June 16, 2008 By Emily Montandon, Associate Editor
Photo: Dr. David Brailer
Health-care professionals, pharmaceutical companies and government officials gathered in downtown Sacramento Thursday, June 12, to discuss the state of California's health-care system and the ways it can be improved.
Health IT was a prominent topic at the forum, which included speakers Richard Sorian, vice president of Public Policy and External Relations for the National Committee for Quality Assurance; California Sen. Darrell Steinberg; and Dr. David Brailer, who served as the federal government's National Coordinator for Health Information Technology from 2004 to 2006.
Brailer, who was charged with implementing President George W. Bush's executive order calling for widespread deployment of health information technology, spoke on the use of health IT's potential to improve all aspects of care, including access, quality and cost. Brailer said the shift to electronic health records is inevitable.
"The battle of electronic health records is already fought and won," he said, but the transition will take time. Hospitals are leading the charge in this area. Larger health-care practices also have made headway, but smaller practices lag behind. As younger generations of physicians demand such tools, Brailer said, even the slower adopters will move ahead.
Interoperability presents a bigger issue, which still needs to be addressed. The cost of necessary infrastructure improvements, which Brailer estimates at $100 billion across the industry, should not be an impediment, he said. Spread over 10 years, those costs are roughly equivalent to what hospitals pay annually for general office supplies, he added.
Among the changes that Brailer predicts electronic health records -- and health IT in general -- will bring to the industry are more in-home monitoring and care, and a new type of empowered health-care consumer. Along with industries like media and retail, Brailer said health-care professionals will begin finding themselves "pushed aside by search engines," as patients research their options and demand more say in their health care. This trend also will fuel different types of competition in the industry.
In a panel discussion focused primarily on personalized health care -- or the use of genomics to tailor health-care strategies for individual patients -- panel members discussed IT challenges, as well as the roles of patients and the government in the future of health care.
Dr. Donald Holmquest, president and CEO of the California Regional Health Information Organization, said widespread compliance with statewide interoperability standards would be difficult to achieve in California due to the large number of health-care providers. But modern IT architectures, such as service-oriented architecture and Web services, simplify the issue of interoperability, he said.
"The question then becomes 'How do we process this information?" said Dr. Jerry Penso, associate medical director of quality programs for Sharp Rees-Stealy Medical Group. With so many measures to keep an eye on, a physician runs the risk of being overloaded with information, he said. "That physician may have a number of alerts, and it gets overwhelming. If you start adding genomic information to that, the question is how is that all going to happen in a 15-minute office visit?"
As far as government's role, Holmquest suggested funding and mandating IT systems in doctors' offices would level the playing field. Penso suggested creating a national entity to gauge the effectiveness of technologies could be a beneficial role for government to play.
This Digital Communities white paper highlights discussions with IT officials in four counties that have adopted shared services models. Our aim was to learn about the obstacles these governments have faced when it comes to shared services and what it takes to overcome those roadblocks. We also spoke with several members of the IT industry who have thought long and hard about these issues. The paper offers some best practices for shared government-to-government services, but also points out challenges that government and industry still must overcome before this model gains widespread adoption.