First, the hierarchical approach of the current HIE architectures mirrors the old phone system. The telcos built local exchanges (those windowless brick buildings) to which consumers were connected via copper. These local exchanges are the choke points that the intelligent distributed routing system called the Internet rendered unnecessary. Unfortunately the exchanges are still necessary….to protect local service monopolies.

Taking this analogy a bit further what we need is semantic health connectivity enabled through the cloud. This cloud based connectivity will enable the really valuable thing–care coordination. The cloud can “drizzle” content (images, HL7 messages) wherever it is required for analysis.

I would also like to amplify your point about the complexities of information sharing agreements in the context of the current HIE architecture. I suggest that you take a look at the space based architecture of the recently completed Tripcom project in Europe. This offers a much simpler, elegant, and dynamic model for sharing health information.

Bill Crounse, MD

I recently posted a brief commentary with a 3 phase recommended path of action entitled “EHRS: A difficult task or a pipedream at http://www.myhealthtechblog.com/2009/07/ehrs-difficult-task-or-a-pipedream.html

The 3 phases recommended are: 1) Develop the “As-Is” picture that describes where you are today; 2) Develop the “To-Be” picture that describes where you want to be and where you are going (i.e. with EHR implementation); and 3) Develop the “Road-Map” which is described as an iterative process, accomplished in phases, and is revised as new information is learned or recognized.

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