Intelligent Healthcare Part 2 – The Standards Dilemma

Over the past twenty years, a number of standards groups have arisen to develop, manage or reconcile Healthcare data or IT-related standards. Much of the focus over the past decade has been dedicated specifically to data exchange standards and identifying standard data elements for various sub-domains of Healthcare practice automation. The primary standards bodies involved in these activities include but are not limited to the following organizations:

•    International Standards Organization (ISO)
•    International Electrical and Electronics Engineers (IEEE)
•    World Wide Web Consortium, Health Care and Life Sciences Interest Group (W3C-HLC)
•    Health Level 7 (HL7)
•    The American Society for Testing and Materials (ASTM)
•    National Institute of Standards and Technology (NIST)
•    Integrating The Healthcare Enterprise (IHE)
•    The Accredited Standards Committee X12 (ACS X12)
•    The National Council for Prescription Drug Programs Standards Charter Organization (SCO)
•    Clinical Data Interchange Standards Consortium (CDISC)
•    Certification Commission for Healthcare In-formation Technology (CCHIT)
•    Federal Health Architecture (FHA)
•    Office of the National Coordinator for Health IT (ONC)
•    American National Standards Institute, Healthcare Information Technology Standards Panel (ANSI HITSP)
•    Workgroup for Electronic Data Interchange for Healthcare (WEDI)
•    Digital Imaging and Communications in Medicine (DICOM)
•    The International Health Terminology Standards Development Organization (IHTSDO)
•    Association for Healthcare Resource and Materials Management (AHRMM)
•    The OMG Healthcare Domain Task Force (DTF)
•    American Dental Association (ADA)
•    International Council on Medical & Care Compunetics (ICMCC)
•    Health Care Financing Association (HCFA)
•    European Health Management Association (EHMA)
•    Healthcare Information and Management Systems Society (HIMSS)
•    Health Industry Business Communications Council (HIBCC)
•    Emergency Care Research Institute (ECRI)
•    Canadian Standards Association (CSA)

Believe it or not, this is not an exhaustive list and there are literally hundreds of formally published Healthcare IT related standards to contend with. In many cases, the function of Healthcare Interoperability has become a “standards integration” or reconciliation activity. 

Healthcare Interoperability is largely today a review of data exchange considerations. The reason for this is simple; passing data is or should be far less complex than designing application capabilities in unison across the multitude of systems and organizations that employ some form of Healthcare automation. This is the essence of ‘loosely coupled’ integration, the notion that the source systems are largely abstracted from the design conventions of any other source system and can send or receive data externally as long as those data sources can be mapped to some part of the source system schema. The prevailing theory of how those data exchanges should be managed is that specific formatting standards ought to be used to more or less regulate the message structures. This standardization approach began before the advent of XML, through Electronic Data Interchange (EDI) approaches and others but has since accelerated. EDI while successful depended upon relatively simple data exchanges and complete agreement across industry segment participants in order to enjoy the full benefit of the resulting standard message formats. This approach works to a degree, but does not often support complex requirements.
Healthcare Standards

The good thing about specialized IT standards is that they can help to coordinate best practices amongst hundreds or thousands of organizations working in the same industry domain. The bad thing about overly-specialized IT standards is that they don’t always keep pace with technological change and they may not support extremely complex environments well. Healthcare represents perhaps the most complicated single practice community of its size in the world. While there are many areas within which standardization can be easily achieved in Healthcare, data management is not one of them. Not only that, though, there is a serious argument to be made that extreme data standardization (or specialization) in Healthcare might actually prove to be counter-productive and could degrade the overall quality of care.
Copyright 2010 – Stephen Lahanas



Standards are definitely

Standards are definitely going to help and manage things in a better way but as discussed in the article these standards for healthcare can not be really defined in any particular manner. As the healthcare industry is complex and full of challenges. These standards should not affect the care in any way as that is what the ultimate goal is. But I am sure in future there will be something designed for healthcare industry in terms of standardization however may not be truly followed in some cases.

Cynthia Miller
Medical alerts

The standards help reduce the problem, but they don’t solve it.

Thank you for the post and this series; I find it informative and right on the money.

The list of organizations and the many standards that they drive certainly serve to reduce the set of possible schematic and semantic contexts that healthcare IT systems may embody. However, there are so many standards, many which overlap (not to mention cross-walk between different versions) that mixing and matching standards in an effective way is still quite a challenge.

I think you’re on the money pointing out that loosely-coupled integrations provide adequate flexibility among standards. The challenge is how to realize this without requiring a non-trivial amount of developer knowledge about the mechanics of the systems being integrated.