So I spent part of yesterday at the HIT meeting west in San Francisco.  The most amusing session has Molly Coye  pretending that she’s the governor, and apart from the wisecracks about steroids and occasionally forgetting that she’s supposed to be pretending to be a Republican, there is some serious discussion of how information exchange between systems in California might work. This is the creation of the RHIO (regional health information network) to get to that mythical state of  inter-operability.

The CMA rep (Jack Lewin) believes that his members–all those poor solo surgeons struggling by on $200K plus a year–can’t afford EMRs or any inter-operability and shouldn’t be given an unfunded mandate to get on it.  In fact he thinks that if a RHIO made health plans better off due to the elimination of duplicate testing, then they should be taxed $25 per head to pay for all this.  I don’t think that Arnie Milstein (Med Director of PBGH) representing the employers. They are not too interested in paying any more than "their fair share". On the other hand Bob Margolis (CEO Health partners, the second biggest group in California with 1,000 docs) thinks that the state and Federal government should just piggy back off the private efforts.  In other words let Health Partners connect to Kaiser and hope everyone else can hang on. No reason for those two to slant it to their advantage, is there?

Well at least they are all talking about business models and there does seem to be some agreement that there is money to be saved, at least if anyone’s information was available when they showed up in the Emergency room. So that may be a place to start, as it appears to be in Indianapolis, but while (as Jeff Rose says) at the end of the day people want to do a good job, waiting for that to happen may take a long long time if no one’s funding the inter-operability. In fact in Santa Barbara there are, after all that time and money from the CHCF, only 50 odd doctors are on the system.

David Lansky (Foundation for Accountability) on behalf of consumers pointed out that the industry is getting $10,000 a year from each consumer and yet it hasn’t got enough money, wants more….and the industry is having the meeting about moving the consumer’s data around without telling the consumer about it! (The only funny line so far!). He wants consumers to get a seat at the table, and wants the product to serve the public more than the industry.  Plus he wants privacy and auditability, and for the info gathered to used for report cards, quality and who to go to–in other words accountability! And he warns that if industry does this without the consumer, then the consumer will torpedo it later (shades of the backlash against managed care).

So how to move things ahead? Jeff Flick from CMS likes demos, like the small and hard to find (unless you know how to spell it) DOQ-IT program. He also likes putting up data for consumers — Medicare has done it for nursing homes and home health. Their comparative data is changing behavior and being accessed by consumers, but at the moment they don’t have the data for the rest of the system, especially doctors.  In the end though he thinks that a successful RHIO will allow access to that data —  another good reason for providers to resist it.

Jeff Fickenhaser (ex WebMD now CSC) says that to get RHIOs to work you need a) organization — all sides at the table inc payers and providers, b) leadership, c) clear sense of where the money will come in and where the value is created, and d) the data has has to be transparent.

It all sounds very like a CHIN meeting in the mid-1990s  I hope it has a better outcome, but I still see no reason why it will. There doesn’t seem to be any common ground and there doesn’t seem to be any money or business reason to do it. And that’s not my idea, it’s what David Brailer himself said at the last HIT conference out here.

BONUS : Great quote from Arnie Milstein"My aim is to change the direction of begging"

(That is begging from medical directors and quality people having to beg physicians to get involved to the other way around because the market is going to punish them if they don’t)