Brailer Takes Stock of His Tenure as National Health-IT Coordinator

Looking back on his two-year tenure as the first national coordinator for health-IT, David Brailer, M.D., said he was "shocked" at how quickly he got things done despite the glacial pace of federal policy-making and his inexperience with the ways of Washington.

"We did something that was unusual for the government," Brailer said during an impromptu roundtable discussion with reporters last week. He and his ever-busy staff delivered a health-IT strategic framework in July 2004, just 76 days after Brailer took the job. "The vision was obvious," he said. The work that lay ahead was not so much.

No longer shackled by government protocol, Brailer opened up to the media during what was called the first National Health IT Week. He said he fought uphill battles not only with the largely paper-based healthcare community but also with the myriad federal agencies responsible for healthcare delivery, financing, and employee health benefits. According to Brailer, most parts of the federal government had a low level of understanding of IT in healthcare. "There's going to be some really, really tough decisions that the agencies will have to make," he predicted.

Brailer also said that the effort could have died at three steps along the way. The first of what Brailer called three "near-death experiences" -- and the only one he expounded on -- was Congress's zeroing out of funding for the Office of the National Coordinator for Health Information Technology (ONC) in the 2005 federal budget. "That appropriation of zero would have effectively shut us down," Brailer said, even though he downplayed the significance at the time.

The Department of Health and Human Services (HHS) shifted some discretionary money to the office to keep the effort going, but Washington outsider Brailer got a painful lesson in the cutthroat ways of the nation's capital. "I got involved in a very brutal fight with parties in the administration that were happy that happened," Brailer said. He did not name names.

That fight caused Brailer to take some risks. "When you start with nothing, you are more willing to gamble," he said. And often, he doubled down. "Every time we won some money, we put it all back on the line."

However, Brailer stated confidently, "We have climbed the mountain." The office is established and running, and health-IT is firmly entrenched in the national agenda. He did not mean that everything is all downhill in meeting President Bush's goal of delivering interoperable electronic health records for most Americans by 2014, however. "It's a steady, incremental process," Brailer said.

Brailer said he would be willing to return to Washington if comprehensive healthcare reform were on the table. "Not under the current administration," he said, however. That feeling may have more to do with bureaucracy and micromanagement from the White House than with HHS leadership, as Brailer has indicated on numerous occasions that he is on friendly terms with Secretary Mike Leavitt and Medicare boss Mark McClellan, M.D.
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