recent DISCUSSION

• Gerard Freriks says:

  Semantic Interoperability in healthcare cross-enterprise and cross-border in Europe can not become a reality unless a few things are in place”
  - an infrastructure I call INFOSTRUCTURE
  - Infrastructures are firmly based on policies, legislation, standards, validation/certification processes
  - It is the ‘market’ that freely produces standards
  - Technology standards must be produced by technology vendors
  - Information standards for the INFOSTRUCTURE must be produced by Information users i.e. the healthcare providers and their organisations
  - Governments have the role to create and maintain the patient safe infra-/infostructure

  - The INFOSTRUCTURE consists of:
  – Model of Documentation/Archiving (like a language systax)
  – Models of Use (document structure, agreements of what and how items are documented. Like common phrases)
  – Codes from coding systems (like a dictionary)
  – Ontology (like an encyclopedia)
  All levels of the INFOSTRUCTURE can be filled by existing standards.
• Jay Kesan says:

  Mattias,
  Yes, I see your point. It is not clear to me that consumers will not benefit from having say two standards for a particular application.
  I am simply suggesting that we let traditional industrial evolution play a role. There will be a lot of firms at the outset, and as the market grows, there will be a shakeout and the number of firms will reduce as the industry takes off and matures. The consumer will benefit from this process because there will be various competition even across standards. We may have emerging network externalities and possible switching costs, so there may be some portability and related issues.
• Jay Kesan says:

  Ajit,
  For example, private standards setting organizations could be working on schema for document (text, images, etc…) handling.
• Jay Kesan says:

  Keith,
  I fear that simply reusing (as opposed to adapting and enhancing) existing IT sector standards in e-health may not be easy or even appropriately responsive to the challenges posed by e-health. I do agree that we should not be re-inventing solutions or pretend that no solutions exist.
  In another context, “digital government” initiatives have also tried to simply reuse existing IT standards and run into problems in various countries depending on the government programs involved.
• Jay Kesan says:

  Helen, I agree with your comments very much. My fear is that in the name of patient privacy, which is a genuine concern, there will be more government intervention and regulation.
• adesina says:

  Some key points from the OECD eHealth report
  eHealth is not about technical standardization alone but it requires institutional, human and social platforms for integration, says a new report on eHealth from the OECD. In summary, the report identified lack of universal standards as a major constraint to impactful eHealth adoption and diffusion in the OECD.
  Key challenges highlighted in the report are:
  1. Lack of coordination and cooperation amongst multiple actors and organizations involve in eHealth standards and use
  2. Successful integration will involve merging technological, legal and business rules together
  3. eHealth mirrors installed base of healthcare fragmentation hereby complicating standardization. Vertical fragmentation at Technology and Industry will need to be reconciled with horizontal ones at healthcare providers and geographical boundaries.
  4. Ensuring interoperability is expensive and costly hereby dissuading providers to adopt. Reactive and costly local customizations further compounds interoperability. Moreover change-over is also costly.
  5. Current private sector or market-driven approach to standardization is slow and fruitful; hence a public sector or government sector led initiative is suggested.
  6. Lack of international consensus constrains global eHealth standardization
  7. Open standards and architecture could provide a technological solution to achieving interoperability

  These points are also relevant to http://www.talkstandards.com/whats-missing-in-us-ehealth-policy/
• Ajit Jaokar says:

  Keith
  Yes, this is a complex area and I watch it with interest. I see the same principles in another domain I am involved in(Smart grids) where you have IT + Telecoms + Energy + Government + Privacy . Fun and games :) Its an evolving space and much to be learnt! rgds Ajit
• Denise Silber says:

  Jay, your comment about premature selection of a standard is a very interesting one. The flip side is not progressing for lack of a standard that pulls ahead of the pack. The Israeli example cited by Helen Disney is a valid solution for merging EHR’s. And I imagine that we are moving with semantic labeling to more and more consolidation possibilities.
• Keith W Boone says:

  Ajit:

  I truly wish healthcare SDO’s would focus on the healthcare sector and simply reuse IT sector standards. Several have done this wisely. Others see a need to rerepresent information already found in IT sector standards in healthcare standard formats. Profiling efforts are needed to express how to use IT sector standards in a healthcare environment, but I find translation or mapping efforts between them to be of dubious value.
• Ajit Jaokar says:

  Hi Jay

  Re
  >>>
  Nevertheless, the ICT private sectors who are the domain specialists in this arena, must be allowed to work together to jointly develop standards within private standards-setting organizations.
  <<<

  I agree in principle. This method is proven and tested in many areas – ex IT, Telecoms etc.

  There is one question though: e-health is cross domain. In traditional sectors(ex IT), the domains are monolithic. e-health, by definition, spans IT and health care. These industries have different existing standards bodies and different industry cycles(ex procurement cycles).

  In which areas do you see an initial role for private standards setting organizations?

  kind Rgds
  Ajit
• Mattias Ganslandt says:

  Jay, One could view standardization and inter-operability in eHealth primarily as a matter relating to the interaction between complementary services. This is the production perspective on eHealth. Alternatively, one looks at eHealth and standardization from the perspective of consumers (insurers) or end-users (patients). In this case, standards do not necessarily play its key role in solving complementarity issues but rather allowing greater substitutability; and hence competition between different providers of the same/similar health care services. While markets are typically good at solving standardization-problems that allows for greater and more effective interaction between complements, the same is not always the case for standards that enhances substitutability for consumers – i.e. increasing competition. On the contrary, differentiation and switching-costs can sometimes be important business and/or political strategies that impede international specialization, trade and competition. Accordingly, there is potentially a role for international (government) co-ordination of standards to allow for patient mobility. This is true in Europe (with its segmented health care markets) and more generally at the global level. /Mattias
• Helen Disney says:

  I very much agree that there is a danger of a top-down approach from Governments, especially in Europe where so many health systems have a high degree of state intervention. This significantly holds up the pace of technological change and also damages patient care – just today I spent hours trying to get hold of my own test results involving several phone calls and a half hour wait at the GP surgery. In other countries, such as Israel, for example, I could have gone online to my own records and simply printed them out in a few seconds. But the role of the state has another effect too – it also means that we tend to think about our health systems in old fashioned ways, rather than letting them evolve in new ways. To take another Israeli example, why not create a system where health information can be ‘picked’ or collected together from a wide range of different places to make a single patient record rather than trying to create a one size fits all model which will be costly to implement and already out of date by the time it is put into place and the data is entered? Isn’t it time to accept that Government’s role is to safeguard the patient’s privacy and rights but for the rest, let the market decide. If consumers want e-health, which they appear to do, then let the race begin to see which entrepreneurs can create the next health revolution.