Wednesday, September 29, 2010

I Am Not Sure There Is Really A Serious Problem Here.

The following appeared last week

http://www.fiercehealthit.com/story/emr-development-debate-focuses-standards-competition/2010-09-20

EMR development debate focuses on standards, competition

September 20, 2010 — 9:05am ET | By Neil Versel
Lest anyone think the issue has been settled, national health IT coordinator Dr. David Blumenthal says there is a "raging debate" in scientific and policy circles about whether standards or competition should drive EMR development, MassDevice reports.

"There is a raging debate in the computer science world, which I have only lifted the lid on because I'm not a computer scientist, but it goes basically like this: Do we want a world where somebody sets very detailed standards for what computers have to do in order to create interoperability? Or do we want a world that's a little bit more like the Internet, where a minimal set of standards was created and an enormous, vibrant competition and spontaneous growth occurred?" Blumenthal reportedly said at a gala for the Lucian Leape Institute of the National Patient Safety Foundation.

"I hear both sides of that argument, constantly, and even those people who believe in the minimal set of standards aren't really sure what that minimal set is, but we're working on precisely that," Blumenthal added.

He was responding to a question from former U.S. Treasury Secretary Paul O'Neill about EMR standardization.

"Why is it that we're reluctant to declare that we are going to design the best prototype that we can with an idea that we will have [iterative versions] as we learn more and we identify more needs?" wondered O'Neill, himself now a patient-safety advocate. "Why is it that we can't call to question and get on with what's a clear and apparent need for a national standard that's a work in progress?"

…..

To learn more:
- take a look at this MassDevice
story

More here:

http://www.fiercehealthit.com/story/emr-development-debate-focuses-standards-competition/2010-09-20

I have to say I am a little surprised that this has become a hot topic.

It seems to me what you do is Standardise the basic infrastructure and then let innovation flourish in matters of user interface, usability, workflow, functionality etc.

As long as the underlying data models and structures, communications protocols and coding systems being used are properly managed a more than adequate level of interoperability should be possible.

I am told that, at the very least, openEHR, has a very good place to start on all this actually developed. If it can be properly proven up at scale - or alternatives with the appropriate clinical richness and integrity developed then there seems to me to be a line that can be drawn between what is standardised and what is level to developer / vendor choice.

Working out just where the line should be might be a trifle exciting - but I reckon it is doable.

Comments welcome.

David.

1 comment:

Anonymous said...

We don't have path labs using LOINC codes for their results, standardised codes for their tests or even V2.3.1 (which is 6 years old). All this is necessary before we can look at interoperability between path lab results. And that is just one small area.

This is an incredibly difficult problem, and it is not likely to be solved soon.