Healthcare IT on the Campaign Trail Everyone agrees on change, but how much and how fast?

by David Orenstein free-lance writer

Healthcare information technology is a campaign issue in 2004.

Both President George W. Bush and Senator John Kerry have made it clear on the campaign trail that their concerns about health care include healthcare IT. Although they have surprising similarities on policy, the candidates differ philosophically on the benefits of technology and the pace of implementing it. Mr Bush’s rhetoric highlights healthcare IT primarily as a means to improve the quality of care. Mr Kerry points to it additionally as a way to lower healthcare costs, and he expects change to happen more quickly than does Mr Bush.

Clearly, both candidates believe the issue is relevant to the everyday lives of Americans. Here are straightforward, non-partisan summaries of what they have been telling voters across the nation. Texas is President Bush’s home field, so Senator Kerry will bat first.

Senator Kerry likes to point out that healthcare transactions can cost $12 to $25, while banks can execute transactions for a penny. The culprit? Slow adoption of advanced IT systems. Mr Kerry proposes giving healthcare providers financial incentives to modernize their IT.

While incentives are Mr Kerry’s carrot to foster change, conditions are his stick: Aware that the federal government does a lot of healthcare business, “John Kerry and John Edwards will require private insurers, as a condition of doing business with public health programs, to use modern IT to file claims with the federal government,” according to a July statement on the campaign’s Web site (www.johnkerry.com/pdf/pr_2004_0726.pdf).

A specific improvement Senator Kerry wants to see is a single, secure electronic medical record for every American by 2008. He notes that the disjointed paperwork regarding medical histories opens the door to redundant, costly testing. Again, Mr Kerry plans to propose financial incentives to make this happen. He wants the Agency of Health Care Quality to develop public-private strategies for meeting the 2008 goal.

Senator Kerry also has called for the computerization of prescribing systems to reduce medication errors and of reminder systems to improve the quality of care.

President Bush highlighted his “Health Information Technology Plan” at a visit to Vanderbilt University in May. He hopes the plan will ensure that “most Americans” have electronic health records within the next 10 years.

To shepherd his plan, Mr Bush has named a national health information technology coordinator, Dr David Brailer. For the past few years, President Bush also has directed the Department of Health and Human Services to work with the industry to develop voluntary electronic healthcare standards, such as ones for electronic transmission of X-rays and lab results, as well as electronic prescribing.

Although President Bush emphasizes voluntary standards, he also looks at the federal government’s clout in the healthcare industry as a means to “create incentives and opportunities for healthcare providers to use electronic records,” according to a campaign fact sheet (www.whitehouse.gov/news/releases/2004/05/print/20040527-2.html). In May, Mr Bush asked several federal agencies for recommendations to that effect.

Mr Bush also seeks to implement his 10-year goal with money for technology projects that demonstrate improvements in health care. His 2004 budget included $50 million to support projects that would bring patient information to hospitals, emergency rooms, and physicians’ offices. This year, he proposed doubling that to $100 million.

Both President Bush and Senator Kerry are putting a lot of stock in the idea of electronic medical records. They differ primarily on pace and scope. They plan to use the federal government’s clout to foster change, but differ on how forcefully to do so. Interestingly, in their literature, both candidates point to technology improvements at the Department of Veterans Administration as a model. As their debate continues, it seems they at least agree that information technology can and must help health care improve.

David Orenstein is a technology and business writer in Silicon Valley. To learn more about a technology topic in Computing Care, e-mail him at davealli@comcast.net.