Monday, December 3, 2007

Limits of Technology - Why Not Regional Health Information Organizations?

“RHIOs Hit Financial Stumbling Block on Path to National Network ”

AMA Medical News headline

Everybody is looking for the telling phrase that clears the underbrush to assure health reform.

For liberals, it’s the long-held and cherished “universal coverage.” Who could be against protecting everybody against every health eventuality and bankruptcy from disease?

For conservatives, it’s the new kid on the block, “consumer-driven care.” Who could be against informed consumers making their own decisions?

For liberals and conservatives alike, it’s “patient-centered care.” Who could challenge the notion the nation should focus on patients?

For the managerial and political classes, it’s “transparency.’ Who could oppose open and honest dealings above the table?

For lawyers and technocrats and paymasters, it’s “accountability.” Who could anyone be against holding everybody else for being “responsible” and “accountable” for their actions?

For everybody, it’s “information” and “data”, or “infodata.” If we only all had all that factual and revealing information – on who is good, who is bad, who is naughty and nice, and who get the best results for the least cost, everything would be OK.

With respect to “infodata,” it’s a dream among many that “RHIOs “(Regional Health Information Organizations) will be the backbone or the central data bank for a national health information exchange. This open exchange will serve as the foundation for a national interoperative computer system linking all major health care entities.

When it comes to RHIOs, I’m reminded to the phrase, “when they say it’s the principle and not the money, it’s the money.” In principle, RHIOs are unassailable. Who could be against sharing infodata for the common good? Though data sharing may be good for society, those sharing the data don’t seem to understand what’s in it for the good of their organization or for the good of themselves. The principle of enlightened self-interest seems to be at work here.

Therefore, human nature being what it is, RHIO participants have a hard time raising money. The financial underpinning of RHIOs in the startup and transitional phases depends on gifts, grants, and members fees.

The dreamers seem not to have stopped and asked: why should regional organizations share their data and operating secrets with competitors when there is no tangible financial return? America is, after all, a competitive society, the pillar of Western capitalism. It may take a while for the concept of cooperation and collaboration for the common good to catch on among close rivals.

Americans’ obsession with competition can be destructive. Alfie Kohn. an academic then living in a cooperative household in Cambridge, Massachusetts (where else?), described this destructiveness in No Contests. The Case Against Competition, Houghton-Mifflin, 1986), in this way,

“Unfortunately the case competition does not stand up under close scrutiny .It has been constructed on four myths. The first myth is that competition is an unavoidable fact of life, part of human nature. The second myth is that competition motivates us to do our best. Third, it is asserted contests provide the best, if not the only, way to have a good time. The last myth is that competition builds character, that it is good for self-confidence.”

Well, maybe, but Americans, including health care players, have been trained not only to compete but to believe in competition. That training and belief isn’t going to go away soon, perhaps too late for RHIOs.

To conclude:

Why not regional networks loaded with transparent data? Doesn’t everybody know infodata will end health care errata? Surely everybody will fork up cash to share their numbers, and willingly stop competing and reveal their blunders. When, oh when, will competitors join the infodata intifada?

You can array against evils of our present culture. You can inveigh against the competitive vulture. You can lead people to the very edge of the stream. But you won’t drink if they believe it to be extreme. Or if it goes against their fundamental nurture.

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