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Father of Health IT Talks History, Upcoming Challenges

October 16, 2012
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David Brailer Looks Ahead, Looks Back

For most people in this industry, David Brailer, M.D., chairman of Health Evolution Partners and the former National Coordinator for Health IT needs no introduction.

Many consider him to be the father of health IT (some apparently even call him the Grandfather of Health IT). He was the first National Coordinator for Health IT and he developed the nation’s strategy in digitizing healthcare under former President George W. Bush.  Unfortunately for Dr. Brailer, at a recent conference where he spoke, he was introduced right before Colin Powell, who for most people in this country absolutely needs no introduction (I would hope).

While Brailer has not achieved this kind of celebrity status yet, his contributions to healthcare may one day be viewed just as highly as those from the famed General. These contributions and where the industry is headed played into theme of the Digital Health Conference this week in New York City, hosted by the New York eHealth Collaborative, where Brailer gave a fantastic keynote speech.

In giving a history lesson, Brailer talked about the industry’s beginnings, dating back to the 1970s when the groundwork for today’s developments was laid by various pioneers. The biggest agents for change, Brailer said, were people from the ground up – just like today. He mentioned the official beginning of the “decade of health IT,” and the various ways in which the industry got a kick start, including President Bush’s executive order in 2004 calling for widespread use of electronic records in healthcare. This order created the Office of the National Coordinator for Health IT.  

“Many of you make fun of ONC, but let me say, it was way better than the original office name we created, which was U.S. HIT,” Brailer joked with the crowd.

Brailer’s speech espoused important things, and it tied humor with insightful anecdotes. One of the more interesting things he said was, “The thing I love most about the effort we live in 2004, 2007, 2010, and today, is healthcare information is completely bipartisan. Try to think of any other part of federal health policy that hasn’t been politicized.” Although, I must note, healthcare IT has been politicized, as recently as two weeks ago, which Brailer actually later addressed (and dismissed) in the Q&A session.

Still, the point was made. This is an effort that has been pushed off the ground, thanks to industry leaders making commitments in the form of investments, federal and state congressman making health IT-friendly policies, on-the-ground physicians advocating and using health IT, patients being interested in it, and many others who have got us to this point. Brailer then perfectly transitioned to the future and how there are still many challenges ahead.

“We have challenges that are getting harder; they are getting harder because the easy work is done,” Brailer said.

Brailer spent the rest of his speech focusing on four specific challenges that the industry faces. Those challenges include the continued investments and never-ending maturation of the EHR market, the need to make health information exchange irrevocable, the fact that health IT must deliver on the promise of reducing cost and waste, and lastly my personal favorite, getting patients to be an active part of this movement.  He talked about the importance of the “super shopper,” the patient that will use health IT to understand their information better and navigate the system.

“That person will be the great ally to health IT because in every industry where an information revolution has happened, an enormous power has shifted from the big-boxes (hospitals/doctors in this case) to the consumers. It serves their goal to decentralize power. This is something we have to do.”

There were a lot of good points, but this was the strongest, in my opinion. This transformation that Brailer talks about relies on the consumer’s involvement. The loudest voice in the industry will be the consumer’s – it seems this is something Brailer strongly believes in.

Brailer ended his inspiring speech by telling the audience of approximately 900 that they were the agents for change. They are the ones that have to address these challenges and move the industry forward and be a true catalyst for a better standard of living, he said.

When Brailer completed the speech by telling us to never give up and move forward, I felt like a football player after having heard a great pre-game speech. I was ready to rush out and do what I can do. I can only hope the others in attendance and the others who have heard him speak before, felt the same way. If so, this industry will indeed move forward, and maybe in the future Brailer will get to be mentioned in the same vein as General Powell.

Please feel free to leave comments below!



Nice piece. Thank you.

I appreciate the tremendous leadership that Dr Brailer brings to HIT and HCIT. He identified four very distinct user cases a decade ago, as well as the impact that standardization could have for health.

Regarding the "politicized" dimension of Health IT, there are a few dimensions to that issue. On the one hand, there's an argument that HIT is unquestionably a good thing. The argument here is pretty instrumental. In the same way it's better to skydive with a parachute than without, it's better to have prescriptions that are more than simply legible (although that's a start.)

CPOE, as we all know, assures legibility, allergy checking, and often much, much more, including the most rapid and reliable delivery possible, compared to the paper it replaces. According to that reasoning, HIT is almost exclusively "all good" and we dont need to study it, discuss it, debate it, or consider the modest costs. Other industries pay for technology and don't lament the price tag.

The counter arguments are discussed extensively elsewhere. The usability and cognitive engineering challenges are surmountable in time, but require patience, and humility. EHRs aren't perfect. The care we deliver, with or without EHRs isn't perfect either.

The required improvements in workflow, culture, medicolegal, and other domains are formidable, as are the potential impacts on the currently non-sustainable economic models for much of healthcare itself. HIT is part of a much larger tough predicament.

I would encourage readers to avoid theory and demand that government and the private sector look at the real impacts, now and going into the future of HIT. Our immediate opportunity to do this is described in this post:

I'd like to add my voice in thanks to Dr David Brailer, for his leadership, clarity and continuing contributions to HIT.

Thanks for these insightful comments Dr. Bormel, and I urge our readers to check out the blog you linked, if they haven't already. Lots of great stuff there.