One of the discussions that I routinely have in HITSP meetings lately is about the cost of the standards to implementers. The assumption seems to be that standards HITSP selects should be available for free to the implementers, and this has been raised as an issue for a number of standards that HITSP has selected. When HITSP reviews the standards it selects (in what we call a Tier 2 evaluation), one of the factors is indeed cost for use of the standard. HITSP does recognize that standards aren't always free, but that reasonable costs shouldn't be a barrier to selection. I reproduce the guidance given for tier 2 evaluation below:
"6.7 Favorable intellectual property and licensing terms
The standard produced by the organization should be readily available to
entities for implementation and usage. The standard should be available to most
stakeholders at no or reasonable cost. Code sets or terminologies should have
licensing arrangements, which do not pose a barrier to usage. This
availability should include a willingness to share necessary standards with the
HITSP and its Technical Committees for use in evaluation and, based on further
agreement, in HITSP Interoperability Specifications. When necessary,
evaluation of favorable IP and licensing terms may be applied to individual
standards if the standards organization maintains different terms for different
standards (see 3.0)"
I can see the point being made by those arguing for free access to the standards. This is especially important those in the open source community who do not have a revenue stream to support purchase of standards. However, I also understand why standards development organizations need to charge for their standards. Developing standards is not without cost, and somehow that cost needs to be recovered, or their simply won't be any new standards to use.
One of the proposals that has been suggested is that the Federal government purchase the rights for implementors to use standards that it mandates for use within electronic transactions through various regulations (e.g, ARRA, eRX and HIPAA). The government has already done this for SNOMED CT. This would make the standards freely accessible to implementors and users of the standards, and would also do something to reduce the costs of implementation of Healthcare IT.
Perhaps ONC should consider using some of the funds that it hasn't allocated yet to ensure that the necessary standards are available. Another important aspect of this would be that it would also allow the American public free access to the technology that is being used to support the provision of healthcare. This brings up several questions, including how each license would be negotiated, how value would be fairly apportioned to the copyright holders, and how access to the standards would be provided.
I think these are all interesting topics, and I frankly don't have an answer to any of them, but I do have another related idea that might be part of the framework for resolving these issues. A lot of what we wind up doing within HITSP which naturally flows outwards to the various SDOs is similar to what Canada InfoWay does with their
Standards Collaborative. It might be interesting to review the Canadian model, and to think about what a public-private collaborative organization serving a similar purpose here in the US might do to make the standards more available.
It's just a thought...
