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.