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Show me the (bailout) money!

January 31, 2009
by Neal Ganguly
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The Obama bailout plan includes $20 billion for HIT. YES! Finally – an administration that not only gets it, but is willing to put its money where its mouth is. (Where is an administration’s mouth anyway? Never mind, I digress.) $20 billion! Our problems are solved! Where’s line for the cash? What? $18 billion of it will be spent at the State level ($2 billion is for the Office of the National Coordinator)? Well, sure, the States have a stake in all this – and hey, they have such a great track record handing out money. $18 billion. My institution is a ‘meaningful user’ of HIT, but how many state lobbyists will I have to stand behind (or hire) to get my money? Come to think of it – what will I do with the money? Sure, I have lots of things to buy: a new data center, more staff, newer CABs (COWs, WOWs, BMWs – whatever you want to call those darned heavy carts). Of course that’s not what the money is intended for – PHR, EMR – that sounds more like it – RHIO? Why not? $18 billion…

The truth is, it’s not hard to spend that kind of money and still see little societal value. John Glasser, CIO for Partners Healthcare warned in a recent Wall Street Journal article (Waste Feared in Digitizing Patient Records – WSJ 1/22/09), that we should not rush to spend the money. He is right – we must spend it wisely, not quickly. Are grants for demonstration projects at the State level a good spend? I don’t know, perhaps, but a better goal is spending the money to take the industry towards real, strong, mandated standards. The kind that will force my ED and OR systems to be able to transfer data to my inpatient system without requiring a supporting cast of thousands. The kind of standards that will let me tell a physician – ‘sure, we can send that data to your office EMR’. The kind of standards that will benefit patients without requiring a massive layer of costly middleware.

I’m really glad the Obama administration has the vision to understand that HIT is vital to improving the state of healthcare. I hope they have the strength to see past special interests to mandate standards and enforce compliance. Perhaps, grants can be set up to help vendors migrate to the standard. Yes, some vendors won’t survive the migration. That’s okay – we could use a thinning of the herd. Let’s help the providers who are left hanging move to vendors that will be compliant. Sounds simplistic, and it probably is – but does it have to be so much more complicated? It would be a real shame to see billions spent without meaningful value.

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Comments

Neal,
Thanks for opening this topic for discussion.

I'd love to see a list of all of the places an electronic health record could be tethered to. You started that discussion in your post:

1) Enterprise-class provider organization with an ED, OR, IP, and Clinics system

2) "My doctors office"

3) "My Healthplan / Insurer," be they United, Aetna, Cigna, WellPoint, etc.

4) My HRB (health record bank, NGO)

5) My state-run RHIO (e.g. Deleware?)

6) My Veterans Health Agency (Health-E-Vet)

7) My Alta DoD or some hybrid with #6

8) My Kaiser (not fair to lump them with #3, right?)

and what else?

As soon as you determine that your policy is to fund the majority through the states, does that leave us with a shorter list?

I'd like to understand the options. I've found little on-line that elaborates these end games.

Joe,

You're right the record will ultimately become pervasive and ties to the whole concept of a true personal health record. I would add schools to that list at a minimum. The whole thing lends itself to a centralized health information infrastructure. This could be federally run, state run, but federally coordinated, or some private-public partnership. Either way it needs to start with strong, mandated standards.

All of the various parties you discussed will certainly need to get tied in. The questions that will arise as to the priority of getting these groups on-board maintaining adequate privacy protections, and who actually owns the information will be interesting.

Neal Ganguly

CIO, CentraState Healthcare System, Freehold, New Jersey

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