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Setting the Standards Stage

February 25, 2008
by David Raths
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If health information exchange is to get to the next level, formulating standards will be an absolute key

John halamka, m.d.

John Halamka, M.D.

Leaders of standard-setting groups in health information technology believe they made considerable progress in 2007 that will pay dividends for healthcare CIOs in 2008 and beyond.

For instance, in December the Healthcare Information Technology Standards Panel (HITSP) completed four interoperability specifications around quality reporting, consumer empowerment, lab tests, and emergency response.

“This is a major milestone, because all these stakeholders, including hospital groups and vendors, came together and harmonized by consensus,” says John Halamka, M.D., HITSP chair and CIO of Harvard Medical School.

“I think it's really going to empower the next wave of personal health records because it's going to help those products get data,” he adds. If labs and doctors’ offices start handling data in standards-based ways, then sharing with those personal records will be easier, he says.

Established by the American National Standards Institute (ANSI), HITSP develops specifications in response to use cases assigned by the American Health Information Community, a federal advisory panel.

Charles jaffe, m.d.

Charles Jaffe, M.D.

HITSP's recommendations have clout because they become part of federal procurement standards, and the federal government pays for about 50 percent of healthcare in the United States. But Halamka stressed that because vendors were involved in establishing the standards, their authority derives from that consensus. “The question is will the vendors actually do what they agreed to do up front,” he says.

Speaking as a CIO himself, Halamka believes the standards harmonization process will translate into fewer choices to have to make. “I think there is going to be a huge cost savings for CIOs,” he says. “I would love to spend $1,000 writing interfaces instead of $100,000,” he says. “I have seven different versions of HL7 running in my data center. I would love to get it down to one.”

Speaking of Health Level Seven (HL7, Ann Arbor, Mich.), the interoperability standards-setting group was quite active in 2007 as well. It put an emphasis on closer ties to the international community and revamped its management process. New CTO John Quinn (see our QandA with Quinn at is involved in making the technical steering committee processes more top-down than bottom-up, says CEO Charles Jaffe, M.D.

“This change in management structure will have a dramatic impact on efficiency and timeliness,” Jaffe says. “We think there were a handful of significant achievements in 2007 that will have an impact in 2008.”

In December, HL7 approved a draft standard of a model for personal health record systems. “For me, the exchange of data between the PHR and the EHR is absolutely critical,” Jaffe says. “As the best custodians of their health information, patients have to have close ties with their physicians’ records.”

Jaffe also pointed to HL7's collaboration with the Clinical Data Interchange Standards Consortium (CDISC, Austin, Texas) on exchanging clinical and research data. “If we can get this data exchanged seamlessly, we could see a dramatic improvement in patient care in terms of decision support for doctors, and also offer clinical data to researchers much more readily.”

HL7 is also moving forward on defining a clinical document architecture (CDA), which seeks to make any clinical data, whether a blood pressure reading or a PET scan, easier to transmit and reuse.

But Jaffe stressed that the demand for such interoperability has to come from CIOs themselves. “The CDA is an architecture, not a product,” he says. Vendors won't go through the time and expense of developing new technology unless customers demand it, he says. “And the demand isn't created by HL7. It's created by CIOs, who are starting to ask for ways to more easily move difficult-to-exchange documents more seamlessly.”

As more EHR interoperability standards emerge, the Certification Commission for Healthcare Information Technology (CCHIT) continues its work on Project Laika, a tool being designed with the nonprofit Mitre Corp. (McLean, Va.) to test compliance with EHR interoperability standards. Integrating the Healthcare Enterprise (IHE) and the U.S. National Institute of Standards and Technology (NIST) recently announced support for the open source project. Besides its use in formal, rigorous testing, says CCHIT Chair Mark Leavitt, M.D., the open source software could be downloaded by vendors to pre-test their products and even by CIOs who want to test whether uncertified software they have is delivering compatible messages.

Health IT execs trying to discern which standards are the most important to consider can look at what CCHIT is including in its criteria, says Leavitt. CCHIT's 2008 criteria for ambulatory EHRs will include more functionality in e-prescribing and interchange of Continuity of Care Documents.

“As far as what we are certifying,” Leavitt says, “if we're doing a good job, then CIOs should be able to look at our criteria and feel confident that these are the most important standards to focus on now.” Some observers believe that although the technical standard-setting bodies are making admirable progress, they still need to do a better job of coordinating their work with groups working on business processes.

“I think there's a little bit of a disconnect between HITSP setting technical standards and groups like the Health Information Security and Privacy Collaboration looking at administrative and business practices,” says Chris Apgar, president of health IT consulting firm Apgar and Associates (Portland, Ore.). “When are those going to come together? There's a gap that needs to be addressed.”

David Raths is a contributing writer based in Philadelphia.

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