The Mother of All HIT Missed Opportunities

Why didn’t I buy Apple stock when the company first went public?  How did I miss the signs of the competitive threat from that start-up that stole my three best clients?   If only I had paid attention to that odd noise my car was making before the transmission blew up because of no fluid!  We all have regrets about missing opportunities that seem all-too-clear in retrospect.   

About ten years ago, I had an inkling that right about now, we in the healthcare technology world would look back to a very unwise regulatory decision made concerning electronic health records.  I was having coffee with a friend who had a senior position within the Department of Health and Human Services.  “Chad,” I asked, “why aren’t you guys determining the technology communication standards and protocols for EHRs?  Right now, each vendor has its own specs, and there is limited ability to trade data.”

“Well,” he answered, “our philosophy is that the federal government shouldn’t micromanage the standard-setting process.  We think the free market should address this.” 

I hope I hid my shock at hearing this totally nonsensical answer.  That would be akin to saying that local electrical co-ops should feel free to determine voltage output to suit their personal preferences.  Why not produce 230-volt current like European countries do instead of the U.S. standard of 120 volts?  That would be no problem as long as both of these conditions exist: 

  • The local power company is a closed system with no need to connect to the larger electric grid. 

  • All of the power company’s customers are OK with their appliances frying from the catastrophically elevated electrical output.

Since one of the goals of HITECH Act of 2009 was to encourage broader adoption of EHRs with the end of greater data portability, wouldn’t it have made sense – to shift metaphors – for everyone to speak a common language instead of some speaking Portuguese, others speaking English, and still others speaking Hungarian?

The other thought that went through my mind was that the federal government regulates seemingly everything hospitals and physicians do, from Emergency Department policies regarding screening and stabilizing all presenting patients, to Occupational Safety and Health Administration requirements, to compliance with Medicare billing protocols.  And the list goes on and on!  Why not set communications protocols?

Although almost everyone agrees that there is a role for regulation, many in the hospital and physician communities consider current regulatory oversight unduly onerous.  So how ironic is it that the one area where strict dictation of requirements would have turbo-charged the nation’s interoperability capabilities was left to the “free market”?

So here we sit in 2016 with providers’ ability to communicate seamlessly among themselves crippled because of an unfortunate decision.  Wouldn’t it have been better to say to vendors, “You are free to write to any communications standards you like, but if you want your customers to buy your products, we suggest you use these standards”?  What a missed opportunity!