Blazing Saddles: the original HIE-NHIN model

Several have inquired as to why I came down so hard in yesterday’s post regarding the CMS-ONC’s approach to link our physicians and hospitals through the development of HIEs and the N-HIN.  I think, as do others, the goal is worthwhile but, is the current strategy going to work?

I think the current plan is fatally flawed, and is racing ahead like a herd of turtles.  Just because everyone is working hard, and has good intentions, does not necessarily mean the outcome will deliver what is needed.  It seems over engineered to the point that it is like trying to put ten pounds of turnips into a five-pound bag.

Unfortunately, until the leadership of the CMS and the ONC come to that realization the CMS, the ONC, and healthcare providers will continue to spend hundreds of millions of dollars to support an infrastructure that:

  • Unnecessarily complex
  • Is not necessary nor sufficient
  • Cannot be built
  • Will not work

Call me Deep Throat.  The perspective that the HIE-NHIN plan will not work is only spoken of in the bowels of the Watergate Hotel’s parking garage in hushed voices late at night.  Many of you have shared with me that you are of the same opinion but, like vampires you shudder that your voice on this matter would see the light of day.  It would be less antagonistic to open a kosher deli in Tehran than to say the CMS-ONC needs to be rethunk but, sometimes a little antagonism is what is needed.

Do you recall the scene in Blazing Saddles when Harvey Korman’s horde of bad guys is racing through the desert on horseback to get to the town of Rock Ridge only to be halted in the middle of a wide open prairie by a lone toll gate?  Instead of being able to go directly to where they wanted to go they are forced to go through the toll gate, and their progress is stopped entirely because nobody has any spare change.

What makes it nonsensical, and quite funny, is their failure to realize that all they had to do was o ride around the toll gate.  Maybe it is just the way my mind works, but trying to get electronic health records to a national network via several hundred disparate HIEs reminds me of the toll gate.  Why not just go around it?


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