Brailer promotes EHR

DALLAS -- Dr. David Brailer, the national coordinator for health information technology in the Department of Health and Human Services, said he views the ability to share clinical data across the health care industry as key to development of a nationwide electronic health records (EHR) system.

But Brailer, speaking here at the annual Healthcare and Management Information Systems Society (HIMSS) conference, said that in much of the health care industry -- the nation's largest industry in terms of revenue and share of gross national product -- data sharing "is not readily available" because of proprietary standards in health care IT. Data sharing, Brailer added, is essential to development of an electronic health record in the next 10 years, a goal set by President Bush last year.

The health care industry also faces what Brailer described as an "adoption gap" of electronic health records by clinicians, with small medical groups and sole practitioners lagging behind the large medical groups, which include 50 or more doctors and hospitals. Brailer said the health care industry, with the assistance of the federal government, needs to "level the playing field" for EHR adoption so all clinicians can use the technology.

HHS last month received more than 500 responses to a request to health care industry for its thoughts on the design and development of a National Health Information Network (NHIN) meant to facilitate exchange of health care information nationwide while protecting patient privacy.

Brailer said a multi-agency federal task force comprised of representatives from 30 agencies and departments, including the Department of Defense Military Health System (MHS), the Veterans Health Affairs (VHA) division of the Veterans Affairs Department and HHS, are helping to evaluate the responses with a report due this spring.

A quick first look at the more than 500 proposals for the NHIN show some common themes, Brailer said, including an emphasis on development of a "central set of standards" for EHRs and interchange of data between health care providers. The NHIN respondents in general also called for development of the NHIN on a regional basis, with nationwide interoperability to support a mobile population.

The NHIN proposals leaned towards the use of the Internet as a backbone, with robust security to insure patient privacy, Brailer said. Financing proposals for the NHIN envision a private/public partnership, Brailer added.

Brailer hailed DOD and the VA for blazing the trail for development of a nationwide EHR with systems deployed decades ago and now a routine way of doing business in both departments. Speaking at a press conference here, Navy Capt. Robert Wah, the MHS information technology director, pointed out that the Pentagon's electronic health care system is so advanced "that you cannot find a prescription slip in our hospitals," with prescriptions automatically handled by the DOD pharmacy data system. This system, Wah said, checks a patient database to insure a new drug will not cause an adverse reaction with another one the patient is already receiving, and has "identified and prevented 130,000 [adverse] drug interactions."

Dr. Robert Kolodner, acting CIO for the VHA, said at the press conference that since the VA first deployed its Veterans Health Information Systems and Technology Systems and Technology Architecture (VISTA) almost 20 years ago, the VA has created electronic patient records for millions of veterans, with those records capturing and storing an additional 1.5 billion orders for drugs, tests, x-rays and other items.

Brailer urged the rest of the health care industry to work on development of a nation-wide EHR with a sense or urgency, saying the industry and federal and state governments need to act this year or next because "health care costs continue to rise [and] the epidemic of medical errors continues unabated."