Hazing Hillary

"Hillary Clinton has no idea how an electronic medical record works!" That came from an audience member weighing in on the appropriate government role in facilitating the adoption of healthcare IT at last week's Towards the Electronic Patient Record conference. The 24th annual TEPR event drew to Fort Lauderdale its usual assortment of IT wonks, curious physicians, and overzealous sales people. Scattered among them were innovators with substantial stories to share. The open forum on what the next president should do drew an equally motley array of commentary, including the Clinton naysayer's. Her point, however, was that few elected officials understand the industry's need for clinical IT, and that education is in order. No one disputed that point, although ideas on how to make such schooling possible were in short supply.

Any elected official who happened upon the forum might have been puzzled by the lack of consensus on the industry's willingness to change. Citing the almost mythical physician resister, one outspoken commentator insisted that an entire generation of older physicians needed to die before any progress can occur. I could just hear a Hillary Clinton listening to that, and wondering, "Now let's see, you want how many billions for this healthcare IT, but you won't be able to put it to use until at least one generation of physicians leaves this planet for keeps." There was a pro-physician rebuttal, luckily, as a practice manager duly observed that until the technology "disappears"—meaning when it becomes a seamless part of the doctor's workflow—physicians will likely continue to balk at its use. Age is not the factor, he said, but rather priorities.

TEPR's tireless champion, C. Peter Waegemann (who serves as CEO of the Medical Records Institute, the event's sponsor), did a nice job of fielding and synthesizing the numerous comments, even when his 60-second speaking rule was ignored. I swear, one reason there has been so little political support for clinical IT is the inability of industry proponents to make a case in anything less than 10,000 words. An open forum always runs the risk of becoming Grandstanding Central.

The broad role that IT plays in daily life was not lost on this crowd. During the conference, I heard multiple references to YouTube, MySpace, and online banking services, all of which have captured the imagination of the public in ways no one could have predicted. Inevitably, these references were couched in a bit of awe, at the sheer popularity of these online services, and also a bit of mystery—why does healthcare struggle for comparable uptake?

We heard from Microsoft's James Mault, MD, on that score. Mault described the software giant's vision for a "health ecosystem," meaning an online personal health record service that consumers will control. In his view, consumers will drive the data exchange and consolidation that people like Waegemann have been promoting for years. And indeed, there were vendors on the exhibit floor selling flash drives designed to house clinical data for consumers to tote from caregiver to caregiver. Even if Hillary Clinton has no idea how that kind of medical record would work, she is not alone. The industry itself is a long way from figuring it out.