activity similarly i talked a little bit about this at the beginning when transformational time was one of the things going to drive that transformation is going to be changes in health information technology whether we want to or not we struggled with a health information technology bill last year we've talked a little bit about one this year the fact remains it's happening whether congress is involved or not and as a consequence i think we ought to do what we can to encourage physicians offices and physically individual physicians to begin to embrace this to begin to investigate this and additional an a and an additional positive update would be available to physicians who voluntarily participated in any improvements in health information technology and their individual practices you know mr speaker one of the things that i think would make a lot of sense and i don't know why we haven't done it we ought to share with our medicare beneficiaries what your care cost last year you know i get a statement from self security administration about what myself security contributions have been your year over year since i first started paying that fica tax we could do the same thing with our medicare patients what did what did you contribute over your working lifetime and now what are what are your expense what are you expenses attributable you that are incurred to the system and that is information should be confidential you don't obviously don't publish that but give back to the patient that information on what the cost of their care was over the past year because otherwise they have no benchmark they have no way to know are they in fact getting value for their dollar or not so there's three bills that i've introduced to help tackle these problems and get at the essential of what is creating the near havoc situation in the physician workforce i think these bills are essential to ensuring that america will always have a good supply of qualified satisfied doctors to address the growing health the care needs of an ever growing population now we've already talked a little bit about the sustainable growth rate formula getting medicare payment policy right is the first point to make in any type of reform it's going to affect the physician workforce paying physicians fairly will extend the careers of many doctors who otherwise would just simply opt out of medicare or opt out of the practice medicine entirely paying physicians fairly also has the effect of ensuring an ad adequate network of doctors that that adequate network of doctors is available to treat some of those complex patients we have in this country and that's the elderly patients on medicare and as this country makes a transition to the workforce of the future now the twenty five eighty five insuring the physician workforce act of two thousand and seven modifies the medicare physician reimbursement policies it's important because you do have to pay doctors fairly for their services so if they want to go into medicine they'll want to continue to practice medicine and maybe even practice medicine at a point to a to a later point in their life so we extend the effective practice life of a physicians we're already out there practicing now the fundamentals of twenty five eighty five we've covered already a little bit but i like to think of it as a workforce solution for the mature physician and provide sustainable medicare reimbursements now and in the future by getting out of the chasm created by the sustainable growth rate formula and the sustainable growth rate formula by the year two thousand and ten it includes truly transformational incentives to further that the development and implementation of quality measures and health information technology in a way that makes sense to the business aspect of the practice of medicine furthermore in two thousand and eight and two thousand and nine physicians could opt to take advantage of those bonuses return value back to their practices and in fact return value back to the taxpayer by participating in those as yours quality measures would be built around high cost quote conditions and strive to improve the quality of care for those conditions and ultimately drive down the cost of delivering the care in the medicare program the bill would also include a federal incentive to implement health information technology along with provisions for providing safe harbors for the sharing of software technical assistance and hardware as well as the creation of health information technology consortium  that last point is it is important because there are laws and regulations that congress has passed in the past that prevent hospitals and doctors working together to develop the type of health information technology network that's really go be necessary to manage this the sea change that we're going to see in medicine in the coming years i will confess mr speaker let me put it down another chart up here is speaker i will readily acknowledge that i have not always been a firm believer in things like health information technology and i'm like health information technology and electronic medical records in fact right before i left practice my practice medicine we were given the charge to beta test of an electronic any prescribe being sort of format and it was certainly no financial outlay on our part we were just simply to use these little handheld devices and report back as to their utility there were obviously some plus sides you knew right away if there was a drug interaction or a patient analogy that wasn't readily apparent on the chart the computer knew it would flag that for you but it slowed you down it slowed you down in that it took about a minute or a minute and a half to add this information in for the patient now mr speaker when i first went into private practice after i  my residency in parkland hospital went into private practice in one thousand nine hundred eighty one reimbursement rates were such that if you saw fifteen to seventeen patients a day you pay your overhead and have a nice amount to take home at the end of the month with everything that's happened with h m o s declining reimbursement rates from private insurance declining reimbursement rates from the government funded sector of health care to be sure and a growing government sector of health care that historically under funds their component and under compensates their component what has happened over time in order to maintain that similar amount of money that's needed to pay for overhead and have something to take home at the end of the month physicians are now finding that instead of seeing three patients an hour they have to see five and instead of working seven hours in the office then the now need to work eight or nine so if you're not seeing thirty five or forty patients a day you may not be measuring up as far as covering that overhead and having something to take back to your family after all they put up with the sacrifice and aggravation of having you there their husband or father as a physician many are frequently gone from from home you go we leave in the middle of the night to attend to problems and we always do that willingly and lovingly but at the same time it does create wear and tear on families and certainly a doctor's family can tell you that at the same time doctors over time have tended to be fairly well compensated and as a consequence families have been it willing to accept that but in order to maintain that same level we've gone from a time where we were seeing fifteen to seventeen patients in a day to thirty five to forty patients in a day and we go back to the prescribing it's taking you a minute and a half to enter in the patient data and hit the send key to send the email to the pharmacy to provide that prescription for that patient that's another hour you've added on to that physician's day how are we going to pay the doctor for that and of this has ever been worked out if you go even further and say we're going to go with a full on electronic medical record there's a learning curve there it's going to take some time and it's going to slow that doctor down not only slowing down so he's less able to see fewer patients it slows him down so that there's less face time if you will what's patient less time to to listen to what the patient is saying to look the patient in the eye and and make sure you're getting the straight story so you come to the correct diagnosis i was late to come to the table as far as  electronic medical records and i'll tell you the sentinel moment that changed my mind that shifted me on this issue and said you know it is going to take more time there has to be a way to compensate doctors for the time involved in doing that he prescribe ing and creating those electronic medical records well two years ago of course we were suffering in the aftermath of hurricane katrina and two years ago next january our committee on energy and commerce had a field hearing down in new orleans and one of the places we went on that field hearing was to charity hospital one of the venerable old teaching institutions in this country many of my professors a parkland hospital had been trained by professors at charity hospital it was it was truly an icon in american medicine and absolutely devastated in the flooding the followed hurricane katrina in new orleans so we went into charity hospital we went down to the basement where the records room typically is in a hospital and here mr speaker is a medical records  charity hospital now this isn't fire or smoke damage on these charts it's black mold you really can't send someone down there to retrieve medical data but up putting the medical records transcriptionist at risk these records are centrally lost forever if the aunt hasn't walked on their pages remember this was all completely underwater because this was in the basement near remember how much water was standing in the streets of new orleans so completely under water don't even know if these are readable but who is going to get in there and risk disturbing all this black mold and failing the spores and getting the health consequences that would result from it so all of this medical data is lost who's to know maybe a kidney transplant there some important data or maybe someone being treated the here and important clinical data lost maybe there was a child with a rare illness that again no one to be able to retrieve those medical records this is the reason why i have now become a believer in the electronic medical records system furthermore when a large number of persons who were evacuated from new orleans and brought to the metroplex to the north texas area north texas physicians turned out in great numbers to receive people who had been in this in the dome stadium in new orleans the superdome i guess is call as well as other individuals who were evacuated from the convention center and they were brought in buses to  downtown dallas doctors met them as they were coming off the bus one of the large pharmaceutical chains set up there with their computer system and if that patient had gotten their prescription at that chain drug store they were able to recreate not their entire medical record but at least their prescription history which a lot of times will give you a great deal of insight into what a pain patients can conditions are and what they're being treated for so the availability of that a t very limited pharmaceutical data provided a great deal a great deal of service to the doctors who were on the ground receiving these individuals who had had to be evacuated out of the city of new orleans and again and really made a believer out of me that that data needs to be retrievable wherever you are wherever you go and all too often we run into in medicine the fact that you know the patient went down somewhere and had a c t scan and now they are seeing a different doctor and that  scan is not available because it's only a written type report and it's locked up in some other office and they're now closed so you either go on a hunch without the information or you repeat the test and spend another thousand dollars so critical to have that information where it's readily retrievable by any doctor involved in in taking up in taking care of the patients now i've digressed just a little bit from the physician workforce issues but i do think this is such an important issue and that's why i included in twenty five eighty five bonus payments for doctors who are willing to begin to make that change into improved health information technology and perhaps consider electronic medical records perhaps consider prescribing there's no question that our handwriting as physicians is generally abominable and i'll tell you what mr speaker it doesn't improve with age medication errors and or because of poor handwriting or illegible handwriting on the prescription pad we've all encountered it during our practices so critical to be able to have that information in a legible reproducible form and have it available when a patient goes from city to city as these individuals were because of  crisis in their hometown where they had to leave and go to other town but even just someone on vacation who develops a problem and if you have the availability of accessing their medical records online or through some service that is going to make a tremendous difference now baker one of the things we talked about too when i first began this discussion on workforce issue is how do we help the physician who's through with medical school and pondering a residency or in fact in a residency could we develop a program that would permit hospitals that do not now currently have a residency program to begin a training program where none is has has existed previously so the second bill twenty five eighty three would create a loan fund available to hospitals to create a residency training program where none has operated in the past these programs of course would require full accreditation by the appropriate agencies and would be focused in typically medically underserved areas we're all suburban fronter community hospitals but she speaker on average it cost about one hundred thousand dollars a year to train a resident and for a lot of small hospitals that's a barrier to entry that they just simply cannot meet and to the balanced budget act passed by this congress long before my service here back in one thousand nine hundred seven ten years ago place some caps on the number of residency slots that medicare would fund making it very difficult for some programs to expand and for some hospitals to create new residency programs so especially for smaller hospitals that are interested in creating a residency training program federal regulations federal regulations stop them cold dead in their tracks from creating that residency program again some of the things that were done in the balanced budget act but these regulations need to be streamlined we need to have a second pathway for these hospitals to follow to establish a  residency training program it's a major financial investment for small hospitals to undertake and frequently they just simply have to forego because they can't afford it even though their community might very well benefit from having such a training program now in the bill before the congress twenty five eighty three loan amounts would not exceed one million dollars in the loan would constitute start up funding for new residency programs the start up money is critical here since medicare graduate medical education funding can be obtained only once a residency program is firmly established the cost to start a training program for a smaller more rural or suburban hospital again is cost prohibitive the barrier to entry is just too high because these hospitals operate on much narrower cost more which is h r twenty five eighty three it is a bill that will it has been introduced as part of the physician workforce package of bills it will allow smaller hospitals to establish residency training programs and as i said earlier mistake or doctors tend to have a lot of inertia we don't fall far from the tree when it comes time to set up practice we tend to go into practice with within one hundred miles of where we did our residency and that would be the reason to move the residency programs into the areas of state into the areas in the communities where doctors are most needed and to this program could be a recruiting tool for small communities to recruit essential professionals to consider residency program in their town and then hopefully stay around once a training program is finished because after all you know all the referring doctors you know personnel in the