On one of the LinkedIn healcthcare groups someone inquired rather indelicately about the source of the data I posted.  I replied with the same degree of indelicacy with the following.

My “curious combination of exact figures and sweeping generalizations” comes from several places including HIT.gov and the New England Journal of Medicine. I posted a PowerPoint presentation on slideshare.com entitled, “EHR-Why Should I be Worried.” Unfortunately, the charts and data in the presentation were pasted directly from these same specious sources. “Things just get curiouser and cuiouser”—Lewis Carroll. Hopefully I’ve addressed the first question.

The second posted opinion questioned my perspective on having writtenthat EHR implementations are difficult and tend to fail.  I wrote from the perspective of a hospital that is required to pass the tests of certifiable, meaningful use, and interoperability. Someone in the computer hardware industry (the holder of the second opinion is an EHR hardware vendor–I peaked at his profile) would see the situation from a different perspective,and would have more of a “what’s in it for me bias.”

Today the feds announced that the standards under which the CCHIT has issued certification should be expected to change significantly, therefore installations passing as certified today shouldn’t assume they will pass once standards are finalized.

The pain from EHR which we will all be facing is my opinion, part of which comes from doing my homework and talking with healthcare providers, some of which comes from being someone not known for drinking the Kool Aid.

Here’s my reasoning:

1. Only half the required HC IT people are in place.

2. None of the products (according to the government) passes the connect or interoperability test.

3. To be of any value, the EMR must connect to the EHR. The EHR must connect to other EHRs via the continuity of care record (CCR) and to the Rhio. The Rhios must connect to the NHIN. This house of cards doesn’t even exist.

4. There is no EHR czar. Can anyone answer this? Who is in charge, who has the authority, who can stand up and say, “I am the decider?”

5. The vendors each want their own standards (big surprise)

6. To me, we have a battle somewhat akin to the one between VHS and Betamax, only with many more technologies in play

7. EHR communicating with EHR ambulatory is worse than when I tried to get by on Spanish in Brazil (before someone feels the need to correct me on this–as they did in the LinkedIn discussion–the error is deliberate and is made to illustrate the point that 2 languages are being spoken.)

8. We are in the middle of a nationwide rollout of EHR.

9. The EHR vendors do not have the staff needed to perform the required number of installations.

10. In-house IT departments that still need an EHR have:
a. never acquired an EHR
b. never installed an EHR
c. never designed processes to support an EHR
d. etc.

I’ll close with this. If I have the only phone in the country, apart from its value to me, my phone is worth nothing. If you and I have the only 2 phones, it’s still worth about nothing. If there are a million phones interconnected then you have something of value.

I use this illustration because I did a fair amount of telco consulting, and a lot of that was with interconnects. When a call goes from point A to point B, more often than not the call passes through the networks of several phone companies. Each company must capture and report call detail records (these are much simpler than healthcare records) for the point of origin and the departure point. They aggregate this data to bill the customer for the call and then to mediate the bills amongst themselves. When was the last time you agreed with your phone bill?

The point is, this example is just telephone billing. Medical billing is much more complex, and EMRs and PHRs add another magnitude of complexity.

Do I think EHRs are complex? Yes. Do I think they will be ready in time? No. Will a working nationwide interconnect be in place in time. No. That’s my opinion, and I base it on my own curious and sweeping data.

What do you think?