[Med-privacy] Wired Act

[peter marshall]

Doctor organizations' concerns put brakes on health IT bill
The medical societies say quality measures should be developed in an 
open process with doctors' input.

By Dave Hansen, AMNews staff. Dec. 10, 2007.

Washington -- An attempt to quickly pass a Senate health information 
technology bill was derailed after medical groups raised concerns about 
its quality measurement, patient privacy and funding provisions.

Senators in mid-November considered but could not agree on "hotlining" 
the bill, a term for passing it by unanimous consent without formal 
floor debate, said Senate Health, Education, Labor and Pensions 
Committee spokesman Michael Mahaffey.

Mahaffey declined to specify the disagreements but said the most 
serious was whether the bill, the Wired for Health Care Quality Act, 
contained adequate patient privacy protections. The delay occurred 
after the American Medical Association and 35 other physician 
organizations sent a Nov. 9 letter expressing their concerns to the 
legislation's main sponsors, Sens. Hillary Clinton (D, N.Y.), Edward 
Kennedy (D, Mass.), Mike Enzi (R, Wyo.) and Judd Gregg (R, N.H.).

The legislation would establish a board to determine HIT 
interoperability standards and require federal agencies to adopt them. 
It would give the Health and Human Services secretary the authority to 
create quality measures and doctor-specific reports on performance on 
the measures.

Quality measures should be developed in a transparent process that 
involves physicians and other stakeholders, the physician organizations 
wrote.

"The [HHS] secretary and federal government are not equipped to 
unilaterally mandate the practice of medicine," the letter stated. 
Without adequate stakeholder input, "there is a significant risk that 
the measures will not be appropriate or valid for the services that are 
to be measured, and, therefore, will not be useful to patients or could 
even harm patients."

The organizations also questioned whether the amount of funding in the 
bill would be enough. The legislation calls for up to $278 million in 
grants to physicians for purchasing new technology.

Financial support is essential, the groups stated. "Adequate funding 
should be provided to physicians investing in HIT to ensure the success 
of an undertaking of this magnitude, with due consideration for the 
constraints already faced by solo or small physician practices ... and 
those who practice in rural, inner-city and medically underserved 
areas."

The grant application process outlined in the bill is too lengthy and 
detailed, the letter also stated. "The process is not well-suited for 
small medical practices or solo practitioners, who have limited 
resources."

The dispute probably means that the Senate will not vote on the bill 
this year, said Robert Tennant, Medical Group Management Assn. senior 
policy adviser. "The letter strongly encouraged them to work with the 
physician community to ensure any legislation will be supported by us," 
he said. "I hope they take that to heart. As providers, we are the ones 
who will implement HIT, so I hope we will be consulted when they 
develop legislation."

At press time in late November, Mahaffey said Senate Health, Education, 
Labor and Pensions Committee negotiators were meeting with various 
physician groups to try to win their support.



  ADDITIONAL INFORMATION:
Unease over bill

The AMA and 35 other medical organizations wrote to sponsors of the 
Wired for Health Care Quality Act expressing concern about the bill. 
Here are some of their suggestions for improvement.

     * Quality attributes measured by a federal electronic medical 
record must be developed in a transparent process involving physician 
organizations.
     * Data used to measure quality must be accurate, drawn from an 
adequate patient sample and able to attribute care to one physician 
when patients see multiple doctors.
     * Physicians must be able to review and appeal data before they are 
publicly released, and their comments should be included with reported 
data.
     * Adequate funding must be available for physicians to invest in 
HIT, and the application process must be simple for solo and small 
practices.
     * A final set of health information technology interoperability 
standards must be agreed upon by all stakeholders.
     * Patient privacy and data security must be addressed adequately 
before the system goes online.


Copyright 2007 American Medical Association.