Sam, the counter man at High Performance Auto in my home town, was legendary among us kids. He was gray and grizzled, yet full of youthful enthusiasm, able to tell the make and model of a car by the carburetor footprint or head gasket shape, and was always willing to help tweak just a bit more horsepower out of an overwrought engine. His genius for each part was unique.

Growing up in the ‘60s, that last heyday of “muscle cars,” such things were important. Each of us had our favorite; some were Chevy people enamored with the Camero, others Mopar junkies, their fix a Road Runner or Challenger, and some, like me, Ford fanatics, my ride of choice a 1966 Mustang.

To the uninitiated, they all seemed about the same. Two-door coupe styling, low slung, a clutch plate you could barely depress with both feet, massive “cheater” slicks and a funny shaped air intake sticking out of the hood, a sort of automotive Frankenstein’s monster.

But for those of us who worked on them, (usually day and night), two things seemed obvious. “Ours” was the best and none of the parts were interchangeable. Period. It was designed that way. Nothing from my Mustang would work as a replacement on a friend’s Camaro or a buddy’s Road Runner.

And so it is with my electronic health record (EHR), that bastion of crisp, tight programming, appearing to the uninitiated to be very much like all the other EHR’s, intake screen for demographics here, the lab under this tab, the progress notes under that tab, the INR result over there.

And yet in reality, like my Mustang, they are proprietary, stand alone, “we’re better than the others,” ICD 9 code inflating documentation machines, Mary Shelly-esk in architecture, no more designed to share with others than my 600 hp Mustang was designed to take my grandmother to the grocery!

But that’s exactly what we are asking them to do; to “talk” to each other, to share openly their secrets, to subjugate themselves to a greater good. Where’s the ROI in that?

So now we, as a nation, are spending billions to develop health information exchanges, a veritable cottage industry trying to make sense of the EHR communication conundrum.

Why not pause a moment, think about the problem and perhaps develop a set of standards for EHR’s and their communications like we did for our PMS systems (who can miraculously send enormous quantities of data to the clearinghouses, flawlessly, every day, with error checking and get us paid on time).

Then our entrepreneurs, small and large, can develop the end user applications we need to enhance our workflow, increase our efficiency, improve our quality and reduce our cost.

Now that’s HITECH.

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