Paul Roemer asks:
Have you ever been a part of a successful launch of a national IT system that:
- required a hundred thousand or so implementations of a parochial system?
- has been designed by 400 vendors?
- had 400 applications based on their own standards?
- has had to transport different versions of health records in and out of hundreds of different regional health information networks?
- needed to be interoperable?
- could have resulted in someone's death if it failed?
The challenges are many, yet many health care systems already are, or soon will be, moving to implement pieces of this national system. Are they motivated by the HITECH Act promise of up to $44,000 per physician for meaningful use of a certified EHR? Perhaps, but that won't cover the cost. The real value is in the ability to manage a patient's care effectively, efficiently and seamlessly across practice sites and, beyond that, to learn from population-level data.
The federales already know this — check out the recent All Things Considered piece on the Medicare claims database. The aggregators of de-identified data putting it to secondary uses already know this, though their work may be made more complicated by the new HIPAA and Son of HIPPA rules out from HHS and FTC. Some health systems know this, and are prepared to match the federales' incentive payments to docs who get on the bus (adding some Stark, fraud and abuse and tax issues to the already-heavy load of considerations).
Health care provider systems are ready to get with the program, but may need some guidance in negotiating the regulatory and operational minefields as they move to implement EHR systems.
If you're part of a system looking for some ground-floor planning and strategic thinking on this thorny set of issues, please get in touch with Paul or me.