Users from the health care community said the resignation of the Bush Administration’s point man for health IT is unlikely to seriously hurt the national move to adopt electronic health records.
But they stressed that whoever replaces David Brailer, the former National Coordinator for Health Information Technology, needs to focus on showing tangible results from the effort and foster closer collaboration between the government and doctors.
Brailer was appointed by President George W. Bush in May 2004 to help lead the move from paper-based health records to electronic medical records (EMR). He was a high-profile advocate of the use of EMRs and of forging the standards and infrastructure needed to exchange them.
John Wade, CIO at Saint Luke’s Health System Inc. in Kansas City, Mo. said Brailer’s departure might actually speed up the move toward a national health information infrastructure (NHIN), if his successor pushes EMR use in more physician practices and fosters regional health networks.
Brailer did a “spectacular job” of building awareness among the public and Congress of how big an effort the move toward EMRs is, Wade said. “He’s the one who had to be the ‘standards advocate,’ while at the same time navigating the political issues to gain and sustain momentum,” he said.
Still, more recently, Brailer appeared to have reached a plateau politically, Wade said. “The time for talking is past and the time for action and getting results is now. There has to be some real results shown, at a local, state or regional level for Congress and the public to remain behind the issue.”
Mark Frisse, a professor of biomedical informatics at Vanderbilt University who is working to develop a regional health information organization (RHIO) in Tennessee, said Brailer brought a human face to obscure and intangible issues “with little legislative authority or funding. The health care IT horse is out of the barn, and sufficient consensus exists that rapid acceleration is possible.”
The new coordinator should foster stronger collaboration among the various federal agencies, he said, and execute on the initiatives Brailer helped start, including: contracts for building a NHIN, a commission for certifying EMR technology standards and research to ensure patient privacy.
“People want a coherent view of the federal government and a sense that agencies are working together to address critical needs,” Frisse said. “States are going to be critical in the next stage of evolution, and collaboration on state initiatives seems important.”
J. David Liss, vice president of government relations and strategic initiatives at the New York-Presbyterian Healthcare System, said the new coordinator should have experience in a large-scale health care operating environment and credibility with the informatics community. In addition, Brailer’s successor must address the emerging policy within the federal government that sees health IT efforts mainly as a way to report on physician performance.
“Clinicians may view health IT more negatively if they perceive the technology’s main function as aggregating and reporting data from their practices,” he said. “This does not make the doctor’s work easier, it merely supports another regulatory burden. The next coordinator should consider the potential wedge ‘pay-for-performance’ may drive between doctors and information technology.”
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