The roots of the issues with health information exchanges—namely, trust and expectations—are important to highlight now. I watched my father over a 50-year practice of medicine as a primary care doctor in a small town in Connecticut. We didn’t have words like “trusted agent” and “medical home” or even “primary care physician.” What we had was a trust of the family doctor that made those individuals much more than service providers. They understood that they were part of an integral community. When any healthcare problems or questions arose—pediatric, geriatric and everything in between—these individuals were a source of wisdom, of comprehensive knowledge of the patient and the comfort that provides.

The explicit trust of the family physician has changed in most places. As a country, we’re feeling the need to self-advocate much more than people have ever had to before. The concern and fear that as illness occurs, one has to become an expert, or try to, usually arises out of frustration with dealing with multiple providers who don’t exchange patient information. In an era where a person who lives in Muskogee can access his or her credit card bill and payment status in Bangkok, a lot of patients can’t comprehend why two healthcare institutions across the street from one another have no communication, no idea what medications you’re taking, and no idea what your problems are.

HIEs are vital because of the diversity of locations, styles, and elements of American healthcare provided today for even the most common problems. It is essential that there be a mechanism for regions, communities and towns to have networks that are connected sources of healthcare information, and which integrate information so as to avoid unnecessary medial mishaps, drug interactions, and safety and quality breaches.

There will be much less excuse over time for being uninformed, as ARRA and other initiatives promote healthcare technology acquisition and implementation. But we need to educate our colleagues, this workforce and the ones to come that they have to leverage this technology, and that this is part of being a good physician. Complete information, irrespective of the delivery device, will become the expectation professionally, not just technologically.

The expectations for HIE also must be clarified. An information-switching environment, a data repository or virtual repository of information and trafficking of information to where it needs to be, will never supplant the human aspect of trust and reassurance, particularly in a time of stress, sickness. We need to set reasonable parameters around this piece of the solution for American healthcare—what it’s going to be able to achieve and what it’s not going to be able to achieve—both from a service and an economic point of view.

As informaticians, as experts in the technological domain of medical informatics, it’s our responsibility to describe to the American public, without apology but without confusing terminology, what we’re really about here. We could get lost in the politics of description and make the HIE sound like my father—the trusted, old family doctor—and it’s absolutely not that.

The training that the general population as well as the medical profession has to go through is substantial. It goes back to trust, reassurance and reliable information. HIEs’ drive back to a virtual medical home is very comforting for non-clinicians, and Americans are sorely in need of that comfort.