ROI is not the right question to ask here in the short term. The bigger question is, how do you strategically position your organization to play in a healthcare market that is increasingly moving toward transparency, towards quality accountability and toward incentives for quality. -David J. Brailer, M.D., Ph.D.
The U.S. has made major strides in the implementation of healthcare information technology (IT) in the last several years, and while much work remains to be done, the future of healthcare IT in the country looks promising.
That’s according to David J. Brailer, M.D., Ph.D., the former head of the Office of the National Coordinator for Health Information Technology (ONCHIT). Dr. Brailer sat down with Imaging Technology News content partner AuntMinnie.com in July 2006 to reflect on his accomplishments in guiding the nation’s drive to digital technology and to discuss what remains to be done to spread the adoption of electronic health records (EHRs).
Recent statistics indicate that over the last two years adoption rates of healthcare IT have grown by about 30 percent, Dr. Brailer said. Pioneering the trend are big hospitals, integrated healthcare delivery networks and large physicians groups, which are far along in implementing EHRs and automated patient care environments. These organizations have the financing capacity and knowledge to make healthcare IT work, Dr. Brailer said.
Another positive trend is the recognition by federal, state and even local agencies that government can play a positive role in healthcare IT adoption. "The government is really seeing its role to push [healthcare IT] along, and more and more it is becoming something of great interest," Dr. Brailer said.
Although some large healthcare organizations in the U.S. have made good progress, in general the U.S. is still lagging other nations in implementing healthcare IT. Nations in northern Europe have a 20-year head start on the U.S. in healthcare IT implementation, while countries like Great Britain and Canada have been making major strides in rolling out EHRs on a national level.
The U.S. suffers by virtue of its heterogeneous healthcare system, with a mix of private and public delivery networks, but there are some examples of "closed" healthcare systems, like the U.S. Department of Veterans Affairs or large health maintenance organizations like Kaiser Permanente, that have the financial capability and the interest in controlling quality to implement healthcare IT.
Still, the U.S. is not totally behind the curve. Even countries that have had EHRs in doctors' offices for some time are struggling with how to make them clinically useful, how to use them to improve quality and how to protect patient data, Dr. Brailer said.
The U.S. also has an advantage due to the fact that it does not rely on a centralized system for allocating healthcare dollars. He points out that every dollar spent on healthcare IT in Great Britain has to go through an appropriations process, while the U.S. is able to spend both public and private money on healthcare IT with fewer restrictions – with aggregate spending far higher than both Britain and even all of Europe combined.
Among international projects, Dr. Brailer in particular likes the example of Canada’s Health InfoWay program. Rather than use a "command and control" approach, authorities have created what he calls a public interest social venture capital group that supports regional governments that are planning healthcare IT implementation.
“InfoWay is a nice mid-stage model between us and Britain, and I think there is a lot we can learn from that,” Dr. Brailer said. “Government’s role as a financer is to provide the capital, but not to control the process: to support innovation, to invest only where there is a chance for success and not because of some political necessity.”
Technology vs. Transformation
Dr. Brailer believes that a common misconception when pondering healthcare IT is to focus too much on the technology rather than transformation — that is, the ability of healthcare IT to transform the way healthcare is delivered. Healthcare IT really should be about changing how decisions are made, how workflow is conducted and how people relate to their patients.
There are signs that this shift has begun to occur, he believes. The segment of physicians who oppose healthcare IT has become more silent, while the segment in favor has become more vocal. Those in the middle are recognizing that the standard of care is changing — particularly those who were born after the introduction of the personal computer. These physicians are not going to tolerate the inability to perform computerized tasks at work that they can easily do at home, Dr. Brailer said.
Still, many large organizations implementing healthcare IT spend too much time focusing both on software and on another potential pitfall — return on investment (ROI). This can distract healthcare systems from recognizing the intangible benefits of healthcare IT, he believes.
“ROI is not the right question to ask here in the short term,” Dr. Brailer said. “The bigger question is, how do you strategically position your organization to play in a healthcare market that is increasingly moving toward transparency, towards quality accountability and toward incentives for quality. There the ROI starts to come in, and you become a leader in a huge inflection point in healthcare.”
Dr. Brailer believes his biggest accomplishment as the nation’s first healthcare IT czar was in raising the profile of healthcare IT and in making the country understand that it represented the future of healthcare. He also cites the establishment of the Certification Commission for Healthcare Information Technology, a private-sector group to certify healthcare IT products, the Health Information Technology Standards Panel and the early work that ONCHIT conducted on privacy.
“I viewed my role as the coordinator not to leave with another 100,000 electronic health records in place, but to leave with a coherent strategy and the institution and tools so that every new electronic health record in place was not a legacy investment — it fit in and it advanced the nation’s capability,” Dr. Brailer said. “That’s where I put all my time, in building the tools to make this happen, and I think we got it done.”
Brian Casey is an AuntMinnie.com staff writer.
For a full audio recording of the AuntMinnie.com interview with Dr. David Brailer, visit AuntMinnie.com’s Healthcare IT Digital Community at http://healthcareit.auntminnie.com