U.S. IT Official Lays Out How He'll Make IT Central To Health Care

Dr. David Brailer says execs need to make standard electronic patient records a reality before politicians try to do it for them.
CHICAGO -- The nation's first national health-IT coordinator made it clear Wednesday that he plans to keep politicians and execs focused on the use of IT as a way to improve care and cut costs.

"This is something I'm committed to do: To remind the policy machine that every day that we delay getting something done, probably five to 10 people die," said Dr. David Brailer in one of his first public speeches since being appointed last month by President Bush to increase the use of IT in health care. Bush wants the industry to have electronic medical records for the majority of Americans within 10 years.

Brailer said Wednesday that he will have a strategic plan by July 21 for guiding the health-care industry toward an interoperable electronic medical records system.

Brailer compared information to medicine--used correctly, it leads predictably and repeatedly to better health, and used improperly or in the wrong places, it can do harm. But he noted electronic medical records hold a second-tier status to technologies such as magnetic-resonance imaging, which is part of the reason they've been so slow to be adopted in the cash-strapped health-care system. Brailer maintains they serve the same essential function for doctors. "An MRI makes their reasoning more fact-based. That's exactly what information technology does at the point of care with electronic health records."

Brailer was speaking here to the National Alliance for Health Information Technology, a nonprofit formed by a diverse group of health-care businesses to tackle the same issues Brailer's been charged with. The feeling from Brailer and many alliance members is that there's urgency right now among industry and government policy makers to do something to speed the adoption of IT in health care--as witnessed by President Bush putting it on his agenda.

"If the health-care industry doesn't address health-care technology, the government will," says Gary Mecklenburg, CEO of Northwestern Memorial HealthCare in Chicago, and chairman of the health-IT alliance. "We're not surprised at the government's interest. We're surprised at how fast the interest has risen among Congress and the administration."

Brailer warned that, once interested, Washington won't wait long for execs to create a technology infrastructure that allows capabilities such as secure electronic information-sharing, so that data can move like patients do from doctor to doctor. If industry members let government take the lead, Brailer said, he doubts they'll like the results, citing the Health Insurance Portability and Accountability Act, which Brailer called a "gross policy error" for its effect on the industry.

"I don't want to see a 'son of HIPAA' put into law," he said. For example, Brailer said that if the industry doesn't create a trusted private organization to certify IT systems for performance and interoperability soon, government will create an organization like the Food and Drug Administration to do it.

Brailer laid out four key elements that will shape his group's effort to spur the effective use of IT in health care:

  • Support automation of health-care practice. This is the starting point, managing information where doctors, nurses, or clinicians meet patients. It also includes potentially disruptive technologies such as electronic intensive care units where doctors monitor patients at multiple ICUs with the help of IT.
  • Interconnecting care. Making systems interoperable offers two vital elements. One is giving doctors a choice of IT vendors, allowing them to switch vendors if they're dissatisfied with a record system or grow beyond its capabilities, since the data can be transferred. But the bigger issue is patient choice. Patients go to many health-care providers, and need their data to move with them.
  • Personalization. Personalizing health-care data to individual patients is critical if patients are going to make more choices about their own care.
  • Population health. This includes efforts such as improving the flow of data from clinical trials to get drugs approved more quickly. But it also includes data-collection requirements that add excessive costs on the industry, such as quality and other monitoring data separate from what providers need to collect to deliver care.
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