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Nearly all of the presidential candidates have promoted the broader adoption of health IT as an essential element of their health care proposals. Over the next four weeks, Government Health IT magazine will look at the reactions those proposals have elicited in the health IT community, at some of the details of the proposals, and what the expectations are for health IT policy in the next administration.
By Brian Robinson
After the recent flurry of announcements, speeches and presentations focused on the major presidential candidates’ health care proposals it seems clear that health IT will be a permanent fixture in any future administration’s health care plans.
Just about all the candidates who have published their proposals, both Democrat and Republican, mentioned health IT as an essential part of future reform efforts.
Some, such as Sens. Hillary Clinton and Barack Obama, proposed spending billions of dollars to promote the use of technology. Others, particularly among the Republican candidates, talked about improving incentives for market-led programs and for state and local efforts.
And that’s all a big change from past presidential races, observers point out.
“Four years ago there was little attention being paid to this,” said Christine Bechtel, vice president of public policy and government relations at the eHealth Institute. “So it’s nice that many of the candidates now see (health IT) as an important element.”
Scott Wallace, president and chief executive of the National Alliance for Health Information Technology (NAHIT), also thinks that the understanding of how health IT works has made major strides since the last election.
“(The debate) is much more grounded than it was four years ago,” he said. “Then there was a tendency to look at technology as some kind of magic pixie dust that would make health care concerns go away. Now, politicians realize it involves a fundamental restructuring of how we think of IT and its role in health care.”
They see it now as “an integral part of the process and not a binary step,” he said.
But that also means that the issues involved with how IT can affect health care are much more complex, and that realization is preventing the presidential hopefuls so far from buttressing their proposals with many details of how they would prosecute their plans.
Most of the candidates are still “at the 10,000 foot level” on this and don’t want to be pinned down, said Dave Roberts, vice president of government relations at the Healthcare Information and Management Systems Society (HIMSS), at least not yet.
That was obvious at a recent Washington, D.C., policy forum at which representatives from the various campaigns laid out their candidate’s views on health care.
“Clinton’s aide, for example, said that health IT really is on (the Senator’s screen) and that she is interested in the role of technology in health care, but that there is so much uncertainty right now among consumers, providers and others,” Roberts said.
The lack of detail is promoting some doubt about the ultimate worth of the proposals.
For example, Chip Kahn, president of the Federation of American Hospitals, noted that all the candidates on the Democratic side have plans that make the assumption that a broad implementation of electronic health records will save money.
“In the ideal case I believe that would be true,” he said, “but the rate of (IT) diffusion now or at the level they propose will not be sufficient to move the cost curve, nor is that something that will happen overnight.”
There are a slew of questions such as on capital investment, patient identifiers, privacy and other legal and financial issues such as who will pay for what that need to be answered first, he said, “and I don’t get a lot of clarity on those from the proposals I’ve seen so far.”
Cost of and access to health care are the issues that will be to the forefront during the election campaign, Bechtel said, and health IT, being more of a “techie” matter, will probably not. Nevertheless, she said, consumers have shown they are generally supportive of health IT.
“But they are rightly concerned about such things as privacy and security (of data),” she said. ‘So I’d like to see a higher level of debate that would engage consumers in these types of things involved in health and healthcare, as well as on cost and access.”
The candidates may not have much choice if some people have their way. Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation, thinks consumer privacy should definitely be an issue for the campaigns.
“I am not assuaged at all by any of the proposals,” she said. “There’s been virtually no attention paid to the problem of how patients and consumers can retain control over the information in their records.”
She believes this is a major “sleeper issue” that her organization will try and bring to the fore during the run up to the presidential election, starting early next year with the launch of a campaign to protect the privacy of data that consumers reveal in getting prescriptions.
Her organization will also send formal questionnaires to all of the candidates to get their views on privacy, she said, and work to raise the overall profile of the issues.
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