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Kick legislatures out of health IT

November 26, 2007 — 7:59am ET
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I don't know about you, but I'm truly sick of hearing the words "health IT" and "legislation" in the same sentence.  Hey, federal and state lawmakers, it's sweet of you to care, but really, you shouldn't have. I mean, really.

While governments can certainly provide incentives to buy an EMR (tax credits), or to hook up to a health information sharing network (connectivity grants), or even to develop interoperability standards, micro-engineering health IT decisions just ain't gonna work.

Take the current measure steamrolling its way through Capitol Hill--a bill which, among other things, is intended to encourage healthcare data internetworking. Sounds good, but what are the odds that the Wired for Health Care Quality Act of 2007 can convince health IT administrators to change their carefully-thought-out, facility-specific networking strategy?  

After all, even if you dangle big grant money, no IT smart exec is going to participate in an HIE network if he or she can't support it or their peers and clinicians aren't juiced about its prospects.  If I were an IT manager, I can't say I'd be too thrilled by the idea of supporting a RHIO/HIE, unless my facility had some specific to gain beyond some feel-good coverage by the local media and a drop in medical record requests by outside parties. (OK, I'm being too hard on HIEs, but you get my drift.)

My sense is that HIE and EMR-related measures are popular in legislatures because they're a way to look proactive in healthcare reform without having to upset powerful constituencies. It looks great -- "Hey, providers get quality improvements, vendors get bucks, everyone wins!"--but the truth is, it's just posturing. As far as I can see, is that the benefits of health information exchanges are still somewhat amorphous and the costs high.

So, all that being said, what should legislators be focusing on if they really want to lend a hand to the health IT sector?  Should they do more to foster standards development? Funding private research on the efficacy of specific health IT options?  Or should they should just step back for a bit and stay out of that which really can't fix? What do you think? - Anne

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Comments

By Brian Wells | Posted 3:15pm | November 26, 2007

We need a HIPAA for clinical data that would define and enforce the usage of standard transactions and transaction content. This would enable PHRs, RHIOs, HIEs, etc. of whatever form the market drives to really be able to securely, accurately and dependably share clinical information.

By Eric | Posted 3:25pm | November 26, 2007

"...micro-engineering health IT decisions just ain't gonna work."

Nor will it work giving away health care providers' precious margins to IT vendors while they slug it out over "standards". Free markets and competition is only one approach towards efficient design, and in this case it's just not in the best interest of health care consumers or the health care industry.

Using market competition to drive standards is what's happening now with CDMA, TDMA, and GSM cell phone technologies in the U.S. The contrarian view are Asian and European countries that settled on standardized cell phone technologies and now are reaping benefits far out pacing the U.S.

By picking a standard (think Google for search), a network effect is created, where a critical mass of users on single platform reduces producer costs and accelerates the pace of innovation.

Like our cell phone companies, competition among HIE vendors is actually stifling innovation compared to standards-based technology design. Standards change the profit motives of vendors from building fragmented communities of users that are closed and proprietary (think Microsoft Windows), to one where producers compete to add value to the larger network or community of users.

We simply can't afford to let fragmentation and free market evangelism be an obstacle to progress. Our resources or capital dollars in health care are highly limited, so the government can serve in a useful role acting in the national interest to advance HIE.

This process should begin by reconfiguring marketplace incentives and defining the standard criteria for interoperable HIE. The experiments we are conducting today, to keep standards out of the government's hands, has already cost too much and yielded only marginal benefit.

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