Friday, December 03, 2004

Health Care Technology Is a Promise Unfinanced

The New York Times
December 3, 2004

Health Care Technology Is a Promise Unfinanced

From the president on down, the Bush administration has been a proponent of modernizing the nation's creaky health care system with information technology.

But while the administration's words of support for a high-technology future for health care have been plentiful, the dollars, it seems, are scarce.

The huge federal spending bill recently approved by Congress eliminated a seemingly modest $50 million request for the office of Dr. David J. Brailer, who was appointed the national health information technology coordinator in May.

Dr. Brailer acknowledged his disappointment in an interview yesterday. "The money is important," he said. "This was a bad bounce, and it shows how big our education challenge is."

One critic of the action was less guarded in his comments. "Congress, in its infinite wisdom, zeroed-out David Brailer's office," said Newt Gingrich, the Republican former House speaker, who is the founder of the Center for Health Transformation, a health policy group. "They couldn't find $50 million to signal that David Brailer has a real job and what he's doing is important. Frankly, I think it's a disgrace."

The Bush administration, Mr. Gingrich said, bore most of the responsibility. "No one in the White House or in the senior staff of the Department of Health and Human Services fought for this," he said.

Most of the investment for electronic health records and networks for sharing information will now have to come from private industry, probably billions of dollars over the next several years.

The $50 million requested for Dr. Brailer's office was to have been used to provide seed money for health information demonstration projects that would encourage the industry to agree on technology standards, hasten investment by private companies and accelerate the adoption of modern information technology by doctors and hospitals.

Bringing patient records and prescriptions out of an era of ink and paper into the computer age, health experts agree, would make health care more efficient and reduce medical errors, saving lives and dollars.

President Bush repeatedly sounded that theme this year, starting with his State of the Union address. "By computerizing health records," he said, "we can avoid dangerous medical mistakes, reduce costs and improve care."

In a debate with Senator John Kerry in October, Mr. Bush said that much of the high and rising cost of health care resulted from hospitals, clinics and doctors' not using "any information technology." Health care, he asserted, was trapped in the past, the "equivalent of buggy-and-horse days, compared with other industries here in America."

"We've got to introduce high technology into health care," the president added. "We're beginning to do it."

The Department of Health and Human Services played host in July to a three-day conference in Washington to promote investment in health information technology. "Electronic health information will provide a quantum leap in patient power, doctor power and effective health care," Tommy G. Thompson, the health secretary, said.

But the appropriations setback for the national health information technology office raises questions about the administration's commitment.

Dr. Brailer, a physician and economist who joined the administration in May, said that he was not an expert in the ways of Washington and was not involved in the budget negotiations. "But I have absolute confidence that the president is totally behind what we are doing," he said, "and it is far more than a rhetorical commitment. And I've been given assurances that the momentum we've built up will not be lost."

Dr. Brailer, who reports to Secretary Thompson, will not lose his job. His principal role is to coordinate and encourage the efforts of government and the health care industry to adopt digital records that share standards.

The budget of the Department of Health and Human Services is more than $500 billion a year. Most of that is pledged to federal obligations like Medicare, but the department does have more than $60 billion in discretionary funds. So it is possible that money could find its way into Dr. Brailer's office to finance some of its favored projects.

Industry executives, meanwhile, said the decision in Congress was disappointing, but probably not a serious blow or a reason yet for companies to rethink their plans to invest in health care information technology.

"This comes after real progress this year under David Brailer," said Michael Raymer, a senior vice president of IDX Systems, a maker of health information technology software. "And after all, the $50 million would have been mostly a symbolic down payment."

Jon Zimmerman, a senior vice president of Siemens Health Services, a supplier of information technology for health companies, said: "The Bush administration showed real leadership with the appointment of David Brailer, but Congress and the administration missed an opportunity to continue its leadership by funding his office. This is not a show stopper, though."

Dr. Brailer's $50 million request lost out in a year of concern about the widening federal budget deficit and Bush administration priorities like tax cuts and the Iraq war. And further funds for the Department of Health and Human Services were going to be difficult to justify in place of the hundreds of smaller local projects that were earmarked for special attention by senators and representatives.

"It looks like classic micropolitics," said James A. Thurber, director of the Center for Congressional and Presidential Studies at American University in Washington. "If you don't have someone at the table, defending your request in the final negotiations, you lose. Brailer didn't have somebody at the table."