And now you've begun sharing your patient data with other organizations, right?
Safyer: Yes, the next step is to have regional sharing of information, and that's the purpose of regional health information organizations, or RHIOs. And we're on the verge of doing that. The Bronx RHIO just got funded with $4.1 million from a state bond act, and we've put together 12 institutions. The plan is to install a system that will allow us to share information. The problem is we have only enough money and gas in the tank to go so far. At some point, we're going to need more gas in the tank, and that's going to be a problem.

And from there we go to national sharing of information, which has a lot of political issues. The left is paranoid about the creation of a national identifier and everybody spying on everybody, and the right is paranoid about such efforts impinging on business activity and all that. So we're not there yet as a country. Definitely not there as a country.

What will it take to get there?
Safyer: Here's the problem. We know we have saved money and gotten higher quality by using IT and sharing information. However, for the most part the rewards on a regional basis don't rebound to the providers, but to the insurers. So the motivation for a provider to fund more than the startup costs is low, because these regional entities will be expensive. And once they are set up, the winners will be the insurers.

So there's a disconnect. The consumer is frustrated because when he goes to different providers, they don't have his records. The providers are frustrated because it's hard to access information from elsewhere. You don't know what drugs people are on, what's happened to them. And then the whole healthcare system is feeling the pressure of the marketplace.

I think all this will eventually converge, because information sharing can save money for the big payors, the big insurers, and Medicaid and Medicare. But they're going to need to bite the bullet and pony up. So far the states haven't been willing to do that to any real degree, and the insurers are not willing to be the leaders because they're doing just fine the way things are.

I believe that in five years we will be sharing patient information nationally, but we can't do it until we do two things: the shared database, and a single identifier like Social Security numbers. One's a technological problem, the other's political. But it will happen.