In September, the AHIC Successor organization announced its new board of directors. The news marked a major development in the groups move from a public entity to a public/private partnership, established in cooperation with the U.S. Department of Health and Human Services. The board has been tasked with developing a unified approach in creating an “effective, interoperable nationwide health information system.” One of the 15 new board members is Paul Tang, M.D., M.S., vice president and CMIO with Palo Alto Medical Foundation in California. HCI Editor-in-Chief Anthony Guerra recently chatted with Tang about his vision for AHIC 2.0.
AG: What would you say is the main stumbling block that holds us back? One of those things that comes to mind would be the reluctance of organizations with different hospitals that are essentially competitors from exchanging information, from cooperating, it’s the natural struggle, would that be one of them and if not, what would you say would be the things that you’re going to have to overcome?
PT: I think that is certainly one of them; and it’s also one of the reasons why you need some “public” entity that goes and sets up the infrastructure and the policies. For example, any one company, whether it’s IBM or Microsoft – I'm not picking on them specifically – could be thinking: 'wouldn’t the world be great if everybody used our product?' Well, that’s one way to have the infrastructure set up, but that sets up the competitive reluctance you described of not wanting to share. Another way to set up the infrastructure would be to create one telephone system that was interconnected, i.e., to create the Internet. I can see how our organization can benefit and the competitor's organization can benefit equally. Then people are more likely to step up and use the utility and compete on quality.
So until somebody steps up to “make the Internet,” or the government creates the Internet, it won’t be mutually accessible for everybody to use. I think organizations are now at the turning point where they believe data sharing is a good thing for patients and consumers. Now, hopefully they are also at the point where they say we need to participate in an organization that’ll help make that happen. I think that’s why AHIC Successor was set up. Once we have a credible entity that does produce credible, practical goods, then what you’d hope is that we’d be at a tipping point where people just start buying in. Because individuals benefit just as much by getting information from another organization as giving it up. So you’re right, that’s the impediment, and I think the only way out of it is by creating a public good that people can buy into.
AG: Does AHIC Successor have a list of specific deliverables with approximate dates, or will you come out with something like that?
PT: That’s among the first agenda items of the group. They have a charge that basically says to accelerate the adoption of interoperable health IT so that we can move data around safely. Second, make sure that there are policies and an architecture that makes data sharing possible. And then prioritize what we should work on first. And they also have a charge to oversee the NHIN. So that’s the big picture. They're not specifics, but I think we can get there fairly quickly. We’ll have to set up appropriate workgroups and involve the membership in creating the work products. I hope that we will have a critical mass of members to accomplish the essential tasks.
AG: If you don’t put out that specific list of deliverables, then people don’t know what’s going to come. You’ve got certain individuals out there that take a wait and see attitude, How do you deal with people like that and wouldn’t putting a list of deliverables out help people who might be in a holding pattern?
PT: You know, I think five years ago, people didn’t really think you needed to move data around. I think now the majority of people feel they need to share data in order to improve coordination of care. Whether the majority of people are wanting to make their own investments is another issue. But as long as there are enough people who understand and believe that we want to share data in order to benefit patients and the population, then they need to step up to the plate. The cost of not doing so, I think is what they’re going to have to consider. So if you sit on the sidelines and wait until things get going, well you’re also not then shaping it. And that may be okay with you, but for the people who want to help shape it, and who want to advance this cause, I think you’ve got to be at the table.
AG: What specifically would you recommend CIOs do to stay abreast of AHIC, just visit the Web site? Do you want people to get involved? What is your specific message to the HCI audience?
PT: I would say get involved. One approach is if you sit there, wait for reports to come out, and then read them, you’re always going to be behind. There is a first mover advantage in terms of doing the right thing. You can think of it as doing the right thing to advance the health and healthcare of individuals and populations. As a consequence, you also get a strategic advantage; because I think more and more, it is true that individuals are going to be more responsible in many ways, more responsible from a self management point of view, but also more responsible in the financial point of view with choosing their healthcare provider. And there is a certain appeal, of course, for providers who are doing all the things necessary to deliver the best possible service and care. And it certainly includes having your information when you make these decisions. I think we need the benefit of the thinking and talents of people to create this thing and to decide what we need to do first. I'm talking a lot from two perspectives, (1) as a patient advocate and (2) as a physician. This is the right thing to do from both those perspectives. And I just hope a lot of people are ready to come, in roll up their sleeves, and work on it.
AG: How specifically do you want them to get involved? Who should they contact, do you have email?
PT: Membership. Send people that (1) have the knowledge to be able to productively contribute and (2) bring information back to your organization. So clearly, a participant can do a lot by bringing both the knowledge and thinking back to their own organization rather than just passively reading the reports.
AG: And just go to the Web site, the 'contact us' section?
PT: It is a membership organization of organizations. I'm hoping certainly by the end of the year the membership structure will be set up. They’ve talked about some kind of tiered way of determining your dues. But that will all be broadcast on the Web when all of that becomes available towards the end of the year. For more information, go to http://www.ahicsuccessor.org/hhs/ahic.nsf/signup.htm