I am far more optimistic since Davids recent remarks actually show a profound shift. It wasn’t that long ago that people weren’t even talking about the needs of the consumer in the publicly funding portion of health IT. I was asked over the summer to literally explain “why” we should even include consumers since there is “no explicit mandate in the funding legislation for it” and had to remind people that in order to have a patient centered health care system you need to start with their needs and design around them. Not that they didn’t support the concept but where was it in the legislation (it is actually a core value of the legislation if you want to end up with a high quality, effective, patient centered health care system)

TECHNICAL BARRIERS Many many people who are late to health IT (and who have never worked in healthcare) don’t seem to realize that there was and still is a multi-billion dollar health IT industry in operation already. John although you nailed the current problem with inter-operability on the head in Boston (where many use in-house systems) but failed to catch that ARRA is already changing and the critically important role of standards and certification and more importantly shifting the locus of control to payers vs providers.

CHANGE IN BUSINESS CASE – In the past vendors (the largest of which is privately held and started by Judy over 20 years ago when she saw the frustration her husband provider had) catered to their customers. Those were hospital systems and there was no business case to exchange data and in fact pro-found disincentives to not remove duplicate tests since they are paid piecemeal vs outomes. You ended up with IT systems that were extremely fast at pulling up individual records (mumps based) but once they were customized it wasn’t easy to exchange data and no one wanted to pay for the IE (interface engine).

ARRA is a game changer since it has shifted the key stakeholder from the providers (hospitals) to the payers (govt, large business and consumers – YEAH) In Palo Alto you have Kaiser, PAMG and Standford all using the same vendor but they couldn’t exchange data electronically (again there was no one willing to pay to do it) and in Seattle you have the UW, Group Health and Swedish Medical Center all using the same vendor – again Epic.

Now however in Seattle they are all working to exchange their data and Epic has a module that makes it easier to do so. In fact with a targeted investment just to link the 150,000 providers who already use Epic (23% of all providers) you can link over 70 million patients. This doesn’t address the bulk of providers who aren’t using a system but by focusing on a quick win (just linking the existing systems) you could for very little cost achieve critical mass. That is a direct result of meaningful use requirements (not even finished drafting) for the exchange of data.

Even if some providers opt out (specialists for example) because they don’t see any need for the seed capital from CMS it is clear that the new standard of care for providers will be a patient centered health care system and the health IT infrastructure to support it.. There might be a few providers who stay on paper but private payers will quickly drop them from their preferred provider panels.

I have seen strong support from the highest levels at ONC for engaging consumers and even stronger support at the National eHealth Collaborative for consumers not simply having a “voice” but that consumer / patient / person centered design will be the norm going forward.

ARRA is seed capital akin to venture capital and much of what we are seeing in terms of resistance by providers and others is typical of any large scale change management process. Once consumers are engaged and empower I expect to see private sector employers, quality groups, private industry, health 2.0 and government coming into alignment and moving very quickly.

Personally I believe that Health IT is the tool that will be the tipping point to move people towards a patient centered health care system that focuses on those with chronic conditions, new compensation models (paying for outcomes and bundles of care, direct pay for primary care), implementing the medical home model and breaking down the walls of where we receive care so that it is where I want it, when I want it and how I want it.