September 7, 2010
Featured Article
The HIE revolution begins...when?

What if it takes us another 15 or 20 years to bring HIE into the mainstream, like it took 20 years for ATMs to become ubiquitous?

By Carole Hodsdon

It was very saddening to read a few weeks ago that John Shepherd-Barron had passed away. Although his 84 years were seemingly very full and certainly eventful, it was still disappointing to learn that he was no longer with us. And as I read the article about Mr. Shepherd-Barron's death, my feelings turned more toward alarm. I began to think about this man's contribution to society and the significance it has had for millions and millions of people. I compared the circumstances of his success with the current state of health information technology, and I found myself with that sinking feeling in the pit of my stomach.

John Shepherd-Barron's claim to fame, posthumously as it may be for most of us, is that he is widely credited with the invention and ultimate ubiquity of the automated teller machine - the ATM. It is one of those essential commodities of life in the 21st century; something that has become such a part of our daily existence that soon entire generations may spend their entire time on this planet without once uttering the term "deposit slip." The telephone had Alexander Graham Bell. The airplane had the Wright brothers. And the ATM has John Shepherd-Barron. Try for three seconds to imagine life without any of them.

So, as I read the article about Mr. Shepherd-Barron's important achievements, the HIT lifer in me took special note of the part where it said his first ATM was installed in North London in 1967. Wait, what? 1967? Think about that. This incredible, wonderful, revolutionary technology that has transformed money management and finance throughout the entire civilized world was first available in nineteen sixty freaking seven? What happened in those 15 or 20-ish years between then and the time that the things started to pop up on (and in) every corner? What the heck took so long?

My thoughts rushed immediately to health IT and, more specifically, health information exchange (HIE). Instantaneously, a question popped into my head that prompted my stomach bottom-out: What if it takes us another 15 or 20 years to bring HIE into the mainstream, the way it did the ATM? All that promise and potential to bring sweeping, positive change to the healthcare system; to make it as easy to manage one's healthcare as it is to stick a card in an ATM slot and press a few buttons. What if it just languishes in some sort of technology purgatory as Mr. Shepherd-Barron's course-altering innovation seemed to?

Alright, so maybe there's a touch of melodrama there. And, truthfully, my fears were tempered a little bit when I remembered that the legislative activity of the past year (ARRA and healthcare reform) will undoubtedly prod along HIE proliferation more so than it would prod itself along, but still. Our industry has made such incredible strides in the past few years to put us on the threshold of a technological revolution akin to those that have forever altered (and improved) so many other sectors, yet we seem reluctant to actually walk through the door. Why is that?

It might have something to do with interoperability or, more specifically, the lack thereof. The "E" in HIE just isn't where it needs to be, and that's a shame. We need look no further than the ATM example to learn a valuable lesson; one that can help us avoid an unnecessary obstacle of our own creation. In fact, this is probably what accounts for the 20-year difference in the availability of the ATM and the widespread popularity of the ATM.

Those of us who were around at the dawn of the ATM era in the 1980s will clearly recall that usage was strictly proprietary to the network upon which your particular bank's cash machines operated. In other words, an ATM card issued by the First National Bank often wouldn't work in ATMs at the Second, Third or Fourth National Banks because each of those institutions used a different network. If you were outside of your bank's service area, you often had to drive around to find an ATM at another bank that just happened to be a part of the same network. If you didn't, you were out of luck.

To bring the example into a more modern context, imagine having a cell phone that only interacts with others from the same wireless provider. If your co-worker subscribes to another service, you can't call or text them. What if your TV only received the signal of a specific cable company? If you want the latest, cutting-edge fiber-optics technology that another provider offers, you're out of luck until you buy a different set.

Eventually, the financial services folks realized that everyone would benefit if ATMs were universally accessible no matter which bank issued the user's card. They removed the barriers of proprietary networks and cleared the pathways to share and exchange information. Suddenly, the ATM concept exploded into the phenomenon it is today.

In many respects, this is exactly where HIE is right now. We're this close to unleashing its full potential. For a long time, we didn't necessarily have the data. We've taken care of that; the data is there. Then, we didn't necessarily have the technologies. Scratch that off the list; the technology is there. All that's left now is - what? What is it that's causing us to drag our feet? Will it take another 20 years for us to get to the point where we walk into the doctor's office, are handed a clipboard and disgustedly scoff, "Paper? Seriously?"

I don't know the answer to that, so I'm asking for your help. What do you think it will take, and how long will it be?

Who knows, maybe together we can come up with the solution that gets us over the edge. Maybe someday people will look back and call us the collective John Shepherd-Barron's of HIE.

About the author

Carole Hodsdon is executive vice president and chief technology officer, MEDecision. For more information on MEDecision, click here.

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