Himss

Fact Sheet

On

H.R. 4157

Health Information Technology Promotion Act of 2006

(Updated:  July 25, 2006)

Call to Action

On October 27, 2005, Ways & Means Health Subcommittee Chairman Nancy Johnson (R-CT) and Energy & Commerce Health Subcommittee Chairman Nathan Deal (R-GA) jointly introduced H.R. 4157, the Health Information Technology Promotion Act, into the U.S. House of Representatives to transform healthcare using healthcare information technology.  To date, fifty-nine Republicans have endorsed this legislation.  On May 24, 2006, following four separate hearings, the House Ways & Means Health Subcommittee passed this legislation.  Between June 8 and 15, both Committees of jurisdiction passed this legislationIt is anticipated that the legislation will go to the House floor on July 27 prior to adjournment for the August recess.

The amended version of H.R. 4157 is divided into four separate titles:

·         Title 1:  Coordination for, planning for, and interoperability of health

      information technology, which contains five sections:

o        Section 101 repels Executive Order 13,335 and replaces it with this legislation that codifies (makes permanent) the Office of National Coordinator for Health Information Technology.

o        Section 102 requests within one year a report on the progress and future of the American Health Information Community.

o        Section 103 requires that a strategic interoperability planning process be implemented not later than December 31, 2006

o        Section 104 authorizes a total of $15 million in grants (with $1 for $5 matching requirements) for both FY07 and FY08 to integrated health systems to promote HIT to improve coordination of care for the uninsured, underinsured, and medically underserved.

o        Section 105 authorizes $5 million in small physician practice demonstration grants for both FY07 and FY08.

·         Title 2:  Transaction standards, codes, and information, which contains five sections:

o        Section 201 promotes new procedures to ensure timely updating of standards that enable electronic exchanges.

o        Section 202 promotes upgrading ASC X12 and NCPDP standards that will be applied to transactions occurring on or after April 1, 2009.

o        Section 203 promotes updating ICD codes; coding and documentation of non-medical information for services furnished on or after October 1, 2010.

o        Section 204 mandates that within six months a strategic plan be completed for coordinating implementation of transaction standards and ICD codes.

o        Section 205 requires a study and report within 18 months to determine the impact of variation and commonality in State health information laws and regulations.

·         Title 3:  Promoting the use of health information technology to better

coordinate healthcare, which is divided into three sections:

o        Section 301 promotes safe harbors to anti-kickback civil penalties and criminal penalties for provision of HIT and training services.  Preempts all state laws.  Requires report and study to assess the effect of safe harbors on the health system.

o        Section 302 provides an exception to the limitation on certain physician referrals (under Stark) for provision of HIT and training services to healthcare professionals.  Preempts all state laws.  Requires report and study to assess the effect of safe harbors on the health system.

o        Section 303 deals with rules of construction regarding the use of consortia as it applies to Stark reform.

·         Title 4:  Additional provisions, which are divided into eight sections;

o        Section 401 promotes telehealth services across state lines and requires a study within 18 months.

o        Section 402 requires within 18 months a study and report on expansion of home health-related telehealth services.

o        Section 403 requires a study and report within 18 months on store and forward technology that provides for the asynchronous transmission of healthcare information in a single or multimedia format for telehealth.

o        Section 404 proposes that the Secretary of Health and Human Services develop a methodology for reporting uniform price data for inpatient and outpatient hospital services.  Requires a GAO report not later than January 1, 2008.

o        Section 405 provides for inclusion of uniform price data starting October 1, 2007.

o        Section 406 ensures that healthcare providers participating in Public Health Service Act programs, Medicaid, State Children’s Health Insurance Program (SCHIP), or the Maternal and Children’s Health program may maintain health information in electronic form.

o        Section 407 ensures that healthcare providers participating in the Medicare program may maintain health information in electronic forms.

o        Section 408 requires a study and report on State, regional and community health information exchanges.

Closing Remarks

HIMSS has endorsed H.R. 4157 and will work with all stakeholders to promote its passage.  We encourage the U.S. House of Representatives to pass H.R. 4157 in order to conference with the Senate on S. 1418 to pass a comprehensive piece of HIT legislation prior to the adjournment of the 109^th Congress.  Questions on this fact sheet should be addressed to Dave Roberts, FHIMSS, HIMSS Vice President for Government Relations, at 703.837.9811 or via email at droberts@himss.org.

There was a similar bill passed in the Senate last year and the two bills will probably be reconciled via conference committee, but this is a good idea of what is likely to come out of Washington.

Opus

I am thrilled to see we may actually see significant HIT legislation emerge from Congress this year. All that remains is for House and Senate staffers to reconcile H.R. 4157 with S. 1418.

http://www.himss.org/Content/files/HIMSSs1418HR4157comparision.pdf 

This legislation contains many important initiatives necessary for our nation’s health information to move from paper to electrons.

However, I have some concerns about relaxing the Stark provisions to give safe harbors to hospitals and enterprises to be able to provide HIT technologies to physicians On the surface, this would be great, as they are in line to be the primary benefactors. However, does anyone perceive a risk that this could become another tool for large systems to gain control of small physician practices? Has anyone already experienced any “heavy-handed” approaches where the systems have told you that you had to use the enterprise software rather than software better suited for use in small practices? Or, if they agreed to provide an interface, was the cost prohibitive or was the project put on hold, forever?

What is the risk of this legislation might put more control of the actual delivery of health care into large enterprises, and what would be the subsequent consequences? If you are already using an EHR with great benefit to you and your patients, what are the likely consequences of having to abandon it and having to move to the software provided by the enterprise?

Randall Oates, M.D.

President, SOAPware, Inc.

I am pleased to report that last Tuesday, 2 draft documents were announced by the 2 Federal Agencies (Health and Human Services or HHS and the Office of Inspector General or OIG) responsible for implementing policies with respect to any legislation affecting healthcare. These documents will be officially posted in the Federal Register this next Tuesday and will become “the law” 60 days later. The drafts explain the specific policy to be implements as a result of the recent Health Information Technology bills that have passed both the House and Senate. Language has been added that should prevent entities donating HIT technologies to physicians from forcing physicians to either use only one EHR or be denied an interface to the system  My interpretation is that docs using just about any certified EHR system can’t be overcharged or excessively stalled for interfaces into a larger information system. This should be true even when the docs choose to obtain their own EHR rather than adopt, or switch to, the one(s) chosen by the regional, larger systems. Finally, It will be counter to the intent of the law to attempt to coerce physicians to use cumbersome EHR’s designed to be more friendly to business than to good patent care.

That is the good news. The bad news is that lobbyists have convinced many congressmen that physicians do not rally need any more financial incentives to adopt EHR’s. Also, they have successfully promoted the concept that there is no need to allocate more financial resources to promote interoperability. The limited resources and short time frames have largely contributed to a certification process that is less than ideal for many physicians, patients and for the diversity in healthcare. In fact, congress is cutting the proposed budget for the Office of the National Coordinator for Heath Information Technology or ONCHIT. Until our nation actually allocates more funds to HIT, our medical records will remain largely paper-based. Talk is cheap, but keep your legislators informed. Lack of participation by physicians and patients in the process contributes to policies that are often more self-serving to those more able to afford to go to the "party."

Randall Oates, M.D.

President, SOAPware, Inc.