This month’s Standard Insight is the last issue as published over the last 11-1/2 years. For those interested in an “oral history” of standards and interoperability, all issues back to 2001 are available to HIMSS members.

One might ask why this current Standards Insight, or series of the publication over more than a decade, would be of value. There are two trends: seeing trends and identifying patterns, which both provide insight into the future.  

As we have noted from time to time, interoperability standards offer a unique perspective on trends in the health IT industry. Although the single vendor solution is once again in ascendency, in fact, most provider organizations find they need IT solutions from multiple vendors.

The most obvious outcome is islands of automation, systems that don’t share data. To overcome the inherent limitations of data silos, industry developers work to create interoperability standards.  The standards chosen and the developers involved clearly identify industry direction.

Interoperability is the necessary condition for successfully integrating new solutions into existing systems. Developing such standards signals the importance of the solution to the end-user.  It also validates the new solution compared to existing legacy systems.

Patterns are sequences of steps that recur as we try to realize opportunities and strategic goals. In our sense, these are the care delivery cycle abstracted.

• We find problems or opportunities;
• We set goals and objectives;
• We plan and act and see results; and then,
• We repeat the cycle.

There has been much recent talk about the government as platform for a learning organization. Yet the basic pattern is repeated, and learning only occurs, if the results of earlier cycles are used to inform the next cycle. If the learning is faulty or ignored, then the cycle is likely to simply repeat past mistakes.

If the last 11 years can be put into some perspective, it is a pattern of growing involvement of the federal government, ever anxious to accelerate adoption, remove the barriers, and then, fix resulting problems to leveraging health IT. In 2003, the National Committee on Vital and Health Statistics may have offered its strategic pathways (market-driven, federal coordination and full federal control) as alternatives, but they seem a repeatable sequence.

We are now in the era of mandates. Incentives have certainly accelerated the adoption of EHR technology. In fact, this may be the only lasting significance to this period in health IT. The proliferation of different EHR systems, particularly among physician practices, will have to be rolled up, and probably replaced, to support coordinated care delivered by Accountable Care Organizations (ACOs).

ACOs, to gain competitive advantage, will not wait for national health information exchange standards to integrate their systems. Even here, we have the same questions as we go from market-driven healthcare to voluntary coordination by ACOs.

• Will these integrated delivery networks succeed where those of 15 years ago failed? 
• Will shared savings for population health succeed where capitated HMOs failed?
• Or, will the government need to extend further control?

Likely, under this or another new administration, health IT will remain a national priority. But will we learn from past efforts and build on them or will we start over, redo what has been done and chase new shiny objects.

How is it that 11 years later, we are still trying to:

• implement the administrative transactions, 
• balance privacy and security concerns with data liquidity, and 
• apply digital signatures to medical documents?

Meanwhile, we have no EHR standard, even after trying all three of the NCVHS pathways.

Eleven years ago, we had guiding principles for interoperability; seven years ago we had a strategic framework; three years ago we had an interoperability model and specifications. But these hard-won lessons did not matter when the industry had the opportunity to chase meaningful use incentives.

What of value will we and Washington have left when the HITECH and meaningful use funds run out?

Details of the interoperability trends and patterns over the last 11 years are highlighted in the July Standards Insight in the HIMSS Member Center.