In Search of the Big Picture

HIMSS welcomes Ed Larsen as a regular guest blogger providing analysis of health information standards initiatives. Mr. Larsen has been the author of HIMSS Standards Insight, a valued HIMSS member benefit, for more than a decade, regularly providing his perspective on key standards activities inside and outside the beltway. We value your comments on this blog post, HIMSS Standards Insight or other HIMSS standards development analysis reporting efforts.  Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN

Health information technology in the summer of 2011 is moving forward, driven by meaningful use incentives and anticipated changes in reimbursement that might lead to better access to quality care at lower costs.

But is there a big picture?

A common theme of entertainment news every summer is speculation about what movie will be the summer blockbuster. Three of the top five movies of all time, when adjusted for inflation, are from the initial Star Wars saga.  With a nod to Lucas and Spielberg, my fanciful recommendation is “In Search of the Big Picture.”

Where is the big picture in health IT? As in any good adventure movie, we are on a journey through many sources to find markers pointing to our goal.

Blogs, like the misty bogs in which we first encountered Yoda, have become the informal guides to what is going on in health IT. Some report, some inform, some complain and some foreshadow. But in the end, no coherent picture emerges from the threads of controversy. We are not sure whether OMG refers to the ancient Object Management Group or the even older complaint to the deity. 

On our journey from the blogs, we occasionally stumble across evidence of lost civilizations, such as HITSP/C32. Here the bloggers point to the failure of complexity, guides referring to other components like some treasure map, the use of directories, registries, repositories, and worse, Unique Object Identifiers (OIDs)! No wonder that the Health Information Technology Standards Panel (HITSP) did not survive.

Yet deep down in these remembrances of things past are glimpses of a future to be faced.  Shaking off the doubts, we push on.

Councils of wise persons were standard fixtures in the intergalactic struggles, and thus, we encounter the federal advisory committees. The HIT Policy Committee (HITPC) is attempting to finalize its recommendations for Meaningful Use Stage 2 even while cautioning ONC to delay implementation.

The promised leap in interoperability in Stage 2, along the memorable soaring arrow to 2015, is now confined to requiring hospital labs to send lab results to eligible physicians’ EHR systems. These systems were supposed to receive and incorporate such results in Meaningful Use Stage 1 and to send (but not receive) clinical summaries at transitions of care.

The Health IT Standards Committee (HITSC) is struggling with which standards to recommend: new health IT standards not widely adopted or Internet standards not widely used for a new purpose. Here the advocates of “simple is best” wrestle with the “complex is necessary” faction. 

§  Work group recommendations are turned aside by just the hint of untried complexity;

§  Consensus is becoming progressively more difficult, the Health Level 7 Clinical Document Architecture (CDA) Release 2 header is too complex and new to be used for meta-tagging data;

§  Multiple emerging web micro formats are more desirable than Integrating the Healthcare Enterprise (IHE) profiles that have only be demonstrated for entity directories; and

§  Evil OIDs must be kept imprisoned in registries.

Obviously, the HITSC does not operate in some big picture framework that provides its wise people with objective decision criteria. No, the big picture is not here in the Federal Advisory Committees.

As with Star Wars, no single episode or, in our case, administration, will resolve all problems for all time. As the current National Coordinator for Health IT has noted, this is a journey.

In that spirit, we are offering this simple allegory. Most journeys begin with some objective, a destination sought—the big picture. These guide our steps today even if they morph over time. We do not depend on the wisdom and bias of individuals, but on the collective agreement that the purpose and goal are worthwhile; that we all can participate to the level of our capability and are thus willing to commit to the long journey.

Health IT needs a big picture, an architecture, a roadmap and the openness to, and willingness of, all stakeholders to participate, to adapt to change and to implement in steps.

To view our other encounters with the Death Star, the Empire, the Force and the Rebellion, please go to the full July Standards Insight available on the HIMSS member page.

And please share your thoughts here on the ‘big picture’ in health IT.

Send your comments or questions to Ed Larsen at erlarsen@erlinc.com

Ed Larsen is an independent strategy consultant and tracks interoperability standards for HIMSS.