Keep Your Crystal Ball – Un-predictions for 2019 – Volume 1

Written by: GLHC
Doug Dietzman

By Doug Dietzman, GLHC CEO

December 6, 2018

There is much uncertainty about what the future will bring for the health information technology industry. Doug Dietzman, Chief Executive Officer of Great Lakes Health Connect, an experienced professional and thought leader in the field, shares his thoughts on the current and future state of healthcare delivery and technology.

This is the first in a limited series of posts. Additional thoughts will be added through the end of January 2019. Find them on the GLHC blog, The Exchange!





The “Top 10” lists that are common this time of year always bemuse me. They all speculate on what will unfold in the year to come.

Those who create them are rarely held accountable for their predictions, but are still called “experts”. The lists all sound similar to each other and typically reflect the “shiny object” themes of the moment.

This is not one of those lists.

I have no interest in predicting what might happen in 2019 and glorifying technologies that are not ready for prime time. Instead, I want to offer practical thoughts and perspectives on what I think SHOULD happen in 2019 to advance health information technology and the healthcare industry generally.

This list will not be exhaustive, nor predictive.  It is meant to be practical and doable, while avoiding the “squirrels” that distract us from addressing the REAL challenges in healthcare.


Volume 1: Interoperability


When did the lack of “interoperability” become the be-all, end-all reason for the ills in our national healthcare system?

If I understand correctly, the premise is … “if all the EMRs could interoperate perfectly (whatever that means) without human intervention, all healthcare issues would be solved”. “Cancer would be a thing of the past”. “The cost of healthcare would drop dramatically”. “Medicare would be able to pay back the Social Security lock-box in full”. “Physicians and other clinicians would love their jobs again and feel no stress”. “Emergency department utilization would fall off a cliff”. “The opioid crisis would disappear”. “Mental and physical health integration with the primary care setting would just naturally occur”. “Social determinants of health would vanish”. “Food deserts would be replaced by food oases”. “Capturing patient quality measures would become obsolete”. All healthcare issues would be solved because, after all, WE HAVE EMR INTEROPERBILITY!

Wait, what? No? You mean none of these great outcomes will happen when EMRs can talk to each other “interoperably”? Well then, why in the world are we spending so much time, energy, and financial resources on a concept that nobody can truly define, and will not solve our big problems?

It is an excellent question, that few are asking publically. Somewhere along the way, the amorphous “interoperability” became the main point and the outcome itself, rather than the means to the outcome. The federal government got into the business of mandating technologies, solutions, and standards in the great chase for interoperability. This was regardless of whether it had any real impact on the triple/quadruple/quintuple aim.

What difference does it make – really – how many million Direct messages are exchanged nationally? Does it mean anything related to achieving or improving quality or safety and satisfaction measure outcomes? If it does not help patients, we have collectively wasted an enormous amount of money and time over the last 5+ years.

We see this in Michigan with a network-of-networks that claims large transaction volumes, but cannot articulate the practical value of those transactions after all the millions of dollars and collective hours invested.

But wait… there is STILL more!

CCDs were going to save healthcare. How is that working out? Those who brought us the CCD and pushed for its mandated use through various incentives now acknowledge they are not the best vehicle for what we are trying to accomplish. Now they are telling us that FHIR and other APIs will save the industry. Be confident, though, this time they assure us they are right.

In 2019, federal incentives should be based on patient/population outcomes and quality measures, while leaving the means to achieve those goals to providers.

Not one organization in the country is failing their quality, safety, and satisfaction measures because they cannot query a provider organization 10 states away. Focusing significant energies on that exchange minimizes and hides the real reasons why those quality measures are not being met and what needs to be done to improve the business and practice of medicine. CMS and the ONC should set the bar on patient health outcomes and leave the industry free to creatively innovate the various business, clinical practice, and technology. Congress should recognize that interoperability is a means not an end and focus on incenting health outcomes, not the means used to achieve them.