Health care pros debate interoperability standards

IT leaders this week debated which standards should be used to build interoperable health information systems – an effort complicated by patient privacy concerns, technology hurdles and competing vendor interests.

At the Health Information and Management Systems Society (HIMSS) event in New Orleans, George Hickman said of health information systems interoperability that “it would seem we are driving the highway faster than the pavement is being laid.”

The chairman of HIMSS was referring to all the work it will take to put in place a nationwide health information network and create electronic health records for every citizen, which President George Bush proposed in 2004. The Bush administration has mandated these be in place by 2014; however recent events, such as a standards debate and implementation concerns over personal health records, may delay it.

At the conference, John Halamka updated attendees on the progress of a group he chairs, the Health Information Technology Standards Panel (HITSP). The panel finished its first round of standards work in 2006, said Halamka, who is CIO of Caregroup Healthcare System in Boston.

HITSP, which is sponsored by the American National Standards Institute (ANSI), delivered the first 30 proposed standards to the Secretary of Health and Human Services’ Michael Leavitt, who is responsible for reviewing the standards and making them available to the federal government for approval in 2008.

“On the federal side, in January 2008, all federal procurement must use these standards. On the non-federal side, HITSP has been working with the [Certification Commission for Healthcare Information Technology] to have a three-year time frame for adoption across all lab systems, vendor health information systems and electronic health record systems,” said Halamka. “So it’s going to be 2009 before you see these [standards] baked into vendors’ products.”

These standards, which are not new and are presently adopted by less than a consensus of vendors and healthcare providers, will govern how health information systems exchange patient and clinical research data. They focus on consumer empowerment, electronic health records and bio-surveillance.

The proposed standards HITSP recommends for implementing interoperable electronic health records include the Systematized Nomenclature of Medicine (SNOMED), HL7 (Health Level 7 v2.5.1) and Logical Observation Identifiers Names and Codes (LOINC), among others.

HITSP arrived at these standards over the past year, Halamka said. In 2007 the group will announce more interoperability standards focused around privacy, security, emergency responder, personal health records, medication management and quality.

Meanwhile, other issues complicating and possibly delaying the creation of a national health information network and electronic health records adoption are the personal health records initiative, which will necessitate a new set of standards, and vendor and healthcare provider reluctance to adopt the technologies in their software.

Within the software industry there is discord, too.

Microsoft CEO Steve Ballmer, who spoke at HIMSS about Microsoft’s new healthcare initiative, seemed to suggest that the eXtensible Markup Language (XML) is the panacea to health IT systems interoperability.

“We talk about connecting systems,” Ballmer said in his HIMSS keynote. “The move of our industry to embrace XML as a set of standard protocols is very important. This will allow us to bring together information for consumers and providers in new ways.”

Halamka countered that indeed XML is a standard that could be used as a data interchange protocol. XML, however, needs to be used in concert with content-based protocols such as SNOMED and HL7.

“XML is a mechanism of transport but doesn’t necessarily describe content,” said Halamka. “What HITSP has done through this national standards activity I lead is create interoperability specifications…to get to the granular level medical applications need. So are we using XML? Absolutely. But that’s a bit like saying ‘Do you speak English?’ It’s the difference between Shakespeare and a pulp novel.”

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