Getting the industry to get along
The cause of information technology in healthcare seemed to get its biggest boost ever in recent weeks, as the federal government begins to push for IT adoption.
At its secretarial summit in late July, David Brailer, MD, national coordinator for healthcare information technology, explained a framework for achieving wide adoption of electronic medical records in healthcare over the next decade.
Now comes the hard part - it's the getting along part.
Implicit in the idea that a "national coordinator" can espouse a "framework" for a national "strategy" is that the individual components that comprise that industry can be coordinated.
That won't be easy in an industry that's competitive, frequently uncoordinated, and often individualistic and egocentric.
Some problems are already emerging. Last month, it was reported that ASTM International and Health Level Seven, two standards groups, were having trouble collaborating.
That's unfortunately common among standards organizations in other industries. The new International Health Continuum technical committee being formed by OASIS is encountering a mixed reception, according to its chair, DeLeys Brandman.
"We're getting absolutely good reception from end users, but we're getting varied receptions from other standards organizations," she said. OASIS' committee wants to play a role in harmonizing standards initiatives, and identifying and filling gaps in achieving interoperability.
Making substantial progress in the next 10 years won't just depend on standards organizations. Industry vendors, who have long sought to maintain competitive advantage by making their systems proprietary, will face increasing pressure to make their products interoperate and more easily exchange data.
That will be essential for exchanging information. For example, hospitals in the Knoxville area, which recently started sharing digital images from PACS systems that are supposedly based on DICOM standards, are struggling because of nuances in how the individual systems apply those standards.
"It's not as fast as it could be," said Mike Ward, CIO of Covenant Health System in Knoxville. "We're trying to get the kinks out and working out incompatibilities."
Payers have stylized supposedly standardized HIPAA transactions by creating hundreds of "compliance guides," which call for individual bits of information payers want in order to process claims, according to Kepa Zubeldia, president and CEO of Salt Lake City-based Claredi. That limits or thwarts the electronic exchange of simple claims information, and lessens the likelihood that the industry will ever save money by moving to standardized transactions.
Finally, providers in local markets can be nasty competitors, although many are beginning to build networks to share clinical data or to provide a unified way for clinicians to access information.
Maybe there is a lesson to be learned from the nation's ATM network. ATMs started as proprietary devices, only applicable to one organization. Where did you find them? In the vestibule of the building where you did your banking.
If you did business with more than one bank, you needed a variety of cards and had to go from bank to bank. If you needed money, you had to go to the bank anyway. That wasn't much of a paradigm shift, and it sounds a lot like healthcare IT today.
But once ATMs were networked, their value grew exponentially. Money could be accessed anywhere, on an as-needed basis. ATMs became a common part of consumers' lives. Best yet for the banks, they levy a surcharge on a high percentage of ATM transactions. That's where healthcare can go with cooperation.
The ability to get along will, in large part, determine the extent of success the industry experiences in bringing about the decade of healthcare IT.