WASHINGTON – The healthcare IT industry's inability to deliver a highly reliable electronic medical record to independent practitioners and small physician groups poses the single greatest danger to the nation's drive for interoperable health records within 10 years.

That's the view of National Health Information Technology Coordinator David J. Brailer, MD, who recapped the federal government's efforts in 2004 before 800 attendees at the Healthcare Information Technology Summit in Washington, D.C., last month.

While he ticked off a list of half-a-dozen accomplishments at the federal level, Brailer warned that the government advances will count for little if clinicians aren't on board.

It's not just small practices that view the national initiative with skepticism. "What everybody has been assuming is that ‘if we build it, they will come'." he said. "That's wrong."

Brailer said hospital administrators and clinicians still don't trust that the IT industry can deliver safe results. Given the profound risks, Brailer added, many are saying, "I'm not sure I want to opt in to this."

Brailer said that without the participation of small medical practices, the concept of a healthcare network would be devalued, perhaps fatally. "If we don't bring them aboard, we won't get the network benefits."

A physician himself, Brailer said it was wrong to blame doctors for the problem. In the past, he said, solutions were either too expensive or too unreliable for sole practititioners and small groups. He called on the industry to develop an EMR aimed at this market segment with a price point of $100 per month, arguing that current offerings simply priced small and medium sized practices out of the market.

Brailer pledged the government would do its part, but not through heavy-handed regulation and probably not through direct subsidies. Instead, it would continue to support efforts by the private sector to develop certification standards for ambulatory EMRs, fund some pilot programs and eventually realign its payment structure to reward physicians who can document improved outcomes.

Skeptics in the audience, however, questioned how far the government is going to get if it doesn't offer financial support. Charles Schade, MD, MPH, of the West Virginia Medical Institute, asked how Brailer planned to incent physicians to adopt IT.

"For many clinicians, there is a negative business case,' Brailer conceded. Three options currently under consideration include STARK waivers, pay-for-use programs, and pay-for-performance. But, he added, "We don't have anything to report on finance" and that such programs wouldn't be available until 2007 "at the outside."

When Meditech President Howard Messing asked Brailer to assess the role of vendors, the coordinator backed away from his earlier statements on unreliability and cost. "I'm very proud and happy with the way the vendor community has stepped up to the plate," Brailer said, pointing to the industry's participation in certification and standard-setting efforts. "In the past, we've been asking vendors to defy gravity."