It's not that David Brailer, M.D., doesn't know what to do as the nation's new healthcare information technology czar. The question is, what comes first?
Just four days into his new job as the Bush administration's first national health information technology coordinator, Brailer was in Fort Lauderdale, Fla., at the 2004 TEPR trade show sponsored by the Medical Records Institute, and said he was still working on a batting order.
But while Brailer's plan is not set yet, his deadline for creating one is--late July, 90 days after Bush signed the executive order mandating the IT coordinator position and assigning the coordinator the task of developing a national plan to promulgate healthcare IT.
One administrative task near the top of Brailer's list is to identify all ongoing government activities that could have an impact on healthcare IT. "I don't have a baseline yet (for) what we're working with," he says. "The first thing I'm trying to figure out is what assets I have at my disposal."
In his keynote address to about 500 tech-savvy physicians and IT professionals at the morning general session of TEPR, or Towards an Electronic Patient Record, Brailer also asked the audience for help in several key areas.
First, he said the private sector should define a minimum set of EHR functions to set a floor for future government assistance to providers for IT initiatives. Also, he said he needed case studies demonstrating a return on investment in EHRs. The clinical case has been made for healthcare IT, he says, but "The amount of information about the economic benefits of these is poor at best."
Given that, Brailer says he sees a similar challenge convincing payers to participate in helping providers purchase IT systems. "I would hope health plans would see the opportunity to be the broker of the personal health record," he says. "I clearly am going to be calling on health plans to match or exceed the government's investment in this."
Brailer says he plans to turn the upcoming National Health Information Infrastructure meeting on July 20-23 into a platform for policy discussion as well as a vehicle to present his strategic IT plan. Brailer also is scheduled to address the National Alliance for Health Information Technology on June 16 in Chicago.
One challenge to rapid IT deployment that Brailer will face is where to focus government energy--at the hospital and large medical group level, or at groups of 10 physicians or less, where the bulk of patient encounters occur but where significant barriers exist. These include limited or no return on investment in IT systems and lack of support staff to roll out and maintain them.
"My personal view--and it's not policy--is it's time to address the physician issue head-on," Brailer says. "Physicians are the flexion point. It's time to work with those who directly are ready."
"(Brailer) understands the importance of physician involvement in development of this stuff," says Joseph Heyman, M.D., a member of the board of trustees of the American Medical Association and chairman of its EHR workgroup.
A gynecologist in solo practice in Amesbury, Mass., and an electronic medical-records system user since 2001, Heyman said he adopted his system with no government or payer assistance.
"For me, there was an economic imperative," he says, because he set up his solo practice in 2001 and bought his integrated EMR and computerized practice management system as a suite from the same vendor to cut office overhead.
Heyman says professional associations could help provide the technical expertise and advice that Brailer noted small groups and solo practitioners lack.
Samuel Bierstock, M.D., vice president of medical affairs for IT vendor Eclipsys of Boca Raton, Fla., , says he is impressed with Brailer's "ideas for very realistic appoaches" to promoting healthcare IT "coupled with a granular understanding of what it's like to practice medicine and the economic challenges to add IT to the practice of medicine."
David Kibbe, M.D., is director of the Center for Health Information Technology of the 97,000-member American Academy of Family Physicians and director of the CMS-sponsored Doctors' Office Quality Information Technology project, which aims to bring IT to small and medium-sized physician groups.
Kibbe, who huddled with Brailer on several occasions during the conference, said he was pleased to hear Brailer say small group practices should not be left behind.
"I think for the first time the (IT) agenda is being driven by the physician," Kibbe says.