爆炸新闻：David Brailer辞职了

张琨 · 发表于 2006-4-21 08:15:45

Nation's healthcare IT leader resigns Healthcare IT News By Caroline Broder, Senior Editor 04/20/06 (WASHINGTON) The nation’s first healthcare IT leader has resigned his post, Healthcare IT News has learned. David Brailer, MD, who first took office in May, 2004, has led the federal effort to make electronic medical records more widely available in healthcare. Although rumors have circulated for several weeks that he would leave his position as National Coordinator for Health Information Technology, Brailer officially submitted his resignation Wednesday, effective May 19. At press time, a replacement had not been named. “I completed what brought me to DC, and I’m eager to come home,” Brailer told Healthcare IT News. Brailer, who considers himself a Beltway outsider, commuted between his home in San Francisco and his job in Washington for the last two years. During his time in the role, Brailer says he is most proud of the fact that his office created public-private sector collaborations to deal with the deficiencies in the healthcare system that have kept doctors and hospitals from adopting information technology. “We’ve shown that there’s a way to do this other than ignoring the market failure of healthcare or leaving it to the government,” he said in an interview Wednesday with Healthcare IT News. In April, 2004, President Bush signed an executive order creating Brailer’s position and calling for most Americans to have electronic health records by 2014. Since taking office, the Office of the National Coordinator for Health Information Technology (ONCHIT) has funded several public-private sector initiatives to prime the market. One initiative, the Certification Commission for Healthcare Information Technology, this summer will begin certifying electronic health records for use in ambulatory settings. Another initiative, the American Health Information Community, will next month provide details on several projects that are designed to speed technology adoption in healthcare. AHIC is composed of 17 members from the public and private sector. ONCHIT also funded four prototype networks to test healthcare data exchange. Brailer, who is also an economist, is quick to point out that his interest in healthcare didn’t start in IT. His focus was on quality, how to measure it and how to pay for it. Brailer says the lack of IT adoption points to the legitimate reasons, from cost concerns to misaligned incentives, that healthcare hasn’t been as quick as other industries to embrace technology. “I’m using it [technology] as a vessel to motivate a need for change,” Brailer said. Reaction"We owe David Brailer a huge thank you. He brought the issue to the forefront and was a most articulate spokesman,” said Healthcare Information and Management Systems Society President and CEO H. Stephen Lieber. “He leaves a great legacy in the four projects under way.”"We congratulate David Brailer on his leadership and contribution to raising awareness of the importance of information technology in improving the quality, safety and effectiveness of healthcare for America's patients," said Janet Marchibroda, chief executive officer of the eHealth Initiative. "Much groundwork has been laid through his leadership, the creation of the office, and the many contracts that were issued to support the development and adoption of standards for interoperability." Lieber said he hoped Brailer's successor would be someone with a vision to say what’s next. "The Bush administration has a real task ahead of them."

张琨 · 发表于 2006-4-21 08:17:45

HHS办公室的反应STATEMENT BY MIKE LEAVITT Secretary of Health and Human Services On Resignation of David J. Brailer, National Coordinator for Health IT It is with regret that I have accepted Dr. Brailer's resignation as the National Coordinator for Health Information Technology. Over the past two years, David has made significant progress in advancing the President's health IT agenda and laying the building blocks for future progress. While I will miss him here at HHS, I am pleased that David has agreed to serve as Vice-Chair of the American Health Information Community (The Community), which is charged with making recommendations to the Secretary of HHS to facilitate the development and adoption of standards-based health IT. David has helped the Community identify promising breakthroughs for near-term progress while continuing to move us closer to longer-term health IT goals. David will also continue to serve as a consultant to HHS to help lead the President's health care transparency initiative. Until a replacement for David's position is announced, the work of the Office of the National Coordinator will continue under the leadership of the four permanent directors of the office.

url · 发表于 2006-4-21 09:30:36

标题上有个小的拼写错误，Brailer 转一篇和他有关的帖子： 技术能否拯救医疗产业？ <a target="_blank" href="http://www.biotech.org.cn/news/news/show.php?id=32064"><a href="http://www.biotech.org.cn/news/news/show.php?id=32064" target="_blank">http://www.biotech.org.cn/news/news/show.php?id=32064</a></a> 据redorbit2006年3月21日消息，“我们需要的是通用标准、是隐私保证！”作者Holstein, William J 说道。 这看起来似乎没什么可思考的：在美国较为单一的医疗系统中采取更多的信息技术就可以制止大量的浪费，因此可以降低医疗成本，提高医疗质量。 但实际上，这是一个极为复杂的挑战——不仅仅由于其本身的技术性问题，真正的绊脚石是人为因素与制度因素。医护人员没有接受过专业的IT训练，而且对于用计算机技术来衡量自己的绩效仍然持怀疑态度。而实际上并没有什么经济刺激因素来促使医生与医院降低成本，因为他们知道，最终保险公司和私人雇主会支付所有的账单。保险公司和雇主需要更高程度的自动化，但是不一定要为此掏腰包。即使他们掏了腰包，他们也没有权利强加给医院、医生和护士。 了解了这一挑战的真实本质就会找出解决问题的方法——2005年11月29日芝加哥圆桌会议的与会者得出这样的结论。这一会议名为“信息技术在建立新的医疗系统中扮演的角色”，由蓝色十字或蓝色盾牌联盟赞助。会议恰逢美国总统布什任命 David J. Brailer 为国家医疗信息技术协调员，隶属于卫生与公共服务部。 该联盟伊利诺斯州主席Gail Boudreaux表示，问题的关键在于，医疗产业分支繁多、结构分散，而且还处于手工阶段。“任何一方在哪种技术上投资都可能亏本，这也是挑战之一，”他表示。 另一个基本问题是，现在没有统一的标准来指导进一步的计算机化进程。与会者强调，医院、医生、保险商以及雇主现有的系统根本无法互相交流操作。“这是人们习惯与过程的改变，”甲骨文全球医疗产业副总裁 Mychelle Mowry 表示。“我们可以开发出最好的技术，但如果我们不知道怎样改进程序然后在技术的支持下将新的程序实际应用，那我们就是一事无成。” 那么到底能够节约多少行政管理资金呢？从医疗系统的总开销中大概可以节约出一万七千亿美元，但是由于整个系统的复杂性，没有人知道是否真正能够实现。蓝十字或蓝盾牌系统的首席执行官 Scott Serota，称自己的行政开销还不到保险金的百分之十。“但是还有例如医院、医药公司等方面的开销，每个人都需要自己的行政管理。其实我们所认为的医疗费用，如果加以细分，其实就是他们的行政管理费用。” 然而，这一观点也可能是错误的，因为它仅仅将注意力集中到改善行政管理费用上。真正的需要改变的是病人与医师的习惯。 大多数讨论都集中在计算机化个人医疗纪录上，目前这方面主要是纸张纪录。如果将这些信息计算机化，势必要涉及个人隐私等等问题，而且随着计算机化的进一步推进，压力可能会越来越大。Walgreen公司的总裁 David Bernauer 评论说：“我认为电子医疗记录十分可行,它可以使成本进一步降低，我想卡特里娜飓风这场灾难多少会让人们意识到将医疗纪录转移到电子媒介上的重要性。” 联邦政府实际上已经宣布允许四大主要系统集成商开始研发技术，将病人医疗纪录与整个医疗系统的其它部分联系起来。 当然，除了个人医疗纪录，还有诸如医生这样的提供方保留的医疗纪录。但是就象个人会反对计算机化医疗纪录一样，医生可能也会反对这一提议。 Savage 认为，如何将IT技术引入并“嵌入”到医生的工作中是个难题。他说：“也许在新英格兰的《医学快报》上回刊登一篇文章来指导在实际操作中采用IT技术，但如何将这些信息资源直接应用到临床工作流程中呢？在这方面，IT业恐怕至今都无能为力。” 而且再使整个系统协作起来也是一大难题，尤其当医疗保险制度或医疗补助制度这样的政府制度存在时。CareFirst BCBS 的总裁 William Jews 认为，怎样在一个问题上达成统一意见将十分困难。 即使整个系统可以整体协作，那么下一个问题就是“电子权利”，也就是什么样的人可以访问什么信息？隐私保护将是一个更大的隐患。医疗信息某种程度上要比财务信息更加敏感。 在过去的20年中，随着医疗保险制度等等保险计划的加入，以及病人资格审核等，整个医疗系统更加复杂。但是，在上个世纪九十年代中期，Walgreen就已经建立起了支付者、州政府甚至医疗保险制度等等方面的相互联系，现在他们不仅仅可以在自己的数据库中可以交互检索药物，而且还可以检索在其他地方的药方。 现在在其他领域也有所进步。甲骨文公司的Mowry表示，其中之一就是将病人的信息包括诊断到对药物的反应联系到一起，然后将这些信息反馈到医生那里以便判断治疗的有效性。但是目前“很多部分还是互不相联的，”她表示。 为了强迫产业方合作，联邦政府可能不得不进行“管制”，BCBSA的Serota表示：“幸运的是，政府现在已经颁发管制条例。”他估计政府会采取软硬兼施的方法：“如果你这么做，那么政府会这么做，他们拥有医疗保险制度、医疗补助制度、以及国防部这几张王牌，这都是医疗系统的主要买单方。” 总之这一过程不会十分顺利。但是更多地利用技术肯定会开始帮助二十世纪手工业似的医疗系统转型。 英文原文链接参见：<a target="_blank" href="http://www.redorbit.com/news/health/436723/can_technology_heal_the_health_care_industry/index.html?source=r_health"><a href="http://www.redorbit.com/news/health/436723/can_technology_heal_the_health_car......source=r_health" target="_blank">http://www.redorbit.com/news/health/436723/can_technology_heal_the_health_car......source=r_health</a></a> 原帖不知道为什么打不开了。但是在redorbit网站搜索brailer这个词，发现一些和他有关的新闻： <a href="http://www.redorbit.com/search_results/?lim=all&string=Brailer" target="_blank">http://www.redorbit.com/search_results/?lim=all&string=Brailer...&string=Brailer</a> 
  <div>此帖由 url 在 2006-04-21 09:44 进行编辑...</div>

xjj97224 · 发表于 2006-4-23 02:00:48

total news<a href="http://www.healthcareitnews.com/story.cms?id=4825" target="_blank">http://www.healthcareitnews.com/story.cms?id=4825</a>

ironstone · 发表于 2006-4-23 09:51:48

是否意味着在美国的热潮已经在开始逐步消退呢?美国政府下一步会怎么做呢?不知道老Brailer辞职的真正原因是什么,值得关注一下

张琨 · 发表于 2006-4-25 22:09:12

当然不是，美国的这方面工作已经不是热潮而是一种趋势。根据内部人士的解释，的确是个人原因使然。

张琨 · 发表于 2006-4-29 00:42:25

<h1>National health technology czar steps down S.F. doctor spent 2 grueling years pushing digital medical records</h1><h2></h2><a href="http://mailto:vcolliver@sfchronicle.com" target="_blank">Victoria Colliver, Chronicle Staff Writer</a>Saturday, April 22, 2006<div class="clear"></div><div id="contentbody"><table id="relatedcontent" cellspacing="0" cellpadding="3" width="160" align="right" border="0"><tr><td><div id="contentobjects"><a href="http://www.sfgate.com/cgi-bin/object/article?f=/c/a/2006/04/22/BUGO8IDBHF1.DTL&o=0&type=health" target="_blank"><img src="http://www.sfgate.com/c/pictures/2006/04/22_t/bu_brailerxx_116cs_t.gif" border="0" onclick="javascript:window.open(this.src);" alt="" style="CURSOR: pointer" onload="javascript:if(this.width>screen.width-500)this.style.width=screen.width-500;" /></a> </div><div id="utilitymenu"><ul class="simplemenu"><li class="print"><a href="http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/04/22/BUGO8IDBHF1.DTL&type=printable" target="_blank">

rintable Version</a> </li><li class="mail"><a href="http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/04/22/BUGO8IDBHF1.DTL&type=friend&emailcolor=%2337CC83&origin=http://www.sfgate.com/cgi-bin/article.cgi%3Ff%3D%2Fc%2Fa%2F2006%2F04%2F22%2FBUGO8IDBHF1.DTL%26type%3Dhealth" target="_blank">Email This Article</a> </li></ul></div></td></tr><tr><td><div id="additionalcontent"><table style="BORDER-RIGHT: #cccccc 1px solid; BORDER-TOP: #cccccc 1px solid; BORDER-LEFT: #cccccc 1px solid; BORDER-BOTTOM: #cccccc 1px solid" cellspacing="0" cellpadding="0" width="100%" border="0"><tr><td class="text2sm" style="

ADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" valign="top" align="center" bgcolor="#eeeeee"><a href="http://www.sfgate.com/health/" target="_blank"><img src="http://www.sfgate.com/templates/types/health/graphics/health_button132x28.gif" border="0" onclick="javascript:window.open(this.src);" alt="" style="CURSOR: pointer" onload="javascript:if(this.width>screen.width-500)this.style.width=screen.width-500;" /></a> <a href="http://www.sfgate.com/health/" target="_blank">Back to Health</a></td></tr></table> </div></td></tr></table><h3></h3>Dr. David Brailer, the man picked by President Bush to promote electronic health records and the modernization of medical technology, has resigned as national coordinator for health information technology effective next month. No replacement has been named. The San Francisco physician, who has held the position for two years, said he is leaving to spend more time with his family. He submitted his resignation Thursday. Brailer, who lives in Pacific Heights and is the father of a 5-year-old son, has been commuting to Washington, D.C., and traveling around the country for much of his tenure. "I completed what brought me to D.C. and am eager to come home," Brailer said in an e-mail. Brailer was sometimes called the federal government's health IT czar. In his job at the Health and Human Services Department, Brailer helped doctors, hospitals and technology firms jointly develop advanced health care systems. Such innovations are viewed as ways to improve quality of care and lower costs. The 46-year-old West Virginia native earned his medical degree from West Virginia University and a doctorate in economics from the University of Pennsylvania's Wharton School. He served for 10 years as the chief executive and chairman of CareScience Inc., a Philadelphia company that makes software for hospitals. He was also a senior fellow with San Francisco's Health Technology Center, a nonprofit organization that helps hospitals evaluate technology. "He's accomplished so much in the short time he established the department and really has been such an inspiration to all states, especially California," said Lori Hack, interim chief executive of San Francisco's nonprofit California Regional Health Information Organization, the statewide umbrella group for health information exchange. Hack said Brailer's background as a physician with business and technology experience made him effective in reaching out to different constituencies. Brailer said he would like to continue working in the health technology field in the Bay Area. "I really love what I do and will probably do something like it in the private sector," he said. Brailer will also serve as vice president of a committee that makes recommendations on health technology standards to federal officials, according to the Health and Human Services Department. </div>

老舟 · 发表于 2006-5-16 07:49:10

Yes. As explained in the articles posted by Zhang Kun, Brailer indeed brought together people around the US from different industries and groups, and have made Health IT a concesus to be invested in. However, his job was really grueling, especially without the full support of current HHS Secretary Mike Leavitt. His resignation had been well expected for a few months.
 
 <div class='quotetop'>引用

张琨 @ 2006-04-25 22:09)</div><div class='quotemain'>当然不是，美国的这方面工作已经不是热潮而是一种趋势。根据内部人士的解释，的确是个人原因使然。</div>

sige505 · 发表于 2006-5-16 11:15:30

美国的这方面工作已经不是热潮而是一种趋势。我不认为这是是个人原因使然。这是社会原因。美国是一个高度发达的经济强国，但美国并不注重人文发展，近几年虽然有些注重，但社会风气难改。

老舟 · 发表于 2006-5-16 11:53:46

From what I know about US's struggles and debates in setting up a good health care policy to curb the sharp increase in its health care cost and yet, provide high quality care to everyone, they've targeted many aspects, such as physician's salaries, pharmaceuticals etc. All previous separate efforts were less satisfactory and always of hot debates because of people have different views on where the line should lie in reducing costs and improving quality of care. Until several studies showed that EHR might not only improve the care, but also reduce costs in the long run, there was a call for a position like Brailer's to bring all the groups together, insteading of fighting each other to get a larger pie for their own group. So he was successful in fulfilling his mission to realize the trend."但美国并不注重人文发展" compare to which country? <div class='quotetop'>引用

sige505 @ 2006-05-16 11:15)</div><div class='quotemain'>美国的这方面工作已经不是热潮而是一种趋势。我不认为这是是个人原因使然。这是社会原因。美国是一个高度发达的经济强国，但美国并不注重人文发展，近几年虽然有些注重，但社会风气难改。</div>

张琨 · 发表于 2006-5-18 21:23:40

<div class='quotetop'>引用

sige505 @ 2006-05-16 11:15)</div><div class='quotemain'>美国的这方面工作已经不是热潮而是一种趋势。我不认为这是是个人原因使然。这是社会原因。美国是一个高度发达的经济强国，但美国并不注重人文发展，近几年虽然有些注重，但社会风气难改。</div> 
 
 美国不重视人文的发展？何以见得？

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