In January President Bush announced bold plans to send astronauts back to the moon-and eventually to Mars. That same month Bush set the more down-to-earth but still highly ambitious goal of equipping everyone in the nation with an electronic health record by 2014.
The moon idea fell flat, as some trial balloons do. Within days the headlines had no mention of a lunar expedition or mission to the red planet. And neither idea has resurfaced. Medical records were a different story.
In his State of the Union message early this year, Bush broadly outlined his vision of a personal electronic health record accessible to providers and patients alike. Through such an initiative, healthcare quality and patient safety will improve while costs decline, the president argued, repeating themes long trumpeted by software vendors and IT advocates.
Bush's mention of health records in his annual address to Congress and the nation may have been brief, but its political significance was immediate-and immeasurable. Dozens of issues compete for time in the president's speech, but only a handful make the cut.
"The (Bush) administration's contribution to this was to say, `Now's the time,' " says David Brailer, the physician Bush appointed in April as national health information technology coordinator. "Latent interest was ready to start magnifying on this topic. It was well-timed in terms of capturing people's imagination."
Brailer's appointment as the nation's first-ever healthcare IT czar turned a political promise into the daily task of an entire staff of HHS employees who collectively report to Secretary Tommy Thompson. This was no Mars mission. This was the real deal.
Vendors as teachers
Hospitals and doctors who had long delayed or even feared new IT were jolted into reassessing how they do business. Vendors, meanwhile, saw the potential to spread their technology across a healthcare system where resistance was rapidly morphing into curiosity-and ideally spending.
But first things first. Brailer has been at his post for only five months. Many hospitals and small physician practices say they'd love to jump aboard the IT bandwagon but don't know how they'll pay for it. A scholarly investigation of health IT costs and benefits by the Center for Information Technology Leadership pegged the total cost of a national infrastructure for healthcare information exchange at $276 billion over a 10-year rollout period. Those estimates break down to $163 billion for physician office systems, $27 billion for hospital systems and another $86 billion for computer interfaces among physician, hospital and other IT systems such as health plans, pharmacies, laboratories and public health agencies.
But standards governing how health records are formatted, edited and exchanged are still under development. And lawmakers and administration officials say they have a lot to learn before committing real money or weighing new mandates.
IT vendors and lobbyists are already playing teacher as they work to keep Congress focused and informed on the issue. They have voiced support for legislation introduced in recent months but say it's too early for lobbying in the traditional sense-permanent programs don't exist yet, so it's hard to have the typical fights over funds and who gets what.
With Capitol Hill and HHS paying more atten- tion-but before standards have been set and mandates crafted-vendors are capitalizing on a unique chance to shape the debate before it even takes place.
"We're not hearing as much from providers, doctors and hospitals as we are from people in the health IT industry," says Michael Zamore, policy adviser to Rep. Patrick Kennedy (D-R.I.), one of several lawmakers from both parties who have sponsored and promoted healthcare IT legislation in recent months.
Zamore adds: "The phone calls are from vendors mostly. They ask where things are going. They want us to see what they're doing. It's not so much lobbying for particular legislation or programs."
One group of companies-Hewlett-Packard Co., Cerner Corp., General Electric Co., Xerox Corp. and Johnson & Johnson-have each chipped in $1 million to have Rand Corp. study the economic and human value of healthcare IT.
The complete study, due out in spring 2005, will be "the strongest body of evidence ever assembled on the broad scale of defining the costs, benefits and barriers to implementing IT," says Neal Patterson, chairman and chief executive officer of Kansas City, Mo.-based Cerner, a major healthcare IT company working to "take the paper chart out of healthcare."
Patterson and others declined to give any preview of the preliminary results.
Cerner does not make political contributions but has strong Washington ties. Former HCFA Administrator Nancy Ann DeParle is on the company's board, and only recently did former Missouri Sen. John Danforth leave the board to become the permanent representative of the U.S. to the United Nations.
Eclipsys Corp., a Boca Raton, Fla.-based provider of clinical, financial and management information software and services, recently brought onto its board Dan Crippen, who previously ran the Congressional Budget Office.
"The expectation is that something will happen down the road and we'll need to be more connected to the action," says Paul Ruflin, Eclipsys' president and CEO.
As they work to gain a stronger foothold in Washington, some vendors are also contemplating a new "vendor-only" trade association that would help bring a unified message to Capitol Hill, industry sources tell Modern Healthcare. Currently, there are at least four major trade associations for healthcare IT, and sometimes their message gets garbled.
"Going forward, I think it may be useful for a member of Congress to deal with a limited number of groups," says Ann Berkey, vice president of public affairs for San Francisco-based McKesson Corp., a drug distribution and healthcare IT provider.
Congressional aides echoed the need for the industry to unify behind an agenda and present the plan coherently if it hopes to make real progress.
Highlighting the issues
Representatives of the trade groups say they are coordinating their efforts, and that the focus needs to be on educating lawmakers and the public on why healthcare IT should be a federal priority. According to the groups, Congress needs to understand not only the opportunities for providers but also the obstacles that could prevent them from participating.
Some hospitals, for instance, are reportedly hesitant to finance new IT projects involving physicians because they fear running afoul of antikickback statutes. "The Stark laws are confusing as to who can pay for what," Berkey says.
To ensure such issues are addressed, McKesson has "stepped up" lobbying in recent months and through its political action committee has raised $250,000 in the current election cycle, more than in any other, Berkey says.
Multiple-business-line companies such as McKesson more commonly make political contributions since they have a broad array of issues affected by regulators, and those donations are not generally linked to a single issue, according to lobbyists and others.
A spokesman for Americas Healthcare Industry Vertical, a division of the computer giant Hewlett-Packard, declined to say how much the company has contributed in connection with healthcare IT issues. He does, however, express strong concerns about ensuring that funds are made available to carry out Bush's 10-year vision for electronic health records (June 7, p. 12; June 28, p. 56).
"The decade of healthcare will be over in seven months if (hospitals and physicians) don't get the funding to make it happen," says Chuck Kinzel, director of Americas Healthcare, which posted $1.5 billion in revenue in the payer and provider market in 2003.
Healthcare IT lobbying groups agree funding mechanisms need to be suggested and studied before any one group puts its weight behind any one proposal.
"Everybody needs to agree on where we're going first-why ask for money when we're not sure what we're trying to get at?" says Bill Head, vice president of policy and government affairs for the National Alliance of Health Information Technology.
Some lobbyists want things to move faster so momentum doesn't dwindle. "The key now is how do we make sure we have forward movement?" says Janet Marchibroda, CEO of eHealth Initiative, a not-for-profit advocacy group. "I'm a little worried about the funding issue. I don't know how we're going to do this without some financial investment" from the government and private sector.
An HHS official disputes that hospitals need help from the federal government to get the job done. "They did Y2K and HIPAA (meeting guidelines of the Health Insurance Portability and Accountability Act) without additional assistance. Why is this any different?" the official, who spoke on condition of anonymity, asks.
And even as the funding debate gains steam, many issues could be affected by the outcome of next month's elections and ramifications of a second Bush term or a John Kerry presidency.
To help maintain the momentum on standards development, the Healthcare Information and Management Systems Society was expected last week to announce the EHR Advisory Council, a new vendor coalition that will be a liaison with the HHS certification council Brailer set up to determine the minimum requirements for an electronic health record (Aug. 23, p. 50).
Only three of the 15 seats on the certification council are held by vendors, leaving many "concerned their voice will not be heard," says Thomas Leary, HIMSS' director of federal affairs.
Brailer says those voices are being heard, and that the best thing vendors can do now is create and adopt standards for their products and help hospitals become better buyers of IT. The landscape for vendors and their lobbyists, Brailer says, "shifted so quickly and nonincrementally that these organizations have to take a step back. ... I personally view that as healthy (and) I see very good evidence they're working together."
Those efforts will begin to pay off even more when the political season is over and lawmakers get back to business, Brailer and others say. Next year, he says, HHS and the industry will "go from a sprint to a marathon."
-with John Morrissey
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