The savvy tech strategy behind Obamacare

Why health IT systems should be more like the Internet, not like ERP

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Part of what we're trying to do is build in the ability to move from one way of doing things to a different way of doing things. If you build one big system and one-size-fits-all, you have to do rip-and-replace, you have to start over.

Remember AOL? It was the easy way to get on the Internet but you could have everything but the Internet. Because it was interfaced and canned, a closed garden. We're really trying to get to the point of "Let's not build AOL for health care. Let's build those fundamental building blocks that allow things that we could not have even imagined now to be able to be enabled."

We need to build in that process the ability to incrementally update and change. That's why I think this notion of agile and Lean and the ability to migrate, if you will, from Version 1 to Version 2 is such an important part. If you have building blocks and get one of them wrong, you can swap it out and put in another one. Or if there's a new way of doing things that comes along, you can insert it into your portfolio and it's not going to necessarily disrupt the rest. That's an important part of our strategy and frankly, it's an approach that is different from what many other countries have approached in terms of their strategies for getting to interoperable health care systems.

InfoWorld: Your AOL recollection made me laugh because I was around this business back then, and a lot of organizations said, "Oh, we're going to go on AOL because it's a pre-fab environment basically that works. People love it. It works. It's pre-fab." But you're right. You could do only what it allowed you to do, and it didn't evolve with people's needs and uses and desires, and it fell away. But I think a lot of people in health care would love the almost-easy answer of an AOL-like approach. It wasn't easy to build AOL -- it was a lot of work -- but the notion that you can build it and be done with it I think is attractive in the short term to people. "Build the health system. We're integrated, now done, move on." But that's not realistic, and the Internet shows us why that's not realistic.

Fridsma: Exactly. We realize that there will be people who will build AOL-like solutions in this space. Our job is to make sure that patients' health information doesn't get locked into those systems if they need to move or migrate to systems that are more modular and have additional functionality.

InfoWorld: That applies to the providers too, if they end up building AOL and realize, "Oops, we didn't want to do that after all, and do something else." They have to be able to move, not just the patient.

Fridsma: That's why we have this stack. We have the stack of vocabulary and content and exchange standards. We just made an announcement around a new initiative we're working on that we're calling our Data Access Framework, which is how can we make sure that EHRs and the data within them has the ability to move with patients if they move. Because once you have that functionality in, you can start layering on things like authentication frameworks that allow you to do that remotely, or information models that allow you to ask questions in consistent ways that allow you to leverage that functionality for public health and the like.

We see that as an important part of maintaining both innovation and modularity and driving toward that world in which if you bought an AOL solution, at least you should be able to get your data out. If you decide that you want to create a highly refined way of doing things by connecting a bunch of building blocks together, that's where we'd like to be. APIs and the ability to connect the pieces are what we will be exploring with the HIT Standard Committee as we think about how to build out this portfolio of standards.

There are some things that we're not going to get quite right. And that's OK. Because we've tried to create these building blocks and this portfolio of standards in a way that should be resilient. But it's going to be hard for a while.

I think everybody is really struggling to do the right thing. I recognize the impatience. I recognize the struggle that people are going to go through. Our job is to try to do our very best to help support them as we go through this, to learn where the problems are and to try to quickly incorporate those changes to make things better as we go to Version 2 and Version 3. Our job is to provide the platform for others to succeed in this space.

This article, "The savvy tech strategy behind Obamacare," was originally published at Read more of Galen Gruman's Smart User blog. For the latest business technology news, follow on Twitter.

Copyright © 2013 IDG Communications, Inc.

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