their histories become relatively unclear.
Without a question, collating the data for these people will be
instrumental in improving their health care.
Additionally, the connectivity that we are envisioning here
will facilitate the education and the provision of preventive
services to all of our population, and, candidly, in the big
picture, that will address what I think is a graver, much
larger issue, and that is the spiraling increase in our health
care costs.
We have a large data base of electronic information. We
realize the value this data has on the development of
electronic health records, and for our own members in
particular. We have already begun to focus on providing claim-
based personal health records to our members because we believe
it is an extremely effective way to positively impact their
outcomes.
I want to emphasize that we are just now beginning to learn
what information is useful, and how do we educate consumers,
physicians and other providers as to the value of the
electronic health records. The flexibility to continue to
innovate is absolutely imperative.
We have heard a fair amount of discussion today from
everyone concerning Katrina. I can tell you that in Texas, we
lived through over 300,000 people coming to Texas as refugees
without any health care information. Most of them could tell
their doctors they were taking a blue pill, a yellow pill, they
had received treatment for cancer, but they didn't know what
drugs they were taking. It was a real debacle.
As we prepared for Rita, we prepared within 4 days time,
from a Thursday morning to Monday morning, patient clinical
summaries on 830,000 patients across the Gulf Coast, and into
western Louisiana. We partnered with the Texas Medical
Association, and on Monday morning, 4 days after starting our
efforts, we were able to put forth an 800 number by either e-
mail or blast fax to over 40,000 Texas doctors, a contact point
where they could get the patient clinical summaries if anybody
had been displaced and showed up in their practices.
Our success in creating the electronic plan-related health
records for the hurricane victims really pushed us forward to
roll out our records to all of our members in HCSC. We will
start the program in Illinois with approximately 3.7 million
members, and continue to roll that out through the remaining
divisions over the course of the year.
The core reason why we began to implement a health record
like this for our members is that we will not consider saving
money or reducing medical errors, but on a higher level, to
ultimately improve the accessibility to quality and affordable
health care for all, and parenthetically, in the process, we
will probably save money and reduce medical errors.
In conclusion, I would like to stress the importance of
allowing health plans to continue to create innovative products
with the flexibility to make changes that meet local customer
needs and market demands. We agree with the need to utilize
technology to establish uniform standards for health data,
facilitating interoperability, efficiency of communication and
safety. We believe that implementing a payer-based health
record is the right thing to do. We will continue to pilot
projects for developing various means of electronic
transmission of plan-related health information in this way. We
feel that other carriers will find the most successful features
to create value and usage for the personal health records.
Thank you very much.
[The prepared statement of Dr. Handel follows:]
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Mr. Porter. Thank you very much, doctor.
Next is Jeannine Rivet. I hope I pronounced your name
right. Executive vice president, UnitedHealth Group. Welcome.
STATEMENT OF JEANNINE M. RIVET
Ms. Rivet. Good afternoon, Chairman Porter. I appreciate
the opportunity to share with you our experiences in offering
personal health records to the consumers that we serve. I am
Jeannine Rivet, executive vice president of the UnitedHealth
Group, a diversified health and well-being company, dedicated
to helping people achieve improved health and well-being
through all stages of their lives.
UnitedHealth Group's family of businesses offers a broad
spectrum of products and services to approximately 65 million
individuals nationwide, everything from commercial health plans
to Medicare offerings such as Part D drug plans, Medigap,
Medicare Advantage Plans, Medicaid services, health analytics
and informatics, and specialty solutions such as nurse triage
services, centers of excellence, dental, vision plans and
behavioral coverage.
To our UnitedHealth business we also offer health benefits
to Federal employees and annuitants under the Federal Employees
Health Benefits program, 14 States and the District of Columbia
with more than 322,000 members enrolled in our various plans.
At UnitedHealth Group we have invested heavily in technology as
part of our efforts to advance the quality of care provided to
individuals and to improve the efficiency of our health care
system. Our investment in technology allows us to provide our
plan members with comprehensive information about the cost and
effectiveness of different treatment options, as well as to
help them find the highest quality providers. This type of
information, we believe, is critical to improving outcomes and
to enabling consumers to maximize the value they receive for
their health care dollar, and to more easily manage their
health care.
One of the primary ways we provide this type of information
to our members is through our consumer Web site, myuhc.com.
Members can log onto UnitedHealth's Web site and find top-
performing providers who meet objective quality and efficiency
criteria, or find information on hospital quality for more than
150 procedures. They can order prescription refills and they
can compare the cost of drug alternatives, and receive monthly
statements providing explanation of benefits for all services.
Last spring, we expanded our Web site capabilities by
integrating a personal health record that gives consumers
greater access to and control over their health care data so
that they can make informed decisions. Through myuhc.com, which
is a secure Web site that protects the privacy and security of
members' data with user names and passwords, our members can
use their personal health record to view their full history
based on claims data, store information on their medical
histories, as well as contacts with health care practitioners
and upcoming appointments, receive condition specific alerts
and appointment reminders, enter and track clinical data such
as glucose levels and blood pressures, as well as their own
information and lifestyle behaviors such as weight and sleep
habits, and they can enter notes, reminders and personal
observations.
In addition, members have the option of giving their
physicians and family members access to their personal health
records including access to their personal health summary,
which is a printable health summary, detailing the most recent
conditions, medications, procedures and lab results, which is
viewable online or through swipe card technology.
Currently, about 4\1/2\ million consumers have access to a
personal health record through our Web portal. We too have a
Hurricane Katrina example regarding the impact and positive
results from having a personal health record. Within the
greater New Orleans area we were a critical resource to our
members. They use their personal health records to reestablish
health care records including medical, lab, pharmacy and
immunization records with their physicians' offices since many
of the physicians were dislocated, or their offices were
flooded and the data was lost.
As part of our effort to design a responsive personal
health record, we conducted a number of in-depth telephone
interviews and focus group sessions with consumers, physicians
and employers. We gathered some very helpful information
through these efforts. Some common themes were: accessibility,
portability and convenience are key benefits of a personal
health record. Primary concerns, not surprisingly and already
noted, were Internet security, privacy and accuracy of data.
And everyone felt that the personal health record would enable
the patient-physician interactions. Consumers had a very
positive response to the concept and were open to using
personal health records. Physician awareness was mixed. Once
the personal health record concept was explained, physicians
responded favorably. However, noted concerns regarding the cost
of the personal health record and the possibility that patients
may be able to block out information from the health care
provider.
Their concerns over the cost of personal health records
verified the need for incentives for adoptions such as the one,
Chairman Porter, that your bill contains. Employers have
limited awareness or experience with a personal health record.
However, again, once explained they saw value, primarily for
their employees, but less value for themselves as the employer.
And all consistently recognized the need for further education
on ease of use, benefits, security and confidentiality.
Based on our experience and research, we continue to refine
our direction, focusing on enhancing the consumer position
relationship. Also we have identified a number of requirements
for facilitating widespread adoption that you may wish to
consider as you move forward with your efforts to expand use of
personal health records in the FEHB program. Most important, a
strong and consistent information and education campaign that
clearly shows the value of using a personal health record, as
Ms. Norton referenced earlier. Also a tailored consider
experience, which is organizing data and features in a manner
that makes it easy to navigate and access information of
choice, with health information displayed and described in ways
that are easy to understand.
Secure and private infrastructures and processes are
critical. Accurate and timely information will build trust and
credibility. Flexibility is needed to address consumer needs,
preferences and desires. Fully integrated records to create
easy access for the individual. And we agree with you, Chairman
Porter, interoperability with provider office technology is
necessary.
In closing, let me say that at UnitedHealth Group we are
confident that the use of appropriately designed personal and
electronic health records will make a significant difference in
improving health outcomes for individuals, and will make it
easier for them to manage their health care effectively. That
is why we have invested considerable time and resources.
Chairman Porter, we appreciate your leadership on this very
important matter, and thank you for the opportunity to share
our experiences with you today, and I would also be happy to
answer any questions you may have for me.
[The prepared statement of Ms. Rivet follows:]
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Mr. Porter. And we thank you for being here. We appreciate
it.
Next, Dr. Malik Hasan, CEO of HealthView, and retired CEO
of HealthNet. Welcome.
STATEMENT OF MALIK HASAN
Dr. Hasan. Thank you, Mr. Chairman, and let me thank you on
two counts: first, for allowing me to present my view; and,
second, I am also your constituent and voted for you.
[Laughter.]
And it seems like I voted right. I am very happy with my
vote.
Mr. Porter. I may ask you to say that again someday, so
don't forget that, OK? Thank you.
Dr. Hasan. As you will notice from my bio, I have had a
very diverse experience in the delivery of health care in the
United States. I have firsthand observed the flow of
information and the current limitations in physician offices--
because I used to run a physician office--hospitals, because I
was involved in the operation of a hospital, also the free-
standing facilities, and was the founder and operator of a
major health plan. The experiences allowed me to observe the
gaps in care. Such gaps result in poor coordination of care
with the resultant poor and expensive care. Resources are very
poorly utilized.
The introduction of the electronic health record, as
envisaged in this bill, will start bridging those gaps and
commence the transformation of the health care delivery system
which is sorely needed, because it is not just the Federal
employees. Once the carrier starts a process for Federal
employees, they will also extend it to their other employee
groups and other members, thus starting a snowballing effect.
The features of the electronic health record as described
in this bill are essential to achieve the goals which are
envisioned in this bill. The bill allows the creation of a
longitudinal record, starting with the carrier's input and
entries by the consumer and additional information imported
from the provider's EMR, thus providing ultimately a very
complete medical record which is important for the continuing
care of the patient. This will also provide prompt and accurate
access to a medical record in an electronic format to the
patients and, more importantly, also the providers who are not
familiar with the patients, with better understanding of the
problems and their management. This electronic record provides
a record which, as I mentioned above before, is going to be
very important for the continuing care of the patient.
In addition, the integration of the SNOMED--and this
alphabet soup stands for Systematized Nomenclature for
Medical--I am blocking on the full name. But it is in my
written testimony--allows the information to be encoded as
opposed to being just text. And it allows for its proper
arrangement and organization within the record. It also
enhances the privacy feature because the information is
encoded. You can basically rifle-shoot which information should
be available to whom as determined by the patient, rather than
giving full access to the record.
The encoding of data through SNOMED is described more fully
in attachment two. It will take too much time for me to go over
that here. It would in the future also allow outcome
measurements leading to standards for evidence-based practice
of medicine, population-based studies, profiling the providers,
and making it much easier and cheaper to conduct drug trials.
One of the problems with the drug trials is that the FDA
considers that anytime they are going to approve something, it
is going to be in the public domain and, so to speak, can be
withdrawn, nobody is going to look at it. On an electronic
record, you can survey, keep on the surveillance, and pull out
the medicine as soon as some red flag arises.
SNOMED also allows the patient to have full control over
the records and fully protect the privacy. So far, any attempts
at reforming health care have invariably centered around the
reform of health care financing rather than addressing the root
causes of poor and expensive care. This legislation is a joint
step toward elimination of the barriers to the high-quality,
cost-effective care.
We are fortunate to have the finest physicians and
hospitals, but this advantage is compromised because of a lack
of electronic health record. The absence of an electronic
health record creates an environment that prevents proper
coordination of care, allows ignorant care, and even worse,
inappropriate care, which is duplicative, wasteful, and allows
serious errors. This legislation will go a long way in
eliminating all those sins of commission and sins of omission.
Thank you, Mr. Chairman, and I am prepared to answer any
questions.
[The prepared statement of Dr. Hasan follows:]
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[The prepared statement of Dr. Ewen follows:]
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Mr. Porter. Actually, you are all going to be lucky because
we are going to be called to vote here shortly, so there is not
time for a whole lot of questions. But we are going to be
giving you questions, if you could submit within 5 days some of
the responses.
I want to make a comment, and then I am going to ask a
question. I met with a veteran the other day, and I know we
have talked about the Veterans Administration here really at
length today. He is probably in his mid to late seventies, and
he actually was here with the Veterans of Foreign War, as they
traditionally come this time of year to talk about veterans
issues. And one of his colleagues was a doctor, and I just
happened to mention this bill that we are talking about today.
And the gentleman that I am referring to that was in his late
seventies, he had a huge smile on his face. And he said, ``You
know, I am now receiving care through the Veterans
Administration,'' and he started bragging about the personal
health record. He went on and on and on, on how he could
communicate with his doctor, he could read it, he knew
exactly--and as Speaker Gingrich said, he had ownership. It was
a tremendous example of what I am hoping every American will be
able to have to take advantage, hopefully with this bill's
passage, moving it along much faster than originally
envisioned.
But having said that, I wanted to share that with all of
you, that this is a real person, a real veteran with real
health problems, that is just so excited to break down these
barriers and have ownership of his own health care. But with
the limited time, I would like to ask Mr. St. Clair a question.
We talked about the system being voluntary or an opt-out. Would
you comment, with your expertise in this area, on that
particular portion for the participant, please?
Mr. St. Clair. Certainly, Mr. Chairman. I was interested in
Speaker Gingrich's remarks around the notion of voluntary
participation in systems like this, particularly when he also
mentioned the fact that disaster recovery, responding to
crises, was a very important goal of his.
Our view is that basic transport of clinical information
that follows the HIPAA regulations is the most appropriate way
to respond to the crisis in quality of care and patient safety
and to crises of different sorts in this country. So we need to
be able to mobilize data that exist within the walls of payers
to benefit the patient through treatment in an opt-out
environment, in our opinion.
However, having said that, the use of personal health
records is truly a voluntary act, and we believe that one of
the real benefits of implementing both the payer-based health
record and the personal health record systems at the same time,
or essentially at the same time, is that the personal health
record lets those early adopters who want to make sure that all
of their information can be sent to their doctors in emergency
rooms and others when they are seeking treatment control that
process and put more information in and make corrections. But,
on the other hand, it also allows those who really don't want
it to happen to opt out very, very easily. We currently allow
opt-out procedures for folks who are having their information
processed in our systems and delivered on behalf of our
customers, but we think that the trickle of records that would
come in would prevent the vast majority of providers,
physicians and others in this country, from ever changing their
work flow to adapt to the presence of records.
The fact that we can go into the State of Illinois with 3.7
million records really makes it so that the hospitals, the
emergency rooms, the physicians there will automatically build
into their work flow the notion that those records are
available. If only 5 percent of that 3.7 million opt in and we
are not allowed to distribute the rest, no hospital, no doctor
will bother to do that, other than those on a very, very sort
of early adopter phase. So we think it is really an issue of
proving to the Nation that, in fact, this basic kind of
information should be delivered unless people say they do not
want it to be delivered.
Mr. Porter. And this question is to whoever would like to
respond. As I have been meeting with the different insurance
companies and the providers that have instituted this new
technology, and they all brag about the advantages, but to an
organization, they have talked about the challenges of a
cultural change within the business, not only for the doctors
but also everyone up and down the food chain.
My goal with the trust funds, or whether we can fix it
through Judiciary and other means, is to also have some of
these funds available to help in training and transition,
because at Sierra Health Services of Nevada, Health Plan of
Nevada, we spent a lot of time looking at their system. And I
spoke of it earlier in my opening comments on how successful it
has been.
But they said one of their biggest challenges was the
cultural change, and in my prior life, I did work for an
insurance company, and we went through major technological
changes--I date myself--in the 1980's and the 1990's and
transitioning. I know that there was a challenge. But do you
have any insights on this change of culture once the hardware
and the software is in place on encouraging this change more
rapidly?
Dr. Hasan. Edison invented the electric bulb, which is a
very obvious and a very easy thing to use. It took over 30
years to be integrated in the usual life and the work flows and
work processes. The PC, we are seeing the benefit of the PC
revolution, which started in late 1970's, early 1980's, now. So
we will have to be patient and make it available, going back to
the issue of whether it should be mandatory or whether it
should be voluntary. For the carriers it should be, in my
opinion, mandatory. For the membership, it would be--by nature
of it, it would be voluntary, whether they use it or not, but
it has a negotiating effect. Once people start using it, get
the benefit, like you spoke to that person from the Veterans
Administration, people have that experience, they go out, talk
to their friends, speak to their acquaintances--that is how you
will see the culture change. Culture is not going to change by
mandate. Culture is not going to change by legislation. But
what legislation can do is to make it available for the people
to change their habits and their culture.
Mr. Porter. Yes?
Dr. Handel. I think Dr. Hasan is on target. The other thing
we realize is if we can integrate what we are doing into the
normal work flow of offices and hospitals, that is going to
make a big difference also. If this is looked upon as yet
another hurdle to overcome, another major problem, I think we
will have resistance. But the experience that we have had in
Delaware already, where the emergency room doctors initially
did not want to use it, but now they understand how valuable it
is, has created a whole new culture very rapidly. And I think
our job as the industry, if you would, is to make this as easy
and as integrated into the work flow as possible.
Mr. Porter. Yes?
Dr. Barlow. Chairman Porter, I would like to suggest that
there are actually two cultural changes that need to take place
here. One is the change to move from thinking about health care
in a provider-centric model to one that is moving to thinking
about health care in a patient-centric model. And what I mean
by that is care today and the information that we have in order
to deliver care centers around the provider and what they have
and what they can effectively get from other individuals to be
able to support that patient.
Giving the patient more information to give their provider
helps to change the provider's focus to a more patient-centric
model, but we really need to get where we can totally organize
data around that patient so that any provider, anyone who
interacts with the system thinks about it in terms of the
patient, not themselves and what they have. I think that is
key.
Mr. Porter. If I can interrupt, you know, in Las Vegas, we
have 40 million visitors a year. Think about that. You know,
the State is only 2.2 million people, but we have 40 million
visitors. And as I have visited the hospitals and the emergency
rooms and the trauma center and talked about health care
delivery to our visitors, one of the major--the largest
hospital in Las Vegas that is part of Humana, they said 8 or 9
percent of all their emergency room visits are by visitors from
somewhere else, and how frustrating in trying to deliver health
care when they cannot find out any information. They are not
sure of the meds. Sometimes they cannot communicate. And I
think you are absolutely right. It has to be driven from the
patient, and that is an example where if you travel anywhere in
the world, you should have access.
I am going to conclude the meeting because we are going to
vote here shortly, but I just want to leave you with one
thought. I started the meeting today talking about a foster
child. You know, these foster kids do not have the advantages
of the latest technology, and they do not have the latest in
health care in many respects and many times do not have a
loving home to take care of other than a foster parent trying
to be their parents.
I firmly believe, as I said in my opening comments, that by
working with a first-class system, which we have as Federal
employees--we have the best in the world, and making it even
better--we will truly help those least among us in this
country. And in combination with the funds we passed in
December, $150 million to help with Medicaid and health
information technology to transition, I believe that not only
do we have the best system today, we will have a far better
system in the future.
So thank you all very much for your testimony, and I look
forward to working with you in the future. The meeting is
adjourned.
[Whereupon, at 5:19 p.m., the subcommittee was adjourned.]
[The prepared statements of Hon. Wm. Lacy Clay and Hon.
Elijah E. Cummings follow:]
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