The appointment of David Brailer, M.D., as the nation's healthcare information technology czar is a grand-slam home run, according to Modern Physician interviews with selected members of the physician-informaticist community -- many of whom know him as a leader and a friend and several of whom say his appointment marks a milestone in the healthcare quality movement.
HHS Secretary Tommy Thompson on Thursday named Brailer as National Health Information Coordinator, a post created in late April by President Bush.
"They couldn't have made a better choice," said Mark Leavitt, M.D., director of ambulatory care at the Healthcare Information Management Systems Society, a Chicago-based trade group for the healthcare IT industry. "In fact, it restores my faith in government to see someone so well qualified appointed.
"We at HIMSS look forward to working with him," said Leavitt, who considers Brailer a peer IT pioneer and entrepreneur.
More than two decades ago, Leavitt banged out copies of an early electronic medical records software program on an Apple II computer and used it to found EMR vendor MedicalLogic in 1985. The Logician brand EMR that MedicalLogic developed was taken over by General Electric in 2002.
Brailer founded Care Management Science, a data analysis and consulting firm in 1993 and worked on the development of the Santa Barbara County Care Data Exchange, a regional collaborative clinical information network. The company, with a shortened name, CareScience, was sold to Quovadix last year.
From the political right to the left, from Rep. Newt Gingrich (R-Ga.) to Hillary Clinton (D-N.Y.) pushing healthcare information technology "seems to be something that everyone embraces," Leavitt noted.
"I don't think he (Brailer) needs my advice, but I think he understands the frontier we need to conquer right now is not in the hospital. I think the great unconquered territory is in the doctor's office," Leavitt said.
David Kibbe, M.D., is busting sod along that frontier as the director of the Center for Health Information Technology with the 97,000-member American Academy of Family Physicians. Kibbe also is project director for the CMS-supported Doctors' Office Quality Information Technology project, which seeks to promote the adoption of IT in small to medium-sized physician offices.
The academy's The Future of Family Medicine report released in March calls for the reinvention of Kibbe's medical specialty via universal deployment of IT, including electronic medical records systems.
"I've known David for a long time and I would say that David is one of the true adults in this industry," said Kibbe. "He understands IT requirements at all of the different levels within the healthcare system. I'm delighted he was chosen.
"I think having a physician in this position makes a whole lot of sense, particularly at this time," Kibbe said. "I think everyone is looking for direction and leadership right now. It is a very propitious time, a real time of opportunity. I do look forward to talking with David once he gets situated to see what agenda he's got."
Ron Pion, M.D., is a special advisor on medical information technology to the Galen Capital Group, a McClean, Va., health care merchant bank.
"We've stayed in touch over the years as colleagues and as friends," Pion said. "I am very supportive. I just hope that the politicians and the bureaucrats and those seeking the status quo don't get in the way.
"What David Brailer has an opportunity to do is bring clinical knowledge solutions to all this stuff that's being talked about," Pion said. Being a clinician, he'll be able to see what IT is and isn't.
"Information technology is a stethoscope," Pion said. "It's a tool. Let us make sure whatever we do is in the best interest of the patients and not the vendors and those that own the industry."
Chuck Denham, M.D., is chairman of the Texas Medical Institute of Technology and chairman of the National Quality Forum safe-practices "leap" for the Leapfrog Group, the business healthcare coalition.
Denham has served with Brailer on the board of the Health Technology Center in San Francisco, a not-for-profit consortium of healthcare providers.
Like Pion, Denham said it is a key issue that Brailer knows that the focus needs to be on quality improvement, not technology for technology's sake.
"I think it's great that they named somebody with real-time experience in the field," Denham said. "I believe that the health information technologies are nothing but an enabler of best or better practices. That's why I think it's good having someone from the front lines in there."
Blackford Middleton, M.D., chairman of the Center for Information Technology Leadership in Wellesley, Mass., deemed the creation of the coordinator position as "momentous and historic" and evidence of "recognition by the government that these are part of the key interventions that have to be woven into the fabric of care."
"It is the right time," Middleton said. "I think its going to be extraordinarily useful if Dr. Brailer can help us mobilize the industry in a few ways."
Middleton said healthcare IT deployment in the outpatient setting is being stalled by what he calls a "market failure" in which the costs of buying and operating the technology fall on the physicians, while most of the financial benefits are harvested by others: payers, employers, patients and the government.
"If Dr. Brailer can induce the power of the purse at CMS or with private payers to reimburse doctors to purchase IT or get low-interest loans, that will be helpful to align the incentives," Middleton said.
Middleton also expressed hope that Brailer's lobbying will be helpful in forming the public and private alliances needed to drive adoption, as well as accelerate the setting of various healthcare IT standards.
"He's a real good guy," Middleton said. "He's got solid academic credentials, clinical credentials, IT credentials. He did good work in Santa Barbara. The key will be if he can get the momentum going. We can't wait a generation."
Molly Joel Coye, M.D., a member of the Institute of Medicine's Committee on Quality of Health Care in America, is CEO of Health Technology Center, a not-for-profit research organization forecasting healthcare technologies supported by providers and healthcare plans nationwide. Brailer served as a founding board member of the center, often abbreviated as HealthTech, where he most recently served as a senior fellow for information technology and quality of care.
Brailer's departure to Washington will be "a loss to us in the research and service community," in general and at HealthTech in particular, Coye said.
"He's a wonderful and very generous person," Coye said. "He understands the delivery of healthcare, for hospitals and physicians, for every aspect of healthcare, and the tough realities of getting IT installed."
Coye said the Santa Barbara data exchange was Brailer's baby.
"He conceived of it and led the implementation of it," she said. "He really was very much the creator and the innovator and the business person who saw it through.
"The greatest challenge for him will be the notable fragmentation of IT efforts not only in the public sector but between the public and private sectors," she said. "This is a historic point. Everyone working on quality in healthcare has been waiting on national leadership to galvanize the sector -- and David is capable of doing it."