Did policymakers get it backwards?


The HITECH incentives are beginning to have a "cart-before-the-horse" feel to them.

There may not be anything to be done about it, but as stakeholders continue to grapple with the issue of interoperability, a recurring theme is "why didn’t we deal with this before?"

This software expert, for example, piggybacks off a recent article in the New England Journal of Medicine (NEJM) that discussed the problem of doctors moving to EHRs -- but doing so within the confines of broader systems that are technologically outdated.

As he begins his own comments, he argues, “The problem is not that engineers don't know how to create the right technology solutions or that we're facing a big governance problem. Rather, the real cross-industry issue is much bigger: Our approach and the methods we have chosen for integration are opaque, decades old, and they reward closed systems.”

Soon, he comes to what, in his eyes, is the heart of the problem: “From the 1950s through the mid-1990s, systems integration required every system to know about each other in advance, agree on what data they would share, engage in governance meetings, put memoranda of understanding or contracts in place, and so on. In the age of the web, the approach has changed to one where the owner of the data provides whatever they decide (e.g., through a web server) and whoever wants it can come get it through a secure access method (e.g., through a browser or HTTP client). This kind of revolutionary approach in systems integration is what the health IT and medical device sectors are sorely lacking…No amount of government money will solve health IT integration issues so long as our approach is incorrect.”

So what to do about it?

He has a number of suggestions, which we’ll leave readers to ponder on their own. For our purposes and, we’d suggest, for the purposes of policymakers involved in considering how public resources can best be utilized moving forward, we’ll just point out how he sums up both his and the NEJM authors’ perspective.

“Health IT vendors should adapt modern technologies wherever possible,” he quotes the NEJM writers. But then he adds, “I'll go one step further and say that the government's multi-billion-dollar incentive push won't do much if the technical methods and approaches being promoted don't match the commonly accepted, lightweight and modern approaches mentioned above.”