Health IT Czar Calls on Private Sector

By M.L. Baker  |  Posted 2004-11-19

Health IT Czar Calls on Private Sector

SAN FRANCISCO—While government will provide incentives and muscle, the private sector must ultimately make functional health information technology a widespread reality, national health IT coordinator David Brailer told a crowd of attendees at a health care IT conference Thursday.

Health IT, particularly for EHRs (electronic health records), promises to make health care more effective and efficient by tracking the medical care a patient receives from different providers and by supplying doctors and nurses with relevant information, such as drug counterindications or preventive care recommendations, while they care for a patient.

Nonetheless, physicians, particularly ones in small outpatient settings, have not embraced health IT.

"My goal is not to get EHRs in the doctors offices; it is to create a marketplace for those EHRs," Brailer said later in an interview with He said the government faces significant constraints, with the deficit as a "black hole sucking everything into it." But he said the government wont regulate EHRs into existence or use brute force.

The conference proceedings seemed to be equal parts chiding and cheerleading. While there was general agreement on what is necessary to encourage IT adoption—constructive financial incentives, interoperability and ease of use—there seemed to be little consensus on the means to the ends. The conference was sponsored by the California HealthCare Foundation and the Center for Health Research of the University of California at Berkeley.

Much of the expensive technology is still clumsy and hard to implement. Worse, even effective products can be made obsolete by new technology. While doctors want products that improve their practice, he said, they worry that investments in EHR are too risky.

"Every clinician knows many people who have failed doing this," Brailer said. "Much investment made in EHR doesnt deliver real value on the other end." The industry needs "shrink-wrapped" products that are more intuitive and obviously useful, and that wont be outdated, he said.

Brailer told attendees that interoperability, the ability of products from different IT vendors to work together, would "lower the risk and lower the cost" of using health IT.

Most health care executives believe EHR eventually will lower health care costs. Click here to read more.

He envisioned a situation where the government would set certain broad requirements for health IT and rely on the market to find solutions. "Well lay out the must-haves," such as interoperability, privacy and authentication, he said, "and everything else can vary."

But the government also must be prevent IT from being "a tool of the haves," he said. "Left unattended, we will be left with an adoption gap." Loans to rural entities, grants, pay-for-performance programs and reimbursement for using technology could ease this risk, he said.

Next Page: Taking the "monolith" out of Medicare.

Medicare Monolith

Nonetheless, "there will be regional solutions" for how to pay for health IT, Brailer said, with some markets driven by purchasers, others by providers and still others by intermediaries. At the same time, he said, government, as a huge employer, could make sure doctors covered by its health plans use IT.

"We dont expect private purchasers to do something were not willing to do," Brailer said. The government also could increase incentives in the way doctors are compensated by Medicare, by far the nations largest health care payer.

"Our hope is that Medicare will be able to select on a regional basis," Brailer said. "If Medicare doesnt have to act as a monolith, well be able to move the market."

"We need a different kind of health care market," he said, one that is more responsive, gives patients more choices, costs less and discourages mistakes, for instance. "All goals are dependent on data delivered by interoperable health records," Brailer said. This would allow a patients information to be moved seamlessly from hospital staff to outpatient clinics and specialists.

Brailer said one huge impediment is that in the current system, the early adopters have to pay the most and they get the least benefit. He compared interoperable electronic systems to fax machines. "If youre the first person to put in a fax machine, what are you going to do with it? If youre the last one, youre immediately connected to everyone else."

Thus, when there are only a few users, using interoperable EHR can be a bad value. Once nearly everyone is using EHR, getting onboard is very cost-effective. Health providers, particularly small physician offices, have a strong incentive to wait.

Brailer and others recently released an analysis concluding that, for most doctors, the business case for interoperable EHRs is inadequate. Click here to read more.

Governments role for spurring interoperability is to "find ways to get us out of the trough, where the disincentive kicks in," Brailer said.

But, he warned, "If were not there in five years, we will have made the problem potentially worse. Every industry that has used electronic technology has done so to build barriers for easy shifting [of customers]."

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