Ann Fishman speaks with Dr. William Braithwaite, Chief Medical Officer for Anakam. Dr. Braithwaite speaks about the privacy and security concerns with health information technology, and how Anakam can be a cost-effective IT partner in maintaining the privacy and security of digitized health information. He further discusses how the practice of medicine will require a paradigm shift in order to effectively and safety utilize health information technology to improve healthcare delivery.
Ann Fishman: I'm Ann Fishman with EHRtv and I have the honor of interviewing Dr. William Braithwaite. He is also known as Dr. HIPAA for his very significant and substantial role as a key architect of the HIPAA bill passed in 1996. Thank you, Dr., for being with us.
Dr. William Braithwaite: You're welcome.
Ann Fishman: Dr., what were your objectives as a key architect of HIPAA and were they, in fact, implemented with that bill?
Dr. William Braithwaite: The key objectives were to set standards so that health information could flow freely, but securely, between the players in the health care system - typically the health care providers and the health care plans - in such a way that it would reduce the paperwork and reduce the amount of time it takes to carry on the administrative functions of healthcare. And in addition, set some standards, some baselines for the exchange of health information, clinical information that would come in the future. Our industry wasn't ready for that second part, but I tried to set the baselines by setting identifiers and mechanisms for exchanging information securely and privately back then.
Ann Fishman: Now that in 2010 it is mandated by ARRA that electronic health care records (EHRs) will be adopted - it's not a question of if, it's a question of when and that's all set forth in the bill - do you feel that technologically we have the ability to protect protectable patient information?
Dr. William Braithwaite: Well, first of all, it's not mandated. There's incentives for people to implement EHRs.
Ann Fishman: Excellent point. I stand corrected.
Dr. William Braithwaite: But yes, I think technologically today we are in a position to be able to implement EHRs well and securely and privately. The issue is not the technology anymore, it's the people. The way we still practice medicine is typically in small practices and everybody practices like a cottage industry and they all do it differently. So we can't have one EHR that works for all general practitioners or one EHR for all cardiologists. It has to be adapted for each one which makes it very expensive not only to build and to sell, but to maintain over time. So it's not enough to incent people to buy them, it's we need incentives to make sure that the practice of medicine changes. The paradigm has to totally change from two people, a patient and a doctor, getting in a room and talking to each other from memory. We have to interact, the patients and the doctors, with the technology. It can be done at the same time in a room without the paper but with electronic records, or you could take the patient and the doctor out of the room and they can interact over the Internet in fact with those records and with each other as long as that's done securely. And of course, the major hold that I've seen in doing that, besides the technology of encryption which is now readily accessible and available inexpensively, was the fact that you didn't really know who it was on the other end of an Internet connection that was trying to get at the records, which is one of the reasons I joined this company called Anakam which provides a cost effective and flexible way of making sure that a person with a remote connection doing an EHR or PHR is in fact who they say they are so you feel comfortable about giving them access to their own medical records or if it's a physician, to the medical records of that person's patients.
Ann Fishman: I think that's a very necessary component of the paradigm. I think it's very important. As we are in the midst of a very significant health care debate about healthcare reform in general, where do you see health IT fitting in the scheme of things as being an engine for change?
Dr. William Braithwaite: Well, it's not only an engine for change because you have to change the way you practice medicine to use HIT efficiently. It used to be that when you implemented HIT, it was the CFO or the billing clerk and if you implemented clinical technology, it was the nurse who did it, not the doctor. The doctors were thought to be afraid of it or they couldn't type. All that is just wrong, you know, if you look at it historically. If you get a technology that will allow a doctor to do a better job of treating their patient for less money and in less time, they will adopt it overnight. Look at CD scanners or fax machines if you want to go back that far. Doctors aren't afraid of the technology if it meets those three criteria. I think the technology is there to do that and the healthcare revolution, the health care reform to provide higher quality healthcare for a lower cost can't be done without implementing that health information technology because human beings are not capable, even doctors. I am one so I can say that.
Ann Fishman: All due respect to doctors.
Dr. William Braithwaite: Doctors are not capable of keeping in mind the 800,000 concepts involved in healthcare at a time when they're working from memory interacting with a patient. They need an IT partner that can integrate the information about the patient from multiple sources, computationally produce advice about what might you have forgotten, what should you be reminded of so that you can do a better job. And then the patient has to interact with that technology as well so that the patient can do a better job. You know, historically, the practice of medicine does very little for our health. It really is the sanitation, the public health and what people do with their own life styles. That will change the healthcare and the health of our nation.
Ann Fishman: It has been a pleasure to speak with you. We've been with Dr. Braithwaithe and we thank you very much for your time.
Dr. William Braithwaite: You're quite welcome.