The New National Infrastructure
Many American citizens hold fast to the concept of limited government, compact and accountable. When the new administration proposed a massive new spending plan intended to rescue a recessing economy, there was much debate over the nature and magnitude of the expenditures as funded by the taxpayer. With a keynote portion of the money designated to stimulate the medical informatics industry we are a part of, some are forced to reconcile their core principles with the genuine pursuit of real innovation. After much thought on this position, here is a line of reasoning I believe answers the critique:
- There is broad consensus that a critical role of government is to coordinate public infrastructure projects that promote the common welfare.
- The private industry has done a brilliant job developing the technology and processes that give us the health informatics capabilities that noticeably improve patient care and deliver information management and integration into the 21st century.
- Despite the success of some RHIOs, the private industry has been unable to develop the national standard; key challenges being the ability to account for and audit the utter mass of data, resistance to the general concept of information sharing, and of course, the high cost.
- In the same nature as the roads, public works, and communication grids we all rely on, I would argue that the strategic management of critical data that serves the public good would constitute a “digital infrastructure”.
- If nationally integrated health records were left to the private market with no central standardization, a successful implementation would take years.
- A central organization with limited conflict of interest is capable of establishing the necessary standards of integration, metrics and quality. Then the profit driven private enterprise has clear parameters from which to develop and implement at the ground level. That strikes me as a solid compromise, provided these three factors are monitored:
- The standards should not be heavy-handed, but rather firm, concise & measurable
- HIPAA standards be maintained and private information be guarded from government inquiry
- The private market continues to be the drivers of the technological advancement as the government incentivizes its adoption by the healthcare community
The technology platform is there. The common benefits are clear. The cost of entry is steep.
With those factors established, this $19+ billion passed for nationwide EHR integration will be a landmark investment in the future of our new national digital infrastructure.
