David Brailer, first and former National Coordinator for Health Information Technology, stepped out of his government position and into the private sector, and took a few minutes to chat with Managing Editor Stacey Kramer about where health IT is and where it’s going.
SK: Talk to me about RHIOs. Why do you think they are failing?
DB: I think we’re in a period that I would call the Great Sorting Out. There has been this tremendous ramp up that to this day surprises me just how intensive and long and durable it’s been. Lots of things have happened. Hospitals have certainly added a lot more electronic records, or they’ve contracted some physician offices. Patients have become highly aware, but I think it has started to level off a little bit. I think we’re in a period now where those that have kind of decided to jump in this kind of realm have jumped in. It’s not that it’s going to flatten out or turnaround, I just think it’s a period now where people are pausing and absorbing. A lot of hospitals signed on for records, but they have five- to seven-year projects ahead of them to get them in use.
I think lots of companies that produce these tools, and people that have invested in them, are now kind of saying, ‘What’s next?’ and ‘Where do we go from here?’ That’s really the entry cart for us to begin doing some of the things we want to do here. Do you see the same thing?
SK: I think that’s true. There were the early adopters, but now others are adopting. Still, there is the challenge of making sure that everything is interoperable, and that’s tremendous.
DB: Yeah it is, but I don’t think it’s going to happen large. I think it’s going to be a bunch of small steps. We’ll see, for example, with this investment we made in informatics, you’re going to see the pharmacy supply chain continue to make progress in interoperability. You’ll see it happen on a different pace with labs, and you’ll see it happen on a different pace with imaging. Because each of them represents different business subsectors, different stakeholders, different economic comparatives, different kinds of quality paradigms, different policy architectures. Interoperability is not a concept that will sweep America large. It will happen through a bunch of steps that have to do with how prescriptions are done or how images get shared, etc. Everyone kind of has come to recognize that it’s a brick-by-brick build-up of the interoperability wall. That’s happening now in the market.
SK: Do you think that we’re going to reach a point where there is going to be a sort of real information exchange, where real companies are competing once this brick-by-brick thing happens? Do you think it’s going to happen at the same time with different companies? Will there be a huge competition?
DB: I think there are two stable outcomes. First of all, I think there will be competition, no matter what. That’s the American way. But I think you could see companies competing on generalized information exchange. A broad set of information across many different clinical uses, domains, etc. Or you could see it done in a group of individual silos right around prescription, the drug supply chain, around images, around labs, around patient specific data. I don’t know which way it’s going to come out. We’ve spent a lot of time thinking about that, and you know, I think the factors that are going to determine which way it comes out probably have more to do with who drives it than anything else — if it’s driven by hospitals or insurance companies, which are by definition, general historic organizations. They touch many, many kinds of people with many kinds of illnesses. You’re going to see the kinds of solutions they want to be very generalized. They’re not going to want to deal with 50 different silos. But if it’s driven more by doctors, where doctors are specialized, then I think you’re going to see the outcome be more sectoralized.
The problem in the U.S. is some markets are insurance company-driven, some are hospital-driven, and some are doctor-driven. So you know the American way is that you might see different solutions in different parts of the U.S., and that’s classic U.S. healthcare. So, I don’t know how it’s going to come out, but I’m certain it’s going to be competitive, and I’m certain you’re going to see lots of paradigms being offered until we see which approach has the best value added and is the most durable. And part of our challenge is to sort out how to participate, and how do we back the right concepts.
What we did with the prescribing was said, this is a place where we believe there is going to be a complete automation of the process from the doctor to the patient. It’s very close, and so we want to back that concept. And then we said, ‘How do we back the right company?’, but we didn’t even think about that until we got that. I think it’s much more concept-driven or sector-driven.