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Time is short, but sponsors still look for IT bill opening

Sponsors of a Senate bill intended to create a nationwide system of electronic health records might try to hotline their proposal today so it can be brought to the floor by unanimous consent, sources said Wednesday.

Comment on this article in The Forum.The bill was introduced by Senate Health, Education, Labor and Pensions Chairman Edward Kennedy and ranking member Michael Enzi more than a year ago but has stalled over concerns by several members.

A source said an agreement has been reached with the Bush administration, which had problems with a standards-setting body the measure would create.

The White House wanted to ensure the proposed panel was compatible with an existing effort spearheaded by the Brookings Institution under a $13 million, multiyear contract with HHS. Sources were conflicted about whether a deal might have been reached on some of the bill's privacy provisions.

One potential holdup is whether Sen. Tom Coburn, R-Okla., will push for the bill to relax rules that let hospitals provide equipment to physicians for free or at large discounts.

That would be the jurisdiction of the Senate Finance Committee, so it cannot be added to the HELP Committee bill without triggering a turf war, the sources said.

Talk of hotlining the bill is nothing new and at least one Republican aide was skeptical.

"The goal has been to move it every week since mid-May," he said. "That's a lot of weeks and this is the last one we've got."

The Senate is set to adjourn this week to return in September. Another aide said a vote on the bill this week is unlikely and even if the Kennedy-Enzi measure does pass, the likelihood of having House language to conference by the end of the session is slim. "I'm not optimistic," he said.

Meanwhile, the House Small Business Committee today will wade into the health IT debate at a hearing on cost, confidentiality and other potential unforeseen challenges faced by small specialty practices.

Small Business Chairwoman Nydia Velázquez said few small physicians' offices use electronic records because of the high price tag and hidden fees associated with training and systems maintenance. Targeted loans and alternative financing through the Small Business Administration can help, she said.

Small Business ranking member Steve Chabot said perspectives presented at the hearing will be helpful as lawmakers weigh health IT bills like the one that passed the Energy and Commerce Committee last week. The bill includes authorization language of $115 million per year through 2013 for grant and loan programs with special provisions for small providers and those in underserved or rural areas.

One program would offer matching funds for equipment purchases; another would let providers leverage private sector low interest loans and a third would support the creation of health IT plans for how data would be shared among healthcare stakeholders in a given region.

House Ways and Means Health Subcommittee Chairman Fortney (Pete) Stark, D-Calif., is working on a bill, which an aide said Wednesday likely will not be introduced before recess.

His proposal would use Medicare reimbursement as an incentive for implementation by healthcare providers and would give individuals the right to sue for damages when their records are breached. It is unknown whether Stark's bill would include provisions for smaller entities.

Representatives from the American Association of Neurological Surgeons, American Psychiatric Association, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists will testify at the Small Business Committee hearing. Robert Plovnick, director of quality improvement for the APA, said he planned to tell members that fears about how e-files are safeguarded might prevent patients from disclosing vital files. He also noted that about 50 percent of psychiatrists are solo practitioners and concerns about implementation costs are paramount.

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