I wrote in my last post how the
government screwed the pooch on Electronic Medical Records by not
requiring interoperability as it invested $30 billion in the
enterprise. With that kind of money going to by EMRs and equipment,
surely the proviso that they be interoperable could be included. Was
it corruption or incompetence that omitted that proviso? I couldn't
be sure. Maybe a mixture
So here's a follow up from JAMA,
September 22/29, pages 1213-1215, a medical news article: “On the
Road to Interoperability, Public and Private Organizations Work to
Connect Health Care Data.” The reporter, Julie Jacob, interviews
the Office of the National Coordinator for Health Information
Technology (ONC) spokesperson, Erica Galvez MA. The article states:
Although
the ONC road map presents the movement toward interoperability as a
smooth, straight road, in reality it's more like fitting together the
pieces of a giant jigsaw puzzle. Several public and private
organizations are working on different pieces, including
organizations creating technical standards, establishing health
information exchange (HIE) networks, connecting those HIEs, and
developing principles of governance and usage. The hope (emphasis
added), according to health care information technology
experts, is that all the pieces eventually will interlock.
Because
the Feds have basically opted out of direct action and laws requiring
interoperability, several organizations have formed to try to fill
the breach, one from the AMA called Healtheway, another called
CommonWell Health Alliance which was spawned by the EMR industry sans
Epic, and which requires a fee from participating institutions.
Another older one is the Indiana HIE. Epic has their own system
called Care Everywhere, available for a fee when you buy Epic and
which was charging for each chart searched when Epic was presented to
me, which links together Epic systems and some others who choose to
join (for a fee which has been waived for five years, I guess under
some pressure.)
Why all the flailing around? The JAMA
reporter:
The
highest barriers are financial and policy ones, not technical ones,
noted those with expertise in health care technology.
“Technology
is almost never the obstacle,“ noted Indiana HIE's (John) Kansky.
“It is really the governance of the data and getting organizations
with different agendas to agree on what you are going to do.”
In
other words, it is precisely the role of government that is not being
well filled here. Government has taken a hike. Amazingly, this is
the ONC goal:
...electronic
exchange of health information among clinicians, health
facilities,and patients should be widely available within 10 years.
Holy
moley – 10 YEARS!! Let's see: Kennedy's speech, 1961; moon
landing, 1969. ONC is not what we would call, let's say,
overambitious.
I
was interested that the spokesperson from ONC JAMA interviewed had
only an MA degree, so I googled her, and got a hit from
four days ago. From Healthcare IT News:
What
is Aledade?
Aledade
was founded in 2014 by Mostashari with a focus on supporting
independent, primary care physicians creating and or running ACOs.
They provide healthcare technology, business transformation services
and upfront capital.
More
from Forbes:
Mostashari, an internist, oversaw the nationwide implementation of electronic health records in the initial stages between 2011 and 2013. Last June, he founded Aledade to help doctor practices, as small as one, band together in so-called accountable care organizations (ACOs).
...By the end of the year, Aledade expects to have more than 100 physician practices in its ACOs, managing 75,000 Medicare patients. Practices pay a membership fee of $500 per general practitioner per month. They keep 60% of savings, with 40% going to Aledade.
In
other words, the former head of ONC left to raise money for a private
venture and hired a former staffer for him at ONC to come to the
private venture. Let me note, however, that Aledade actually is
interesting in that it focuses on private practices and has software
that is designed to keep them independent of large hospital networks.
Still, as they used to say, is this any way to run a railroad? But I have to say that I myself was in government early in my career, and
looking around at what took place there, I decided that it was not a
good place for me in the long run, much as I learned and loved some
of my years there. I can't criticize others for making the same
decision.
So,
here is the picture. There are so many loose ends in the current
non-system, it's not at all clear that this puzzle can be put
together. To my mind, the Federal government has never looked so
bad. They fail to look forward to see where private enterprise –
here, EMR development – needs some help, some regulation if you
please, to pave a road ahead so that companies can innovate and
compete, but still develop a system that works together for the
public's benefit. Companies themselves put a low priority on working
together, as would be expected; that's why government is needed, as a
convenor. Even when the Feds have a $30 billion windfall from ARRA,
which would ensure they had the clout to enforce standards, they fail
to exercise it. ONC continues to be meek and silly, setting a 10
year horizon for something that has governance and political
impediments rather than technical ones. Government continues to fail
to see, or at least talk about, the implications for the system as a
whole, where some large capitalistic systems will benefit from lack
of interoperability to the detriment of true competition and
progress. Government accepts the role of bystander and beggar.
Private companies seek to fill the government void of data
coordination and interoperability. The problem of rotation of
personnel from government to private business continues in health
care as with other fields. Given the toothlessness and fecklessness
of government, one can hardly blame them, although I'm sure there is
much connivance from the private world. In fact, perhaps I am
blaming the victim as I blame government. Who knows?
What I
do know is, this really sucks.
Budd
Shenkin
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