Mark Frisse, a professor of biomedical informatics at Vanderbilt University who is working to develop a regional health information organization (RHIO) in Tennessee, said Brailer brought a human face to obscure and intangible issues 'with little legislative authority or funding. The health care IT horse is out of the barn, and sufficient consensus exists that rapid acceleration is possible.'

The new coordinator should foster stronger collaboration among the various federal agencies, he said, and execute on the initiatives Brailer helped start, including: contracts for building a NHIN, a commission for certifying EMR technology standards and research to ensure patient privacy.

'People want a coherent view of the federal government and a sense that agencies are working together to address critical needs,' Frisse said. 'States are going to be critical in the next stage of evolution, and collaboration on state initiatives seems important.'

J. David Liss, vice president of government relations and strategic initiatives at the New York-Presbyterian Healthcare System, said the new coordinator should have experience in a large-scale health care operating environment and credibility with the informatics community. In addition, Brailer's successor must address the emerging policy within the federal government that sees health IT efforts mainly as a way to report on physician performance.

'Clinicians may view health IT more negatively if they perceive the technology's main function as aggregating and reporting data from their practices,' he said. 'This does not make the doctor's work easier, it merely supports another regulatory burden. The next coordinator should consider the potential wedge 'pay-for-performance' may drive between doctors and information technology.'