“Somewhere, over the rainbow, way up high…” sang Dorothy Gale after falling in the hog pen and being scolded by Auntie Em. More on that later.

Speaking of over the rainbow, imagine the possibilities if Health Information Exchange (HIE) data could be mined statewide or nationally. Imagine for a moment the clinical questions that could be answered by observational data (with all its limitations.)

• In the last 10 years, which ACE inhibitor/ARB provided the best clinical outcomes in CHF/Diabetes?
• Which surgical technique – single- or double-row repair – provided the best results in rotator cuff tears over the subsequent years?

Insert your clinical question to be answered here.

But, privacy issues rise up. No, don’t mine the data, people deserve their privacy! Don’t open HIE’s to research on clinical questions, it might reveal something about me I don’t want others to know.

Can we create protections sufficient to satisfy and still mine data sufficiently to answer questions for which no double blind study will ever be done because there is no sponsor, no profit, no gizmo to sell, just improvement of clinical practice as a result. Imagine the clinical questions that could be answered with the right data inquiry.

But it is over the rainbow, because the data storage isn’t formatted right, NLP (Natural language processing) might work, but there are issues… Sigh. “Somewhere, over the rainbow…”

So, while we try to solve this “over the rainbow” issue, don’t forget that by the end of “The Wizard of Oz,” Dorothy was saying “There’s no place like home.”

So, while we try to get to the Emerald City of a state or national HIE data analysis, don’t forget that you can start at home. You can compare data with your colleagues in your group practice or in your region or outside.

Talk to your clinical colleagues, agree to share data and discuss techniques, then actually do it. Our patients will benefit.

Maybe, just maybe, we can all eventually wake up in a real world that meets our expectations for our patients.