Latest electronic medical records bill differs from Energy and Commerce version

House Ways and Means Health Subcommittee chairman's legislation calls for availability of low-cost public IT system for those who do not want to buy into proprietary one.

House Ways and Means Health Subcommittee Chairman Fortney (Pete) Stark, D-Calif., Monday introduced a bill to create a nationwide system of electronic medical records that would use Medicare reimbursement to prod physicians and hospitals to adopt new technologies.

Comment on this article in The Forum.Physicians who utilize an approved system would be eligible for payments of as much as $40,000 over five years, while hospitals could receive several million dollars for complying. Incentives would eventually be phased out and Medicare payments would decrease for those who do not use a qualified system.

The bill, which Stark's staffers have been working on for months, also provides funds to help spur adoption through a matching grant program aimed at those who provide care in low-income, rural and medically underserved areas as well as nonprofit facilities and providers who receive little or no Medicare incentives, according to a description of the proposal. More grant programs would be offered to fund low-interest loans to help local providers finance health IT systems and regional health information exchanges.

To improve harmonization of health IT deployment, Stark's bill would codify the post of health IT coordinator within HHS, a job President Bush created by executive order in 2004. The legislation also calls for a federal advisory committee made up of government and private sector health experts who would make recommendations to the agency for issuing standards on interoperability, security and maximizing the clinical utility of health IT. Under the proposal, HHS would be required to finalize the first generation of those standards no later than September 2011.

On the privacy front, Stark's bill would prohibit the sale of personal health information and require authorization before entities use that data for purposes like marketing. The bill encourages encryption or other methods of cloaking sensitive files and extends to business associates the same protections and penalties that apply to physicians, hospitals and other providers. Furthermore, patients would be able to request an audit trail of medical record disclosures and civil monetary penalties would be increased for violations of federal privacy rules.

Stark views his legislation as complementary to a bill that passed the Energy and Commerce Committee in July, but it differs in several areas -- namely the Medicare language; the imposition of a deadline for HHS standards; the availability of a low-cost public IT system for those who do not want to buy into a proprietary one, and an overarching emphasis on clinical functionality.

Stark did not include a "private right of action" proposal that would have let patients sue for improper use of records. A similar proposal was rejected by the Energy and Commerce Committee.

Ways and Means Health Subcommittee ranking member Dave Camp, R-Mich., supports advancements in health IT infrastructure but has concerns about the cost and incentive structure of Stark's bill.

He introduced a measure in June that would allow physicians who purchase health IT systems to deduct a larger portion of the expense more quickly. It would also eliminate a 2013 sunset that HHS placed on the practice of hospitals providing physicians with software for e-health records.

Stark aides said timing for a markup is unclear but the bill would probably go straight to the full committee for deliberation. They said their boss would like to pass legislation before Congress adjourns, but the chances are slim given the short calendar and roadblocks that a companion bill faces in the Senate.

That bill, introduced more than a year ago by Senate Health, Education, Labor and Pensions Chairman Edward Kennedy and ranking member Michael Enzi, has stalled and a Kennedy spokeswoman said Monday that further action is unlikely this month.