Keep Healthcare Standards Simple

November 25th, 2009 by Jon Mertz

During the past few weeks, the debate and discussion on healthcare standards have been interesting. Outlined below are a few highlights.

Highlight 1: In NextGov, an article entitled “Keep Health IT Standards Simple, Says Chief Technology Officer” highlights an exchange on how healthcare standards need to be “easy-to-understand,” unlike today’s HL7. HL7 was described as not the ideal model for implementing the objectives of HITECH. A specific quote about HL7:

“A person attempting to comprehend, let alone use the current Health Level 7 standards, would end up with ’17 documents on their desk that all point to each other,’ Halamka said. They need to be simplified and posted online, he said.”

Highlight 2: On iHealthBeat, an article entitled “Work Group Stumps for Simplicity in Health IT Certification Standards” outlines the key recommendations for EHR certification:

“Begin with small and simple standards;

Create easily downloadable vocabularies and code sets;

Do not pursue perfect standards at the cost of sufficient ones;

Do not strive for a complex universal system;

Keep costs low by eliminating licensing fees and other expenses;

Leverage standards that already function effectively on the Internet;

Promote measures that spur standards adoption and quality reporting;

Provide implementation assistance to small physician practices;

Separate content and transmission standards; and

Support implementation with guides and reference materials.”

Highlight 3: Charles Jaffe, MD, PhD, CEO, Health Level 7, Inc., testified before the Health IT Standards Committee and offered a concession in the “keep it simple” debate. As was highlighted in the Federal Advisory Committee blog:

“Perhaps most important, HL7 saw an opportunity to further reduce the barriers to implementation. We have submitted a proposal to HHS that would allow the licensing of HL7 intellectual property (including the standards and the supporting technology) free of charge for use in the United States. We have further proposed coupling this with several initiatives to streamline standards development and standards harmonization, while retaining our open, collaborative ANSI-approved process. As this moves forward, we expect to add momentum to the process of enabling ‘meaningful use’ for all of our stakeholders.”

What can we take from all of this? Three points:

Keep healthcare standards simple – a worthy objective which should – and needs to – be done. Having said that, keeping it simple when the Federal government plus many, many healthcare standards organizations mixed in with the other special interests are all involved, this will be a near impossible task.
Keep it like the Internet. Using the Internet as the guide for EHR certification and healthcare standards is a popular statement and discussion to have. However, see point number 1, and see the healthcare XML post.
Keep it cheap. Yes, access to healthcare standards, like HL7, should be free, if the objective is to simplify and use standards more easily. There will be a cost to implement the new world of healthcare data exchanges. Cheap, free, low costs, etc. will probably not be the enablers to make this happen. Logical, supportable, and easy-to-comprehend and use technology and process solutions will be, mixed in with reasonable people to make this all happen.

All of the above is a great discussion. Simplicity, Internet-like, and Cheap will meet reality and, hopefully, at least simplicity will still prevail.