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Tech Giants Push Open Standards for Health Network

Posted by michael on from the eschewing-proprietariness dept.

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."

21 of 233 comments (clear)

  1. About time ... by malcomvetter · · Score: 4, Interesting

    Finally ... now maybe health care systems won't rely on dial-up as their primary method of sharing information from facility to facility.

    Amazingly enough, health care is probably 5-10 years behind in IT. The optimistic note: Health Care IT can learn from the mistakes of the 90s (which they were thinking about implementing next quarter- honest) and with movements like this, perhaps they can finally adopt proven standards.

    1. Re:About time ... by Rei · · Score: 4, Informative

      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.
    2. Re:About time ... by Waffle+Iron · · Score: 3, Funny
      Amazingly enough, health care is probably 5-10 years behind in IT.

      I would say they are further behind than that. The incredibly poor communication between providers and insurers is one of my pet peeves. Transactions often take many months to clear, and involve numerous cryptic paper printouts, and often must be mediated by patients with no clue as to what the codes mean. Just how hard can this be?

      More than once a doctor or hospital in a PPO network has started hounding me over an unpaid balance that the insurer was supposed to cover. They called me up and tell me that I should coax the insurer to pay up. I'm usually a calm person, but this was just too much. *They're* the ones who entered into a contractual agreement with the insurance company when they joined the network. *They're* the ones with multimillion dollar mainframe systems who can communicate with the insurer's multimillion dollar mainframe systems. Why the hell do I need to get on the phone to try to fix their data interchange problems? Do they have kindergardners running their IT operations?

      The couple of times I've had to use this rant on their pesky bill collectors, it seems to have worked. The charges mysteriously got settled.

    3. Re:About time ... by Rei · · Score: 3, Insightful

      Actually, malpractice is miniscule. For a percentage of doctors, it is a significant percentage of their income (not for all doctors; some have it much worse than others). However, "doctor salaries" are just a portion of total medical costs themselves (for example, have you ever seen how much an MR scanner costs simply to buy, let alone maintain?); you're looking, consequently, at a percentage of a percentage of a percentage of total costs being in malpractice. The net result? Malpractice costs amount to around 2% of total system costs.

      Most of medical costs are in overhead, and what I described is precisely that: serious, bloated, unnecessary overhead.

      --
      People said I was dumb, but I proved them.
    4. Re:About time ... by BWJones · · Score: 4, Informative

      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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  2. Where's Apple? by Foozy · · Score: 4, Funny

    After all, an apple a day keeps the doctor away...

  3. Typo in Submisson by jaymzter · · Score: 5, Funny

    Somehow Microsoft got into the same sentence as non-proprietary
    Please correct and resubmit

    --
    If thou see a fair woman pay court to her, for thus thou wilt obtain love
  4. Control and privacy. by Anonymous Coward · · Score: 3, Insightful

    Well we like technology. We like services that make life easier for us. Now how about the privacy, and control issues raised?

  5. Interoperability and sharing... by PornMaster · · Score: 4, Interesting

    Interoperability and sharing are all kinds of nice for the interchange of information, but what happens when a third-party developer comes up with something that can also plug-in, so it gets access to the data, but has some kind of big open hole in other parts of its code, so everyone's records are available to anyone?

    Without resorting to a paranoid rant about huge databases where authorized people have access to my personal data... what about the unauthorized?

    For some reason, I don't see a security framework coming down the line that is *good*, consistent, and enforced by the system as a whole.

    --
    500GB of disk, 5TB of transfer, $5.95/mo
    1. Re:Interoperability and sharing... by Rei · · Score: 3, Interesting

      You think this isn't already an issue? I for one welcome any upgrades to the system - it's bound to be a lot more secure and have a lot less human eyes on the data.

      At a job I used to work at, there was an officefull of people who really didn't need to be there if the system had just been designed properly to begin with. Each of them looked at huge amounts of personal data every day as they typed it in from one system to another. Then I, as a software developer, had access to all of it when trying to write scripts to ease access to this data. We transmitted it to several places, each of which probably had similarly inefficient and human-intensive systems. No encryption was used at any stage that I'm aware of. I mean, seriously, how is it going to get worse?

      --
      People said I was dumb, but I proved them.
  6. Minor points by sczimme · · Score: 3, Informative


    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.
  7. I for one... by fizban · · Score: 4, Funny

    I for one welcome our new open, nonproprietary technology standard overlords.

    --

    +1 Insightful, -1 Troll. What can I say, I'm an Insightful Troll.

  8. Microsoft - Open Standards - ??? by BigAlexK · · Score: 3, Insightful

    That's all great, but Microsoft seem from history to have a corporate psychological flaw whereby on the rare occasions they try to support open standards they cannot help themselves trying to manipulate and distort that standard to their own devious ends.

    MS should truly be proud of themselves if they manage to avoid that this time.

  9. "Insurers"? by CrystalFalcon · · Score: 4, Insightful

    The network is the first step in moving from paper to electronic patient records and sharing health data between doctors, researchers, insurers and hospitals.

    This was completely mind-boggling to me, until I realized we're talking about the big ole US of A.

    If a commercial enterprise that was supposed to be working in my interests got access to my medical data here in Europe, there'd be fucking hell to pay. Heads would roll.

    Can't see why you keep putting up with it.

  10. HL7 by Kainaw · · Score: 5, Interesting

    Anyone who has worked on IT in the health field knows about HL7. It is a free protocol for sharing any and all medical information. As of version 3, it has become XML compliant to allow programmers to use XML parsing tools to read/write data. I don't understand why there is such a need to make a new protocol for sharing health data when one already exists and is in use with most EMR systems.

    --
    The previous comment is purposely vague and generalized, but all of the facts are completely true.
  11. It's not amazing by sczimme · · Score: 3, Insightful


    Amazingly enough, health care is probably 5-10 years behind in IT.

    It's not amazing, really: healthcare as an industry is often both very very conservative and rather frugal. The combination results in an atmosphere of sticking with what works because a) well, it works and b) the new item(s) will cost money and might not work (see a)). It's actually not a bad viewpoint much of the time because it discourages upgrading for the sake of upgrading (i.e. with no clear and necessary benefit).

    --
    I want to drag this out as long as possible. Bring me my protractor.
  12. and why is this? by ecalkin · · Score: 3, Insightful

    Medicine is behind because of the doctors. I have done computer work about 15-18 medical offices and the doctors seem to have a 'this shouldn't cost me any money' attitude towards technology. In a lot of (but not all) the offices, things were not updated/replaced until the gun of hippa was placed to their heads.
    Apparently, the ability to get more accurate records, better customer satisfaction, faster data retrieval, etc, doesn't seem to matter. It's like a lot of the doctors take out as much money as they possibly can in their pockets *now*, and do very little reinvesting for the future.

  13. Freedom Of Information Act by amdg · · Score: 5, Informative

    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:

  14. As a Hospital IT Professional by 314m678 · · Score: 5, Interesting
    I can tell you that this is great news. Our hospital currently has myriad legacy systems running on dinosaur mainframes all linked together buy buggy interfaces which sometimes resort to screen scraping.

    Let me give an example of one of our systems, a text based system, with functionality similar to telnet, when I used it for the first time I noticed that it was slow to open, so I put a ethereal on it and noticed that to connect it sends 8MB of info every time you connect. Approximately 20,000 packets, each with every permutation of two ASCII chars.

    We deal with crap this daily. For another program we are forced to use a non-standard telnet client that takes 100% of the CPU regardless of the machine you are using.

    Open standards that could link admitting, clinical and financial hospital systems will save billions of dollars and probably a few human lives. Additionally, this will allow small software companies and open source coders to make applications that can be widely used. Ive been working on a multi million dollar project the last few months where an aspect of it was completely screwed up because one software vendor uses a non-standard interface that they will not allow us to access directly, as a result, our users have to settle for diminished functionality.

    If encryption is built into this standard it will be a step ahead for HIPPA protection and most systems just send everything, (passwords too) in plain text. I for one, look forward enthusiastically to open source hospital applications made possible by open standards.

  15. Re:The biggest obstacle to this is doctors by Torqued · · Score: 3, Informative

    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.

    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! :) But, the reality is that it often takes longer to compose your patient documentation on a computer than with pen and paper.

    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.

  16. Asking important questions about health records by invincerator · · Score: 3, Insightful

    I've read all the posts on this topic but it seems like many important questions and comments haven't been made about the implications of having national health care records.

    • Why would doctors and HMOs put money into a national system if it makes it easier for patients to jump to another provider? Maybe that's why it takes national leadership to make this happen.
    • How would updates to your health record get disseminated to other hospitals and clinics? How often? You have to assume there will be multiple data stores, not just one central one. And, remember, bad data could kill you.
    • Shouldn't patients be able to carry their records with them for emergency rooms or new doctors? What's the best way to carry that record because don't I already have to carry my health insurance card whereever I go?
    • How do you authorize certain people to see your medical record but not others?
    • In an emergency room situation, a portable record (on the patient) with drug allergies, current prescriptions and medical history could save your life. Isn't that worth it to make it part of the standard then? How does an unconscious patient grant authorization or does she have to? Can EMTs unlock an on-person record if needed?
    • Exactly how does a national health record improve the quality of patient care, instead of just enriching or giving more control to third parties such as government and insurance? Is improved care the #1 goal of this initiative?
    • Controls and standards aren't just needed at the data level (think database) to ensure security and privacy. Aren't they needed at the "view" level also? What if a doctor is on one terminal in a hospital and they walk to a different one? How fast should the view lock up? Should the first view of your record close if the doctor opens a second view of that record on a second terminal?
    • How can we guarentee that patient records are made sufficiently anonymous when researchers are using records en masse for statistical analysis?
    • Who gets the money for usage of the records for research ... or are they free?
    • Should you get a royalty if your record is used as part of a study? Do you have a right to know which studies your record was used in?

    I could go on but I won't. As you can see, this isn't just about data, like the HL7 standard. It's about a heckuva lot more.