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One-on-One with David Brailer, M.D., Ph.D., Part II

October 20, 2008
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The former National Coordinator for Health Information Technology jokes and says he's not sure why any self-respecting CIO would want to work in the public sphere.

David Brailer, first and former National Coordinator for Health Information Technology, stepped out of his government position and into the private sector, and took a few minutes to chat with Managing Editor Stacey Kramer about where health IT is and where it’s going.

SK: Just in terms of your perspective, now that you’re outside, what do you think of what the government is doing?

DB: I have way too many friends and colleagues throughout the process to comment on it.

SK: I didn’t think you were going to, but I was going to try.

DB: It’s a good try. I guess I would come back to kind of where I started. I am pleasantly surprised at how sustained and how durable this initiative has been. It’s now going on its fifth year, and it still is very robust and very strong, with a tremendous amount of energy. I mean that doesn’t happen very often, and so I’m really pleased with it. I know Secretary [Michael] Leavitt is committed to seeing this through his term, and I’ve had conversations at length with various people who might be in those kinds of roles in the future and I think they’re going to try to pick it up and continue it. I feel good about it. But I think we’re now in for the long fight. The big ramp up slowed down and we’ve got the long fight that’s going to be playing out over another decade.

Even if I was going to be really confidential with you, I wouldn’t have much to complain about because I think it’s going well.

SK: That’s good. It’s a slow process because it’s so involved. I mean there are so many things.

DB: It’s got to be broadly based. It has to be something that everyone has a sense of ownership over. And given that, it just takes time to get everyone onboard. But what really matters is that it is broad based.

SK: Do you have advice for CIOs who want to get into policy and who want to take these types of leadership roles in the future?

DB: I guess I’m not sure why a self-respecting CIO would want to get into a policy role.

SK: I couldn’t tell you that either, but I think there are probably a few who would.

DB: Someone had a talk with me when I started, (and said to me), ‘David, if you're going to have an impact on the policy sphere, you have to be able to sort out the big rocks from the little rocks, and you have to be able to find the key important things that really matter. And they may not be what you thought they were when you were in a different role.’ I thought about that a lot, and I think that would be my advice.

The things that I focused on, which were building the institutions for long-term equilibrium and sustainability, gaining the support and confidence of the American public for this initiative, ensuring that there was an economic pathway to success. I don’t know if those are the factors in the future, but I didn’t spend much time looking at a specific standard or a specific kind of technology because my belief was if the environment was right, all of the great technology and innovation could have its place. I think if there is any advice that I would give, it is that ultimately the health information technology at the national level is like a campaign. It’s not about technology. It’s about winning the hearts and minds of the American public, and of doctors, and of board members of hospitals. So it’s probably not a lot different from what a very senior CIO does in their own hospital in trying to get everyone onboard. But I still come back to, I’m not sure why a self respecting CIO would do that.

SK: Do you think that there is any similarity between this movement of getting everyone onboard and the election?

DB: Yes. The elections are partisan. Your choice is candidate A, or candidate B. Health IT isn't health IT A, or health IT B. It’s a fight against inertia. And if you look at the American healthcare system, the irony is that people are highly dissatisfied with it — doctors, nurses, patients — people recognize it. Yet, on the other hand, we are so afraid of making it worse, of creating a condition where it actually becomes less able to deliver. People are in a bizarre way unable and unwilling to play with the inertia, kind of with the status quo. So the campaign in healthcare change is trying to envision and achieve a reality that’s different without messing up the status quo, without making it worse. And that’s what I think it takes. That campaign is between today’s reality and tomorrow’s reality, and that’s very different than a campaign where it is choose candidate A or candidate B. I think it’s got all the same things. It has to do with helping people envision, helping people understand, helping people begin moving. I would say it’s not a campaign in the political sense. It’s education in the sense of helping people understand where they could be, and what steps they have to take to get there.

SK: People are dissatisfied, but petrified.

DB: Yes. This again was what I took to the role I had. Health IT has been around for 30 year. It’s clear that it’s not the new idea on the block. What it lacked was connecting its capacity to the solutions that people are seeking, to the world that they want to seek. I think it’s very much an education process.

I visited every state in the United States. Across any healthcare sector area of locality, people really were yearning for some kind of change. They really saw the time for change was here. And that’s one of the reasons I believe that we’re going to see significant changes in the industry in the next three to five years. I just think that the American public doesn’t step back from the brink when they get this close. There might be distractions, whatever the issue might be, but they’ll get there.

SK: So your timeframe is three to five years.

DB: I think it’s during the next President’s first term.

SK: That’s pretty specific.