Advice for President-Elect Obama

OK, here is what the last guy screwed up. If you are serious about interoperable health records for every American, this should get you started.

Firstly, treat the initiative like the moon shot that it is. It is complicated, it requires a great deal of planning and a great deal of money. Think of NASA, now you have an idea of what it will take.

Secondly, you will need a patient identifier for everyone in the country. This includes non-citizens, because they get care too. If you are worried about the privacy implications of that, then scrap the whole thing. If every provider can’t use a single number to correctly identify their patient then this doesn’t work.

Thirdly, this is a national project. Treat it as such. Americans don’t stay in regions – we travel; we relocate. Focus on a single national solution.

OK, now the important stuff. The first time I ever heard the phrase “standards harmonization” was from the first person that the existing administration put in charge of health records. It is a STUPID concept. The existing standards cannot be reconciled. They are apples and oranges. Even if they could be, we can’t waste time trying to add a layer of complexity on top of something that is already too complex, which brings me to my last point…

Don’t try to make everyone happy. There will be winners and losers. There will be technology companies and healthcare providers that made bets on the wrong technologies and standards. You are going to have to break some eggs to make this big omelet.

9 thoughts on “Advice for President-Elect Obama

  1. Well stated. There are some things were pure free market “the business competitors will figure it” reasoning does not work. Standards development and adoption seems like a good place for government intervention. Go back to the 19th and early 20th century and imagine were we would be today if railroads did not eventually standardize the gauge of the rails or the electrical power generation industry did not coalesce around standards for power delivery. As in these industries, healthcare IT is at that stage of requiring standards adoption to move beyond the old paper model of islands of patient information.

  2. Being in this business, I can attest that it takes herculean effort just to export data from a current HIM software solution, much less try to make it talk with any other vendor software. Getting the ER registration software to interoperate properly with the MRI department alone can be impossible – so many systems within the same hospital actually contain their own copy of the patient registration database and try to keep in sync with the main system yet fail, causing duplicate medical record numbers for patients in the same hospital! Add to that the fact that in certain areas of the country, as much as 20% of patients (my personal experience analyzing the data) lie at registration to avoid bills or immigration, making it impossible to provide any benefit from even having a record, much less making it electronic and sharable.

    Couple that with the fact that the majority of hospitals are not huge 400+ bed facilities in downtown Atlanta. They are the 80 bed hospitals barely scraping by in rural Arkansas. Hospitals that even if they were given a great new free software upgrade wouldn’t have the expertise or funds to implement it.

    We still have a long way to go – there’s definitely a problem, and the market hasn’t been fixing that on it’s own. The first step would unfortunately be mandating a simpler set of information transfer standards that all vendors would need to implement. Just throwing money at the problem isn’t going to solve it.

  3. Sorry, I’d like a pass on this one.

    Medicare, Medicaid, VA, how many examples of pure gov’t screw ups in health care do we need before this begins sounding like a bad idea.

    Let me manage my own health care, keep the gov’t’s mitts off of it; it’s non of their business.

  4. Really glad I came across this posting. Very interesting letter/comments. Not much else to do up here in the arctic north now that the Pack have retired for the season and the ice isn’t thick enough for fishing… Suppose I should study my biz…

    I work on the HIT vendor side of things and don’t see this as a money problem, nor do I feel we need a Nasa-like focus on connecting every doctor to every hospital in support of every patient in the country driven by the gov’t.

    Industry MUST provide simple (little to no training req’d), effective (outcomes/admin) and affordable HIT for physicians that enables them to appropriately share relevant clinical data/history with providers anywhere in the country without losing control of the patient relationship or their practice. So far, industry has failed to do so and physicians have acted COMPETELY rationally in not purchasing what has been presented to them as “21st century medicine:” Complex, expensive, confusing and not friendly towards physicians.

    Tony made a GREAT point regarding hospitals. Some have LOTS of money to play with and others are closing departments just across town. Many reasons for all that not relevant to this discussion, but the fact is EVERY hospital is feeling the pinch right now (and will for years) yet each CIO must figure out some way of aligning community-based physicians, delivery networks, etc. with the significant internal HIT investments they’ve made to further enhance not only patient care across the community, but their own profitability as well.

    My company works with a large hospital system that spent untold MILLIONS of dollars and years to deploy one of the most recognized names in EMR-land (GREAT company) for their in-patient services and are now trying to extend the ambulatory version into the community. The system can’t GIVE away licenses to the community doctors because the physicians don’t want to feel beholden to that one hospital or system.

    I have supported three different industries migrate from paper to digital workflows during my civilian career, and Healthcare is doing the same thing the others did: try to digitize paper-based practices/processes focused on creating perfection with some future potential ROI rather than creating good enough, showing value NOW and innovating towards “perfection” over time as the “users” learn what the really need/don’t in the “new age.” Each “mature” IT-enabled industry I’ve worked with follows the latter path…

    Wow, that was some good coffee! Sorry for the long note… THANKS for your blog. Please keep posting!

  5. The industry has spent a great deal of time working to implement really complicated tools. It’s a wonder something as simple as a PID has not been implemented. Amen! Hope the current administration notices.

  6. Agree. However waiting for the Fed is like waiting for the tooth fairy. Its always late and never enough. The Health care industry needs to buck up and use private industry to solve the problem. It just so happens that the solution provider for this identifier is in Madison WI. However the Governor of this fine state is not small business friendly. Also the providers are not receptive to “in our back-yard” solutions. This is not that difficult that providers need to rely on the Federal Government. The truth of the matter is citizens will reject a federal identifier of any kind. Follow the last five years of REAL ID.


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