With a war in Iraq still under way and a presidential election on the horizon, computerizing healthcare may not seem like an issue that would get time in the Oval Office. Surprising some and meeting the long-held expectations of others, however, President Bush has become a champion of hospitals and doctors making better use of information technology.
The arguments are clear and rarely disputed. When physicians enter orders into a computer instead of writing them on a paper chart, the chances of a medical error drop significantly. Electronic prescribing can prevent a pharmacist from dispensing the wrong medication or dose. And at least $140 billion per year can be saved through further automating the industry, HHS Secretary Tommy Thompson has said.
Such data run alongside a 6-year-old Institute of Medicine recommendation that the healthcare industry should better employ information technology, as well as similar findings by the Medicare Payment Advisory Commission and other groups.
A trifecta
Thompson has been interested in healthcare IT for at least two years and is puzzled why supermarkets can so effectively use it while hospitals and doctors struggle. Bush decided to act on the issue when he realized the trifecta of cost reduction, quality improvement and industry transformation that automation can produce, said a White House official who would only speak on condition his name not be used.
In the past six weeks, Bush has given at least three speeches highlighting healthcare IT. On May 27, he visited Vanderbilt University Medical Center in Nashville to put his eyes and hands on the technology he has been championing. Afterward he gave an address and led a discussion about how IT can make a difference, as it has at Vanderbilt, where all prescriptions are written electronically.
In addition to medical liability reform, "Another way to save money is to introduce information technology into the healthcare world," Bush told the crowd of about 900 at the Vanderbilt discussion. Accompanying Bush at the event was David Brailer, the newly appointed health-information coordinator, who reports directly to Thompson.
"One of the amazing discrepancies in American society today is we're literally changing how medicine is delivered in incredibly positive ways, and yet docs are still spending a lot of time writing things on paper," Bush said. "Therefore, sometimes it's difficult to have the spread of accurate information so that doctors can make good decisions."
Bush also repeated his call for everyone in the country to have a personal, electronic medical record within 10 years. Despite the fanfare, however, where there are lofty goals in Washington, potential controversy is always nearby. Healthcare IT is no exception.
As the White House and Congress bring new national attention to the issue, some hospitals are wary of how much help they'll really get, and Capitol Hill is moving slowly despite bipartisan support. In his proposed 2005 budget, Bush requested $100 million in grants to help hospitals and doctors adopt information technology. That's a doubling of the 2004 funding, but in the minds of some providers not nearly enough to make a dent.
"The problem the (Bush) administration is going to run into here is that you can't get away as much on the cheap as they seem to be trying to," said James Mongan, president and chief executive officer of Partners HealthCare System in Boston. Five-hospital Partners will spend
$30 million on IT-related efforts this year alone, Mongan said. "It puts in perspective how pitifully inadequate $100 million is to do this job."
Defending the $100 million that Bush proposed spending next year on healthcare IT, the White House official called the increase from $50 million a "dramatic step" toward encouraging the installation of new systems. The money will be used to "test the effectiveness of health IT and pave the way for broader adoption," the official said. Technologies and incentives to use them, he added, need to transform the delivery system rather than build layers onto it.
HHS spokesman Bill Pierce said the
$100 million is "at best seed money to spur ideas and good practices." The federal government's primary role right now, he said, is to prompt a national dialogue on the issue and develop a long-term plan of action.
Defending the president
Republicans in Congress also came to the president's defense on funding. "We're fighting a war. ... The federal government can't just pick up the tab for information technology for our healthcare system," said an aide to the Senate Health, Education, Labor and Pensions Committee. Bush's May 6 appointment of Brailer to coordinate healthcare IT initiatives is evidence of the president's seriousness, administration and industry sources said.
"We went from no mention of electronic health records to a single-sentence reference in the State of the Union, to appointment of a sub-Cabinet official with broad authority, to the president sitting with that person onstage and making a whole day event out of it," said Scott Wallace, president and CEO of the National Alliance for Healthcare Information Technology.
At a separate conference last week in Washington, Brailer told the Greater Washington Board of Trade that just 5% of hospitals and doctors use the most up-to-date information systems and that healthcare is the "only industry where doing the right thing by your customer will make you bankrupt."
While the federal government will not cover the cost of putting new systems in every hospital, it should also not mandate hospitals do so without helping them pay, Brailer said.
Before Bush and Brailer took to the stage touting healthcare IT, Congress had been gaining its own traction. Since February of last year, members of the House and Senate have introduced at least five bills addressing healthcare IT, and the Medicare reform law authorized a series of IT-related grants and demonstration projects (May 17, p. 30). Only one of the proposals now in the hopper, sponsored by Sen. Edward Kennedy (D-Mass.), would link Medicare payments to the use of IT, giving a 1% reimbursement increase in 2005 to hospitals that operate a qualified clinical informatics system and meet other requirements. That bill has been referred to the Senate health committee (May 17, p. 4).
With so many Democratic and Republican proposals floating around, the Senate health committee is working to write one bill that can make it out of the committee, several aides working on the effort said last week. The benefits of IT include "making the system more efficient and providing more savings, which then translates into making healthcare more affordable," said a committee spokeswoman.
A seamless and secure health IT infrastructure could save the nation more than $140 billion per year, Thompson said at a recent summit on the matter. Several officials argued that the money can be used to help cover the nation's 43 million uninsured.
While that may be true theoretically, Democrats said, it is difficult to earmark savings for new federal benefits. Some, including those in the campaign for presumptive Democratic presidential candidate John Kerry, went further, saying Bush's IT plan falls far short of the reform that's needed.
Currying favor?
"It appears the Bush administration is trying to curry favor by associating themselves with a popular and innovative idea without putting the funding behind it to make it a reality," a senior Kerry aide said last week. "Kerry proposes his IT plan in the context of a larger health-reform package, not one little piece hanging out there."
Kerry's healthcare plan, which the aide said was proposed more than a year ago, would provide an unspecified "technology bonus" to hospitals and doctors that use IT effectively. At deadline, it was unclear how much of Kerry's 10-year, $895 billion healthcare plan would be spent on IT initiatives. As much as $175 billion per year can be saved by reducing medical and administrative waste, according to Kerry.
The Bush administration stood by its own 10-year plan, estimated at $89 billion over 10 years. With steps such as promoting technology, expanding community health centers, supporting recently enacted health savings accounts and proposing medical liability reform, Bush is addressing health costs and "tackling the big issues of the uninsured," the White House official said.
Even with the funding obstacles, said Partners' Mongan, the industry and government have reached a "sweet spot of time" when it comes to healthcare IT. "We're getting to the tipping point where we can link up IT with specific quality and safety initiatives and make significant progress," Mongan said.
