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Federal Health Architecture

A low-key question at the end of a routine hearing left the smooth and usually well-prepared Mike Leavitt, secretary of the Department of Health and Human Services, searching for an answer: How many federal agencies have adopted the health information technology standards that Congress approved in 2003 and 2004 as part of a White House-sponsored e-government initiative?

Leavitt told Sen. Debbie Stabenow (D-Mich.), that he didn't have a number at his fingertips. That didn't seem to surprise Stabenow. Throughout the July 20 Senate Budget Committee hearing on health IT, she pressed Leavitt to modify his insistence that interoperability should be HHS' top priority for advancing health IT.

"Right now, we still are not completely interoperable in the U.S. Senate," she said, but that hasn't stopped senators from relying on e-mail and other networks.

Stabenow and Sen. Olympia Snowe (R-Maine) are sponsoring a bill that would establish a $4 billion grant program to help doctors, hospitals and other health care institutions install new computer systems for clinical information and patient safety. Medicare payments would increase for providers using clinical IT systems.

Leavitt said the government should not pay doctors and other health care providers to buy health IT systems that cannot communicate with anyone outside the system. "The place for our laser focus is on interoperability of systems," he said.

Leavitt got support from Sen. Wayne Allard (R-Colo.), who said that once doctors buy health records systems, they won't want to spend more money to modify them to meet interoperability standards.

Other observers, such as Joseph Kanter, founder of the Kanter Family Foundation and a health IT activist, say the lack of interoperability standards may be keeping some doctors and other medical professionals from investing in new systems.

Federal agencies have been slow to adopt the standards that were approved as part of the White House's Consolidated Health Informatics initiative. Leavitt and the national health IT coordinator, Dr. David Brailer, now expect that a set of standards will become Federal Information Processing Standards. Then it will be mandatory for federal agencies to implement the standards as they buy new systems.

Rather than mandating national standards through federal regulations, Brailer said after the hearing, "we're acting by our purchasing power."

The initiative has been subsumed by the Federal Health Architecture project, which Brailer's office manages.

LeRoy Jones, senior technical adviser in Brailer's office, told the National Committee on Vital and Health Statistics in June that some agencies' tendencies to remain loyal to their own architectures is hampering progress on the Federal Health Architecture.

Ferris is a freelance writer in Chevy Chase, Md. She can be reached at [email protected]


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