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Time for Feds to Stand and Deliver on Health IT, Brailer Says

JUNE 7, 2006 -- Lauding the private sector for "remarkable progress" in moving toward common standards for health information technology (IT), the federal government's former top IT coordinator said Wednesday that the time has come for Uncle Sam to step up to the plate too.

"It's now time for federal agencies to start doing their piece," former National Coordinator for Health Information Technology David Brailer said in a speech to health IT executives in Washington. "We have announced a market-based strategy for making health IT work," Brailer noted. "If we're going to have that happen, it has to start around the purchasing habits of the agencies themselves."

"The federal government has to be the first in line to be able to do this. And this means that agencies have to be able to look at their contracts, how it is that they procure services from health plans, from doctors, from hospitals, from other suppliers," Brailer said.

Also key is how the federal government invests in its own systems, how it purchases health coverage, and how it awards grants, he added. "We're at a point where we have tough decisions to make," Brailer continued. "The standards are complicated, but the decision . . . to turn those standards into purchasing behavior" is a matter of will.

Brailer expressed hope that when the first round of common standards are articulated this September by the Health Information Standards Board—an industry group that coordinates the standard-setting process—government officials will "rapidly take those up into the internal systems, into the contracting, into the benefits purchasing of federal agencies."

If the federal government doesn't do so, it lacks the means to lead in implementing IT, he said. Standards-based purchasing "is something the agencies are committed to, but you have to join with me to redouble those efforts, to make sure that this happens," he added. "Our ability to make sure that the federal government walks the walk and not just talks the talk is going to be a critical factor in our ability to do this."

Brailer suggested that if government purchasing isn't based right away on common standards as they emerge, their adoption could take five to seven years rather than a year or two. The first sets of standards emerging from the Health Information Standards Board will deal with summaries of medical histories, secure messaging, and lab results, among other health information.

"This next six-month period, where we begin looking seriously at how it is that this happens, will be one of the critical events in the life of health IT in the United States," Brailer said.

In an interview after his speech, Brailer predicted that Congress would pass and President Bush would sign legislation this year aimed at speeding the adoption of health IT. Brailer has expressed concern in the past about legislation hindering current government and private sector efforts. But he expressed confidence Wednesday that drafters of health IT legislation will keep that from happening.

The West Coast–based Brailer, who resigned for family reasons, predicted that his successor would be in place by the fall. Brailer, who is heading the search committee to find his replacement, said names of potential successors would be forwarded to the White House in July. But he said there is no short list of names yet.

Brailer said he isn't worried that the process of finding a successor will hinder health IT adoption, saying the Department of Health and Human Services is strongly committed to furthering the technology. He noted that in his current role as a consultant, he is still spending half his time assisting federal health care IT efforts.

Centers for Medicare and Medicaid Services Administrator Mark B. McClellan also addressed the conference, which was sponsored by the Healthcare Information and Management Systems Society.
McClellan said CMS is working hard to develop systems of quality-based payment for Medicare, saying that when providers get paid more for higher quality, they find it much easier to make investments in IT.

McClellan also listed a number of federal pilot projects planned or under way to promote quality-based payment and the use of health care IT. The pilots include efforts to widen the use of handheld computer devices among doctors to prescribe drugs and guard against inappropriate prescribing and grants to encourage the formation of regional networks to speedily transmit electronic health care data. Another pilot aims to develop electronic health records for Medicare beneficiaries, he said.

Quality improvement organizations, which contract with Medicare to improve the quality of care in the program, have recruited 3,500 medical practices to take part in a project to spur health IT adoption by physicians, he noted.

But McClellan said the greatest force for spurring health care IT adoption is "our consumers." The administration is seeking to promote the availability to the public of information on the cost and quality of medical procedures, which in turn will spur providers to increase use of health care IT, he suggested.

McClellan added that final regulations would be issued in late summer allowing hospitals and other health care organizations to donate computers, electronic health record systems, and electronic prescribing hardware and software to doctors without running afoul of federal anti-kickback legislation. The current concern is that such a practice could be seen as illegally inducing referrals of patients or recruitment of enrollees.

In prepared remarks to the conference, Sen. Edward M. Kennedy, D-Mass., urged IT executives to work with him to ensure that the Senate version of IT legislation (S 1418) prevails in any House-Senate conference.

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