"There are very few, if any, altruistic standards. Standards that take hold take hold because there are economic drivers for that to happen."
Thats the view of Robert Seliger, chair of a new HIMSS (Healthcare Information Management Systems Society) steering committee. The committee is charged with finding ways to make health information systems more capable of exchanging data. Such functionality promises to decrease costs and improve quality of health care, and is a major goal of the Bush administrations health information technology policy. In a phone conversation, with eWEEK.com, Seliger suggested that the industry is finally starting to define, and slowly embrace, practices in line with this goal.
In August, the General Accounting Office concluded that legal uncertainty prevented some collaboration between health IT users and vendors and discouraged health care providers from adopting new technologies. Another uncertainty is that health care providers cannot know how well a technology product will work with other products until they purchase it. To address this, three industry groups, including HIMSS, collectively appointed a committee to certify health IT products.
Though the Steering Committee on Integration and Interoperability also formed just this month, Seliger has worked on these issues for over two decades. He is currently CEO at Sentillion Inc. in Andover, Mass., which provides tools that bring information from several health data applications into a single clinician interface using a standard called CCOW.
One of Seligers goals for the committee is refuting the notion that the absence of standards can protect vendors. "Many vendors come [to a health care provider] and say, Look, the only way that you can get all your systems to work properly is to buy everything from me." This makes some companies reluctant to embrace open standards that already exist, but Seliger said that attitude was slowly changing, particularly for newer ventures. "The only valid way a new company can get a good product in the market is if that product can interoperate with other systems."
Seliger is also encouraged by the attention and organization that David Brailer, the National Health IT coordinator, has brought to efforts toward a common medical record, one that can transmit, store and present data from a wide variety of sources in a wide variety of ways. But, he said, these efforts are "just the tip of the iceberg in terms of the galvanizing role that the government can play."
While he doesnt think the government should enforce technical standards, he does think the government should enforce certain standards of care and privacy. For example, the government might set standards for maintaining patient confidentiality but not dictate how data encryption happens.
Already, standards addressing at least 20 different areas have been adopted by the Department of Health and Human Services, but that doesnt mean different information systems are speaking the same language, let alone that they can speak to each other. For standards to foster interoperability, they must strike a balance between being specific and broadly applicable. Thats a task thats easier said than done. "How do you get the specificity without it becoming so parochial that it excludes people who have to make very technical decisions?" asked Seliger. The key is "to provide all of the detail a software developer needs to develop the technology correctly without locking the developer into a particular technology."
Seliger said his experience with CCOW has shown him how to make standards both useful and usable. CCOW, a standard covering an area called context management, allows systems to link applications and present users with a suite of tailored information when they log on. Seliger led the committees responsible for CCOWs adoption by HL7 (Health Level Seven Inc.) and approval by ANSI (American National Standards Institute), both of which demand high levels of support across the industry.
Seliger said he worked hard for it. "We defined the standards in terms of the behaviors systems needed to have, then we defined that for multiple languages and technologies so that the end behaviors were the same. We made the effort to get very specific and then translate the specificity."
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