Countdown begins for HIT legislation

NEW YORK

T minus 10-9-8 …

That’s more or less where federal lawmakers are at right now on a new economic stimulus bill that could have wide-sweeping implications on retail pharmacy; and not the kind where consumers wind up with a few extra bucks in their pockets and spend some of it the next time they’re in the drug store either. This could end up costing retail pharmacy big time, and it has the serious potential to set patients and payers even further back than they already are.

Figure by the time you read this, the clock will be at about 8-and-counting. Well, maybe 9, depending on whom you’re talking to. And that’s a good thing. Because at least now there is time to do something about it.

This past Tuesday, members of the 111th U.S. Congress met for the first day of a new session in Washington, and as has been widely anticipated, its first official act of business is to come to a speedy resolution on a quick solution to turn around our failing economy, in time to make signing this potentially groundbreaking new piece of legislation the first official act of our 44th president—perhaps, even as soon it would take for Barack Obama to raise his right hand, swear the oath of office and officially drop the “-elect” from his title. Sen. Robert Menendez, D-N.J., came in calling it their “first, second and third priority,” and he was certainly not alone in his sense of urgency.

But as they got a bit further into it, others, including Senate majority leader Harry Reid, D-Nev., began to realize that, the bigger and more complex this thing becomes — and more expensive — the less likely that Congress will come back with a plan in time for Inauguration Day; President’s Day may be a more realistic target date.

One thing that has been loaded into this in the name of economic stimulus is a healthcare information technology component. And as much as Drug Store News favors the widespread adoption of HIT—as it is a fundamental component of what will be required to evolve health care in this country from its highly fragmented present state to an actual system where providers actually communicate with each other, patients actually get better and payers actually get what they paid for—it needs to be part of a separate discussion. It’s not quite so simple as flipping the switch on a new road somewhere. HIT is far from “shovel ready” as they say.

As bad as America needs the help right now, it needs to get this right even more. Democrats understand this fully well; they know that in many ways the future success of every plan and every reform they have may be hanging in the balance. A screwup here can easily derail any spirit of nonpartisanship that might exist across the aisle right now, to say nothing of the buy-in of the American public.

The point of economic stimulus must be to stimulate the economy and create the 3-million-or-so jobs Obama’s team has said it can deliver over the next couple of years.

HIT is far too big, too important and too complicated to be a part of this economic stimulus plan. Not if the goal here is to come up with something to get the economy jumpstarted any time soon.

Right now, discussion among lawmakers of how to proceed with HIT has been mired in concerns about patient privacy, and there is a very real fear that any HIT legislation that could come as a result would most definitely mean a whole new round of privacy rules and regulations above and beyond what has already been mandated under HIPAA. That brings a very logical question from retail pharmacy and other key healthcare stakeholders: So, what’s wrong with the HIPAA regulations? And that’s a good question, not just because HIPAA has cost millions of dollars and countless manpower hours to implement, but more simply because HIPAA seems to be working just fine as it is.

In a joint letter sent just before Christmas to Reid and House speaker Nancy Pelosi, D-Calif., and signed by the National Association of Chain Drug Stores in partnership with the National Community Pharmacists Association, the Food Marketing Institute and the American Pharmacists Association, the broad coalition of community pharmacy stakeholders urged, “Our primary concern with any combined [HIT] legislation is to assure that it doesn’t interfere with pharmacies’ ability to provide the communications necessary to ensure high quality patient care, while assuring adequate provisions for protected health information.”

Champions for greater privacy safeguards have talked about measures, such as a new prior consent regulation, that would require any healthcare provider to receive a patient’s consent before they could use that information to perhaps try to save or, at the very least, improve that patient’s life considerably. That means, for instance, even if a doctor were to transmit a new electronic prescription for a newly diagnosed patient with heart disease or diabetes, the pharmacy could not use that information to try to determine if that patient might benefit (read: live longer, healthier) from some sort of disease management program. You’d need their consent just to send that patient a lousy refill reminder. Otherwise, you’d be violating that patient’s privacy.

Then there’s the accounting of disclosures provision that is also being tossed around; the idea that healthcare providers would need to keep detailed records going back several years, tracking each time a patient’s information was accessed and why.

In the meantime, HIPAA seems to work just fine as it is and last year noncompliance and poor drug adherence cost this country an estimated $177 billion.

And so, retail pharmacy, the clock is ticking; T-minus 10-9-8… OK, maybe the clock’s still at 9. That’s a good thing. Because you have all this time to make sure that your Congressmen know to leave healthcare IT out of the present economic stimulus package. It’s important to be sure; but it’s too important to get wrong, and the economy can’t wait for an answer right now. Tell your congressmen to stimulate the economy now and figure out healthcare IT later—soon, to be sure, but not now as part of this discussion.Tick-tock.