Washington is suddenly where the action is on advancing the use of information technology in healthcare. But before action can be taken, federal legislators and policymakers have to bring themselves and their staffs up to speed on the vast complexities of an issue that until recently was a foreign notion to many of them.
Several IT-related trade groups based in Chicago are busy organizing for that opportunity, establishing or fortifying a presence in the Washington area and pursuing favored status with the congressional committees and executive offices looking for a window in on the issue.
The latest to pack for the nation's capital is the National Alliance for Health Information Technology, a coalition of providers, payers, standards groups, supply chain representatives and technology companies working to overcome barriers to making IT achieve improvements in patient safety, quality and efficiency.
The alliance, founded in 2002, opened a small office in mid-April on Pennsylvania Avenue near Capitol Hill and hired a seasoned lobbyist, Bill Head, who formerly was director of congressional relations for the national Blue Cross and Blue Shield Association.
After 15 years overseeing policy issues primarily for health insurance organizations, Head says the realm of healthcare IT will take some time for him to understand in detail. But he knows that his contribution to the cause is based not so much on what he knows but whom he knows. "The topic is new for the Hill, too," he says.
The breadth of alliance membership "represents an enormous amount of expertise on these issues," says Scott Wallace, the alliance's president and chief executive officer. "And Bill's presence helps us to deliver that expertise."
The aim is the same for the Healthcare Information and Management Systems Society, which opened an office near the White House in early 2003 and has since moved to the top floor of an office building in Alexandria, Va.
Already the organization can claim to have played a key role in the creation of a bipartisan congressional caucus officially announced in mid-June. Modern Healthcare broke the news of the caucus' formation in the May 28 Daily Dose electronic newsletter. The caucus will focus on bringing IT deep into the workings of healthcare and changing financial incentives so providers are rewarded rather than penalized for improving patient outcomes.
The two new Washington operations join an experienced government relations office started more than 10 years ago by the American Health Information Management Association, representing professionals who create and manage medical records.
AHIMA made its mark as an expert source on issues surrounding the Health Information Portability and Accountability Act of 1996, both in the law's passage and in the waves of regulations hammered out since then, says Dan Rode, Washington-based vice president of policy and government relations. "AHIMA definitely has pushed standardization and privacy and confidentiality as key issues," he says.
The alliance started as a forum to forge consensus within the healthcare industry on issues of standards and interoperability of computer systems, hoping to dash barriers and accelerate adoption of IT (Aug. 25, 2003, p. 56).
It wasn't long, however, before Wallace was spending a sizable portion of his time hopping planes to Washington as the federal government began in earnest to tackle the same set of issues. The alliance began to fall into a role of information broker between policymakers and member organizations with firsthand knowledge and experience in the suddenly high-profile subject of advancing IT penetration in the healthcare industry.
In mid-February, for example, the alliance assembled senior staffers of seven senators for a session that included presentations by two senior information executives from healthcare systems: John Hummel, senior vice president and chief information officer of Sutter Health, Sacramento, Calif., and Robert Murphy, chief medical information officer of Norton Healthcare, Louisville, Ky.
Head says the need arose to "establish this (alliance) as a viable and important organization to impact and influence public policy." But with only ad hoc Washington relationship-building from Chicago, a piece was missing.
Head's Washington presence provides not only a full-time advocate for healthcare IT in the nation's capital but also someone with "the knowledge of where to go, who to see, integrating the work of the alliance" into the first round of policy development, he says.
As a conduit between alliance members and emerging fronts of IT activity at HHS, Congress and the White House, Head says he can "bring expertise about what works, what doesn't work to create the best policy."
And unlike most of his previous lobbying jobs, the IT issue for everyone is how to achieve a goal, not how to win.
"In healthcare, everyone is for it. The policy discussion is around how you do it," Head says. "We're not trying to stop something; someone's not trying to stop us."
Proximity has its benefits
The bipartisan atmosphere and catalytic role of healthcare advocacy activities were both evident in the formation of the 21st Century Healthcare Caucus, officially launched June 17 but in the works since late February in the aftermath of the HIMSS annual conference in Orlando, Fla.
The Feb. 22-26 conference was stocked with educational sessions and hearings on the government's role in moving IT forward through leadership and investment incentives. It closed with a speech by U.S. Rep. Patrick Kennedy (D-R.I.), who seized the moment to introduce legislation that would address those areas. It's one of many bills on IT issues pending before Congress (May 17, p. 30).
On the plane back to Rhode Island, Kennedy and health aide Michael Zamore came up with the caucus idea as a way to bring like minds together in Congress, says Thomas Leary, HIMSS director of federal affairs. Within days, Kennedy's office contacted HIMSS about the effort and enlisted its help, Leary says.
Recruiting a Republican chair as a counterpart to Democrat Kennedy was the first order of business, and HIMSS had it on a short list of talking points for members who were scheduled to visit their members of Congress during an "advocacy day" event April 1.
But first there were overview talks and speeches by HIMSS and government officials, including a keynote by U.S. Rep. Jim Greenwood (R-Pa.). One of the first things Greenwood told them was that he had decided on the spot to be the caucus co-chair after reading up on the day's agenda and seeing that objective on the list.
"I certainly would not have known that you are doing that if you had not come here (to Washington)," Greenwood said in his opening remarks. "On the way up on the elevator, I asked if you had found a Republican co-chair to join in with Patrick Kennedy and they said, `No.' And I said, `Would you like it to be me?' And they said, `Yes.' So now I am the co-chair of your caucus."
The initiative also recruited bipartisan vice chairs: U.S. Reps. Anna Eshoo (D-Calif.) and Charles Norwood (R-Ga.). Expanding the current membership of 10 is one of the objectives of HIMSS representatives in meetings with congressional staffers, says Leary, who is based in the Alexandria office.
Heading the government relations arm is David Roberts, director of public policy, who is based in Solana Beach, Calif., but spends much of his time in Washington.
HIMSS is getting support from Donald Asmonga, government relations manager for AHIMA, in talking up the caucus every time he meets with a congressional staffer, Leary says.
Asmonga and Rode are veterans in a four-person Washington office who represented AHIMA member interests during six years of regulation-writing for HIPAA and are now concentrating on federal support for a national health information infrastructure and related issues.
With no product to push, no traditional demands for concessions and no political action committee behind it, the four-member AHIMA staff has had success in getting seen on Capitol Hill, Rode says. "We've had more time face to face with congressmen than most because of this," he says.
But as issues become more technically oriented in the tilt toward healthcare IT, he's tapping more and more into an 18-member staff of technical experts back in Chicago and increasingly has to "beg, borrow or steal their time" to keep up with policy needs.
Sessions with Washington policymakers have gone from single-issue discussions to more encompassing visits because of multiple hot-button issues, from financing and incentives to data standards and HHS priorities such as implementing a nationwide common medical vocabulary in information technology systems.
"If I go in to talk about infrastructure, I'd better be ready to talk about the other issues as well," Rode says.
Over time, the band of IT lobbyists says they're aiming not just to lend expertise to the handful of legislators spear-heading an agenda but also to put the issue in front of more senators and representatives.
Most legislators are at least vaguely aware of IT as a HIPAA issue but not as a broad topic, Head says. "We want to help make it become more of a mainstream issue," he says.
AHIMA for one has pushed for a post of national leadership on healthcare IT for two years, Rode says. And HIMSS has lobbied for the post to report directly to the secretary and have its own budget, Roberts says.
The executive order creating a national healthcare IT office and the appointment of David Brailer to lead it are victories for those efforts, but now the new push is for the office to be written into legislation so it can withstand a change of administration, Roberts says.
A bill on healthcare IT issues introduced by U.S. Rep. Nancy Johnson (R-Conn.), who chairs the House Ways and Means Committee's health subcommittee, would create the office by statute. Passage of that law ranks high on the agenda for both HIMSS and AHIMA.