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House Ways and Means Committee

Hearing on Efforts to Promote the Adoption and Meaningful Use of Health Information Technology
July 20, 2010

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.

Background and Summary

The passage of the American Reinvestment and Recovery Act (ARRA), that included the Health Information
Technology Act (HITECH), initiated the release of several final rules related to the use of HIT as part of efforts
to improve the performance of America’s health care system as well as the health of its citizens. The final rule
on meaningful use incorporated over 2000 comments during the public comment period, and consequently
underwent several revisions. Notably, meaningful use requirements now split into core and menu sets, with
eligible professionals and hospitals able to choose among the requirements in the menu set. Some
requirements have been lowered or removed altogether, such as e-prescribing and administrative provisions,
respectively. Other areas were not changed despite public comment, most notably on incentive payment rules
for multi-campus hospitals with one CMS certification number. Lastly, there were some additions as a result
of public comment, including the inclusion of patient-education resources as a requirement as well as
hospital-based physicians for incentive eligibility. Overall, the final rule generally included more flexibility for
eligible professionals and hospitals in their effort to demonstrate meaningful use of HIT.

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

Key Issues Raised by Committee Members:

1. Lowering of meaningful use requirements

This was the most frequented issue by some committee members and some members of the second
panel, who were concerned that the final rule lowered the standard requirements too much and would
result in incentive payments that did not fully realize the goal of meaningful use of HIT. They expressed
particular concern that the final regulations would result in “entitlements” rather than true “incentives,” and
was not the best use of taxpayer money. Dr. Blumenthal and Mr .Trenkle responded by noting that
flexibility was necessary as the first part of an overall escalation towards widespread adoption and
meaningful use of HIT. Subsequent stage 2 and stage 3 of meaningful use would include much more
robust requirements, and this initial step was crafted to ensure attainable long-term goals. Dr. Blumenthal
added that the final rule represented a balance between promoting adoption and creating meaningful use.
Among the second panelists, Phyllis Teater responded that health care providers strive not to just meet
requirements but to achieve beyond them. Dr. Heslin offered that many physicians in small practices
would see the requirements as tough but achievable goals and that the incentives would help persuade
many other small practices to begin embracing HIT.

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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.