far, three IT trade associations have responded and formed the Commission of Health Information Technology to set standards for health-care IT tools, such as EHRs. In January, eight vendors -- IBM, Microsoft, Oracle, HP, Cisco, Accenture, Intel and Computer Sciences -- agreed to pursue open technology standards for building a national health information network, and formed the Interoperability Consortium to speed standards development for the network.
But automating such a large industry so quickly is a daunting challenge. In a speech before the Healthcare Information and Management Systems Society in Dallas in February, Brailer talked about progress but focused on hurdles.
"First is an adoption gap. My concern is not low EHR adoption, but variable EHR adoption," he said. Citing the growing disparity between the few large group practices with EHRs and the many solo practices without them, Brailer pointed to the lack of a level playing field that would allow all practices to adopt EHRs and benefit from automation.
He also cited the growing amount of proprietary data in the health-care world at a time when both the private and public sector are pushing for interoperability.
"If interoperability is not solidified and built into EHRs, a generation of investment will be lost, as will an opportunity for fundamental improvement in care delivery," he warned.
The third problem, according to Brailer, is privacy and information control. He emphasized the benefits of IT over paper as a means for information security, but acknowledged that when it comes to privacy, most people don't understand how IT can be preferable to paper.
"We need to be disciplined about developing the business rules, policies and protections that get consumer health information where they want it -- immediately -- and keep it from going where they don't -- ever."
Legal problems also loom.
Writing for Health Data Management, Joseph Goedert echoed concerns voiced by many that existing laws could impede progress in information sharing. "Providers believe anti-kickback provisions in federal laws -- particularly in a law known as Stark II that restricts physician referral practices -- prevent large provider organizations from helping affiliated smaller ones to automate," he wrote.
Others, including Brailer, have expressed concern about state laws that prohibit certain types of information sharing.
Footing the Bill
Finally there's the political situation with moving health-care IT to the front burner. In a lengthy examination of the issue, Goedert urged the health-care IT industry to give Brailer better support and step up its lobbying efforts. Goedert observed, in the February issue of Health Data Management, that Congress has introduced various pieces of legislation to kick-start the adoption of data standards for interoperability as well as authorizing funds ranging from $100 million to $2.5 billion spread over many years, but noted that authorizing funds isn't the same as getting them appropriated.
Brailer hopes to channel the $4 billion the federal government spends annually on health-care IT through the VA, DoD and other agencies to stimulate the market for interoperable health-care IT. He said nearly two dozen federal agencies are working together to align health-care IT across government.
And some federal money is being freed up to stimulate health-care IT projects directly.
President Bush proposed $100 million in fiscal 2005 to cover project grants through the Agency for Healthcare Research and Quality, and projects attached to Brailer's office. In November 2004, however, Congress deleted the $50 million meant for Brailer's office. The administration asked Congress to restore the $50 million.
Though at press time the issue was still unresolved, many saw the cutback as a sign that the administration wasn't pushing hard enough to support health-care IT. Newt Gingrich, former speaker of the House and founder of the Center for Health Transformation, told The New York Times the loss of financing support was "a disgrace" given the administration's previous statements.
And some have questioned the overall size of the administration's request given the industry's size. The Lewin Group estimates the cost of implementing EHRs nationwide to be $27 billion to $50 billion.
The administration has requested $125 million for fiscal 2006.
In October 2004, the HHS also announced $139 million in grants and contracts to promote health-care IT. Some of the money is going to small and rural communities, hospitals, providers and health-care systems to help them develop and use IT in health care.
Whether the Bush administration's push for standardized EHRs and a national health information network is derailed by the current setbacks remains to be seen.
In November 2004, Brailer's office issued an RFI asking whether and how a national network could be developed. Some advocate a large central data repository for EHRs. Others push for data storage at multiple regional sites. Still others see a distributed storage solution -- where the generating party maintains each piece of the patient record -- as the best approach. Everyone agrees the federal government should not impose a one-size-fits-all solution to the network.
Whatever the solution, the need for change is clear, said Brailer. "Health-care costs continue to rise, our population continues to age and the epidemic of medical errors is unabated," was his bleak assessment of the situation.
But he added hope: "Health IT has shown a challenged but resilient industry that there is hope for change, and that hope doesn't have to come from the top down but from the inside out. Health IT is not just about better treatments for the ailing and ill among us, nor just for all of us who want to prevent or limit illness in its early stages. It is ultimately about treating the industry itself so that we can have not only the best science, infrastructure and professionals in the world, but also the best value, safety and productivity."