The other day I came across an interview with David Blumenthal. I didn’t find anything all that meaningful in the interview itself. However, in the comments, someone provided some really interesting commentary on what Blumenthal said in the interview.
Dr. Blumenthal says we need operability before we move to interoperability. Yet if you don’t design your systems from the start to interoperate, you’ll inevitably wind up with operable systems that do not interoperate – at all. Having accomplished this, we’ll then have to develop and impose an after-the-fact standard to which all systems must comply. This will mean redesign, retrofit, and plastering all kinds of middleware layers between disparate systems. It may even result in retraining tomorrow all those providers you hope will learn new ways of working today.
Dr. Blumenthal also says that new and better technology is coming out every day. Yet the current incentive and certification programs heavily favor the older technology which he himself says frightens many providers away from this migration. Many of the older vendors have huge installed bases and old technology. They no doubt influence advisory boards much to lean towards what is versus what might be, all assurances to the contrary.
The cost of fixing practically anything is much higher than doing it correctly the first time. I realize you can’t design perfection, and anything we build will need adaptation and improvement. But we’re following a path that ensures that we will have to do much more fixing than we would if we’d just stop and think a bit more.
The inevitability of this evolution is not a justifcation for doing it carelessly.
Talk about bringing up some valid issues. The second one really hits me that the incentive money favors older technology. I’m afraid this is very much the case and that 5 years from now the major topic we’re covering on EMR and HIPAA is switching EMRs.
Your last sentence is the my belief, too. The false demand of the EMR system “reimbursements” has caused docs to make rushed bad decisions.
The tricky part will be this: as you now can’t seem to get “just” an EMR…the vendors are trying (as they always have) to make switching away from their software as difficult as possible. They try to intertwine everything (PM, document mgmt, etc) into an EMR…the attempt to lock in a customer…the the real affect is to have a lousy product.
John,
My experience is a little bit different in this regard. There were many EMR vendors who just did EMR and didn’t have any interest in doing PM. However, the customers they talked to wouldn’t take anything but an integrated PM and EMR. Some of these EMR vendors had to build an EMR or die on the vine cause they couldn’t sell product otherwise.
I have a lot of sympathy for the innovative physicians from ten years ago, they jumped on board with EMRs that were on the market at the time to find out now that interoperability is the current buzz and only a select subset from the hundreds on the market are CCHIT certified. EMR switching will likely be the key in the future but only if you can convince a burned physician to live through it again!
Who would care that their EHR is CCHIT certified or not? That doesn’t mean anything any more. Now people should only care about ARRA EHR certification and even that won’t matter for many.
Of course, if interoperability is what’s important, certification still doesn’t get us there either. Maybe in meaningful use stage 2 or 3 they’ll address this to a greater extent.
Dr. Blumenthal’s is quickly stepping off a pretty fast moving train…you think he see’s some hazard ahead or might a nudge be involved?
National Health IT Coordinator Blumenthal Stepping Down
I don’t think he sees disaster ahead. I think he’s just tired of being the punching bag. That’s a hard position to be in since no matter what you do you’re going to make someone unhappy.