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Among the vocabulary standards, there are several important players. What are those areas? There are some standards that are easy to implement or easy to understand, but which lack coherence, scalability, or broad adoption, while others are difficult to understand or cumbersome to write code for implementation. Some organizations write specifications or artifacts that are useful but painfully limited. Some are built on strict models and development frameworks to improve interoperability. Others meet the needs of the specific domain but are incapable of being used to share data with our healthcare environments.

Some are meant to be international while others are simply realm-specific. Perhaps the most difficult challenge is to bind the standards to structured vocabularies to ensure that there is the unambiguous transfer of meaning. And as always, most lack the tools to adequately facilitate implementation. What role do you think government needs to play in order to accomplish this broad, complex and accelerated process?

Among the other English-speaking countries, we trail far behind in providing the federal leadership and resources for healthcare standards creation and management.

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For more than a decade in the UK and nearly as long in Canada, we have seen far-reaching federal management of healthcare resources that greatly overshadow the efforts of US agencies and organizations. While Canada and the UK have approached this process very differently, both have achieved significant progress to enable healthcare IT to improve the delivery of care and reduce its cost.

The philosophy articulated in the very early hours of the new Administration is focused on reversing that position and committing the needed resources to this complex process. Who are they, and what can we learn from them? With any ground-breaking initiative, mistakes have been made. Certainly, the business model of each cannot be easily reconfigured to the US environment because of the central payer system in those countries.

In addition, the UK and Canada have recognized many of the shortcomings of their respective approaches and have made even more significant efforts to mitigate them. The US can learn a great deal from the experiences of these countries. Mistakes will be made, but we need bold initiatives to prevent continued erosion of our healthcare delivery and further escalation in the rate of our healthcare expenditures.

It has been over a decade since the Institute of Medicine issued its landmark report, To Err is Human, which detailed the deficiencies in our healthcare system. This startling condemnation was followed two years later by Crossing the Chasm , which provided recommendations to remedy some of the most significant problems.

Not much progress has been made since then to rectify the problems in our delivery process which lead to the erosion of the quality of care. Of course, the expenditure of such large sums cannot be accomplished without significant oversight. Success needs to be clearly defined and metrics for success must be established. Nonetheless, the amount of the proposed funding is not out of proportion with the per capita resources dedicated to healthcare delivery in the UK and Canada.

How about the architectures upon which the standards must be based? Without exception, every effort and initiative is hampered with self-interest and complex fiscal philosophies. In the past, the US has relied almost exclusively on the marketplace to drive decision making.

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The commitment of the Federal government to healthcare IT for improving our delivery system is the first step for which no price tag can be assigned. I expect them to provide broad objectives and identify the agencies to translate that agenda into an action plan. Early drafts of the legislation have carefully articulated certain stakeholder groups and important guidelines such as privacy. Ironically, the draft of the legislation from the House Ways and Means Committee fails to mention two important stakeholders: physicians care providers in general and standards development organizations.

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If not, what would be reasonable? I don't believe we have the manpower to install and maintain the necessary technology and systems even if the funding were available to pay for all of it. One of the HL7 goals is the acceleration of training of individuals to provide these skill sets.

Perhaps the biggest obstacle is the human factor. What incentive carrot or stick will we provide to caregivers to promote adoption of these technologies that will surely alter workflow, re-prioritize incentives, and perhaps restructure the way we represent knowledge.

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Secondly, we must change the funding model of our organization so that we no longer rely upon voluntary contributions and membership fees to dictate the limits of the reach. Lastly, we must rededicate ourselves to responding to the needs of the government agencies that rely so much on the productivity of our organization, whether or not these requirements are consistently and clearly articulated.

In a more global environment, the US government can learn from the experiences, both positive and less so, from other countries that have paved the way for healthcare information interoperability. In many instances, other government agencies have cooperated with and benefited from the expertise of the HL7 rank and file.

While the technology may not be immediately transferable, the experience on many fronts certainly is. For further blog entries on Standards and Society, click here. Skip to main navigation. Chris, There are, of course, many types of standards, and some of the earliest formal standards in modern times were related to safety - specifically, setting standards for hot water and steam boilers, since they had an unfortunate tendency to explode.

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Industry got together to set standards for design, maximum pressure and the like, and several things began to happen. First, the boilers stopped exploding. Second, people could get insurance to protect them again, because the risks to insurers were lower. And, not coincidentally, boiler makers began selling a lot more boilers. Now let's look at commercial passenger aviation - hand's down, in the first world, the safest way to get from point A to point B, including walking. So that a pilot will never have to think about how to do something - especially in an emergency - no matter what plane they are flying. Ahier has 50, Twitter followers and decades of experiences in the trenches of healthcare IT. He combines that practical knowledge with keeping updated on all current healthcare trends. As a result of his broad background, the interview touched on everything from democratized artificial intelligence to blockchain to certified electronic health care records and cybersecurity. This is a timely topic because of the proliferation of IoT devices in hospitals.

Ahier is current with all the developments on Capitol Hill when it comes to healthcare legislation.


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