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On the Third Hand: Gibberish

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It took high school kids and recent college grads to get us out of the age of giant mainframe computers eating Hollerith cards in some secret basement where some bad guy was probably holding the Bionic Woman captive.

It then took a new generation of college kids to help break computers out of the isolated silos created by grownups with marketing degrees and have those computers talk to one another through, first, the Internet, and, later, the World Wide Web.

I think, now, that the obvious truth about health information exchange — efforts by doctors, hospitals, clinics, and, possibly, health plan administrators and health insurers to share people’s health information — is too important to be left to multiple layers of adults with management degrees and stakes in legacy systems who are just pretending to know what random-access memory is or why one might want to have a twitter account.

We have to go to the nation’s good high schools and good colleges, locate the rooms with the largest piles of unwashed laundry in the corners, and free some kids to replace the current zoo of clunky, stakeholder-shaped, advisory council-reviewed, largely incompatible systems, with one standardized system that isn’t perfect, will occasionally leak sensitive health information to the wrong person, and doesn’t make anyone do cartwheels, but actually does a good enough job that health care system participants can use it to communicate with one another.

The need for an emergency high school student development effort, or, possibly, some equivalent, quasi-adult version of that process managed by, say, some renegade Google spinoff, came to me as I was going through a batch of meeting materials for a health information exchange public hearing

The hearing was organized by the HIT Policy Committee and HIT Standards Committee, two organizations that are supposed to help U.S. health system players use computers to communicate with one another.

Of course, witnesses at technical advisory committee hearings are not always great prose stylists, and they are bound to feel as if they can get away with using some buzzwords. I didn’t have time to listen to the Webcast of the hearing, and it could be that the witnesses were models of elegant clarity when they were speaking.

But what was striking about the written materials is that a lot of the witnesses seemed to be lost in the weeds involved with describing little local tech projects that really didn’t do anything especially impressive; writing about various other projects, regulations and regulators as propagandistically as if they were North Korean labor camp prisoners who had been offered a potato if they wrote a nice article; were pretty vague; and/or were flinging incomprehensible buzzwords around.

My experience is that people tend to write in gibberish when they don’t understand what they’re writing about very well, or when they’re trying to use scary-sounding buzzwords to get other people to go away and leave them alone with their legacy systems.

MaryAnne Sterling was clear — mainly because she is health information technology consultant and Alzheimer’s disease caregiver who had the luxury of just having to explain that her mother’s health care provider could barely communicate with her and her mother face to face, let alone with one another via some kind of electronic system.

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“The idea that mom’s primary care doc, cardiologist, and pharmacy are even close to working as a team and exchanging information to improve her health care is a work of fiction,” Sterling testified, according to the written version of her testimony. “Frankly, I would be happy if these three critical components of her health care ecosystem would simply exchange phone numbers!”

Micky Tripathi, president of the Massachusetts eHealth Collaborative, seemed to be approaching something like a useful assessment of the state of “health information exchange” (HIE) when he said the fragmentation of the health care delivery industry makes it hard even to measure how health information exchange is going

One big challenge is that HIE “systems are not interoperable because not enough customers asked for interoperability,” Tripathi said.

No one is really doing much to integrate the underlying data, Tripathi said.

Tripathi pointed to electronic prescriptions as an example of a success story: In most states, more than 90 percent of pharmacies can handle e-prescriptions, and, in some states, more than 80 percent of the physicians are using e-prescription systems.

When federal regulators were working on health data exchange standards, they didn’t even try to touch the e-prescription standards. They just let the folks who’ve been running that system continue to run it.

Of course, informally, in the real, actual world, doctors and hospital administrators are probably putting all kinds of data in all kinds laptop computers that are just one bad break-in away from ending up in a seedy pawnshop. The young doctors are probably all on Facebook at least a little bit. They all can probably distribute some mean, truly funny joke about malpractice lawyers to one another in about 5 minutes.

In the real world, it would be great if some powerful, antitrust-resistant someone — UnitedHealth and WellPoint; a semi-deranged Medicare administrator; or maybe the Pope — could slice through the current spaghetti of HITECH Act processes, Patient Protection and Affordable Care Act (PPACA) processes, standards development efforts and public comment processes, and just set some actual crummy standard, now.

Create Version 1.0 of the standard today, make everyone mad, let a few e-mails of protected health information go to the National Enquirer by mistake, and make Version 1.01 better. 

But have an actual standard, not a path that supposedly will get us to having a standard sometime in the late 2080s.

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