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Dr. David Brailer, the newly appointed national health IT coordinator, is already attempting to rally physicians, health care organizations, government agencies, insurers and information technology providers to move more quickly and effectively toward the implementation of electronic medical records in the United States.
A consultant to the administration for the past several months, Brailer is assessing the resources at his disposal—which span across the 14 or 15 federal agencies—that touch upon the issues of health care and IT.
He is tasked with coordinating the efforts of these federal agencies, working with the industry and commenting on all health-care-related budgets.
He argued Wednesday that his role, rather than creating an entire additional agency, is to more effectively put existing resources to use.
Brailer defined his role as analogous to previously established positions for AIDS, drug and terrorism appointees. “I dont want to build a new fiefdom,” Brailer said. “Were not here to start programs, but to harmonize” existing ones.
In July, Brailer plans to release a full strategic plan for the future of health care and IT in the United States at the National Health Information Infrastructure conference in Washington, D.C.
In his remarks at the Toward an Electronic Patient Record conference in Ft. Lauderdale, Fla., he called for greater industry self-regulation, particularly around thorny technology-interoperability issues.
Brailer defined his role in this process as helping to “shape an industry consortium.” His plan for achieving improved interoperability is an industry certification of products that meet minimum feature, interoperability and security standards.
Health Level 7 (HL7) standards, Brailer argued, are insufficient because of varied interpretations by vendors and customers.
If the industry fails to successfully regulate itself, Brailer said Congress is likely to eventually do the job for it. He argued that this trend has already been initiated with the signing into law of the Health Insurance Portability and Accountability Act (HIPAA).
Another priority for Brailer is consistent, accurate measurement of electronic medical record adoption and usage. He estimated that the current level of adoption is 5 percent to 15 percent of physicians, but cautioned that “were flying without a lot of good data.”
Next Page: Raising the capital to stimulate innovation is an urgent task, Brailer says.
Raising Capital
Brailer said he sees the raising of the necessary capital to stimulate innovation as an urgent task. He said this will require a shared investment across physicians, patients, health plans and private investment, as well as the investment of local, state and federal governments.
Although electronic health records are starting to be adopted on a small scale, there is little infrastructure for circulating them across multiple health-care providers. Brailer suggested that the creation of local and regional infrastructure to share electronic health records is a potential solution.
In the near term, Brailer said he hopes to increase the uptake of IT within the health-care industry and enhance interoperability.
He argued that the successful execution of this endeavor could improve the quality of health care, with a concomitant increase in the ability of the American worker to be productive.
But he is conscious of the perils of moving too rapidly into the widespread use of electronic medical records. A potential consequence could be to increase the rate of physician uptake but to simultaneously increase the failure rate. “I dont want to lead people into oblivion,” Brailer said.
The top priority, he said, should be to focus on the health-care organizations that are most ready to transition and to help create industry momentum, rather than to push for implementation uniformly across the sector.
Still, there is an urgent need among physicians and patients for electronic medical records, Brailer said.
“The pain in the industry today is so high that I think a lot of what we have to do is pain avoidance. Were in the fire right now,” Brailer said. “If we dont move forward, our lives will really be challenged.”
Brailer noted that many patients with chronic diseases must carry around paper copies of their own medical records. This is “a symptom of how broken the system is,” he said.
He has been personally touched by medical errors that might have been avoided through more accurate records; Brailers father and brother both have experienced the effects of significant medical errors.
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