At last, someone is announcing a Health Information Technology (HIT) initiative that opens the door to efficient, secure IT systems that will be able to talk to each other nationwide. At some point in the not-too-distant future, if you live in Pennsylvania and are in a terrible car accident in California, a Kaiser hospital on the West Coast will be able to tap into your medical records at Geisinger and capture information about your medical history, allergies to certain medications, and other critical information in less than a minute.

Already, thanks to the steps that Kaiser Permanente in California has taken, if you live in the San Diego area, are admitted to a Veterans Administration (VA) hospital, and visit your Kaiser physician when you are discharged, with your permission, he can view your VA records, finding all of the information he needs about results from tests done at the VA hospital, what drugs VA doctors prescribed, and recommendations for follow-up treatment.

Who is finally creating a model that could serve as a prototype for a rational HIT system nationwide?

Our government in Washington? Well, no. When the electronic medical record (EMR) revolution began, politicians in Washington decided to leave it to “the market to decide” how to implement Health IT.  In our current system, for-profit vendors compete for business, and hospitals and doctors have wound up with a hodge-podge of systems that cannot communicate with each other. In some hospitals, the IT in the ER isn’t able to talk to a department on the third floor.

What about forward-looking corporations such as GE? Back in 2009 the company that Jack built announced that it was creating a new unit, eHealth, to pursue the business opportunity presented by the challenge of making sure that digital health records “flow seamlessly and securely among labs, clinics, hospitals, doctors’ offices and patients.”  But no, GE is not on the cutting edge of this movement. Neither for-profit corporations nor our federal government have taken the lead.                    

                   The Care Connectivity Consortium

Instead, five of the nation’s most innovative non-profit health systems—Geisinger Health System (Pennsylvania ), Kaiser Permanente (California ), Intermountain Healthcare (Utah ), Group Health Cooperative (Washington) and the Mayo Clinics in Minnesota, Florida and Arizona—have just  announced that they have joined together to create the Care Connectivity Consortium. They are linking their IT systems so that they can send electronic medical records to each other; the first data exchange is scheduled to happen next year. Suddenly, millions of patients will find themselves in the 21st century’s “medical information age.” Although the five are located in different parts of the country, they treat patients from all 50 states.

“It turns out this was a good environment to do this,” Dr. Jack Cochran, executive director of the Permanente Federation of Kaiser Permanente, Kaiser’s national physicians’ organization, told me yesterday: “We have good IT on all sides—and eager leadership. We were all early adopters of IT, on the leading edge in terms of automating and putting in electronic health records, and we have been learning together and talking to each other. We have shown that it could be done. Ultimately we should be able to create a model for national distribution of information.”

“Learning together and talking together”—these non-profit groups are able to lead because instead of competing with each other, they have been sharing information. As the Affordable Care Act recognizes, we will be able to lower costs and lift quality only if those who provide and distribute care stop vying for market share, and begin collaborating. Over time, newly formed accountable care organizations are likely to join the Consortium’s network, along with other hospitals and physician groups.

To be fair, under the Obama administration The Office of the National Coordinator and National Health Information Network has laid out standards for data sharing. “But those standards are voluntary,” observes Dawn Milliner, Chief Medical Offers of the Mayo Clinic in a video press briefing. “Right now every state has its own rules and regulations. Every one requires different kinds of patient consent and each group is using a different approach to the type of data they share, making this very complicated for any health system that cares for patients in more than one state”.

It’s worth noting that these five organizations did not wait for financial incentives before beginning the task of coordinating their systems. They are funding the Consortium themselves. Going forward, small groups that lack their resources will be able to benefit from their trail-blazing work.

                      Kaiser Connects with the VA

Kaiser pioneered interconnectivity by hooking up with the VA in Southern California, Cochran explains: “What we are doing in the consortium is very similar to an interoperability pilot involving Kaiser and the VA in the San Diego area that we started last year. It’s now up and running.”

But what about the critics who have said that VA’s VistA system is too old-fashioned and clumsy to be adapted to other systems? This is the excuse the Department of Defense  (DoD) used for not adapting VistA when developing IT for its own health care program. Instead, it reached out to the for-profit market, creating a separate system that cannot communicate the VA.

“There is a lot of uncertainty and mythology out there,” says Cochran. “People claim, ‘This is too hard.’  ‘This is s impossible.’ It is what it is.  This is frontier work.”

“We’re hoping to create a prototype,” Cochran adds. “We need standards for privacy and interoperability. If I have an electronic health record and don’t happen to be in the right state or the right hospital, those records might as well be buried in the ground. Ultimately what we are doing should become a model for more national distribution.”  But he makes it clear that information will be distributed only with the patient’s permission.

In other developed countries, governments or a group of medical experts laid out standards early on in the process of adopting electronic medical records. In the U.S., by contrast, many health care providers will find themselves trying to figure out how to build bridges between incompatible systems that they have already purchased. Why did we decide to let the invisible hand of the market determine which systems hospitals and physicians’ choose, depending on which vendor has the best sales pitch—or the strongest relationship with a supposedly unbiased IT consultant?

“Well, we’re are the land of the free and the home of the brave, aren’t we?” Cochran replies, with a soft chuckle. “People in developed countries around the world do not find universal coverage of the country’s citizens a controversial idea,” he adds. “We do.”

                              The Future of Reform

I have long argued that while many for-profit insurers just won’t be able to survive under the rules and regulations of the Affordable Care Act, non-profits like Kaiser will become more and more important. The fact Geisinger, Group Health Cooperative and Kaiser are part of a single EMR network will make their insurance plans that much more attractive, especially to patients who might want to travel to the Mayo Clinic to see a specialist.  In the years ahead, I wouldn’t be too surprised to see other non-profit insurers join the consortium, along with other integrated medical systems.

Lately, I have begun to think that whatever happens in Washington, health care reform is already unfolding on the ground. (See “Health Care Reform is Becoming a Reality” below.) The Care Connectivity Consortium serves as a brilliant example of what I have in mind. The nasty and ultimately boring beltway battle, pitting tea-party conservatives who loathe reform against tepid defenders who seem unwilling or unable to really stand up for reform is becoming increasingly irrelevant.

Conservative dreams of killing Medicare while strangling rational reform are just that—their dreams, our nightmares—but not likely to become reality. Out there, in communities throughout the country, our health care system is beginning to transform itself, from within. This is not happening everywhere. And even in places where reformers are committed, they will not always be successful.

But, as Cochran says, “we’re making a dent.”  And this is just the beginning.