Tuesday, October 16, 2007

Presidential Candidates and Health Care Information Technology: Where Do They Stand?

Election day is more than twelve months away, but the contest for president of the United States is already shaping up to be a fierce one. Many presidential candidates have either released or announced their intention to release a comprehensive plan for health care reform. Following is an attempt to summarize each candidate's position on health care information technology such as e-prescribing and electronic medical records. You are encouraged to visit each candidate's Web site on your own, as their positions may change in the future.

Joe Biden (D): His home state of Delaware is a leader in adopting new health information technology, and the candidate notes the Delaware Health Information Network (DHIN) is a state-wide health information and electronic data interchange network for public and private use. Biden says the potential savings to the health care industry from full adoption of electronic medical records is substantial. He notes that researchers at the RAND Corporation estimated that full adoption of electronic medical records could save $77 billion annually. RAND also determined that by 2004, 15 to 20 percent of U.S. physician offices had adopted electronic medical records systems.

To get to 100 percent adoption of EMR/EHR software, Biden says he would invest at least $1 billion dollars per year in moving to electronic health records systems, provide grants to states to develop electronic medical records and other health IT systems, and assist hospitals, medical facilities and doctors in upgrading to electronic record systems and implementing them in their practice.

Electronic Medical Records Information and Resources

Sam Brownback (R): Brownback advocates for lifetime electronic medical records. On his Web site, he notes that he is " ... the sponsor of a bill that would offer patients both ownership and control over their personal health information and ensure that personal health information is not used by third parties without the consent of the patient. This proposal would also offer patients debit-like cards containing their private and portable personal health information."

Hillary Clinton (D): In her comprehensive plan for health care reform, Clinton pledges to ensure that all health care providers and insurance plans use privacy-protected information technology. She says her proposal will give doctors financial incentives to adopt health information technology and facilitate adoption of a system where high quality care and better patient outcomes can be rewarded. Clinton also notes on her Web site that the Business Roundtable, SEIU and AARP estimate that “widespread adoption [of such IT reforms] raises the potential savings to $165 billion annually.”

Chris Dodd (D): In his plan, Dodd says health insurance premiums will be affordable based on leveraged negotiating power, spreading risk, reduced administrative costs and incentives for adoption of information technology and savings from better care. He implies that technology such as electronic health records and practice management software systems will help integrate clinical information tools, monitoring technologies and care management such that chronic diseases are kept under control.

John Edwards (D): Edwards advocates for universal health care, and healthcare information technology will be critical to ensuring his model delivers high quality care without breaking the bank. On his Web site, the presidential candidate notes: "Many insurers and hospitals still rely on cumbersome paper systems and incompatible computer systems. The outdated 'paper chase' causes tragic errors when doctors don't have access to patient information or misread handwritten charts. It creates needless administrative waste recreating and transporting medical papers, performing duplicative testing, and claiming insurance benefits. Edwards will support the implementation of health information technology while ensuring that patients’ privacy rights are protected."

Edwards pledges to support new technologies, such as handheld devices and electronic medical records, to give doctors the latest information at their fingertips. Edwards also promises to support public-private collaborations that reduce medical errors through electronic prescribing (e-prescribing).

Rudy Giuliani (R): Giuliani has pledged to invest in health information technology to reduce medical errors, improve efficient and detect health threats, noting that thousands of hospital deaths each year are attributed to preventable medical errors. He sais public-private partnerships to improve and set standards for health IT but without overbearing regulations can play a major role in improving quality of care and reducing health care costs.

Mike Gravel (D): It does not appear that Gravel has a position on the role of information technology in health care reform; if he does, we were unable to find it.

Mike Huckabee (R): Huckabee is famously known for losing 100 pounds after being diagnosed with diabetes, and for his steadfast support for preventive health care. He has not released a comprehensive plan for health care reform, but he does note that health care can be made more affordable by adopting electronic record keeping, among other strategies such as medical liability reform and health insurance portability.

Duncan Hunter (R): There's no mention of health care on his Web site, let along discussion of electronic medical records.
Kucinich's proposal is for universal, single payer health care plan completely funded by the government.

Dennis Kucinich (D): Kucinich has proposed a universal, single payer health care plan completely funded by the U.S. government, called the United States National Health Insurance Act (H.R. 676). In his proposal, he calls for the creation of a "standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy," and that "notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record."

John McCain (R): He says that reforms to federal health care policy and programs should focus on enhancing quality while controlling costs, but we were unable to find any references to health care information technology in his campaign materials.

Barack Obama (D): In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging that paper-based medical records make it difficult to coordinate care, measure quality and/or reduce medical errors. He also says processing paper claims costs twice as much as processing them electronically.

Obama pledges to invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT, and promises to "commit the necessary federal resources to make it happen." He also pledges to ensure that these systems are developed in coordination with providers and front line workers, including those in rural and under served areas.

Ron Paul (R): He's a Medical Doctor, but he has not proposed a plan for health care reform, and makes no mention of electronic medical records in his campaign materials.

Bill Richardson (D): To achieve health care for all, Richardson proposes streamlining health care administration by using "21st Century Health Care Bonds" to invest in health information technology, thereby saving the system $22 billion per year.

Mitt Romney (R): In August, Romney shared his health care reform plan with physicians in Florida, where he underscored the importance of bringing market dynamics and modern technology to health care. In his presentation, Romney supported the idea of federal incentives to foster more widespread adoption of electronic medical records technology.

Tom Tancredo (R): He has announced a very basic plan for reform, but there's no mention of electronic medical records or other types of information technology.

Fred Thompson (R): Thompson says he is committed to a health care system with five key attributes. One of those five guiding principles: "Modernized delivery and administration of care by encouraging the widespread use of clinical best practices, medical information technology, and other innovations."

For more information on each candidate's health care ideas, visit the Association of Health Care Journalists.

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