Are There Really Any Health IT Standards?

By Joy Kuhl, Chief Marketing Officer, Lantana Consulting Group and Executive Director, Health Story Project

“What would you say to someone who says, ‘There are no standards [in health IT].’?” Someone in the audience asked this question last week of Jamie Ferguson, vice president of HIT Strategy & Policy for Kaiser Permanente, and keynote speaker for the IHE NA Connectathon Conference 2013, an event sponsored by IHE USA.

There were crickets for about 5 seconds – I suspect as everyone in the audience, including me, pondered a possible reply.  Jamie then responded with a sharp, “I’d disagree.  There are standards that are capable of many things – we just need to be using them.”

It was my first time at the IHE NA Connectathon and Conference.  I’d been hearing about this basement full of smart vendor programmers in downtown Chicago going at it for days to test their products against the latest IHE profiles and national health IT standards.    It was time to see it myself.  And, I LOVED it.

As executive director of the Health Story Project, I’d been working with IHE USA to include the HL7 Consolidated Clinical Document Architecture (C-CDA) in the Connectathon testing this year.   C-CDA, as you may know, offers a library of CDA templates, which specify the structure and semantics of clinical document types for the purpose of exchange.

Over two dozen vendors signed up to test for C-CDA – including a diverse group of EHR, document imaging and HIE vendors.  After knocking on the virtual doors of EHR and HIE vendors for years encouraging acceptance of CDA document types, I have to say that the Health Story members are thrilled about the potential uptake of C-CDA and its role in contributing to comprehensive electronic patient stories.

Why?

U.S. physicians create over a billion clinical notes each year.  These notes contain the lion’s share of the clinical record and continue to do so, even after EHR system adoption.  Most of this rich store of information is not available within the EHR unless rekeyed by referencing a printed copy of the note or keyboarded by physicians.  Sadly, yet today, our friends in dictation/transcription routinely suppress (dare I say, dumb down) their source data because EHRs cannot accept it, even when it is coded to a national, industry standard.  Even when the electronic source document contains discretely coded data – most EHRs are not yet capable of pulling it in.

So, Jamie’s response resonated with me. “There are standards…we just need to be using them.”  I’m encouraged by the testing I saw last week at the Connectathon and hopeful that this helps translate to real adoption in the field.

So, how would you answer the question?

More from Jamie Ferguson:

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3 Responses to Are There Really Any Health IT Standards?

  1. The key to interoperabililty is the ability to consume structured and unstructured data between and among HIE that promote EHR/CPOE systems. Further, interoperability was anticipated by then President Bush to have occured in less than 10 years. We haven’t accomplished this ONC requirement leveraging HL7. The question to raise is why, if we have standards, have we not accomplished interoperability?

  2. Deb Wells says:

    The question of interoperability is one of great frustration for me. On the one hand people tell me that as long as we can send a CCD document, we can exchange data with anyone else who can send a CCD document. As long as we’re using LOINC codes we can exchange lab data with anyone else using LOINC codes. They make it sound so easy. On the other hand, see and hear lots of people saying we are nowhere close to being able to acheive interoperability and standards are and standards do.
    I talk to people from the easy-squeezy point of view and am convinced that we are on the verge of having longitudinal patient records (could someone define that for me please) at our finger tips. Five minutes later I talk to the “not in my lifetime” contingency and am convinced that it will take a small army of systems and data analysts to map a couple fields to share with a couple other organizations.
    Will I ever get this sorted out?

    • Deb:

      You can sort it out. The analogy is the telephone network model. Think of the telephone as an application. It talks to all other applications (telephones) seamlessly (end-to-end). The analogy to the encrypted CCD as an attachment to a closed loop referral 360X message, an email, is call forwarding, call waiting, transfer call, last number dialed, etc., i.e., all the functions of a telephone switch (e.g., small office server – e.g. AT&T Sync 248) all in one bundle. The CCD grows throughout the episode of care.

      An example: It is important that the extended care team, including the patient or someone with health power of attorney, be enabled to participate in the welfare of the patient. To accomplish this we need a social network fabric that allows all authenticated, authorized care givers to participate in the Patient Centered Medical Home model. Direct p2p (end-to-end or node-to-node) is the only technology that meets the healthcare needs of the public as 100,000,000 elderly come online, and where 1/2 will have some form of dementia and some comorbidity, and where a significant number of these persons will be cared for in their home. This model fits the future of hand held healthcare devices.

      It is important that 360X not prohibit, nor any other standard prohibit, the ability to establish a social network fabric that extends the care team to all care givers, including first responders. Hence, we must require the CCD, Clinical Notes, and all associated MU2 related information to exist in this network in encrypted form at rest and in transit. Further we can not take “BABY STEPS” nor “WALK BEFORE WE RUN.” It has already been 10 years since executive order 13335, hence we must prohibit the power and influence peddlers from destroying healthcare for the citizens of the USA.

      Given we implement node-to-node everyone who is on a care team will be able to grow the CCD into a longitudinal record. These records would be encrypted at rest and in transit. The process of sharing supports forenics. The owner of trust is the PCP/patient encounter and theh PHR resides at the PCP server. The patient owns the PHI and agrees to share his/her information with the care team. if we need to do research the patient must be compenstated for the use of their de-identifed information. If we need acute care, a CCD is transfered as needed to a trusted, authenticated and authorized doctor who has an NPI, not a machine. This model supports transition and continuity of care easily. The current HIE/EHR approach does not.

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