Despite the wealth of companies rolling out new computer-automated systems promising more efficient and safer medical care in the U.S., the costs of healthcare and the instances of medical errors "continue unabated," according to David Brailer, MD, national coordinator for healthcare information technology.

Leveling that charge in a keynote address last week on the final day of the annual meeting of the Healthcare Information and Management Systems Society (HIMSS; Chicago) in Dallas, Brailer charged that medical errors in the nation's hospitals constitute an epidemic rate and that the time for developing one solution to deal with it a national electronic health record (EHR) is running short.

That timeline was set last year by President George Bush, who said a nationwide electronic system for handling patient medical records needs to be in place by 2014, and he tasked Brailer to meet that goal. The result has been termed a National Health Information Network (NHIN).

In his appearance at HIMSS, Brailer pointed to the rapid rise in healthcare costs as a key reason why such an NHIN system needs to be put in place, and soon. (He also could have pointed to the lack of financial resources in his own office as another troubling hurdle hoped to be relieved in upcoming reallocations but for obvious reasons avoided mentioning this.)

Beyond citing economic issues, Brailer pointed to various systemic barriers that will make it difficult to turn a variety of fragmented parts into a centralized, interoperable and totally secure network that is both easily accessible by providers and well understood by patients and other users.

At the top of this list of barriers, he put the proliferation of proprietary electronic standards as preventing broad healthcare data sharing, and he noted also a large "gap" in the general adoption of electronic health data systems: good overall adoption by large systems but weak and very slow adoption in smaller health groups and offices.

For both problems, he said the federal government probably needs to take a hand in "leveling the playing field."

Brailer said his office is tackling these problems by reviewing the mass of information presented in response to its request for information (RFI) concerning key issues and ideas for moving toward a national EHR.

The RFI has resulted in the generation of 500 responses and 5,000 pages of material from individuals, agencies and consortia, and a task force made of personnel from various federal agencies is currently combing this material to compile key themes, plus areas of agreement and conflict.

The task force has been divided into three groups to sift the material in terms of legal issues, technical architecture and policy issues, Brailer said.

Analysis of this material, he said, should result in a report that will help drive a plan for creating the NHIN and to serve as blueprints for prototype systems leading to its creation.

While this process is not yet complete, Brailer said that a handful of themes from the responses are beginning to emerge. These include:

  • The need for agreement on generally accepted standards as a first step but with Brailer noting that making these generally required or even mandatory would be a key problem.
  • The need for a system to govern and administer a national health network.
  • The need for guaranteed privacy of such a network while at the same time providing a system of patient control of such a system. Generally, the Internet is seen as the backbone of the system, Brailer noted.
  • The difficult challenge of making the NHIN both regionally controlled and nationally interoperable.
  • Questions concerning methods of financing such a network, specifically the mix of private and public funding that will be required.
  • Regulatory issues, including the need for anti-kickback laws.

While largely laying out the difficulties for creation of an NHIN, Brailer saw some positive signs in the leading-edge efforts of the Department of Defense (DoD) and the Department of Veterans Affairs (VA) for the systems they have long had in place to handle patient information and healthcare business activities.

At a HIMSS press conference last week, U.S. Navy Captain Robert Way, information technology director for the DoD's Military Health System, said, "[Y]ou cannot find a prescription slip in [the Pentagon's] hospitals."

Prescriptions are automatically handled by the DoD pharmacy data systems. This system, he said, surfs a patient database to insure a new drug will not cause an adverse reaction with others the patient is taking, with the result of preventing at least 130,000 adverse drug reactions.

Robert Kolodner, MD, acting chief information officer for the Veterans Healthcare Administration, in a presentation he made at HIMSS, reported that since the VA launched its electronic patient records system for veterans 20 years ago, it has captured a total of 1.5 billion orders for drugs, test, X-rays and other healthcare transactions.

Such efforts need to be translated to a combined public/private effort, Brailer said, emphasizing that action needs to move forward "this year or next."