National leadership for health IT

The health IT community was rather stunned when President George W. Bush dropped this one line into his 2004 State of the Union address: "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care." Bush followed up that statement in April of that year by calling for "most Americans" to have interoperable electronic health records within 10 years.  He also, by executive order, established the Office of the National Coordinator for Health Information Technology within HHS. Not long after, Bush appointed Dr. David Brailer to head that office, and report directly to Secretary Mike Leavitt. (Leavitt, a self-described "techno-geek," was a major force behind the creation of the Utah Health Information Network when he was governor of that state in the 1990s.)

Brailer took the reins of ONC with a bully pulpit and not much else. With a tiny staff and a shoestring budget, he produced a strategic framework containing four goals and 12 strategies for improving healthcare in America with information technology, then set out on a whirlwind tour of the country to raise awareness for health IT and gather feedback from countless healthcare professionals. The office issued a series of contracts to test interoperability, harmonize standards and start a certification program for EHR technology.

Some programs did better than others. Today, there is more clarity in the realm of standards, and the only bidder for the certification contract, the Certification Commission for Healthcare Information Technology, is going strong today as a privately financed entity. But so many of the regional health information organizations (RHIOs) that sprouted in the middle of the decade at Brailer's urging--and with help from federal, state and philanthropic grants--failed once the seed money dried up.

Brailer, who had been commuting to Washington from San Francisco weekly, left after two years, and was replaced by Dr. Robert Kolodner, formerly the chief health informatics officer in the Department of Veterans Affairs. During his tenure as national coordinator, Kolodner advanced interoperability of health information between federal agencies, transitioned the American Health Information Community advisory panel to the private sector, pushed for greater health IT security measures and began real-world testing of the Nationwide Health Information Network.

This year, the American Recovery and Reinvestment Act made ONC permanent, and the job of coordinator now comes with much more than just a bully pulpit. Dr. David Blumenthal, the Obama administration's choice as national coordinator, is the key person in the provision of billions in federal stimulus dollars for health IT.