I recently spoke with several reporters about Steve Jobs' impact on healthcare, thanking him for the past 15 years of innovation. In preparing for those interviews, I reviewed Steve's career milestones.

In 1997, Apple Computer was in trouble. Its sales had declined from 11 billion in 1995 to 7 billion in 1997. Its energies were focused on battling Microsoft. It had lost its way.

Steve Jobs made these remarks at MacWorld 1997, a few months before becoming Apple's CEO. He outlined a simple go forward plan:

1.  Board of Directors
2.  Focus on Relevance
3.  Invest in Core Assets
4.  Meaningful Partnerships
5.  New Product Paradigm

How can we apply these 5 ideas to the work we're doing in HIT?

It's clear that Health Information Exchanges across the country are in trouble - CareSpark closed its doors,  the CEO of Cal eConnect resigned, and Minnesota Health Information Exchange ceased operations.

Let's consider the application of Steve's principles to Healthcare Information Exchange in Massachusetts.

1.  Board of Directors - Governance in general is very important to healthcare information exchange. HIEs need a multi-stakeholder governance body to set priorities, monitor progress, and ensure all stakeholders are engaged. In the past few months, state government and the private sector experts have worked together to define roles and responsibilities. The State's HIE coordinator, Rick Shoup, and I presented this consensus plan to the state's HIT Council, the decision making body established by state regulation Chapter 305. Governance will be done by the HIT Council plus an HIT HIE Advisory Group consisting of payers, providers, employers, patients, academics, and government.  This "Board of Directors" of the Massachusetts HIE activities is top notch.

2.  Focus on Relevance - HIEs can do many things. They can push data among payers, providers, patients, and public health. They can create master patient indexes, record locator services, and registries. However, what will the market pay for today? At the moment, simple secure transport that connects every stakeholder with easy to use web applications and native EHR interfaces seems to be the answer. Rather than do everything simultaneously, we need to tightly focus on just secure routing, making 2012 the year of the state "information highway."

3.  Invest in Core Assets - Massachusetts already has production HIEs that serve the business needs of several customers. We have NEHEN, CHAPS, SafeHealth, North Adams HIE, and the MAeHC Quality Data Center. Rather than reinvent these, we need to focus on the gaps, creating a state backbone that will connect every stakeholder, establishing a network of networks that leverages existing investments.

4.  Meaningful Partnerships - The State Medicaid Health Plan includes 14 projects that cover over 90% of the providers in Massachustets. Since Medicaid is eligible for 90/10 matching funds (90% Federal/10% State), it makes great sense to do as much as we can via Medicaid. Multiplying our purchasing power by 10 is a meaningful partnership!

5.  New Products - Once connectivity from every stakeholder to every stakeholder is in place, we can create novel functionality such as clinical registries and the ability to query data to support the "unconscious in the emergency department" use case.  

Thus, if 2011 was the year of governance, 2012 will be the year of connectivity, 2013 the year of registries, and 2014 the year of queries.

Thanks Steve, for an approach that gives us focus and momentum. I'm completely confident our Massachustets HIE activities will succeed by embracing your 5 principles.

John Halamka, MD blogs regularly at Life as a Healthcare CIO.