Despite information exchange plans, healthcare ultimately is local

The truism "all healthcare is local" seems to have been forgotten in the ambitious plans to hook up far-flung healthcare providers and create a national health data exchange. That was one of the thoughts I had back in 2004, when the Bush Administration called for the creation of a National Health Information Network (NHIN) before most doctors and hospitals even had electronic health records. The same thought occurred to me again last week, when five big healthcare providers established a Care Connectivity Consortium to allow the interchange of patient data.

The five CCC founders--Geisinger Health System, Group Health Cooperative (GHC), Intermountain Healthcare, Kaiser Permanente, and the Mayo Clinic--all reside in different parts of the country. (The only area of overlap is in Washington State, where Kaiser and GHC operate in different markets.) The chance that any of their patients will need care in one of the other systems is fairly small, so the interoperability they're going to demonstrate doesn't seem to serve a purpose, other than to accelerate the formation of the NHIN.

The real collaboration we need among healthcare systems is at the local level, where most care is provided. Until now, that kind of health information exchange has developed slowly--although the $546 million that the federal government is pouring into HIEs through the states may speed things up.

The main challenge to the development of HIEs is not technological. Local and regional HIEs have had trouble getting established because of their lack of a viable business model. The key to that financial viability is inducing rival healthcare systems and physician groups to work together. If they all agree to support a community HIE that goes beyond their own business enterprises, it will succeed--as have pioneering exchanges in Indianapolis and Cincinnati.

When HIEs are widespread, so will be collaboration among providers--or at least that's the hope. And, according to an international survey reported last week, that's the kind of coordination that will really improve healthcare. In the poll of government officials running healthcare programs in 16 countries, 65 percent of the respondents said they thought that online collaboration on diagnosis and treatment of patients had a high potential to transform healthcare.

In contrast, only 32 percent said that remote patient monitoring and treatment had great transformative potential. That's still a popular option, but it's the collaboration among professionals--rather than online links with patients--that's viewed as most likely to make a real difference in patient care. If that's true, the meaningful use criteria in Stages 2 and 3 should place an increasing emphasis on information exchange among doctors caring for the same patients. - Ken

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