Monday crack of dawn saw me heading of to San Diego to sit in a room with thousands of (almost all female) hospital coders at the American Health Information Management Association conference. You know the reality of "information" in health care when you figure out that this conference is not about the $25-30 billion spent on hospital IT systems, it’s about the $25-40 billion spent on transcription and coding, and up coding, down-coding and paper records management. This ugly step-sister of the EMR hype is still there and not going no-place any time soon.

First up (and earlier than advertised so I missed half his talk) was none other than Health IT Czar David Brailer. Those of you following the press releases know that he’s been a tad busy, even if Cerner’s Neal Patterson thinks that it’s all inside the beltway bullshit. Brailer said that the Fed’s process is at the "end of the beginning" — October is a pivotal month. The time for discussion is soon over, and the Federal government is moving towards exact plans and near and certain deadlines for health care IT. Brailer views health care IT as being inevitable. He notes that interns in training today were born a year before the IBM PC came to market…so doctors will use computers at the point of care.

But he was clear that we can still get this whole thing wrong. In his view portability and interoperability is not an option, it’s essential — so we need to do interoperability right and build it in from the beginning. (Yup, I’ve been cynical about this before, but the man is trying!)  Meanwhile, for presumably political reasons his office had a study about Cyberfraud out Monday, and he mentioned fraud about 5 times. After all, who can be against stopping fraud — so long as it’s not called a no-bid contract to an oil-services company, in which case Dick, Scooter and the boys love it.

Brailer said that we will have a single process for creating standardized standards. Standards bodies now are siloed. Standards start now with types of data, which is why they’re siloed. Instead he wants to move to standards addressing business problems and then use them to solve those problems. The Federal government will be bringing them together and he was insistent that we should have high expectations from the new supra-standards body. In addition we also now have a certification commission (made up of HIMSS, AHIMA, & NCHIT) which will be judging EMR based on three features a) security, b) clinical features (prompts, reminders) c) interoperability. The commission will later move to inpatient tools, etc. While some of my capitalist friends fear this will restrict innovation, my thought is that this certification process will be a floor not a ceiling on getting EMRs that are somewhat effective onto the market.

And soon NHIN will will award national Health information contracts to develop the nation’s infrastructure. Of course this has been getting controversial (especially after Cerner’s CEO’s remarks last week). Brailer simply said that apparently someone had disagreed with him for the past year and a half but forgot to tell him. He never mentioned Patterson’s name.

Brailer wants criteria for the architecture of the infrastructure for interoperability. He likens the EMR to the cell phone network, and hopes that like with cell phones, for a regular fee you can plug your EMR in and get on top of that infrastructure. He thinks that once the base is set that there’ll be lots of competition in services running on top of it. But it’s not just hurtling towards any old infrastructure, but the Feds will be making sure that it’s tied together, that it’s integrated and secure from day one.

He is also (rightly in my view) concerned about the adoption gap, and thinks that we need to make it easy for everyone — not just big organizations. For this he thinks that the recent anti-kickback exception (Stark exception) so that hospitals can donate EMRs to physicians, but has to be linked to certified EHRs, is very significant. And finally, in order to count how effective this all his, HHS is buying a bunch of surveys to objectively tell us how we’re doing. I wish I was still selling them!