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78–126 2013

IMPLEMENTATION OF THE HEALTH INFORMATION 

TECHNOLOGY FOR ECONOMIC AND CLINICAL 

HEALTH (HITECH) ACT 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

JULY 27, 2010 

Serial No. 111–149 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 


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COMMITTEE ON ENERGY AND COMMERCE 

HENRY A. WAXMAN, California, Chairman 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

Vice Chairman 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANE HARMAN, California 

TOM ALLEN, Maine 

JANICE D. SCHAKOWSKY, Illinois 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

BARON P. HILL, Indiana 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

JERRY MCNERNEY, California 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

ROY BLUNT, Missouri 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 


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SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

JOHN D. DINGELL, Michigan 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JANE HARMAN, California 

CHARLES A. GONZALEZ, Texas 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

NATHAN DEAL, Georgia, 

Ranking Member 

RALPH M. HALL, Texas 

BARBARA CUBIN, Wyoming 

JOHN B. SHADEGG, Arizona 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 


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C O N T E N T S 

Page 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 1 

Prepared statement .......................................................................................... 4 

Hon. John Shimkus, a Representative in Congress from the State of Illinois, 

opening statement ................................................................................................ 8 

Hon. Lois Capps, a Representative in Congress from the State of California, 

opening statement ................................................................................................ 9 

Hon. Phil Gingrey, a Representative in Congress from the State of Georgia, 

opening statement ................................................................................................ 10 

Hon. Janice D. Schakowsky, a Representative in Congress from the State 

of Illinois, opening statement .............................................................................. 11 

Hon. Joseph R. Pitts, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 12 

Hon. Anna G. Eshoo, a Representative in Congress from the State of California, opening statement .................................................................................... 13 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 14 

Prepared statement .......................................................................................... 16 

Hon. Donna M. Christensen, a Representative in Congress from the Virgin 

Islands, opening statement ................................................................................. 22 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 22 

Hon. John P. Sarbanes, a Representative in Congress from the State of 

Maryland, opening statement ............................................................................. 23 

Hon. Marsha Blackburn, a Representative in Congress from the State of 

Tennessee, opening statement ............................................................................ 24 

Hon. John D. Dingell, a Representative in Congress from the State of Michigan, opening statement ....................................................................................... 25 

Hon. Kathy Castor, a Representative in Congress from the State of Florida, 

opening statement ................................................................................................ 26 

Hon. Gene Green, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 27 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 28 

Hon. Zachary T. Space, a Representative in Congress from the State of 

Ohio, opening statement ...................................................................................... 29 

Hon. John Barrow, a Representative in Congress from the State of Georgia, 

opening statement ................................................................................................ 30 

Hon. Jane Harman, a Representative in Congress from the State of California, opening statement .................................................................................... 31 

Hon. Henry A. Waxman, a Representative in Congress from the State of 

California, prepared statement ........................................................................... 155 

WITNESSES

David Blumenthal, M.D., National Coordinator, Health Information Technology, U.S. Department of Health and Human Services ................................ 32 

Prepared statement .......................................................................................... 35 

Answers to submitted questions ...................................................................... 165 

Anthony Trenkle, Director, Office of E-Health Standard and Services, Centers 

for Medicare and Medicaid .................................................................................. 48 

Prepared statement .......................................................................................... 51 

Answers to submitted questions ...................................................................... 167 

Frank J. Vozos, M.D., FACS, Executive Director, Monmouth Medical Center, 

on Behalf of New Jersey Hospital Association .................................................. 82 


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VI 

Frank J. Vozos, M.D., FACS, Executive Director, Monmouth Medical Center, 

on Behalf of New Jersey Hospital Association—Continued 

Prepared statement .......................................................................................... 86 

Gregory D. Starnes, CEO, Fayette County Hospital ............................................ 93 

Prepared statement .......................................................................................... 96 

Christine Bechtel, Vice President, National Partnership for Women and Families ......................................................................................................................... 100 

Prepared statement .......................................................................................... 102 

Roland A. Goertz, M.D., M.B.A., President-Elect, American Academy of Family Physicians, CEO and Executive Director, Heart of Texas Community 

Health Center ....................................................................................................... 107 

Prepared statement .......................................................................................... 109 

Matthew Winkleman, M.D., Physician, Primary Care Group, Harrisburg, Illinois ........................................................................................................................ 116 

Prepared statement .......................................................................................... 118 

Glen E. Tullman, Chief Executive Officer, Allscripts ........................................... 121 

Prepared statement .......................................................................................... 124 

Peggy C. Evans, Ph.D., CPHIT, Director, Washington and Idaho Regional 

Extension Center, Qualis Health ........................................................................ 128 

Prepared statement .......................................................................................... 131 

SUBMITTED MATERIAL

Statement of The Academy Advisors, submitted by Mr. Shimkus ...................... 160 

Statement of The Premier healthcare alliance, submitted by Mr. Shimkus ...... 162 


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IMPLEMENTATION OF THE HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND 

CLINICAL HEALTH (HITECH) ACT 

TUESDAY, JULY 27, 2010 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 1:05 p.m., in Room 

2322 of the Rayburn House Office Building, Hon. Frank Pallone, 

Jr. [Chairman of the Subcommittee] presiding. 

Members present: Representatives Pallone, Dingell, Eshoo, 

Green, Capps, Schakowsky, Harman, Gonzalez, Barrow, 

Christensen, Castor, Sarbanes, Murphy of Connecticut, Space, 

Waxman (ex officio), Shimkus, Pitts, Murphy of Pennsylvania, Burgess, Blackburn, Gingrey and Barton. 

Staff present: Ruth Katz, Chief Public Health Counsel; Purvee 

Kempf, Counsel; Katie Campbell, Professional Staff Member; Emily 

Gibbons, Professional Staff Member; Tim Gronniger, Professional 

Staff Member; Virgil Miler, Professional Staff Member; Alvin 

Banks, Special Assistant; Ryan Long, Minority Counsel; Clay 

Alspach, Minority Counsel; Sean Hayes, Minority Counsel; Brandon Clark, Minority Professional Staff; and Garrett Golding, Minority Legislative Analyst. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. I call the meeting of the Health Subcommittee to 

order. 

Today we are having a hearing on implementation of the Health 

Information Technology for Economic and Clinical Health Act of 

2000, or the HITECH Act. Now, I should mention, and Mr. Shimkus reminded me, that this is actually in the Recovery Act, so we 

are actually talking about the implementation of the HIT part, if 

you will, of the Recovery Act. And I will recognize myself initially 

for an opening statement. 

The HITECH Act contained unprecedented funding to promote 

the adoption of health information technology among hospitals, doctors and health care providers through initiatives by the Office of 

the National Coordinator of HHS and through Medicare and Medicaid incentives. This historic investment will serve to modernize 


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our Nation’s use of technology to truly ensure a high-performing 

21st century system. 

The Energy and Commerce Committee has worked on a bipartisan, collaborative basis for many years on health information 

technology. This hearing will examine the progress made so far and 

opportunities that will be realized in the future through the implementation of the HITECH Act. 

While the United States is a leader in medical technology and innovation, we have a curiously antiquated system today related to 

health IT. Only 20 percent of doctors and only 10 percent of hospitals use even basic electronic health records, making coordination 

between health care providers challenging and leaving the burden 

on patients to ensure that each provider knows what tests have 

been done and what medications have been prescribed. Too often, 

this information falls through the cracks, resulting in wasteful, duplicative tests and preventing providers from having the full snapshot of a patient’s medical profile. 

The successful adoption of health information technology will 

have a transformative effective on the quality of health care in the 

United States. The provisions of the HITECH will ensure that 

Americans nationwide have access to a truly patient-centered 

health care system with better quality, more affordable health care 

delivered in an efficient and coordinated manner. It also will promote the advanced use of electronic health records to facilitate the 

ordering of tests and medication, aid in clinical decision-making 

and allow for secure data-sharing and privacy protection among 

providers, insurers and patients. 

Now, it is timely that we have this hearing today, in my opinion, 

since CMS just announced on July 13th the final rule for the minimum requirements that eligible Medicare and Medicaid providers 

must meet through their use of a certified electronic health record 

technology to quality for the incentive payments included in the 

HITECH Act. This rule was dually released with companion final 

regulations on the standards and certification criteria needed for 

EHR technology to be successfully used by eligible professionals 

and hospitals. 

There are over 2,000 health care providers, patients and other 

stakeholders who weighed in on the proposed rule when it was released in January. Many changes were incorporated into the final 

rule, which preserved the goals of the HITECH Act while also making the requirements attainable. I look forward to hearing an update on these rules from our witnesses today as well as on other 

aspects of the HITECH Act. 

I will note we have two great panels of government and private 

witnesses here with us today. I am particularly pleased that Dr. 

Frank Vozos, the Executive Director of my hometown hospital, 

Monmouth Medical Center, can be with us today. I had the opportunity to tour Monmouth Medical Center, which is a community 

teaching hospital, over the, I guess it was the July 4th recess or 

work period, and I was very pleased to see the work they are doing 

already to implement HIT adoption and to learn how they plan to 

use HITECH funds and guidelines to further advance their medical 

care, so I want to thank Frank Vozos, another Frank, for being 

with us here today. 


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I have mentioned in the past sort of a personal story with regard 

to the HIT issue. My mom passed away from pancreatic cancer 

about 18 months ago now, and for the 7 months or so from when 

she was diagnosed until she finally passed, we went to various institutions including Monmouth Medical and Johns Hopkins, and it 

would also drive me crazy because we would have, I guess it was 

the CAT scan put on a disc—Robert Wood was another one that we 

visited—and at each place I would try to carry the CAT scan with 

me and say OK, here it is on a disc, you know, these are the tests 

she had, and without reference to any particular institution, I always had to have it redone, because they couldn’t use, either there 

was no interoperability or whatever. And it drove me crazy but it 

just seemed to make no sense, and of course, I was worried because 

she was in a bad situation, that this wasn’t a good thing for her 

to have to be restested all the time. So that is just my own personal experience that hopefully that type of thing we can guard 

against in the future. 

[The prepared statement of Mr. Pallone follows:] 


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Mr. PALLONE. With that, I will ask Mr. Shimkus to give us an 

opening statement. 

OPENING STATEMENT OF HON. JOHN SHIMKUS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Mr. SHIMKUS. Thank you, Mr. Chairman, for holding this hearing 

to update us on the progress of implementing the HITECH Act. 

This issue has shared bipartisan support as we seek to modernize 

and create efficiencies in our health care delivery system. 

Despite the enthusiasm and promises of HIT, concerns have been 

voiced from the provider community as we move forward. Some 

issues have already been addressed such as loosening the number 

of requirements in the first year to comply with meaningful use 

and allowing critical-access hospitals eligibility for certain payments under Medicaid. However, other roadblocks remain and we 

must ensure providers across the country are able to meet the requirements in the timeline set out. 

The hearing today is a chance for us to review where we stand 

and ask ourselves if we are trying to make providers run before 

they can walk when it comes to HIT. I particularly want to thank 

a few of our witnesses for being here today from my district back 

in Illinois. First, Mr. Gregory Starnes is here from Fayette County 

Hospital, which is a critical-access hospital. Mr. Starnes lends a 

voice to rural hospitals and the unique challenges they face in trying to implement their systems without the budget and attention 

of some larger urban hospitals. I also want to thank Dr. Matt 

Winkleman from Harrisburg, Illinois, for making the trip here 

today, and of course everyone knows Harrisburg, Illinois—and that 

is supposed to be a joke. My staffer is fired. That is a good joke. 

It is all in the delivery, he says. 

I look forward to hearing from Dr. Winkleman on his practice 

was able to rise to the challenge of implementing HIT while working off the small margins that come from serving a rural workingclass community. 

Despite the promising future the HITECH Act holds, it is difficult to look past the failures of the so-called stimulus bill it was 

part of. The American people paid the tab on what they were told 

would create jobs, keeping unemployment at below 8 percent and 

to stimulate the economy. The country has lost over 3 million jobs 

since the stimulus passed and unemployment hovers at 9.5 percent, 

even higher in my district in Illinois, all this at a cost of $1.2 trillion to the American taxpayer, an enormous failed policy continued 

with the health reform law. We have been in session 15 weeks 

since the health care bill was signed into law by the President in 

March, 15 weeks and 15 hearings on health, not on the law. In 

what is likely our last hearing before recess, the majority has never 

responded to numerous requests to hold hearings on implementation of the new law. On several occasions we have asked for the 

Administration to come before the committee, to no avail. Yet with 

ease we were able to have representatives of both HHS and CMS 

to discuss the HITECH Act today, and we appreciate them coming. 

It has been over four months and the majority won’t even acknowledge problems exist with the new law and they aren’t going 

away. According to CBO, premiums in the individual market are 


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going to increase 10 to 13 percent as a direct result of this law. 

Nearly all small businesses will see no relief from the tax credit in 

the law. Many small businesses will opt to pay fines rather than 

buy health insurance because they can’t afford the cost. Instead, 

they will raise prices to customers and stop hiring new employees. 

High-risk pools that were supposed to provide immediate coverage 

uninsurable are going to have to have waiting lines and use preexisting conditions to limit those who enter the new pools. We were 

told the President’s Executive Order would prevent federal dollars 

from being spent on abortion services yet we already know in 

Pennsylvania and New Mexico, millions of new federal dollars will 

go toward coverage of abortion services through their high-risk 

pools. The President promised the pro-life community and pro-life 

Democrats in the House his executive order would prevent this 

from happening. Will the President now make good on the promise 

or is this evidence of what many of us feared all along, that the 

health reform law lacks critical protections to prevent taxpayersubsidized abortions. 

Millions of Americans will be forced into a Medicaid program 

that is going broke. At the same time, half of all seniors with Medicare Advantage will lose their coverage. Those lucky enough to 

keep them will see increases in cost while losing dental coverage 

and other benefits they rely on. For those in traditional Medicaid, 

the billions of dollars in cuts are unsustainable and will cause 

problems and reduce quality of care for seniors. Leading the charge 

will be Dr. Donald Berwick, CMS Administrator without any Congressional approval, and we need to talk to the new CMS Administrator. He is a big supporter of the British health system which has 

just reported that it has failed and they were moving to a decentralized process in system. The list continues to go on. 

We have a responsibility to hold hearings on the implementation 

of the new health care law just as we are doing here today when 

it comes to the HITECH Act. Madam Chairman, with the law that 

will touch every American life, I hope we will at least have an explanation for the majority to the American people on why this request is being ignored, and I yield back the balance of my time. 

Mrs. CAPPS [presiding]. The Chair recognizes herself for an opening statement. 

OPENING STATEMENT OF HON. LOIS CAPPS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mrs. CAPPS. I am so pleased that today we are exploring the beginning stages of the HITECH Act and our Nation’s considered effort to move toward a more efficient and effective system of health 

care. Like many of my colleagues, I was here for some of the earliest conversations we had in this committee about HIT and I am 

really proud of what we have accomplished. This includes Chairman Dingell’s bill last Congress, the Protecting Records, Optimizing Treatment and Easing Communications through Health 

Care Technology Act of 2008, and that bill is actually the one that 

laid the groundwork for many pieces of the HITECH Act. 

I hope that today we will be able to explore the implementation 

of the HITECH Act to date including both the successes as well as 

the challenges that have been encountered, but I also hope to disVerDate Mar 15 2010 21:13 Mar 28, 2013 Jkt 078126 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 E:\HR\OC\A126.XXX A126

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cuss the future implementation steps of this bill as our Nation’s 

health care system moves from paper-based recordkeeping to a dynamic electronic system. The promise of health information technology for both patients and providers is, I believe, remarkable, 

and as the public understands how it is so beneficial, it is going 

to make a difference in the way we accept the changes in health 

care that will come about as we see that they are very cost-effective. 

I am a nurse by background and I am also a mother and a 

grandmother, and I know firsthand the logistical challenge that 

paper-based systems pose. That is one I have been familiar with as 

a nurse most of my professional life. Every parent knows how you 

struggle to find the proper records of their child’s vaccinations 

when they start back to school in the fall. Medical specialists unsure of a senior’s medical regimen from their primary care provider, the senior maybe can’t remember all of the things that have 

happened since. Moving to a new town, trying to fill out one’s medical history at the doctor for the very first time, or even when you 

go back and you are asked to re-fill the form and you can’t remember all the things that have happened. Electronic health records 

can follow the patient and can flag potential issues while at the 

same time enhancing the medical provider’s practice by reducing 

inefficiencies in recordkeeping and frustration in collecting an accurate medical history. And while HIT is not a silver bullet to all of 

our health care problems, it is a key step in modernizing our health 

system. 

So I look forward to the testimony of our witnesses and I yield 

back. 

At this time I will recognize Mr. Gingrey for an opening statement. 

OPENING STATEMENT OF HON. PHIL GINGREY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA 

Mr. GINGREY. Madam Chair, thank you so much. 

Health information technology has the potential to improve the 

quality and reduce the cost of health care in this country. In fact, 

according to the Rand Corporation, the potential savings for both 

inpatient and outpatient care could average $77 billion annually if 

most hospitals and doctors actually adopted HIT, health information technology. The study found that the largest savings would 

come from reduced hospital stays and administrative time as well 

as more-efficient drug utilization and not having doctors order the 

same test two weeks apart, expensive scanning and that sort of 

thing. 

Therefore, Madam Chair, I am interested to hear the witnesses, 

Mr. Blumenthal’s and Mr. Trenkle’s thoughts on how providers will 

achieve the broader information exchange requirements specified 

under stage 2 in light of the relaxed requirements that the final 

rule has under stage 1. In addition, I look forward to hearing from 

our second panel of witnesses and their thoughts on how we move 

forward. 

Madam Chair, if there were silver bullet solutions for our health 

care system, information technology would surely be one of them, 

maybe the main one. This technology has the potential to improve 


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the quality and the efficiency of our health care system while ensuring that tax dollars are spent wisely. With it, we can better 

identify and we can cut waste, fraud and abuse out of the system. 

Once implemented, we will be better able to protect patients’ privacy and eliminate the inefficiency of a system based on paper 

charts. I know of what I speak. I practiced medicine for 31 years. 

Therefore, a series of targeted bills based on silver bullets, medical liability reform, increased transparency, electronic medical 

records, health insurance reform for sick and low-income Americans could have passed in a transparent and bipartisan manner. 

Instead, what did we do? We passed a 2,400 page omnibus bill that 

few members could read and understand. Madam Chair, I have repeatedly used my opening statement in this committee over the 

past few months to support my ranking member, John Shimkus’s 

call for a hearing on Obamacare, Patient Protection and Affordable 

Care Act of 2010. Why? Well, because on March 9th, Speaker 

Pelosi said that the bill is, and I am going to quote her now, ‘‘going 

to be very, very exciting but we have to pass the bill so you can 

find out what is in it away from the fog of controversy.’’ Now, that 

is a direct quote. Speaker Pelosi was successful and this Democratic majority did pass Obamacare, but the fog of controversy still 

exists in spite of her promise. It turns out that a large majority of 

workers won’t be able to keep the health care they like today and 

they may even lose their jobs because of the law. The cost projections for patients, employers and our government continue to rise. 

Health insurance will not be available or affordable to hundreds of 

thousands of sick Americans. These problems all represent broken 

promises made by the President to the American people. Where the 

President’s rhetoric has not lived up to his product, Congress indeed needs to investigate. The American people deserve to know 

what is in this law, and I fear that unless we hold hearings immediately to investigate the new law, our constituents will find out 

the hard way. 

Madam Speaker, I have gone a little bit over. Thank you for your 

patience. I would like to submit three things for the record as I 

yield back. One is a statement in regard to electronic medical 

records by the American Medical Association, another by the 

United Health Group, and finally, by Electronic Health Records Association. 

Mrs. CAPPS. Without objection, so ordered. 

[The information was unavailable at the time of printing.] 

Mr. GINGREY. And I yield back. Thank you so much, Madam 

Speaker. 

Mrs. CAPPS. The Chair now recognizes Ms. Schakowsky for 5 

minutes—for 3 minutes. 

OPENING STATEMENT OF HON. JANICE D. SCHAKOWSKY, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS 

Ms. SCHAKOWSKY. Thank you, Madam Speaker. 

I just want to respond briefly to the ranking member, who rather 

than addressing the potential for reducing costs and improving care 

of health IT decided as usual to restate the talking points of the 

insurance industry including saying that this historic and imporVerDate Mar 15 2010 21:13 Mar 28, 2013 Jkt 078126 PO 00000 Frm 00017 Fmt 6633 Sfmt 6633 E:\HR\OC\A126.XXX A126

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tant piece of legislation is the cause of higher costs. Instead, what 

we have seen is excessive premium increases—see Well Point—and 

higher profits—see United Health Care, who at the same time as 

their profits went up the amount of health care they actually provide for each dollar has gone down. And a part of this bill is talking 

about the advantages that we can reap from taking advantage of 

health IT, which is vital for this country. 

The development of a nationwide interoperable health information technology system is a critical component of improving health 

care quality, promoting care coordination and reducing medical errors. I have been in the record rooms of clinics and hospitals, rooms 

overflowing with files taking up space that could be put to significantly better use. These clinics need health IT, and the $2 billion 

provided in the American Recovery and Reinvestment Act will go 

a long way to upgrade and improve this Nation’s health care system. As someone who recognizes the substantial rewards of moving 

our health care system toward health IT functions, I also know 

that we must ensure complete security and privacy for consumers. 

Through the chairman’s leadership, the HITECH Act strengthened federal privacy and security laws to protect personal identifying information from misuse. Without critical privacy and security guarantees, consumers will simply not be willing to utilize 

electronic records. As we move forward with greater utilization of 

electronic records, this is an area where we have to remain diligent. 

I would also like to thank the witnesses today for their testimony, in particular, those from the Administration. Congress 

tasked HHS with a large job when we passed the HITECH Act, 

and they have worked quickly to implement this program. They 

have also been responsive, addressing concerns with implementation. I was one of several members that urged HHS to reevaluate 

their first consideration of meaningful use, and they have subsequently taken many of those concerns into account during rulemaking. I look forward to working in the months and years ahead 

as we implement the full promise of health IT. 

So I thank you, Madam Chairman, and I yield back the balance 

of my time. 

Mrs. CAPPS. The Chair now recognizes Mr. Pitts for his opening 

statement. 

OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH 

OF PENNSYLVANIA 

Mr. PITTS. Thank you, Madam Chairman. 

On February 17, 2009, the President signed the American Recovery and Reinvestment Act, also known as the stimulus bill, into 

law, promising that the $787 billion bill would create or save 31⁄2

million jobs over the next 2 years. We were also told that the stimulus would hold unemployment under 8 percent. At this point in 

the recovery, unemployment would be at 7.5 percent. No one, not 

the White House, not Congressional leadership, can tell us with 

any degree of accuracy how many jobs have been saved or created. 

In fact, it is impossible to calculate how many jobs were not lost 

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ter. As for jobs created, we have an ever-expanding federal workforce, not a thriving private sector, and as we all know, unemployment is currently at 9.5 percent after peaking at 9.9 percent earlier 

this year. 

One of the provisions included in the stimulus was the Health 

Information Technology for Economic and Clinical Health, or 

HITECH Act. While I would question how the HITECH Act is stimulative or how many jobs it has saved or created, we all see the 

promise of health information technology from reduced errors, 

greater efficiencies to being able to share information across the 

country with the click of a mouse, and I support the goals of the 

HITECH Act. Many of us have been contacted, however, by providers from back home who panicked when the proposed rule came 

out earlier this year, and it seemed that few hospitals and doctors’ 

offices could meet such an aggressive implementation timetable or 

stringent criteria. 

I hope that our Administration witnesses will discuss how the 

final rule has been changed to address some of these concerns, and 

I look forward to hearing from our witnesses. Thank you, Madam 

Chairman. I yield back. 

Mrs. CAPPS. The Chair now recognizes Ms. Eshoo for her opening 

statement. 

OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. ESHOO. Thank you, Madam Chairwoman. It is nice to see 

you in the chair, and thank you for holding this important hearing 

on the implementation of the HITECH Act. 

The legislation we included in the American Recovery and Reinvestment Act to promote health information technology was adopted to revolutionize the health care delivery system in our country. 

I have been so often struck by this: we live in the Information Age 

and yet our health care system has really been mired in the penand-paper past, and so the money that is directed toward a comprehensive, interoperable and nationwide HIT system is one that 

really meets what the 21st century is all about, and I don’t think 

that there is a doubt that this will have a salutary outcome in 

terms of enhancing patient safety, reducing medical errors, improving the overall quality of care, and of course, having a system that 

protects the privacy of patients as well. 

I have been concerned for a long time about this issue. I introduced comprehensive legislation, HIT legislation, in 2007. We spent 

months meeting with doctors, with hospitals, with technology companies, which I think everyone knows, many of them make their 

home in my Congressional district, as well as HIT vendors, and I 

am proud to say that the work that my staff and myself did on that 

legislation really became the basis of the legislation that Mr. Dingell introduced and now we are going to be reviewing it. 

So I am really pleased that Dr. Blumenthal, the National Coordinator for HIT, and Anthony Trenkle from the Office of E–Health 

at CMS are going to share with us their experiences in implementing the legislation. I know that there are bumps in the road. 

There always are. When constituents ask me about legislation, I alVerDate Mar 15 2010 21:13 Mar 28, 2013 Jkt 078126 PO 00000 Frm 00019 Fmt 6633 Sfmt 6633 E:\HR\OC\A126.XXX A126

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ways say well, understand that legislation is shaped by human 

beings and that legislation bears the mark of humanity. It is less 

than perfect. But what is exciting to me is that we have launched 

the effort. We have placed significant resources next to it, $2 billion, and so today is a good chance to hear about how we are doing 

on this very important journey. So I look forward to hearing from 

our friends that are here to be witnesses and also to the second 

panel that will instruct us as well. 

So I thank the chairwoman, I thank the chairman of the subcommittee for scheduling this and I thank the witnesses and look 

forward to hearing from you. 

Mrs. CAPPS. I thank my colleague. 

Now we turn to the ranking member of the full committee, Mr. 

Barton, for his opening statement. 

OPENING STATEMENT OF HON. JOE BARTON, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BARTON. Thank you, Madam Chairwoman. I thank you and 

Ranking Member Shimkus and Subcommittee Chairman Mr. Pallone for holding this hearing. We thank our witnesses on this 

panel, and I know we have several on the second panel. We thank 

them for participating, especially the witness from the Heart of 

Texas Community Health Center down in Texas. We are glad that 

he is here. 

Obviously the Republicans are not against health information 

technology. Last year we worked on a bipartisan basis to pass a bipartisan health IT bill. Unfortunately, that bill did not become law. 

Instead, at the start of this Congress, our friends in the majority 

passed their version of health IT as part of the so-called stimulus 

bill. I would like to hear from the witnesses later this afternoon 

just how stimulative that has been. The unemployment rate is 

about 91⁄2 percent around the country. This bill that we are looking 

at today didn’t do much in the private sector. It focused more on 

spending federal dollars while ignoring the less-expensive avenues 

for health IT deployment. I think it would have been better to 

allow hospitals and physicians to donate health IT systems to each 

other, for example. It has been over a year since this bill became 

law, the stimulus bill, that is. That package is going to cost about 

$11⁄2 trillion. Numbers that I have been given indicate that according to the Bureau of Labor Statistics, we have lost over 3 million 

jobs in that time, so I think it is a fair question: where are these 

jobs and how has this particular bill helped create jobs. 

While it is not the focus of the hearing, last week myself and several other Republicans asked for a hearing on the recess appointment of Dr. Berwick to head the new CMS. Dr. Berwick was appointed without being approved by the Senate, which I think is a 

bad precedent, although not unprecedented. Obviously other Presidents have done recess appointments. As we try to implement the 

new health care law, the bigger law, I think people have a right 

to know how Dr. Berwick plans to implement that law and make 

all those cuts in Medicare in the neighborhood of $145 billion. 

So in any event, Madam Chairman, again, we are not opposed 

to health IT, we are not opposed to the federal government being 


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involved, but we didn’t have much say in this particular bill, so it 

is going to be an interesting dialog as we go forward. 

With that, I will put the rest of my statement in the record. And 

again, we do thank our witnesses and we look forward to their testimony. Thank you. 

[The prepared statement of Mr. Barton follows:] 


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Mrs. CAPPS. Thank you, Mr. Barton. 

And now we turn to Mrs. Christensen for her opening statement. 

OPENING STATEMENT OF HON. DONNA M. CHRISTENSEN, A 

REPRESENTATIVE IN CONGRESS FROM THE VIRGIN ISLANDS 

Mrs. CHRISTENSEN. Thank you, Madam Chair, and I want to 

thank you and Chairman Pallone and the ranking member for 

holding this hearing on implementing of HIT, an issue that has 

been of particular importance for me. Of course, it is important to 

all providers, but providers of color, those in minority and poor and 

rural neighborhoods in my district have a particular interest in 

how it is going to be implemented. 

The Health Information Technology for Economic and Clinical 

Health Act holds out great promise for improving medical care, and 

although a few would disagree, reducing health care costs in the 

future. But I also want to make sure that it eliminates disparities, 

not exacerbate them. I appreciate the response of the public comments on what constitutes meaningful use, but if some of the big 

guys like Partners in Health Care, Kaiser Permanente and others 

have concerns about being able to meet the standards, certainly the 

smaller, poorer, understaffed, overworked providers will definitely 

have problems. I can imagine that OMC has in balancing the need 

to get this implemented, ensuring privacy and bringing all providers in. On the other hand, I know the challenge of providers like 

I was would have getting this implemented while trying to take 

care of patients. We will be looking to the regional extension centers like the one at the University of Ponce in Puerto Rico with the 

Virgin Islands Medical Institute for their help in getting this done. 

Dr. Blumenthal, in your testimony you say that we should look at 

this not as investments in technology per se but as efforts to improve the health of Americans and the performance of their health 

care system, and of course key to improving the health of all Americans is to ensure that those who are disproportionately affected by 

health inequities are able to access and take full advantage of the 

provisions of the HITECH Act. 

So I look forward to the testimony and thank and welcome our 

witnesses for being here today. 

Mrs. CAPPS. The Chair now recognizes Mr. Burgess for an opening statement. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BURGESS. I thank the Chair for the recognition. Welcome to 

our witnesses. We are grateful that you are here. I am grateful 

that our committee is exercising proper oversight to see if the 

HITECH provisions of the stimulus bill are being implemented as 

intended. After all, the United States Congress put $20 billion on 

the table with the goal of increasing and ultimately achieving universal electronic medical record adoption. 

For the record, I did not support the stimulus bill and I continue 

to believe that some of the provisions relating to health information 

technology contained within that bill have actually been inhibitory 

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lieve that claims-based incentives ultimately make more business 

sense. 

In addition, our lack of addressing safe-harbor issues is a flaw, 

and early in an early iteration of a health IT bill, H.R. 1031, I introduced such a concept but unfortunately it was not part of the 

language that was adopted by the majority when the stimulus bill 

was passed. I would also like to be certain that new federal guidelines are working in coordination with the quality improvement initiatives that many in the industry are already undertaking and 

certainly not work at cross purposes to those efforts. 

We need to focus on implementation. Even if I didn’t agree on 

how, I am committed to ensuring that the taxpayer dollars are now 

used responsibly to establish the goal that was set forth. Even if 

$1 doesn’t go out the door, penalties for providers are coming no 

matter what, and guess what? They are coming pretty darn fast. 

They will be here in just a couple of years. I have been committed 

to see that the rules set up by the federal government encourage 

adoption and allow providers to avoid the proverbial sword of Damocles hanging over the head of every doctor and every hospital in 

the country in just a few short years. I have certainly been fearful 

that federal regulations might bog down the normal and routine 

medical treatment by requirements that are unnecessary and that 

I imagine both patients and doctors will have some difficulty with 

complying. Unfortunately, the draft regulations put out in February were, in a word, unworkable. I authorized with representatives Space, Stearns and Engel a letter pointing out several issues 

with the proposed rule. These were so intuitively obvious that 250 

Members of Congress agreed to sign on to the letter. Dr. 

Blumenthal, to his credit, has always taken my calls, always listened to my concerns and did address many of the issues that were 

raised. I do remain concerned about the multi-campus issue which 

has been mentioned and on certification of existing systems as 

qualified to receive incentive payments, and Madam Chairwoman, 

I would like to insert into the record a statement by the Premier 

Health Care Alliance addressing that issue. 

So we will continue to work in Congress on legislation to address 

these issues as they come up. We hope we can achieve a bipartisan 

consensus with our members in this committee on both sides of the 

dais and with committee members of Ways and Means. I certainly 

look forward to hearing the testimony today and I will yield back 

the balance of my time. 

Mrs. CAPPS. Hearing no objection, the Chair will insert the letter 

that is recommended by the gentleman. 

[The information appears at the conclusion of the hearing.] 

Mrs. CAPPS. And now turning to Mr. Sarbanes for an opening 

statement. 

OPENING STATEMENT OF HON. JOHN P. SARBANES, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MARYLAND 

Mr. SARBANES. Thank you, Madam Chair. I look forward to the 

testimony from the witnesses today. 

The search for the tipping point on health information technology 

has sort of been for some like the search for the Holy Grail. I don’t 


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think when we get there that is what it will turn out to be but I 

do think it is going to make a huge difference, first for patients and 

then for the costs of the system in terms of reducing cost, promoting more efficiency and so forth. 

I always have every head in the room nod when I talk to an audience about how frustrating it is when a patient goes to a provider 

and has to have the baseline medical record recreated for them because it is so difficult for the provider to put their hands on tests 

and other records that have been done and are available out there 

somewhere but they somehow can’t get hold of those, the result 

being that the patient is then subjected to more tests, more pushing and prodding when that information that we give the provider 

a baseline picture of the person’s health and condition is available, 

it is just not at their fingertips. And HIT has the potential to solve 

that problem. When it does so, it is going to make a tremendous 

advance forward for patient care and obviously, as I said, improve 

efficiency and reduce cost. 

So I think the investment in this both in the stimulus bill and 

in the health reform law was a smart investment. I am looking forward to hearing from you today as to how we are making progress 

on that investment, and I yield back my time. Thank you. 

Mrs. CAPPS. The Chair now recognizes Mrs. Blackburn. 

OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE 

Mrs. BLACKBURN. Thank you, Madam Chairman, and we do welcome our guests and we thank you for being here. 

We do want to keep tabs on what is happening with the HITECH 

Act, with health IT as it moves forward. We are concerned about 

the funds that were provided in the stimulus bill, what was included there and we are also concerned with the rules. I am glad 

that CMS has finally published the final rules for the electronic 

health records and we know that our doctors and our hospitals are 

working diligently to try to comply with these rules because we are 

hearing from them, and while we know that the EHRs are going 

to hold tremendous promise, we also know that we have got some 

hurdles out there if we are going to reach the goal of everyone having an electronic health record by 2015. 

I think that everyone is concerned with this deadline of January 

1, 2011. We will have some questions about that because that is 

the time for provides to have in place a certified EHR to qualify 

for those Medicare health IT incentive programs, and between now 

and then our providers and vendors are going to have to ramp up 

very quickly. I will say, Madam Chairman, I think that when Congress does not engage in putting some of these items in statute and 

leaves it to agencies to put in place, we see unworkability and having to do some revisits. It also appears that CMS had lowered the 

bar in some areas in the recent rule while remaining overly prescriptive in others. An example, Tennessee hospitals are extremely 

concerned about the financial implications on multi-campus hospitals that share a single Medicare provider number. That is another area we will want to discuss with you today. 


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What we must keep in mind that government excels at regulation, not innovation, and we are going to need to listen to the private sector on this and we will look forward to some questions 

there for our second panel, and as this rush is taking place to build 

this nationwide network very quickly, I am concerned that CMS 

could end up building a national but suboptimal system, and I hope 

that we are going to continue to see working through these problems together. 

Tennessee is a leader in the health IT innovation and implementation and we are hopeful that this can be put on the right direction and some of these concerns and stumbling blocks addressed as 

we move along the way. 

I thank you for the time. I yield back. 

Mrs. CAPPS. The Chair is now pleased to recognize the chairman 

emeritus of the full committee, Mr. Dingell, for his opening remarks. 

OPENING STATEMENT OF HON. JOHN D. DINGELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. DINGELL. Madam Chairman, thank you, and thank you for 

holding this important hearing. 

Health information technology has the ability to modernize and 

improve our entire health care system by allowing for more informed decision-making, by reducing duplicative and unnecessary 

paperwork, by speeding up diagnoses and by reducing medical errors. The Health Information Technology for Economic and Clinical 

Health Act, HITECH, that was passed as a part of the American 

Recovery and Reinvestment Act of 2009, created an unprecedented 

investment in health information technology. In fact, the Congressional Budget Office noted the adoption of health IT would reduce 

Medicare spending by $4.4 billion over the 2011–2019 period and 

create federal savings in Medicaid over $7 billion in the same timeframe. Given this potential, we must ensure that we get a good return on that investment and vigorously move forward on the implementation of the statute. 

These resources will put us on the path to a more coordinated 

health care system, which is why the topic of health information 

technology has long been a focus of this committee. I would like to 

note that not only has this committee spent many years studying 

and legislating on the matter but that we have done so in a bipartisan fashion. For example, in the last Congress, this committee 

passed the bipartisan health information technology bill, H.R. 

6357, the Protecting Records, Optimizing Treatment and Easing 

Communication through Health Care Technology Act of 2008. This 

bill included language to codify the Office of National Coordinator 

for Health IT and to provide grants designed to stimulate the 

spread of HIT. It also included strong privacy protections. This bill 

became the basis for the HITECH Act. 

The Administration recently issued rules, final in character, to 

support meaningful use of electronic health records. I am delighted 

that the Office of National Coordination for Health IT and Centers 

for Medicare and Medicaid Service have worked with all interested 

parties to develop standards that are attainable but also propel our 


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health technology systems forward. They have had to thread a very 

fine needle, and overall they have done a commendable job. However, we all understand that a few concerns remain. I am confident 

the Administration will continue to hear and respond to the legitimate concerns. I am also aware that the work of the Congress may 

not be totally done on this issue. 

I want to thank both of the panels of our witnesses today for 

joining us and look forward to their updates on the implementation 

process. We will find that the testimony today will be in front of 

a group of people that has a real interest in ensuring that HITECH 

Act moves forward in a way that fulfills the intent of the legislation. 

Again, Madam Chairman, I thank you and I yield back the balance of my time. 

Mrs. CAPPS. The Chair is pleased to recognize for an opening 

statement Ms. Castor. 

OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. CASTOR. Thank you, Madam Chair, for calling this hearing 

on how we improve health care through modern technology. You 

know, the health care investments that have been made through 

the Recovery Act have really been a godsend to communities all 

across the country and created thousands and thousands of jobs including in my hometown of Tampa and the Tampa Bay area. 

One of the initiatives that I am most proud of was made possible 

by the HITECH Act included in the Recovery Act and it is the 

Paper-Free Florida Collaborative Regional Extension Center. In 

April, Paper-Free Florida was awarded nearly $6 million for its initiative developed by the University of South Florida in my district. 

It is one of more than 70 regional extension centers authorized by 

the Office of National Coordinator. I notice that Glen Tullman from 

Allscripts is here. He gave us great advice and encouragement from 

the get-go, so I am glad you are here, Glen. Paper-Free Florida will 

effectively implement electronic health records in more than 1,000 

priority clinical practices, and I heard from the other side of the 

aisle where are the jobs. Well, I am grateful that a number of the 

jobs are right in my hometown in Tampa because what we are 

going to be able to do is recruit and train and employ over 100 ehealth ambassadors as HIT extension agents in 20 countries. We 

are going to avoid costly medical errors for patients, and you 

should have seen the young doctors when we made the announcement. They are already there. They know this technology and they 

just can’t wait to get started, and it is exactly what we intended 

by the Recovery Act, creating these high-wage jobs that communities like mine need in this economic downturn. So thank you. 

While I am proud that one of the many success stories made possible by the HITECH Act comes from my community, there are a 

few roadblocks that we need to address to ensure that more health 

care providers are able to coordinate care, and one area of improvement I think I am hearing consensus across the board here is the 

meaningful-use rules, and I think you for granting additional flexibility as you took comments from folks and providers all across the 

country, but we have more work to do here. Dr. Blumenthal, you 


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have worked hard to make sure that certain entities that are eligible for HIT incentive payments are going to be eligible, but as 

many of the members today mentioned, the hospital systems with 

multiple campuses remain in a tough spot under these new rules. 

And I was with a chief medical officer in Florida for a big hospital 

system yesterday, they were singing your praises, but this is giving 

them real heartburn. The decision to allow only one payment per 

provider number, even if that provider number is used for more 

than one facility, puts multi-campus hospitals at a real disadvantage. Meanwhile, they have great potential to deliver results, the 

results that we need. 

Nevertheless, the overall benefit of the HITECH Act is among 

the most exciting components of the Recovery Act and alongside 

the Affordable Care Act, we will continue to make great strides to 

improve the health for American families. 

So thank you, Madam Chairman, and I look forward to hearing 

from our witnesses today. I yield back. 

Mrs. CAPPS. The next opening statement will be by Mr. Green. 

Mr. GREEN. Thank you, Madam Chairman. Before I begin I 

would like to ask unanimous consent to include a written statement for the record. This is written testimony of Dan Hawkins of 

the National Association of Community Health Centers. 

Mrs. CAPPS. Hearing no objection, so ordered. 

[The information was unavailable at the time of printing.] 

OPENING STATEMENT OF HON. GENE GREEN, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GREEN. Like my colleagues, I thank you for holding this 

hearing to check on the implementation and progress of the Health 

Information Technology for Economic and Clinical Health Act of 

2009. For many years, this committee and Congress has the goal 

of encouraging large-scale implementation of electronic health 

records. The passage of the Health Information Technology for Economic and Clinical Health Act of 2009, HITECH, in the American 

Recovery and Reinvestment Act of 2009 demonstrated Congress’s 

commitment to improving and coordinating patient care as well as 

streamlining and updating our medical records system. In a hightech world, the days of paper records should be well behind us. 

With integrated information technology, patients can manage 

their own electronic records and avoid having to haul multiple 

records to various physicians. The lack of coordinated care in the 

country is startling, but if we can coordinate our care systems 

through health IT, we have a potential to change our health care 

system. 

We are all aware of the benefits improved IT will bring the 

health care sector and the patients it serves. If implemented correctly, health IT will improve patient safety and garner cost savings. That is why I am glad we are having the hearing today to 

discuss the status and the implementation of the HITECH Act. As 

we know, no legislation is perfect and Congress has a history of revisiting legislation many years after its passage. The HITECH Act 

is no exception. I am particularly interested in discussing potential 

changes that need to be made to assist community health centers 

and mental health providers adopt health IT. 


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The implementation of health IT has dramatically improved the 

community health center coordination of care in our district and we 

are excited about the potential this has to improve quality of health 

care for medically underserved in the district. I do want to discuss 

how payments to health care IT are made to individual providers 

at the community health centers rather than the actual health center, which is a more common practice in allowing recurrent funding 

for health centers. 

With regard to mental health providers, I sponsored the Community Mental Health Services Improvement Act for many years. This 

legislation contains funding for the establishment of grant programs to improve health IT for mental health providers. I recently 

began working with Representative Patrick Kennedy and Representative Tim Murphy on H.R. 5040, the Health Information 

Technology Extension for Behavioral Health Services Act, which 

would amend HITECH to give mental health providers, substanceabuse providers and psychiatric hospitals in parity with other 

health care providers for medical use of health information technology and electronic health. This legislation clarifies the definition 

of health care provider to include mental health professionals, substance-abuse professionals, psychiatric hospitals, behavioral mental 

health clinic and substance-abuse treatment facilities. The legislation requires HHS through the National Coordination of Health Insurance Technology to award grants for mental health treatment 

facilities not eligible for meaningful-use incentives through the 

HITECH Act. The grants would allow for purchase of certified electronic records training of medical staff and the use of electronic 

records and improve the exchange of health information between 

mental health providers and other health care providers. I am 

hopeful these issues can be discussed in the future the community 

health centers and mental health providers are an integral part of 

our health care system. 

Again, I want to thank the witnesses for appearing. I want to 

welcome Dr. Roland Goertz, CEO and Executive Director of Heart 

of Texas Community Health Center in Waco on the second panel, 

and I yield back my time. 

Mrs. CAPPS. Thank you. 

Mr. Murphy is now recognized for his opening statement. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Mr. MURPHY OF PENNSYLVANIA. Thank you, Madam Chairman. 

We all know that electronic medical records hold enormous potential for the practice of medicine but tools like IT with health are 

only valuable if we know how to use them and if we have them, 

and that process began with more than $20 billion in federal resources allocated. Today, only 6 percent of hospitals and 2 percent 

of physicians rely on these health records. 

These incentives no doubt are going to increase participation but 

as I have heard from many doctors and hospitals in my district, 

that initial requirement for incentive payments seems to be too 

complex and unobtainable. Now with CMS cutting back on the 

scope of HIT mandates, it has given providers more time to adopt 


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records that will collect essential patient data, and I look forward 

to hearing what providers can do before being financially penalized 

for noncompliance. 

HIT will be an essential component of medicine, or as Dr. David 

Blumenthal has put it aptly, as accepted in the daily lives of health 

professionals as the stethoscope and the exam table. Well said. 

Health IT is most valuable when it is available to providers across 

all disciplines, and as it advances, we want to make sure government is not a barrier but a team member to work better, effectively, efficiently and economically. 

I also believe that health IT needs to be integrated, interactive, 

interoperable and intelligent in order to provide great patient outcomes, and that is where I am afraid sometimes we may fall short 

in terms of integrating care, and let me give two quick examples. 

Patients in skilled nursing homes are extremely ill on average and 

take eight different kinds of medication. Eighty percent of this population comes from a hospital, but there is little exchange of patient data electronically, so a hospital may discharge a patient to 

a skilled nursing facility on Friday, the paper records are sent to 

the skilled nursing facility via fax a day or two later. If it was electronic, that facility could do a better assessment upon admittance 

and know the patient’s medications immediately. 

Second, we need to be thinking about the overall health of an individual. Unfortunately, the incentives exclude mental health providers. As my colleague, Mr. Green, said, Congressman Patrick 

Kennedy and I have put in a bill, the HITECH Extension for Behavioral Health Services, H.R. 5040, to make mental health providers eligible for the federal incentive payments. This is a critical 

bill, and it would extend Medicare and Medicaid reimbursements 

for meaningful use of electronic health records to mental health 

professionals across a spectrum. 

So as Congress continues to support advances in technology, I 

look forward to working with this committee to secure passage of 

this bill and others. Keep in mind that those with chronic illness 

run the risk twice that of the population for having depression and 

other mental illnesses. We have to make sure that all these records 

are integrated together so that whatever medical problem they 

have, whatever complications people with chronic illness have, the 

key feature of electronic medical records is to make sure we can 

use them and provide the incentives and provide the facilities for 

us to be able to make better medical decisions. 

With that, I yield back. 

Mrs. CAPPS. Thank you, Mr. Murphy. 

Mr. Space, you are now recognized for your opening statement. 

OPENING STATEMENT OF HON. ZACHARY T. SPACE, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF OHIO 

Mr. SPACE. Thank you, Madam Chairman. 

Thank you for holding the hearing on an issue that of considerable important to all of us. When it comes to health IT, there does 

seam to be a great deal of agreement on both sides of the aisle with 

very good cause. Both Democrats and Republicans, providers and 

consumer groups by and large seem to agree that improving the 

adoption of health information technology around the country will 


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be beneficial to the practice of medicine, reduce redundancies, save 

money, provide a safer environment for patients and I certainly include myself in this support. How we achieve the adequate adoption of health IT is what has brought us here today. Ensuring that 

every hospital, doctor and clinic in this country have high-quality 

record systems that ensure patient safety is not an easy task and 

there is no simple answer to how we reach that destination. 

The HITECH Act included as part of H.R. 1 earlier this year offers a promising framework for accomplishing this goal, establishing an Office of the National Coordinator and developing a 

structure for incentive payments has created a framework for pushing the adoption of health IT in a strategic and meaningful way. 

However, the meaningful-use rule provided by CMS 2 weeks ago 

holds some troubling provisions that I fear may steer us away from 

adoption, and I would like to touch on two of those issues today. 

First, the multi-campus issue that was brought up earlier I think 

during Mr. Burgess’s statement. I believe firmly that it was the intent of this body in passing the HITECH Act to ensure that each 

hospital would be entitled to its own incentive payments. The rule 

offered by CMS denies those payments to hospitals that have chosen to structure themselves with multiple campuses under a single 

provider number, and I am disappointed in this decision, particularly after we worked with Representatives Burgess, Engel and 

Stearns to send a letter to CMS that was signed by 240 members 

of this body. My staff will continue to work with those members 

and their staffs along with the staff of this committee and the 

Ways and Means Committee so that this issue can be resolved. 

And the second concern we have is what this rule will mean for 

smaller rural hospitals, like the 13 that we have in Ohio’s 18th 

Congressional district. Most of those hospitals, indeed, all of those 

hospitals, see an exceptionally high caseload of Medicare and Medicaid recipients with an ever-growing number of self-pay cases. 

That is a euphemistic term for charitable cases. We see these cases 

increasing with the economy. For these hospitals, investing in the 

needed capital to purchase health IT systems that meet the criteria 

spelled out today is especially challenging. Even with the promise 

of incentive payments, these investments are costly and difficult. I 

still have concerns about what these requirements will mean for 

our hospitals and I certainly hope to learn more about how HHS 

and CMS intend to help small rural hospitals in accessing this vital 

technology. 

Thank you, Madam Chair. 

Mrs. CAPPS. Thank you. 

The Chair recognizes Mr. Barrow for an opening statement. 

OPENING STATEMENT OF HON. JOHN BARROW, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA 

Mr. BARROW. I thank the Chair for the opportunity to explore 

this topic. 

In getting ready for this hearing, I reached out to some of the 

folks on the ground back in my district and some of the folks who 

represent them up here, and there still seem to be a lot of unknowns and unanswered questions out there. We spent a lot of 

time poring over legislative language and debating the definitions 


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of legislative terminology. I would like to bring to the attention of 

the committee some of the more fundamental challenges that I am 

talking about. 

I represent areas that don’t even have access to reliable 

broadband services. I represent counties that are at least an hour’s 

drive away from the nearest IT professional. I am concerned that 

even if we do everything right up here, we make grant funding 

available, we offer technical guidance, we provide reasonable rewards for proper implementation, many providers out there are 

still going to be left behind because we still don’t have the proper 

technological infrastructure in place to take full advantage of this. 

So my concern is that we make great leaps forward in all other 

kinds of places with information technology that we don’t forget 

those folks who are still struggling to get on board the IT bandwagon in the first place, and I hope that can be addressed in the 

course of the hearing. 

Thank you, Madam Chair, and I yield back the balance of my 

time. 

Mrs. CAPPS. Ms. Harman, the Chair recognizes you for an opening statement. 

Ms. HARMAN. Thank you, Madam Chair. It is nice to have a 

school nurse in the chair, and the quality of school nursing care 

matters to this committee, and I think electronic IT will be helpful 

even at that level, and I am sure you agree with me. 

Mrs. CAPPS. Absolutely. 

OPENING STATEMENT OF HON. JANE HARMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. HARMAN. Most of our colleagues have described what is in 

this legislation, which is absolutely essential. I just wanted to add 

a couple of things that haven’t been said. One is that a firm in my 

district makes dog tags, electronic health dog tags for soldiers, and 

has had some success in selling these to the Pentagon. I have no 

idea, and probably others would know better than I, whether these 

could have a civilian application, but the notion that a soldier hit 

on the battlefield would have all of his health records in this tiny 

little chip that he wears around his neck is an exciting idea and 

it might really be useful to people who for any number of reasons 

could get into problems and urgently need one health provider to 

be able to download their history. There would obviously be some 

notion of choice here. I don’t assume everyone would be compelled 

to wear these things, but I just put it out there as something that 

I think may have promise. 

The other thing I would want to mention that has been said, I 

am sure, before but not while I have been sitting here is the issue 

of both privacy and accuracy of records. I mean, once we consolidate and integrate health data, and boy, do I think ‘‘integration’’ 

is a critical word, it has to be accurate. The goal here is obviously 

to reduce errors and duplication, but what is on those records really matters and so while our legislation goes a long way in that direction, I just mention to our witnesses that this is something that 

will need renewed focus. 

And I congratulate this committee for legislating on a bipartisan 

basis in an area that is absolutely critical to the quality and cost 


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of health care for Americans including school kids who go to excellent school nurses like our friend Lois. 

Thank you very much. I yield back, Madam Chair. 

Mrs. CAPPS. And on that note, we conclude our opening statements by members of the subcommittee and we turn now to our 

witnesses. I want to welcome you both and thank you for your patience in listening to all of us. We have on our first panel Dr. David 

Blumenthal, National Coordinator of Health Information Technology for the U.S. Department of Health and Services, also joined 

by Mr. Anthony Trenkle, Director of the Office of E-Health Standards and Services, Centers for Medicare and Medicaid Services. 

Welcome to you both. 

Dr. Blumenthal, you may begin your testimony. 

STATEMENTS OF DAVID BLUMENTHAL, M.D., NATIONAL COORDINATOR, HEALTH INFORMATION TECHNOLOGY, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES; AND ANTHONY TRENKLE, DIRECTOR, OFFICE OF E-HEALTH STANDARD AND SERVICES, CENTERS FOR MEDICARE AND MEDICAID 

STATEMENT OF DAVID BLUMENTHAL 

Dr. BLUMENTHAL. Chairwoman Capps, Ranking Member Shimkus, distinguished subcommittee members, thank you for the opportunity to submit testimony on behalf of the Department of 

Health and Human Services regarding the implementation of the 

Health Information Technology for Economic and Clinical Health 

Act. 

The provisions of the HITECH Act are best understood not as investments in technology per se but as efforts to improve the health 

of Americans and the performance of their health care system. 

Three interdependent rulemakings were required to implement the 

provisions of the HITECH Act generally and the Medicare and 

Medicaid EHR incentive programs in particular. The first rulemaking establishes the requirements that eligible health care providers will need to satisfy in order to qualify for incentive payments. The second specifies the technical capabilities and standards that certified EHR technology will need to include to support 

these health care providers, and the third creates the processes for 

EHR technology to be tested and certified, thus providing confidence and assurance to eligible health care providers that certify 

the EHR technology they adopt will perform as expected. 

On July 13th, with the issuance of the Medicare and Medicaid 

EHR incentive programs’ final rule and the initial set of standards, 

implementation specifications and certification criteria final rule, a 

17-month effort was capped to publish the three rulemakings necessary to implement meaningful use, stage 1. These rules cumulatively reflect over 2,000 public comments from stakeholders across 

the health care system and illuminate the initial pathway to 

achieving an integrated and electronically connected health care 

system. Our health information technology policy committee and 

health information technology standards committee played vital 

roles in advising me and the Secretary on these rules and many 

other matters. 


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With the adoption of these three rules, attention now turns to 

their implementation. The ONC, the Office of the National Coordinator, is now ramping up the development of other processes that 

will need to be in place to enhance interoperability. Many of these 

processes will be components of a comprehensive standards and 

interoperability framework developed by the Office of the National 

Coordinate to expedite standards harmonization as well as their 

adoption and use. 

I am also pleased to report that in the approximately 4 weeks 

since the temporary certification program rule was finalized, ONC 

has already distributed 32 applications to organizations seeking to 

become authorized testing and certification bodies to test and certify EHR technology. I am highly encouraged by the strong interest 

shown thus far and I am optimistic that multiple organizations will 

be granted ONC-authorized technology and certification body status and thus be authorized to test and certify complete electronic 

health records and EHR modules under the temporary certification 

program. Such a result should create a competitive market and 

would provide EHR technology developers with multiple options 

and could lower the costs to EHR technology developers that are 

associated with testing and certification. 

ONC has engaged in a number of cross-cutting activities related 

to administering the provisions of the HITECH Act. The major program investment established to date with the $2 billion appropriated to ONC under ARRA include the Health Technology Extension program, the State Health Information Exchange Cooperative 

Agreement program, the Beacon Community Cooperative Agreement program, the Health IT Workforce program, and the Strategic 

Health IT Advanced Research Projects program. 

The Health Information Technology Extension program includes 

the establishment of a national health IT research center and a nationwide network of regional extension centers. Regional extension 

centers will be dedicated to ensuring that providers have all the 

necessary resources to meet the challenges ahead to adopting and 

becoming meaningful users of certified electronic health record 

technology. They will place a special emphasis on providing technical assistance to clinicians furnishing primary care services from 

individual and small group practices. 

The State Health Information Exchange Cooperative Agreement 

program has the overall aim to advance appropriate, secure and 

sustainable health information exchange within and across States 

and other jurisdictions. Over $500 million has been obligated to 56 

States, eligible territories and qualified State-designated entities to 

support health care providers, demonstrate the meaningful use of 

certified electronic health record technology and to leverage the additional efficiencies and quality improvements gained from health 

information exchange. 

The Beacon Community Cooperative Agreement program provides certain communities with funding to build and strengthen 

their health IT infrastructure and health information exchange capabilities. These communities will demonstrate the vision of a future where hospitals, clinicians and patients are meaningful users 

of health information technology and together the community 


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achieves measurable improvements in health care quality, safety, 

efficiency and population health. 

The HITECH Act provides for an unprecedented level of funding 

to improve the quality and efficiency of health care through HIT 

and its historic investment will undoubtedly help transition our 

current antiquated paper-dominated health care system into a 

high-performing 21st century health care system. 

It is my privilege to testify before you today and I look forward 

to continuing to work together in answering any questions you 

might have. 

[The prepared statement of Dr. Blumenthal follows:] 


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Mrs. CAPPS. Thank you very much, Dr. Blumenthal. 

Now Mr. Trenkle for your testimony. 

STATEMENT OF ANTHONY TRENKLE 

Mr. TRENKLE. Thank you, Chairwoman. Chairwoman Capps, 

Ranking Member Shimkus and other members of the subcommittee, thank you for the invitation to discuss the CMS incentive program for electronic health records, which is part of the 

American Recovery and Reinvestment Act of 2009. Certified EHR 

technology use in a meaningful way is one piece of a broader health 

information technology infrastructure needed to reform our Nation’s health care system and improve the quality and safety of 

care for both Medicare and Medicaid beneficiaries. 

On January 13, 2010, we published a proposed regulation that 

defined meaningful use and described the eligibility and payment 

methodologies for the EHR incentive programs. This NPRM was 

developed through close cooperation between CMS and the Office 

of National Coordinator and also allowed for extensive stakeholder 

input and recommendations from several federal advisory committees, in particular the HIT policy committee. The NPRM laid out 

three stages of meaningful use with stage 1 covering the first 2 

years of the program. We received more than 2,000 comments on 

the proposed rule from interested stakeholders including health 

care providers, associations and patients. Most of the commenters 

felt that the proposed set of objectives was too difficult for stage 1 

and asked for some flexibility in meeting them. The agency carefully reviewed and considered all submitted comments and took 

them into account in making policy decisions for the final rule. Our 

goal was to be as inclusive and flexible as possible within the 

bounds of the statute. We continued to work closely with ONC and 

received additional recommendations from the HIT policy committee. It is important that this program provides payment incentives for both Medicaid and Medicare. The programs have different 

statutory requirements but we tried to harmonize the meaningfuluse requirements as closely as possible for stage 1. Both the CMS 

rule and the ONC certification standard rule, which sets out the 

functionality requirements for EHR, were displayed the Federal 

Register on July 13, 2010, and will be published in the Federal 

Register tomorrow, July 28, 2010. 

I will now discuss some of the key areas of the final rule. Eligible 

professionals, the major change in that was to expand the definition of ‘‘eligibility’’ to hospital-based physicians who work primarily 

in outpatient departments. This is made possible by a change to 

the original statutory language made in the Continuing Education 

Extension Act of 2010. Most Medicare Advantage-affiliated eligible 

professionals will also quality for this incentive if they are able to 

show meaningful use, and on the Medicaid side we provide additional flexibility for determining patient volume in order to quality 

more EPs. 

Eligible hospitals—we have received, as was noted by a number 

of the committee members, much comment and request that CMS 

recognize each campus of a multi-campus hospital for the incentive 

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agency’s perspective, we believe it is important to treat hospitals 

consistently, and the decision to deviate from longstanding policy 

in this particular instance without clear statutory direction to do 

so would have made CMS vulnerable to legal challenges asserting 

our policies are being implemented in an arbitrary manner. We intend to remain consistent with other payment policies and make 

incentive payments based upon how hospitals have organized 

themselves under provider numbers. There is a more detailed discussion of this issue in my written testimony and I am happy to 

respond to questions on this. We will continue to work with all interested stakeholders in future rulemaking related to the implementation. 

The other major hospital issue was with the Medicaid program, 

and in response to public comments on the proposed rule, we added 

critical-access hospitals to the definition of a Medicaid acute hospital in order to allow CAHs to quality for both programs. The 

major changes we made in the rule were with the meaningful-use 

definitions. As we mentioned in the NPRM, we received a number 

of comments that asked for more flexibility, and we decided to 

make some changes based on these comments that I will address 

in the next few moments. 

Some of the major changes were modifying the all-or-nothing approach to objectives that must be met for meaningful use and reducing this requirement to a required set or a core and a menu set 

or optional set. Eligible hospitals and professionals have the flexibility to defer up to five of the menu set objectives. Where appropriate thresholds to meet meaningful-use requirements were reduced in the final rule in response to comments. We also removed 

the administrative transaction requirements in the final rule in response to comments these transactions are often done through 

practice management software as opposed to EHRs. We also modified the States’ ability to impose more-robust requirements that 

would have made it more difficult for Medicaid providers to achieve 

elevated targets. We believe it is important for States to have some 

flexibility so we preserved the flexibility. However, in response to 

the concerns raised, it was limited to four public health measures. 

We also added additional objectives for patient-specific education 

resources and advanced directives for hospitals were added in response to numerous requests in the comments and the HIT policy 

committee recommendations. 

It is important to note that Medicaid providers are not required 

to meet meaningful-use criteria in their first participating year. Instead, they may qualify for an incentive payment if they adopt, implement or upgrade certified EHR technology. In subsequent years, 

Medicaid providers must demonstrate meaningful use in order to 

receive the EHR incentive payments. The meaningful-use definition 

described for Medicare will also be the minimum requirement for 

the Medicaid EHR incentive program. Unlike the Medicare program, however, there are no Medicaid penalties for EPs and hospitals that will unable to demonstrate meaningful use. 

Finally, I want to mention that Congress recognized the critical 

importance of reporting quality measures through EHRs in the 

HITECH legislation. We support this requirement but recognize 

that the infrastructure to support the reporting of quality measures 


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through EHRs is not yet available. In response to comments, CMS 

limited CQMs to only those which have electronic specifications. Eligible providers will now be required to report on three core measures from a set of 41 measures. Hospitals will be required to report 

on 15 measures as applicable to their population. 

In conclusion, the CMS and ONC final rules lay the groundwork 

for establishing a robust national health care infrastructure that 

supports the adoption of EHR technology that can help providers 

practice safer, more effective medicine. CMS understands the scope 

of these programs is vast and the doctors and facilities across the 

country have varying awareness of EHRs and of the program. We 

are working closely with ONC to conduct wide-scale outreach to 

educate those eligible for the program as well as working with the 

States and provider stakeholders. We look forward to working with 

Congress and our many stakeholder partners as we implement this 

rule and future rules and advance the use of HIT in our health 

care system. 

Thank you very much for allowing me to testify. 

[The prepared statement of Mr. Trenkle follows:] 


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Mrs. CAPPS. Thank you, Mr. Trenkle. And the statements of both 

of our witnesses in the first panel will be made a part of the hearing record. Each witness may also submit additional pertinent 

statements in writing and at the discretion of committee be included in the record, and now I recognize myself for 5 minutes of 

questioning. 

My first question is for you, Dr. Blumenthal. Dr. Blumenthal, I 

believe that health information technology will benefit all of us but 

it can also be particularly important in improving the health of individuals with complicated comorbidities such as people with severe mental illness. I am aware that mental health providers are 

not authorized to participate in Medicaid and Medicare reimbursement under the HITECH Act. Because of that omission, I am a cosponsor of a bill I want to acknowledge by our colleague here, Mr. 

Murphy, and our colleague in Congress, Mr. Kennedy, H.R. 5040, 

to correct that situation. I do worry that without health information technology it will becoming increasingly difficult for behavioral 

health providers to provide the necessary coordinated care for people with serious mental disorders. They cannot receive reimbursement for adopting HIT. Can behavioral health providers participate 

in any part of the HITECH Act technical assistance regional extension center program and will you describe that for us? 

Dr. BLUMENTHAL. Sure. Thank you, Madam Chair. Well, as a 

long-term primary-care physician, I well understand the value of 

behavioral health information. I treated many patients with dual 

diagnoses, that is behavioral health and problems or substanceabuse problems as well as so-called physical problems. So it is absolutely vital that that information be available for accurate and 

careful management of patients. There is no question that the regional extension centers can serve any physician who is using electronic health record and intends to become a meaningful user of 

that electronic health record. There are certain priority providers 

that we have outlined in order to achieve the intent of the law and 

we have focused on primary-care physicians, critical-access hospitals, physicians in small groups and in underserved areas but 

there is no restriction that prevents a regional extension center in 

addition from serving mental health providers. 

Mrs. CAPPS. And you are reaching out to these communities? 

Dr. BLUMENTHAL. Yes, we are. 

Mrs. CAPPS. OK. So that they know about what services they can 

be eligible for? 

Dr. BLUMENTHAL. We certainly are making every effort to make 

those services known. 

Mrs. CAPPS. May I also mention another topic? The HITECH Act 

provided $2 billion to the Office of the National Coordinator for 

Health Information Technology, partly to build an infrastructure 

that promote the electronic exchange and use of health information. Can you describe how the health information network and the 

health information exchanges are critical to this effort? 

Dr. BLUMENTHAL. Well, exchange is absolutely essential to good 

health-care management. Knowing what your patients’ experiences 

have been in other locations is a great benefit, potential benefit of 

health information technology. At the same time, we need to make 

it possible for exchange to occur. It is not something that is under 


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the control of individual providers. Exchange is in many ways a 

team sport. You need to have someone out there to get your pass 

when you throw the pass and you need to be able to take the pass 

when it comes back to you. So the health information exchange cooperative agreement programs that provide funds to the States are 

meant to empower the States and encourage the States to lead in 

the development of health information exchange capabilities within 

state jurisdictions and across state jurisdictions. Similarly, the Office of the National Coordinator has undertaken an aggressive program for the development of new standards and technologies that 

can provide a tool kit for exchange that the States can use and that 

local service providers can use. 

Mrs. CAPPS. One final question to you. Your office, I know, has 

been in touch with the providers that are required to start exchanging health information electronically but once they have 

begun that, is there the national infrastructure to allow it to continue to work forward? In other words, are you building a network? 

I have just a half a minute left for you to respond. 

Dr. BLUMENTHAL. We want very much for this to be an ongoing 

feature of the health-care system and of health information technology so we are working hard with our health information exchange groups at the State level to make them sustainable over 

time. 

Mrs. CAPPS. So there is a network that is building within the 

State and then will that filter—— 

Dr. BLUMENTHAL. Absolutely. That network has to be created or 

else exchange will not continue. 

Mrs. CAPPS. Thank you very much. 

Mr. Shimkus. 

Mr. SHIMKUS. Thank you, Madam Chair. 

First, I want to segue into and follow on the line of questioning 

that Mrs. Capps talked about. Also, there is a provision on the absence of physical therapy as part of being not eligible to receive and 

I just want to throw that out there. I think your answer would be 

very similar in the response. But I think it is worth noting that 

there are some gaps there and there will be a debate on who is eligible and who is not eligible. 

Dr. Blumenthal, what happens to eligible professionals and hospitals that fail to meet the meaningful-use requirements? Are they 

penalized? Will they be penalized? 

Dr. BLUMENTHAL. Well, Congressman, the law specifies what will 

happen for failure to meet meaningful use. 

Mr. SHIMKUS. And since you are implementing that law, what 

would that be? 

Dr. BLUMENTHAL. Well, as of 2015, eligible providers that have 

not implemented, not become meaningful users would be potentially penalized in their Medicare and Medicaid—— 

Mr. SHIMKUS. When? When will that start? When will the penalties start? 

Dr. BLUMENTHAL. Twenty fifteen. 

Mr. TRENKLE. Yes, 2015 is specified in the legislation. 

Mr. SHIMKUS. We don’t have any idea based upon where people 

are in a survey of projection of how many providers may be penalized? 


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Dr. BLUMENTHAL. I think it would be premature to speculate 

about that. 

Mr. TRENKLE. We put some estimates in the impact analysis as 

part of the regulation, but—— 

Mr. SHIMKUS. And what would those analyses show? 

Mr. TRENKLE. We had both a high- and a low-end projection for 

that. 

Mr. SHIMKUS. I will give you a chance to look for that. 

Mr. TRENKLE. No, I have got them right here, actually. The projection we had on the low end was by 2015, 21 percent of EPs 

would be meaningful users, and on the high end, 53 percent would 

be meaningful users, but keep in mind that that represents numbers based on previous studies that our actuaries used to come up 

with these numbers. They don’t take into account what the effects 

of outreach and other activities that will be done under this Act 

will do. 

Mr. SHIMKUS. You know, and I think from colleagues on both 

sides of the aisle, especially those of us who represent rural communities, I think, you know, our one of many concerns would be 

major institutions have the capital or the foundations to move in 

the aggressively upfront cost. Poor, rural hospitals do not, and our 

concern is the timeline and our concern would be then when they 

are servicing in poor areas that they will then have a penalty when 

they are still trying to comply. So that is part of the question. 

Mr. TRENKLE. Excuse me just a second, but the numbers I gave 

you were for the professionals, not for the hospitals. 

Mr. SHIMKUS. Well, it is true for them too. 

Mr. TRENKLE. Right. I understand. 

Mr. SHIMKUS. What about the other issue that we have heard of 

is interoperability between the family practitioner and maybe the 

hospital, and the question would be, and it deals with the incentive 

payment issues. Who would pay if you have two systems that are 

not compatible and then you have to develop a compatibility software system? The family practitioner may balk and say well, that 

is our deal. The hospital may say well, that is not our deal. How 

are you going to take into consideration those issues? 

Dr. BLUMENTHAL. Well, one of the reasons why we put back to 

stage 2 some of the more complete exchange capabilities was to 

give the local providers a chance to work those things out, come to 

agreements locally on who is going to do what to create exchange. 

I think the two key factors at work here are the incentives which 

will be available if exchange occurs, and perhaps for some the 

avoidance of penalties. And the second, the availability of good 

tools for exchange including open source free software, which we 

are developing. 

Mr. SHIMKUS. And my time is real short, but I want to just ask, 

in your testimony, Mr. Trenkle, you have a range of estimates between $9.7 billion and $27.4 billion over the next 10 years, and 

that is a pretty large range. Can you explain why that is the case 

and that can’t be narrowed down a little bit more? 

Mr. TRENKLE. For the purpose of the impact analysis, we did 

both a high- and a low-end scenario. As I mentioned a few moments ago, those are based on studies and actuarial projections. We 

also changed some of the numbers based on input we received from 


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a number of organizations including the American Hospital Association, which allowed us to actually we had to lower the lower end 

because some of the cost projections and projections of getting up 

to speed had to be lowered because of the longer implementation 

lead time they projected. 

Mr. SHIMKUS. Thank you, Madam Chair. 

Mrs. CAPPS. Mr. Waxman, the chairman of the full committee, is 

recognized for his questions. 

The CHAIRMAN. Thank you, Madam Chair. 

The gathering of health IT should not be a goal in itself. It is a 

worthy goal, but that is not the only reason we want it. The lack 

of timely clinical information is a contributor to our Nation’s welldocumented problems with uncoordinated care. Health IT is a tool 

that can help deal with that problem right at the time of the patient’s visit. The health reform legislation contains numerous policies to improve the delivery system such as establishing accountable care organizations, reducing hospital readmissions and moving 

towards greater bundling of services. 

Dr. Blumenthal and Mr. Trenkle, what role will health IT play 

in making sure these kinds of delivery system reforms are successful? 

Dr. BLUMENTHAL. Well, Mr. Chairman, you can’t have accountable care organizations without knowing how to make them accountable, and to be accountable you need to know what you are 

doing, and health IT is the best possible source of good information 

about performance in real time quickly. Once you have a system 

up and going, the system should generate information about quality and efficiency and cost in real time as a product of the work, 

not post-retrospectively through chart review, which is costly, 

lengthy, and by the time it is available often no longer relevant to 

the performance of the organization. So it is really I think enormously empowering for enabling providers to take responsibility for 

their performance. 

Mr. TRENKLE. I would follow up on what Dr. Blumenthal with 

the fact that we are actually building infrastructure over the next 

several years that will support much of the health reform from the 

electronic specifications for the quality measures to the health information exchanges and the other work we are doing will allow us 

to have the infrastructure, that will allow the flow of data and support many of the objectives of health reform, so we feel this is a 

critical first step in moving towards some of the goals set out in 

the legislation. 

The CHAIRMAN. Is it fair to say that without health IT we 

wouldn’t be able to have the reforms be as successful as we hope 

them to be? 

Dr. BLUMENTHAL. Well, I would certainly agree with that, Mr. 

Chair. 

The CHAIRMAN. Now, there is another value in electronic health 

records. The availability of information in these records has the potential to support population research to better understand disease 

and treatment patterns. What plans are underway with other 

agencies to make use of the information for public health planning 

and what role do you think this can play in improving the quality 

and efficiency of health care delivery? 


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Dr. BLUMENTHAL. That is an excellent question. We are working 

with our sister agencies to try to define how records can privately 

and securely capture and make available information that is relevant to the missions of other agencies like the Food and Drug Administration or the National Institutes of Health or the Agency for 

Health Research and Quality or the Centers for Disease Control 

and Prevention, how we can, for example, in real time learn about 

the occurrence of influenza-like illness so that we can keep track 

of influenza epidemics and know where vaccine needs to be administered or keep track of foodborne illness outbreaks though realtime availability of information on related types of illness. So there 

is an enormous public health benefit and there is enormous value 

with patient consent and agreement recruiting patients into clinical 

trials for relevant new experiments whether it is in cancer or heart 

disease or diabetes, patients who want to be part of these experiments but who might otherwise be located without the benefit of 

the information that is available in electronic form. 

Mr. TRENKLE. Let me also mention that under the meaningfuluse objectives, one of the major goal areas was to improve population in public health and we included a number of objectives that 

provide for the capability to exchange public health data, and as 

I mentioned in my testimony earlier, we are also allowing States 

to have the flexibility to make some of these objectives core measures and core objectives for the purposes of meeting the meaningful-use criteria for the incentive program. 

The CHAIRMAN. Thank you. I yield back my time. 

Mrs. CAPPS. Thank you, Mr. Chairman. 

The Chair recognizes Mr. Gingrey for 5 minutes of questioning. 

Mr. GINGREY. Madam Chair, thank you very much. 

I don’t know who to ask this so I will ask both of you. The HIT 

policy committee adoption certification work group recently recommended that ONC work with the FDA and representatives of 

patient clinician vendor and health care organizations to determine 

the role that the FDA would play to improve the safe use of certified electronic health record technology. Recently the FDA has 

suggested that direct-to-consumer genetic tests—we had a hearing 

on that just last week—that those should be classified as medical 

devices for the purpose of oversight. Do either of you believe that 

the FDA should consider electronic medical records as medical devices for the purposes of regulating these records? 

Dr. BLUMENTHAL. Congressman, our concern and the concern of 

the policy committee that you cited was to take maximum advantage of health information technology and electronic health records 

to improve the safety of concern, and what actually the committee 

focused on in addition to the FDA was other alternatives for collecting information about the implementation of electronic health 

records to make sure that those implementations are as safe as 

they could possibly be. So we also discussed using patient safety organizations and using our new certification to collect post-market, 

post surveillance, post-certification surveillance information. So I 

think that the mandate to us, the recommendation to us, not a 

mandate, was to develop and look at all the ways we could collect 

information to make sure that our work was doing everything it 

possibly could to enhance patient safety. 


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Now, whether or not the Food and Drug Administration takes 

any action beyond what it already has I think is premature to speculate about. They have no plans right now that I am aware of to 

do anything further than what they have already done. So we are 

right now at the Department looking at these information collection 

opportunities that we already have and have created and not looking at anything else beyond that. 

Mr. GINGREY. Mr. Trenkle, do you have any further comments on 

that? 

Mr. TRENKLE. No, I agree with what Dr. Blumenthal said. 

Mr. GINGREY. I thank you. I hope that I understood correctly 

your response, Dr. Blumenthal, that you really don’t think that the 

FDA should treat electronic medical records as a medical device. 

Dr. BLUMENTHAL. Well, there are issues, there are legal issues 

which I am not qualified to speculate about as to what a device is 

or isn’t. From the standpoint of policy, I would say there is no plan 

right now for the FDA to do anything of that sort. 

Mr. GINGREY. Thanks. I have got about 2 minutes left. 

Technology companies have told me, and we have a very good 

one in my district, the 11th of Georgia, in Carrollton, Georgia, I 

won’t mention the name of the company but they are very good and 

they have been out there doing this for a while, that is, providing 

electronic medical record hardware and software to specialty-specific groups, general surgery, OB/GYN, et cetera, and they have 

told me how critically important it will be to have 12 to 18 months 

of lead time in order to align their products with the stage 2 criteria. Understanding how critically important quality products are 

to the viability of our future nationwide network, can you give 

these companies like the one in my district some public reassurance today that the development of stage 2 criteria will allow these 

companies a 12- to 18-month window in order to bring their products into compliance? 

Dr. BLUMENTHAL. We are going to do everything we can to give 

companies as much warning as we can about what the criteria will 

be, and we want to have time to learn from stage 1 about what the 

experience has been of providers and vendors and others, patients, 

with the new rules and implementation efforts. So we want to wait 

a while before we get that experience. Then we also want to get 

the rules done as early as possible. 

Mr. GINGREY. Well, I don’t want to interrupt you, but I definitely 

want to ask Mr. Trenkle a question before my time runs out. I have 

10 seconds. 

You said to one of my colleagues that the issue of the final rule 

on the hospitals that have multiple campuses, that they would just 

be eligible for one meaningful-user incentive payment for Medicare 

and Medicaid. How about physician groups, let us say a family 

practice group of five individual physicians, they are affiliated in 

some way, how would you deal with them? Would that group only 

be eligible for one payment, $44,000 or $77,000, whatever it is, or 

multiple payments for each individual doctor? 

Mr. TRENKLE. I just want to add one thing to the previous question on the meaningful use stage 2. We have, in addition to what 

David mentioned, we have also signaled in the preamble for this 

particular rule that we were going to move the menu items to the 


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core objectives for stage 2 and also signaled our intent to add administrative transactions in stage 2 as well as increasing the percentage measurement for computerized physician order entries. So 

we have given some signals. 

But to answer your second question, we have—for this particular 

rule, we have payments are made to individual eligible professionals so they are not made by group, they are made by professionals, and we made that decision very much after listening to 

some of the comments, reading some of the comments that came 

in and listening to some of the concerns that people had on both 

sides where they felt the way the legislation was written and the 

ability to track the dollars spent in the performance to meet the 

criteria, we have determined that we would go with the individual 

eligible professionals. So if there are five members of a group practice, each one of them would have to show meaningful use to meet 

the requirements to get an incentive. 

Mr. GINGREY. But they would each be eligible if they did for the 

bonus payment? 

Mr. TRENKLE. That’s correct. 

Mr. GINGREY. Mr. Chairman, thank you. I thought that was very 

important. I am glad you let him answer. 

Mr. PALLONE. Thank you. 

Our chairman emeritus, Mr. Dingell, is recognized. 

Mr. DINGELL. Thank you, Mr. Chairman. 

Dr. Blumenthal, would you agree that lack of certified EHR technology has the potential to hinder our progress and discourage physicians from participating in the EHR incentive, yes or no? 

Dr. BLUMENTHAL. I don’t think that is going to be a problem, Mr. 

Dingell. 

Mr. DINGELL. It does have the potential, though, does it not? 

Dr. BLUMENTHAL. If certified technology were not available, yes, 

it would have that. 

Mr. DINGELL. Now, if eligible providers don’t know which technology will eventually pass the test, they will be slow to go out and 

buy it. Isn’t that correct? 

Dr. BLUMENTHAL. I don’t think that is going to happen, but yes, 

that is correct. 

Mr. DINGELL. It is a possibility. So it is critical that we have a 

strong certification program in place as soon as possible to provide 

some level of certainty for providers. Do you agree with that? 

Dr. BLUMENTHAL. I agree with that. 

Mr. DINGELL. And I don’t want you to be defensive about this. 

I just want you to understand, I have the apprehension if we don’t 

make these things flow, there is going to be trouble. 

Now, while the Medicare/Medicaid incentive programs begins 

next year, the permanent certification program is not expected to 

be fully operational until early 2012. Is that correct? 

Dr. BLUMENTHAL. That is correct. 

Mr. DINGELL. Now, what has the Administration done to remove 

the potential uncertainty surrounding certification to ensure that 

we have as much as early participation for providers as possible? 

Dr. BLUMENTHAL. Well, we have already published in mid-June 

a final rule creating a temporary certification process which will be 

in existence until the final permanent process is available. That 


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process can certify records, will certify records, will certify them by 

the fall, so that we believe there will be ample time for eligible providers to have not only installed a record but have some time to 

look them over, think about what they want to install, and then 

some time to install them, and still qualify for the full payments 

available under the incentive plan. 

Mr. TRENKLE. Congressman Dingell, can I make a comment also? 

One of the things we took into account when establishing the criteria for meaningful use is to have a 90-day reporting period in 

year one in recognition of the fact it will take some time to set up 

the certification program and also to allow the providers and hospitals additional time to sign up for the program and demonstrate 

meaningful use. 

Mr. DINGELL. Thank you. I think you are both telling me then 

that the temporary program is necessary but that it is not going 

to be sufficient over the long haul. Is that correct? 

Dr. BLUMENTHAL. The temporary program will be, we hope, a 

high-quality program but it won’t meet all the criteria that certification bodies should meet in order to meet international standards. 

Mr. DINGELL. Now, will the technology certified through the temporary program be subjected to additional certification under the 

permanent program? 

Dr. BLUMENTHAL. It will continue to be certified for stage 1 until 

additional criteria come into play. 

Mr. DINGELL. Now, Dr. Blumenthal, I note that HITECH has 

made substantial program investments including funding for support of the Beacon Community Cooperative Agreement program. 

The first round of awards were announced, and I understand that 

there were strong applications from Michigan, but I also understand that none of the Michigan applications were selected. Am I 

correct that you plan to announce two additional awards? 

Dr. BLUMENTHAL. You are correct, sir. 

Mr. DINGELL. And am I to assume that Michigan will be most 

sympathetically considered? 

Dr. BLUMENTHAL. We will give it every sympathetic consideration, sir. 

Mr. DINGELL. I will be looking forward to that. What will be the 

timeline for this announcement? 

Dr. BLUMENTHAL. Middle of August, I believe. 

Mr. DINGELL. Beg your pardon? 

Dr. BLUMENTHAL. Mid-August, I believe. 

Mr. DINGELL. Now, I would like to get your assessment of the 

current EHR marketplace. HITECH included a provision that 

would require your office to make certified EHR technology available if the marketplace fails to do so. Is that correct? 

Dr. BLUMENTHAL. That is correct. 

Mr. DINGELL. Now, what is your current assessment of the marketplace? Do you feel that there is adequate innovation currently 

going on so that I don’t need to be apprehensive about the prior 

point? 

Dr. BLUMENTHAL. I do believe so. 

Mr. DINGELL. Mr. Chairman, I note my time has expired and I 

thank you for your courtesy. 

Mr. PALLONE. The gentleman from Texas, Mr. Burgess. 


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Mr. BURGESS. I thank the chairman. 

Dr. Blumenthal, the American Medical Association in the brief 

that was submitted by Dr. Gingrey for the record makes note about 

the need for small physician practice representation on your policy 

committee. How are you addressing that? 

Dr. BLUMENTHAL. I think that is a fair point. We certainly want 

to make sure that we have heard from the full spectrum of physician practices and perspectives so we would be, I think, open to 

that suggestion. 

Mr. BURGESS. Another thing that I have encountered, I don’t 

know if it has come up—— 

Dr. BLUMENTHAL. Congressman, if I could just make one amendment to that? 

Mr. BURGESS. Yes. 

Dr. BLUMENTHAL. The membership of that committee is actually 

determined by the GAO and the Congress and then specified by 

law as to who else the Secretary can appoint. The only way we 

could appoint small physician practice representatives would be as 

a member of a working group, not as a member of the policy committee per se. That is just a matter of the way the law is written. 

Mr. BURGESS. How many of those working groups do you have? 

Dr. BLUMENTHAL. We have several, so it would be quite possible 

to include them. 

Mr. BURGESS. I would also then ask you to consider, I know I 

have heard from a number of physicians who practice orthopedics 

that they face a particular challenge in instituting this technology 

from their offices and that the packages that are available to them, 

the products that are available to them that also include digital imaging, the broadband requirements are so high, the storage requirements so high that they are sometimes looking at systems 

that cost in excess of several hundreds of thousands of dollars 

which obviously is a barrier to entry. So I would encourage you to 

hear voices from across the spectrum of the real world in practice 

because ultimately these are the individuals you are going to count 

on to make this work, and if it is not workable for them, clearly 

we will have a problem. 

What happens to professionals who fail to meet the meaningfuluse requirements? 

Dr. BLUMENTHAL. Well, in the period between 2011 and 2015, 

they fail to accumulate the incentive payments that are available. 

In 2015 and beyond, they are subject to the penalties that were 

placed in the law with respect to Medicare reimbursement. 

Mr. BURGESS. So if a practice elects to do nothing, it is not that 

they will just ultimately be left alone, they ultimately would be penalized by the provisions of HITECH and ARRA? 

Mr. TRENKLE. Yes, if they are under the Medicare program if 

they qualify. 

Mr. BURGESS. And what—— 

Mr. TRENKLE. And that was legislatively mandated. That was 

part of—— 

Mr. BURGESS. But what are the penalties that they are looking 

at? 

Dr. BLUMENTHAL. I will let Mr. Trenkle answer that. 


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Mr. TRENKLE. The penalties are as they were put into the legislation. It is 1 percent in 2015 and then it goes upward beyond that, 

but we implement them as they were put into the legislation. 

Mr. BURGESS. And just for the record, I argued strenuously 

against that type of punitive approach to this because I don’t know 

if we have allowed ourselves enough time to ramp this up. Dr. 

Blumenthal, you have worked a Herculean effort this past year to 

get where you are right now. Imagine putting that effort on top of 

a small physician practice working 16 hours a day just to take care 

of their patients and pay their bills and keep their doors open with 

all of the other stipulations we have put up them. This one does 

seem onerous. For either of you, how many providers are going to 

be penalized? Do you have some notion as to how extensive this is 

going to be? 

Dr. BLUMENTHAL. There are estimates that were made by the Office of the Actuary which I will let Mr. Trenkle summarize, but I 

will add a prior comment to say that all those estimates were 

based on experience prior to the availability of incentives and prior 

to the availability of the regional extension center program, the 

Beacon community program, our workforce training program and 

all the other efforts we are making to assist providers in becoming 

meaningful users. 

Mr. TRENKLE. As I had mentioned earlier in a similar question, 

we had scenarios both high and low in the impact analysis that 

were compiled by our actuaries using data from studies and other 

information that they had. 

Mr. BURGESS. Maybe you could get back to me with that in writing because I am going to run out of time and I would be interested 

in your response to that. 

Mr. TRENKLE. OK. 

Mr. BURGESS. But I guess one of the other follow-up questions I 

have is, obviously there are going to be people who have these systems for sale. Now, the people who have the systems for sale, the 

vendors, are they under any sort of punitive aspects under this law 

or do they just simply present their wares for sale and that is that? 

Mr. TRENKLE. No, they are not under any penalties. The only 

issue with the payment adjustments was what was in the legislation. 

Mr. BURGESS. Let me just see if I have this right. The doctors 

are under penalty, under threat of penalty if their practices are not 

compliant, but the doctors technically don’t really make any money 

off of having an electronic medical records system. It may be good 

practice and it may be important for patient safety but they don’t 

actually benefit on the bottom line from these systems and yet the 

vendors are going to significantly benefit from the forced sale to 

practices of these systems. Are you doing anything to mitigate that 

discrepancy? 

Dr. BLUMENTHAL. Well, the provisions of the law are the provisions of the law, Mr. Congressman, as you well know, so we have 

limited—what we are doing is working very hard to make sure that 

every well-intended provider who wants to be a meaningful user 

has the opportunity to become a meaningful user and that—but 

they won’t fail through any lack of effort on our part. So that is 


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I think our commitment at the Office of the National Coordinator 

and from the federal government. 

Mr. BURGESS. But with all due respect—— 

Mr. PALLONE. The gentleman’s time is a minute and a half over. 

Mr. BURGESS. I will follow up with this in writing because this 

is an important point, and we have already seen how your rulemaking has progressed since the beginning of the year, and it is 

going to affect practices all over the country. 

Mr. PALLONE. Thank you. Let me mention that you will get additional questions from us in writing, and any member is entitled to 

do that. 

The gentlewoman from the Virgin Islands, Mrs. Christensen. 

Mrs. CHRISTENSEN. Thank you, Mr. Chairman, and thank you 

both, Dr. Blumenthal and Mr. Trenkle. 

My first question is to you, Mr. Trenkle. The territories are not 

included in the EHR program under Medicare and Medicaid. It is 

just the 50 States and the District of Columbia. Is the reason because we don’t use a prospective payment program? I don’t see why 

that should make a difference but you can explain if it does. And 

Medicaid is different in the territories, and while I don’t agree with 

that either, Medicare is not. And in the territories, Medicaid can 

only be used in public hospitals and public clinics. So why are we 

excluded? 

Mr. TRENKLE. In determining eligible professionals and hospitals, 

we followed what was in the statute. 

Mrs. CHRISTENSEN. OK. So we did it? 

Mr. TRENKLE. Right, so you did it. 

Mrs. CHRISTENSEN. We will try to see what we can do about that 

because it really shouldn’t—in the territories, Medicare beneficiaries and Medicaid beneficiaries should benefit from the same 

benefits of HIT as everyone else. Don’t you agree? 

Mr. TRENKLE. Yes, I agree. As I said, we followed what was in 

the statute, so—— 

Mrs. CHRISTENSEN. Thank you. 

Dr. Blumenthal, on the Beacon Community Cooperative Agreement program, and we heard that the first round has been awarded, certain communities are provided with funding to build and 

strengthen the HIT infrastructure and HIT capabilities. Could you 

describe briefly the criteria for other communities that are chosen? 

I am trying to get at—and if you know this, if you would help me 

to understand, what proportion of racial and ethnic minorities and 

low-income communities were served in the first round? 

Dr. BLUMENTHAL. Well, I would like to get back to you with specific numbers. I can tell you that my memory is that the communities’ populations are representative of the underserved populations in the country as a whole. The beacon community program 

was awarded, vendors were chosen through an objective review 

competitive process. As a matter of fact, it took place in the recordbreaking snowstorm in February, and we funded those programs in 

the order in which they were picked by the external reviewers, just 

as an NIH grant would be awarded. The criteria took into account 

of course the quality of the application. It did take into account diversity. Seven of the 15 are rural communities. And it took into account the commitment of the communities, the quality of the health 


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IT infrastructure, the governance arrangements and the believability, the credibility of their goals which were very precisely laid 

out in the applications. 

Mrs. CHRISTENSEN. Did you identify or have to respond to any 

unique challenges in the implementation process or through the 

comment process from poor, rural or communities of color? 

Dr. BLUMENTHAL. We certain tried to. There is a beacon community in the Mississippi delta. There is one in the Piedmont area of 

North Carolina. There is one in Tulsa, Oklahoma. So they really 

go from Hawaii to upper New York and I think are quite representative of the country as a whole. 

Mrs. CHRISTENSEN. And I guess to both of you, and you may 

have answered this already but I didn’t see it in reading your testimony specifically. How have the providers been incorporated into 

the setting of the standards, not just in the comment period but as 

you were developing the standards? Were doctors, hospitals, other 

providers included? 

Dr. BLUMENTHAL. We have two advisory committees that you all 

provided us under the statute, the policy committee and standards 

committee. They meet in public. Their work groups meet in public. 

We have had over 180 public meetings of those groups. We have 

had testimony from a wide range of advisors. 

Mrs. CHRISTENSEN. One other question. I am sorry. I am hearing 

your answer. But there is room, because many older doctors are 

used to dictating. Is there room in EHR for including the dictation 

transcription process in the implementation since that might provide an easier transition? I needed to get that question and I have 

to leave, so I am sorry for cutting you off but I hear where you 

were going with your answer. 

Dr. BLUMENTHAL. Well, progress notes are not part of the requirement for meaningful use in stage 1, so yes, there would be an 

opportunity to dictate into the record in stage 1. 

Mrs. CHRISTENSEN. Thank you, Mr. Chairman. 

Mr. PALLONE. Thank you. 

Next is the gentleman from Ohio, Mr. Space. 

Mr. SPACE. Thank you, Mr. Chairman. 

Mr. Trenkle, like many of my colleagues, the hospitals, as I mentioned in my opening, in my Congressional district are going to be 

impacted, at least some of them, by your decision on multiple-campus hospitals, and in fact, Genesis, which is one of the largest hospitals in my district in Zanesville, Ohio, the largest city in my district, stands to lose about $2 million in incentive payments based 

on your rule and, as you might understand, they are little frustrated by that rule. Won’t decisions like this ultimately make it 

more difficult for hospitals like Genesis Hospital to adopt the very 

technology that this law is designed to promote? 

Mr. TRENKLE. As I mentioned in my written and in my oral testimony that we base this on existing policy and the provider number 

is based on how the hospitals choose to organize themselves for 

payments under other Medicare programs, so what we did here 

without clear statute intent was to be consistent with the payment 

policies that we have adopted for other programs, many of which, 

as I said, were due to hospitals themselves wanting to be organized 

in this manner to be paid in a certain way. 


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Mr. SPACE. So absent clear statutory intent, at this point you 

don’t envision reconsideration of that rule? 

Mr. TRENKLE. That is correct, although we are happy to be working with committee staff and others to look at potential ways to 

work with us. We recognize that there has been a lot of public comment as well as comment from yourself, your staff and other staffs 

here that express concerns about them. We have heard, of course, 

from many hospital groups as well. 

Mr. SPACE. I appreciate your working with us on it because it is 

a real problem for us and for our health care providers which already are at so many disadvantages, given the rural nature of our 

district, and the class of patients, the Medicare, Medicaid, self-pay 

percentages are so high. In fact, we have got one hospital now that 

is desperately attempting to avoid bankruptcy and if these hospitals can’t survive, it will have a direct and profound impact on 

the folks that live in places like Ohio’s 18th district, and broadband 

and health IT represents an opportunity to bridge many of the divides that exist between rural America and urban and suburban 

area. So I am grateful that you have expressed a willingness to 

work with us. 

Dr. Blumenthal, I understand last week you testified before 

Ways and Means and you mentioned that Secretary Sebelius had 

convened a working group on rural providers. Can you talk a little 

more about how this working group will help hospitals like the 

ones that I represent meet the health IT standards? 

Dr. BLUMENTHAL. Secretary Sebelius, as you know well, Congressman, was the governor of a rural State so she has been very 

interested in the issues that pertain to HIT access in rural areas. 

She is convening the secretaries of commerce, Agriculture, the Veterans Administration and the chairman of the Federal Communication Commission actually next week for a first meeting to discuss 

ways in which we can work together using the resources of these 

different departments to bring to rural communities the resources 

they need to be meaningful users of health information technology. 

I don’t want to presume what is going to come of that meeting, it 

hasn’t been held yet, but there are broadband resources available 

at Commerce and USDA. There are tele-health resources. The VA 

does a lot of outreach in its communities. The FCC spends $400 

million a year on broadband and communications so we are trying 

to make sure that between the Department of Health and Human 

Services and these other agencies that we are dedicating all the resources we can to making up for the differences, the special burdens that rural communities have. 

Mr. SPACE. Thank you, Dr. Blumenthal and Mr. Trenkle. 

I yield back my time, my one second. 

Mr. PALLONE. I thank the gentleman and recognize the gentleman from Connecticut, Mr. Murphy. 

Mr. MURPHY OF CONNECTICUT. Thank you very much, Mr. Chairman. Thank you both for your all your work and for being here 

today. 

I wanted to build on a question that Chairman Waxman raised, 

and let me first pose it to you, Dr. Blumenthal. I think one of the 

most exciting pieces of the health care reform bill is the path forward we have set on the change in delivery system and the change 


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in which we pay for medicine to really move from a system in 

which we today value volume to a day in which we can place the 

appropriate value on outcomes and quality. I am obviously very 

happy to hear your emphasis on the connection between health 

care IT and the day in which that can happen. I think your response to him was in regard to accountable care organizations, 

which I think will be transformative. 

I wanted to ask you about some other potential payment changes 

and new models of delivery. One of the pilot programs that I and 

others worked very hard on was looking at new ways to bundle 

payments in particular with respect to post-acute care, and in that 

setting, you are dealing with complex patients that are coming in 

and out of hospital and physician settings, often having some of 

their most expensive care in, for instance, skilled nursing facilities. 

I know we can’t cover everybody with the payments in this law but 

I wanted to get your thoughts on how we continue to broaden out 

the number of providers that are eligible for these payments, or in 

the absence of doing that, how we find a way to get comprehensive 

health care information technology to places like skilled nursing 

centers so that we can really implement these payment delivery 

system changes that we know have the potential to do some great 

things. 

Dr. BLUMENTHAL. Well, in my role as a provider, as a practitioner, a primary-care practitioner, I am extremely sympathetic to 

the need to bring long-term care, home care, rehab in coordination 

and get the information from those sites into the acute care part 

of the system. As you pointed out, the law as currently structured 

does not make incentives available to those provider settings, and 

that is a limitation. It doesn’t prevent, though, those institutions 

from finding electronic heard record technology themselves, especially if bundled payment arrangements were to make available 

some savings that they could get access to and if having that technology enabled those savings as I am certain it would. 

So I don’t think we should forget that the rest of the health care 

world continues to march along and that this technology is really 

inevitable. It is the way to collect and use information and it will 

take over other sectors as well. 

Mr. MURPHY OF CONNECTICUT. I don’t know exactly what the 

number is but the statistic always given about the very small number of patients who comprise a very large number of costs, these 

are patients that are obviously in and out of hospital settings and 

so whether it is through bundled payments or another way, I do 

think we have to find a way to get some help, especially skilled 

nursing. 

Maybe I will ask the question, a little different version to you, 

Mr. Trenkle. As HHS is looking at and CMS is looking at how to 

implement these new payment methodologies or these new pilot 

programs for delivery system change, are you looking at implementing them on a time schedule that is consistent with the rollout 

of health care information technology and specifically on this 

change, post-acute-care bundle payments, are you worried that 

there will be a lag in development of good IT systems in skilled 

nursing facilities that might present a barrier to that particular 

pilot program? 


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Mr. TRENKLE. I don’t have all the implementation dates here but 

I will tell you, we are working closely with other parts of the agency to ensure that we are coordinating with the rollout of the health 

care reform implementation and the HITECH provisions. 

Mr. MURPHY OF CONNECTICUT. One last question, back to you, 

Dr. Blumenthal. Talking about certification, the temporary system 

that we have set up today, obviously one of the things you hear a 

lot about is providers and hospitals who have been early adopters 

and who fear that they are going to be forced to make some expensive and onerous changes going forward. Do we expect that the certification process will be only for new technology or do you think 

we will have existing technology that might be out there today, it 

might have been out there for a period of time certified as well? 

Dr. BLUMENTHAL. The requirements for certification are new because the meaningful-use requirements are new, and we know that 

frequently technology that is in place, though it may be beneficial, 

doesn’t meet the standards or the certification requirements that 

meaningful use has created. So we can’t assume that technology in 

place right now is capable of supporting meaningful and therefore 

we can’t assume that it is certified. So yes, if you have technology 

right now that hasn’t been certified under the new certification 

process, you will have to get it certified. It may be quite easy to 

do that. It may be that you have technology that is very capable. 

But we can’t assume that, and we don’t want to create the impression for providers that something they are using now will be capable of meaningful when it is not. 

Mr. MURPHY OF CONNECTICUT. Nothing preventing an existing 

system from being stamped as certified as long as it meets that requirement? 

Dr. BLUMENTHAL. Absolutely not. 

Mr. MURPHY OF CONNECTICUT. Thank you. Again, thank you for 

all your work. This is incredibly important. I appreciate your being 

here. 

Mr. PALLONE. Thank you, Mr. Murphy. I am going to recognize 

myself since I wasn’t here earlier. 

I assume, and I missed the beginning, that there was some discussion about meaningful but it is the most or one of the most controversial aspects of this round of rulemaking, and demonstrating 

meaningful use is the key to attaining eligibility for incentives for 

Medicare and Medicaid so there is a lot of interest from provider 

communities about how those rules are structured. So I wanted to 

ask each of you, first, Mr. Trenkle, you have been criticized for setting the bar too high for providers to demonstrate meaningful use. 

Others have said the agency isn’t demanding enough from providers. I actually haven’t heard that one. Please, if you would explain to the committee how you define the balance between high 

standards and reasonable expectations and how the final rule reflects that balance.¥¥¥ 

Mr. TRENKLE. Yes, I would be happy to do that. I think it is important to point out that the final regulation reflects a 17-month 

process. The Recovery Act was passed in February of 2009. The 

final rule came out in July of 2010. And during that time we convened several committees that as Dr. Blumenthal mentioned received input from a number of stakeholders. We had a public comVerDate Mar 15 2010 21:13 Mar 28, 2013 Jkt 078126 PO 00000 Frm 00084 Fmt 6633 Sfmt 6633 E:\HR\OC\A126.XXX A126

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ment period of 60 days. We came out with a notice of proposed 

rulemaking. We heard back from the community that a lot of the 

objectives were too high so we adjusted in response to the comments. So I think a combination of all these efforts have led us to 

what we believe is a balance between a strategic framework for 

promoting future adoption and meaningful use and recognizing the 

realities of the infrastructure and the adoption rates today. 

Mr. PALLONE. I mean, I guess the concern that I hear is that a 

lot of providers simply won’t meet the bar and then our efforts are 

in vain, but at this point you don’t feel that is the case? 

Mr. TRENKLE. Well, I think we heard loudly from the community 

that the bar was too high so we have added flexibility in terms of 

the objectives. They have a core and they have a menu set. We lowered some of the thresholds. We eliminated the administrative 

transactions and we did a number of other changes to the meaningful-use requirements that reflected a need to lower but also maintain a framework that will propel us towards future stages. 

Mr. PALLONE. All right. Let me ask I guess essentially the same 

question of Dr. Blumenthal. from your experience, do you believe 

that providers will be able to meet the meaningful-use criteria laid 

out in the final rule? 

Dr. BLUMENTHAL. I believe they will. I believe there are tens and 

even hundreds of thousands of physicians who are already effectively using electronic health records and are close to meeting 

meaningful-use criteria. By the way, that is true of many small 

hospitals as well, critical-access hospitals. I have met with them 

and seen them with my own eyes. So I think it is quite possible 

to do this, and the question will be whether the physicians and 

hospitals feel that it is possible and will devote themselves and 

make the effort. We have to make sure that the taxpayer was rewarded with getting real value from these records for the tens of 

billions that were in the legislation, but at the same time we have 

to make sure that it was achievable, and that is a balance that we 

have been trying to find constantly over this 17-month period. We 

will closely at what the experience is, try to learn from that experience and see whether we have set the bar at the right level. So we 

have done our due diligence. We have made our best analyses and 

we are moving forward from there. 

Mr. PALLONE. I heard some of the members say that they were 

concerned about the penalty if someone doesn’t move forward at a 

certain point with the HIT, but there is also an exemption. Do you 

want to address that, Mr. Trenkle, in case we run into a situation 

where they are facing the penalty but—— 

Mr. TRENKLE. Yes, I should have mentioned that earlier, that 

there is a legislative exemption in case of hardship on a case-bycase basis, and we will need to define the criteria for that hardship 

in future rulemaking. 

Mr. PALLONE. But that is not something you are doing in this 

first round, in other words? 

Mr. TRENKLE. No, because the adjustments aren’t scheduled to 

come in until 2015 so we will be addressing that in future rulemaking. 

Mr. PALLONE. All right. I know I have got a couple minutes here. 

I just wanted to ask, you know, I always get the questions, Dr. 


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Blumenthal, about the small practices. The majority of physician 

practices continue to be small practices of one or a few physicians 

and of course, you know, given the economics today, a lot of them 

are struggling, and it is an investment obviously to move towards 

health IT and they say it is going to decrease productivity when 

it is initially implemented, a lot of things of that nature. What 

would you say about that? I mean, the HITECH Act provides $2 

billion to your office but there is also the regional extension centers 

and beacon community programs. Is this going to be some way to 

help these single practitioners, or how do you envision that? 

Dr. BLUMENTHAL. Well, the small practice if the target of the Regional Extension Center program. That is where we are focusing 

our effort because we realize that those are the practitioners who 

are going to have the hardest time and are going to be the least 

attractive and have the fewest resources to attract a commercial 

vendor, a commercial consulting company or a so-called integrator 

to help them. So we are intending to enroll 100,000 small practices 

through the Regional Extension Center program in programs to assist them becoming meaningful users, and I think that is going to 

be a big opportunity for small practices, and over time I think we 

will learn how to do that better and better and we will continue 

to provide that. That is over the first couple of years. Later on I 

think we will be able to do more as time goes on. So they are very 

much aware of this group and the practice is changing and younger 

physicians are much more adept at adopting these technologies 

than physicians my age, and so I think over time this problem is 

going to largely take care of itself. 

Mr. PALLONE. All right. Thank you. 

The gentleman from Texas, have you been recognized? I wasn’t 

here earlier. The gentleman is recognized. 

Mr. GONZALEZ. Thank you very much, Mr. Chairman. I apologize. 

I have been absent for much of the hearing, but I do thank the witnesses. 

I have a couple of questions. One is going to be more parochial. 

I will start with the more general one, and that is going to be— 

and first of all, the sources of the questions come from the medical 

community, hospitals and such in my area because my staff is very 

sensitive to getting their input, and they say why don’t you ask 

these particular questions, and they are much better questions 

than I would come up with on my own, so I want to make sure that 

I get some of the, I guess the verbiage here, the quality improvement organizations and the proposed rules, and back home they 

are saying because of preexisting relationships with these quality 

improvement organizations with the regional extension centers, 

what do you see prospectively as those particular right now it may 

be prime or subcontractors with individuals in San Antonio—I am 

from San Antonio—as we go forward? Will you have some of these 

same individuals, organizations playing a role? It seems like it 

would be a good idea just because of preexisting relationships and 

of course the expertise that they would bring to the table. 

Dr. BLUMENTHAL. Our regional extension centers, which is what 

you are referring to, I think, here were chosen on a competitive 

basis. We had many more applications through the regional extension centers than we were able to fund. I think about a third, if 


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I am not mistaken, of our regional extension centers are quality 

improvement organizations so that that coincidence, that overlap 

already exists. Where are there are not quality improvement organizations, we are instructing the regional extension centers to work 

with quality improvement organizations and with all the other pertinent organizations in their community. 

Mr. GONZALEZ. The other question, and I don’t know how unique 

it is to San Antonio but obviously we have a very large military 

presence. At the present time we have two major military hospitals. One actually just closed recently, Wilford Hall, but BAMC 

is being plussed up, Wilford Hall will have a state-of-the-art ambulatory center, and we have a major VA hospital. The issue that 

comes up is of course can they still—will they be able to communicate, the interoperability issue that comes up, the different guidelines and requirements that maybe a military hospital or a VA may 

be subjected to as opposed to the other hospitals in San Antonio 

because there is quite a bit of overlap, believe it or not, as far as 

patient care. Your thoughts on that? 

Dr. BLUMENTHAL. We work very closely with the VA and DOD 

to help them achieve seamless interoperability between their local 

facilities. As a matter of fact, we prioritize some beacon communities where there were VA and DOD facilities that were trying to 

communicate because we wanted to support that activity. So one of 

the ways we are doing that is by developing software and standards that will work specifically to facilitate their interoperability so 

very much on our radar screen, Congressman, and we hope we can 

continue to help them and make this a reality because I know it 

is also of great concern to the President that our current servicemen and our veterans get integrated care that benefits from all the 

information that is available about them. 

Mr. GONZALEZ. Well, thank you very much, and I yield back, Mr. 

Chairman. 

Mr. PALLONE. Thank you. I want to thank both of you for your 

testimony and answering our questions. As I mentioned before, obviously some members have said they are going to follow up with 

written questions as well, but this is an issue that is hugely important to our hospitals and our providers, so thanks a lot really 

for—— 

Mr. SHIMKUS. Mr. Chairman, will you yield? 

Mr. PALLONE. Sure. 

Mr. SHIMKUS. And I would hope that our first panel would follow 

the hearing record. On the second panel, we have seven folks on 

there. They are from small hospitals. They are from family practitioners. A lot of these questions that we have addressed come from 

them. I know you probably won’t stay, but I would encourage you 

to get the hearing record and see some of the issues that have been 

raised in the second panel. 

Dr. BLUMENTHAL. Absolutely. 

Mr. PALLONE. I agree with Mr. Shimkus. Thank you very much. 

Dr. BLUMENTHAL. Thank you. 

Mr. TRENKLE. Thank you. 

Mr. PALLONE. And I will ask the second panel to come forward. 

Now, we are expecting votes on the floor fairly quickly so I doubt 

we will get through all seven people that are on the panel but we 


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are going to try to start and get as far as we can because there are 

seven of you, I believe. 

Well, first of all, let me welcome everyone. I know we have a 

large panel here. I am going to introduce each of you. Beginning 

on my left is Frank Vozos, Dr. Vozos, who is Executive Director of 

Monmouth Medical Center speaking on behalf of the New Jersey 

Hospital Association. Thank you for being here, Frank. Monmouth 

Medical Center is in my hometown of Long Branch, and I was actually born there. Next is Mr. Gregory Starnes, who is CEO of Fayette County Hospital. That is Fayette County, Georgia? 

Mr. STARNES. Illinois. 

Mr. PALLONE. Fayette County, Illinois. OK. Sorry. And then we 

have Ms. Christine Bechtel, who is Vice President of the National 

Partnership for Women and Families; Dr. Roland Goertz, who is 

President-elect of the American Academy of Family Physicians and 

CEO and Executive Director of the Heart of Texas Community 

Health Center; Dr. Matthew Winkleman, who is a physician with 

the Primary Care Group in Harrisburg, Illinois; Dr. Glen E. 

Tullman, who is Chief Executive Office of Allscripts; and Dr. Peggy 

C. Evans, who is Director of the Washington and Idaho Regional 

Extension Center with Qualis Health. 

We ask each of you to limit your testimony to 5 minutes. You can 

certainly add additional testimony if you like and then you will get 

more written questions from us later, and I will start with Dr. 

Vozos. 

STATEMENTS OF FRANK J. VOZOS, M.D., FACS, EXECUTIVE DIRECTOR, MONMOUTH MEDICAL CENTER, ON BEHALF OF 

NEW JERSEY HOSPITAL ASSOCIATION; GREGORY D. 

STARNES, CEO, FAYETTE COUNTY HOSPITAL; CHRISTINE 

BECHTEL, VICE PRESIDENT, NATIONAL PARTNERSHIP FOR 

WOMEN AND FAMILIES; ROLAND A. GOERTZ, M.D., M.B.A., 

PRESIDENT-ELECT, AMERICAN ACADEMY OF FAMILY PHYSICIANS, CEO AND EXECUTIVE DIRECTOR, HEART OF TEXAS 

COMMUNITY HEALTH CENTER; MATTHEW WINKLEMAN, M.D., 

PHYSICIAN, PRIMARY CARE GROUP, HARRISBURG, ILLINOIS; 

GLEN E. TULLMAN, CHIEF EXECUTIVE OFFICER, 

ALLSCRIPTS; AND PEGGY C. EVANS, PH.D., CPHIT, DIRECTOR, WASHINGTON AND IDAHO REGIONAL EXTENSION CENTER, QUALIS HEALTH 

STATEMENT OF FRANK J. VOZOS 

Dr. VOZOS. Good afternoon, Mr. Chairman, Ranking Member 

Shimkus and distinguished members of the committee. Thank you 

for inviting me to testify today. I am Dr. Frank Vozos, Executive 

Director of Monmouth Medical Center located in Long Branch, New 

Jersey. Monmouth Medical Center is a member of the San Barnabas Health Care System, the largest not-for-profit integrated 

health care delivery system in New Jersey and one of the largest 

in the Nation. I am also here on behalf of New Jersey Hospital Association. 

I am pleased to appear before you today to highlight how the 

HITECH Act will support the transformation of Monmouth Medical 

Center by helping us successfully fulfill our goals related to the acVerDate Mar 15 2010 21:13 Mar 28, 2013 Jkt 078126 PO 00000 Frm 00088 Fmt 6633 Sfmt 6633 E:\HR\OC\A126.XXX A126

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quisition and implementation of health information technology and 

to applaud the federal government for establishing a program that 

will provide incentive payments through Medicaid and Medicare to 

doctors and hospitals who demonstrate meaningful use of the certified EHR system. 

By way of background, Monmouth is a 527-bed community teaching hospital that provides a full spectrum of services from 

neonatology to geriatrics with more than 800 medical and dental 

staff members. The medical center admits more than 22,000 adult 

and pediatric patients and cares for over 120,000 outpatients annually. We are one of the largest and oldest teaching hospitals in New 

Jersey and we are the largest academic affiliate of Drexel University College of Medicine and that is a relationship that we have 

had for over 4 years. We are further distinguished among the landscape of health care providers in New Jersey by our relationship 

with the Long Branch federally qualified health center, which 

opened in April 2004 and grew directly out of Monmouth Medical 

Center’s longtime motto of providing primary care to the community through charity care clinics. 

It is important to note that Monmouth is the leading health care 

provider in the city of Long Branch, a multi-ethnic enclave of residents who are disproportionately poor, young, uninsured and members of minority groups. More than 35 percent of the city’s population lives at or below 200 percent of the federal poverty level. 

There are four census tracks with the city that have been federally 

designated as low-income, medically underserved populations, and 

although there are 40 primary care health care providers located 

in the area, most do not accept Medicaid or offer charity care. So 

as a result, the medically indigent population of Long Branch and 

its surrounding communities use the low-income clinics or our 

emergency room at Monmouth as their only source of health care. 

While Monmouth was moving fairly well down a path of HIT 

adoption before the passage of the HITECH Act, the new law certainly strengthens our ability to effectively transition to more comprehensive adoption. I think we have pursued this goal enthusiastically, embarking on a facility-wide effort to upgrade our health information technology capabilities on multiple fronts. 

As an example, in our emergency department we have invested 

significant resources to install many sophisticated information 

technology components including directing the interface between 

the emergency room clinical information system and hospital 

charts using the EDIMS computer framework. All records and tests 

are available of the care of the patient and it links to our medical 

center health information record. Repeating testing unnecessarily 

has declined and patient safety combined with more timely care 

has been the core outcome of this initiative. 

Monmouth Medical Center’s clinical information system suite of 

products, which is current the Cerner Millennium, is currently 

CCHIT certified. These products adhere to requirements dealing 

with functionality, security and interoperability. On a regional 

level, we are one of the leaders in developing protocols and an infrastructure to share clinical data with four medical centers 

through Monmouth and Ocean County, and that is regardless of 

our competitive marketplace. 


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One aspect of the new system we are very focused on is computerized physician order entry. We are dedicating significant time 

and effort to changing behavior of physicians to enter orders into 

the computer instead of handwriting them. In a teaching hospital, 

it becomes important to leverage that technology infrastructure 

such as CPOE as a teaching modality as well as a recordkeeping 

modality as the large resident staff interacts most frequently with 

the patients and completes written orders. 

Moving outward from our emergency department, the extent of 

EMR use is varied throughout the rest of the hospital. In the emergency department, EMR includes medication orders, lab results, radiology readings, history and physicals, nurse and physician notes 

as well as discharge instructions. On the floors, the EMR has lab 

results, radiology readings and other test results and other parts 

of the record are still handwritten, although with easy access. So 

it is part of our global IT initiative that all areas of the medical 

center will be EMR active by 2011. 

Further meaningful-use requirements with a compliance goal of 

2011 at Monmouth include provisions for a physician to take advantage of EHR in their own private practice. Private physician offices and their style of practice are being taken into account as vendors are linked with these clinical partners to create the EMR 

interface with Monmouth. By 2011, there will be active physician 

connectivity with the hospital. Part of this deliberate strategy includes the costs associated with linking physicians and the medical 

center through EMR. What can be subsidized and what is funded 

by the medical center or physicians are important factors as we 

work through this connectivity goal. The ability to eliminate potential errors and medical errors including handwriting and timeliness 

of order gives clear quality markers for both private physician practice and care provided at Monmouth Medical Center. 

In addition, we were recently selected and are currently actively 

engaged as one of only two hospitals in New Jersey to begin a 

CMS-funded 21-month pilot project to test and model transitioning 

Medicaid patients who present to the emergency department with 

non-emergent care needs to the appropriate primary care setting 

through collaboration with our federally qualified health center. 

This data-driven pilot has further integrated electronic referral systems and electronic health records through infrastructure enhancements and a recommendation to the State and federal agencies administering and coordinating the pilot in New Jersey and in 19 

other States. Currently, the FQHC clinicians can electronically access the hospital record for a previous hospital history and test results for their patient. By 2011, the new CPOE functionality will 

be fully interoperable between the emergency department and the 

Long Branch federally qualified health center, allowing for truly 

comprehensive EMR for our patients as well as CPOE for our physicians and other clinicians both in the medical center and private 

offices. 

Mr. PALLONE. Frank, I am going to have to ask you to summarize the rest. 

Dr. VOZOS. OK. I am done. I just want to let you know that for 

the patients in this pilot study, we have seen a 70 percent conversion rate from people that have been using the emergency room as 


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their medical home now to the federally qualified health center as 

their primary care. 

So again, thank you for inviting me. I appreciate this opportunity 

to appear before you today and I will answer any questions. 

[The prepared statement of Dr. Vozos follows:] 


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Mr. PALLONE. Thanks so much, really. 

Now, that was the bell. I think we can get at least two more in, 

maybe three, before we go vote. 

Mr. Starnes. 

STATEMENT OF GREGORY E. STARNES 

Mr. STARNES. Chairman Pallone, Ranking Member Shimkus and 

other distinguished members of the committee, thank you for this 

opportunity. My name is Greg Starnes and I am the Chief Executive Officer of Fayette County Hospital and Long Term Care in 

Vandalia, Illinois. I have been in health care administration my entire career, and I consider it an honor to be here today to talk with 

you about the HITECH Act. 

First, please know that my colleagues and I support the HITECH 

initiatives. Fayette County Hospital and Long Term I is a criticalaccess hospital with 25 beds and 85 long-term care beds. The facility serves a county of 21,000 people and resides in the county seat 

of Vandalia with a population of 7,000. The average household income is below the State average. The percentage of elderly in the 

population is higher than the State average. The unemployment 

rate is 10.8 percent. The number of Medicaid eligible has increased 

in the last year and the numbers of individuals who find themselves with no ability to pay for health care services have also 

risen. They represent the reality in today’s rural health care environment and many parts of Illinois. 

The challenges I have faced during the last 18 months have been 

the most difficult of my career. In early 2009, my hospital began 

to feel the effects of the changing economy. July of each year has 

typically been the month during which I have been able to provide 

merit pay increases for my dedicated employees. In May of 2009, 

I informed my employees they would not be receiving any wage increases in July. The hospital finances did not improve in the ensuing months as a local employer with 140 employees relocated to another State. In early October 2009, I conducted numerous meetings 

with all employees to inform them that I was reducing the work 

hours by 5 hours per 2-week pay period, which represented a 5 percent decrease in their wages. My managers and I accepted a 10 

percent reduction in our salaries. I reduced vacation accruals and 

temporarily halted the employees’ 401(k) match and I eliminated 

several positions. We saved a great deal of month in the fourth 

quarter of 2009 yet we finished the year in the red with a net income of a negative $74,000. On January 1, I increased the managers’ salaries 5 percent. Since that time there have been no hour 

or wage increases for anyone. The number of full-time-equivalent 

employees in September of 2009 was 225. The total now is 195. I 

represent only one example of many hospitals that have faced those 

same challenges, hospitals that are within the top three employers 

in the communities we serve. 

We are not just about health care in our communities, we are 

also about jobs. We are about jobs for nurses, nurse aids, physicians, lab and X-ray technicians, housekeepers, cooks, maintenance 

workers, therapists and so on, and of course, information technologists. In some of these jobs categories, there are shortages of 

qualified personnel. In all of these categories, these workers need 


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the proper tools to do their jobs to the best of their abilities. CT 

scanners, MRI units, operating room equipment, ambulances, et 

cetera are hugely expensive. Software, hardware and training are 

extremely cost. To achieve the expectations of our patients along 

with those of the governing authorities requires a great deal of 

money. Awareness of this among our Congressmen and Congresswomen is vital as we endeavor to improve health care in America. 

There are 51 critical-access hospitals and another 15 rural hospitals in Illinois out of 200 plus total hospitals. All are taking steps 

toward meaningful-use criteria. At least 10 of the critical-access 

hospitals have less than 20 days cash on hand because of the impact of increased Medicaid and self-pay patients. A reasonable estimate would suggest that roughly half of the hospital have inpatient 

health information systems and two-thirds of them have lab and 

radiology systems. However, only 20 percent have physicians using 

computerized physician order entry. The new meaningful-use rule 

with allow other practitioners to enter orders into the system and 

that will help but it will also place additional burdens on the hospital staff. 

Thank you for your support of the changes in the final meaningful-use objectives. Some of them indeed lessen the burdens for critical-access hospitals to achieve those objectives. The loosening of 

the CPOE requirements as well as inclusion of critical-access hospitals for Medicaid incentives represent a very positive change from 

the original proposed guidelines. That said, the challenges our hospitals still face should not be underestimated. The capital necessary to procedure the software and hardware is still less accessible in today’s economy than it was 12 to 18 months ago. In my 

case, the estimated cost for software and hardware necessary to 

achieve meaningful use will likely be close to $750,000. There will 

also be substantial costs associated with establishing interfaces to 

enable hospitals and providers systems to connect. An additional 

$50,000 to $100,000 will be necessary for training and process 

changes. So these numbers are large for my hospital and for many 

others. 

At this time my hospital needs a new CT scanner for a minimum 

of $350,000 because the one we currently have is 8 years old and 

increasingly unreliable. We also need to buy a digital mammography unit for approximately $350,000 so that women in the community can take advantage of up-to-date technology and so that 

unit can work with an electronic health records system. There are 

numerous other needs that are very expensive, and we all face 

challenges like that already, and I know that we face the acquisition implementation of EHR as well. I believe there may be rural 

hospitals that will not meet the imposed timeline under HITECH. 

Additionally, qualified health IT professionals are in high demand and the supply is currently a problem. So increased need for 

them in order for hospitals to achieve the IT requirements for EHR 

systems may present real-time and cost concerns. It is indeed fortunate that there are efforts underway to boost the health IT workforce through funding for community colleges. However, the boost 

might not materialize in time for hospitals to realize the currently 

structured incentives for meaningful use. Failure on the part of 


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some hospitals to arrive at meaningful-use capabilities could jeopardize patient safety. 

It is my understanding that assistance to overcome these challenges will be available through the RECs, and I applaud that effort. However, I am concerned as we have seen through other federal offices and programs there will not be a sufficient focus on the 

challenges—— 

Mr. PALLONE. Mr. Starnes, I am going to have to ask you to summarize the rest, too. 

Mr. STARNES. All right. Thank you. 

My colleagues and I truly want to offer patients the benefits of 

a fully functional electronic health record system. We understand 

the advantages it can have in reducing overall costs, duplication 

and errors while also improving accountability and patient safety. 

However, I also want this committee to understand that rural providers and patients face unique challenges. A recent survey exemplifies that only about 30 percent of the critical-access hospitals nationwide would quality for stage 1 incentives. 

Thank you for this opportunity to offer my testimony. I look forward to working with you to ensure that all hospitals, providers, 

urban and rural, realize the benefits of electronic health record systems. Thank you. 

[The prepared statement of Mr. Starnes follows:] 


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Mr. PALLONE. Thank you. 

We still have another 61⁄2 minutes, so I am going to ask Ms. 

Bechtel to go and then we will break. 

STATEMENT OF CHRISTINE BECHTEL 

Ms. BECHTEL. Good afternoon, Mr. Chairman, Congressman 

Shimkus, Congressman Gonzalez. Thank you for having me here 

with you today. I am Christine Bechtel and I am the Vice President 

of the National Partnership for Women and Families. We are a 

nonprofit consumer advocacy organization here in D.C., and I was 

also appointed as a consumer representative to the Federal Health 

IT Policy Committee. 

So I am honored to be with you today to discuss the ways in 

which meaningful use of information technology will benefit patients and their families. That said, our discussion today shouldn’t 

actually be about technology. It should be about the ways in which 

changes in health care payment and delivery can create the kind 

of truly patient-centered system that we all envision and that every 

consumer deserves. That means designing systems around what 

patients say they want and need to improve their own health outcomes, and what patients want is simple and straightforward. They 

want their doctors to talk to each other. They want information 

about their conditions. They want providers to know them well 

enough to make treatment recommendations that actually make 

sense for them and they want their care team to have the information and support that they need to do the best job they can. Technology plays a critical role in delivering this kind of patient-centered care. It cannot be done right, done well or done consistently 

without interconnected health IT, and the regulations issued by the 

Administration on meaningful-use lay the groundwork for doing 

just that. 

I would like to highlight some of the ways that the meaningfuluse program will result in tangible improvements for patients and 

families by sharing with you the story of Susan Crowson, who is 

a family caregiver from Maryland. Susan looks after her father, 

Pop, who has Alzheimer’s disease, heart arrhythmia, prostate problems, low blood platelets and is susceptible to other infections. He 

sees a primary care physician, a cardiologist, a urologist, a hematologist and a neurologist. Each monitors and treats a separate 

problem and yet they don’t talk to each other. So Susan had to 

build a spreadsheet to keep track of it all. She leaves copies with 

each doctor and asks that Pop’s records be sent to his primary care 

physician and his other specialists, but it is rarely done. When she 

takes her dad for lab tests, she is the one who makes sure that 

each doctor gets the results or it just doesn’t happen. Pop takes 

there prescription drugs, two over-the-counter drugs and vitamins 

as well as occasional antibiotic. These drugs are prescribed by different doctors. When his doctors prescribe a drug, they actually tell 

Susan to make sure that she checks with Pop’s other doctors about 

potential drug interactions. 

Susan’s situation is common. Millions of patients struggle to 

gather and update hundreds of pages of medical records if they can 

get them at all, toting them from doctor to doctor, knowing that no 

provider is likely to have their full medical history and test results. 


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Mr. Chairman, I am confident that we can help Susan and other 

patients and families get better care by leveraging the requirements that are now part of the meaningful-use program. The new 

regulations are strong, sensible and patient-centered. If the members of Pop’s team were meaningful users of EHR today, they 

would maintain up-to-date problem lists of his conditions and medications. They would check those lists for drug-drug interactions 

and allergies. They would provide Susan with education resources, 

summaries of care after every office visit, reminders about followup care and more, and his care team would also start to develop 

the ability to communicate with each other electronically. 

Stage 1 of meaningful use also builds the foundation for overall 

improvements in the quality, safety and efficiency of care. For example, it requires the collection of race, ethnicity, preferred language and gender data so that we can identify and target health 

disparities. It asks physician meaningful users regardless of specialty to focus on hypertension, smoking and obesity so that we can 

better address the public health challenges are driving the increase 

in chronic conditions and causing costs to skyrocket, and it advances an important set of criteria for protecting the privacy and 

security of health information. 

But our work on meaningful use is not done. Stage 2 should enable the robust, secure exchange of clinical information across all 

the providers in settings involved in the patient’s care in compliance with federal and State privacy laws. Patients and families 

should have timely, ongoing access to their health information in 

a way that is portable so that they can assemble it in a secure 

place and quality measures should assess outcomes, functional status and patient and caregiver experiences. 

Put simply, future criteria should be driven by the goal of highpatient patient-centered care. It is what Susan deserves and what 

all patients deserve. After all, health care transformation is not 

about money and it is not about technology, it is about people and 

it is about leadership, and we thank you for yours. 

[The prepared statement of Ms. Bechtel follows:] 


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Mr. PALLONE. Thank you. 

We have three votes which normally takes about half an hour, 

so we are going to recess and then we will come back and hear 

from the rest of you and then take questions, so the subcommittee 

now stands in recess. 

[Recess.] 

Mr. PALLONE. The Subcommittee on Health will reconvene, and 

we left off with Ms. Bechtel, so Dr. Goertz, you are next. 

STATEMENT OF ROLAND A. GOERTZ 

Dr. GOERTZ. Thank you, Chairman Pallone and Ranking Member 

Shimkus and other members. As you said, I am Dr. Roland Goertz, 

President-elect of the American Academy of Family Physicians and 

I really am excited about the opportunity to give you our testimony. As a user of EHR for nearly 14 years, the CEO of a federally 

qualified health center that has won the HIMS award for EHR use, 

and a representative of 94,700 members of the AAFP, many in 

small- and medium-sized practices, I believe my perspective and 

the AAFP’s will be useful, particularly as to how to implement HIT 

in small practices, how to serve diverse populations with its use 

and how the HITECH subsidies will help them. 

Nearly one in four of all office visits is made to family physicians. 

We provide more care to America’s underserved and rural populations than any other medical specialty. Our commitment to improving patient care and clinical outcomes has long made us supporters of HIT. We believe that the recent meaningful-use regulations will support what the AAFP already has been doing for many 

years. Our focus has been to ensure that the meaningful-use rules 

are achievable by physicians in small- and medium-sized practices 

and also improve patient care. Our members want to accomplish 

what Congress intends. Fifty-nine percent of our members currently have electronic health records but their use of it varies 

greatly. We need to help the rest purchase IT, encourage those who 

have it to become more comprehensive users of it and have all 

begin to use it more effectively. We ask that your committee ensure 

that the first rounds of reporting and incentives from CMS be both 

consistent and reliable. 

Let me talk briefly about my FQHC’s experience with HIT. The 

mission of FQHCs is to provide health care to those under 200 percent of poverty, which includes Medicaid patients and those who 

are dual eligible. Our center serves almost 50,000 people in the 

Waco-McClellan County area of Texas. That is about 18 percent of 

the total population of the county. Our center has 13 sites, two of 

which are in rural communities. I am absolutely convinced that our 

use of EHR has led to improved patient care and efficiencies. 

Fourteen years ago, a number of our physicians were uncomfortable with computers. Indeed, some even got cold, clammy, sweaty 

hands when they came close to a keyboard. We also are in a rural 

area, which is more challenging for physicians using EHRs. Today, 

not one of our providers would return to paper records. 

Let me make two general observations about adoption of HIT. 

One, physicians coming out of residency today expect to use HIT 

and do so almost automatically. The issue of adoption is a 

generational one and will resolve over time. However, we are in the 


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middle of a significant health care transition and must assist all 

physicians by supporting the regional extension programs, beacon 

communities, medical-home pilots and dissemination of best practices. 

Two, small, solo, rural practices in particular are short of time 

and dollars. They are busy focusing on patient care and operating 

on small margins. Assisting them is critical to making HIT work 

in the United States. As an example, if your office has a major 

computer problem, you have an outside support team to analyze 

and fix the problem. I think of the regional extension centers as a 

comprehensive support team for small practices. These centers will 

provide not only technical assistance but general information when 

these small practices need help. Therefore, we ask you to closely 

monitor the implementation and resources of the regional extension 

program because they are essential to success of these practices. 

We strongly support the HITECH Act incentives. These investments are staged and crucial to improve quality and cost-effectiveness of patient care. FQHCs also will need similar support. 

Let me conclude by restating three points. Number one, HIT is 

critical to improving quality and effectiveness of patient care; number two, physicians in small rural practices must receive effective 

technical support during implementation and use of HIT; and number three, the HITECH grants are crucial as physicians make these 

transformative changes to their practice. 

I thank you again, and I am personally excited about the potential for improving patient care that the tools of HIT offer us. 

[The prepared statement of Dr. Goertz follows:] 


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Ms. SCHAKOWSKY. [Presiding] Thank you, Goertz. 

Dr. Winkleman. 

STATEMENT OF MATTHEW WINKLEMAN 

Dr. WINKLEMAN. Chairman Pallone, Ranking Member Shimkus 

and Congressman Gonzalez, let me begin by thanking you for the 

opportunity to provide testimony today. My name is Matt 

Winkleman. I am a family physician practicing in Harrisburg, Illinois. Our community is in rural southern Illinois and has a population of about 10,000. I practice full time and I am one of the owners of Primary Care Group in Harrisburg where we serve patients 

not only from Harrisburg but from several surrounding communities and rural counties. Our practice is a rural health clinic that 

includes eight primary care doctors, five mid-level providers and a 

general surgeon. In total, the clinic employs around 50 people. I am 

honored to share with you today our experience with an electronic 

health record and a little bit about it impacts our practice and the 

care we provide to our patients. 

One of the obstacles many physicians cite in the decision to employ an electronic record is the initial upfront cost. Not only is the 

software, hardware and necessary infrastructure costly but the 

process of seeing patients at least in the initial weeks of 

transitioning requires changes in work flow that will likely decrease efficiency and the number of patients seen. As you are all 

aware, under our current reimbursement system, fewer patients 

means less added to the bottom line, and as a result, many physicians calculate they cannot afford the initial financial investment. 

This is especially true for physicians like myself who practice in 

rural areas where the average payer mix includes minimum commercial insurance and where profit margins may already be thin. 

Thankfully, the HITECH bill is going to help physicians address 

many of the challenges and begin reaping the benefits of electronic 

health records. The approach taken within the legislation to reward 

utilization and not just purchase was smart. The regional extension 

centers will be immensely useful to small practices without the 

know-how to feel comfortable moving to an EHR on their own and 

the funds going to develop broadband networks and other infrastructure will be crucial in eventually allowing us to exchange clinical information. 

The benefits of EHR use, as I said, are significant. At a time of 

great uncertainty within the general health care industry, at least 

one thing seems clear to me: technology will have a role in helping 

us provide the kind of high-quality, safe, efficient care our patients 

deserve. On nearly a daily basis, my EHR helps me avoid prescribing a medication to a patient because they have an allergy to 

it, allows me to print out materials for patients to help them understand their diagnosis and reminds me to order a mammogram 

on a 55-year-old patient who came in only for a sore throat. 

It is not uncommon for me to see patients struggling to manage 

six to eight medications, caring for three to four chronic diseases. 

Medicine is complex, and the reality is that even the most astute 

of clinicians can benefit from the safety checks provided by an electronic health record. Furthermore, while the individual patient 

benefits from the improved safety that stems from use of an EHR, 


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my practice has begun to see the benefits to the population as a 

whole. With the use of our EHR, we were recently able to generate 

a report of all the diabetic patients from the practice’s census who 

had not received appropriate follow-up and proactively schedule an 

office visit to get them back in, giving them a much greater chance 

of avoiding the costly complications that can result from diabetes. 

Additionally, after the recently controversy surrounding the diabetes drug Avandia, we were able to generate a list of all of our patients receiving this medication within a matter of only minutes. 

These types of things would have been nearly impossible with a 

paper system. 

It is also important to keep in mind, however, that all of these 

things I am describing would have been just as impossible if the 

information in our EHR such as lab data and medication history 

were not included as discrete structured elements in a database. 

Had they been scanned copies of paper reports, the information 

may as well have been in a paper chart. There must be standards 

in place which foster the use of technology in such a way that it 

truly benefits patients and provides the most value to the physicians when they are making care decisions. For this reason, while 

I am not generally an advocate of large-scale government involvement and government management of health care, I do think this 

is an area where focused guidance steering the medical community 

is absolutely needed. 

In summary, as a rural family physician practicing with an electronic health record, I have seen the benefit they can provide by 

helping improve safety, increase compliance with recommended 

preventative care and proactively manage chronic diseases. My 

practice is located in a county ranked by a recent Robert Wood 

Johnson Foundation study as 98th out of 101 in Illinois with regard to the health of its population and many of the neighboring 

counties were also near the bottom of that list. I am optimized that 

the meaningful-use incentives and the work of the regional extension centers can help providers in rural areas like Harrisburg to 

begin not only to take advantage of health information technology 

but recognize it as another instrumental tool in the pocket of their 

white coats. I am excited about what the future holds and look forward to the next steps in the process as we move even further forward in connecting providers to allow the exchange of health information. 

Thank you for the opportunity to provide testimony today. 

[The prepared statement of Dr. Winkleman follows:] 


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Mr. PALLONE. Thank you, Dr. Winkleman. 

Dr. Tullman. 

STATEMENT OF GLEN E. TULLMAN 

Mr. TULLMAN. Actually I am not a doctor. 

Mr. PALLONE. Mr. Tullman, CEO Tullman. 

Mr. TULLMAN. Chairman Pallone, Ranking Member Shimkus and 

other distinguished members of the committee, thank for the opportunity to testify today. My name is Glen Tullman and I serve 

as the Chief Executive Officer of Allscripts. Allscripts is the largest 

provider of electronic health records, electronic prescribing, practice 

management software and other software that helps physicians 

manage their patients. More than 160,000 physicians, which is onethird of all practicing physicians outside the four walls of the hospital, use Allscripts software along with 800 hospitals and over 

10,000 other health care providers in post-acute care facilities and 

home care agencies to manage their patients. Allscripts solutions 

automate daily activities and connect their clinical and business 

operations. 

It is now 17 months since the passage of the American Recovery 

and Reinvestment Act and it is clear that health care information 

technology as an industry is forever changed. It is my belief that 

we are at the beginning of the single fastest transformation of a 

major industry in the history of our country. Congress and the Administration in a sign of true leadership have provided an investment in technology that will lead to the delivery of better care for 

all Americans, improve patient safety and deliver significant savings due to efficiency. 

I speak to hundreds of health care professionals every month 

across the entire spectrum of care and it is clear from them that 

the meaningful-use incentives in the stimulus package are an essential component of the sea change that health care is undergoing 

and that will benefit all of us today. However, understanding how 

the stimulus and meaningful use applies to our clients and how to 

implement an electronic health record can be challenging. This is 

especially true because our clients span the entire continuum of 

care from single physician primary care practices and rural geographies to federally qualified health centers to the largest and most 

prestigious academic medical centers in the country. 

Allscripts have committed extensive resources over the past 17 

months to educating all of these groups, not just our clients, about 

meaningful-use incentives. We have hosted hundreds of free educational sessions across the country and webcasted many more, and 

in 2 weeks since the release of the final rules on July 13th, we 

have already provided educational content to thousands of webcast 

attendees. We expect our educational efforts to continue as we 

work closely with regional extension centers in the coming months 

and years. 

The HITECH incentives had a measurable stimulative effort on 

our business in three ways. First, inquiries about our electronic 

health records have been at record levels since the initial passage 

of ARRA. Second, we have increased our annual R&D expenditures 

a full 25 percent from $72 million to $90 million, which will help 

drive innovation into the industry. And third, we have hired more 


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than 560 people since the passing of ARRA with plans to hire several hundred more in the next year. These are high-paying technology-centered jobs, just the kind of jobs that the American workforce needs. 

Even more importantly, our clients are also hiring directly as 

they work to ensure success in their health care IT adoption efforts. For example, Denver-based Catholic Health Care Initiatives, 

in part spurred by the meaningful-use incentive program, has announced that they will be hiring 200 health IT professionals over 

the next year, and we have many other clients with similar plans. 

So if you had any questions, the health care incentive stimulus 

plan is working in our industry. 

Now, the final rule is out and hospitals and health care organizations among our client base are very pleased. The uncertainty 

about meaningful use has been removed and many of the changes 

that the provider community requested during the comment period 

were in fact incorporated. This process was a positive example of 

a productive public-private partnership. Many physicians particularly appreciated the flexibility related to what constitutes meaningful. 

You have created real incentive and real momentum with meaningful and with health care reform efforts. Now I would encourage 

you to take three steps to build on that success. First, push vendors 

like Allscripts and providers to achieve even higher standards related to more-robust connectivity. All systems should be able to 

connect and accept data from outside systems as if it were their 

own by using common standards as the banking industry does 

today. Second, it is time to mandate electronic prescribing. This is 

a patient safety issue and one we believe we can address. And finally, let us continue to focus on performance metrics and use payment and delivery system reforms to reward physicians who demonstrate positive outcomes for their patients. 

In summary, the final rule on meaningful use will result not only 

in a higher number of providers participating in the incentive program but more importantly higher quality and safer care for patients. We expect most providers not only to meet but to exceed the 

requirements of meaningful use, which we call meaningful value, 

by doing more than the minimum. We have key clients across the 

country who are doing just that. For example, the University of 

South Florida and Wellspan in Pennsylvania are both using electronic health records to deliver better diabetes care and better inform patients. Sharp Healthcare in San Diego is approaching 90 

percent electronic orders. Heritage Valley Health System in Pittsburgh is writing 100 percent of their prescriptions electronically 

and there are a host of others who are leading the way. We also 

see leaders like North Shore Long Island Jewish, Hartford Hospital 

and the University of Massachusetts, who are leading the way by 

connecting their communities for better care with the goal of one 

patient record. 

Your actions have served to both encourage and accelerate all of 

these activities and to spur other organizations to take similar actions. As the technology becomes part of the regular work flow and 

electronic health records provide critical information, we will see 

that meaningful use is essentially a jumping-off point, ultimately 


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resulting in the connected system of health that we are all working 

towards. 

Thank you for all of your efforts and the opportunity to testify 

today, and I would be happy along with the panel to answer your 

questions. Thank you. 

[The prepared statement of Mr. Tullman follows:] 


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Mr. PALLONE. Thank you, Mr. Tullman. 

Dr. Evans. 

STATEMENT OF PEGGY C. EVANS 

Ms. EVANS. Thank you. Good afternoon, Mr. Chairman and members of the subcommittee, thank you for inviting me here today. I 

am Peggy Evans, Director of WIREC, the Washington and Idaho 

Regional Extension Center for Health Information Technology. I 

represent Qualis Health, a private not-for-profit health care consulting firm and a Medicare quality improvement organization for 

the States of Washington and Idaho. I am honored to be here today 

to tell you about how WIREC will provide vendor-neutral EHR 

adoption services to help health care providers attain meaningful. 

Providers often start their EHR adoption believing that once the 

technology has been installed, they are at the end of their EHR implementation journey. In fact, once implementation has occurred, 

the journey has just begun. Technology is a great tool when it 

works well, but no matter how well it works, it is just a tool. Training people to utilize their technology is an essential component of 

successful EHR adoption. 

Our initial experience working with providers strongly indicates 

that there is a need for EHR technical assistance service through 

the REC program. For example, there is a community health center 

in the readiness planning stage of EHR adoption. They received a 

bid from a commercial, that is a non-REC, consultant for services 

at $225 an hour for a total bill of $45 million. The cost of a commercial consultant was prohibitively expensive for a community 

health center and they enrolled in WIREC, thus saving $45,000 for 

support of patient care and other administrative needs. 

Another story is that at our first site with another small clinic, 

we learned that the practice had not considered designating a 

project manager for their EHR implementation with only six weeks 

until their go-live date. While EHR vendors help providers with a 

bulk of their implementation and technology needs, providers often 

need to understand that there are tasks on their end that should 

be completed in order to help them help themselves, which is 

where WIREC steps in. 

WIREC’s program strategy is threefold. First, we provide on-theground health IT coaches that deliver one-on-one customized technical assistance to providers. Second, we establish and maintain 

network IT communities of practice to share learning. For example, 

we have implemented an EHR regional group purchase committee 

with an independent consultant who is facilitating the process and 

committee members supporting the work. Third, we plan to support 

peer-to-peer networking activities that will allow participating providers to learn from one another, a very powerful method of communication. Our WIREC staff delivers a suite of services to providers across the three stages of the EHR adoption continuum: selection, go live and optimization. For providers in all stages, we disseminate information about the CMS incentive payments, help providers understand the meaningful-use criteria within a framework 

for reaching that level of EHR use and provide assistance in 

workflow evaluation and redesign. 


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The importance of workflow redesign cannot be stressed enough. 

Many providers are under the assumption that they will transition 

from paper to EHRs but continue to use the same workflow processes that supported their paper-based records, but if they do that, 

they are unlikely to succeed with their EHR adoption. Health IT 

professionals and researchers have shown time and time again that 

workflow redesign is critical for successful EHR implementation 

and that it is not business as usual. 

Recognizing that providers in our region may have already 

adopted a multitude of EHR systems as a starting point toward 

meaningful use, WIREC offers vendor-neutral services and will 

work with providers regardless of their choice in EHR systems. 

Among the first several hundred providers who have enrolled with 

WIREC, they are currently 14 different EHR products already in 

use which hopefully you can see displayed on the screen. There you 

go. I won’t take the time to read them all but you can see that 

there is a wide variety of EHRs that we currently support. 

Because one of WIREC’s major objectives is to assist providers in 

meaningfully using their EHR systems, our consultants help identify the gaps between where the provider is now and where he or 

she needs to be in order to reach meaningful use. We then lay out 

a customized path for how to achieve meaningful use. We have received feedback from many providers that the meaningful-use criteria just seem like a long list of unorganized requirements. 

WIREC staff provides a framework for organizing the criteria in a 

way that is more readily digestible by providers and their staff and 

then suggest doable chunks that providers can tackle without being 

overwhelmed. To date, we have successfully enrolled practices that 

represent about 500 primary care providers as indicated on the 

map. Among our initial enrollees, there is a distribution of practice 

locations across the two-State region that includes both urban and 

rural sites. 

The REC program focuses on smaller provider offices, community 

health centers, rural health clinics and other ambulatory practices 

affiliated with the critical-access hospitals and rural hospitals and 

providers that primarily treat the underserved and uninsured. As 

you can see on the display graph, a vast majority of our enrolled 

providers are from smaller practices. Of the larger practices that 

we are serving, mostly all are community health centers or rural 

health clinics. 

The WIREC consulting team has now begun providing educational programs and direct assistance in the field to our participating practices. Initial survey results suggest that providers find 

REC services to be valuable. As you see on the display screen, 

among our practice sites thus far, 100 percent of the providers have 

reported satisfaction with WIREC services. The number of practices surveyed thus far is small but the results are encouraging. 

Additionally, our educational webinar series for providers has 

been well received with evaluation responses showing consistent 

ratings around 90 percent of respondents agreeing that each of the 

sessions has been a value as indicated again on the display. 

In conclusion, Qualis Health’s startup experiences show that providers across our region, both urban and rural, are enrolling into 

the WIREC program and initial feedback from providers shows 


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that they are finding value in working with the REC program as 

a supplement to the support that they may receive from their EHR 

technology vendor. Implementing an EHR system and moving toward meaningful use is a transformation far beyond the technical 

aspects of implemented a computer system. WIREC looks forward 

to helping providers embark on that transformation through our 

vendor-neutral support. 

Thank you again for the opportunity to share our experiences. 

[The prepared statement of Ms. Evans follows:] 


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Mr. PALLONE. Thank you, Dr. Evans. 

We are going to take questions now, and if we don’t have votes, 

we will do two rounds. I just don’t know when the votes are coming 

to come. I will start with myself for 5 minutes. 

I want to start with Dr. Vozos. One of the most important functions of health IT is to connect a patient’s doctor and hospitals together across a patient’s illness, and EHR could follow a patient 

from an outpatient clinic to the hospital, back home again, facilitating communications and care along the way, and of course, I am 

following up on my visit to Monmouth Medical Center where we 

discussed this. You describe how Monmouth is integrating its 

health records across settings including with your affiliated federally qualified health clinics. Just tell us more about how that 

project is progressing, and I of course witnessed part of it when I 

was there a few weeks ago. 

Dr. VOZOS. Our health system, as you know, was developed really back in 2004, April 2004, and the reason we put it together was 

that though we had a lot of clinics, you know, we saw that the 

long-term evolution of those clinics was going to be a continuing 

loss of money and plus we had declining of services to the community in our area there. So converting that to a federally qualified 

health center and also with the reimbursement that was available 

to a federally qualified health center, you know, really kind of 

saved it, not only saved it, actually grew it to where it is probably 

one of the premier health providers in the area. In fact, it provides 

pretty good competition to private practitioners. 

Mr. PALLONE. I used an example about one day when I visited 

and there was a guy sitting there in a business suit, which I 

thought was unusual, but may not anymore. 

Dr. VOZOS. Well, what is a little bit unique about this particular 

FQHC is that it was necessary that we incorporate our teaching 

programs into the FQHC because the clinics, as everybody knows, 

are a major source of teaching for residency programs so we did incorporate them in, so our faculty actually are doctors in the clinic 

and the residents are also there. So it is a little bit unique, maybe 

not quite as efficient as Dr. Winkleman’s FQHC or, I mean, Dr. 

Goertz’s FQHC, but it is an excellent source of care. So it has 

grown tremendously. 

Mr. PALLONE. How does the HIT fit in with—— 

Dr. VOZOS. What we did was initially we connected them. It is 

a one-way connection right now from the FQHC into our hospital, 

meaning that they can access all the record of the patients that are 

in our hospital that they see in the clinic, and as you could imagine, most of the patients in that clinic when they do need to come 

to the hospital, they use Monmouth Medical Center or the Monmouth emergency room. So the physicians of the FQHC have direct 

access through the Internet into our—— 

Mr. PALLONE. But wasn’t there also something where if you went 

to the emergency room and they thought that you could use the 

services of the community health center, that they set up an appointment or something for you, right? 

Dr. VOZOS. Well, that is our other pilot program where, you 

know, under a grant we—— 

Mr. PALLONE. This is the demonstration program? 


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Dr. VOZOS. Right. 

Mr. PALLONE. That was my second question. 

Dr. VOZOS. Yes, and that program, what the pilot was to take all 

the patients who really were using our emergency room as their 

medical home, so to speak, identified those that really needed to 

have a primary care provider and arranged for them to be followed 

up in our federally qualified center. We thought initially we could 

easily make that happen once but we were kind of curious as to 

what the true conversion was going to be where they were not 

going to use the FQHC as their private, you know, physician office. 

There has been a 70 percent conversion. It has been really a tremendous success, and what it has done is, it has decompressed the 

emergency room, improved the throughput for the emergency room 

and really unclogged our emergency room and created a whole—a 

much better atmosphere even in our emergency room. 

Mr. PALLONE. But it also made it possible for the people that 

have regular care so they didn’t—— 

Dr. VOZOS. Well, they now have—— 

Mr. PALLONE [continuing]. End up just using the emergency 

room. 

Dr. VOZOS [continuing]. A regular physician in the FQHC. 

Mr. PALLONE. Now, is there also a Medicare demonstration program that looked at whether gain sharing between hospitals and 

physicians can reduce cost? 

Dr. VOZOS. Right. 

Mr. PALLONE. And then there was an electronic health records 

component of that too? 

Dr. VOZOS. Yes, there is. We are part of a Medicare demonstration project, which is 12 hospitals in New Jersey, where we put together a set of criteria with the coordination of the New Jersey 

Hospital Association, a set of criteria to measure quality care, and 

if in the performance of these measures there was a savings of 

money, you know, the federal government has kind of relaxed itself 

a little bit and allowed us to share in those cost savings. So we 

have recently gone through the first phase of that where there was 

not only the signing up of physicians but we completed the first 6 

months of measuring data, and what we are looking at right now 

is length of stay, complications, mortality rates and readmission 

rates, and there was—we actually issued the first set of checks and 

now we are going through the second phase of additional enrollment because initially not everybody wanted to enroll. They either 

didn’t trust the project, they didn’t want to have their name in 

some file that the federal government could be steering. There is 

all kind of reasons why doctors wouldn’t sign up. But after the first 

phase of this, not we have had about three times the number of 

physicians signing up. So we are going to be well over 200,000 physicians signed up for this, and it has actually produced savings. 

Mr. PALLONE. All right. Thanks. 

Mr. Shimkus. 

Mr. SHIMKUS. Thank you, Mr. Chairman. I have been writing 

and scratching notes all over the place, so this may get really disjointed, which would be very similar to most of my questions that 

I ask. But it has been very educational. I am a very outspoken critVerDate Mar 15 2010 21:13 Mar 28, 2013 Jkt 078126 PO 00000 Frm 00151 Fmt 6633 Sfmt 6633 E:\HR\OC\A126.XXX A126

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ic of the stimulus bill but obviously we can se some future benefits 

down the line in this provision. 

My first question is, all of the examples of health care information technology that is being used now, how many have been deployed based upon stimulus dollars? I mean, there are a lot of examples of health information technology that have been talked 

about. Mr. Tullman, you sell it. Dr. Winkleman, you are using it. 

Dr. Vozos, you are using it. How much of that deployment was 

based upon taxpayer dollars? 

Dr. VOZOS. I would say at Monmouth the upgrade to the Cerner 

Millennium—— 

Mr. SHIMKUS. Let us talk about stimulus dollars. 

Dr. VOZOS. Right. I mean, we need to do that in order to be able 

to qualify at any point for the stimulus dollars. 

Mr. SHIMKUS. So your upgrade was, but your original deployment 

was not? 

Dr. VOZOS. No, original deployment was Cerner. 

Mr. SHIMKUS. And Dr. Winkleman, I know that none of yours 

was done based upon—your practice made the decision on their 

own and incurred the capital expense and assumed the risk. 

Dr. WINKLEMAN. Yes. I mean, our practice made the decision to 

move forward with this several years ago before there was discussion of money available. 

Mr. SHIMKUS. OK. I just want to put that—I mean, it is an important thing to be placed on the record. Again, no one is argue 

that is not beneficial and that we shouldn’t be all in but I also 

want to point out that a lot of the examples being used are people 

who have done it without government help and government intervention. 

I want to go to the—again, Mr. Tullman, we understand how this 

really does benefit your business plan and your ability to hire a lot 

of folks because there is a new market being generated by this government push, which we hope will provide savings and better recordkeeping and hopefully lower medical liability costs based upon 

all those benefits. But Mr. Starnes from my district, in your opening statement you made some compelling arguments about the crisis in rural America of operating a small rural hospital. Can you 

incur these costs and provide the continued service? 

Mr. STARNES. Well, the economic downturn did play a very devastating role for us, so we have had to make lots of changes in 

order to rebound from that. What we find and what I was commenting about was we do have several capital needs, you know, diagnostic equipment—— 

Mr. SHIMKUS. And you would put those above HIT? 

Mr. STARNES. If I have a person come into the emergency room 

and need a CAT scan, I need a reliable CAT scan machine in order 

to provide that service, so I have got to put that just ahead of EHR 

at this point. 

Mr. SHIMKUS. Right, and that does segue into kind of Dr. Evans’ 

point because I think your testimony mentioned about how you can 

be in essence a low-cost consultant for small rural hospitals and 

practitioners but you are paid on the government dole, you are not 

a private consultant that is for profit, paying taxes, paying for the 

office space, paying properly taxes and other issues because you are 


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part of this government payout that we are doing, but I am not 

going to argue with the help but there is probably some computer 

consultants who now, you are the lowest bidder on providing, you 

know, consulting services and so they are probably going to Mr. 

Tullman trying to find a job over in his sector. 

Let me—my time is short. For the two hospitals here, the CMS 

actuary stated that about 15 percent of Part A providers would become unprofitable within 10 years based upon the new health care 

law because of lower payments, and the new health care law cuts 

$500 billion from Medicare. Dr. Vozos, are you going to be one of 

those 15 percent? 

Dr. VOZOS. If that it all that occurs, yes. 

Mr. SHIMKUS. You would be? 

Dr. VOZOS. Of course I would be. 

Mr. SHIMKUS. You are a major—— 

Dr. VOZOS. I am a major teaching hospital but I am going to rely 

on those 32 million or the 1.3 million people in New Jersey who 

now have insurance to cover that reduction in Medicare reimbursement. I have to rely on that. 

Mr. SHIMKUS. Well, we can talk about that later on. And Mr. 

Starnes, kind of the same question. I am shocked. I thought you 

would be saying I can survive it because we are big. 

Now Mr. Starnes. 

Mr. STARNES. Under the critical-access hospital designation, then 

hopefully we will be fine, but it is not going to be easy for sure. 

We will have to be lean from—— 

Mr. SHIMKUS. You are already lean. You already can’t provide 

needed capital equipment to your hospital. 

Mr. STARNES. Right. Yes. 

Mr. SHIMKUS. Mr. Chairman, my time is expired and I will yield 

back. 

Mr. PALLONE. Mr. Gonzalez. 

Mr. GONZALEZ. Thank you very much, Mr. Chairman. 

My first question, and it may have been covered in the absence 

with the other witnesses and it would have been appropriate for 

them, but it is a situation that in San Antonio the hospitals have 

made me aware of, and I want to make sure that I frame the question, that is that the Medicare incentives to grantees would be 

based on a CMS provider number if you have multiple campuses, 

so if there is anyone on the panel can explain the consequences of 

having one Medicare number but having more than one campus as 

far as the incentives and how that would be paid. I don’t know if 

Doctor, is it Vozos? 

Dr. VOZOS. Yes. I mean, it doesn’t affect us because we have our 

own Medicare provider number but I can explain to you how it 

works. You know, there are hospital systems, let us say, five hospitals within one system all operating under one provider number 

so therefore they are going to get the stimulus once, not for each 

of the five hospitals. So theoretically some of the smaller or more 

rural hospitals in that system on a standalone basis would never 

be able to probably go through all this. 

Mr. GONZALEZ. Anyone else have an opinion on the problems 

that that may present? 


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Mr. STARNES. We just have the one campus and so it really 

doesn’t apply for us, but I can imagine that it is going to be devastating for hospitals with several campuses because each facility 

is going to have its own separate staff to be trained and all of those 

costs that they will incur. 

Mr. GONZALEZ. I understand a rural setting is totally different 

from what I have described, and Mister—let us see. Where is— 

well, it is Dr. Winkleman. I apologize. Mr. Shimkus has touched on 

the cost and how we would go about assisting. We know about the 

stimulus money but of course that is finite and such, but prospectively, as a physician, how is someone’s practice going to afford the 

technology and the training? We introduced a bill a couple of years 

ago and it was a bipartisan bill. It was never passed, but we had 

everything in there. But I want your opinion, anyone on this panel 

that could give me an opinion as to the best way to assist the physicians to make that transition. We could have grants, a combination of grants. We could have low-interest loans, guaranteed, or tax 

credits or tax incentives. Is there any way that we should rank 

those or just have them all available? Anybody? 

Dr. WINKLEMAN. Well, I think that having money and grants 

available to help physicians use electronic records is a positive 

thing but ultimately I think even better than that is that physicians begin to get paid for doing a good job and that as we start 

to—that our practice gets transformed by things like electronic 

health records, that industry will be motivated to make a product 

that works well, they will be motivated to make a product that produces better care, I am going to be motivated to use that product 

to provide better care, not just intuitively for my patients but because I am rewarded for it. So I think creating an environment 

where we are encouraged to use things like this to improve the 

quality helps make that transition make financial sense to a doctor 

because when you look at it on paper, sometimes it is a tough sell. 

There is a lot of upfront capital cost. There is initial reductions in 

productivity. On the long term, there are gains. I think a lot of 

practices become more efficient. They certainly do a better job of 

billing and coding to get paid for what they actually do. So I think 

one of the ways to do it is to make them make financial sense, and 

part of that would involve creating a situation where our reimbursement is tied to us doing a good job, not just seeing a volume 

of patients. 

Mr. GONZALEZ. I think that is built in as far as the incentives 

and how we proceed with that and do it right. Of course, any time 

you have some positive reinforcement or reward or whatever you 

want to call it that encourages that behavior, there is another way 

of doing that, and that is obviously you are penalized for not adopting, for not being more efficient in the use of the technology, so 

there is all sorts of different angles. Of course, we would like to do 

it in a positive mode, and I appreciate your testimony today and 

I yield back, Mr. Chairman. 

Mr. PALLONE. Thank you. I am going to have a second round for 

anyone who would like to participate, and I will start with myself. 

I am going to go back to Dr. Vozos, but I guess any of you could 

answer it. When I was—I mean, we asked many of you to come 

here today because we knew that you were being innovative with 


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HIT, you know, before we passed the Recovery Act and we put in 

this legislation that we have been discussing. I mean, the idea at 

least in my mind was to hear from those who have sort of been the 

precursors and did this before there was any money from the federal government through the Recovery Act. But I would like to 

know, because I know when I went to Monmouth Medical Center 

that even though we discussed all the things that we are doing, you 

also discussed with me what you could do if you were able to tap 

the funds under this legislation. So maybe you should talk to me 

a little bit about where you would go from here, assuming you participated in this program. 

Dr. VOZOS. I mean, we are on the road and we are making a lot 

of moves but we are far from there, and it is going to be a tough 

journey and an expensive one, so really funding for us it going to 

be a big issue going forward. You know, for Monmouth Medical 

Center the full-blown HIT system is going to be about $19 million 

over some period of time, and when I listened to Mr. Starnes talk, 

I said I want to go find out where you are buying that one, that 

$750,000 one. So it is a $19 million project for our system. It is just 

shy of $100 million. So as you can imagine, there needs to be all 

type of incentives to be able to spend that kind of money. Now, 

there is the return on investment so I would say right now, you 

know, we are moving forward on a regular basis. We still have to 

install more modules into our system to be able to get to the level 

where we are fully operable to even qualify for the stimulus money 

and that is what we are doing right now. So it will change the 

practice at the hospital for sure. I mean, it will change even how 

testing is done and what the residents are learning and the efficiency of the hospital but we have a road to go, but there is a bit 

team working on it and continues to work on it. And our big thing 

is linking the physicians and private practices and private offices 

and having a two-way exchange of information. We want to be able 

for them to populate the record in the hospital from what they’re 

doing in the office but at the same time what is happening with 

their patients in the office should be able to go the opposite direction back into their office records too, so that is why we view as 

very important to have very compatible EMRs in the physician office and at the hospital with the appropriate interfaces set up, and 

we are putting a lot of effort into doing that. 

Mr. PALLONE. Maybe I will go to Mr. Tullman because Dr. Vozos 

gives me the analysis from the hospital, but what about you in 

terms of your systems? I think I said in my opening statement that 

currently less than 20 percent of hospitals and 10 percent of physicians are using electronic health records, and CMS is saying that 

they are going to go to 95 to 100 percent of hospitals and 70 percent of physicians. How are you going to get there? Are you prepared, and what are the pitfalls? 

Mr. TULLMAN. I think it is a good question. What we have seen, 

and you recognized that this panel includes a number of innovators 

who have taken those steps, and I commend Dr. Winkleman and 

the other physicians and members of the panel for taking those 

first steps, but in technology adoption generally you get the first 

20 percent are early adopters. The next 70 percent are where the 

real dollars and the benefits are and they take longer, and so the 


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incentive program that you have put into place will help us get the 

next 70 percent and drive that throughout the rest of the market. 

From our perspective, we believe we are ready. We are investing 

heavily in making sure that the systems are easier to use, more 

easily deployed, and again produce the kind of measurable results 

that we need in health care, and I think the RECs, the regional 

extension centers, the other programs that have been designed are 

going to help us move that along. There are tremendous employment opportunities. There is tremendous work to do, and that is 

not just from the vendors, that is from actually the medical centers 

across the country. 

You know, the one thing I would say in terms of a recommendation that we were asked about before is, I think there is an opportunity to open the program even further to rural providers who in 

some cases are excluded because they are not off the same revenue 

schedules and to certain other programs like Medicare Advantage 

where some of our leading clients like Sharp Healthcare in California in fact have problems in terms of getting their physicians 

covered to use that, and they cover a significant amount, but overall, we think we are ready and we think the country is ready for 

better health care. 

Mr. PALLONE. All right. Thank you, Mr. Tullman. 

Mr. Shimkus. 

Mr. SHIMKUS. Thank you, Mr. Chairman. 

Mr. Starnes, do you know, what is your closest REC? do you 

know it? 

Mr. STARNES. It is Northern Illinois University. 

Mr. SHIMKUS. And that is located where? DeKalb? 

Mr. STARNES. Yes. 

Mr. SHIMKUS. And how far is DeKalb from Vandalia? 

Mr. STARNES. I couldn’t tell you. Somebody else? 

Mr. SHIMKUS. Four and a half, five hours. 

Mr. STARNES. OK. 

Mr. SHIMKUS. I know Idaho-Washington is a big area too, so, I 

mean, it is just a point I wanted to raise. 

If we follow up on the chairman’s point, Mr. Tullman, about trying to get those numbers of 75 percent to 90 percent, that is really 

a rush for obviously a population that you and the other 12, 15 providers—Dr. Evans, you had that list up, I don’t know how many 

there were, 12, 15 providers who provide the same type of services 

as Mr. Tullman. Are we concerned that they will go to the bigger 

institutions prior to the smaller ones? 

Mr. TULLMAN. We really—I will take the first shot at that. We 

believe and what we are seeing is accelerated adoption across the 

board, so we know that at least until the stimulus package, the 

larger organizations were in fact advantages because they had 

CIOs, they had a capital budget and the like. What the stimulus 

program does it open it up so smaller physician groups and offices 

and independent physicians can do that. That is number one. Number two, a lot of the larger organizations, for example, I mentioned 

North Shore Long Island Jewish, what they have done is, they not 

only bought licenses for their 1,200 employed physicians but they 

have actually extended that offer to 7,000 affiliated physicians in 

the community to help connect them up and bring those benefits. 


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The last point is that many of the vendors have come out with innovative programs like a financing program with no payments for 

6 months to help bridge the gap until smaller providers actually 

get the stimulus funding. So I think you are seeing a lot of innovation. 

Mr. SHIMKUS. And I appreciate that. My time is short and I don’t 

mean to be disrespectful but I think that is going to be an interesting case study to follow to make sure that happens. There are 

just in the broadband world, the other committee I serve on is Telecommunications. There are still communities on dial-up. There are 

still communities not—and one of our attacks on the stimulus bill 

is they are overbuilding broadband areas and not deploying to what 

we call unserved areas. Well, Dr. Evans, you probably know that. 

Probably in Idaho and the eastern part of Washington State, there 

are unserved areas. So the stimulus on the other end has to get 

broadband out so everyone can take advantage of this. 

I got a chance to visit with Dr. Winkleman earlier today, and he 

brought up this issue that even though he is—and I have to do this 

before I do that. I am sorry. Two letters, I ask for unanimous consent, and one is a compelling argument of a community of 15,000— 

Mr. Starnes would know— Washington County Hospital, Nancy 

Newby, president and CEO, a population of 15,000. They are on 

HIT already and did the risk, did the same thing. So there are 

folks who realize the importance of this and did it previous to the 

government intervening. 

In the HITECH Act, incentives are based on charges under the 

Medicare fee schedule or a provider can qualify for more than 30 

percent of their volume is from Medicaid patients. As a rural 

health clinic, will you meet either of these criteria? 

Dr. WINKLEMAN. We will have a very hard time achieving the 

standard under the—well, let me back up. We will be very close 

under the Medicaid, the arm of being 30 percent. Our problem 

under the Medicare arm is that since our reimbursement comes via 

the rural health clinic system and not directly from Medicare. Our 

charges to the Medicare fee schedule are very limited. The only 

thing we bill to Medicare fee schedule under fee-for-service are 

some ancillary things. So we really don’t have a Medicare option 

despite the fact that we see a good percentage of Medicare patients. 

You know, we really are limited to the Medicaid option. And so for 

some of my partners—it would be different for me, I do family medicine where a see a good portion of children and a lot of them are 

Medicaid, but some of my partners that do primarily internal medicine, primary care and see mostly adults, a lot of those patients are 

Medicare and then they could be sort of left out in the cold. Seeing 

a large number of Medicare patients, having adopted EHR, using 

them meaningfully, and yet we don’t really have the Medicare 

charges per se technically that qualifies under the incentive. 

Mr. SHIMKUS. Thank you, Mr. Chairman. My time is expired but 

I want to note Dr. Evans was nodding yes, I think and I guess she 

would agree with pretty much of that analysis. 

Ms. EVANS. Yes, and actually we have heard the same concern 

from many of the rural health clinic providers that we have been 

talking to that they are shut out because they may not—they basically bill via a bundled mechanism rather than the provider fee 


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schedule so that leaves them out of Medicare, and then they don’t 

see the 30 percent patient panel required for Medicaid or 20 percent of their pediatricians. So they are really very much interested 

in how CMS is going to address the fact that there may be no incentive payments coming to them. 

Mr. SHIMKUS. Well, hopefully CMS is paying rapt attention to 

this hearing and that is part of the record. 

We haven’t talked about HIPAA implications. We haven’t talked 

about the whole privacy debate. That is really critical when data 

is flowing, and I am not smart enough to go into, Mr. Chairman, 

so I yield back. 

Mr. PALLONE. Thank you. Mr. Shimkus has asked unanimous 

consent to enter these two documents into the record. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. PALLONE. Mr. Gonzalez. 

Mr. GONZALEZ. Thank you, Mr. Chairman. 

This question will go to Dr. Evans. Has it been your experience— 

now, my understanding is, you are vendor neutral. That means 

when you go on site, the hardware has been purchased, the software. The system is in place, you just—I am going to read something to you. I am almost embarrassed, Mr. Chairman, and I am 

hoping Mr. Shimkus is not listening as to my sources of information. 

Mr. SHIMKUS. I usually don’t. 

Mr. GONZALEZ. That is an understatement. But anyway, this is 

Hilda Gorito of Kaiser Permanente: ‘‘If you give a lumberjack who 

has been using an ax his whole life a chainsaw and he starts hacking at a tree with it, it is not going to help him at all. It is what 

you do with the technology that makes the difference.’’ So you go 

there, and so now the physician who used to be a lumberjack now 

has the chainsaw, and you are going to teach him basically how to 

use that effectively about the technology. When you go on site, are 

you discovering that many times—I don’t know how to put this— 

they have overpurchased? One size doesn’t fit all, and my experience has been with my friends who are physicians and a couple of 

friends who actually sell the systems that a lot of physicians really 

are not—because you are coming after the fact, that prior to the 

purchase of what is a very expensive investment that it is not done 

many times with the knowledge. And Mr. Tullman, I want you to 

chime in as soon as Ms. Evans finishes. Where does a physician or 

a small practice get the direction and the advice to purchase only 

that which they really need and to make an investment and not realize the return that they could? 

Ms. EVANS. Well, my experience in doing some of the consulting 

out in the field is that many times providers purchase something 

and then underutilize the system for a variety of reasons. I can’t 

really speak to whether they have overpurchased, but what I have 

seen is that there are many functions and features that are available to them, particularly for reaching meaningful use, that they 

haven’t even necessarily looked at or they don’t know exist. And so 

we go into the practice to educate them about some of the availability of the features and functionality as well as determine the 


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workflow by which they might be able to use the system is a more 

effective manner. 

Mr. GONZALEZ. Your thoughts, Mr. Tullman? 

Mr. TULLMAN. Yes, I think I would concur, and we think the 

largest problem, most significant problem is underutilization, and 

that would be true in most pieces of software that people buy. They 

tend to use them not at the maximum but the minimum, so we 

think the RECs are a good idea. We also are seeing more and more 

physicians get counseling from a variety of ratings services so as 

a vendor we are evaluated by a number of different organizations 

and of course CCHIT, there are minimum requirements, so there 

used to be about 300 different electronic health record providers. 

Last year under CCHIT to meet the minimum standards, that 300, 

only 70 qualified as meeting the minimum requirements. Those requirements are now even greater and will continue to get greater, 

and we think that is a good thing. We think that it improves the 

value of the products. 

But your point I think is very important, and that is, and we believe it is one reason this legislation made sense and that was you 

weren’t simply buying physicians electronic health records, you 

were saying we will help pay for them if you use them, and that 

is really the critical aspect of meaningful use, which we are very 

supportive of. 

Mr. GONZALEZ. Last question. I have a minute. Ms. Bechtel, you 

represent the consumer and such, and I am one of those that just 

believe that a patient goes in there believing that the doctor is up 

to date on the latest literature, continuing education, has the best 

equipment and so on. Do you believe that HIT should be part of 

that equation, that each patient should expect that that particular 

physician have that electronic medical records and the efficiency, 

effectiveness and cost savings that it should bring? 

Ms. EVANS. I do, and I think it is interesting because there are 

a number of consumers who see technology in every other sector in 

this country and assume that their physicians have it as well, but 

then they experience the acute challenge of trying to communicate 

with the care team, trying to coordinate their own health care, understanding that doctors just aren’t talking to each other fully and 

in the way they could be without interoperable health IT and so 

we have done actually a fair amount of research with consumers 

directly to understand what do they think about information technology and the reasons that it appeals to them are exactly those 

but they get that it will begin to reduce the burden that they face, 

particularly around care coordination. So we would be delighted to 

start to see consumers asking their physicians are you a meaningful user of information technology, do you have an electronic health 

record. I know that when I chose my own doctor recently, it took 

me several months to find out that has an electronic health record, 

and I did, but to the point of this hearing, the practice actually 

doesn’t use it in a meaningful way whatsoever. They really just actually automated paper. So I think the conversation has to start 

with, do you have an electronic health record, but it can’t end 

there. It has to be, how are you giving me access to my health information, how are you sending me reminders, how are you summarizing my care for me and other benefits of technology. 


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Mr. GONZALEZ. Well, I thank all of you for your testimony. I yield 

back, Mr. Chairman. 

Mr. PALLONE. Thank you. That concludes our questions, so we 

want to thank all of you for spending all of your time here today, 

and obviously this is very helpful and it is probably just the beginning of what we are going to have to look at in dealing with HIT. 

The way the rules work, you will get some written questions 

from members. We try to have them to you within 10 days, and 

then of course we ask you to respond as quickly as you can, and 

if you want to submit testimony, you can. But thank you very 

much. I really appreciate it. 

Without objection, this meeting of the subcommittee is adjourned. 

[Whereupon, at 5:30 p.m., the Subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 


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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 166 here 78126A.082
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 167 here 78126A.083
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 168 here 78126A.084
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 169 here 78126A.085
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 170 here 78126A.086
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 171 here 78126A.087
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 172 here 78126A.088
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 173 here 78126A.089
165 


srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 174 here 78126A.090
166 


srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 175 here 78126A.091
167 


srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 176 here 78126A.092
168 


srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 177 here 78126A.093
169 


srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 178 here 78126A.094
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 179 here 78126A.095
171 


srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 180 here 78126A.096
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srobinson on DSK4SPTVN1PROD with HEARINGInsert graphic folio 181 here 78126A.097