Finger Pointing

FROM ONE SIDE of the continent to another, CIOs Patrick Carney at Staten Island University Hospital in New York City and Richard Skinner at Providence Health System in Portland, Ore. commiserate on the deplorable state of standardization in healthcare. Carney has a comparison point--he crossed over from private industry. He is not only baffled by the discrepancies in healthcare standards, he’s frustrated as he tries to integrate his information systems throughout the enterprise. Skinner is unhappy too with the state of affairs at Providence, attributing most of his technology problems in integration to lack of standards. Their businesses are different. Carney has strong roots in traditional fee-for-service but wants to expand his institution’s share of a growing managed care market; Skinner is deep in managed care country. But however different their businesses, they both agree that what they want is a reliable body of standards.

Vendors often take the rap on the standards issue, but it may be unfair to place allthe blame on the vendors’ doorsteps. Vendors, after all, are the core members of such standards development organizations as HL7 and CORBA.

In defense
Rusty Lewis, chief technology executive and VP of research and technology for HBO & Company in Atlanta, acknowledges that the lack of standards is an industry issue. What standards there are are fairly soft, he says, using HL7 as a prime example. There is so much compromise that it has become a non-standard with every vendor having its own dialect. "As vendors, we are confused by what we should do, he admits, "and often we are doing two different approaches." For example, almost everybody wants enterprisewide scheduling, he continues, but conflict-free scheduling isn’t possible without a single enterprisewide product. So, to accommodate those who do not want to be part of the enterprise, HBOC accommodates two ways of scheduling. "Often, what people want does not reflect an organizational vision," he says.

Although HBOC’s corporate decision is to develop standards consistent with industry standards and remove ambiguity, it takes time, Lewis says. Typically, it’s not the technology, he laments. It’s the people, the process and the data ownership issues that stand in the way of building a cohesive enterprise.

The master list
But where to start? Until last year, nobody had ever compiled an industry-wide standards inventory--so nobody really knew what was in use.

With no inventory in an industry facing government regulations under the upcoming Health Insurance Portability and Accountability Act of 1996 (HIPAA), The American National Standards Institute’s Healthcare Informatics Standards Board (ANSI HISB) embarked on a major project last year to compile a list of standards currently in use from all U.S. standard developing organizations. After gathering standards that pertained to HIPAA legislation last year, HISB, under the leadership of Jeff Blair, VP of consulting for the Medical Records Institute in Newton, Mass., submitted a supplementary inventory for clinical information standards this spring.

HISB efforts also resulted in establishing an international technical committee for health informatics, the International Organization for Standardization (ISO). Approved by ISO in January, the new technical committee will have its first international meeting in Orlando, Fla. in August. Chaired by C. Peter Waegemann, executive director of the Medical Records Institute, the new committee should change the dynamics of standards development and adoption in healthcare. "It will be very interesting," says ANSI program administrator in charge of healthcare informatics Alison Turner, "because it will force the U.S. to take one position."

Charlene Marietti is senior technology writer at Healthcare Informatics.