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Tech Giants Push Open Standards for Health Network
securitas writes "The New York Times' Steve Lohr reports that 'Eight of the nation's largest technology companies, including I.B.M., Microsoft and Oracle, have agreed to embrace open, nonproprietary technology standards as the software building blocks for a national health information network.' Microsoft, IBM, Intel, Oracle, Accenture, Cisco, Hewlett-Packard and Computer Sciences have formed the Interoperability Consortium to build a health information network proposed by the Department of Health and Human Services (HHS). The network is the first step in moving from paper to electronic patient records and sharing health data between doctors, researchers, insurers and hospitals. Mirrors at IHT and CNet News.com with additional coverage at IDG/ComputerWorld Australia."
Microsoft, IBM, Intel, Oracle, Accenture, Cisco, Hewlett-Packard and Computer Sciences have formed the Interoperability Consortium
This part of the summary (lifted from the article, apparently) mentions "Computer Sciences"; the company is actually Computer Sciences Corporation.
As an aside, the printer-friendly (i.e. less cluttered) version of the CNet link is here.
I want to drag this out as long as possible. Bring me my protractor.
Some of those are also the ones who are propelling trusted computing...
The AACS key is NOT 0xF606EEFD628B1CA427BEA93A9CA9773F
5-10 years? You're being too kind. As of when I left Terre Haute Medlab in the late 90s/early 00s (I forget exactly when), they were still required to transmit their data via bisync modem. It was one of those "We could have saved a lot of money just by burning CDs and driving them a couple hours away if they had allowed us" situations.
But yeah, the paper situation really needs to be resolved. A site that I know from my current job is looking into a system where interviewers conducting research on patients will use tablet pcs with the forms on them. The data is automatically entered from the digital forms into the database, where it can be shared cross site with appropriate access restrictions. No need to have two people enter the data to insure data entry correctness, or anything like that (although you may still want two raters).
Back at Terre Haute Medlab, they had an office of a dozen or so people whose job it was simply to type in to the system printouts of records spit out from a different system. In short, the data was going from the doctor and the patient, to paper records, to a digital record, to a printed record, to a digital record again, which was then transmitted via bisync, often multiple times if there was an error in the batch, each transmission taking overnight... oy, it was just a complete mess.
If you wonder why healthcare costs are so much in the US, you have to at least consider things like this a contributing factor.
People said I was dumb, but I proved them.
There are several companies that are already working to do this, that have been doing software for years. Why do these big name companies think that they can offer something these the specialists aren't already doing/planning to do.
There are big projects in the works with large national health care providers such as Kaiser Perminente that use Epic's software to share medical record information across the country. The Kaiser/Epic project is up and running in most locations in their Enterprise already.
These big names, I think, just don't want to be left out of the game. I call this more a marketing move than anything else. If their intentions where truely to advance this "call to arms" that President Bush has called for, then you would see companies like Epic, GE Medical, Philips, Cerner, etc on the list.
Just my two cents worth...
I've been following this story for some time now. For me, the cool thing about this quasi-open-source project is that it will be built using source code that was released to the public thanks to the US FOIA (Freedom of Information Act).
This software was built years ago by the Department of Veterans Affairs for its hospitals and clinics. Similar commercial software is easily sold for over US$1 Million. I would love to see more software developed by the US government with taxpayer money released into the public so that the open source community can benefit. If you know of any government software that could be useful, file a FOIA request! (Assuming of course that it does not violate national security, yada, yada.)
For more info on this software and other open source stuff going on in the healthcare world, see these links:
Probably because there are so many systems out there that generate hl7 messages but don't actually follow the protocol correctly.
I agree with you there, but that isn't a problem with HL7. It is similar to another project I worked on - website readers for the blind. The website reader could handle HTML if it was properly coded. However, most people do not follow the HTML standards correctly. Actually, most HTML WYSIWYG programs produce invalid HTML when pages get a little complicated.
I don't assume that a new protocol will suddenly make people follow the rules. As for HL7, the #1 rule is that everything is optional. It is that way by design. With HL7 version 3, the optional stuff isn't such a bother, but it is still there and needs to be. For instance, trying to import Social Security Numbers from a Chinese medical database will not work regardless of the protocol, so it has to be optional.
The previous comment is purposely vague and generalized, but all of the facts are completely true.
Personally I think the main reason is the malpractice insurance that docs have to pay.
This is certainly part of the problem. Let me give you an example: My mother (a physician), used to love delivering her patients babies. It was one of the high points of her practice. Then one day, we were going over her budget for the practice and we discovered to our horror that every baby she delivered was costing her $200 because of insurance and other costs. Note: she has never been sued either. So, we made the business decision to stop delivering babies. But here is the real galling thing: She has to maintain an insurance trailer that goes down a little every year, until the last baby she delivered turns 21!. Is it any wonder they tried to discourage me from going into medicine? Is it any wonder that physicians are abandoning medical practices left and right in this country? There are also other regulatory issues physicians have to deal with that would boggle the mind. No other business in the US has to deal with these issues to the degree that physicians do.
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Your examples are embedded systems, not the IT infrastructure that is addressed here. Embedded medical devices are subject to FDA review.
I used to write and debug C for a medical device company.
The clearance system sounds logical. It is not. It is completely arbitrary. -- John Bolton
As someone who as worked in the within the Medical establishment, the issues you are talking about are more vendor specific. The equipment used in Lasik cases and others have been thoroughly tested, because of the fact they have to be so precise. Calibrations on these machines are often conducted before every use, or on a very regular basis. As far as MRI's diagnosing problems, that's not the case. MRI's take the pictures, and the Radiologist then interprets the MRI results. So, human error is the consideration in this case versus a software error.
IT is moving rapidly within the Medical arena. Utitilizing systems such as PACS (Picture Archiving and Communication Systems) for X-Rays and other radiological procedures to be available via computer versus hard copies would be one example. Also applications that properly document, bill, and track a patients travels through a hospital are becoming more and more prevalent.
What this Open Standard is driving for, is to standardize that information, so that it can be easily passed from one medical facility to another. Currently, the extensive use of Fax machines, to fax entire patient records to other Doctors, and hospitals is common. For the patient, the results are positive, because their care can be more continuous, and well documented. Having a standard format to facilitate this will be a tremendous advantage, and probably help cut down on cost in the long run.
Adian
I thought [DICOM and HL7] were distinct...?
And as I'm sure you know, there are different flavors of DICOM produced by different vendors. Last time I checked, Siemens DICOM doesn't play nice with GE DICOM. Yes, there are standards, but they're GOVERNMENT standards, not customer standards. They all have loopholes big enough to drive a truck through, and the vendors exploit these loopholes to lock customers into a one-vendor package.
If you are a Siemens sales guy, which one is better for you- a Siemens patient monitor that listens to a GE pulse ox, or a Siemens monitor that only works correctly with other Siemens equipment?
All the vendors make stuff that works. It just doesn't always play nice with the other kids. Standards compliance *on paper* is worthless if the box doesn't work with your other stuff when you plug it in. Publishing another set of standards won't fix this situation unless customers have a uniform, objective test for interoperability, and obtain the contractual right to RETURN a system that fails this test to the vendor for full refund (and some $$$ penalty for the inconvenience of being a guinea pig)...
An organized national health care system would produce "reference systems" for components of the OR suite, and provide them to the vendors with the understanding that if the vendor wanted to sell anything, their products would need to successfully interoperate with the reference system. Fortunatley for the continued financial well-being of GE and Siemens, the health care system in the US is about as far from organized as you can get.
To reply to parent's parent's parent's post- the issue is not standards. The issue is ENFORCEMENT of standards BY CUSTOMERS rather than by the government. HL7 was written by the vendors so that customers can't use "standards compliance" to change the market dynamic. DICOM was written to fix/extend HL7, but didn't change the approach. You can write RFC's all day, and turn them into a standard if you want, but the real problem is that to drive change in the market for healthcare devices, you need to take power from the vendors and put it into the hands of the customers, and the only way to do that is with contracts that carry financial penalties for the vendor if they fail an objective interoperability test.
Humpty Dumpty was pushed.
Similar situation here, They feel that they should be paid for the healthcare service they provide. Nobody is reimbursing them for dealing with your crappy insurance. I am the IT department for an independent pharmacy and my hardest task has been convincing the 50somthing-technophobe-owners that it really is a good thing. At present we spend 10% of time and effort on the patient and 90% dealing with 3rd party problems.
"the dreamers of the day are dangerous men, for they may act their dream with open eyes, to make it possible." T.E. Lawr
It's not just the doctors... it seems to me that many healthcare providers (doctors, pharmacists, nurses, etc.) don't like having their workflows messed with. It is much quicker and easier for any of the above mentioned professions to pull a pen out of their pocket and scribble something on a piece of paper in a chart than it is to find a workstation, log in, and then several mouse clicks later, finally be at a screen where you can type in your note, click on your orders, etc.
:) But, the reality is that it often takes longer to compose your patient documentation on a computer than with pen and paper.
The problem with most EMR (electronic medical record) systems that I have seen is that on the front end, they don't end up saving you any time. The actual data entry into a computer will frequently take more time to enter than if you had scribbled it in a paper chart.
Where you really reap the benefits is more on the "back end" of the process through electronic processing of orders - potentially reducing errors, improved billing/payment procedures, data analysis/mining that can be used to identify quality improvement opportunities (such as improved utilization of resources or decreasing infection rates), etc.
In my experience as a nurse, there is some limited benefit on the "front end" for when you're giving patient care such as lab alerts; graphs showing trends of lab values, vital signs, etc.; and being able to actually read the physician's notes!
Adding to this problem is issue that the healthcare industry keeps asking the providers to "do more with less", but then they want to introduce some computer systems that take more time to use.
There are other issues such as the nursing shortage, the fact that the average age of a nruse is in the mid-40's, and that the aging baby boomer population will soon start to place a crushing load on the healthcare industry as they begin experiencing the onset of chronic disease such as hypertension, heart disease, diabetes, etc.
Also, I have been involved with healthcare information systems for the past several year, and the user interfaces and system configuration tools need a LOT of work! You can put all the nifty infrastructure in place that you want, but if you can't configure an acceptable, efficient workflow and user interface for the user, the system will either fail miserably or be poorly/inappropriately utilized.
But here is the real galling thing: She has to maintain an insurance trailer that goes down a little every year, until the last baby she delivered turns 21!.
Good, she needs to in the current climate.
Look up how John Edwards(D-NC) made his fortune if you're not familiar with it.
My God, it's Full of Source!
OUTSIDE_IP=$(dig +short my.ip @outsideip.net)
It's spelled (acronymed?) HIPAA. And part of it is a (gasp) open standard for data exchange format. I don't think what the big boys are doing will have any effect whatsoever on the healthcare IT field. Most IT departments in healthcare related businesses blew several years worth of budgets becoming HIPAA compliant. That generally meant new or upgraded software and hardware. Now the deadline for the HIPAA Final Security Rule of April 20th 2005 is fast approaching, and any competent IT department already has all their software in place.
Nice thinking Microsoft, IBM, et. al, but you're a day late, and a dollar too much. They should be embarassed that the US Federal Government beat them to it.