The near monolithic public support for the information technology agenda of David Brailer, HHS' national health IT coordinator, is showing signs of cracking.
Following the Oct. 6 disclosure of three HHS contract winners, Brailer's effort is attracting some criticism. One contract awarded concerning privacy has detractors among those concerned about patient privacy rights, while another contract not yet awarded was questioned by Cerner Corp. President and Chief Operating Officer Neal Patterson.
Brailer's office declined to comment on the criticism.
The formal request for proposals on the privacy contract repeatedly refers to challenges to health information exchanges posed by state laws. Under the Health Insurance Portability and Accountability Act, the states may-and many did-enact more stringent controls than those in HIPAA. The RFP calls for the winning bidder to find ways to reconcile the differences between state and federal laws while somehow maintaining the same level of privacy coverage (Oct. 10, p. 8).
But Emily Stewart, a policy analyst with the not-for-profit Health Privacy Project, is skeptical. "We're really concerned that this is going to lead to weakening the privacy protections," Stewart said, which could sap public support for electronic healthcare records overall and derail progress.
Patterson's remarks came during an Oct. 8 keynote address at an IT forum Cerner hosted in Orlando, Fla. The software company executive was talking about the regional health information exchanges, or RHIOs, favored by Brailer as the building blocks of a national IT network (See related story, p. 34).
"I think we need to debate (IT) architecture," Patterson said, adding that IT architecture can be like religion, with devoted adherents to different forms, "but unlike religion, it can be proved" through computer simulation.
Patterson said one RHIO model is an employer-sponsored IT network Cerner has spearheaded in Kansas. Another, SharedHealth, is a for-profit joint venture Cerner is developing with Blue Cross and Blue Shield of Tennessee. "That's a RHIO, but it's not his model," Patterson said. "His model is basically Beltway bandits. Brailer has aligned himself with the grant babies."
Also, Patterson accused Brailer of preaching interoperability but not coming out foursquare for a national patient identifier. "You can't have interoperability without a national ID," Patterson said.
Several industry IT groups support a national patient identifier.