TL: Can the systems in use today talk to one another?
JO: We don’t have a national health IT system that is interoperable. Interoperability means that records from one doctor’s office can actually speak to a doctor in a different office or to a hospital. To really be effective in managing care, that sort of information sharing must happen. The Kaiser and VA systems are integrated systems, and that may be one reason they have better results.
TL: Is there a requirement that systems be interoperable?
JO: I think the stimulus legislation requires hospitals to make progress in this area before receiving federal money.
TL: What is the key story journalists should be sniffing out about health IT?
JO: How the Obama administration defines the use of electronic records. Here it’s not just a case of the devil being in the details—the dollars are in the details.
TL: What other stories should the press be tackling?
JO: I would say there haven’t been many stories looking at who stands to profit from the money we are spending on IT—with the exception of The Washington Post. I also think there needs to be more attention to the experience of Kaiser and the VA. The question of why providers are not using the VA’s VistA system, even though it’s available to them, is an interesting story that The Boston Globe highlighted.
TL: What does lack of acceptance about the VistA system, which is freely accessible, say about American marketing and sales practices?
JO: We have a fragmented health system, and that fragmentation shows up in many ways, including the marketing and sale of multiple health information technology systems. That decentralization has advantages—it may produce more innovation. But it makes coordination quite difficult. If health IT is going to help us better coordinate medical care delivery, first we have to ensure that we have a coordinated health IT system.