I read with interest Steven J. Vaughan-Nichols' opinion piece, "EHR is health care reform we call all agree on." For the same reasons he gave, as a consumer I want a physician outside my doctor's group to know my medical history when he or she is treating me for the first time. I want him or her to know that I'm allergic to sulpha drugs, and know some other critical pieces of my medical information that would inform the treatment plan.

I agree with him that I respect the unease and fear some people have with having their patient records computerized. I agree that something bad will likely happen, but the benefit far outweighs the liabilities. To boot, bad things have happened to paper records in the past and no doubt will in the future, too.

If you have an opt-out system, you won't go far with improving population health, which by the way is something that the Beacon community grants want to see happen. If you could somehow gather patient safety data for those who opt out versus those who have EHRs, you just might find a compelling reason to opt in.

There are cases out there that show clear benefit. I had interviewed Joyce Beck, CEO of Thayer County Health Services in Hebron, Neb., about going paperless and interoperable. The benefits were, as Beck described it, "a slam dunk." There was a dramatic improvement in patient safety as a result of deploying interoperable EHRs and cultivating a culture that embraced every voice being heard, especially in the face of significant changes.

There were 48 reported medication errors involving medications being swallowed in the first quarter of 2004. Today, the medication errors, which include near misses that didn't result in the wrong medications being swallowed, are down to six. Medication reconciliation went up from 16 percent to 100 percent, according to Beck.

Vaughan-Nichols talks about the difficulty of having different EHR systems talk to one another, and that's a real issue. He says he lives in hope that there will be agreements to standardizing formats, ending with "hey, I can dream, can't I?" To which I say, "You can do more than dream." You can argue about the lack of speed, but standards panels are making progress. The proposed meaningful use criteria reflect that, which will only push the various committees to finally come out with standards that everyone can use sooner rather than later. Thayer County Health Services had to wrestle with standards, but they did the hard work now rather than wait for ONC to deliver the standards. So many healthcare organizations are taking on the challenge to get to interoperability faster with their EHRs.

Secondly, health IT vendors have a vested interested in building interfaces or making their EHRs interoperable with other EHRs. And with the ARRA timeline, you can bet they are working against a real deadline.

So, why dream? It's happening, and thanks to ARRA, we'll likely see standards released this year. I say, live in hope, real hope.