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Federal health information czar pushes for electronic medical records for all

John Leschofs/VAS

David J. Brailer, the national health information coordinator, spoke Friday at the Center for Clinical Informatics’ weekly seminar series.

BY JONATHAN RABINOVITZ

David J. Brailer, MD, PhD, is not exactly a household name, but when Modern Healthcare asked its readers last year to pick the most powerful person in health care, he was the winner.

As the federal government's first-ever health information czar, Brailer is leading the Bush administration's high-priority initiative to create a seamless national health information system—including an electronic health record for virtually every American—within the next 10 years. And the urgency of his mission was highlighted Friday morning when a standing-room- only crowd packed the James H. Clark Auditorium to hear him outline his efforts at a seminar sponsored by the School of Medicine's new Center for Clinical Informatics.

"People die because of paper," Brailer said, citing Institute of Medicine research that 48,000 to 98,000 deaths per year can be attributed to medical errors, with many of the mistakes occurring in filling prescriptions. That's in addition to about 2 million errors annually in ambulatory settings, he remarked. The cost of this is huge, he noted, estimating that the nation is spending $100 billion annually in treatment because of these problems.

Brailer, who is both a doctor and an economist, offered what he and many others believed could be the solution to these and other shortcomings in the health-care system. "No. 1, every clinician should use an electronic health record when they see a patient—not just doctors but nurses and potentially caregivers who are not licensed in the orthodox sense," he said. "We should have this tool to represent the facts about the patient and put them in context with evidence for reviewing, for guidance and for the decision process that can enable multi-stakeholder communication.

"We consider that to be a necessity," he said.

While Brailer in an interview after his talk brushed aside Modern Healthcare's ranking of him, he said that it underscored how health information technology has become the issue to watch among policy makers in Washington. He noted that President George W. Bush has mentioned the importance of this effort in his last two State of the Union speeches and that the president's first official trip outside of Washington this year was to spotlight a medical center that has done pioneering work in this area.

Policy leaders from both parties, including Rep. Patrick Kennedy (D-R.I.) and former Speaker of the House Newt Gingrich, have lined up behind this movement to get health-care providers to develop new systems for recording, using and sharing data. And the effort has become a critical area of inquiry at the School of Medicine, where the newly established Center for Clinical Informatics has been charged with finding new ways to improve human health through innovation in information technology. (Brailer was the first speaker in the center's weekly seminar series on developing new health care information technologies, with all of the presentations to be posted as streaming video on the center's web site, http://clinicalinformatics.stanford.edu/.)

Some skeptics have questioned whether boosters of this initiative are overstating the potential savings, and they have noted that the cost of implementing such systems will cost hundreds of millions of dollars.

Still, at the request of Brailler's office, hundreds of companies and think tanks, including Microsoft, Oracle and Hewlett-Packard, have offered recommendations about how to craft uniform standards to make sure that providers have systems that can communicate with each other and with the government. And Brailer, as the administration's national health information coordinator, already has a budget of $100 million to finance seed projects that could become nationwide models.

While Bush's call for an electronic health record is often compared with President John F. Kennedy's call to put a man on the moon, Brailer warned that the administration's effort was not going to involve massive government spending but would instead take advantage of market forces to get the job done.

"The federal government is not going to build, buy and operate this system," Brailer said. "We're actually working in the most complicated way possible: we're trying to set up forces which will create market conditions which will create a favorable milieu where this will happen.

"And that," he added, "is the American way to do it."