This morning I was looking out my window at a new 3 inches snowfall while making conference calls. Tonight, I’m driving past palm trees. This afternoon I was on I-95 driving to the Providence airport for a 
flight to see a new client. Tonight, I’m exiting a Florida airport in a rental car and merging onto I-95 heading south.
With google maps piped through the car rental audio, I am confident I will get to the hotel 50 minutes away. I have done all the initial lane changes and merging, so now I’ve got a 19 mile stretch before the next turn. It’s safe to call home on speed dial and chat with my husband. I do the ritual “woe is me” that my flight was delayed, the airport was busier than I expected, and there was a long wait for the car rental center shuttle. But I’m finally on the road to my hotel much later than expected and very hungry. I am aware that these all are first world problems.
We have the “I’m still on I-95 but with palm trees” conversation. When I exit I-95, it is crystal clear that I am 1,500 miles south of the I-95 I’m used to. The “lady” in the car audio is telling me to merge onto Dolphin Expressway. No road in Rhode Island is called Dolphin Expressway!
I dislike busy unfamiliar expressways, driving at night (especially with lane changes) and driving in the rain (in that order). Fortunately, this was only 2 of the 3 – it was dry, with no rain (or snow). In these situations, lane management is critical, and the navigator system can only help so much. And good signage is critical or as my daughter says, “use your eyes”.
What does this have to do with healthcare and IT? Think about it – the interstate highway system was championed by President Dwight D. Eisenhower back in the 1950’s. Construction was authorized in 1956 but the original portion was not completed until 35 years later. The network of highways was over 47,000 miles as of 2013.
It’s now 2018. We are still working on the “health highway” – seamless interoperability that allows easy but secure access to a person’s medical record between providers across the country when needed. For routine care and procedures, emergency hospitalizations far from home, and at times of disaster when healthcare access is critical.
Yes, we’ve made a lot of progress since President George W. Bush called for widespread adoption of electronic health records during his 2004 State of the Union address. He said we should do it in 10 years. Those of us doing health IT work were encouraged that our field of work was even mentioned and by such a bold declaration!
So how far have we come? According to the Health IT Dashboard published by the Office of the National Coordinator (ONC), as of 2016 over 95% of hospitals eligible for the Medicare and Medicaid EHR Incentive Program had achieved meaningful use of certified health IT. And over 60% of all office-based physicians had demonstrated meaningful use of certified health IT.
Interoperability measurements are multi-dimensional. Health Information Exchanges (HIE) vary in their success across different states and regions. The ONC measurements on exchange and interoperability paint a picture of our progress. My colleague at StarBridge Advisors, David Muntz, served as the first Principal Deputy National Coordinator, Chief of Staff and CIO at ONC from 2012 to 2013. He certainly knows the challenges of interoperability and shared his insights in a great piece last year, Interoperability, make it so!
Those of us doing EMR and interoperability work should feel good about our overall progress but recognize we still have plenty of work to do. Let’s make significant progress in 2018!
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Rich Pollack on said:
Great comparison, Sue.
I’m reminded of a silent payer I gave to President Ike about the interstate hwy system shortly after 9/11.
I was the first speaker that morning at the annual NCHICA conf in Asheville, NC, when we got the news.
The meeting immediately adjourned and everybody got in their cars and headed home to various parts of NC.
However, I was from Houston back then and “stuck”, hoping flights might soon resume.
Luckily I kept my rental car.
After a few days and armed with a good paper map (before GPS), I decided to drive back home. Took me two days and a chance to see the country at ground level. But I made it home thanks to remarkable achievements of Henry Ford and Ike.
Interoperability will eventually succeed, I have no doubt. But we need perseverance and a “good map”.
Sue Schade on said:
Rich, thanks for sharing your story and perspective! Great point about needing both perseverance and a good map for interoperability to become a reality.