Very sage and timely advice.

One comment I would like to add is that I have seen many institution’s I.T. departments grow to unsustainable spending levels, typically associated with EMR implementations. Depending on how deep and prolonged this recession is, organizations under financial duress will make cuts. Those I.T. organizations that don’t benchmark well financially with their peers will likely be facing the challenges you mentioned with a smaller staff and budget.

I think we’ll start to see more examples emerge in the market where HC organizations prove they can share information at a basic level. Unfortunately, this may create a false sense of security on our progress. I don’t believe HIE’s will move the needle on controlling HC costs and growth without making an impact on complex chronic disease patients. These patients have between 5-15 doctors who care for them, each of whom need clinical data and images that goes far beyond the easy values. Even with huge amounts of Obama stimulus money dumped into solving this problem, it’s a 10+ year journey.

I’m 100% supportive of this country moving in this direction and fully expect us to muddle through solutions wasting lots of the money in discovery, however, it will be worth it in the end. And it will take a long, long time to complete.

One point I would like to address is your pessimistic view on interoperability and HIEs. Although this has been a quagmire – mostly of expense – I blame the EHR vendors for not thinking their customers would ever have to share information. Our thinking and demands for solutions need to be reversed. Instead of thinking about connectivity from the edge (EHRs); it should be thought about at the intersection (HIO). Once this is understood, solutions are easier to sort out. However, technology is the easy part. Practical issues like community competition and misaligned objectives often get in the way of creating successful exchanges. Stakeholders become disillusioned and value is not realized. Instead of discussing how community solutions will improve care and provide value, disproportionate time is spent on how to protect individual turf.

The ‘holy grail’ I believe you are referring to when speaking of misplaced expectations for HIEs is often around the future promise of semantic interoperability. Many of the CIOs I talk to on this politely smile at the promise of semantic operability which is often a euphemism for ‘vendor cha-ching’. They know very well that the technology de jure in their community is the fax machine. They need simple solutions to send and track documents, let alone having the ability to perform community-wide population reporting. Until a standard vocabulary is adopted, the promise of semantic interoperability will remain illusive.

In the meantime, the ONC and the Federal Partners have supported the move toward IHE as well as open source. I believe that interoperability solutions will be best solved collaboratively. We should be promoting and supporting the good work that is happening in the open source community to help answer this problem. This requires that we demand the use of standards and require transparency in development. Our reward will ultimately be reduced costs associated with interoperability and better solutions with higher value. With over 90% of the citizens in the US not participating in any exchange, the opportunities to create value are great but the complexities associated with aligning stakeholder value must not be trivialized. With the right focus, dramatic improvements can take years; not decades.

I would like to take a closer look at your solution – StatShift.

Perhaps lead me in the direction to your web-site. Do you offer services, implementation and support?

Best,

Don Lyons
http://www.interoperant.com