The Potential and Perils of Standards in the Health Care Industry

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Often, when I read about an integration challenge, the experts will say it's really not so much a technology issue as a business rules or process problem.


It seems to me health care is an exception-it manages to be both. Data formats vary widely, health care systems are generally legacy with custom code and, sometimes, records aren't even stored electronically.


The <strong>Burton Group's Joe Bugajski has said a national records management system would be "biggest data integration challenge ever undertaken by the IT industry</strong>." He and others have raised a slew of technology and other challenges, such as the medical community's business culture, that could undermine efforts to create a national records management system.


While the problem may be overwhelming -- right now-on a national scale, there are signs that the integration challenges can be solved, at least on the micro-scale. How? Two pieces published recently at Information Management suggest national standards may make or break the health industry's efforts.


I know. That standards can help with integration is hardly shocking news. But remember-we're talking health care, an industry that's years behind the private sector, and possibly even the government. This is ground-breaking stuff for it. If you're involved even tangentially with the health care industry, you'll want to stay abreast of the emerging standards. If you're not, well, it's still an interesting story to watch and who knows, your tax dollars will probably finance part of it.


The first piece is "Health Care Is Going Through an Information Led Transformation," a recent column by Robert Abate, an IT veteran with expertise in enterprise architecture and operations/infrastructure, among other things.


Abates makes a case for why many of health care's systemic problems-rising costs, medical mistakes, poor care-are really an information problem. To overcome them, he continues, IT needs to learn to leverage data and create interoperability standards, which means being able to integrate systems, share data with health care partners-basic integration stuff. On top of that, they need to become more agile and responsive to business needs.


But one problem at a time, right?


Ironically enough-and we've seen this in other IT industries-one of the problems that is there are too many competing and overlapping standards bodies, according to Abates. He introduces each of these standards bodies, organizations and open source groups, and promises in a follow-up column to outline what he thinks should be included in a national health care records standard.


Shortly after publishing Abate's column, Information Management published what I would call a mini-case study explaining how a rural hospital in Vermont created its own records-management system.


Now, mind you, this is not a huge hospital-it has only 55 beds. By comparison, I'm within a mile of two hospitals, with 1,161 and 356 beds-and that's not counting the hospitals in my city's downtown.


Still, Mt. Ascutney's system extends well beyond the hospital's walls, pulling in and sharing data from the ambulance system and the state's health department's chronic care information system. It also includes radiology information systems, picture archiving, a legacy system and a Web portal for doctors and other clinicians.


It was built over three years, with an IT staff of six, for an approximate cost of $1.3 million, which includes the data-integration project, software, hardware, and administrative expenses. Pricey-but it's not bad for a totally new system that includes a master patient index and clinical data repository.


Vermont seems to be impressed. The hospital now serves as a pilot site for its statewide data exchange, which will use the same technology.


How did Mt. Ascutney solve the data-integration problem? It used the Health Level Seven messaging standards. According to Abate, Health Level Seven addresses clinical and administrative data and is "one of several American National Standards Institute-accredited Standards Developing Organizations operating in the health care arena."


So, as always, standards can be both the problem and the solution. It'll be fun to see whether health care can learn from the mistakes of other IT standards efforts.