The announcement at the end of April ended rumors circulating in Washington of David Brailer's resignation as national coordinator for health information technology. But he’d been sending signals even before that. In San Diego, at the Health Information Management Systems and Society keynote in February, he told his keynote audience, “There is a long way to go, but we've come a long way. We're on a marathon. The sprint has ended.”
Brailer is a sprinter. A physician with a Ph.D. in economics, technical expertise and business acumen, the senior level presidential and political appointee had a unique set of qualifications for leading the national initiative toward electronic health records implementation and building collaboration among competitors, with one exception — None of his experience prepared him for life in Washington, where getting things done requires a whole new set of skills.
That first year of his appointment, Congress delivered a serious blow to his project, and to him personally, by refusing to grant his office appropriations. The project suffered a 13-month setback.
With limited funding and few tools, Brailer's strategy to move Washington was to create a groundswell of support and build national consensus. Embarking on an exhausting travel schedule, he gave keynotes, led information sessions and met with hundreds of special interest groups. One of his biggest challenges, however, lay at his doorstep — Many government officials simply did not understand healthcare.
He carefully built his case and won support. Now that the directional momentum and purpose are set, the inertia that makes it so hard to get anything under way in Washington is working in favor of his programs. Congress appropriated $61.2 million to his office this year. (His office will receive an additional $500,000 from Health Care Fraud and Abuse Control funds.)
Brailer publicly says his departure time coincides with achievement of his primary goals. He irreversibly engaged official and unofficial Washington in healthcare. He laid the foundation for flexible and innovative private-public partnerships within a regulatory environment. And lastly, despite a market-driven approach, he thinks he has ensured that the project is in the public interest.
“The direction is there,” he says, “but, in the end, industry must walk through the door and the government must hold the door open.”
Although Brailer has left Washington officially, he continues in an advisory role to Secretary of Health and Human Services Michael Leavitt, serving as vice chair of the American Health Information Community, the federally chartered commission charged with making recommendations on digital, interoperable and secure health records. He is also leading the Secretary's Transparency Initiative, which aims to make quality and price issues more open for consumers.
The foundation for the national health information network and the certification process for electronic medical record products are to Brailer's credit. But there remains much to do. More funding is needed to expand the certification process and enable the Healthcare Information Technology Standards Panel to become self-funded.
Although there were some disgruntled by Brailer's leadership style, he set a standard. His visibility was remarkable and his presentations, both formal and informal, nearly always compelling and concise. Now, as he passes the baton, many decisions remain to be made and various aspects of the project to be assembled. Areas including decision-support systems, secondary uses of data and public health haven’t been addressed.
Now the nation needs a world-class marathoner. And if he or she has experience in Washington, all the better.