Do we need David Brailer?

Health Management Technology, Oct, 2004 by Robin Blair

Now that I have your attention. ... At the outset, let me state clearly that HMT likes Dr. David Brailer. He has authored for this magazine and is a luminary in healthcare IT. He is the right guy for a tough job.

At the same time, David Brailer is an unforgettable reminder of the potential for government intervention and interjection into a landscape where healthcare providers, payers and even consumers should be the directors and producers, not the supporting cast. When a sector fails to keep pace as it should, count on government to step in and nudge.

Following Brailer's appointment, I received at least 100 spammish e-mails proclaiming, "The XYZ Company, a leading provider of wireless services for healthcare, supports the appointment of Dr. Brailer...." Who cares? What a waste of time and money--vendors' and mine--in a typical attempt to grab the spotlight for 15 seconds of fame. Is that the inane contribution to the NHII initiative that vendors want to be known for?

HIPAA rocked the healthcare world a few years back. Yet I have spoken with at least a dozen CIOs who, essentially, said HIPAA was unnecessary--or more accurately, should have been unnecessary. Not much happened technologically, politically or operationally as a result of HIPAA that couldn't have happened without it--if the healthcare industry had stepped up to the plate, been foresightful enough to project and protect its own future, and hit a home run.

Do we need a national healthcare infrastructure founded upon open standards and supported by interoperability? Of course we do. Do we need a nation full of doctors, hospitals, clinics, labs and imaging facilities that use electronic health records, transmittal of data and communication with peers, payers and patients? Ditto--another no-brainer. The mission is easy to support, simply because the vision of what could be accomplished in healthcare delivery is so sensible and meaningful.

Could the healthcare sector--providers, payers and vendors who service them--get to the infrastructure and implementation destinations without direction from David Brailer's new office? Could--sure. Should--sure. Would--doubtful.

Even if they wanted to--and it's not a given that they do--hospitals, IDNs and physicians don't have the money to fund all the needed infrastructure upgrades and application licensing and purchases themselves. They will need help. But no one wants to be the financial benefactor behind the vision of a national healthcare infrastructure, least of all the payer community upon which so many eyes have turned.

And what about vendors? Too many live and die on proprietary IT systems that don't play well with others, despite vacuous promises that everything talks to everything else. Those vendors who do embrace interoperability--and not at an additional six-figure price point--undoubtedly risk losing some market distinction attached to their own proprietorship of products, If all systems truly interoperated, what exactly would separate one product from another in the marketplace? Functionality, perhaps? Price? Customer service? User-friendliness?

The future belongs to those who walk onto the ball field today and deliver, at minimum, a base hit. We are fortunate that David Brailer is so exceptionally talented and insightful. In the future, this sector needs to identify, cultivate and inspire leadership from more David Brailers before the government steps in with another sector-consuming mandate. Change needn't wait for an election year; it should emanate from within.