There are many inter-health system/community Health Information Exchange initiatives. Federal and state grants are available, dollars are allocated, loosely organized boards are formed, and consultants are engaged to guide vendor selection, technology design and implementation activities. One thing remains constant among such endeavors: with an infinitesimally small number of exceptions, such HIE initiatives have consistently fallen apart. In short, competition and the prospect of lost revenue create a disincentive for organizations to jump into such “clinical data cooperatives”.
HIE technology is not the problem. The value proposition for real-time, secure data exchange and clinical data access is not the problem. Both are well established, and clearly understood. The issue, in my humble opinion, is the top down approach implicit in virtually all inter-health system/community exchanges. Such an approach is predicated on the notion organizations will participate simply because “it will be good for everyone if patient health information is shared between health systems and communities”. Such a benevolent perspective is admirable but naïve and fails to account for the competitive pressures placed on both non-profit and for-profit health systems.
I submit true inter-health system/community exchanges and ultimately a valuable National Health Information Network (NHIN) will grow from the ground up. Why? Because, in a free market, capitalistic democracy, it is in a health system’s best interest to compete first then cooperate when survival (read “sustainability”) compels such. My experience in the healthcare industry has convinced me the best results follow when health systems are left free to choose how to solve their information technology needs, and do so in a manner that provides competitive advantage. Allow me to quote Adam Smith, the founder of modern capitalism. “It is not from the benevolence of the butcher, the brewer, or the baker, that we can expect our dinner, but from their regard to their own interest.” For our national drive to streamline and radically improve clinical data exchange and availability, we have to depend upon the “invisible hand” of competition to drive innovation and adoption. The mantra for those in the HIE market should be “competition first then cooperation”. Health systems should compete for physicians and patients using information technology as a competitive advantage. Exchanges, more than any other type of information technology, provide health systems the opportunity to leverage technological innovation to establish and improve relationships with their physician and patient communities, while simultaneously improving patient care and outcomes. The inter-health system/community exchange of information will naturally follow, using national standards and freely available infrastructure such as the NHIN-CONNECT, as health systems reach a point at which their physician and patient communities require inter-health system/community cooperation. The health system calculus regarding return on investment will change accordingly, and the “invisible hand” of competition will compel cooperation. Just look at the commercialization of the World Wide Web as the case study.
In short, health system-based exchanges will reach a critical mass at which point “clinical data cooperatives” comprised of multiple health systems and regions will become a technological imperative. Forcing inter-health system/community exchanges as the starting point is counter-intuitive to the competitive spirit and a free market economy and generally fails the sustainability test.
Well said, and as an Econ major the Adam Smith quote was appreciated. In order for the invisible hand to work it will require that the meddling government hand stay out. That may not happen for a few years.
[...] Economic dimension is best viewed as time. I’ve previously written that an economic model based on self-interest’s “invisible hand” is important to ensure sustainability. While some cooperative models have succeeded, they are, unfortunately, the exception: those [...]