SAN FRANCISCO – The proposed meaningful use criteria up for public comment reflected “thoughtful policy,” David Brailer, MD, told Healthcare IT News shortly after the government made the rule public on Dec. 30, 2009.

"It would have been easy to be symbolic rather than meaningful," said Brailer, the nation’s former healthcare IT chief – its first ever –and the founder and chairman of the San Francisco-based healthcare investor firm Health Evolution Partners.

Brailer said he expected the criteria to "be looser, less meaningful." Instead, he said, "I'm pretty impressed."

Brailer’s assessment came before the Office of the National Coordinator released the final rule on July 13, which did relax some of the requirements put forth in the proposed rule.

In the short term, the criteria reflected the body of work and the broad consensus of the definition of standards from the private sector, quality agencies and forums, a product certification organization and the disbanded AHIC (American Health Information Community), Brailer said. As health IT chief, Brailer's philosophy was having government be a supportive agent of the consensus of the work being done by the private sector.

"The meaningful use criteria are highly consistent with what we did," he said. "It feels right to me.

"ONC has matured wonderfully in terms of appropriate policy going forward, using various tools as drivers for healthcare IT adoption, targeting HIEs with grants and testing ideas," he added, pointing out that under his tenure ONC built test models of the Nationwide Health Information Network.

Brailer had high praise for his successor, David Blumenthal, MD, lauding a "fantastic job." When he headed ONC, Brailer said he benefited from Blumenthal's advice on health IT adoption.

"He has deep policy capabilities," he said.

Brailer said he hoped ONC would remain a key player, and that it and wouldn't get co-opted by the federal health IT efforts of the Centers for Medicare and Medicaid. He noted that it was an "open secret" that ONC and CMS were at odds during his term, and was also critical of Congress rushing to put health IT in the American Recovery and Reinvestment Act (ARRA). "It puts more risks on healthcare IT adoption than are necessary," he said.

Under ARRA, Congress provides incentives first and then penalties. But citing its track record with regard to Medicare issues, Brailer didn't believe Congress would follow through with penalties and would either delay or phase them out.

The problem, however, is that the Congressional Budget Office expects $30 billion in additional net bonuses over the next 10 years to come from the penalties.

"It sets up expectations in the market; it confuses the market," he said. "We need to make sure that physicians and hospitals are in a stable, non-erratic market."

While healthcare IT adoption, particularly getting physicians to use true clinical decision support, will continue to be a challenge, "the outcome is obvious," Brailer said. Information technology will eventually carry into the industry.