Medical breakthrough: Dr. David Brailer is moving the goal of electronic health records for most Americans, along with a national health information technology infrastructure, closer to reality.

Key points

* A national information technology infrastructure is recommended to help ensure patient safety and care and save money.

* The economic benefits of reducing medical errors through electronic health records go directly to payers.

* The cost of national health IT is estimated at $200 billion.

In April 2004, President Bush established a goal that most Americans would have an electronic health record within a decade. Dr. David Brailer, the first national coordinator for health information technology, said the government is nearly two years ahead of schedule in making that goal a reality.

Brailer is responsible for coordinating government agencies and private health-care companies in creating a national health information technology infrastructure. This infrastructure, including electronic health records, is recommended to help ensure patient safety and care, and save money.

According to a 1999 Institute of Medicine report, medical errors--many of which result from providers' illegible handwriting--account for as many as 98,000 deaths of hospital patients each year. Some studies estimate that a national health information network could save about $140 billion a year through improved care and reduced duplication of medical tests.

In one of his first tasks last year, Brailer studied options to create incentives in Medicare and other U.S. Department of Health and Human Services programs to encourage the private sector to adopt interoperable electronic health records.

Brailer recently talked to Best's Review about current health IT infrastructure initiatives and where they're headed in the next several years. The initiatives, he said, win have a significant impact on the health insurance industry, and he believes there are several critical things health plans can do to further those efforts.

Where does the nation stand today on the electronic health records front, and is President Bush's goal of widespread health information technology within 10 years still on target?

We're actually ahead of where we thought we would be by at least a year or two.

We're laid out a plan for the initial three years in terms of having market-based infrastructure, some adoption incentives and alignment of various parties toward key goals. And with the second meeting of the American Health Information Community [a federally chartered commission to provide input and recommend to the U.S. Department of Health and Human Services how to make health records digital and interoperable, and to assure that privacy and security of records are protected], we have largely come to where we thought we would be in February 2007. That reflects in part that things are moving faster than we thought they would, and that we underestimated how quickly things can move along when there's so much momentum and interest.

Will widespread implementation of electronic health records be an answer to curbing rising health-care costs, increasing access to care and fixing what many call a broken health-care system?

It will be part of the solution. Health IT can do a lot to reduce errors, save lives and improve health status, and that can go a long way toward saving money. Up to $100 billion a year is wasted in treatment of errors of unnecessary tests and procedures. Also, health IT can support much more fundamental changes in how consumers are involved in healthcare and how we can use the capacity and innovation in health care more effectively, which leads to more long-term infrastructure changes, similar to what happened in retail, banking and insurance.

Finally, for health IT to come about there will have to be some policy changes. We need to look at how doctors can treat patients remotely-things that have in the past been policy taboos. In order to bring about health IT, we're going to have a significant touch on a number of the key policy issues. It's by no means a magic fix. Health IT isn't going to deal with everything going on around healthcare, but it's a tool that gives us more options to address the issues in health care.

What will widespread adoption of electronic health records mean to the health insurance industry, and how are health plans helping on this front?

It will mean a big change. There are three areas of impact:

1) The economic benefits of reducing medical errors go directly to payers. If there is an error, the patient's care is more expensive and is paid for by employers and payers. One of the issues it raises is that doctors and hospitals have to put the technology in, so we need a way to get plans, doctors and hospitals to cooperate so that those with the financial benefits can help pay for the investments. Otherwise, those investments may never be made. We expect plans to step up to the plate.

2) We intend for health IT to level the playing field for consumers so they get personal health records, better access to performance data about physicians and hospitals, and more information about their treatment options. This will allow them to become true health-care consumers. Plans will have the opportunity to offer value to consumers in ways they haven't in the past, by providing personal health records and helping guide much more customized treatment decision-making for the consumer. On the other hand, it also will lead to new risks. There will be new life forms of health insurance that could threaten traditional models if the industry is not innovative.

3) It's really going to affect how we look at best practices, medical evidence, review of performance and all the complicated issues of ensuring that the end-result of care is good. I think IT can help health plans do a much better job of policing quality of care.

What should health plans be doing to help advance this front?

For one, they need to support physicians, hospitals and their networks as they adopt health IT. The Office of Personnel Management, on behalf of the Federal Employees Health Benefits Program, has already laid out in its call letter in April 2005, and will do so again this spring, the importance of health plans that participate in the federal program. We will keep emphasizing that health plans have the finance capability, the know-how and the scale to really help small physician offices and hospitals see their way through this.

We also want health plans to participate with regional health information organizations that share patient information locally. It's not just enough for a doctor to have an electronic health record. We want them to have a whole set of data in one place for each person. Health plans as customer-based organizations are the critical factor in getting that done.

Finally, we'd like to see health plans make sure every consumer gets access to a personal health record that can be accessed in real time and used to interact with his or her physicians. We also think it's critical for health plans to begin looking at how we support better surveillance, better monitoring of care quality, adverse events and pandemic bioterrorism events.

What are some barriers to developing a national health-information network?

There are a lot, particularly around technology issues, that need to be worked out. Also, consumers have significant privacy concerns, largely because the paradigm we use for privacy in this country is paper-based. It's not yet ready for the information age. We want to make sure our privacy paradigm is moved into digital medicine.

But there's also a Financial barrier. The cost of national health IT is estimated at $200 billion. The benefits over the decade, however, are estimated at $700 billion to $800 billion, which is a huge return. The problem is that costs accrue to doctors and hospitals, while benefits accrue to payers. We have to level the playing field so everyone wins, and we can get past this investment.

There are also challenges with helping physicians with small practices come along in the efforts. They don't have the depth of IT know-how, the management staff or capacity to re-engineer their businesses in the same way as large group practices.

What are your plan for the next several years in leading the charge for health-care IT and electronic health records?

We have three major categories that we're working on. First, we're laying down long-term infrastructure, which includes standards, certification of technology and national architectures (single ways of sharing data across the United States). We laid out contracts for those and are working on them. However, that will take a few years to get up and running.

Secondly, we're also working on new policies, whether it's waiving the Stark regulations [Named after Rep. Fortney "Pete" Stark, D-Calif., the law limits referrals by physicians to facilities with which they have a financial connection] or the anti-kickback rules to help promote adoption, new privacy paradigms or new issues about barriers to practice innovation, such as recognizing telemedicine or remote care as a legitimate form of care.

Thirdly, we're galvanizing specific achievements and breakthroughs. We want to make sure we focus not just on the big general pictures but on very specific things. That's why we've conveyed to the American Health Information Community breakthroughs around biosurveillance, e-prescribing, quality management and medication history for every consumer. Those are among the leading things we'll start focusing on right away as key drivers of change.

How have your past experiences prepared you for your current role?

Constitutionally, I'm a technology lover and a status quo hater. I like to see change and evolution. Health care, which is sometimes frozen in time, is one of the things that attracted me to this position. I'm also a physician who deeply respects doctors and hospital care as something that's necessary, so I understand the plight of hospitals and physicians. I'm also trained as an economist, so I understand the fundamental sociological and economic barriers that exist. I don't see this as an IT challenge, but rather it's about changing the professional, cultural, economic and social expectations of medicine. In a lot of ways, I've been training for this job my whole life.

Dr. David Brailer

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services

Appointed: May 6, 2004

Duties: Execute the actions ordered by President Bush in his April 27, 2004, executive order, which called for widespread deployment of health information technology within 10 years to help improve safety and efficiency.

Prior positions: Senior fellow at the Health Technology Center in San Francisco; chairman and chief executive officer of CareScience Inc.; physician.

Major accomplishments: Recognized leader in strategy and financing of quality and efficiency in healthcare, with particular emphasis on health information technology and health systems management; established the nation's first health-care Application Service Provider; designed and oversaw the development of one of the first community-based health information exchanges in Santa Barbara County, Calif.; among the first medical students to serve on the Board of Trustees of the American Medical Association.

Education: M.D. degree, West Virginia University; Ph.D. degree in managerial economics, The Whartan School.