Response to: Why RHIOs Aren't Working

There's lots of truth in both articles, but its both unfair and inappropriate to compare the US RHIO / NHIN progress, as flawed and ineffective as it is, to the Canadian Health Infoway project. The Canadian project has the singular ability to impose standards, consent directives, protections, and funding, all of which are presently lacking in our national initiatives. As both authors point out, US healthcare financial incentives are presently not aligned with national HIE objectives, and there's no question that data still equals market share in our competitive market.

HITSP is moving forward with consensus standards, and CCHIT continues to add to its repository of criteria for certification, but at the end of the day providers have no incentive to pay the extra cost to vendors for the HIE interfaces and changes in practice that such standardization requires.

What our country needs is a transition strategy to HIE that paves the way in consumable steps. If there is truly value in transportable health data, and there is value in shipping it around the country and populating it into many different repositories, that won't happen overnight, and it certainly won't happen in the absence of national progress toward a single standard for authentication, user provisioning, and protection of those following the standards.

As a provider who strives to do the right thing, I am not happy when people accuse the provider community of shunning data exchange simply for competitive reasons. That can't be farther from the truth. We have a very large private network that encompasses as many physicians as will subscribe to it because we want our physicians to have as much data about their patients as possible. No, its not competition we are afraid of.

Note the word "private". That's our present requirement, because of the litigious nature of our society, and especially in today's economy when inappropriately disclosed data can be the meal ticket of a lifetime. If HIE is to become truly widespread, there have to be standards and there have to be safe harbors for those of us willing to pay the necessary security costs to keep our patients' data out of the hands of those who would violate patient privacy mandates. The first prosecuted security breech of exchanged data will set the industry back 10 years. And you can bet that it will happen without nationally instituted standards and protections. So, who wants to be first?

Dave Minch
HIPAA/HIE Project Manager
John Muir Health
Walnut Creek, CA