A STANDARD IN LESS than a year? Yes, Virginia, with a speed uncharacteristic of standards development organizations the Clinical Context Object Workgroup (CCOW) has done it. This informal consortium of vendors, providers and consultants stands alone with 22 contributor members at last count. CCOW (pronounced sea-cow) developed, tested and published the first of its Patient Link Standards in time for a demonstration at the Healthcare Information and Management Systems Society conference in February. The second, the Patient Identification Mapper Index, is scheduled for publication by late spring--ahead of schedule.
CCOW’s Patient Link Standard provides visual integration that enables applications to work together for a one-stop view of patient information. When the user selects a different patient, the Patient Link updates links and synchronizes applications. This front-end harmonization does not replace other standards efforts nor does it take the place of a single, fully integrated, enterprisewide information system. It specifies software interfaces to shield the user from back-end integration problems.
The standard is not complete. And for the time being, its operating environment is limited. Although the first implementation is based on Windows 32-bit operating system or Windows 95, the architecture has been designed for use with any graphical user interface. CCOW chair Wes Rishel is quick to point out that work is under way to extend the environment, probably to include products that run through Web browsers.
Some push, some pull
Standards grow through a recurring cycle of vendor push and user pull. The first push comes from vendors, then, once some credibility for the standard is established, a few users pull. The cycle gains momentum as more vendors and users join. "CCOW is now in the credibility-building phase," he says. User pull is still nascent, primarily coming from CCOW members who are already leading the pro-standards brigade. In the vendor community, he reports somewhere between enthusiastic response and quiet monitoring. Even so, he adds, "After a year of developing and first publishing, I see more user pull for CCOW than I saw in the second year of Health Level Seven (HL7)."
"Most standards efforts are successful because they are populated by people who see a win in collaboration," says Rishel, president of Wes Rishel Consulting of Alameda, Calif. Most vendors recognize the need for standards, but the larger companies are slower to react to industry trends. For example, he reports substantial interest from non-member SMS, opining that they are simply doing their homework, preparing for the time when a customer requests the standard. This is very typical for standards adoption, he observes. The big vendors don’t get out in front and push--they simply respond.
For provider organizations considering pulling the Patient Link standard onboard, necessities include healthcare applications that support the standard and a Context Manager software component that is accessible on each workstation. The "push" vendors behind CCOW have either already modified their software or intend to. (See http://www.mcis.duke.edu/standards/ CCOW/index.html for a current list.) Hewlett-Packard, IDX and a third, as yet unidentified vendor have a Context Manager in the works. The third component covered by the standard is the soon-to-be-released Patient Identification Mapper.
The standard is young and the future looks bright. Making different applications work together on the front end, CCOW can be a powerful hedge in the long-running integration games. Summarizing its potential, Rishel says, "The CCOW standards are a low-cost way to get more IS meat to the user table faster."
Charlene Marietti is senior technology writer at Healthcare Informatics.