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28–571 PDF 2006

CAN SMALL HEALTHCARE GROUPS FEASIBLY

ADOPT ELECTRONIC MEDICAL RECORDS TECHNOLOGY?

HEARING

BEFORE THE

SUBCOMMITTEE ON REGULATORY REFORM AND 

OVERSIGHT

OF THE

COMMITTEE ON SMALL BUSINESS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

WASHINGTON, DC, APRIL 6, 2006

Serial No. 109–47

Printed for the use of the Committee on Small Business

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/house 

COMMITTEE ON SMALL BUSINESS 

DONALD A. MANZULLO, Illinois, Chairman 

ROSCOE BARTLETT, Maryland, Vice 

Chairman 

SUE KELLY, New York 

STEVE CHABOT, Ohio 

SAM GRAVES, Missouri 

TODD AKIN, Missouri 

BILL SHUSTER, Pennsylvania 

MARILYN MUSGRAVE, Colorado 

JEB BRADLEY, New Hampshire 

STEVE KING, Iowa 

THADDEUS MCCOTTER, Michigan 

RIC KELLER, Florida 

TED POE, Texas 

MICHAEL SODREL, Indiana 

JEFF FORTENBERRY, Nebraska 

MICHAEL FITZPATRICK, Pennsylvania 

LYNN WESTMORELAND, Georgia 

LOUIE GOHMERT, Texas 

NYDIA VELA ́ ZQUEZ, New York 

JUANITA MILLENDER-MCDONALD, 

California 

TOM UDALL, New Mexico 

DANIEL LIPINSKI, Illinois 

ENI FALEOMAVAEGA, American Samoa 

DONNA CHRISTENSEN, Virgin Islands 

DANNY DAVIS, Illinois 

ED CASE, Hawaii 

MADELEINE BORDALLO, Guam 

RAU ́ L GRIJALVA, Arizona 

MICHAEL MICHAUD, Maine 

LINDA SA ́ NCHEZ, California 

JOHN BARROW, Georgia 

MELISSA BEAN, Illinois 

GWEN MOORE, Wisconsin 

J. MATTHEW SZYMANSKI, Chief of Staff 

PHIL ESKELAND, Deputy Chief of Staff/Policy Director 

MICHAEL DAY, Minority Staff Director

SUBCOMMITTEE ON REGULATORY REFORM AND OVERSIGHT 

W. TODD AKIN, Missouri Chairman 

MICHAEL SODREL, Indiana 

LYNN WESTMORELAND, Georgia 

LOUIE GOHMERT, Texas 

SUE KELLY, New York 

STEVE KING, Iowa 

TED POE, Texas 

MADELEINE BORDALLO, Guam 

ENI F. H. FALEOMAVAEGA, American 

Samoa 

DONNA CHRISTENSEN, Virgin Islands 

ED CASE, Hawaii 

LINDA SA ́ NCHEZ, California 

GWEN MOORE, Wisconsin

CHRISTOPHER SZYMANSKI, Professional Staff

(II) 

C O N T E N T S 

WITNESSES

Page 

Magruder, Ms. Joan, Vice President of Development and Planning, BJC 

Healthcare ............................................................................................................ 2

Normile, Dr. Christopher, Medicinae Doctor (Doctor of Medicine) ...................... 4

Price, Mr. Jack, Vice President, Services, HIMSS Analytics ............................... 6

Gingrey, The Honorable Phil (GA-11), Congressman, U.S. House of Representatives ..................................................................................................................... 14

APPENDIX

Opening statements: 

Akin, Hon. W. Todd .......................................................................................... 20

Prepared statements: 

Magruder, Ms. Joan, Vice President of Development and Planning, BJC 

Healthcare ..................................................................................................... 22

Normile, Dr. Christopher, Medicinae Doctor (Doctor of Medicine) .............. 25

Price, Mr. Jack, Vice President, Services, HIMSS Analytics ........................ 30

Gingrey, The Honorable Phil (GA-11), Congressman, U.S. House of Representatives ................................................................................................... 37

Additional Material: 

Kasoff, Ms. Barbara, Women Impacting Public Policy .................................. 52

Barnes, Mr. Justin, Greenway Medical Technologies ................................... 59

(III) 

(1)

CAN SMALL HEALTHCARE GROUPS FEASIBLY 

ADOPT ELECTRONIC MEDICAL RECORDS 

TECHNOLOGY? 

THURSDAY, APRIL 6, 2006

HOUSE OF REPRESENTATIVES

SUBCOMMITTEE ON REGULATORY REFORM AND

OVERSIGHT

COMMITTEE ON SMALL BUSINESS

Washington, DC 

The Subcommittee met, pursuant to call, at 2:00 p.m., in Room 

2360 of the Rayburn House Office Building, Hon. W. Todd Akin 

[Chairman of the Subcommittee] presiding. 

Present: Representatives Akin, Sodrel. 

Chairman AKIN. The Subcommittee will come to order. The 

Ranking Member is trapped in another committee hearing, which 

is not surprising. We usually schedule about two or three in the 

same time period for anybody in any committee. So she gave us 

permission to go ahead and proceed with the hearing. She may join 

us a little bit later. 

I have a prepared opening statement here. 

First of all, I have already said this, but to everybody good afternoon. Welcome to today’s hearing. It’s entitled ‘‘Can Small 

Healthcare Groups Feasibly Adopt Electronic Medical Records 

Technology.’’ 

I especially want to thank those of you who have traveled here 

from some distance. Two of our witnesses are from the congressional district that I am proud to represent. And so we are delighted particularly to have those of you who have made the trek 

up from the St. Louis area, we appreciate that. 

In my role as Congressman and Chairman of this Subcommittee 

I have had the opportunity to interact with many businesses in just 

about every industry. I talk to business owners and CEOs about 

the many challenges they face, both domestically and abroad and 

time and time again they state that the rising cost of health care 

is crippling their firms. 

Because many small businesses operate in slim margins, any increase in costs can turn a profitable business into an unprofitable 

one. The rising cost of health care is an important issue and there 

are many different voices in the public square advocating different 

approaches to offset these rising costs. Today this Subcommittee 

will focus on the electronic benefits derived through the adoption 

of technological processes. Is the adoption of electronic medical 

2

records technology feasible for small businesses, specifically small 

doctors’ practices? We also hope to determine the challenges these 

small groups face in adopting such technology. 

There is little doubt that the adoption of electronic medical 

records can play an important role in increasing efficiency, reducing paperwork and redundancy and more importantly, reducing 

medical errors. 

According to the Department of Health and Human Services it 

is estimated that the introduction of health information technology 

can reduce healthcare costs by up to 20 percent per year. The Bush 

Administration has stated the importance has stated the importance of implementing electronic healthcare systems, and made it 

a priority. 

That said, doctors have increasingly faced higher liability costs, 

potential cuts in Medicare physician payments, and additional regulatory burdens resulting in a question as to whether smaller practices can afford to adopt this innovative technology. 

I look forward to hearing the testimony of the witnesses to learn 

more about whether small practices can adopt this technology. 

And because our Ranking Member is not here, I am not going to 

yield to her, but we will proceed immediately to our witness list. 

I have a very bad reputation in this Committee to keeping people 

on time in terms in making their statements. That way we get out 

on time, too. So the way we are going to do things will be I am 

going to take a five minute statement from each of you. Usually 

when there is other Committee members we save our questions 

until you get done with making your statements. Now my recommendation is that you can submit a more extensive written response which we will accept as part of the record. And so my recommendation because you have just five minutes, it is maybe almost better just to put your notes aside and just say the two or 

three things that you really want the Congress to be hearing about 

what you have to say on this subject. But if you feel a little bit 

more psyched out than that and you want to just read some of your 

notes, you can do that. But my advice is maybe just say hey this 

is what I think about the subject. 

So with that we’ll start with our opening witness. Oh, they are 

trying to trick me here. They have got Jack first. I go by the order 

coming across. So we are going to start with Joan, is it Magruder? 

[Chairman Akin’s opening statement may be found in the appendix.] 

Ms. MAGRUDER. Magruder, yes. 

Chairman AKIN. 

Joan, five minutes please. 

STATEMENT OF JOAN MAGRUDER, BJC HEALTHCARE

Ms. MAGRUDER. Thank you. Thank you, Mr. Chairman and Members of the Committee. 

My name is Joan Magruder, and I am pleased to be here today 

really to talk about a very innovative way we at BJC Healthcare 

are approaching the introduction of the electronic medical record. 

3

We recognize, as you said in your opening remarks, that technology has an incredible ability to transform and improve 

healthcare delivery and have a significant impact on the cost effectiveness of what we do. We also recognize that the timing of this 

is incredibility pivotal on, as the opening remarks confirmed, our 

physicians today are in a circumstance where as a small business, 

in and of themselves, the margins are slim and eroding. And in 

light of the malpractice issues and clearly the rising cost of 

healthcare, they really have two very pivotal role with the electronic medical record. One is as a self-employed business themselves is that the cost of labor and benefits of their own employees 

who is integral to them and, second of all is obviously providers. 

They ultimately are the enablers of this electronic medical record 

capability. 

First just a couple of comments about a context for our circumstance. BJC Healthcare, as you may know, is headquartered in 

St. Louis. We have about 13 hospitals, about $2.5 billion of revenue. For purposes of the electronic medical record the important 

aspect is that we have a very diverse geography, a very diverse patient population and we have an opportunity to serve a few rural 

markets as well as suburban and urban. 

Our goal ultimately clearly is to be a national leader on both patient advocacy, medical research and financial efficiency. 

Today, really, I come to you representing one of my responsibilities which is our BJC Medical Group. We have a couple hundred 

physicians that we employ through our organization in about a 225 

mile radius. All of these physicians are in small office settings, generally three to four person situations. And we are working as we 

speak to roll out the electronic medical record to these physician 

offices. It will represent about 300,000 patients that we will be able 

to cover during this time. Almost 20 percent of those are in the 

rural markets. These patients really represent a cross section of 

subspecialties. Most or about two-thirds of our providers are primary care, but we really cross the entire specialty aspect. 

BJC has committed to a $8 million investment in the electronic 

medical record across these 200 providers. And our thinking is a 

couple of things. 

One is that we will be able to set up this project to provide connections to external as well as internal labs. So a lot of the electronic medical records you hear about today are actually in selfcontained private offices. And one of the things that we feel responsible to do is to take that precedent and extrapolate it to interface 

it with the hospital connectivity. And so we have actually moved 

ahead choosing a product that is very centric to the physician office 

setting and we are going to support, underwrite if you will, the 

interfaces back to our emergency departments, our hospitals, 

etcetera. 

The benefit of that, obviously, from the perspective of the universal patient record is clearly to get the continuity of care not just 

outside the hospital, but all the way through to home care, post 

discharge, etcetera. 

In addition, we recognize there is a lot of unnecessary are being 

provided. There is a lot of avoidable emergency department visits, 

readmissions for circumstances where patients are put on contraVerDate 0ct 09 2002 19:57 Nov 02, 2006 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 G:\HEARINGS\28571.TXT MIKE
4

indicated medications, and obviously that’s a function of the fragmented healthcare system that we have today. 

So the ability to really roll this out across our 13 hospitals enables us to advance what many of you have heard about, with is 

the shared records capability. You have heard of a portal, you have 

heard of sort of a regional health network at times. And this 

shared records capability allows us across these 13 hospitals to in 

fact for about 30 percent of the patients in our market, understand 

the entirety of care that has been provided and understand what 

really would have been the ideal patient care system. 

In addition, we feel strongly as was indicated as well about this 

interoperability issue. The concept of requiring the vendors to really have a product that really can transcend from one to another. 

Our vision ultimately is to take this prototype and create a community health portal that will allow multiple provides to access 

medical records and allow patients to view their medical records. 

We think that having records through the internet will, obviously, 

be very advantageous and promote from the perspective of education, advice, etcetera. 

In closing, we would say that BJC Healthcare is committed to 

the successful introduction of the electronic medical record. Our 

hope is that this will catalyze a regional health wide practice. As 

we move forward today in our conversations, we are anxious to talk 

about some of the obstacles from a cost and an implementation perspective which will enable the proliferation to occur. 

Thank you. 

[Ms. Magruder’s testimony may be found in the appendix.] 

Chairman AKIN. Thank you very much, Joan. And right on the 

five minutes. Appreciate that and your perspective and looking forward to asking some questions. 

Next we are going to go to Dr. Christopher Normile. And you are 

the doctor of medicine from St. Charles, Missouri, which is also 

part of my district. Good. 

Would you please proceed? 

STATEMENT OF DR. CHRISTOPHER NORMILE, AMERICAN 

ACADEMY OF FAMILY PHYSICIANS 

Dr. NORMILE. Mr. Chairman, fellow AAFP member Representative Christensen, and Members of the Subcommittee, thank you for 

the opportunity to provide testimony today. 

Chairman AKIN. Could you get that mike and just sort of slide 

up a little closer there. 

Do you go by Christopher or Chris or— 

Dr. NORMILE. Chris will be fine. 

Chairman AKIN. Chris. Okay. Thank you. 

Dr. NORMILE. I am a partner in a two physician practice in St. 

Charles, there are only two of us. We are independent, we are a 

small business. I am also a member of the American Academy of 

Family Physicians, one of the largest national medical organizations with more than 94,000 members. 

Chairman AKIN. You are still dropping off. Could you pull that 

mike even a little closer there. 

Dr. NORMILE. Your Subcommittee’s concern for physicians practices is well placed. We are small businesses with a significant imVerDate 0ct 09 2002 19:57 Nov 02, 2006 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 G:\HEARINGS\28571.TXT MIKE
5

pact economically on our communities. Family physicians and 

AAFP have been in the vanguard in promoting electronic health 

records and they have provided information that has supported 30 

percent of family physicians adopting EHR so far. 

My job I think today was to give you my experience. And some 

time ago, say, in ’95 I had a palm pilot and it became very apparent to me the power of these tools in improving medical care for 

patients. I convinced my partner to purchase an electronic health 

record, and we have been using it for two years now. 

Today on a typical day I will come in and electronically synchronize my laptop and take information from home and work that 

I have done at home and file it into our computer. I log onto an 

internet connection with the local hospital, put up that information 

on my hospitalized patients. I review labs, phone messages, all sitting at my desk in just a few minutes. My efficiency has improved 

in that regard. 

After office hours I dictate notes through a voice recognition software . I do not need to use transcriptionists. They cost us thousands of dollars anymore. 

In the near future we will communicating more and more with 

patients through the internet. And this will be another expense 

that we will have absorb. 

Currently the time I set aside for electronic communications with 

patients is not paid for by insurance company or Medicare, even 

though it does improve care and reduce the medical costs for the 

whole system. 

The benefits for our office have been, you know, longer stacks of 

papers. We have information our fingertips. Any doctor who calls 

me I have information immediately at hand. The same when patients call me, I have patient’s immediately at hand to discuss with 

them about their care. 

It is much more easy to manage a diabetic or a chronic care patient’s care and to keep track of those results to improve quality 

of their care. 

The technology does not come cheap, though. We are fairly typical among users of the electronic health record. Our initial cost 

was about $50,000 and annually we spend about $10,000 for software upgrades, hardware, etcetera. 

Far more significant to the actual financial cost, this tool has 

cost me a lot of time and effort. It is a very complicated system. 

As those of you who hate setting the clock on your VCR can only 

imagine the time and expense and time it takes to organize and coordinate the medical records. We are a complex office to start with 

and the computer makes it even more complex. So we have learn 

this and develop it so that it works for us. 

Because of dwindling and third party reimbursements, which in 

our market is dominated by a few powerful insurers, we have found 

ourselves with progressively shrinking incomes. Therefore, the system upkeep has landed in my hands. Computer consultants charge 

about $150 an hour for their services. Currently that is more than 

three times more my hourly income. Five times more if you calculate the time and effort to put into the electronic work records 

and with paperwork, phone calls, etcetera. So I have to do all of 

the care of our computers. 

6

As these systems become more widely adopted, costs will eventually decrease. But in order to accelerate adoption, the AAFP recommends that Congress work to provide financial incentives for 

small to medium size practices, and; (2) establish federal standards 

of interoperability, and; (3) support technical assistant programs to 

help small practices through the cycle of selecting, implementing 

and redesigning their work flow. We can use all the support we 

can. 

Thank you. 

[Dr. Normile’s testimony may be found in the appendix.] 

Chairman AKIN. Thank you, Chris. You actually redeemed some 

of your time there. You should get extra points for that. And we 

appreciate your interesting testimony. 

Now we have been joined by my very good from Indiana, Congressman Mike Sodrel. We are just going to finish the hearing from 

the witnesses and then we will have things open for questions, 

Mike, in just a minute or so. 

Our third witness, Mr. Jack Price is Vice President of Service for 

HIMSS. Is that His Majesty’s Secret Service or something? Analytics from Melford, Delaware. Maybe that is not exactly what it 

means, but we are glad to have you just the same, Jack. 

STATEMENT OF JACK PRICE, HEALTHCARE INFORMATION 

AND MANAGEMENT SYSTEMS SOCIETY, HIMSS ANALYTICS. 

Mr. PRICE. Well, thank you very much, Mr. Chairman and the 

Ranking Minority Member Bordallo and distinguished members. 

Thank you for allowing me to appear before this Subcommittee. 

As Mr. Chairman stated, HIMSS is the Healthcare Information 

and Management Systems Society and HIMSS Analytics is a research arm associated with HIMSS. 

My role is that I lead a lot of research projects, produce surveys 

in order to routinely obtain data that is critical to efforts to improve the quality and cost efficiency of patient care. 

One of these surveys that I’m currently working on right now is 

we are interviewing 2500 physician offices across the country. And 

of these 2500 offices we have found out that when we ask them if 

they had practice management system, the answer was always 100 

percent yes. We asked them if they had an electronic medical 

records system, we found out that only 26 percent of those offices 

answered yes. 

And when we further drilled down and asked the other 70 some 

percent if they plan on purchasing one in the next two years, the 

answer was no. So we are very interested in why they did not want 

to purchase that EMR when all the evidence suggests that on the 

contrary there are tremendous benefits and return on invest from 

purchasing an electronic medical records system. 

And in healthcare we look at ROI two different ways; the soft 

side which is more associated with looking at patient safety factors, 

improved communication and the ability to improve clinical processes. We also look at hard ROI, which is really associated with 

things like reduction in material and resource expense, improving 

patient flow, therefore increasing revenue. And also improving billing improvements so you can capture more revenue that way. 

7

So, you know, when you look at hard ROI, when you look at 

charts they can be seen on a clinic’s computer and patient encounters can be documented in a few mouse clicks. The flow of patients 

through a clinical environment changes dramatically and as a result, volumes of patients can be increased and then also as a result 

of that, more revenue can be achieved. 

EMRs also reduce the need for paper, and that is one of the big 

pushes for EMR. So you eliminate that paper trail. And when you 

do that you can also eliminate the number of transcribers that are 

responsible for having to do the transcription. It can be automated 

by the physician. 

And so you can also reduce the amount of space that it takes to 

actually store these tons of medical records that are out there. 

So there are many benefits along a hard ROI perspective. And 

it also provides a very easy way to capture data that normally 

could not be captured for billing and submitting it electronically to 

the payors. 

So from the standpoint of a small business practice, we see many 

advantages from using EMRs. And so clinics have reported doubling or even tripling their case loads with corresponding jumps in 

revenue and with only marginal increases in staffing. And at the 

same time many report that they more easily pass regulatory audits than before. 

And after EMR implementation practices see decreased medical 

liabilities, they see more accurate and thorough documentation, enhanced patient care and improved quality of review. 

Patients also no longer must wait to see a physician. And so the 

patient satisfaction increases dramatically as well. 

However, as the results of our recent survey pointed out, many 

providers are still reluctant to invest in EMR technology. And one 

reason may be the fear factor associated with these enormous 

startup costs and the cost of the software, hardware, implementation, training and support. And you also have to realize that many 

physician practices do not have that support staff that hospitals 

have when they implement EMR. So a lot of it falls on the physicians, as we have heard in previous testimony. 

So the amount associated with implementation is a daunting and 

can be a very disruptive task for a practice. And perhaps one of the 

biggest barriers to overcome is really more of a resistance to 

change itself. 

But we see ambulatory care clinicians who have implemented 

EMRs really have no shortage of advice for their colleagues. And 

one of the things that we suggest is that these physicians continue 

to be champions and offer a valuable experience, hands-on experience to those physicians that really need to grasp EMRs and move 

forwards. So for small healthcare groups considering EMR, this is 

a very valuable resource and must be tapped. 

So with that I will say on behalf of HIMSS and HIMSS Analytics 

thank you again, Mr. Chairman and Ranking Minority Member 

Bordallo for the opportunity appear before this Subcommittee. 

Thank you. 

[Mr. Price’s testimony may be found in the appendix.] 

Chairman AKIN. Thank you very much. And also doing a great 

job on time there for us. 

8

The staff that put the hearing together because of the nature of 

this Committee, focused a lot of it on small business, which is appropriate, particularly the small business of the smaller practices 

and things. I guess the two questions that sort of jump out at me, 

and they are partly small business related but partly just in general on these medical records, I would like to toss them out to any 

of the three of you that want to take a shot at either of these questions. 

The first one it seems like, you know I used to work for IBM. It 

seems like there is a technical question as to what software you 

use and what sort of format that you use in transmitting medical 

information. And I have heard there are some different theories. 

One of them is stand back and wait patiently for a couple of years 

until somebody in the government comes up with an absolutely 

perfect way of doing it. 

The other approach seems to be well you are waiting for the government, you will wait forever. Maybe it is a better thing just to 

let free enterprise take over and while there will be a little bit of 

some fitful starts and maybe some competing software, competing 

approaches, it may be a little harder to get to some perfectly standardized approach, yet probably the market will sort that out faster 

and more efficiently than letting the government do it. 

So if you have a thought on that, or any other thing that relates 

to the problem of how do you format the information and make it 

so that you can talk from a doctor’s office to a hospital to a hospital 

somewhere else where somebody is vacationing, to get that record. 

And then the second question I have we have got every since the 

days of AIDS became a politically correct disease to protect and everything, we have got some very, very strong laws regarding patient privacy. And I am just wondering if that gets in the way also 

of transmitting records. You know, Todd lives in St. Louis, works 

in D.C., he is vacationing in Massachusetts and has some sort of 

bad symptoms, goes into an emergency room or something. Can 

Massachusetts pull up the records from St. Louis and Washington, 

D.C., all at once the doctor is making a decision with all of the 

data? And what are the questions in terms of the legality of transmitting that information. 

I just wanted to toss out, those are the two main things I had. 

If you could just give me, anybody who wants to take a shot at either of those it would be helpful. 

Ms. MAGRUDER. I guess I would comment on the question about 

how much to allow to free enterprise versus government interaction. You know, I think for us we have thought that the ideal is 

sort of a hybrid of the two, a combination of sort of a public and 

private partnership. 

The idea behind BJC putting $8 million behind the electronic 

medical record is all the earlier testimony about the risk aversion 

of the physicians and the fact that it is not time neutral. And, in 

fact, in the short term it is costly to them in many ways. And so 

our piece of the investment was let us get them over that hump 

and hold them accountable for none of the one time costs, but only 

the in-office costs. 

Now the reason that we thought that was important was your 

other point, which is that our experience has been that the elecVerDate 0ct 09 2002 19:57 Nov 02, 2006 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 G:\HEARINGS\28571.TXT MIKE
9

tronic medical records that have been adopted are only in freestanding independent office situations and feel to really get at the 

cost effectiveness of care, needed the benefit of an interface to the 

hospitals, the emergency departments, etcetera. And so the public/

private aspect is that we would like to see a situation where people 

like ourselves seed large sums of money and ideally can have a 

partial match from the public sector to inscient that that proliferation really be accelerated but with a clear understanding that it is 

not a proprietary product, that it really can continue to move in an 

interoperable fashion and proliferate in the community. And that 

we can serve somewhat as a financing vehicle for the physicians 

that maybe they have to pay back some of it over time, but make 

that less onerous in the long run. So sort of a public/private partnership. 

Chairman AKIN. The public aspect being that there would be 

some maybe tax incentive or something like that to try to help reimburse the hospital some for your investment in that technology. 

Ms. MAGRUDER. Exactly. Because honestly one of the things that 

I was up against, I happen to run our physicians practices. And 

most institutions are going to want a product that is centric to an 

institutional approach to things, which is often synonymous with 

not what is in the best interest of the physicians. What I really 

wanted was a product that was physician centric that really spoke 

to the ambulatory environment so that physicians would ultimately 

adopt it and find it to be useful. 

So the incentive idea was that hospitals or otherwise are not 

going to readily approach it in the way that really inscients a win/

win there. 

Chairman AKIN. Thank you. 

Chris or Jack, either? 

Mr. PRICE. I see it as a very complex problem and it does require 

a lot of balancing between what is good for the hospital, what is 

good for the physician offices sometimes. And, for example, if you 

have a system within a healthcare integrated delivery s stem that 

you can push out to your physicians, your independent physicians, 

as we just heard, may not really like that type of an approach. And 

they may want to have additional systems which would then put 

an extra burden on the hospital in being able to support a myriad 

of different types of technologies. So that sort of a cost shifting type 

of thing. 

But to get back to your question— 

Chairman AKIN. Do you not think that the individual physicians 

would tend to kind of go with the main hospital they work with, 

though, from a data processing point of view? 

Mr. PRICE. They could or they could be in a scenario where they 

are admitting patients to a number of different competing facilities, 

and that could create some problems, too. 

Chairman AKIN. So now maybe you got putting patients into 

three different hospitals, each one is on a different system, and 

now you really got a headache? 

Mr. PRICE. And some of that drives some of the work that is 

being done with the regional health information organizations in 

order to ensure that we have this level this communication between different organizations. So there is great work that is being 

10

done with creating standards, but a lot of it ends up not being the 

physical standards as you were speaking to earlier, but a lot of it 

is related to sort of like translating. If I am speaking Spanish and 

they are speaking English, how do I translate between one organization and another? Because what I call a CBC may not be called 

a CBC in a system that we are trying to communicate with. 

So there are a level of problems that complex that we are trying 

to work through. But I think over time we will reach a point where 

we can do those types of transmissions very easily. 

Chairman AKIN. In answer to my other question, do you think 

it is a good thing just to let the hospitals and doctors work on this 

just in the free side of things instead of saying ‘‘Hey, hold everything. The government in D.C. is going to come up with a—’’ 

Mr. PRICE. No, I do not. And I say that simply because I do not 

think that that is always going to be a priority for those organizations. Because you are going to see a competition for capital and 

there is going to be much more money being shifted to buying new 

MRIs and things of things of that nature, and there is only a limited amount to spend. 

Chairman AKIN. So you are saying that you do think that government should be coming up with sort of a standard format for 

the transmission of data? 

Mr. PRICE. The government is working on and through certification groups is working on standard formats. 

And also I believe that the payors are going to have to play a 

significant role in this just so that we can find some other opportunities to help fund the physicians as they start up these practices. 

There may also be some relaxation of START that has to happen 

in order to eliminate the issues and things of that nature. 

Chairman AKIN. Go ahead. 

Dr. NORMILE. You know I think that certainly there should be a 

national situation. This is something where we all need to work together, LabCorps and different labs we use are national organizations. To be able to communicate with one hospital group and not 

another just is not going to work. We need to have something that 

will work for everyone. And I can communicate to a doctor in New 

York and California just as well as next door. 

Chairman AKIN. I think we are okay time wise. 

I assume that right now are there vendors that have software 

packages? Is that what you went shopping for, Joan? 

Ms. MAGRUDER. Yes, we did. We went with a vendor called 

NextGen. There are lots of vendors, I think several of whom are 

very credible. 

I think you asked a question earlier about inferentially whether 

the software was where it needed to be. I think the software, in 

and of itself, is reasonable as a starting point. But I think that the 

real key is that, again, it remains mostly a silo technology in freestanding physician offices. It is difficult enough to get individual offices to go up. I think what we really need to get to is the integration of all healthcare providers. And I think that that’s really going 

to cause some alignment of incentives. 

I think the payors have to pay a key part of this. I think that 

if we are going to advocate transparency, which is part of what this 

will do for us, we need to make sure that the payors treat that as 

11

a positive and appropriately. And so I would love to see a situation 

where physicians who have been willing to step up are in fact rewarded for doing so and not at risk for things going on a website 

about their information because they were— 

Chairman AKIN. The first to stick their head up? 

Ms. MAGRUDER. Exactly. Exactly. 

Chairman AKIN. Okay. Sounds good. 

Dr. NORMILE. Personally my experience has been, you know this 

technology really is almost there to the point where it is a break 

even situation for me. I think it still has a ways to go. 

Chairman AKIN. Okay. Anybody want to comment on the second 

part of the question about the privacy of information transmitted? 

Is that a problem or is that no sweat? 

Mr. PRICE. No. It is a problem. It is a problem in the sense that 

organizations are very aware of what they need to do to protect 

that information. And, in fact, some of that has driven the way 

some RHIOs have designed their architecture so that information 

is not resident in anyone, let us say, database and that you have 

processes that can go out through secure networks and be able to 

pull information from these different locations where a patient may 

have been at some point in time. 

So it is at the forefront of every organization in terms of addressing security, internally and externally. 

Chairman AKIN. Are you saying that that is being built into a 

lot of the programs in the system’s design? 

Mr. PRICE. It is being built into software programs. It is being 

built into physical safeguards for facility’s procedures, policies. Auditing is taking on a whole new front. I mean, a lot of this really 

started with HIPAA. But it is just the right thing to do, as we all 

agree, to protect the privacy of individuals. 

Chairman AKIN. Thank you all very much. 

And now I will turn to my good friend, Mike, did you want to 

ask some questions? 

Mr. SODREL. Yes. Thank you, Mr. Chairman. 

I am certainly not a computer wiz, did not grow up in the era, 

but I ran a business before I came to the Congress. And, in fact, 

this is the first time I have ever served in elective office. Ad some 

of the questions that I have been asking of the American Medical 

Association, some other doctors I have talked to about interoperability. You know, I mean how do you get a system that talks nationwide and talks to the providers and the payors and everybody 

else might be appropriate. And the answer I get is, no offense, Doc, 

but they said doctors are kind of like to herd cats. Unless the government provides some carrots and sticks to the process, everybody 

will go out and buy independent systems and they are not necessarily going to talk to each other or reach the desired end. 

And it is kind of a follow up on the Chairman’s question, how 

do we provide the carrot and stick for the industry to come up with 

a standard software practice and standard language and standard 

system so that they can talk to each other, both the hospital to the 

insurance company to other appropriate entities? I mean, how do 

you think we should be approaching the problem? 

Dr. NORMILE. The primary think I think would be to approach 

the software company that produce these and if they start seeing 

12

that there is a common way to communicate, doctor’s practices will 

want to get on and involved with that. And doctors, we all want 

to be able to communicate and that is vital to our practice. So, you 

know, I do not think the issue is really hurting as far as the patient. It is a matter of getting the software companies to provide 

it. 

Mr. PRICE. Dr. Brailer is currently heading up a lot of different 

approaches that are requiring certification processes. And what we 

are hoping is that over time software vendors will have to adhere 

to certain certifications. And part of that certification will require 

this interoperability issue to be addressed. 

So these types of things are happening right now. But in the 

meantime, you still have to conduct business. So there is still organizations that have to make these types of purchases and hope for 

the best in terms of being able to communicate outside the confines 

of their office. 

We have addressed a lot of that with HIPAA for the financial 

side of the equation, and it may be beneficial to have things that 

are similar on the clinical side to be able to share that type of information back and forth. But a lot of that is like the train is already moving on that. 

Mr. SODREL. The other thing that occurs to me is you lose a 

paper trail when you go to electronic records that a hot site is 

going to be really important. I mean if you look at Katrina, Rita, 

tornados go through the midwest. You are a doctor and the system 

is gone in an F3 tornado, those records need to be someplace else 

on a clone or some system that is running parallel where you can 

get them back up in a short period of time. So it seems to me that 

is a risk as well of losing the data. 

Dr. NORMILE. Those are becoming more available where you can 

copy information to another site. And certainly in our practice we 

copy all the data to a tape and I take it home at night with me. 

It is one of our biggest fears that our system would go down. It 

would be devastating. But we do have backups for patient information. And all that information is on a tape and I have it at home. 

Ms. MAGRUDER. I think the other form of redundancy goes back 

to this issue of whether these EMRs are going to be self-contained 

in an ambulatory setting or connected to the in-patient settings. 

Because you then, obviously, have another set of redundancy. 

In our circumstance we are trying to create the backbone and 

allow physicians to choose to attach to it or not. And so whether 

they have the option to back it up in their office and we then have 

the backup, if you will, at the organizational level. So that becomes 

sort of a double protection. 

I do think, though, that whatever we do in this regard if we really think we want to get at sort of the cost effectiveness and the universal care aspect, I think we are going to have to figure out a way 

to get the in-patient centers to get moving, not just the physician 

setting. Because right now there are so many things that are being 

vested upon in the in-patient setting, this is really not a top priority. And so I think that that is something we just do not want 

to lose track of as we try to think that we are targeting a very universal comprehensive record. I think that will be important. 

Mr. SODREL. Thank you, Mr. Chairman. 

13

Chairman AKIN. If I could just do a follow up question about 

Mike was saying. At least it seemed like to me, maybe one thing 

that might be helpful, maybe this has already been done, but the 

information that you are going to be collecting if you could define 

what the fields are? In other words a treatment date and have 

some common definition for what that is or whatever the other 

basic things that would go with it regardless of what software, how 

to design the database. If your definitions of what this, that and 

the other term meant, it would seem like it would make it much, 

much easier to make things interoperable if you are using a common set of definitions. Has that been thought of is that already 

being taken of or is that something that maybe some sort of national group could help with? 

Mr. PRICE. I believe SNOMED, which I can’t remember exactly 

what that stands for, but it is a common vocabulary that is being 

looked at as one of the key sort of integration languages to use for 

this interoperability. This sort of translation between the Spanish 

and the English. But get everybody to speak the same using 

SNOMED vocabulary in the way they define diseases, the way 

they— 

Chairman AKIN. Is that a commercial— 

Mr. PRICE. Yes. It has been used in pathology for a number of 

years. Yes. 

Chairman AKIN. So it is one that is already somewhat established and it is almost one that is starting to take on a sort of 

standard in and of its own, to some degree? 

Mr. PRICE. Right. And there is discussion about other formatting 

types of capabilities whether it be a continuity of care record or 

some other mechanism for being able to ensure that these data elements were defined properly and they are the same, whether you 

are talking in an ambulatory and acute care setting. 

Chairman AKIN. Okay. That covers it pretty well. 

Okay. I did not have anything else particularly. I just wanted to 

thank you all for coming in. 

We have broken our witnesses into two panels and if you would 

like to stick around, you will see that we have saved an interesting 

witness for our second panel here, a colleague of ours, a medical 

doctor who is a friend of ours and somebody from the city of Atlanta who we like to harass, but in a friendly sort of way. 

Thank you all so much for your testimony. And we will just proceed right into the second panel. 

Mr. PRICE. Thank you. 

Ms. MAGRUDER. Thank you. 

Chairman AKIN. Welcome to the Subcommittee, Congressman. 

Mr. GINGREY. Thank you, Mr. Chairman. 

Chairman AKIN. Congressman Phil Gingrey is also a doctor and 

a honorable, and from according to my notes, Georgia 11. I have 

been there, but I did not know it was 11. But we are delighted to 

have you, Phil. If you would like to proceed. I understand that you 

have some legislation that you are working on, and we are all ears. 

We would like to hear what you have got. 

14

STATEMENT OF THE HONORABLE PHIL GINGREY (GA-11), U.S. 

HOUSE OF REPRESENTATIVES 

Mr. GINGREY. Mr. Chairman, thank you very much. I didn’t realize that a panel could be a panel of one, but I am proud to be here 

not as a VIP or a DV, as a doctor member of the House. And it 

is an honor to be here before this Subcommittee, Chairman Akin, 

Representative Sodrel. I know Ranking Member Bordallo, a very 

good friend, and other members of the Regulatory Reform and 

Oversight Subcommittee. 

I have got some written remarks, Mr. Chairman. I would like to 

go through those and submit them in their totality for the record. 

Chairman AKIN. Without objection. 

Mr. GINGREY. But let me just say that on behalf of the citizens 

of Georgia’s 11th Congressional District, and I thank the Chairman 

for visiting in my District and holding a field hearing, thank you 

all for allowing me the opportunity to testify before you today. 

Every day we read in the headlines about the rising cost of 

healthcare and what it means to every American in this country. 

There are many ways to tackle the problem of skyrocketing 

healthcare costs, but today I am here to focus on healthcare information technology, just as the previous panel. Why does Congress 

need to be invested in the adoption of healthcare information technology? Well, in September of 2005 the RAND organization released a study that showed how a health information technology 

system that is implemented correctly and as the previous panelists 

said, widely adopted could save the American healthcare system 

more than $162 billion annually. 

Since we all know the tremendous stress our healthcare system 

is currently operating under, these savings alone are very compelling justification for congressional involvement. Even more important than saving money. Integrating technology into our healthcare 

system will reduce medical errors and save lives. However, it was 

not until I went out into my District, I met with physicians like the 

physician from Missouri and representatives from the health IT industry, I realized the answer to the question of congressional action. 

The key to the RAND report and my personal research centers 

around the concept of, as I said, widely adopted. And this is why 

we are here today. What role can and should the government play 

in ensuring healthcare information technology is widely adopted? 

There are a variety of thoughts, opinions and pieces of legislation 

centered around this particular question. The RAND study simply 

states that in order to take full advantage of this potential savings, 

we needed incentives for physicians to buy quality systems and integrating system. So the question becomes not only what would be 

the most effective way to incentivize physicians, but what is the 

most fiscal responsible way to incentivize the physicians. 

I was anxious as a physician member to go out and visit doctor’s 

offices that were already utilizing health information technology to 

see what differences it makes out in the real world. And make no 

mistake about it, the physicians in the trenches have already lead 

the charge. You know, I know the government is very important, 

that we get it right. But there are a lot of systems out there, Mr. 

Chairman, that are already operating and operating well. It was 

15

just three short years ago that I stopped practicing medicine. I remember vividly the overwhelming burden of administrative paperwork. It robbed physicians of time with their patients, literally taking away from them the real joy of the profession. And what I saw 

in a paperless medical practice when I went out recently was just 

amazing to me. 

I visited a three doctor OB/GYN group, that is my specialty, in 

my District, Carrolton, Georgia. And they had purchased their electronic health records system in 2002. We are talking four years 

ago. 

I was able to watch Dr. Rick Martin of West Georgia OB/GYN 

as he demonstrated the established routine he follows during a patient visit utilizing his computer tablet. Not a paper chart. He stated that the vendor company that they had worked with, they had 

worked very hard to ensure the process flowed to his liking and the 

words and the phrases that he used most frequently were utilized 

in the chart template. 

It was amazing to me how efficient the system was in documenting a patient’s chart and any necessary tests and imagines, all 

at the point of care when it was needed. I saw how revolutionary 

health IT was to the health care world. It transfers how physicians 

do business on a daily basis by streamlining the process, giving 

them the tools and the information they need when they need it. 

It even left me thinking if this political career work out, I might 

want to go back, jump into medicine and enthusiastically embrace 

this new paradigm. 

What I heard from my discussions were how satisfied the customers were. The physicians I spoke with are enjoying a higher 

quality of life, more efficiency in follow up with their patients, the 

flexibility to complete charts and, indeed, even take calls from the 

comfort of their homes. 

The office managers spoke emphatically about the almost immediate increased revenue from automating their coding and billing 

process. Not only did they receive payment from insurance companies, third party payers we call them, quicker but they received 

more accurate payments. An increase in revenue to a physician’s 

bottom line is one of the biggest wins in purchasing electronic 

health record system. The system not only automatically codes the 

patient’s visits, but correctly codes the visits to ensure the physician is reimbursed accurately for the services rendered. 

Early in their career physicians learn quickly that it is easier to 

actually down code a visit than to submit a claim that ends up 

being rejected by the insurance company which requires your office 

to then resubmit the claim, wasting valuable staff time and taking 

money away from the practice. But different sections in the 

healthcare system and the Federal Government that there are numerous, maybe too many hurdles preventing physicians from practically incorporating health IT into their offices. These concerns 

range from the time and energy required of physicians to learn a 

new system, teach an old dog new tricks, a potentially 

unsustainable decrease in productivity over the short haul and a 

natural apprehension that comes with any large financial investment. However, I want to present an example of what one practice 

16

saw as a return on investment in their first year of purchasing a 

complete health IT system. 

I would like to submit for the record an example administered 

by Microsoft Windows Service System, Mr. Chairman. They performed a customer solution case study on a five doctor OB/GYN 

practice in New York. For this practice implementing an integrated 

electronic health record system has cut down on the administrative 

work required by each doctor by one hour a day. And it has allowed 

them to see an additional 25 patients each week and given them 

a first return on investment of $400,000. 

It is for this particular reason that I believe the best thing Congress can do is to create incentives for physicians to incorporate 

health IT and then get out of the way. 

And, Mr. Chairman, you alluded to it at the beginning of my testimony. This is why I introduced HR 4641 the Adopt Health IT Act. 

This is what it does. It creates these incentives by increasing the 

deductions offered under Section 179 of the tax code for health care 

providers that purchase an EHR system. 

I have heard from physicians and industry alike that Section 179 

is a strong incentive for their decision to invest in health IT. But 

under the current law the maximum deduction is not adequate to 

increase adoption among all physician groups. Under current tax 

code small businesses can deduction around $100,000 of the cost of 

a qualified business expense that are placed into service in that tax 

year. 

Basically what my legislation does is it increased this maximum deduction in the first year from $100,000 to $250,000, therefore 

creating a more realistic incentive to spur adoption among physician practices of all sizes. Current small businesses have a maximum threshold of $400,000 for qualified equipment purchases in 

any given year. My legislation would further increase that amount 

to $600,000, again, narrowly defined to include only those 

healthcare professions that purchase an EHR system. 

The logic behind the idea, Mr. Chairman, is that physicians like 

all small business owners look at what the tax code can offer them 

as they consider purchasing equipment for their business. And HR 

4641 allows section 179 of the tax code to better represent the actual cost of EHR systems. 

For example, the cost of a system for an average practice including four to six physicians, like a single specialty OB/GYN practice, 

can be as much $200,000. This then restricts what other medical 

equipment that office can purchase that year. So that is why we 

increased the overall amount from 400,000 to 600,000. 

By appealing to a physician’s business instinct and allowing the 

tax code to provide incentives we can create a much more effective 

way of getting healthcare information technology into every physician’s office around the country. These incentives will work far better than simply dumping federal grants into the healthcare system. 

So, Mr. Chairman, in closing I want to again express my gratitude for this opportunity, respectfully ask for your consideration of 

the initiative that I am laying out to you this afternoon. 

Mr. Chairman, I am prepared to respond to any questions or 

comments you or Representative Sodrel or other Members may 

have about the legislative proposal that I am recommending. 

17

[Congressman Gingrey’s testimony may be found in the appendix.] 

Chairman AKIN. Thank you for your testimony. 

I gave you a little extra time because you are a Republican. 

Mr. GINGREY. Thank you, Mr. Chairman. I appreciate that. 

Chairman AKIN. But I thought your comments were very helpful 

and in good order. You came to the end what I was going to ask, 

just some sort of basic numbers. One of these systems can cost you 

200,000 bucks if you are a physician. Is that hardware and software or is that— 

Mr. GINGREY. Mr. Chairman, that is right. That is hardware and 

software. And that would not be an individual physician cost, but 

a group of about five members; that is about what that cost would 

be. And, of course, it is a first year cost but it does include an update and a training part in addition to, as you point out, the hardware and software. 

Chairman AKIN. So that is basically the package to get you up 

and going in a way? 

Mr. GINGREY. That is indeed the package to get you up and going 

and actually probably covers a couple of three years of upgrades to 

the software system and hand-holding, if you will, training of the 

office personnel, not just physicians. But the front and back office 

people. 

Chairman AKIN. You say that is a five doctor group, maybe? 

Mr. GINGREY. That would be for about a five doctor group. 

Chairman AKIN. What would happen if you were just one or two 

or something? Would it start to get pretty iffy in terms of cost justifying it? 

Mr. GINGREY. A great question, Mr. Chairman. The way these 

systems work. of course, is you would not be able to divide that six 

member group by six and come up with a cost of $30,000. It is 

going to be significantly more than that for just one person. And 

there are those one and two person practices out there, believe it 

or not, that just like to work independently. Maybe it is an OB/

GYN, maybe it is a family doctor that is making house calls. But 

they need, and I think the previous panel would agree, that we 

need to make sure that everybody is into this system and can afford to do that because the chain is only as strong as your weakest 

link. And if we do not have those small group practices that really 

cannot afford to come up $75,000 to $100,000, let us say for a 

smaller group, they are not going to do it. And patients lives are 

going to be in jeopardy because of that. So this is an opportunity 

to incentivize them. It is not the government necessarily giving out 

grants and deciding who needs some money, is it a big hospital system that needs a big government grant or is it the small doctor situation. And I am afraid if we look at it from that perspective, most 

of the time the big doctor organizations will win out in any grant 

proposal. And they probably can afford to invest on their own a lot 

better than a small medical doctor group can. 

Chairman AKIN. Okay. Thank you very much for that. I think 

that made a couple of things clear. 

Let me just ask if you have different physicians motivated to use 

this technology, now they are getting a tax break in a sense to try 

to get this thing up and going, are you going to have any trouble 

18

with just the format of the medical records so that you are going 

to have all kinds of different systems that do not really work together. And have you thought about that, or is that something 

where there is enough standardization going on now that increasingly they are going to be able to talk back and forth? 

Mr. GINGREY. Mr. Chairman, that is a hugely important issue. 

And, of course, the previous panel as I caught the end of their testimony talk about it. And Dr. Brailer, who is the National Coordinator for Healthcare IT under Department of HHS is working as 

far as credentialing and making sure that we get it right, that the 

RHIOs are established and that there is connectivity. I am kind of 

like Representative Sodrel. I am not a computer wiz kid and I have 

got to learn a lot about this and the acronyms and that sort of 

thing. But it is very, very important that the software companies 

that have been involved in this business for six years now, like the 

company in Carrolton, Georgia that have developed a very good 

software program, kind of unique maybe to the general surgery 

specialty or the OB/GYN specialty, we cannot all of a sudden have 

the government create a program that carves them out when many 

of these physicians, they are out there, they have marketing people, they have salesmen that are selling these programs and doctors that have bought in at about an average price of $200,000. We 

have to make sure that they’re not left on the sideline holding a 

bill of goods that now becomes worthless. It is very important that 

we work together with them. 

Chairman AKIN. Is it your understanding then that there is an 

ongoing cooperation between the software developers and people 

defining what the fields mean? So that we are talking the same 

language, more or less? 

Mr. GINGREY. Well, it is my understanding, Mr. Chairman. I 

think that is true. But I think there is an angst and heartburn 

among some of these vendors who are sort of on the outside looking 

in and they are concerned. And obviously they want their member 

of Congress, you, Mike Sodrel, myself to make sure that we represent them at the table. And that is a part of why I am here, and 

that is part of why I have introduced this bill. 

Chairman AKIN. Thank you. 

And, Mike, would you like to ask questions? 

Mr. SODREL. I think you stole all my good questions, Mr. Chairman. 

Thank you. 

Chairman AKIN. Well, I really appreciate your leadership on this 

and particularly the fact that you are coming at it from being a 

doctor and understanding what those practices are like. It is really 

important. 

It sounds like you have got a pretty good balance, too, between 

some sort of structure that we are trying to provide and at the 

same time letting the market develop products. 

I just have one last question. How far away are we on not just 

your OB/GYN office talking to the local hospital, but my wife being 

off on vacation somewhere and their being able to tap in so that 

the doctor making a decision away from home has the same data 

that her doctor would have at home? 

19

Mr. GINGREY. Mr. Chairman, a great last question. I am so glad 

you asked that. You know, the President has said that he wants 

to see a fully integrated operational system by I think the year 

2014. I really believe we can and desperately need to do it before 

then. At $162 billion cost savings per year, that is a lot of money. 

That could pay for a lot of Head Start programs and other things 

that we want to do that we maybe cannot afford to fund as fully 

as we would like to. 

It is hugely important that we get this done sooner rather than 

later, as you point out. I think we can do it. I think we are on the 

track to do it. I hope that we can get this done maybe within five 

years. 

And you mentioned an example of your wife. I was just recently 

in Antarctica on a trip and I was able with my American Express 

card to get U.S. dollars so I could buy some souvenirs at the New 

Zealand Station. And that was a wonderful thing. And yet I could 

not help but think if I had slipped down and fallen and hit my 

head on the ice, there was plenty of that there not much grass, and 

gone to an emergency facility and was unable to speak, you know 

they would not know that I had open heart surgery three years ago 

and I am on four medications and that I am a little goofy to boot 

that they would know how to treat me. And I think it is just so 

important that we are able to do that. And even more so in, let us 

say, a country where they do not speak your language. And that 

is why we really need to get this done. 

Chairman AKIN. Well, I really appreciate the wisdom of your answers, Congressman, and also the courage of a southern boy to go 

all the way to Antarctica. It would not have thought it could have 

happened. 

Thank you. 

Mr. GINGREY. Thank you, Mr. Chairman. Thank you, Representative Sodrel and the Committee. I appreciate the opportunity to 

present to you. 

Chairman AKIN. Committee’s hearing stands adjourned. 

[Whereupon, at 3:07 p.m. the Subcommittee was adjourned.]

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