AHLTA is Intolerable

30 years ago, in December 1978, I attended a meeting with folks from the VA, DoD, Indian Health Service, and others about building a shared software infrastructure for medical records. (This is where I met Rob Kolodner, who has patiently stuck it out in federal service and the National Health Information Network.)  It was an exciting time for me to think up a software architecture that would serve as a foundation for federal health information.

I was big on the Whorf-Sapir hypothesis and how language can shape our thinking, so my idea was to design a speech community built around the language that I thought would communicate the needs of the community using it.  Rather than trying to integrate all the “silos” I saw in the bureaucracies surrounding me, I sought to build tools that allowed folks (or sometimes forced them) to communicate.  Out of this came the MailMan system, one of the first implementations of the SMTP mail protocol widely used today.  I saw all of this as primarily a problem of communication; the data base was merely one aspect of that communication.

The system was wildly successful in the VA, winning numerous awards and becoming a topic in Philip Longman’s Best Care Anywhere, Why VA’s Health Care is Better Than Yours (see my video interview of him)  I interfaced the VA Loma Linda’s system to the neighboring March Air Force Base hospital in 1983, which drew a lot of congressional attention.  The DoD responded by hiring Arthur D. Little consultant (this is where I met John Glaser, who has since rehabilitated himself with Partners Health Care) to study the conversion, paying them more to study the installation than it cost to install it.  This was my first introductions to beltway economics.