There is widespread acknowledgement that our health-care system is ‘in the midst of a radical transformation.’  This transformation some believe is a direct result of the $36.3 billion that the US government plans to spend over the next several years to drive adoption of the Electronic Health Record (EHR).
I believe that the massive stimulus package signed by President Obama in early 2009 was just a step in the process, an incentive package, or moreover a catalyst to a situation that was already fraught with issues – the integration of information in health care.
First, there is a ‘knowledge void’ in the healthcare community – it is drowning in oceans of information, and still does not know the best ways to identify medical trends, prevent health problems and treat them cost-effectively.  When you are drowning in an ocean, you try to keep afloat and also recognize that you cannot drink the water – what a situation to be in!
Some of the reasons that there is an information-led transformation and that the problems were there previously:

  • All patients ‘…are at risk for receiving poor health care, no matter where they live; why, where and from whom they seek care; or what their race, gender, or financial status is.’
  • Healthcare is increasingly more expensive and less accessible, with more than 46 million uninsured in the U.S. from every age group and at every income level, 8 out of 10 being in working families.
  • One-third of patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results—the highest rate of any of the six nations surveyed.’
  • Some of the confusion with the act and the wording of incentives for “Meaningful Use of Certified EHR’s” is an example of the need to define the information and create standards.  This currently is under the jurisdiction of the Department of Health & Human Services Office of the National Coordinator (for Healthcare IT) (ONC).

There is a driving the need for Healthcare IT systems to leverage data and create interoperability standards, these include the need to:

  • Connect – integrate systems across the enterprise boundary
  • Share – high value data among communities
  • Accelerate innovation – rapid deployment of new services
  • Improve efficiency – re-use existing assets and infrastructure
  • Address business problems – transparently allow business requirements to be captured and realized in the IT System

One of the problems is that there are many interested stakeholders and parties in the process of standardization including (but not limited to):

Standards Bodies

ISO Technical Committee on Health Informatics [ISO / TC 215]

  • Standardization in the field of information for health, and Health Information and Communications Technology (ICT) to achieve compatibility and interoperability between independent systems. Also, to ensure compatibility of data for comparative statistical purposes (e.g. classifications), and to reduce duplication of effort and redundancies.

Health Level Seven [HL7]

  • Health Level Seven is one of several American National Standards Institute [ANSI] accredited Standards Developing Organizations [SDO’s] operating in the healthcare arena. Health Level Seven’s domain is clinical and administrative data. 

Digital Imaging and Communications in Medicine [DICOM]

  • The Digital Imaging and Communications in Medicine [DICOM] standard for distributing and viewing any kind of medical image regardless of origin.

International Health Terminology Standards Development Organization [IHTSDO]

  • The IHTSDO has been established as an association under Danish Law, and its purpose is to: Acquire, own and administer the rights to SNOMED CT® other health terminologies and/or related standards, and other relevant assets (collectively, the "Terminology Products"). Develop, maintain, promote and enable the uptake and correct use of its Terminology Products in health systems, services and products around the world. Undertake any or all activities incidental and conducive to achieving the purpose of the Association for the benefit of the Members.

Standards Organizations

  • Healthcare Information and Management Systems Society [HIMSS]
    • HIMSS is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology [IT] and management systems for the betterment of healthcare. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems’ contributions to ensuring quality patient care.
  • Integrating the Healthcare Enterprise [IHE]

 

    • In 1998, the Radiological Society of North America [RSNA] and the HIMSS funded the “Integrating the Healthcare Enterprise” [IHE] initiative with the goal to increase the pace of non-proprietary integration of information systems for typical multi-vendor settings.
  • Continua Health Alliance

 

    • The Continua Health Alliance is a group of technology, medical device, and health and fitness industry leaders. Continua’s mission is to establish an eco-system of interoperable personal health systems that empower people & organizations to better manage their health and wellness

Healthcare Open Source Communities

  • Open Health Tools (OHT)
    • Open Health Tools is an open source community with a vision of enabling a ubiquitous ecosystem where members of the Health and IT professions can collaborate to build interoperable systems that enable patients and their care providers to have access to vital and reliable medical information at the time and place it is needed.  Open Health Tools will generate a vibrant active ecosystem involving software product and service companies, medical equipment companies, health care providers insurance companies government health service agencies, and standards organizations.
  • Open Health Framework (OHF)
  • The Eclipse Open Healthcare Framework (OHF) is a project within Eclipse formed for the purpose of expediting healthcare informatics technology. The project is composed of extensible frameworks and tools which emphasize the use of existing and emerging standards in order to encourage interoperable open source infrastructure, thereby lowering integration barriers. We currently provide tools and Frameworks for HL7, IHE, Terminology, Devices, and Public Healthcare Maintenance.

In my next blog, I will try to address the need for a healthcare standard for EHR and EMR and what it should contain.

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