Brailer Reflects on First 15 Months as National Health-IT Chief

In the 15 months he has been on the job, national health-IT coordinator David Brailer, M.D., has crisscrossed the country many times over, listening to hundreds -- if not thousands -- of healthcare professionals and technology specialists and delivering speeches to just about every audience that would have him.

From the Cleveland Clinic to Evanston Northwestern Healthcare in Illinois, from the Healthcare Information and Management Systems Society winter conference in Dallas to the same organization's summer meeting in New York City, at a Medical Group Management Association confab in San Francisco, an American Medical Informatics Association symposium in Boston, and in the halls of power in Washington, D.C., Brailer has been focused on one task. He is leading the effort to meet President Bush's goal of having comprehensive, interoperable electronic health records for a majority of Americans by 2014.

It has been just over a year since Brailer unveiled his strategic framework for achieving this goal, a four-pronged plan of informing practice, interconnecting clinicians, personalizing care, and improving population health, and he has been touting the plan at every opportunity possible. "We are now fully underway with our strategy," Brailer says.

When he accepted President Bush's appointment in May 2004, Brailer knew he was getting a heavy workload. But he clearly is enjoying the job. "It's a lot more fun than I expected it to be," Brailer said on June 22 as he darted out of a morning session with fellow tech-savvy physicians at the Association of Medical Directors of Information Systems meeting in San Diego and headed to his next appointment in Seattle.

He remains in constant touch with his team in the Office of the National Coordinator for Health Information Technology (ONCHIT), who now are occupied with reviewing proposals from a series of solicitations on how to build what Brailer calls the "medical Internet." (See "HHS Publishes Four RFPs for Proposed Medical Internet.")

ONCHIT is legally prohibited from disclosing details of the proposals until it awards contracts in September, but staff indicated that the office received a large number of responses prior to the mid-July deadlines.

Brailer, who has a Ph.D. in management science from the Wharton School in addition to his medical degree, promises that the plan to harmonize healthcare standards among all federal agencies will be well underway within six months after the contracts go out. (A law enacted last week requires the Department of Health and Human Services to adopt national standards for integrating health-IT systems. See "Patient Safety Act Calls for Voluntary Error Reporting" in this issue.)

The idea is for the federal government, as the largest payer and purchaser of healthcare services in the country, to exercise its market clout by choosing interoperable, standards-based technology, then let the private sector follow this lead.

"It will not be a clean process. It will have many iterations and variations. But we need a foundation," he says. This, according to free-market advocate Brailer, is preferable not only to government mandates but also to a completely hands-off approach from Washington. "As much as a free-marketist as I am, I don't believe we should let physicians buy technology without clinical decision support built in," Brailer says.
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