The biggest challenge facing health reformers, whether public or private, is illustrated by the latest edition of Kaiser Permanente's Thrive commercials.
Kaiser's effort to create its Electronic Health Record (EHR) system was truly epic. As in Epic Systems, its lead contractor. Kaiser and Epic spent most of this decade wrestling with the contract for what is now called HealthConnect, and critics had a field day.
The Epic system is, in essence, a mainframe. It was designed years ago, before the Kaiser contract was signed. It may be 2009 where you live but in health IT it's still 1979.
Even with full cooperation from all sides, getting from there to here will not be easy, it will not be quick, and it will not be smooth.
The $1.8 billion Kaiser-Epic contract was signed in 2003, and while Kaiser is large it does not represent the whole market. Far from it. As other insurers, and hospital networks, build out their EHR systems, how are they all going to be connected?
Such data today is typically moved through a Regional Health Information Organization (RHIO) or Health Information Exchange (HIE). The key word in the above sentence is regional. There is, as yet, no national exchange of health information data. Nor will there be for several years.
All this spells big trouble for health reformers, regardless of party. The big Republican idea right now is to let insurers compete across state lines. How are they to then move the resulting data, if their service areas cross incompatible RHIOs? The big Democratic idea is a "public plan," which means an entirely new EHR infrastructure.
Health IT vendors began construction of an "interoperability roadmap" just last year. Once the map is ready the roads must be built. Then they must be connected. They must be paid for. Each step is a massive system integration task, with dozens of moving parts. Each will take years.
The industry is changing, in other words, faster than IT can adapt to it. Even national efforts to set standards are subject to industry sabotage.
Companies that have their plans in place, like Kaiser, will doubtless want to take full market advantage from their technology investment. They will not be anxious to surrender those advantages in the name of interoperability, changing or even transforming large hunks of infrastructure in response to outside demands.
The biggest health reform challenge, in short, is engineering.