As you can tell from this week's cover story, something big happened in healthcare information technology last week. I don't know of anyone outside of the upper echelon of the Bush administration who can tell you for certain what that event was, but here is my best guess: Either the White House or HHS Secretary Mike Leavitt grew impatient with the lack of progress being made by healthcare IT coordinator David Brailer, who has been relying mostly on the private sector to devise his dream of a web of interconnected IT systems.
Thus Leavitt took over the process, announcing he will lead a new public-private panel to design a national network, create standards for interconnectivity of IT systems, establish a certification process for software and test some prototype systems.
Excuse me, but isn't this what Dr. Brailer is supposed to have been doing for more than a year?
Back in early 2004 Brailer had all the momentum behind him. President Bush had set a goal of a national electronic medical record within 10 years, the media were interested and the industry was eager to help. Brailer was even seen by our readers as the most powerful person in healthcare.
But after making some fine speeches, Brailer went quiet like a hunted submarine, while everyone in healthcare waited for his work product. He did make a call for public comment about the form and function of the proposed national health IT network. When he announced the results last month, however, they read like one of his speeches, one he could have made before this whole thing started.
Indeed, that was the finding made recently by the Government Accountability Office, which said that although some steps have been taken to develop a strategy for adopting health IT, little had been done to spur the kind of market-based institutions the administration has been talking about as the centerpiece of its plans.
And those new institutions are just part one of a three-phase process the GAO says needs to occur but hasn't. Phase two involves investment in clinical management tools and capabilities, and phase three supports the transition of the market to robust quality and performance accountability.
Significantly, the GAO said Brailer hasn't looked hard enough at the work already done on health IT by the departments of Defense and Veterans Affairs. Nor has he glanced at the efforts of other countries that are further along than the U.S. in developing such systems.
To be fair to Brailer, he was never given all of his promised funding. Given what he did have, however, surely more could have been done. His cherished private sector remains a byzantine set of IT interest groups, each duplicating all or part of what others are doing, though some are better funded and organized. I keep having to look up which group is which, be it the eHealth Initiative, Snomed, DICOM, the Medical Records Institute, the Certification Commission for Healthcare Information Technology, Health Level 7 or any of the other organizations either supporting or directly involved in the puzzle of designing a national health IT system.
Now Leavitt wants to pick winners from this free-for-all. While the administration still favors the private-sector approach, if private industry isn't up to the task, Brailer told us that the winner will be the federal government, which will use its standards-making office to devise the technical IT standards that all providers seeking federal reimbursement will have to use.
From all the fawning being directed Leavitt's way from the industry last week, he's clearly got people's attention. Let's hope this is progress at last.
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