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Why the ONC can't endorse a particular EHR vendor

After Dr. David Blumenthal, national coordinator for health information technology, delivered the Tuesday keynote at last week’s IEEE-AMA conference on personalized medicine in Washington, D.C., an audience member representing the Mayo Clinic asked him whether his office (the ONC) might endorse an electronic health record (EHR) vendor — that, or at least influence vendors to standardize their products in the name of lessening the burden on providers charged with the task of making them interoperable.

The questioner detailed his experiences coordinating EHR systems at multiple facilities across five states for Mayo. Software from more than 440 vendors in the system must work together for the health care system to create its meaningful-use-ready EHR system that will plug into the National Health Information Network.

“It’s just like the United States, except smaller,” the audience member said, calling each installation a “little fiefdom” of data.

The United Kingdom’s government, he concluded, limits vendors in the EHR space, so that health care providers do not have to bear such an enormous cost of interoperability. Why can’t ONC do that for the United States?

“I guess I could come back to you and say, ‘And why didn’t Mayo succeed in overcoming all those independent fiefdoms?’ and then ask you to put yourself in the position of someone sitting in the Hubert Humphrey Building in Washington, trying to make that happen across a population of 300 million in 50 states,” Blumenthal said. “If it were the right thing to do — and I don’t think we know yet whether that exactly is the right thing to do, the British experiment is a very astute one [but] it’s not been without its problems — the right of people to choose what they do in their own office with respect to electronic health systems is a right that your colleagues in the medical profession would staunchly defend.

“We have a culture of autonomy and independence, valuing liberty and innovation in the United States. Our health [care] reform debate has shown the power of that cultural norm, in spades, and I think we are at the right place for where our country needs to be right now with respect to the level of central control and local control in implementing electronic health systems,” Blumenthal added.

Translated: Run this up your flagpole — there won’t be an ONC-approved EHR system coming to a doctor’s office near you, at least anytime soon.

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