You could blink twice and miss the Office of the National Coordinator for Health Information Technology. A cluster of 10 cubicles, some open and others displaying vain attempts to create a little privacy, are wedged into the south end of the fifth floor of HHS' cavernous Hubert H. Humphrey Building in Washington, nearly indistinguishable from surrounding turf occupied by the Office of Audit Resolution and Cost Policy and the Office of Small and Disadvantaged Business Utilization.
The staff phone list contains only 20 names, including an office manager, several people to handle scheduling and travel, and-for a seven-week stint-me.
As small a crew as it was, there wasn't enough room to accommodate this upstart office. To get to my space and those of several other staffers amid the cubicle colony, I had to walk 40 paces west, take a right turn and go another 25, squeezing in between federal employees working for the Office of Information Resources Management.
The only room with actual floor-to-ceiling drywall and a door was occupied by the national IT coordinator, David Brailer, when he wasn't on the road getting the word out about the IT challenge-which was often. From May to mid-December 2004, there were 266 requests for him to speak and 64 requests for him to visit a site where IT was going gangbusters. Brailer (or occasionally a senior aide) managed to speak at 91 events.
At our makeshift headquarters, the atmosphere was frenetic. It seemed like 20 different issues and projects were going on simultaneously, each convening earnest groups of staffers and outside experts in government and healthcare in whatever pockets of space they could squeeze themselves into. Much of the activity took place in the only other walled room-a glassed-in meeting space with a boardroom-size table-which was casually referred to as "the fishbowl."
Figuratively that label could be expanded to characterize the whole operation. Any words issued or moves made had to be carefully scrutinized for their potential impact on healthcare IT fortunes and future direction, though the words and moves have been few and far between. The scrutiny reached a high-water mark at the end of last November after a $50 million appropriation for IT programs was reduced to zero in the federal budget for 2005.
I can vouch for the productive activity going on but not in detail, because one of the terms of my inclusion was a confidentiality agreement. Brailer, in an on-the-record interview he agreed to near the end of my fellowship, would say only this:
"In addition to cheering people on and supporting them and educating people about what needs to be done on the outside, we have some heavy lifting to do on the inside-and we can't talk about it. We respect the policy process and we want to work through that. And so the challenge is, it's hard for people to see (progress) until they see the finished products, but I have to tell you, I'm pretty impressed with the rate (of progress). The number of different line items we're working on will become visible."
And it's being done with a collection of people borrowed from other agencies or hired under contract as temporary federal employees without benefits, some commuting long distances to be part of what Brailer calls a "startup" in the middle of a giant bureaucracy.
"If you look at startups that I've been involved in, it suffers from all the same challenges of resources and space and of clarity of organizational roles," he said. "But it also gets all the benefits. It doesn't get caught up in secondary issues-it focuses on things where it can have an impact, and it's relentless in its pursuit of its goals."
Answering Brailer's call to serve were advisers from the days when he founded and ran a healthcare IT company called CareScience in Philadelphia and then moved to San Francisco to head the company's development of technology to power a regional healthcare information exchange in Santa Barbara County, Calif. Lori Evans, who ran the company's operation there, is now in charge of extending that concept nationwide.
Adviser Kelly Cronin, a specialist in health policy and clinical-trial coordination, is on loan from the Food and Drug Administration; Kathleen Fyffe and Mary Forbes come from elsewhere in HHS; and Brailer's scheduler, Toni Knight, is from the Department of Homeland Security.
Jared Adair, who once headed the CMS' effort to implement sections of the Health Insurance Portability and Accountability Act, left for a private-sector position with Computer Sciences Corp., which lent her back to Brailer's office to work on the federal government's health IT plan. She commutes from Baltimore, and she isn't the only one.
My fellowship involved living in the D.C. area and flying home to Chicago on weekends, but I had no room to grouse. The office's senior technical adviser and former CareScience technical officer, Lee Jones, commutes from Philadelphia-daily. And we had nothing on Brailer, who commutes from San Francisco-trying to go home on weekends but not always succeeding.
It's a cross-cultural mix that's "dominated by people from the private sector, who have developed close working relationships with their peers who have had long-standing federal careers," Brailer says. "It really is symbolic of what we're trying to do. Our people are learning the regulatory and the policy ropes, and those people (in government) are learning a new way of thinking about issues."
John Morrissey covers information technology for Modern Healthcare. He is based in Chicago.