I agree that data integration is not the only problem. But no user interface and no decision support function can work sufficiently without data. Indeed it has been the sense of the people who built the RMRS, that you first need to give physicians useful data before you can ask them to enter data (as notes or orders.) So, while data is not the only problem, it is the most crucial problem.

"The software is the standard" sounds catchy, almost like "the message is the standard" as it had been said by the XML (then SGML) proponents in the past. Neither is really true, because you need to interpret the XML message and interpretation of non-trivial content is not self-evident. The same is true for software. Any large software project, the RMRS not exempt, has a big problem with rules of interpretation of data being hidden in program code. The key of a standard is that it lays these rules open. As the data and the rules for their interpretation get more complicated, it is not an easy thing to do even for a standard.

But the most important point about a standard is that it is implementation independent. I can overload any data with my software so that it works beautifully, but I cannot expect anyone else to do the same tricks, if I even understand those myself.

I think the right approach for VistA is to find an adopter in one of the new RHIO projects that are presently ongoing. I think the excercise of transplanting VistA to a truely new organization will be a great way to make that point. Are you not involved with any of the federally funded RHIO projects? I think you should.

I agree that it might be a lot more effective for struggling RHIO consortia who spend millions of $ on meeting and consulting fees to instead forge ahead with a VistA implementation. But I do not think that a federal mandate that requires the use of VistA should be considered, and I don't think you mean to say that.

I agree with your last sentence. There is a lot of activism to do something even before that is reasonably possible. With really useful HIT we are still in an era akin to the time when people tried to build contraptions that would allow them to fly. There were many beautiful devices, some even worked a little, but it took all that to figure out how best to fly. Let's not try to establish an FAA to regulate the early efforts of the Wright brothers. ;)

• Re: Editorial: RHIO's and the Illusion of Health I by Ignacio H. Valdes, MD, MS on Monday December 12, 2005 @ 04:31 PM

  I'd like to be involved with a local Houston RHIO, but for whatever reason, I don't know them and they do not know me. The biggest reason for me is time, time, time and a history of local agitation over many years that went nowhere. The sayings 'you can't be a prophet in your home town' and an expert is someone from out of town, so far is true. As well, now is as good a time and place as ever to disclose my recent involvement with Sequence Managers Software: http://www.linuxmednews.com/disclosure -- IV

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• Re: Editorial: RHIO's and the Illusion of Health I by Scot M. Silverstein, MD on Monday December 12, 2005 @ 04:52 PM

  In fact, it's inflated claims and promises that reduce chances for health IT success, through clinician disillusionment. These claims of cybernetic medical miracles have been made for decades (perhaps since the days of vaccuum-tube-based, mercury delay column-memory computers)... In fact, I sat on the technology committee of the Delaware RHIO (Delaware Health Information Network) of the state health care commission for several years and contributed substantially to the initial planning phases. However, leadership elected to higher positions of authority the very people in charge of clinical computing at the hospital where I was Director of Informatics. If other RHIO's import such people, then they are destined to have the same (or lower) success rates as hospital-based clinical computing. My thoughts on these issues are at http://home.aol.com/medinformaticsmd/failurecases.htm and have resided there for about seven years now. Regards, Scot

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• Re: Editorial: RHIO's and the Illusion of Health I by Ignacio Valdes, MD, MS on Monday December 19, 2005 @ 10:54 PM

  What healthcare system uses Siemens Invision exclusively, nationwide? In what way does the VA not have nationwide interoperability today? Why zero probability? How is healthcare the same as Starbucks/McDonalds/Gap? -- IV

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• Re: Editorial: RHIO's and the Illusion of Health I by J. Marc Overhage on Monday December 19, 2005 @ 11:07 PM

  Its not that any particulary "system" uses Siemen's Invision just that there isn't anything "special" about a particular application being used in many sites across the country. I would be happy to be corrected but to my knowledge DATA from one VA medical center cannot flow to another VA medical center today. You can open a view into some data from another medical center but data does not move so in view they are not interoperable. the reason I say zero probability is that there is no compelling reason for thousands and thousands or healthcare organizations to switch from their existing systems that they spent millions to purchase and implement at some risk to their organization. They are not going to change without compelling reasons and even if they decided to we don't have the manpower to implement a different system nationwide. Maybe I misunderstood your point but I thought you were suggesting that everyone in healthcare adopt the same interface and I was asking why that would happen in healthcare when it hasn't happenedin these much less complicated service industries.

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