Outgoing Health IT Czar Worries About Information Silos
The outgoing health IT czar, David Brailer, said April 24, in Washington, that making sure health care information follows patients as they receive care from different providers should be one of the governments chief goals.
"Everybodys connected but nobody is sharing," he said. "Thats the natural consequence without federal intervention," and one of his two biggest worries for the future of health IT.
The other worry is that poorer and smaller health care providers will be left behind as their larger and wealthier counterparts continue to adopt health IT at a faster pace.
Brailer announced April 20 that he will be leaving his post on May 19. One of his main initiatives was planning for a National Health Information Network so that doctors could better follow a patients medical history. Many medical errors and redundant procedures occur because doctors do not know what their predecessors have done or they dont have access to previous lab tests.
Over his two years as the National Coordinator for Health Information Technology, Brailer has argued consistently against top-down approaches. Hes been vocal about what the government should not do. It shouldnt create and mandate standards or buy health IT for every doctor or become a health IT vendor itself. But assuring "full portability of information" should be the governments job, he said.
"If the federal government continues to support [portable information], we have a pathway for portable information," said Brailer, but he added that the industry would "need to walk through that door," and that government would need to "hold the door open" and help push people through it.
Brailer said that anti-corruption legislation widely acknowledged to hinder health IT adoption would soon be on its way out. The Stark and anti-kickback laws prevent hospitals and sometimes vendors from donating computing equipment to physicians or helping them set up health IT systems. Exceptions to the legislation proposed last year were largely deemed ineffective, but Brailer said the exceptions had generated useful feedback for crafting smart policies.
Brailer admitted that much other work remained to be done, particularly in helping physician offices with just a few doctors adopt health IT. Right now, said Brailer, the technology is too expensive, not sufficiently useful and too risky.
Brailer, a medical doctor with a Ph.D. in economics, was named to the newly created post almost exactly two years ago and has been widely praised by providers, vendors and policymakers.
"Dr. Brailers passion for a safer health care system through the use of information technology enabled him to make great strides in a very short period of time," said Molly Coye, M.D., CEO of HealthTech and a CalRHIO board member. "He has put into motion the creation of the components essential for a secure interconnected health care system."
His office also established many grants for establishing national frameworks for health IT standards and seed grants to help individual hospitals and regions adopt health IT.
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