This past week I was fortunate to sit in on a conference call that Don Berwick, MD ran with David Brailer, MD, PhD, the National Health Information Technology Coordinator appointed this past April. Berwick sponsored the call for some of the Institute for Healthcare Improvement's program participants.
Brailer summarized the first report his group has put out, the Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care. (PDF)
Here's the essence:
One. Brailer's vision centers on the key consumers, patients and clinicians. The system should be portable and should enable choice. It should: enable access to geograpically distant specialists, improved management, a better functioning market, dealing with fragmentation and misaligned incentives. There was a heavy emphasis on longitudinal information (i.e., following the patient over time) both here and throughout his discussion.
Two. How are we going to make this happen. Brailer emphasizes standard setting a lot, but here he also discussed what he called a "sleeper," the amount of money the Federal government already spends on health care information technology. He estimates that it's about $1.7 billion. That's a lot of leverage. (Think about it, if the Federal government said we expect all those who care for active duty military personnel, their families, veterans, and Federal employees to use systems that met certain standards ...)
Three. Goals include:
a. Informing clinical practice, i.e., bring information and information tools to the professional rather than to the site or institution (Brailer's emphasis). This includes providing access to every MD. It also includes establishing incentives for adoption, including grants, contracts, loans, changes in the Stark anti-kickback rules, pay for use (think of IT as just another clinical technology), and pay for performance.
He also discussed reducing the risk of failed system implementations (more on that later) and promoting use in rural and underserved areas.
b. Inter-connecting physicians. If we deploy IT, but still provide care in "silos," we will have lost a substantial opportunity. The most important lost opportunity is, again, following the patient longitudinally. He also discussed -- and emphasized regional collaboratives and the need to start in more than one or two systems. Systems should be "somewhat standardized" and not just the result of organic growth. There must be interoperability between systems.
c. Personalizing care. Brailer mentioned that this was the third goal in sequence, not priority. A personal health record should enhance personal choice, provide performance information, enable the use of telehealth services.
d. Improve population health. This includes public health surveillance, quality and health statistical monitoring, and support of clinical trials and research. He believes that the time for drug trials can be reduced by years.
Brailer expects this work to take five to ten years, which sounds about right. They are now working on establishing priorities and should have something out next month.
Brailer makes a lot of sense and this is where the Federal government is going now. My guess is that even if Kerry replaces Bush, there won't be much fundamental change in the direction of Federal policy. At the most macro level, this whole area is one of the few "win-win" areas of policy these days. So government officials of all stripes are looking to get on the bandwagon.
Of course, New York is going nowhere near the same direction. Instead New York is reinforcing all of its old dysfunctions most notably having hospital "silos" as the center, if not the only part of the system. While Brailer talks about regional collaboratives and getting clinical information to clinicians, we in New York talk about sending money to individual hospitals with no requirements that they interact with anyone outside their walls.