Brailer opens HIMSS06
David Brailer, MD
“American healthcare is embarrassingly deficient,” said Blackford Middleton, MD, chairman of HIMSS, this morning in his remarks welcoming attendees to this year’s annual convention in San Diego. “The overriding challenge is righting what is wrong while keeping what is excellent.

Middleton called for achievement, commitment, involvement and alignment in health IT. “I call for all physicians to embrace IT. I think HIT will, in fact, make it fun to practice medicine again.”

Middleton gave his remarks after a “fun” introduction that included a song and dance production of popular songs rewritten full of puns on health IT. He also introduced the keynote speaker, David Brailer, MD, PhD, national coordinator of HIT, to the audience that numbered in the thousands. 

“We are poised for one of the greatest changes in healthcare that America has seen in decades,” said David Brailer, MD, PhD, national coordinator of HIT. HIT can stand among such efforts as decoding the genome and the development of antibiotics, as a turning point. Putting the power of information in people’s hands when they need it is transformative with few rivals, he said.

“Our success is the success of the rest of the industry,” Brailer said. HIT is necessary to deal with the complex, medical decision making doctors face today. “So much of this is up to you,” he said. “We’re well along as a synchronized force. It takes an army to drive this change. That army is you. If you are here, you are by definition a leader of HIT.”

We’ve come a remarkable distance in the past two years, he said. The infrastructure being created will drive sustained and robust growth. Brailer cited the HIT standards panel that is working on creating a single cohesive set of standards, the Certification Commission for HIT that will result in sustained growing marketplace for HIT adoption, and a national healthcare information network (NHIN) that will result in an easy-to-use, cost effective system. (See “RHIO Symposium keynote sets forth aggressive timeline for a national healthcare information network.”)

“What remains to be done is much,” he said. A major step is including consumers in HIT efforts. Recent survey results show that only 30 percent of consumers know about federal HIT efforts and they are split about whether the goal is feasible. “We must bring consumers along and give them their rightful place in health information,” he said. It’s not enough for technology leaders, hospitals, nurses and other providers to gather and talk about what we’ll do for medicine. It’s not appropriate to not have consumers involved. We need to shift our focus to bringing them along.”

Brailer said he hopes to avoid mandates and conditions of participation. In a press conference following the keynote address, he said that if we don’t succeed with the market model currently underway, mandates will come back with a vengeance and we will have lost all credibility.

“Only the marketplace can ensure that we have sustained innovation,” he said. “A marketplace approach will result in faster and bigger change because it aligns the key drivers. We have ensured that the federal government will not build, own or operate the infrastructure of America’s health information.” A market-based program is in everyone’s interest and this is the group that can make this happen, he said.

Brailer in his keynote address also discussed the fact that previous attempts at health information networks failed. The costs of technology communications in the pre-internet era were prohibitive. However, RHIOs are coming together in every community without prompting and enthusiasm continues to grow. RHIOs have made remarkable efforts and “moved forward independently with great courage,” he said. “It’s time for us as a nation to support the maturation of our RHIOs.” To that end, Brailer has set forth the following goals for RHIOs over the next three years:

  • Every state will have a RHIO
  • Those states that have more than one RHIO will have one overarching, coordinating RHIO
  • RHIOs should meet a minimum set of standards for governance, standards, function and transparency
  • RHIOs should follow the principles, goals and practices of the American Health Information Community
  • RHIOs should define whether they have a business case or that they are a public good—either way, they should be financially sustainable

Brailer also plans to undertake efforts to work with RHIOs and create a body of work that will move RHIOs to full maturation. He plans to gather information about existing RHIOs, and then analyze those findings to determine best practices. This effort “represents a final, big piece of the infrastructure we need to deploy HIT,” he said. “We are past the beginning, we are now in the broad middle stages. The vision is becoming a reality. All of us have an opportunity to do something that is quite unique.” 

In the press conference following the keynote, Brailer admitted that he initially did not believe that the nation’s interoperability solution would be a network of regional networks. He said he views RHIOs as being essentially required to provide governance and public oversight. The public governance process is what people can put their trust in.

The goal for the [National Healthcare Information Network] is to allow those who don’t want to do that not to have to. “We’re not going to tell RHIOs that they have to use the NHIN,” Brailer said. When the NHIN is available, Brailer said RHIOs will have a choice to make. “The bottom line is that the nation’s network in the future will be a hybrid of regional networks which are tied to a national network or a national network that pipes directly into physician offices.” Either way, he wants to make sure that every citizen has a local, state-level governance process. However, he said the NHIN is a work in progress and won’t just all of a sudden be ready to use one day. “What we’ll see is a trickle of innovation.”

The HIT budget for 2007—$116 million—essentially is funding for the efforts already on the table. There is nothing new programmatically that we don’t have largely underway right now with the exception of the RHIO piece, he said.

When asked about the SureScripts announcement of the development of an electronic medication record, Brailer said the little he knows about it at this point “seems to be in favor of the kinds of things we’d like to see the private sector do. I hope it’s met in kind by other companies. It’s clearly the first step of mobilizing the low hanging fruit.”