I spoke with David J. Brailer, MD, former federal healthcare IT czar for the Office of the National Coordinator (ONC), last Friday about ARRA, meaningful use criteria and the challenges the industry faces in 2010 and beyond. Read the article in Healthcare IT News.

Here, I want to focus on what Brailer identified as some of the challenges the industry faces in 2010 and beyond.
Despite the plethora of EHR solutions flooding the market, there's a still a gap for cost-effective solutions in the one-to-ten physician group market, he said. While he appreciated the effortsof the partnership between eClinicalWorks and Wal-Mart to bring a cheaper access model to the technology to market, vendors are still charging to cover the true cost, he said.
Right now, there's more technology than physicians can handle, Brailer pointed out. As founder and chairman of healthcare investor firm Health Evolution Partners he sees a lot of "smart people" trying to bring a cost-effective, simple-to-deploy solution to market. "A lot of people, a lot of entrepreneurs are playing the lottery and trying to win," he said.
Another challenge is getting physicians to use "true" clinical decision support, including e-prescribing, prompts for such things as drug-drug interaction and reminders, he said. "Doctors notoriously do not like that," he said. "It will either stick or not. These things will shape themselves."
That said, Brailer pointed out that "the outcome is obvious." "Information technology will eventually carry into the industry," he said. One of the major factors in choosing where to practice for physicians graduating from medical schools these days is the deployment of health IT at the facility, he said.
In the meantime, expect disruption, particularly the "nightmare of mismatched expectations and reality" with regard to ARRA incentives and penalties, and the flow of funds from the Centers for Medicare and Medicaid, he said.
Despite the challenges and upheaval as the industry moves toward "massive transformation," the one thing to remember is that progress is being made, Brailer said.