The "hand of thoughtful policy" created the proposed criteria for meaningful use, according to David J. Brailer, MD, former healthcare IT czar for the Office of the National Coordinator.

"It would have been easy to be symbolic rather than meaningful," the founder and chairman of the San Francisco-based healthcare investor firm Health Evolution Partners said. He expected the criteria to "be looser, less meaningful." Instead, he said, "I'm pretty impressed."

In the short term, the recently released criteria reflect 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 old AHIC (American Health Information Community), he 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. (Find the proposed criteria for providers here, and the proposed criteria for hospitals here.)

"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 said, 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, saying he is doing a "fantastic job." When he headed ONC, Brailer said he benefited from Blumenthal's advice on health IT adoption.

"He has deep policy capabilities," Brailer said.

Brailer said he hopes ONC will remain a key player and doesn't get co-opted by the federal health IT efforts of the Centers for Medicare and Medicaid. It's an "open secret" that ONC and CMS were at odds during his term, he said. He is 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. Citing its track record with regard to Medicare issues, Brailer doesn't believe Congress will follow through with penalties and will 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.

"Ours was a battle of timing," he said. "The question for government policy is how do we get there faster?" The challenge, he said, is determining how policymakers and industry leaders help create massive transformation with the least disruption for providers and patients.

Expect to see more fragmentation in 2011, Brailer said. "We'll be approaching the peak of the hype cycle," he said. He presages a "real slide back to reality," with the money coming from CMS flowing "slower than everybody thinks."

The pushback to reality is predictable and required with any hype, he said. Despite the challenges and problems ahead, Brailer said, "the problem isn't whether we are making progress. We are."