In Parts 1 and 2 of this series on Hitting 'All Fruit' on the Payline of Healthcare, I not only laid out a Vegas-inspired paradigm by which to think of the many moving parts of healthcare but also began a pivot from patients to the other people engaged in this powerful system of care.  Part 3 fully pivots to discuss the numerous "linked people" that are just as critical as the "linked data" in our evolving EHRs.

The interesting dynamic with the $20 billion investment in EHRs by the HITECH act is the assumption that with absolutely no other changes in the entire healthcare system, this magic bullet will change everything. However, the data which comes together to comprise an EHR, EMR, or PHR is actually a very small slice of the information swirling around within the system. There are a lot of pieces of the "payline of healthcare" that have to come into alignment for success, and all of the fruit to win this payout can not be found in the EHR.

To understand this, think about what happens when we "present" in an emergency room. What factors must come together for a successful intervention and the saving of a life? First of all, there must be a suitable room or physical space for the team of medical professionals to come together around the patient. Then, that physical space must include all of the necessary apparatus related to the condition of the patient to be treated. If that equipment is not already present, then it needs to be found elsewhere in the hospital and delivered. Interestingly, all of these critical factors are only addressed after the patient arrives at this hospital in the ambulance. Using the Vegas-inspired analogy, hitting all fruit on the payline of healthcare assumes we have entered the right casino before we even start playing.

What if the right combination of doctors, nurses, specialists and emergency room availability is not at the hospital room to which we have been driven?  Once the patient has arrived is a lousy time to discover this. Fortunately, we've all heard stories of paramedics demanding an ambulance driver or emergency helicopter pilot go an extra 10-15 minutes to find the right hospital for a condition, like a stroke, for example. What if these stories weren't left to chance? What if the wheels of our healthcare slot machine were connected to the rich fabric of information which makes up a hospital or other healthcare facility (the way the rest of the Internet works already)?

If iTunes can connect to the iCloud and know whether a song is available or must be downloaded to my iPad or iPod, then certainly we can tag not only the equipment in a hospital but tag the people, too. Just like we are building an EHR for patients, shouldn't we build an EHR for each of the medical staff, too? As I wrote in EHRs and sheet music, it is not just important to know the notes but to have players that can play them. A clarinetist may be able to read a C note, but if the C note is to be played by a celloist, then the note on the sheet music doesn't do the orchestra much good with someone incapable of playing it.

The same is true within our healthcare system. We don't who the orchestra players are before the patient arrives or going back to the Vegas analogy, we don't know who will be dealing the cards at our table. It seems to me that meaningful use targeted at the EHR misses the point if the wrong medical professional is looking at it in the first place. We need to be thinking about linked people and not just linked data if we are going to hit "all fruit" on the payline of healthcare.