I borrowed the following paragraph from the August 31 post of the Healthcare Blog.

August 20th, HHS Secretary Kathleen Sebelius and ONC head David Blumenthal announced $598 million in grants to set up about 70 “regional extension centers” (RECs) that will help physicians select and implement EHR technologies. Another $564 million will be dedicated to developing a nationwide system of health information networks.

It goes on to state that the RECs are based on the federal agricultural extension offices of the early 1900’s.

Do you ever get the sense that some days the topics just walk up and slap you in the face?  I may have deciphered the difference between the federal sector and the private sector—for those of you who were thinking I was going to write competency, it crossed my mind, just couldn’t decide to which group.  I think it’s speed and planning.  The private sector travels at the speed of the Dow and plans at speeds approaching the half-life of a fruit fly.  The federal sector travels at the speed of a ten-year-old eating broccoli and plan around the life span of a black hole.

They plan, and then plan and then write the backup plan, and then back that up.  It’s like the healthcare version of the movie Fail Safe.  Only this time it’s not done ‘in case’ the plan fails, it’s done for ‘when’ the plan fails.  Here’s my take on all of this as relates to EHR.

• Certification—a backup in case EHR doesn’t looks like it will work
• Meaningful Use—backup in case certification looks like it won’t work
• Speaking in parentheses—as I’m wont to do—at this point, neither matter, because under the current schema, interoperability won’t work.
• Did I mention we still don’t have a set of standards?
• Next comes RECs
• And, another half billion for nationwide system of health information networks—HIEs?
• Does the last point mean we are done with the notion of RHIOs and HIEs, or are HINs their backups?

What to do?  Set up another backup plan—REC centers.  The first time I read about this I thought REC centers were something like the Police Athletic League—if EHR failed, let’s play basketball.

Since you asked, here’s what I think we should do with this billion.  Give it to the EHR vendors—I can’t even believe I wrote that.  This is the same group of businesses who haven’t learned how to share their toys and play nicely in the sand box.  Ready?

1. Some small number of EHR vendors (let’s label them Group A) does account or will account for a percentage of the installed base in the upper nineties.  The also-rans are Group B.
2. It can be argued that not having a single set of standards is the reason we must have all of the intermediary non value-add strictures which make interoperability insurmountable.
3. It can further be argued that not having a single set of standards causes the need for certification and Meaningful Use which would otherwise have no meaningful use.
4. Give Group A the following mandate:
   1. Agree upon a set of standards to which you will modify your systems
   2. Modify your systems to those standards
   3. Provide that version to your installed base
   4. Agree that all future install will be of the standards-meeting application
5. Group B may continue to market provided they meet the standards.

This could work.  It would fix a lot of the current problems and make a lot of the upstream ones disappear.  What do you think?