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  Today in Health it, we look at the chime interview with David Brailer, the original ONC National Coordinator for HIT under the Bush administration. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current.

And engaged. I provide executive coaching and advisory services for health leaders around technology and it, if you wanna learn more, check out health lyrics.com. Alright, here's today's story. Scott McLean, CIO, for MedStar out of dc interviewed David Brailer for the closing session of the Chime Summer Forum.

This is loaded with great information. Once again, if, if you have a chance, sign up and watch the On-demand content from Chime. There's just a lot of great stuff there, so I highly recommend it. All right. Let's get to it. Some of the stuff David Brailer talked about, he talked about meaningful use, obviously came out during the Bush administration, the original medical record speech, and he talked a little bit about that and he talked about some of their accomplishments and he said one of the things, even as you look back at meaningful use, you have to appreciate it.

There was no foundation, right? It was the start of a program. And he said one of the things he's most proud of is the fact that they got the government on one agenda built around electronic records, interoperability, digital research, consumers online and digital public health, and they achieved a unified budget and a unified direction.

And we saw that when all the national coordinators got on stage, how this agenda has really continued in a nonpartisan way. Over a number of different administrations just built around this, these concepts of using health data to the benefit of the patient and the providers for better health. He was asked to go over some of the things he was a little disappointed in with regard to their time in office, and he said, COVID has revealed that the public health information infrastructure failed.

It failed us at our time of need. And he goes on to say, I came into the government not long after nine 11. When the LEXS, the law enforcement exchange system was put in place to allow information sharing from local police departments to the intelligence agencies. So it was a seamless and integrated system that analyzed the data, and it was really a perfect metaphor for public health PHXS that we wanted to build and we designed and that we could never get funded.

And to this day, we're living with a really dilapidated and obsolete public health information. Infrastructure. And so that from David Brailler, he goes on to say, we believed philosophically that interoperability should come first. I love that. This is really interesting to me. The medical internet, as we called it, then the Nationwide Health Information Network should come before we start putting appliances and technology on the end.

And of course, because of the stimulus during the Great Recession and the High Tech Act, electronic records came first and now we're still catching up with our interoperability. So those are some of the things that he looks back on and says, Hey, these are things we wanted to do, which we didn't really get right and has caused us problems since they go on to talk about some of the futures.

And I, I, again, I like this discussion around AI and algorithms and whatnot. He says, if you look at the things that are underway with AI and algorithmic development, they're quite significant and I think have an enormous power to change healthcare for the better. The challenges in there are several, but I really put them down as four key challenges.

They are privacy bias, validation of models and issues around IP and proprietary behavior. He goes on a little further to say, I'm sure that people viewing this know this well, but I'll just start with the analogy of healthcare to driving. AI makes autonomous vehicles possible, maybe because it aggregates the individual decisions and mistakes that drivers make and collects that across Millions.

Doctors are the same thing. Every doctor is doing their own experiments and their own treatments. And there's no aggregated learning, enormous potential to use aggregated data to build algorithms and tools that will change therapeutic development. So that's an interesting perspective on the future and specifically around AI and the development of algorithms.

He was asked about the information blocking rules and where things are going in those kind of things. He said he starts by saying, I strongly support the information blocking. Open API and the trust context rules that have come out. But he knows that this is leftover work that should have been done and was not realized by meaningful use.

These rules aren't gonna solve the entire problem, but they're gonna make possible the ability to start solving the problem. In the next section, he really gives us a warning, and I'm gonna read a lot of this because it's really interesting to me. 'cause he just lays out what the future is going to look like, what they envision the future to look like, and what the impact and the ramifications are on health systems today.

So let's start with this. What's good about it from a public point of view? We have been living in a world where there is HIPAA data strictly regulated. I think highly protected, deep investment in making sure that data is protected and collected and used in the proper way. And then there's the whole other growing set of data about people, your activity and your location and your consumption of food, and all things that we do in our lives that are becoming a much, much larger set of data that are streaming and ongoing.

And it's going to allow for the first time those to come together. I'd hoped for a long time that the big hospitals and the plans would become the aggregators of all this data. But I think generally there's a sense that we don't want to touch non HIPAA data because it creates lots of nightmares for us.

So someone's going to assimilate all of this data, and with these new rules, it looks like it's going to be app developers and they're going to act on behalf of the patient and get their HIPAA data and mix it with their other data and start innovating. And I think you're going to see a massive explosion of innovation around a more assimilated, holistic set of data about the person.

And I think that will drive digital health, prescribed apps, telemedicine, preventative care, and I think it's going to be messy. I. But quite good. He notes the negative. The downside is how many app companies are there? 1.5 million at least. And any of them can get the consumer to create something that lets them act as them to get their data into their app from you.

And they can do with it largely anything they want to, as long as it's in their user agreement, which probably is everything. There's no regulation. There's no oversight except some FTC and some state level privacy protections. Basically, they have to comply with the terms of their agreement, and that's the 87 page document that you click on.

I agree whenever you accept the app, so this is going to be a nightmare of privacy problems. And a nightmare of concerns about data, and I just don't know where that ends. I think it ends with a more stringent regulation and probably in the end, a redefinition of HIPAA that covers any health relevant data from any actor.

So it's no longer a covered entity, it's a covered use of information, but that's going to be a while and it's going to get challenging. And here he gets to the warning for health systems. He goes on to say, and I ask people, what are you doing to prepare for this? And everyone says, I'm not worried about it.

I think this is going to become an enormous disruptor because you're suddenly going to have potentially thousands, hundreds of thousands of requests for data for people, and they're going to start doing things with it and then disrupt the normal flow within the hospital. That's going to accrue back to the hospital with people coming into the emergency room because of the app.

So they have a problem and it's based on the data they got from you and to me, I don't think the providers are prepared for it, and I think they're not prepared for the care delivery impact and what it means that they can no longer protect the fiefdom. They have of their own data and use it to secure an advantage in the market.

So we'll see. I'm optimistic because I think sometimes you've gotta break things a little bit to be able to fix them. So that's the warning that's out there for us, that things are gonna change. Think about that. Model thousands of app developers. Going to consumers directly. The consumers requesting the information from your health system.

They pull it in and then they start to create a whole person profile. Hey, can we have your information on your grocery shopping? Can we connect into your rewards program there? Can we connect into some of the social determinants of health data? Can we send you a questionnaire? And they start to aggregate that data and provide services around it.

But at the end of the day, the high acuity care is still gonna be done by you, and they're gonna send people in at that point. All the while they're scraping off a percentage of the revenue along the way. So that's the warning. That's what's out there. That's what we have to think about. He does note that it creates a problem, and one of the biggest problems it creates is that the app developers aren't under the same regulatory environment, and because they're not, they're gonna have a lot of freedom.

To move laterally to do things that health systems aren't going to be able to do, and that's a disadvantage that needs to be addressed. He was asked about the priorities that the incoming ONC coordinator should have, and he spoke very highly of MIC tripathy and all the work that he's done over the years.

And he says, priorities to me number 1, 2, 3, and four are to reinvent our public health information infrastructure. And then he goes on to talk about payment reform. So some good comments there. And to close this out, Scott asked him about what are his concerns? What are some of the things he's seeing out there?

And he said to me, the issue in healthcare isn't what is being done at the cutting edge, what the very best, most well financed providers or plans are doing. These are as advanced as any of the peers in other industries. To me. The issue in healthcare is that we tolerate a disparity between the best and the worst.

That is just unconscionably large. You would never see that in banking. You wouldn't see that in transportation. You wouldn't see it in energy. The other sectors of the economy, you can't compete if you don't keep up in the infrastructure, in the data infrastructure, in the knowledge infrastructure, and the user infrastructure that create the overall result in healthcare.

We tolerate it, and to me. That's the issue. It's not that we can't use technology. How can we use it more equitably, more fairly, more widespread, and close those gaps? This is a phenomenal conversation. Again, if you have the opportunity to go ahead and subscribe on the Chime website and download the on-demand.

Interview it was, uh, really well done and I appreciate Scott McLean doing that. And David Brailer for his comments. That's all for today. If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com or wherever you listen to podcasts.

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