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Herger Statement: Hearing on Meaningful Use of Health Information Technology

July 20, 2010

Thank you, Chairman Stark, and I appreciate you calling this hearing to examine efforts to promote the adoption of health information technology.

The Stimulus law included $36 billion in incentive payments, largely through deficit spending, for providers who “meaningfully use” electronic health record technology, or EHRs.  Members of this Subcommittee may recall that during the markup of the Stimulus bill, Republicans raised concerns about spending this money before interoperability standards were in place.  Today we will hear specifics of how that money will be spent.

There is bipartisan agreement that EHRs hold great promise.  I am hopeful, as I think we all are, that widespread adoption of health I.T. will result in better outcomes, higher quality, and improved efficiencies.

However, I am concerned that we could have received a better return on the taxpayer’s $36 billion investment, and that the final regulations on meaningful use represent a missed opportunity to improve patient care and reduce waste.

Much less is expected of health care providers receiving subsidies than what CMS had initially proposed.

Under the final rule, it’s up to providers to decide if they want to record clinical lab test results and harmful drug interactions.  Providers can also decide for which patients they want to incorporate prescription drug information, medication allergy lists, and vital signs. So each of the practices that experts have told this Subcommittee are vital to improving patient safety and eliminating waste, are optional. 

The final rule also lowers the compliance thresholds for providers in many categories.  For example, in the proposed rule, electronic prescribing was required for 75 percent of prescriptions written.  The final rule reduced this requirement to 40 percent.  Despite these lower standards, the providers will still receive tens of billions of dollars in taxpayer subsidies.

MedPAC stated in its comment letter “we strongly support CMS’s proposal to require that a hospital or eligible professional meet all of the Stage 1 meaningful use criteria…”  I am concerned that by lowering the capability requirements, we will end up with a lower standard and lower compliance rates. 

I am also concerned that the final rule does not require electronic health systems to communicate with one another in any meaningful way.  Under the final rule, providers are deemed to meet the interoperability requirement if their EHR system can execute one test of exchanging data with another system.  The provider does not have to actually exchange any actual patient data.  As we’ll hear from one of our witnesses later today, the private sector has developed solutions to the interoperability problem.  We should build on what has already been proven to work, instead of kicking the can down the road on a capability that’s vital to improving patient care.

The new HIT regulations are a step in the right direction and should put Medicare on a path to improved quality and efficiency.  However, by watering down the final regulations, we have missed an opportunity to advance health care delivery and ensure wise use of taxpayer money.  I’m certain that if and when CMS decides to expand what’s expected of providers, we’ll be hearing how providers need billions of dollars more in order to meet the higher compliance standards which should have been put in place from the start.   As one of the witnesses we’ll hear from later today points out, “these were meant to be incentives, not entitlements.”

Thank you, Mr. Chairman.