Senate health IT bill draws fire as it progresses

The Senate’s major health information technology bill for the year cruised though the Senate Health, Education, Labor and Pensions Committee on a voice vote the day after its official introduction, then encountered a bump in the road when the Department of Health and Human Services took issue with several provisions.

HHS Secretary Mike Leavitt wrote to the committee’s chairman, Sen. Edward Kennedy (D-Mass.), that the Wired for Health Care Quality Act “would create significant barriers to continued progress already under way.”

The HHS opposition came despite bipartisan support for this year’s version of the bill, passed by the Senate in 2005. The first bill died last year when the House and Senate could not agree on a compromise between their health IT measures. This year’s primary Senate co-sponsors are Kennedy, Mike Enzi (R-Wyo.), Hillary Clinton (D-N.Y.) and Orrin Hatch (R-Utah). Enzi is the ranking Republican on the Committee.

Leavitt, who said the White House concurred with his comments, objected especially to provisions concerning the American Health Information Community (AHIC), the only HHS advisory committee that the secretary heads. “The draft legislation would undo what is presently a successful health IT public/private partnership and stop current work in its tracks,” his letter states.

Leavitt aims to convert AHIC from a federal advisory committee into a nongovernmental organization, partly on the grounds that it would be less affected by politics. The Senate bill, however, would freeze AHIC in its current status and calls for Congress to appoint community members. “It would politicize the successful collaborative work ongoing through AHIC…and would create barriers to rapid implementation,” Leavitt wrote.

He also took issue with the bill’s provisions that would create a second advisory committee that would be called the Partnership for Health Care Improvement. “Adding a second advisory committee…would be counterproductive – adding an additional layer of complexity to the health IT governance structure,” the letter states.

Without changes in the provisions concerning the two advisory panels, the letter states, “the [Bush] Administration would oppose passage of this legislation.”

Leavitt also expressed disagreement with the bill’s provisions creating grant programs to spur health IT adoption. “The most appropriate and efficient ways to achieve widespread use of health IT are through market forces rather than through direct subsidization of health IT purchases,” the letter states.

The bill would provide grants for low-income health care providers to buy health IT systems, for the establishment of health information exchanges, for telemedicine programs serving residents of more than one state, and for health IT training. It also would create a state-run loan program to finance providers’ acquisition of systems.

Leavitt also objected to provisions that would create quality reporting organizations, require HHS to designate a single organization to promote development of performance measures for health care, establish a health resource center in HHS, and extend the privacy rules under the Health Insurance Portability and Accountability Act of 1996 to operators of e-health record repositories and exchanges.

“HHS and AHIC have been giving consideration to what kind and level of privacy and security protections should apply to various kinds of entities that may be included in the language of this section,” Leavitt wrote, and it would be premature to extend HIPAA coverage.

The secretary also complained about other provisions of the 80-page bill, such as language about the adoption of standards and publication of quality measures.

Leavitt is not the only one who objects to the bill. Some privacy advocates, including the Patient
rivacy Rights Foundation and the American Psychoanalytic Association, say it doesn’t go far enough to protect privacy a
d confidentiality of patients’ medical records.

The Healthcare Information and Management Systems Society, a leading advocate of health IT, has not taken a position on the bill. “We are pleased that the Senate is focusing” on health IT, said David Roberts, HIMSS vice president for government relations.

The bill would authorize spending of up to $163 million a year on all its provisions, although Congress still would still have to appropriate the funds in the annual process.

The House committees with jurisdiction over health IT have not focused on a comparable bill because other health issues are at center stage. The eHealth Initiative advised its members that the timing of a matching House bill is up in the air.