The View from Underneath the Bus

EHR causes Ebola!  EHRs hold data hostage in stovepiped legacy systems!  There is no interoperability in America!

How many headlines have you seen over the past month that are either completely false or a vast oversimplification of complex issues.

As I tell my staff, there is no problem that cannot be morphed into an IT shortcoming.

There a point at which CIOs, EHR vendors, and those working on policy feel like each day is spent being thrown under a bus.

The journey of the last decade has been the continuous progression of technology, policy, and cultural change that has moved us from 10% adoption of EHRs to over 70%.

In Massachusetts, millions of transactions are exchanged for care coordination, population health and quality measurement every month.

Web-based, mobile friendly, cloud hosted products are either live or soon to be live from all the leading EHR vendors.

Am I satisfied with our position?  No.   We still have work to do.

Am I satisfied with our trajectory?  Absolutely.    There is a pace of cultural readiness that cannot be accelerated if adoption is our measure of success.   Alignment of economic incentives, public education, and the evolution of technology are necessary pre-requisites for change.

When I was growing up in Southern California, I remember dropping envelopes into the Diebold "after hours" bank repository.   Then one day, a machine became available that automated transactions with that one branch of that one bank.

A few years later, those machines worked with all branches of that one bank.

A few years later, those machines worked across different banks in California.

A few years later, those machines worked across the country.

A few years later, those machines worked across the globe in multiple currencies.

Automated Teller Machines evolved over time to address growing demands once workflow redesign, changes in consumer expectation, and worldwide network enablers were in place.

EHRs are in the biplane era and we’ve not yet invented jet engines, but we’re working on them.

We cannot go directly from horse drawn carriages to the Dreamliner.

I’m optimistic.

At the October 15, 2014 joint meeting of the Standards and Policy committees we’ll review the JASON report which will emphasize the need for open EHR Application Program Interfaces (APIs) without impediments (such as high fees) to data exchange.

HL7 is likely to have the necessary Draft Standards for Trial Use (second version of FHIR) by mid 2015.

Meaningful Use Stage 3 is likely to focus on interoperability.

So instead of a view from under the bus, it’s time for everyone to recognize the progress we’ve made, acknowledge the hard work ahead, and agree that there are unemotional next steps to address specific needs in specific timeframes.

I’ll do my best to educate all those stakeholders and journalists who focus on the absence of flying cars instead of the fact that horses have already turned into Teslas.

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