By Richard Shelby Dunlap

$787 billion dollars.  Unless you’ve not turned on a television, a radio, or picked up a paper in the last week, you already know this is the amount of money attributed for the latest US economic stimulus bill signed into law a couple of days ago.  Ten billion of this stimulus will go to the National Institutes of Health (NIH), with $8.2 billion going to the NIH director for his own discretion.  A further $17 billion in incentives are included for health care providers to adopt electronic health records (EHR). 

That’s a fairly large amount of money earmarked for a generic term, and I might say somewhat confusing as I expect a sizable portion of the health care providers in America are already using, or planning to use, an electronic medical record (EMR) system to track patients.  The Certification Commission for Healthcare Information Technology (CCHIT) in fact has certified dozens of products in the EHR.  The industry is not in need of EHR per se, rather it is in need of compatibility and interoperability.  Hospitals have an inordinate number of systems, ranging from patient admittance, to x-rays, and to billing.  It is a wonder sometimes how the entire system manages to function, efficiently or not. 

Americans live with incompatibility in our daily lives.  For example, this Tuesday, Feb 17, was the originally proposed deadline to switch from analog to digital television (Congress recently moved this date to June 12), a change that will prevent some 5.8 million US households, or 5.1%, (according to Nielson Co.) from receiving television over-the-air (the old TV and rabbit ears).  5.8 Million households.  That’s a fairly big incompatibility problem, and to be fair, the analog to digital conversion has been in the works since 2005.  So those US households have had a fair amount of opportunity to find any number of possible solutions to this problem.  Nevertheless, I’d hate to see that many household without access to news and entertainment.

Another example of incompatibility we suffer from is in the cellular technology arena.  US consumers have four major competitors in the cellular market.  The four generally use differing technologies for the transmission of cellular data (voice or otherwise), and differing frequencies within those technologies.  To make matter worse, those frequencies will differ from region to region in the world.  Buy one of those new 3G GSM-based phones in the US, travel to Japan, and find yourself unable to find a signal.  Take that same 3G phone to Europe and, depending on country, find you’re surfing at EDGE or GPRS speed (a much slower legacy technology).  Finally, just try and switch carriers and take your new wiz-bang phone with you.  Only two of those carrier use similar basic networks (but not the same hi-speed frequencies!).

In the end, I’d much rather deal with those kind of incompatibilities than those in the healthcare system.  The ones in healthcare ultimately cost me dramatically more than having to buy a new digital converter box or a new cell phone.  I only wish it were that simple.

In 2005, the United Kingdom began its journey towards a centralized EMR by 2010, as they recognized the EMR was the best direction to see further progress and a better patient experience.  Perhaps now is the time for the US to use this stimulus to incentivize health care providers, and the application vendors that run the systems they use, to settle on some universal standards that will rid us of some of these incompatibilities to yield greater mobility, and just hopefully, a more efficient and productive system for patients. 

In unrelated news, I just spent the weekend in San Diego, CA, taking in the 2009 USA Sevens Rugby tournament, the latest round in the iRB Sevens World Series 2008/09.   Congratulations go to the team from Argentina who took the crown today (Sunday).  The USA Rugby team also deserves praise for reaching the Cup semi-finals for the first time, where they were edged out by the day’s ultimate winners.  I personally would like to thank all 16 teams that competed at this year’s event, and gave the entire crowd a fantastic show!  I can hardly wait for next year’s event.