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April 18, 2006
Analysis: Health IT czar touts Bush plan
Analysis: Health IT czar touts Bush plan | UPI
Analysis: Health IT czar touts Bush plan
By Olga Pierce
UPI Health Business Correspondent
Apr. 18, 2006 at 11:47PM
The Bush administration is pursuing a "guided market" approach to encouraging doctors and hospitals to adopt healthcare information technology, health IT czar David Brailer said Tuesday.
"I really had a profound distrust of the government getting close to individual health information," Brailer said at the World Health Care Congress. "Now I'm in the government -- and they're nice people -- but I definitely don't want them anywhere near my medical records."
The guided market approach will involve bringing together stakeholders, certifying vendors, and increasing the coordination of government agencies and quasi-government bodies, said Brailer, who was tapped by Bush to be the country's first-ever national health IT coordinator in the Dept. of Health and Human Services. What it will not involve at any early stage is legislation establishing standards for IT products.
The end goal is a system with free-flowing, portable information readily available to consumers, he said, but market forces alone cannot accomplish that because of imperfections in healthcare markets, and especially the non-competitive way much of healthcare is financed.
"We can't simply ignore the market forces that put us in the position we're in," Brailer said.
The process of establishing a basic framework in which the market can function is already underway.
One of the early steps in the administration's strategy, Brailer said, was getting federal government agencies, which were like "puppies in a bag" to coordinate their efforts.
"We can't have 35 agencies creating their own health information technology networks," he said.
Under Brailer, the nation's Regional Health Information Organizations (RHIOs), quasi-public bodies established to bring together healthcare providers, payers and consumers to work toward establishing healthcare IT infrastructure, are being increasingly coordinated so that they know what the other bodies are doing -- and can learn from each other's mistakes.
Also nearly complete is a certification system for health records for ambulatory care, he said. "I think certification is a precursor for a market that is developing."
In the market, he said, which because of its relative newness is still risky, he said, purchasers of health IT need government help to make sure they "get what they think they're buying."
"Breakthrough groups" of experts will be unveiling wide-ranging recommendations to jump start telemedicine, e-prescribing and electronic health records. In addition, grants will be disbursed to states so that they can update their privacy laws to both enable electronic records and protect patients' privacy.
To advance the goal of price transparency, projects are underway to publicly reveal quality and price information about healthcare providers in ten to 12 markets, he said.
Government-established standards are off the table, he said, because legislators could get standards wrong and the legislative process is too slow to keep up with rapidly changing markets. They could also leave companies that have already heavily invested in the healthcare equivalent of Betamax videos in the lurch, Brailer noted.
Furthermore, as the United States increasingly adopts healthcare IT, it will account for a greater and greater share of the global market, and regulatory decisions in the United States could have repercussions in other countries.
At the end of the adoption process when 65 to 75 percent of providers are on board, however, mandatory health IT could be useful to encourage stragglers, Brailer said.
"The real power (of healthcare IT) is to take fragmented and episodic care and make it continuous," said Robert Pearl, CEO of the Permanente Medical Group, and from the payer end, doctors can be encouraged to use more technology through changes like insurance coverage of online communication with patients.
Having the leadership of Brailer at a top level is useful, said Glenn Steele, president and CEO of Geisinger Health Systems in rural Pennsylvania and chair of the section for health care systems at the American Hospital Association. But economic incentives for small practices and healthcare systems, the building blocks of the healthcare industry, need to be created so that change also occurs from the bottom up.
"If we start paying for results, this will be adopted very quickly," Steele told United Press International.
While the administration's efforts to date have resulted in movement toward coordination, their success is anything but certain, Brailer said.
"These institutions are not done. They could fail...but we've gotten them underway."
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