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[Celena Sessler]

President Discusses Transforming Health Care for Americans with Health IT
Vanderbilt University Medical Center
Nashville, Tennessee

President's Remarks
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listen Fact Sheet: Transforming Health Care for All Americans
In Focus: Healthcare
1:43 P.M. CDT THE PRESIDENT: Thank you all for coming. Please be seated.Tommy, thanks for the kind introduction. You can keep your job for awhile. (Laughter.) I put him in my Cabinet because I knew howeffective he was as a governor. He was the Governor of Wisconsin. AUDIENCE MEMBER: (Applause.) THE PRESIDENT: And I knew when I asked him to -- don't gooverboard for Wisconsin, please. (Laughter.) I knew when I asked himto join my Cabinet, that he would reform programs that needed reform,focus resources on programs that needed resources, and would do a greatjob. He really has. He's been a remarkable Secretary of Health andHuman Services, and I'm proud he came here today. We're going to talk about an interesting subject, and it's one thathas got a chance to change our country for the better. As you can see,I've surrounded myself with people who probably can -- not probably,will be able to explain the subject better than me. But before we get talking about health care and how to make surethe costs are reasonable and health care is affordable and medicalerrors are reduced by using information technology, I do want to thankthe good folks here at the Vanderbilt University Medical Center foryour hospitality. I particularly want to thank Harry Jacobson forwelcoming us, for allowing us to use this facility to talk about healthcare. No better place to talk about health care than at a place thatdelivers excellent health care, right here at Vanderbilt. Thanks forhaving us. (Applause.) Neal Patel is with us. Where are you, doc? There he is. Nealshowed us the new children's hospital, some of the parts of thechildren's hospital. It's an impressive facility. Thank you for beinga doctor. Thank you for caring about America's kids, and thank you forgiving us a tour. I want to thank Jim Shmerling, who is the CEO; BillStead, who is the Chief Information officer. Thank you all for coming. This is a -- the reason we're here isbecause this hospital knows how to use information technology for thebenefit of patients and docs. That's why we're here. You're ahead ofthe country in using technology to your advantage. And we'll talkabout that here in a second. I want to thank my friend, Senator Bill Frist, for joining ustoday. (Applause.) You're doing a heck of a job. You cut your teethhere, right? That's where you started practicing? That's good. Hemarried a Texas girl, I want you to know. (Laughter.) Karyn is withus. A West Texas girl, just like me. We both married above ourselves,didn't we, Senator? (Laughter.) But Karyn, thank you for coming. I'mproud you're here. I want to thank members of the Congress who are here with ustoday. First, Congressman Jim Cooper from this district. Thanks forcoming, Congressman. Proud you're here. Jimmy Duncan is with us,Jimmy. And you brought your son, John, I see. Thank you for beinghere. (Applause.) I know Zach Wamp and Kim are here. Thank you allfor coming. (Applause.) Appreciate you being here. And MarshaBlackburn is with us today. Marsha, thanks for coming. (Applause.) I know the mayor is here. Mr. Mayor, I appreciate you coming.Thanks for being here. (Applause.) Fill the potholes, that's the onlyadvice I can give you. (Laughter and applause.) I'm sure you are. Today, when I landed, I met Phuong Le. Phuong, please stand up fora second, will you? Thanks for coming. I'll tell you why I wanted tointroduce Phuong. She is a soldier in the army of compassion. That'swhy I want you to hear about her. She is a person who just graduatedfrom high school, like a week ago, right, Phuong? Yes, a week ago.For six years, she has been volunteering at the Siloam Family HealthCenter, to not only help people who can't speak English, communicatewith the care-givers there, but to help provide love for those whohurt. That's what she's there for. The reason I bring up Phuong isbecause I want to remind you that the strength of this country is inthe hearts and souls of our citizens. We're a mighty military power.We will stay that way to make the world more free and more peaceful.We've got a mighty economy. We are a wealthy nation compared to othernations. But our strength is in the hearts and souls of our citizens.That's our true strength. Our strength is found when people take timeout of their life, like Phuong has done, to help somebody who hurts. See, the great hope for America is neighbor loving neighbor. Thehope for this country is when somebody who is hungry, or needs shelter,or needs love can find it when a fellow citizen says, what can I do tomake your life better. I appreciate, Phuong, you serving as such agreat example for the folks here in this community. I call on othersto love your neighbor just like you'd like to be loved yourself. Andyou can join the army of compassion, which is changing America for thebetter one heart, one soul at a time. Thanks for coming. (Applause.) One of the important subjects in America is, how do we make surehealth care is affordable and available. Part of making sure healthcare is available is for medicine to use information technology. Andthat's what we're here to discuss. I want to talk real quick about some other ways we can help withhealth care. One, we've modernize the Medicare system. Senator, thankyou. Members of the House who voted for the plan, I want to thank youfor your vote. The modern Medicare system begins with making sure seniors have gotdrug discount cards, and they're now being passed out. And seniors aregoing to be able to save between 15 to 30 percent off the retail priceof most brand drugs and more for generic drugs. As well, there isgoing to be a $600 credit for poor seniors. This is the beginning of areform package that will affect seniors' lives in a very positive way,by making sure our drugs are more affordable. And the cards are out. They're heading out right now. Unlike mostgovernment programs where they say, the check's in the mail, actually,the cards are in the mail -- (laughter) -- and people will be able touse those cards to their benefit. They'll also be able to get on theInternet and comparatively shop for drugs. In other words, you can geton the Internet, put in your zip code, and you'll be able to see theprice of retail drugs in drug stores close to you and in yourcommunity. And that in itself will serve as a -- as a way to putpressure, downward pressure through the market, not through governmentedict, or government declarations, but through the market for thebenefit of consumers. This is a major -- the beginning of a majorreform to the benefit of our seniors. We've also got -- inherent in that bill, what's called healthsavings accounts. You can put in after-tax money; you can earninterest after tax; you can take out money after tax. Put it intax-free, earn it tax-free, take it out tax-free, in order to pay fornot only medical costs, but also catastrophic care. These are calledhealth savings accounts, which will be a really good vehicle to helpcontrol costs and to make sure patient and doctors are the center ofthe decision-making process in health care. We're working with Congress to expand what's calledassociation health care plans, which will allow small businesses topool risk, so just like big businesses do to get better prices fortheir health care plans for their employees. We've also got to make sure that we continue to expand communityhealth centers -- again, appreciate the members of Congress here.Community health centers are a really effective use of tax payers'money, in my judgment. They provide primary care and preventative carefor people who need help with medicine. And it takes the pressure offthe emergency rooms. The most expensive place to find health care isan emergency room. These community centers are being expanded all across America.They want to open up -- or expand 1,200 community health centers.That's on top of the 3,000 that exist. We want to see to it that 16million Americans are taken care of in these community health centers.In other words, it's a safety net for people. I recognize peoplearen't covered by insurance. We'd like more people covered byinsurance. Until they are covered by insurance, here's a way forpeople to get good, cost-effective health care, cost-effective forthem, and as importantly, cost-effective for the taxpayers. And finally, in order to make sure that we've got available andaffordable health care, the United States Congress needs to passmedical liability reform. Our doctors -- (Applause.) If you get suedall the time, you're going to practice defensive medicine. And whenyou practice defensive medicine, it means somebody's cost is going togo up. In other words, you're worried about winning a lawsuit, andtherefore, you're going to do more procedures than might be necessaryjust to protect yourself. And these lawyers are filing suit after suitafter suit, and you know what I'm talking about. That's just the wayit is. People ought to have their day in court. But frivolouslawsuits are running up the cost of medicine and they're running docsout of business. Just talk to docs. Just talk to people in ruralAmerica what it's like to try to keep a professional -- a group of docsaround when these junk lawsuits are making it hard for them to stay inbusiness. When I got to Washington, I said, we'll just let the states takecare of it and then I saw what the cost of defensive medicine andincreased premiums are doing to our budgets. The cost of Medicare goesup with all these junk lawsuits. The cost of Medicaid goes up with allthese lawsuits. The cost of veteran health care goes up for all theselawsuits. It's time for the United States Congress to pass nationalmedical liability reform. (Applause.) It's out of the House ofRepresentatives. You don't have to worry about your United StatesSenators from Tennessee, they're on board. I appreciate you.(Applause.) We've just got to convince some other ones. These are all ways to affect cost and to make sure thedoctor-patient relationship is central in medicine. What we can'tafford to have happen in America is for the federal government todecide to run it all. That will not work. America has got -- is onthe leading edge of medicine for the whole world. We've got the bestresearch and development, we've got great docs, we've got fantastichospitals. The federal government just cannot run the system as wellas docs, professionals, administrators and patients can. (Applause.) Another way to save money is to introduce information technologyinto the health care world. One of the amazing discrepancies inAmerican society today is, we're literally changing how medicine isdelivered in incredibly positive ways. And yet, docs are stillspending a lot of time writing things on paper, and sometimes it's hardto read their handwriting -- (laughter) -- and therefore, sometimesit's difficult to have the spread of accurate information so thatdoctors can make good decisions. The idea of making sure we use information technology starts withsetting this goal: within 10 years, we want most Americans to haveelectronic health care records. That means your records. And you'llhear us talking about it here today, I'll try not -- I'll try to giveit my best shot. Your records are on -- in a digital form that can betransformed, transferred over the Internet, so that if you happen to betraveling somewhere and you get in a wreck, a doctor or emergencyphysician in Texas can call up the information or ask for informationor seek information, not only off the card, but to your home doctor'soffice and they'll be able to know what's wrong with you or right withyou, what has been wrong with you and how to treat you. You can imagine what kind of system that will do. It will cut downthe cost of paperwork. It will also cut down on medical errors, which,if you're going to be a patient, that's something you really hopehappens. (Laughter.) Sometimes information gets lost. Sometimespeople inadvertently prescribe the wrong drug because the informationisn't correct. And so the fundamental question is, how do we usetechnology, how do we modernize health care? That's what we're here totalk about. How do we, you know, do the same thing that is happeningin other industries to health care? And we believe we can change howhealth care uses IT. And it starts with the federal government.Listen, the VA is doing a fabulous job with using informationtechnology. This hospital is doing a fabulous job for usinginformation technology, which we will talk about. And so, one of the first things we're going to talk about is whatcan the federal government do to help. Now, we hired a guy name DavidBrailer. David's right here to my right. David's an expert oninformation technology and how it is applied to medicine and to healthcare. Tommy hired him, see -- yes, he's got a pretty good title: theNational Health Information Technology Coordinator. (Laughter.) Theway I look at it, his job is to use the federal government's abilitiesand our Medicare law and our VA and other assets we have to spread thisfantastic opportunity throughout America. And I just want to say one other thing before I turn it over toDavid. Privacy is really an important part of, in my judgment, of anAmerican system that works well. I don't want some people looking atmy records. Of course, my line of work, everybody gets to look at myrecords. (Laughter.) It's too late for me. (Laughter.) It's not toolate for you, and therefore, as you hear the idea of moving yourinformation across the Internet, you've just got to know it's got to bewith your permission. These are your records, it's your health, andyou can decide whether or not people can use your records. This isimportant for people to understand that, that those of us in governmentwho talk about spreading information also, first and foremost, keepyour privacy in mind. Now with that -- David is the coordinator named on May the 6th.And here he is sitting with the President right here in Vanderbilttalking about his job. But David, tell us what you do, why you do it,and when you're going to finish it. (Laughter.) MR. BRAILER: What time is it? THE PRESIDENT: Yes, exactly. MR. BRAILER: Well, thank you, Mr. President. And first, let mejust say thank you to American Medicine for your historic leadership ininformation technology. (Applause.) THE PRESIDENT: Thank you very much. Thanks. * * * * * THE PRESIDENT: Let me ask you a couple of questions. One of theinteresting challenges -- evidently the medical lingo varies. In otherwords, part of your challenge has been to standardize, as well asdevelop a common vocabulary. Would you explain that, so -- obviously Ican't. Would you explain it, please, so people can understand itbetter? MR. BRAILER: We have a different vocabulary. When a physiciansees a patient, we write down a problem list, which is the list ofissues that's active with that person. We create a label, called adiagnosis, which is the formal name that you know. We do procedures,the things that we do to people's bodies whenever they have to havetreatments. We make estimations of what is happening with someone.And all of these things are codified in language. And traditionally in medicine the language has been informal. It'sbeen variable by physician. I might call something hypertension;someone would call it high blood pressure. I might say you have a hightemperature; someone says you have a fever. And there are over 50,000language terms that are in medicine that cover. And the point ofstandardization is to make it one vocabulary. This is very hard, notjust in terms of what the vocabulary is, but being able to make thispart of the normal daily activities of physician's days. THE PRESIDENT: Yes, see, that's part of the challenge. I'm sureyou can envision it. If people call the same disease or symptoms bydifferent names, obviously there needs to be a standardizationprocess. The federal government can help. As I understand it, we'requite far down the road in terms of developing the standards. DR. BRAILER: Mr. President, the federal government has had anextremely positive effect in the last two years. Secretary Thompsonset up an effort to take the standards that are being developed in theprivate sector -- the federal government hasn't developed the standards-- but has taken those and put them into government procurement, intothe contracting arms of the Health and Human Services and elsewhere.So they go from being on paper into real systems that are usedeveryday. And we have a lot more that can be done. THE PRESIDENT: Good. I imagine they say, scrape your chin whenyou fell of the bicycle the same in Tennessee as they do in Texas,though. (Laughter.) What do you think? (Applause.) Okay, thanks. Good job. Dr. Jim Jirjis is with us. Jim, thanks for coming. He is theAssistant Chief Medical Officer here at Vanderbilt University MedicalCenter. Appreciate you coming. DR. JIRJIS: My pleasure. THE PRESIDENT: Here's your chance. (Laughter.) * * * * * THE PRESIDENT: You helped set up the electronic records here atthe hospital? DR. JIRJIS: Correct. THE PRESIDENT: So what does that entail? DR. JIRJIS: Well, I have the funnest -- second funnest job in theworld. (Laughter and applause.) Vanderbilt is a wonderful sandbox, Ilike to say. Harry Jacobson and Bill Stead are visionary leaders andthey have developed an infrastructure that allows guys like me andNeil, whose passion -- you know, I was the guy in high school behindthe computer -- I was also an athlete, too, don't make any mistakeabout it. (Laughter.) But when I came to medicine and computers, whoknew, at Vanderbilt, I would have a sandbox. * * * * * THE PRESIDENT: Yes, and one final question along these lines. Youdo prescribe prescription drugs over the -- through the internet yet? DR. JIRJIS: Most of the prescriptions through the internet, wecan't interact with the pharmacies yet, though there's a lot of workgoing on nationally to try to arrive at that. THE PRESIDENT: Yes. DR. JIRJIS: In our hospital, 100 percent of our prescriptions aredone in the computer. THE PRESIDENT: Which is important. DR. JIRJIS: If I try to order the wrong thing, Bill Stead, if youtry to order the wrong thing, even if it's 1 a.m., a little, "beep"comes up, says, you're going to hurt this patient. THE PRESIDENT: See, that's really important for people tounderstand. The ability to make sure that we prescribe the right drugand the right dosage can be controlled by proper use of medicalrecords, which is really important. And it's cost effective. I hope you're getting a sense for what we're talking about here.It's a really exciting opportunity. Again, I repeat, we're atVanderbilt for a reason. It's because this hospital is -- and systemis innovative and different. And it's on the leading edge of change.It benefits a lot of patients, obviously, in your illustrious careerhere, one of whom is Bob -- Bob McNeilly. He's a patient, Bob. He'slike your patient, right? DR. JIRJIS: Yes, he is. THE PRESIDENT: Bob, welcome. MR. MCNEILLY: Thank you. THE PRESIDENT: Tell us how electronic records affected you. * * * * * THE PRESIDENT: How does that work? You say it communicates withyou. MR. MCNEILLY: Well, I've got -- I've got email. (Laughter.) THE PRESIDENT: Yes, there you go. (Laughter.) There you go. Youlook like an emailing kind of guy. MR. MCNEILLY: Absolutely. (Laughter.) Give me your address andI'll send you one. (Laughter and applause.) There's anotheradvantage, also. I've got more than one doctor here at Vanderbilt.I've got, as a matter of fact, two other doctors who are bothcardiologists. One calls himself my plumber, and one my electrician.(Laughter.) They prescribe medications, and I want to make sure JimJirjis knows exactly what they have