11 Nov Standards Needed for Advances in Healthcare Technology
MILWAUKEE – Patient record standardization was one of the hottest topics among both attendees and presenters at the Evolving Healthcare Technology Conference held Friday at the Medical College of Wisconsin (MCW).
“I have seen innumerable decisions made without the right info at the right time in the right place,” said Doug Bingenheimer, IT enterprise strategic planning consultant with the Wisconsin Department of Administration, who attended the conference. “Even if the resident is a good clinician, he can be making a poor decision.”
The concern of the attendees – which may mirror the concerns of the healthcare industry at large – were not lost on Dow Wilson, president of GE Medical Systems – Information Technologies, who was a keynote presenter at the symposium. Wilson is interested in standards that would allow patient records to be accessed easily by clinicians not only in the institution where they originated, but by healthcare practitioners working for different systems in different geographic locations.
“We are totally supportive of a portable platform,” Wilson said. “We really believe the world has to go that way. Our society is just too transient to do otherwise. If you are in Milwaukee today and in St. Louis tomorrow or an inpatient today and an outpatient tomorrow, or at St. Luke’s tomorrow and Froedtert the next, the long-term vision has to be one of portability.”
GE Medical Systems Information Technologies has already introduced a product designed to deliver information to radiologists. GE Centricity Information Systems integrates radiology information together with information from other care areas of hospitals to provide radiologists with medical images and patient information together in a single desktop application. Wilson said there might be parallels between the industry standard for radiological data – DICOM – and a potential standard for patient records.
“DICOM is a very standard format and you can pull up info at any radiology department in the country,” Wilson said.
DICOM was standardized by The Radiological Society of North America (RSNA) – which has been working with the standard since 1992. Standard file formats and delivery systems for patient records are in the very early stages of development, according to Gary Dickinson, co-chair of a committee involved in defining interoperability standards for patient records systems. Dickinson co-chairs a committee working on an index and framework for exchanging clinical data for HL7, an Ann Arbor-based standards body.
“I have been saying 20 years for a long time,” Dickinson said when asked how long it would be before standard electronic health files could be accessed by physicians across geographic and organizational barriers. “At this point, I would say 10 to 20 years.”
Dickinson, whose job involves the development and management of health care standards for California-based, Per-Se Technologies, Inc., complained that HL7 is dominated by vendors to the healthcare industry rather than by clinicians. “This is slowing down the process of establishing an interoperability standard.”
“They (vendors) voted down our proposal for an interoperability standard in the first round of voting,” Dickinson said. The measure will once again come up for a vote in February or March, he said. If the second proposal is voted down as well by members of the standards body, Dickinson is hoping for government intervention in the matter.
“If we don’t get it done in the second round, I am sure the federal government will intervene,” Dickinson said. “But they will at least have given the private sector a shot.”
Bingenheimer is supportive of government intervention – and posited that Wisconsin may have some clout in expediting the process.
“In Wisconsin, we have a lot of past and current decision makers – the last two health and human service secretaries,” Bingenheimer said. “So perhaps there is a chance to take a leadership role.”
Bingenheimer also believes that Wisconsin’s health care technology leaders – including Madison-based EPIC Systems and GE Medical Systems-Information Technologies could play a role in advocating for standardization.
Health and Human Services (HHS) Department Secretary Tommy Thompson already supports patient record standardization. In July, Thompson announced that SNOMED, a standardized medical vocabulary system, would be available for free distribution. According to Bingenheimer, this is at least a step in the right direction.
“SNOMED is a more granular way to describe things than the International Classification of Diseases (ICD),” Bingenheimer said of the system developed by the College of American Pathologists. “So many things are shades of gray, and SNOMED provides more shades of gray.”
The co-chair of an HL7 committee on clinical document architecture – Liora Alschuler, a Vermont-based healthcare XML consultant – said HHS’ attention is commendable, but the department may be putting the cart before the horse.
The problem, according to Alschuler, is providing wide access to the clinical documents and then not defining the language used within the document.
“Trying to share information on a distributed basis – that’s hard,” Alschuler said. “That needs to be the first thing you do. Trying to standardize the entire record so you have perfect semantic interoperability is the last thing you do – not the first thing you do… The government needs to provide the pavement – the rail road tracks – a very basic infrastucture – and then let the private sector design their own cars.”
Chuck Rathmann is a freelance writer and contributor to Wisconsin Technology Network. He can be reached at firstname.lastname@example.org.