Problems with the nation's error-prone healthcare system include a culture of low expectations, a lack of public trust and a design that relies on the heroic efforts of individuals to overcome its flaws, said National Coordinator for Health Information Technology David Brailer, M.D., while speaking at the American Board of Medical Specialties interim assembly meeting Thursday in Rosemont, Ill.
"We just can't ask physicians to do more and more and more," Brailer said, especially when these same physicians are being paid "less and less and less."
Errors and inefficiencies have become an accepted part of a broken system that lacks portability of data and can't keep up with scientific and technological advances, Brailer said.
Compounding matters is that the system lacks "a foundation of public trust" upon which it could build its quality-improvement efforts, he said. And while most members of the public trust their own personal physicians, they now distrust doctors in general and trust health plans and the government even less, Brailer said.
Where technology can play a role in turning this around is by giving patients ownership of their own health records and making sure they can see and understand all the information those records contain, he said.
"This is about the information and the information is about transparency," Brailer said. "In black and white, no questions asked, the data belongs to patients."
This means physicians must relinquish ownership of records and become "stewards" of the information -- doing away with the traditional paternalistic relationship between doctors and patients, he said.
Brailer also gave examples of how technology is already being used to transform healthcare. Specifically, he highlighted how Kaiser Permanente's use of IT alerted the Food and Drug Administration to the increased risk of heart attacks and strokes in patients using Cox-2 inhibitor drugs; the Veterans Affairs Department's use of bar-code scanning has led to a dramatic reduction in medication errors; and relief teams were able to create a prescription drug database for 80% of Hurricane Katrina evacuees within seven days.
Brailer praised regional efforts such as the Indiana Health Information Exchange, which links 14 healthcare facilities operated by five hospital systems with a clinical messaging service that provides a single source for laboratory/pathology, radiology and electrocardiogram reports; transcriptions; and information on emergency department encounters.
Brailer also said he was excited about emerging remote-monitoring technology, which could make it feasible for at-risk patients to live at home and avoid the need to place them in an institutional setting.
President Bush has set a goal for most Americans to have their own electronic medical record by 2014, and Brailer said that should be achieved.
"I don't worry about it happening, because it will happen," he said, adding the key is to make sure the transition from a paper to an electronic system is smooth and that the government doesn't "mess it up."
He defined messing it up as a system in which patients can't get access to their health records and physicians can see only part of the picture.
Brailer used candor and humor to answer a question about how interoperability standards would be developed. He said there are more than 35 standard-setting organizations with overlapping areas of expertise, and he described them as "pseudo-proprietary organizations battling over turf."
To focus the efforts of these groups, he said a "harmonizing" organization will be named next week.