You Can’t Find a RHIO In A Box

Well, I guess I am on a Microsoft bashing streak (the folks at the Leapfrog Group will appreciate the repreive). I read Dr. Bill Crouse’s blog with regularity and generally find it to be quite good. But this post makes me crazy.

Dr. Crouse is employed by Microsoft. In this post he blogs about a a Micorsoft partner, HealthUnity, that has developed something called a RHIO In A Box. The name alone makes me crazy. Anyone that has tried to exchange data between healthcare providers knows this is a huge challenge that cannot be solved with software or technology alone. All of the problems in creating a RHIO are outside the box. Posts like this only serve to make CEOs think that creating a RHIO is as easy as buying software.

I picked up this marketing gem from the vendor’s web site:

“A hospital that wants to tap into the HealthUnity™ network can do so using our low-cost, plug and play solution. Once deployed, this solution will enable your physicians to collaborate with internal as well as external parties over secure and HIPAA compliant mechanisms. We provide all the services required to maintain smooth operation of the system. This keeps your IT investments minimal while increasing the returns on your investment.”

When I got to “plug and play” I began to involuntarily heave.

Neither the HealthUnity web site, nor Dr. Crouse’s post, address the complexities of patient matching. For example, how does the RHIO know that John Smith with Medical Record Number 123 is also Jack Smith in another provider’s database with another medical record number?

Then we have the fact that most physician offices don’t collect allergies in a codified manner. In fact, many don’t even have the free form text online. The solution to that problem is not going to be in a box.

Dr. Crouse points out that the product has the ability to exclude parts of a patient’s chart from automated access, yet make it available for case by case requests (e.g. an AIDS test result). Driven by patient privacy and state laws. How does the RHIO In A Box know which of the lab tests are for AIDS tests? While there are some emerging standards for univerally coding lab tests (i.e., LOINC) less than 5% of health care providers use them. How does the box know what my hosipital lab system calls an AIDS test?

My mission in writing this blog is to add some realism into the healthcare IT debate. Healthcare IT has over-promsied and under-delivered. We have been selling unrealistic dreams. These are complex topics. To pretend they are not is the worse thing we can do to forward the IT cause in healthcare.

Maturation of Healthcare IT

One of the great things about being in the same industry for 20 years is that there are some people that I have known for a long time.

It is great to see them at HIMSS. I was going through some pictures and found some that reminded me just how much things have changed. I guess these pictures are a metaphor the maturation of the entire healthcare IT field. Here are some examples:

Me and William Greskovich (left) in 1987 when we were FCG
consultants working on a gig at St. Mary’s – Evansville.
William is now the Vice President of Oerations and
Chief Information Officer for St. Agnes Hospital in Baltimore.

Mary Pat Fralick is currently the co-president
of Vitalize Consulting. This is her in 1986, wearing my
EMU sweatshirt, when we were low-level SMS employees.

I haven’t seen Bobbi Coluni in 15 years. But I believe she is still the
Director of Product Development at Thomson Medstat. This is us circa 1985.
I have no idea what we were doing here, but it wasn’t as intimate as it appears.

Hey Microsoft: it is EHR – not HER

I have identified the single greatest contribution that Microsoft can make to healthcare.

They need to remove the Auto Correct option in the office applications that turns “EHR” into “HER”. I am so tired of correcting Microsoft’s correction. I realize that this can be turned off through options. But, I use many computers (including Citrix). And everytime I get a new one I have to make this change.

I also know that this could probably be fixed globally with some good desktop management tools and a registry change (let me know if you know where this resides). However, my desktop management fokls have not figured this out yet.

It seems like Bill Crounse would have enough pull to have Microsft make this fix globally.

HIMSS: Day 2

I was just reading at Mr. HISTalk’s blog how much he enjoyed the entertainment portion of the opening keynote. I thought I could count on him for sarcasm and a jaded point of view? Personally I thought the entertainment portion was very cheesy. Being from Wisconsin I know 8-year old cheddar when I see it. I didn’t come to HIMSS to be semi-entertained.

Brailer’s speech was the first opening keynote that I ever fully attended. I sat in the front-most section. Clearly the message was that Brailer and the president only want to “prime” the capitalism pump. They are going to let the free markets lead us forward to an interoperable EHR. One of the ways that this would be done is through “standards harmonization.” Which sounds like new standards on top of standards. Cool, I was hoping for more complexity.

Meet The Bloggers turned out to be as big of a nerdfest as I expected. It was great to meet the folks that share my interests. They were genuinely nice people that really wanted to discuss healthcare IT at a meaningful level. But if a fight broke out I didn’t have anyone I could hide behind. Thanks guys, I had a great time.

I have vowed not to mention the weather when calling back home. Too cliche.

HIMSS: Day 1

Everything is going smoothly in my travels, unlike those on the East coast. It sounds like many MEDITECHers won’t arrive until Tuesday due to the weather.

When I travel my goal is to keep my expenses so minimal that it isn’t worth submitting them for reimbursement (other than lodging and airfare). Ground transportation is an expense that can really add up. The great thing about San Diego is that you can take the city bus from the airport to downtown for 2.25. I had about a half mile walk to the Hyatt from there.

Speaking of the Hyatt…I made my lodging reservations way too late. The hotel problems for this conference are well known. Luckily CHIME books a block of hotels for member CIOs. That saved my bacon.

I worked at the University of California – San Diego Medical Center in my consulting days. During that gig I remember waking up every morning and saying “this is the most beautiful day God ever made.” That is still the case. It is a beautiful day. I went for a run along the harbor and I loved every minute (except the running part).

Now I am getting ready to head over to the HIMSS welcoming reception (I will be fashionably late). My big decision is clothing. I am torn between business attire and a shorts/Hawaiian shirt combo. Maybe I will compromise.

Then it is off to the Meet The Bloggers event. It will be great to see my friends in the blogosphere.