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On Carts and Horses

A recent essay in Health Affairs (Dec. 11, 2007), "The State of Regional Health Information Organizations: Current Activities and Financing," likely won't make it to CNN. Nevertheless, for IT proponents, this is essential reading. The report suggests that many--perhaps even most--data exchanges, or RHIOs, are not going to survive. Among 145 surveyed RHIOs, nearly one in four was defunct. Only 20 were exchanging clinical data.

Despite federal support for the idea, data exchanges face plenty of hurdles. The industry is pouring plenty of effort into them. Perhaps that's why, when the well-known Santa Barbara data exchange folded up shop last year, you could practically hear the collective sigh. After all, isn't data sharing the whole point of IT? And ultimately, if you can't make it work beyond the boundaries of one hospital, what's the point?

Well, for my money, many data exchanges are the cart before the horse. Local hospitals and medical groups need to get their own acts together first before they can even begin thinking about trading data with others. I've interviewed numerous industry leaders involved with data exchanges. They invariably point to politics, not technology, as the challenge. To be sure, they are intertwined. Take the cross-community master patient index. Before that hurdle can be approached, there needs to be a community consensus--at least on the need, if not the solution.

One IT industry group, the National Alliance for Health Information Technology, is attempting to spark that consensus. The group ended 2007 with a renewed call for a national patient identifier. "One of the biggest obstacles to progress in developing an interoperable national health information network remains reaching agreement on how to correctly match medical information to patients while guarding their privacy," says Scott Wallace, Alliance president and chief executive officer.

A national identifier may be a lofty goal, especially when you reflect back on the Health Insurance Portability and Accountability Act of 1996. The original law called for a national patient identifier, but the provision generated so much controversy it was scrapped. The need, however, has not disappeared. The patient identifier is just one of many political roadblocks that can block data sharing, regionally or nationally. It is one of many horses needed to pull the cart. Kudos to NAHIT for recognizing that.

-Gary Baldwin

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