Uncommon Common Sense

Recently, I ran across a podcast sponsored by Deloitte called "Sharing the Health: The Promise of Health Information Exchanges." John Halamka and John Glaser (HIT household names, to be sure) were the featured panelists. I commend this podcast to you without reservation, because their views are devoid of hype, and grounded in the hard realities of HIT transformation in this country. Here is my take-away list.
a. HIT may be able to reduce the 15% redundancy rate in medical practice, but the 15% cost savings for payers equates to 15% income loss for practioners, who won't suffer that kind of income reduction lightly.
b. Two winning business propositions for HIE's are e-prescribing and sending discharge summaries to referring MD's.
c. The information exchanges are a social good, and therefore, governments need to play a major role in their funding--certainly well beyond the current support levels.
d. President Bush's goal of most Americans having access to EHR's by 2014 is unrealistic (I've often referred to it as a "mirage," not a vision). This vision will take decades to be realized. We'd better set in for the long haul.
e. Leadership will come from the States, and not the Federal government. The States can serve as funders, convenors, standard setters, and trust builders.
f. Payer sponsored personal health records are intended to capture market share. The payers are powerful, well funded, uncoordinated, and present real problems for the RHIO's community coordinating function.
g. BEWARE of the grant funding model, unless the grant covers 100% of the work to be done.
h. A shakeout in the RHIO world is forthcoming, akin to the dot com bust of the past. We're in an era of "irrational expectations." They anticipate that about a dozen HIE's will achieve financial sustainability (Out of 160 HIE's currently in existence).
i. There are much more pressing system needs than HIT (i.e., the uninsured). Sobering, but true, I believe.
j. RHIO's may have a better chance to thrive in regions with few payers, local ownership, and non profit structures.