Healthcare IT standards still in flux

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Amid the calls from President Barack Obama's administration and Congress for a proposed $20 billion investment in healthcare IT, a tempest is brewing as to what standards should be adopted by providers to ensure interoperability of medical records on a nationwide basis.

Late last year, Representative Pete Stark, D-Calif., introduced legislation outlining the federal government's role in the U.S. adoption of electronic health record (EHR) systems and the development of a national health information network (NHIN).

Tucked into the Health-e Information Technology Act, which did not pass, was a provision that would make the Office of the National Coordinator for Health IT (ONCHIT) a permanent position with significant new authority to manage the development, routine updating and dissemination “of an open-source health information technology system that is either new or based on an open-source health information technology system such as VistA.” VistA is the Veterans Administration's EHR.

Stark, chair of the Ways and Means Health Subcommittee, stated that his patience with industry to adopt interoperable IT systems is gone.

“If we want a uniform, interoperable healthcare system in America, time has shown us that we can't depend on the private sector to do it on their own,” Stark said. “This is the perfect role for government. We should work with stakeholders to develop the standards, ensure an affordable product is available and pay providers to adopt it. That's exactly what the Health-e Information Technology Act does.”

The Healthcare Information and Management Systems Society (HIMSS) responded to Stark’s bill with a letter objecting to this provision.

The letter, from Charles Christian, chairman of the HIMSS board and H. Stephen Lieber, president and CEO of HIMSS, stated that the establishment of a Health IT Advisory Committee to advise ONCHIT “would dismantle the work that the federal government and private sector have already achieved in transitioning the federal healthcare IT advisory committee, the American Health Information Community (AHIC, now known as the National eHealth Collaborative), into the private sector.”

In addition, Christian and Lieber said that the “development, routine updating and provision of an open source healthcare IT system is not the role of the federal government and such product development should remain in the private sector.”

However, not all industry stakeholders oppose Stark’s call for the government development of an open-source health IT system. Bill Vass, the president and chief operating officer of Sun Microsystem’s Sun Federal group, wrote in his blog this week that “The key to any eHealth reform program (no matter the price tag) is to facilitate information sharing across multiple agencies and to eliminate the information silos that exist today, allow the government to reduce costs and errors and to better serve our veterans, senior citizens and disabled.”

Vass pointed to the development of CONNECT, an open-source software solution that lets federal agencies securely link their existing systems to the NHIN.

“The solution was built with federal agency participation, and in September of 2008, three agencies were already demonstrating the ability to share information with the private sector through the NHIN,” Vass wrote. “The number of participating agencies grew to six for the December 2008 demonstrations, and the plan is to have those six federal agencies participate in the NHIN by the end of 2009.”

In the meantime, as work on the CONNECT project continues, the newly formed National eHealth Collaborative (NeHC) stated that it will work in partnership with the Health IT Standards Panel (HITSP), the Certification Commission for Health IT (CCHIT) and the NHIN, as well as other healthcare and IT member organizations to drive the development and adoption of an interoperable health system.

The NeHC’s private-public partnership may yet prevail in its efforts to define standards to guide the development, sharing and updating of confidential individualized health information within a secure national network.

Ilyse Schuman, managing director of the Medical Imaging and Technology Alliance (MITA) noted that such a private-public partnership was successful in the past with the creation of DICOM, the standard for the interoperability of medical imaging informatics.

“Medical imaging has had a role as sort of the poster child for the value of interoperable health information technology,” she said. “DICOM has provided us with the experience, expertise, and understanding of how critical it is to have an interoperable system in healthcare. We’re very encouraged by the efforts of the Obama administration and Congress to invest in an interoperable NHIN.”