Andy Oram

The HITECH act of 2009 (part of the American Recovery and Reinvestment Act) gave an unprecedented boost to an obscure corner of the IT industry that produced electronic health records. For the next eight years they were given the opportunity to bring health care into the 21st century and implement common-sense reforms in data sharing and analytics. They largely squandered this opportunity, amassing hundreds of millions of dollars while watching health care costs ascend into the stratosphere, and preening themselves over modest improvements in their poorly functioning systems...

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The role of open source software in healthcare is relatively hidden and uncelebrated, but organizations such as the tranSMART Foundation prove that it is making headway behind the scenes. tranSMART won three awards at the recent Bio‐IT World conference, including Best in Show. The tranSMART Foundation is a non‐profit organization that develops creates software for translational research, performing tasks such as searching for patterns in genomes and how they are linked to clinical outcomes. Like most of the sustainable, highly successful open source projects, tranSMART avoids hiring programmers to do the work itself, but fosters a sense of community by coordinating more than 100 developers from the companies who benefit from the software.

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It is salubrious to stretch oneself and regularly attend a conference in a related field. At the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, one can bask in the wisdom of experts who are truly interdisciplinary (as opposed to people like me, who is simply undisciplined). Their Tenth Anniversary Conference drew about 120 participants. The many topics–which included effects of the Supreme Court rulings on the Affordable Care Act and other cases, reasons that accountable care and other efforts haven’t lowered costs, stresses on the pharmaceutical industry, and directions in FDA regulation–contained several insights for health IT professionals...

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The health care insurance industry looks like no other insuranceAndy Oram
industry in the world. When we think of insurance, we think of paying semi-annually into a fund we hope we never need to use. But perhaps every twenty years or so, we suffer damage to our car, our house, or our business, and the insurance kicks in. That may have been true for healthcare 70 years ago, when you wouldn’t see the doctor unless you fell into a pit or came down with some illness they likely couldn’t cure anyway.
The insurance model is totally unsuited for health care today...

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The previous section of this paper introduced problems found in HIE by two reports: one from the Office of the National Coordinator and another from experts at the Oregon Health & Science University. Tracing the causes of these problems is necessarily somewhat speculative, but the research helps to confirm impressions I have built up over the years. The ONC noted that developing HIE is very resource intensive, and not yet sustainable. (p. 6) I attribute these problems to the persistence of the old-fashioned, heavyweight model of bureaucratic, geographically limited organizations hooking together clinicians. (If you go to another state, better carry your medical records with you.) Evidence of their continued drag on the field appeared in the report...

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