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Hearing on Efforts to Promote the Adoption and Meaningful Use of Health Information Technology
July 20, 2010
Overview
The House Ways and Means Committee held a hearing on Tuesday, July 20, 2010 on the adoption and
meaningful use of health information technology (HIT). The hearing consisted of testimony from both the
Office of the National Coordinator (ONC) and the Centers for Medicare & Medicaid Services (CMS), as well
as a panel of health IT leaders. This is the first congressional hearing since release of the final rules on the
meaningful use of HIT on July 13, 2010. The hearing itself discussed major issues related to the final rule,
and the panel presented many comments and answers to address legislators’ concerns.
Panel I
David Blumenthal M.D., ONC
Tony Trenkle, Office of E-Health Standards and Services, CMS
Panel II
Christine Bechtel, Vice President, National Partnership for Women and Families
Phyllis Teater, Chief Information Officer, Ohio State University Medical Center
Eugene Heslin M.D., Bridge Street Medical Group
Charles Jarvis, Vice Chair of the Electronic Health Record Association
Jonathan Hare, Chairman of Resilient Network Systems
818 Connecticut Avenue, N.W, Suite 500 Washington, D.C. 20006 Tel: 202.624-3270 Fax: 202.429-5553
www.ehealthinitiative.org
2. Health information exchange
This was another major concern, that the final rule limited the exchange requirement to only a test, and
that the test itself was performed using only dummy patient data. As information exchange is essential to
meaning use, this requirement seemed too low as well. Dr. Blumenthal addressed this issue by saying
that there are already other forms of health information exchange in the final rule (such as e-prescribing)
and that better infrastructure is needed before meaningful information exchange can take place. He noted
that there will be robust requirements in stage 2 meaningful use. He also responded that in addition to the
meaningful use requirements, there are ONC programs, such as the support for the National Health
Information Network (NHIN), the Regional Extension Centers (REC), as well as the health information
exchange state designated entities (SDEs), which are all concurrently moving ahead with plans to
improve health information exchange.
3. Multi-campus hospitals
This issue was raised both from public testimonies by various stakeholders and from House members. As
hospitals stand to receive millions in incentive payments, large multi-campus hospitals with only one CMS
certification number would be treated as just one hospital, despite having multiple facilities for purposes
of HIT implementation. Phyllis Teater, representing the Ohio State University Medical Center, stated that
there is an estimated $5 million gap between incentive payments and cost of HIT implementation as a
result of this rule. Other panelists also suggested similar financial burdens on multi-campus hospitals.
Tony Trenkle, representing CMS, addressed this issue in his written as well as oral testimony, stating that
CMS carefully considered the issue, and concluded that they needed to align the definition of hospital in
this incentive program with definition in similar regulations, and CMS cannot change the definition without
the proper statutory direction. This ultimately leaves it to Congress to introduce legislation dealing with
this matter.
4. Financial incentives
Some committee members wanted to know why there was such a wide range in estimated cost, and
whether individual payments to eligible professionals were too much. The actuarial estimated range of
$9.7 billion to $27.4 billion was based on actuarial projections of adoption percentages, which were
provided in oral testimony by Tony Trenkle to be 10% to 36% for year one (2011) and 36% to 70% for
year two (2012). As to individual professional incentive amounts, Dr. Heslin commented that the funding
he received from a New York State grant amounted only to licensing and implementation fees, and did
not get him to meaningful use requirements. He noted that he spent far more than the incentive to
redesign the workflow and train his staff, and that the meaningful use incentive amount was appropriate
given his overall expenditures.
5. Others
Two other issues also were raised during the hearing. First, rural health disparities were mentioned as a
concern moving forward with HIT adoption, especially those areas with a limited technological
infrastructure. Dr. Blumenthal acknowledged that getting HIT to rural communities posed a challenge, and
that there were already efforts in place to help solve this. He also stated that the Secretary of HHS was in
the process of forming a rural HIT task force to be composed of several organizations, including ONC,
HHS, USDA, FCC and others to address this issue. Second, clinical laboratory and electronic prescription
information exchange was also identified as barriers to greater meaningful use. Panelists acknowledged
there is need for both greater infrastructure and standards for laboratories and pharmacies to receive and
send clinical information.
Final Comments
Overall, the hearing addressed many pressing issues that arose from the meaningful use final rule. House
members as well as panelists were all encouraged that this marked the beginning of an ambitious project to
utilize HIT for improving health and health care. Although final requirements were more flexible and lowered
in some instances, the final rule represented a reasonable balance in the opinion of most panelists.