Health information technology legislation passed by a House committee last week is being called a good start in what ultimately is a challenging and lengthy process to electronically connect physicians, hospitals and pharmacies to the patients who rely on them for care.
But provider groups and health policy shapers say that they are still leery over some of the bill's payment, privacy and security components, and they are eyeing potential tweaks to the legislation that they said would reduce the burden to hospitals and physicians. And on another front, privacy advocates said that the bill is too lax; previous bills have stumbled because of privacy concerns.
In some ways, it's the same debate that bogged down previous health IT legislation, said Neal Neuberger, executive director of the Institute for e-Health Policy at the HIMSS Foundation. He warned that the bill could prove too cumbersomeand too controversialto pass in the remaining time that Congress is in session this year. Not only does the Energy and Commerce bill need to go through two other committees, but eventually it would have to be melded with a bill in the Senate.
"That same sort of thing could happen again, given the lack of time," Neuberger said.
"It's a good first step, but it can't be the last step," said Steven Stack, chairman of the health information technology advisory group for the American Medical Association.
On Capitol Hill, members of the Energy and Commerce Committee approved the Protecting Records, Optimizing Treatment and Easing Communication Through Healthcare Technology Act, or PRO(TECH)T Act, which would give providers more than $560 million in grants and loans to adopt health IT while providing stronger patient privacy and security provisions.
A day later, another House committee, this time Ways and Means, said it would also introduce a health IT bill, but one presumably different in the way that it pays for provider incentives. The two bills would likely need approval from both committees at some point, though Rep. Pete Stark (D-Calif.), chairman of the Ways and Means Health Subcommittee and sponsor of the as-yet-to-be-introduced legislation, said that his legislation is not a competitor to the Energy and Commerce bill.
At the outset, the PRO(TECH)T bill would make the Office of the National Coordinator for Health Information Technology a permanent part of HHS while establishing a secondary advisory committee to help shape future health IT policy. The bill also includes provisions requiring patient approval before any of their health information is shared, and requires that they're notified if any of that data have been breached.
"This bill has reached a delicate balance between promoting and encouraging the electronic flow of health information and protecting that information from those who should not have it," Energy and Commerce Chairman Rep. John Dingell (D-Mich.) said at the vote.
But the American Hospital Association, in a letter that it sent to committee leaders, targeted two parts of the bill that it said could hinder rather than help providers as they increasingly begin to adopt health IT.
For instance, a provision of the bill would require providers and other healthcare workers using an EHR to account for disclosures of protected health information made in the course of treatment or paymenta move that runs counter to the Bush administration's 2002 amended requirement of the Health Insurance Portability and Accountability Act. "While electronic medical records make it feasible for audit trails to track down disclosures, the sheer volume of information generated in direct-care activities, payment and healthcare operations and the storage capacity needed to hold the information and make it accessible and intelligible to patients, would divert already scarce resources away from patient care," the AHA stated.
The AHA also said that another provision requiring patient consent before using the health data contained in an EHR could stall quality-reporting initiatives. "Because these are voluntary programs, (the bill) clearly puts these programs at risk, jeopardizing both the need for quality information and hospitals' financial viability," the AHA states, adding that other processes, like credentialing of physicians and training of health professionals, could also be delayed.
"While HIPAA protects the individual's privacy by permitting the use of only the minimum necessary amount of information for these activities, (the bill) requires a covered provider that uses electronic medical records to obtain the consent of each patient before using for healthcare operations any part of the information in the patient's EMR," the AHA stated in the letter.
Other groups also expressed concern over the legislation's privacy and security provisions, but making the opposite case. The American Civil Liberties Union said that the bill doesn't go far enough in protecting the patient, leaving them "vulnerable to bad, lost, stolen or misused data."
"As part of the transition from paper to electronic health records, Congress should go for the gold standard of medical privacy," Timothy Sparapani, the ACLU's senior legislative counsel, said in a written statement. "Lawmakers must define medical privacy as patient control of electronic medical records. Ideally, when any company wants to use patient records for a secondary purposeone that does not involve treatment, bill payment or reimbursementit should require patient consent."
And Rep. Edward Markey (D-Mass.), who introduced his own health IT bill earlier this year, said that meaningful gaps in patient privacy exist in the current bill. During negotiations over the bill last week, he said that the legislation used the word "privacy" 22 times, but doesn't go so far to define what it means.
The AMA's Stack, while lauding several provisions in the Energy and Commerce bill, warned that without strong financial incentives, physiciansmany of whom are already cash-strapped because of Medicare's flawed payment systemmay be detoured from adopting new technology.
About 20% of physicians in practices that have more than 21 doctors have some form of health IT, according to an AMA study. But that number declines considerably for smaller practices, where the adoption rate is about 13%, the study states.
Stack said that financial incentives are needed to defray the costs of such systems, and warned against penalizing physicians who don't adopt EHR or e-prescribing systems. "Punishment is not a good motivator to positively effect change," he said.
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