Electronic Health Record Legislation Gains Traction in House

Federal lawmakers are debating a bill that promises to accelerate existing federal efforts to promote electronic health records technology but that also would speed up the switch to the ICD-10 code set.

H.R. 4157, the Health Information Technology Promotion Act of 2005, (type "H.R. 4157" in the search box after selecting "Bill Number") would officially sanction the Office of the National Coordinator for Health Information Technology, which was established under a 2004 Presidential Executive Order. It also would provide the office with a budget line and set new guidelines for achieving the office's mandate of promoting federal standards.

In a statement introducing the bill, sponsor Rep. Nancy Johnson, R-Conn., said that the measure would “overcome some of the key obstacles that have slowed our progress toward adoption of a national, interoperable electronic system.”

Although many are enthusiastic about government taking on a larger role in encouraging the adoption of health information technology, support for the bill has been tempered by several factors, including the absence of money to communities seeking to pay for these new systems, said Doreen Bell, a government relations representative in AAFP’s Government Relations Division.

In a May 17 letter (PDF file: 2 pages / 172 KB. More about PDFs.) to the House Ways and Means Committee, AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., voiced support for pursuing strategies contained in the bill. "Thank you for your leadership to help accelerate adoption of health information technology," Frank said. However, she also asked that House members consider providing financial assistance. "We would encourage you to consider upfront, direct financial assistance in the form of grants or loans for those physicians who operate in solo or small group practices," said Frank.

Although no such direct funding is being discussed as part of the legislation, the bill would provide an exemption from a federal antikickback statute, removing the prohibition against the transfer of technology from hospitals to physicians' offices.

The AAFP letter also encouraged the House to include more privacy protections in the final legislation.

“While we believe patients stand to benefit the most, in terms of improved patient safety and better outcomes, legislation should include specific provisions ensuring a patient’s right to control data, with criminal penalties to enforce adherence to privacy protections,” said Frank.

Several groups also are balking at the ICD-10 provisions included in the bill. These would require health care providers to switch from the ICD-9 to the ICD-10 classification system by Oct. 1, 2009.

“We want to move to ICD-10 in the long run, but we need to preserve good business practices,” said Rob Tennant, senior policy advisor with Englewood, Colo.-based Medical Group Management Association, which has offices here.

“The industry is starting to realize that (conversion) might be a problem,” he said.

America’s Health Insurance Plans, a Washington-based private insurance trade group, recently released Impact of ICD-10 Code Set Adoption on Health Insurance Plans, (PDF file: 57 pages / 448 KB. More about PDFs.) which projected that, due to the complexity of shifting from roughly 24,000 codes in ICD-9 to the more than 207,000 codes in ICD-10, even large payers would need at least until 2012 to fully prepare.

Physicians who lived through the conversion to electronic transactions under the Health Insurance Portability and Accountability Act of 1996 should be able to appreciate the benefits of having enough time to pilot test the changes, Karen Ignagni, AHIP CEO and president, said during a press briefing here.

In her letter, Frank encouraged lawmakers to include the International Classification of Primary Care as an acceptable upgrade from the ICD-9 code set.

“ICPC is a concise, appropriate and comprehensive classification for family medicine and is fully mapped and compatible with ICD-10,” advised Frank.

Some lawmakers have responded to concerns about the addition of ICD-10. Last week, the House Energy and Commerce health subcommittee passed the bill with an amendment that strips out the ICD-10 deadline. The bill previously was approved by the Ways and Means health subcommittee with the deadline intact. The two versions still have to be approved by the full committees and then consolidated before coming up for a House vote.