WASHINGTON – Much of the healthcare IT community was left scratching its head at the end of 2004.

President Bush's call to arms in the State of the Union address to get the healthcare system wired and his subsequent appointment of David J. Brailer, MD, to the position of National Coordinator for Health Information Technology seemed to signal that HIT issues would finally be included in health policy debates.

But in the waning months of the year, Congress deflated a bit of that optimism when it failed to provide $50 million in the fiscal year 2005 budget for the Office of the National Coordinator for Health Information Technology.

Determined not to lose another round, healthcare IT organizations entered 2005 with a renewed commitment to make sure members of Congress understand technology's potential to improve care and save money.

The National Alliance for Health Information Technology is hosting a series of Capitol Hill briefings for House and Senate staff members designed to highlight healthcare IT benefits. The Steering Committee on Telehealth and Healthcare Informatics also hosted a standing-room only event in Congress to discuss the president's budget and prospects for healthcare IT legislation in the 109th Congress.

It's all part of what Thomas Leary, director of federal affairs for the Healthcare Information and Management Systems Society, calls "knowledge development" in Congress. Simply put, the industry is pressing harder in its lobbying efforts this year.

Sue Quantius, a staff assistant on the House Appropriations Subcommittee on Labor, Health and Human Services, confirmed that the axed $50 million for Brailer's office came down to tight budgets and good, old-fashioned lobbying.

"The problem is that it was partially the timing of it and competing forces within the appropriations budget," Quantius said. "It was easy to target a program that was new and not terribly defined at that point."

Even if the healthcare IT industry's lobbying is a success, it could still be difficult to squeeze money out of already stretched-thin budgets. The White House is requesting $125 million in its fiscal year 2006 budget for healthcare IT-related projects, including $75 million for ONCHIT. HIMSS' Leary called that amount a good "baseline," but acknowledged it could be a struggle to get the funding.

Congress has until Sept. 30 to review and pass the budget for fiscal year 2006.

Also at issue are a number of competing healthcare priorities in Congress, including medical malpractice reform and moves to reduce physician reimbursements. Leary said if Congress were to reduce physician reimbursements under Medicare, it could further dissuade doctors from investing in information technology.

However, it's not all gray skies for healthcare IT policy. Bush again sounded his support for technology's potential in healthcare during the State of the Union address and made a trip to the Cleveland Clinic to tout the benefits of an interconnected healthcare system. And in his first few days as secretary of HHS, Michael Leavitt announced proposed regulations to support electronic prescriptions for Medicare.

In Congress, members of the House 21st Century Health Care Caucus have been busy recruiting new members. So far, about 20 members have joined the group, which focuses on changing healthcare through information technology.

This month, look for the Medicare Payment Advisory Commission (MedPAC) to recommend that the Centers for Medicare and Medicaid Services give financial rewards to physicians who can produce certain types of data about their patient populations. While not requiring the use of IT, it is likely physicians could only provide this data by using information systems.

In addition, CMS in January announced a demonstration project under which Medicare would provide bonuses to 10 physician groups that make improvements in the care they provide to fee-for-service beneficiaries. All of those groups will be using technology in the demonstration project.