For example, MidSouth eHealth Alliance is a network of 16 primary care sites and 14 emergency rooms in 16 hospitals located in Memphis, Tenn. ICA has aggregated more than two years of data, including almost 4 million patient encounters.

The proprietary systems that CareAlign has partnered with in this network include Allscripts, Ulrich and NextGen EMR solutions, Cerner and McKesson hospital information systems, and Meditech's MAGIC laboratory, nursing documentation, pharmacy and radiology information system. Most vendors are doing what they can to accommodate data integration, but competition and proprietary wariness are still an issue.

"Since we are working more community-wide versus enterprise it was an easier bubble to burst, because it wasn't so competitive," says Zegiestowsky. "On the hospital side it's a little more challenging because now you're moving in on vendors' territory, but if you're not providing the client in the hospital or physician practices everything that they need, either you're going to cooperate or you're not going to stay in business. It's the nature of the game at this point. You're not going to see homogeneous, closed systems."

Zegiestowsky says that the first barrier is often a vendors' inability to feed outbound data. ICA works with vendors to free-up their data in whatever form or language it takes. CareAlign also provides interface templates that fill in the blanks when legacy EMR applications don't provide needed functionality. CareAlign can build nursing documentation templates or system-wide messaging and alerts that build intelligence into the workflow.

On a grander scale, ICA's population management tools allow health care networks the ability to set up specific disease dashboards to help communities manage trouble areas, like ventilator-associated pneumonia and diabetes. These dashboards can drive clinical effectiveness and may be under the American Recovery and Reinvestment Act's umbrella of meaningful use, which will be officially defined by the ONC later this year.

Dr. Stead co-chaired a study for the National Academies in January and released a report that signaled a warning: If the medical community stays the current course toward haphazard implementation of health IT without the proper knowledge and design for a united, dynamic system, "not only will it not lead to the fixes in health care that we want, it actually could make it worse," says Stead. "That's because of the focus on transaction process and the competition between suites of applications, each of which are designed to work very well with its own parts but not with anything else. It just won't work."

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