Most healthcare information technology prognosticators say that big money is finally coming to add muscle to a federal IT booster program that began in 2004. President Bush set up the Office of the National Coordinator that year in an executive order that also limited the use of federal funds to get the job done.
That should change this year. The Healthcare Information and Management Systems Society has appealed for $25 billion in spending, and President-elect Barack Obama has gone on record in favor of spending $10 billion a year for IT over a five-year period. As further evidence, in December 2008, Vice President-elect Joe Biden said that money for healthcare IT spending would likely be rolled into an economic stimulus bill that could be ready for Obama to sign soon after he is sworn into office.
In earlier IT bills, if any money at all was mentioned, the dollar amounts typically were in the millions, with a bill sponsored by Sens. Debbie Stabenow (D-Mich.) and Olympia Snowe (R-Maine) being one of the few exceptions to use the dreaded B word. Now, it seems billion is no longer a dirty word.
Our minimum is $25 billion, said Meredith Taylor, director of congressional affairs at HIMSS. Thats what weve put together for ambulatory and acute-care practices. A HIMSS policy statement contains a detailed explanation for that number and some potential applications for that funding, Taylor said.
The question remains, however, of how to spend the money. A couple of tough nuts to crack will be small hospitals and small physician office practices, where the penetration rates of electronic health-record systems have remained minuscule despite more than 4½ years of federal promotion. IT vendors find it hard to market to those smaller operations, particularly physician offices, where roughly half the doctors in patient-care practices work in offices with three or fewer physicians.
Privacy is looming as another huge issue, with several IT bills drafted that would roll back the Bush administration erosions of privacy protections that include removing the requirement for patient consent before transmitting and utilizing patient information for multiple uses aside from treatment and payment.
Also in 2009, privacy is an important part of the arguments for or against health IT. Two key players likely to figure in the privacy fight this year are Indiana University law professor Dawn Johnsen and Rep. Pete Stark (D-Calif.).
Johnsen is Obamas choice to head the Office of Legal Counsel at the Justice Department. She worked there for five years during the Clinton administration and led the office for two years. One of her first tasks when she returns to her old job will be to revisit many opinions written during the Bush administration, including those regarding the Health Insurance Portability and Accountability Act.
In 2005, Office of Legal Counsel head Steven Bradbury issued an opinion binding on all federal prosecutors that the criminal penalty provisions of HIPAA were generally limited to covered entitiespayers, providers and claims clearinghousesas defined under the 1996 statute. HIPAA calls for up to five years of prison time for the most egregious criminal privacy violations, including wrongfully using patient data for a profit. However, since most covered entities are corporations, and since a corporation can't be put behind bars, privacy advocates have concluded the Bradbury opinion defied common sense.
Johnsen, who has been blogging on Slate magazines Web site for several years, has been scathing in her criticism of the Office of Legal Counsels operations under the Bush administration. She was critical of some of Bradburys opinions specifically.
Stark, meanwhile, was one of many members of Congress who had a healthcare IT bill in the hopper last session. It included language that would have overturned the Bradbury opinion.
The Stark bill also would have reversed the 2002 HHS revision of the HIPAA privacy rule. That Bush administration rule modification did away with the patient consent requirement for exchanging protected healthcare information for the purposes of treatment, payment and a broad, catch-all clause: other healthcare operations. It was a change, privacy advocates say, that turned the HIPAA privacy rule on its head, converting a broad privacy protection requirement into a wide-open medical records exchange authorization.
The resurgence of legislative interest in privacy regulation and enforcement quickly got the attention of the Healthcare Leadership Council, a Washington-based organization whose members include executives of health plans, pharmacy benefits managers and pharmaceutical manufacturers whose businesses use patient data. While not targeting the Stark bill by name, the council sent letters to every member of Congress warning that restoring the patient consent requirement could have dire consequences for healthcare quality and safety efforts as well as counteract the positive benefits of HIT.
A privacy advocacy group, however, sent its own letter to congressional leaders welcoming the renewed commitment in Congress and by the president-elect to protecting consumers over special interests.
Look for Stark to reintroduce his bill this year and figure as a player in negotiations on any other IT booster legislation this session.
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