Remember Joe Btfsplk? Joe (last name pronounced like a raspberry or Bronx cheer) was a character in the Li’l Abner comic strip, whose perpetual—and contagious—bad luck was symbolized by the dark cloud hovering over his head. A well-meaning and pleasant fellow, Joe unwittingly brought misfortune and calamity to everyone around him.
Joe Btfsplk came to mind last week during a meeting on Capitol Hill, as I explained to a very astute House staffer the differences between athenahealth’s cloud-based health information technology (HIT) and EHR services, and many of the outdated, software-based systems that share our market space.
A growing challenge for us, I explained, is the fact that the purveyors of those anachronistic systems increasingly use today’s language of innovation while continuing to tether doctors and, by extension, the health care system, to the technologies of yesteryear. “Interoperable” is the description du jour. Mentions of “clouds” dot the marketing landscape.
Of course, these terms mean different things in different technological contexts. Technology that enables communication between two providers who operate within the same proprietary information silo are, in a literal sense, experiencing “interoperability…” but it is a radically limited interoperability compared to the definition DC policymakers envision when they say, on a bipartisan basis, that interoperability in HIT is a policy imperative.
Let me provide an example:
Say I speak English and you speak Russian, but we need to communicate. I send an e-mail to a translator who, for a sum, re-types it in Russian and passes it along to you. You respond by reversing the process. We’re “inter-operating,” and the translator probably likes the deal just fine. But nobody would mistake this process for a paragon of efficiency.
The word “cloud” is likewise hijacked with increasing frequency and thrown into marketing materials to describe proprietary systems that are anything but truly cloud-based, as the term is understood in the wider world. An electronic health record vendor that retrofits Internet capability to a legacy software system, and moves to remote server storage, hasn’t “harnessed the power of the cloud”—it’s simply erected a different kind of wall around its proprietary information silo.
That House staffer immediately got that one. “So it’s like they’re setting up their own little clouds, hovering over their own systems,” she said. Bingo. Joe Btfsplk, and his little, isolated black clouds, jumped to mind.
Pondering the image later, I realized Joe is an even better visual analogy than I’d initially realized. Sure, an EHR based on outdated technology doesn’t have the immediate calamitous impact that Joe’s arrival on the scene used to have (car accidents, toppled shelves, broken windows), but the decision to implement a static software-based EHR can have serious negative consequence. Most immediate is the sunk cost. Worse is the eventual need to upgrade or replace the system to keep pace with the ever-changing technological environment in which doctors operate. A recent survey by KLAS Enterprises demonstrated that “50% of experienced EHR users want to replace their systems …” That is an awful lot of lost time, energy, and dollars pumped into systems that talk the talk of technological innovation, but remain anchored to 20th century technology.
Meanwhile, users of athenahealth’s cloud-based services report an over 89% satisfaction rate. And we led the industry with 85% of our eligible providers successfully attesting to Stage 1 Meaningful Use, compared to an industry average somewhere in the 40s. These metrics prove that the differences are much more than merely rhetorical.
It is incumbent upon we HIT innovators to make sure that policymakers in Washington and providers in Peoria know the difference between a true cloud-based service and the legacy software pretenders. At the least, so the lawmakers stop subsidizing life support for those legacy systems.
There is no such thing as a proprietary cloud. Interoperability within closed systems cannot empower nationwide information sharing. And nationwide exchange of health care information is exactly what we need. Joe Btsfplk was retired in 1979. It is long past time for software-based HIT to follow him.
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