Resigning health IT chief: Efforts on track

Washington -- National Health Information Technology Coordinator David J. Brailer, MD, PhD, announced late last month that he would step down on May 19. For the past two years, he has headed the federal effort to get the majority of U.S. patients equipped with an interoperable electronic medical record within the decade, a call made by President Bush in 2004.

AMNews spoke with Dr. Brailer after his announcement.

Question: What made you decide to leave?

Answer: When I was negotiating this job, I was very clear that I was not able to move my family to Washington and that my period of service would be at most two years. I felt then that if I wasn't able to get the foundation set and get people moving in the right direction, I should leave after two years anyway because it would be a failure. There was no drama to it. I felt a very strong personal obligation to give something back because I got so much from being a doctor and an entrepreneur in health care. But in the end, my time was up.

Q: When it comes to getting health IT into physician offices, what has your office accomplished?

A: First, we've been able to move health IT from an obscure area that only geeks and tech types understand to an issue of national mainstream importance, to get people to understand that this is not about software and computers, it's about what happens in doctors' offices and in patients' lives. The only way I thought we could do that is if we demystified health IT and got it out of the realm of data and widgets and digits.

Second, we've built the foundation to drive the agenda forward. We built the panel to ensure the U.S. finally has a single set of standards. We built a condition for certification for health IT to make sure we can understand how to evaluate electronic health records and help doctors understand how to pick one from the other. We've built the oversight process to make sure we have the networking capacity to share information. We've pushed pay-for-performance to create the incentives for health IT.

Third, we have directly linked health IT to the budding movement of consumerism in health care. We've made sure that we understand how this links to the president's transparency initiative in terms of how we get better quality and cost data out about health care to consumers.

Q: What does your successor need to do to get physicians to accept health IT?

A: There are three strategies to get doctors to put these tools in place, short of a mandate. One is lower the cost of the technology, two is raise the economic benefit, and three is lower the risk. My successor has to make sure that we continue to push standards that would have the long-term effect of lowering the cost, to keep linking health IT to pay-for-performance in Medicare and in other programs, and to continue finding ways to help doctors implement these tools in a very simple way.

Q: What particular pressures do physicians who haven't implemented these tools face in the years ahead?

A: We're at a point of irreversible recognition that the electronic health record is an essential information tool in the doctor's office. Soon people will recognize that it is substandard and that there will be liability risks if doctors don't have these in place. More patients are shopping around and asking if a doctor has an electronic health record. Doctors are facing the inevitability of these products, and they're going to have to either sit it out until their retirement and take the hits or just kind of jump into it.

Doctors are facing a world where more and more information will flow to them. They're not just going to be putting their charts on an electronic record but they're going to be getting lots of information from other doctors and hospitals in an automated way that makes their lives a lot easier. The push for transparency is going to continue. Doctors are reporting more statistics about their quality, more about their costs. The consumer movement is well under way.

We're coming very close to a world where doctors are going to have more electronic interaction with their patients. Secure messaging, secure e-mail, being able to monitor how a patient is going with their congestive heart failure therapy while they're at home. Electronically monitoring how well an Alzheimer's patient is doing with activities of daily living via electronic sensors. I see patients being monitored by remote monitoring stations. I've talked a lot with the AMA about making sure that medicine is really ready for the world where not all doctor-patient interactions are in person.

Q: Have you started to tackle the anti-kickback statutes that prohibit hospitals from donating health IT to physicians?

A: We're very close now to be able to release a final rule on anti-kickback safe harbors that allow those donations to occur. The direction that we've given to the lawyers is to make it clean, make it easy to do, make it something that is beneficial to doctors and that really helps us get these technologies in place. So you should see that coming out within months.

Q: You expressed some frustration about lawmakers' initial failure to set aside funding for your office in 2005. Any other regrets or frustrations?

A: That was just an example of how the ball can bounce badly. It just happened because of the confluence of events happening during appropriations time, and it was really a near-fatal event for our effort. But we got a good appropriation last year, and I would expect it to go up again this year.

I had the same frustrations that any parent has when they're up to their head in their career and they have a 5-year-old at home who's growing and developing and they're not a big enough part of his life.

In terms of regrets, at this point I don't have the hindsight to know what we would have done differently. In a couple of years, I'm sure people will be talking a lot about what we should or shouldn't have done.

Q: Are we still on track when it comes to the president's 10-year plan?

A: I actually think we're ahead of schedule. So many things are going into implementation mode, and the value will be seen if someone who really is an implementer can come in now and oversee this. But I also recognize that at the end of 10 years, we won't be done. We'll have met the president's goal, but the adoption of technology in the health care system is a never-ending process.

Q: Any plans right now on where you might be going?

A: I've got to reconnect with my family and deal with a number of personal things. Then and only then, I'll start thinking about what's next. My whole career has been about health care technology and quality. I would not doubt that I would be doing more of that.

Q: Wherever you end up, will you continue to represent the concerns that you feel are particular to physicians?

A: I am indelibly a doctor. As a former trustee of the AMA, I think a lot about small physician practices. Our metric of success is not that the big, leading, name-brand, corporate doctor groups do this, but that the doctor in a one- or two-man office on Main Street does it. So, yes, I'm an advocate. But I'm also a prodder for change. I've spoken many times with doctors' groups and told them that they need to not just get on the technology revolution but to really look at where medicine is going as patient consumerism becomes a much bigger part of the health care market. I'll continue that without a doubt.