5. Spend the money from the new stimulus package for a National Health Care Network and Health Care Exchanges and not Electronic Medical Record System

I have read in some recent publications that there is growing support to use the stimulus money earmarked for EMR adoption for the development of health care exchange networks both regionally and nationally. This is sort of like a highway to allow digital information to move from physician to physician from facility to facility from insurance companies to doctors and the like. Think of it as either a digital highway or a health care internet. Again, I don’t want to sound like I think health care data exchange is a bad idea. I wouldn’t be in this business if I did. Let me try to give you a couple of examples why I think the concept of health care exchange is putting the cart before the horse.

To further the analogue, let’s consider that the first automobile was created in Europe in the late 1800’s. We began automation of the automobile in the beginning of the 1900’s and assembly line production occurred prior to 1915. By 1920 Ford had produced over 18 million automobiles. Yet we did not get a National Highway system until the 1950’s, more than 50 years after the first car. Building a highway system sooner would have been a waste of money. There was not enough use to warrant it. The idea of “build it they will come” did not make sense.

We had personal computers in the early 1970’s; they became popular in the 1980’s. The internet became available in the late 1980’s and by the 1990’s some people had the idea that the internet was the next big thing. They put together business models for making money and everyone got excited in the late 1990’s (we had millions of personal computers in operation at the time); however, we had a technology bust in the marketplace due to the unrealized potential of the internet business models. In short, we had computers but not inexpensive internet communication technology. It took another 10 years for the internet to become viable. The business models that did not work in the late 90s are becoming main stream today.

There is real value in getting physicians to use digital information systems in their practice. It provides data to providers more quickly; errors are reduced by structuring the data collection process. The data can be accessed by multiple individuals simultaneously. The data can usually be printed and faxed more quickly, etc., etc. I have a problem when I hear “experts” in EMR’s say that EMR’s are not useful if they don’t interface to all other health systems and integrate all of the patient’s data in one spot. People forget that the current system of clinical data collection and reporting dates back to the 1700’s; we are using pen and ink on paper and storing this paper in folders and only one person can review the paper at a time. Single papers can be taken out of the folder and folders can be misfiled. Some practices order the folder by the alphabet and they are not even using a digital number sequence to insure proper filing. There are considerable benefits to EMR’s in their own right that are not connected to anything. To say that adoption would only occur rapidly if we have an easy way to exchange the data suggests that we have good data to exchange, and I would challenge that assumption in a paper world.

In summary, there must be a critical mass of users before data exchange and digital highways make sense. Data exchange is not the barrier to EMR adoption. Money and lack of efficiency for the physicians are the barriers. The stimulus money should be used to offset the cost to the physicians directly and products that increase the efficiency of the physicians should be encouraged.