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Wednesday, June 30, 2010

Are we lost?

For the last four years, the healthcare standards imperatives in the US have largely been driven by AHIC, ONC, CCHIT and use cases delivered to ANSI/HITSP.  Now that the HITSP and CCHIT contracts have ended, and meaningful use is in the process of being enacted those drivers no longer exist.  This has to some degree caused a shift in what we are working on in healthcare standards.

So what is happening in the meantime?

HL7 is working on an overall model of healthcare in at least five different initiatives:
  • hData
  • Micro-ITS
  • VMR
  • A framework based on the EHR Functional Model
  • Green CDA
There's progress on some of these, yet not a lot convergence, and quite a good deal of overlap.  I'd say we are still in the "Research" phase of this R&D effort on standardization.  When we get there, I think this will be a pretty disruptive innovation (see my previous post reviewing the Innovator's Dilemma where this term is described).

IHE is focusing on refining HIE oriented profiles in the IT Infrastructure Committee, Patient Care Coordination is focused on meaningful use in perinatal and post-natal care, and Cardiology is working on the Image enabled office.  IHE Radiology is examining Web services.  There are few breakthrough activities going on here; most of what I see is sustaining innovation.

NHIN Direct is the one US government initiative that is getting some attention, although it is behind by about a month after delays in obtaining consensus (now nearly achieved). 

The HITSP Harmonization process is due to be replaced by an NIEM oriented process, but while submissions were due back in March, nothing has been announced.

The industry is still waiting for various details of the "Meaningful Use" regulations to be completed, some of which are expected "REAL SOON NOW".

The abscense of a strong "requirements" driver in the US is clearly having an impact on standards initiatives here.  Collaboration among the various standards bodies is reduced due to the lack of deadline driven projects.  Most of us are waiting for the other shoe to drop, mostly on several regulatory fronts, including standards, meaningful use incentives, and long term certification, but also on standards and harmonization contracts due to be announced by ONC.

Does that mean the standards community is lost?  I don't think so.  But I do welcome the opportunity to "catch my breath".  The last four years have been very intense.  While I would do it all over again in a heartbeat, I'm glad I'm not at that level of intensity right now.  I expect that to change any day now.

I appreciate the struggle that HL7 is going through right now.  They've latched onto an old problem (models of healthcare information) and are seeing it in a very new light (simplicity in use and access) and at a higher level of abstraction that the RIM.  Given that many workgroups are currently struggling with the same issues, I expect that there will be some divergence for a few more months, followed by a convergence and reinvigoration of HL7 Version 3 activities focused on making it more readily used.  My hope is that a reemergence of a strong driver in US government activities will not distract HL7 from engaging in this work.

IHE PCC has started some work in a new paradigm in Patient Care Coordination that addresses workflows crossing various healthcare settings.  That space will probably produce a profile a year for the next three or four years.  This too is sustaining work, and I believe will continue regardless of what happens here in the US.