Friday, January 13, 2006

RHIOs are dead, Long live RHIOs

Read the link prior to reading my commentary  (gml)

“DANGER, DANGER WILL ROBINSON”,  that was the call from a robot attempting to protect his  young friend in the old science fiction movie of the early 1960s.

This was brought to mind today as I read from Health Data Management the latest blurb from ONCHIT, and David Brailer MD.  Some of it was a bit disconcerting and also conflicted  with previous encouragements from ONCHIT for us to get off our proverbial posteriors and acquire health IT.

Well, many RHIOs are doing just that, and without the help of “big brother”.  Perhaps Washington is concerned that we can and will do it without their help and without their bureaucratic snafus so evident with recent events involving FEMA and other large federal entitites that are there to “help” us.

A sustainable business model is possible, quite contrary to Dr. Brailer’s statements about this being an MBA idea.  I don’t believe Brailer is giving this a chance and is unintentionally sabotaging all the good work put in by many many volunteers in IT and the healthcare community.

It’s been only a year and many of these entitites have just formed and are beginning to gain buy in from stakeholders.  I think local and regional entities are not going to wait for a “cenrtalized bureaucracy” to come on line. They are willing to put together the business and finance structure ready to go when the interoperable standard is released. Many RHIOs have begun with grants, with not a nickel committed for maintaining them when the grants run out.  We have seen this on many occasions.  I am not certain I want my or any of my patient’s health data controlled by governmental or insurance entitites.

Dr. Brailer raises many good points in his recent comments for Health Data Management, but  his recent comments conflict with his own previous statements regarding RHIO development, and worse than that if providers and those who were interested in pushing forward with IT believe or listen to his statements it throws cold water on the now steamy development of RHIOs.  I for one have spent the better part of 14 months developing interest in a RHIO in my neighborhood of 6 million patients 3500 or more providers, and 20 major hospitals.  Our model is based upon a sustainable business model.  True, non profits and government entitites may or may not look at their bottom line, nor are they responsive to local markets and economic incentives, but  I also  see a quick knee jerk reaction to provide funding for IT as a result of a national or regional disaster. These events  should not be the main incentive for a government to take action. That is short sighted in the long run.  Although opportunistic to obtain funding, it belies the fundamental dysfunction of our health care system.

Once again I hasten to admonish physicians and group providers to look at and watch these developments closely and get off their duffs to  create and use our own Health IT networks.  There is no better commitment than one’s own money, interest and use of such a system.  One “handed down” from above will not be respected and certainly would not obtain “buy in”.

This pronouncement from Dr. Brailer creates confusion.  There are lots of alphabet soup non profits and governmental agencies espousing funding for RHIOs but all I have seen is money going to large corporate entitites who will develop this “system”.  I don’t think Microsoft, Verizon, or other very successful business communications entities were developed with the type of thinking that seems to emanate from Dr.  Brailer’s latest speech.  

David Brailer who is known and respected for his health IT entrepreneurial bent appears to have  done a 180 degree turn, if I am not mistaken.

When I speak to most physicians, they don't have any idea what a RHIO is, or can do for them, their practices and patient's.   Some RHIOs are well along now, and at least partly operating in integrated systems.  Dr. Brailer, RHIO coordinators and I are very familiar with where we are going and the path to it.  However the vast majority of potential stakeholders remain very wary of investing in temporary technology and also forming the business structure of a RHIO.  We have not really seen many big players initiate a sustainable busines model for many reasons.  San Diego is now one one that is just starting.
When one enters government service one tends to see things from a very different perspective.  The "entrepeeurial" motivation seems to disappear. and big national projects warrant federal programs, grants and congressional action as opposed to private businesses.  I think it's fine for ONCHIT to stimulate payors, providers, consumers and IT industry with incentives, and to motivate Congress and States  to pass laws enabling RHIOs to function.

I don't think the actual entity belongs in federal hands. (they brought us the post office, the IRS, FEMA, HHS and other large bureaucracies that when they go wrong are impossible to fix.
Dr.  Brailer has a leadership role and  a vision  which could  lead to confusion amongst the ranks. More time is needed to incubate RHIOs without giving birth to them prematurely, expecting them to metamorphose from a larval stage  to a butterfly in an instant.


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