WHITE HOUSE ORDERS HEALTH INFORMATION STANDARDS AS STATES MOVE AHEAD

Christina Kent

On Aug. 22, President George W. Bush gave a potentially enormous push to the health information technology (HIT) efforts now being established around the country by the private sector, states and others.

President Bush issued an executive order that requires certain federal programs (including Medicare) to develop interoperable HIT systems. The intention is to increase “transparency” in the health-care sector by providing enrollees in these programs with information on the prices paid to health-care providers for procedures, as well as the quality of that care.

The White House order specifically excludes Medicaid and SCHIP, even though many states are moving toward developing HIT systems. However, states may be involved in the development of the federal standards, as the order says that those standards should be interoperable with existing systems and developed “in collaboration” with the private and non-federal public sectors.

Transparency in health care has become increasingly important as the administration, some states and some employers have sought to encourage individually owned health insurance—mostly high-deductible health plans linked to health savings accounts. The same actors have been developing HIT systems (such as electronic medical records) in an effort to increase portability of insurance and to reduce medical errors.

However, the very fact that different groups have been developing different systems means that not all the systems can “talk” to one another. Congress has debated, but so far has been not agreed on legislation that would support the development of interoperable HIT. The executive order could be of enormous help in standardizing the current patchwork quilt of HIT programs because the federal government is the single biggest payer of health care—all the hospitals, health plans and physicians who contract with Medicare will have to adopt the program’s new interoperable HIT systems. All the pharmacies and groups that participate in the Medicare Part D prescription drug program also will have to use the new systems.

Standardization is crucial if HIT is to move ahead, said Wisconsin Rep. Gregg Underheim, who sponsored a recent HIT-related law. “It’s the same as railroad technology,” he explained. “When the railroads were first built, the rails were of different sizes and were spaced at different distances apart. And the federal government said, ‘No, they’ve got to be a standard size and a standard distance apart.’ That made transportation across the nation possible. The analogy to health care is very strong. The federal government must say what the specifications for the technology are.”

Transparency also is crucial, he added, regardless of whether or not the nation moves toward an individually owned health-care system, Underheim added. “It doesn’t matter whether you believe in a government- or a market-dominated system,” he said. “We’re moving into an era in which people will make decisions about health care based on cost and quality. If your HMO has a particular panel of physicians, you’ll want to be able to be able to identify the quality and costs of that panel.”

States Taking Action

With encouragement from federal initiatives and the private sector, many states already have moved toward establishing HIT systems. About half the states have either a legislative mandate or an executive order in place to stimulate HIT, according to a new policy brief from the eHEALTH Initiative, a private, nonprofit organization.

In Wisconsin, a new law (AB 907) instructs the Department of Health and Family Services and the Department of Employee Trust Funds to contract with a nonprofit organization to create a centralized claims repository. The nonprofit shall request health-care claims information from insurers, and the resulting data on cost, quality and effectiveness will be analyzed and publicly reported. If the effort fails, the state will reactivate a 1998 law that requires physicians to submit claims data (hospitals were already doing so).

NCSL’s Project HITCh—for Health Information Technology Champions—supports state legislative decision-making about HIT. For details about what states are doing, go to www.ncsl.org/programs/health/forum/hitch/ or contact Kala Ladenheim, program director, at Kala.Ladenheim@ncsl.org. Also, a new NCSL report describes and provides links to specific state legislation on HIT and public reporting: www.ncsl.org/programs/health/Transparency.htm