Health Information Exchanges: a Telco analogy and warning
Deregulated or re- regulated markets always encourage new investment. The new opportunities opened up by the creation of Health Information Exchanges and massive EMR investments are no exception. Despite the new investments and strategic positioning by very large healthcare vendors and insurance companies no one has a clear view of the speed bumps and obstacles that will be part of this market’s transformation.
By looking back at other deregulated markets one can see that very basic and ,in hindsight, wrong assumptions can destroy millions if not billions of dollars in new investment. One example of a bad assumption 10 years ago within the deregulated telecommunications industry destroyed the DLEC sector. This Data Local Exchange Carrier sector received massive investment from very large VCs. The prevailing wisdom stated the DLEC companies were in a land grab. They needed money to purchase DSLAM hardware, deploy this hardware in telco central offices across densely populated communities, and sell DSL bandwidth to consumers in those communities. Common wisdom suggested the first DLEC to enter a community would dominate the market since businesses and consumers were rapidly ditching dial up service and moving to high speed alternatives.
At that time, DSL could only be delivered to any consumer or business up to 18,000 feet from the local central office housing the new DSLAM. Specifically, this 18000 foot distance needed to be measured as the telco’s copper ran through the street or overhead lines. It wasn’t measured as the crow flies. Also, guaranteed bandwidth deteriorated as the distance from the CO increased. These technical limitations were all well understood.
Here was the problem. No one had a reliable database of customers overlaid on the incumbent telco’s copper and central office infrastructure. No one had good data, not even the incumbent monopolies like Verizon, let alone the newly formed DLEC companies. In fact, it took Verizon years to make DSL available to its customers. Investing in capital equipment wasn’t the problem. Taking orders and delivering the service in a consistent manner was impossible without good data on the customers physical location and corresponding copper infrastructure. Effectively, no one had a good map! The industry never truly needed a good map so there wasn’t one. The DLECS died on the vine waiting to deliver DSL services to customers.
We have a similar concern for the HIE efforts and EMR industry. Across the country, there are few high quality databases of physicians. Our client Folio Associates provides the most accurate database service across Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania, and Ohio.
For HIE or EMR transactions to take place thousands or millions of times a day, week, or month the ability to reliably transmit protected, secured patient records from one organization, department, and physician to another organization, department, and physician needs to be done quickly and accurately every single time. Sending patient records to the wrong place accidentally is not as mundane as dialing a wrong phone number.
By most estimates, hospitals tend to maintain their own physician database that is on average 70% accurate using today’s practices. However, the new HIE standards for physician databases are being ramped up in complexity. Hospitals, healthcare organizations and insurance companies have trouble keeping their own subset of physician databases up to date let alone the entire set of physician databases in their State or even across State lines. Like in our telco analogy, the industry never truly needed a good map so there wasn’t one.
Before we get too far down the path of making huge technology investments and trying to transmit high speed healthcare data we need to make sure that we have the foundation of good physician databases. We need to make certain there is a good map.
