Drinking the Kool-Aid

Last week I attended the initial Board of Directors meeting for the newest RHIO in the country, the Appalachian Health Information Exchange.

Brian Phillips, CIO for the Ohio University School of Osteopathic Medicine and Elissa Welch of the Appalachian Regional Informatics Consortium have worked tirelessly to make this a reality. They are absolutely to be commended for their vision and leadership.

I’ve lived in Appalachia all my life; though I moved across the river to Ohio in fifth grade I still claim West Virginia as my home. I’m well aware of the preconceptions folks have about our part of the country. (Why would we need to exchange medical information when the doctors make house calls and get paid in chickens?)

The truth is that real medicine does get practiced out here, we do use them newfangled computer systems, and our patients are at least as mobile as city folks. If anything, our issues are compounded by the lack of reliable infrastructure- especially the limited and expensive access to high-speed network connectivity.

All that would seem to make aggressive participation in RHIO activities a no-brainer, right?

Not so much.

It’s fairly easy to enumerate a RHIO’s benefits as they relate to the provision of care. But the inconvenient truth is that it’s darn near impossible to make a business case to justify the investment in time and resources needed to realize those benefits.

Therein lays the fallacy of this Administration’s “free market” approach to health care IT data exchange and interoperability.

Why do we see RHIO initiatives failing at a faster rate than they are succeeding? Why do I sit in a Board meeting for a brand new RHIO and wonder if I’m the last guy buying stock in the leading manufacturer of carbon paper?

I had a neighbor once who decided that it was time to redo his lawn. Spring time came. He plowed and cultivated his whole yard. He sowed expensive grass seed and covered it with mulch. The weather was right, the ground was right. Within days tender little blades of grass began peeking their heads toward the sun.

But he never got around to watering it and it all died out.

Do I need to explain the parable of the yard guy?

I’m not suggesting that we want or need the “gummint” to do our interoperability for us. But without the “watering” of reasonable funding to offset some of the real costs of doing the right thing, I expect to see these noble efforts continue to wither on the vine.

I won’t call myself disillusioned by the Bush administration, because I never had any illusions about them in the first place. But I really had my worst fears confirmed during Secretary Leavitt’s keynote at this year’s national conference.

While other speakers, including Bill Frist, seemed to display some hint of pragmatism, Leavitt struck me as an ideologue- far more interested in proving the righteousness of his cause as opposed to helping solve the very real problems we wrestle with daily.

I wish that Leavitt was an anomaly in the halls of government. Of course that’s not the case. The rule of thumb regarding appointments seems to have been, “Only true believers need apply.”

As I left the hall that day, it occurred to me that many of the leaders within the Bush administration had spent years on the fringes of power or in academia developing neo-conservative theories of how the world should work. The past seven-plus years have given them the laboratory in which to show the world that they were “right”. We- all of us- have been their experimental subjects.

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