The nation's new healthcare IT czar isn't granting interviews just yet, but if physician informaticist David Brailer, M.D., follows his own advice, his diagnosis and treatment plan for some of the nation's healthcare IT ills is available for interested physicians to review online.
In October, as a senior fellow for information technology and quality of care with the San Francisco-based Health Technology Center, Brailer authored a 42-page policy paper for the California Healthcare Foundation, "Use and Adoption of Computer-based Patient Records." Click here.
Brailer notes a first task is to set a baseline for current levels of adoption of electronic medical records system.
Despite numerous studies on EMR penetration, including those conducted by the Healthcare Information Management Systems Society, the Medical Records Institute and Modern Physician (in partnership with PricewaterhouseCoopers), Brailer concludes that due to various internal biases ? lack of random sampling, for example -- their findings should be reported only with "due caution."
Sternly, he advised that "study design raises serious questions about the reliability of nearly every study we examined and whether conclusions can be drawn from (them) individually or as a whole."
In fact, merely defining just what constitutes an EMR is part of the problem. Brailer himself chose the label computerized-patient record, or CPR, but listed 12 other possible names for the record systems and concluded that confusion "contributes to conflicting information about whether these tools are used by clinicians."
Brailer, as has many others, identified the cost of EMRs and physician resistance to using them as "substantial and enduring" barriers to wider adoption.
"The policy challenge in many ways it not to make the benefits of CPRs more compelling, but to make the barriers less challenging," he said.
A key way of doing that is through wider adoption of standards that will provide for interoperability of medical records systems across hospitals, physician offices and other providers, Brailer said. But he said creating standards and the technological connectivity, while important, overlooks another necessary component of adoption, what he called "creating the demand for standards," which means getting physicians pushing for them.
What must be done is make "a clear case for how interoperability changes the daily work of physicians, patients and others in health care in a positive manner," he wrote. "As learned through the diffusion of the Internet, the widespread adoption of standards and interoperability may not only drive CPR adoption but will transform the very notion of the CPR."
Lyle Berkowitz, M.D., is the medical director of clinical information systems for Northwestern Memorial Physicians Group in Chicago, president of Back9 Healthcare Consulting, an IT consultancy, and contributing author to the American College of Physician?s book, "Electronic Medical Records."
Berkowitz said Brailer's writings show that he "gets" the EMR problem.
"First, he does not fall into the trap of simply accepting the wide-ranging reports and opinions about use and adoption," Berkowitz said. "Instead, he formally analyzes them well and recognizes that while they point to some trends, they are not full reliable and should not be used as the main means of making policy decisions. Furthermore, he suggests that public policy would benefit from improved study of the business process use and adoption of CPRs.
"Second, he fully recognizes the reality that the main barriers to CPRs are economic, in that neither physicians nor hospitals have a good business case to implement CPRs, since the return on investment is complex and not well aligned," Berkowitz said.
"He points out that CPR projects will be most successful if they are managed by large organizations (e.g. hospital systems) and that there is a growing CPR adoption gap between large urban centers that are using this model versus smaller and rural physician groups who are unable to adopt CPRs on their own.
"Brailer therefore suggests that the policymakers consider how to best enable those organizations to serve physicians, both legislatively and financially," he said.
