Even with Brailer set to leave, health IT efforts locked in

Financing, meeting milestones remain challenges for next federal coordinator

What's on tap

Over the next several months, contractors are charged with accomplishing several major milestones:

  • The Health Information Security and Privacy Collaborative will announce agreements with 43 states to study and eventually harmonize their privacy laws.

  • The Certification Commission on Health IT will announce in June the first set of electronic health records systems that meet minimum standards.

  • The Health IT Standards Panel will recommend foundation standards and provide implementation guides this summer.

  • The four contract groups developing prototypes for a nationwide health information network architecture will provide draft architectures this fall and demonstrate their prototypes in December.

  • Brailer also has proposed exceptions to Stark anti-fraud and anti-kickback laws to let hospitals help physicians acquire health IT. That should increase health IT adoption among small physician practices by reducing their investment risk. The final changes will be finalized soon, he said.

    At some point, industry has to decide to walk through the door or the government has to decide to hold the door open and push people through it.'

    ' David Brailer, outgoing health IT coordinator

    The next national health IT coordinator will likely have it easier than outgoing coordinator David Brailer, who shaped the position from scratch, initially with no funding, to lead the federal effort to promote electronic health records.

    The challenges for the next coordinator, however, remain the same: accelerating adoption of electronic health records and ensuring portability of health information, Brailer said. Financing health IT also needs to take a higher profile, industry and health IT experts say.

    Brailer recently resigned his post, effective May 19, and anticipates that the Health and Human Services Department will have a new coordinator in place by the end of the summer. He expects the health IT efforts underway will stay the course.

    Bully pulpit

    For two years, Brailer used the bully pulpit in a grueling schedule crisscrossing the nation, giving speeches to help fuel and focus the groundswell for electronic health records and other health IT. Brailer said he hopes that HHS can limit the public communications activities for the next coordinator.

    'My ability to move Washington was based on my ability to produce a groundswell, traveling around to meet every group known to mankind because I didn't have any other tools,' Brailer said.

    Now with contracts and relationships with collaborative groups established and funding in place, the task should be smoother for the next coordinator, said Rod Piechowski, vice president for technology leadership at the National Alliance for Health IT, an industry group. 'The coordinator's role will evolve. Start-ups are always challenging.'

    The new coordinator will benefit from early support for the foundation work, Brailer said of the presidentially appointed position.

    'We've gotten much deeper buy-in and support than what I had hoped for. We've solidly set a foundation that I think we'll be building from for a while,' he said.

    The next coordinator will step chiefly into a management role, Brailer said. The coordinator may be a fresh driver at the controls but will find those controls are already configured.

    'There are two years of promised objectives, where we must meet certain goals. This is a management objective now. They have got to deliver on the things that we promised we were going to do,' Brailer said.

    Under Brailer's leadership, HHS has awarded contracts to develop standards for interoperable electronic health records, product certification, a nationwide health information network architecture and evaluation of variations in state privacy laws.

    Those contractors are also collaborating with public and health industry organizations associated with the American Health Information Community to realize initial versions of systems to deliver electronic health and consumer-owned personal health records, biosurveillance and chronic-care management.

    To focus on what it would take to realize health IT adoption, Brailer brought government and private-sector voices together, said Stephen Badger, CEO of the George Washington University Medical Faculty Associates, a large physicians' group in Washington, D.C. 'As a result, the private sector is implementing governmental recommendations.'

    For example, several vendors are seeking certification for their electronic health record systems.

    Brailer embraced a guided market approach to health IT adoption, said Janet Marchibroda, CEO of the eHealth Initiative, a collaborative health care industry group. That approach has encouraged the formation and growth of more than 200 local, regional and statewide organizations, each working to link health care information at their level and eventually between markets, she said.

    The next coordinator will need to develop a more thorough plan and create national standards for patient authentication and confidentiality of medical information, said Jane Horowitz, vice president and chief marketing officer for the National Alliance for Health IT.

    Brailer's two biggest concerns are that the health IT adoption gap persists among small physician practices and that providers will be computerized but will not be able to share information.

    'They both are part and parcel of a health care system that delivers the next round of real value and improvement or it's just piecemeal and sporadic,' Brailer said.
    The lagging gap is the likely outcome in the absence of intervention by the federal government or states so small doctors' offices or community centers have health IT systems. Interoperability gives industry an option, if it chooses to do so, he said. The federal government is providing a pathway to make health information portable through standards, product certification and a nationwide health information network architecture.

    'At some point, industry has to decide to walk through the door or the government has to decide to hold the door open and push people through it. It's premature for that to happen, but at some point there are going to be some tough decisions,' Brailer said.

    Brailer built on his successes and gathered steam through his tenure, said Rep. Patrick Ken- nedy (D-R.I.), who has introduced health IT legislation. He started with no funding and no institutional power but a mandate to move bureaucracies and the private sector. In the last year, his office has become institutionalized and Congress allocated it a limited budget.

    The administration deserves credit for talking up health IT and for promoting at least modest funding, but much more investment in health care infrastructure is needed, he said.

    'Investing in health IT could do for health care what investing in the interstate system did for the economic explosion of the '50s and '60s,' Kennedy said.

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