Advice abounds for new healthcare IT czar

By Bernie Monegain
12:00 AM

THERE IS NOT A LOT of room for proprietary technology and variant terminology in healthcare. Being able to share data securely through a broad range of devices is critical to making it all work cost effectively and efficaciously.

Standards that all vendors must adhere to would allow passing of information across systems, such as from order entry to ancillary systems (pharmacy, lab, radiology, etc.), to become more seamless and real time with lower interface development and maintenance costs. The goal should be greater than sharing the information internally, i.e., within a hospital's four walls, but rather universally, so that proper and effective care can be rendered no matter where the patient is seen. Obviously standards that technically allow the sharing of data is a cornerstone to that but of equal, or even more importance, is the security piece. Health records are very personal and should not be accessible by anyone without a legitimate need to see it.

– David Janotha, Outcomes & Analytical Services,
Eclipsys Corp.

UNDERSTANDING THE BROAD SPECTRUM of stakeholders in the electronic health record marketplace (should be Dr. Brailer's first priority). EHR is not simply about clinicians and caregivers; other healthcare workers, such as health information management professionals, also hold key positions and manage processes critical to widely adopted EHR strategies.

Also, working with today's technologies and evolving them into future visions is important, rather than simply envisioning what the future might hold.

– Kelly McLendon
Information Evolution Management,
Titusville, Fla.

GIVEN THE LOW AMOUNT of funding for this initiative ($100 million), his impact should be on loosening up the major bottlenecks.

One, since physicians really only listen to other physicians, he needs to recruit "IT medical evangelists" to spread the word at major medical conferences. Two, he should allocate some portion of the funding for selected pilots in physician offices for EHRs.

– Jon Bogen
President, HealthCIO Inc.

WHILE IT IS DIFFICULT to name a single priority for Dr. Brailer, one thing is clear, our current healthcare IT environment is a prime candidate for standardization and compliance.

We want to reduce adverse medical errors and adverse drug events, but less than 10% of the healthcare providers currently have CPOE implemented.

We want to provide a national data model for medical records, but HL7 RIM, NEDSS, and PHIN have all been lacking in adoption.

We want physician offices to collaborate better and provide a patient record that can move with the patient from MD to MD (much like cell phone numbers), but we cannot move patient information from a single state agency to another.

When HIPAA became law, most healthcare organizations immediately challenged the cost of the upgrade as prohibitive to adoption, and even when mandated, continue to request extension after extension to ease the burden of the transition. Because of the lack of standards, we fall short on any quality clinical outcomes statistics, which leads a consumer market generally driven by quality in the dark about the true quality of our healthcare system.

To me, the question is simple.  How do we get patient data standardized across provider, payer, and pharma?

There are over 1,100 independent software vendors in today's healthcare IT landscape, each with its own variant of the answer.  We can't eliminate that market for a "nationalized model", but we could mandate that they become compliant to a patient data standard much like HIPAA has from a security standard.

– Greg Aaron,
General manager,
Healthcare Practice

THE CHALLENGE RIGHT NOWin HIT isn't that nothing is happening, it's that a lot is happening all at once with no visible means of coordination.

The NHII efforts are moving forward with the LHII concepts – but there doesn't seem to be anyone coordinating to be sure all the LHIIs add up to the NHII!

CHI has announced 20 standards for use in the federal health enterprise – but this needs to get broadly communicated to the private sector providers and vendors so they understand the opportunity this creates.  

And there is the very real fear that the monolithic software solution is going to be "the answer" – according to the vendors.  (And, this needs to be combined with the CHI standards to see what is still needed on the standards front for transactions and content)...

The JCAHO announced a bedside bar code medication administration requirement by Jan. 1, 2007 ... but do folks really know what has to precede this in terms of IT infrastructure and foundational systems? All this being said, I think it would be most useful if Dr. Brailer could establish a coordinating function to make sure all these efforts are working together and what we end up with are synchronized components that we can assemble into the ubiquitous EHR.

There isn't going to be one monolithic solution that descends from on high… We have to figure out how to leverage what's installed and working, and incorporate standards to improve interoperability.

We have to work out a rational way to make sure all the individual provider systems (hospital & doctor) add up to an integrated system of health information that supports more efficient and effective care (the holy grail); our nomadic life style (I've lived in six states in the last 20 years and there's no way I can track down all my health records!); and our need for automated bio-surveillance.

– Randy L. Thomas,
VP Advisory Services,
Healthlink Incorporated

DR. BRAILER SHOULD begin by building a strong team. I intend to send him my resume.

– Christine Forman,
Vice President, CIO,
Nassau Health Care Corporation, Nassau University Medical Center, East Meadow, NY

THESE ARE the things the IT czar has to do:

1. DUCK: There will be lots of shots fired from powerful forces to test him initially as healthcare is going through major technological changes.

2. PROVIDE A VISION: It's amazing, but many people can not function in a world that has no structure. The direction has been provided by the president, he just has to sell and provide a mandate for change.

3. WHAT TO DO: Low hanging fruits may be different for everyone. I would get 20 reps from each industry (insurance., hospitals, clinics, etc.) have them develop their top 10 low hanging fruit issues that they need resolution for. Find the top three across all industry categories that are synergistic. Make them the absolute priority of this position. For me a low hanging fruit is deciding which standards to follow. I can't tell you how much work is associated with communicating financial and clinical data sets across desperate systems.

4. MAKING DECISIONS: The operative word in his title is Czar, and he needs to leverage it. Reduce the number of people at the table trying to make a decision. We have many groups developing many standards with no end in sight. Have the users develop the standards with the government and the vendors will follow.

5. ADVOCACY: Be an advocate for the industry to the government. Regulations should never be used to make the provision of healthcare more difficult. Example, HIPAA needs to be specific and the tools to carry out the requirements must be available reasonably.

6. CHANGE WITH MEANING: Once momentum has developed and the position has been empowered, he should go after the harder items that will be the most meaningful. The American population is on the move and a turning point in how we do business in this country will be the healthcare ID card.

Director of Process Reengineering, MBA, MHA, CPHIMS
Carle Clinic and Foundation Hospital

DR. BRAILER SHOULD get all of the HIPAA mandates in order and complied with 1st, especially the EDI X12 entire data set. There should be more stringent penalties and an effective ways to enforce them for those providers, clearing houses and payers that refuse to comply. How else can our nations health system begin to recoup the financial benefits proposed as one of the primary purposes of the legislation?

President Bush speaks of a National EMR....we'll own Iraq and be on Mars before that happens if we can't get the HIPAA mandates straightened out and flowing like our nations highways!

Glen Golden,
Toms River, NJ

AS WITH ALL NEW political appointments and positions, the new HIT Czar ideally wants to show leadership in three critical facets of the job - policy, politics and implementation, not necessarily in that order. At the same time he will be inundated with the agendas of the existing agencies and their various roles in the emerging NHII efforts to date, not to mention the industry lobbying efforts along the same lines. How he makes his mark in these three areas or perhaps on which aspect of the NHII will be up to him, but I have a lead candidate that has been underemphasized thus far in the latest NHII push.

Establishing and leveraging the role of the consumer/patient in health management as something other than a down stream stakeholder and recognizing that access to the NHII will need to be accommodated in a broad range of telecommunications infrastructure, i.e., not just the web. Todays NHII efforts are heavily focused on health institutions, and for the most part the largest institutions.

They have only recently turned to engaging individual physicians let alone ancillary care, other health professionals, and consumers in their homes. In this broader stakeholder arena it will be critical to recognize existing and simpler technologies could revolutionize health care as we wait for the ever-emerging standardized EHR. Picking something that has not been the pet project of many active stakeholders could also facilitate moving ahead on the three core fronts.

I wish Dr. Brailer alot of luck as our first NHII political leader in an election year.

Shannah Koss,
Vice President, Health Solutions
Voxiva Inc.
Principal, Koss on Care
Ex-Fed and participant in several prior NHII initiatives

MY OPINION IS that the Healthcare Czar should meet with JCAHO (Joint Commission) to find out what technologies are emerging that are contributing to patient safety, staff efficiencies, and cost savings. Once the education and knowledge transfer to this new czar is complete, Mr. Brailer should focus on initiatives that support these benefits to end-users and develop a committee to drive these efforts.

Kathy McCall,
Marketing Manager



Tie improved reimbursements to said standardization.

Robert Gerick,

ONE SUGGESTED PRIORITY for Dr. Brailer and his staff would be: in the physicians' office market that Dr. Brailer's office would publish needed requirements of electronic IT vendors to be approved and following that publishing, an approved vendors' list would evolve.

Tommy Green,
Chairman & CEO,
Greenway Medical Technologies

THE FACT IS that medical care is poorly distributed among poor, minority and other groups and, somehow, medical dollars should be spent in these areas.

If IT can be used to provide PA's, NP's and other local extenders with access to physicians who can guide them and provide advise, this should be a priority.

Dr. Robert Noven,
NMPG Corporate Health

AS A VENDOR of practice management and EHR solutions, our clients are actively marketing EHR modules to our physician client base. However, other than the specialty practices and some surgical groups, the investment required is somewhat out of the reach for the average group practice. Please consider a Medicare/Medicaid "Per Claim" credit to small-medium sized medical practices to help them afford the upfront costs of automating the medical record. For pediatric groups you could look into Immunization credits.

Also please use your platform to move payors off the mark and accept STANDARD data sets. Each vendor continues to hold on to unique data requirements which creates a backlog of programming issues for all the vendors. The spirit of HIPAA promised to do away with this nonsense but we are still far from the mark in this area.

Michael Dougherty, President
Northeast Division
Pulse Systems, Inc.
Andover, Mass.

ONE OF THE FIRST orders of business should be the development of a team to compose specifications for a national MPI, Master Patient Index. Basically, a single medical record number for each person at the national level. It's the foundation from which all else can be built and achieved.

Dave Hemendinger,
Chief Technology Officer

PRESIDENT BUSH laid out a bold vision for healthcare, which included the necessity of using electronic health records to transform healthcare.

The transformative value of electronic health records will be achievable only if we use them for such activities as care coordination, proactive care, chronic disease management, and non-visit based care, which are all currently nonreimburseable. While I have seen some proposals floated that create incentives for IT adoption, achieving the vision of President Bush and others will require far broader changes in reimbursement - ones that create a sustainable business case for information management.

I envision the first and most important task for Dr. Brailer to be the creation of demonstration projects within the Medicare program that pavethe way for these broad reimbursement changes.

Peter Basch, MD,
Medical Director, e-Health Initiative
MedStar Health

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