Ajit Jaokar spoke of the possibility that eHealth will take off in emerging markets and what the implications thereof could be. As an illustration, Jaokar mentioned the M-Pesa mobile payment service which took off in Kenya, serving 6.5 million subscribers by May 2009; such a service is yet to be deployed in Western countries. Jaokar argued that emerging markets have a way of solving real life problems which is likely to mean that eHealth innovation will take place in emerging markets. Further, the lack of infrastructure might actually provide further incentives, as it did in the M-Pesa case. The implications of such a development for global standards are not clear but it is important to not only think of eHealth as a ‘Western’ concept.

Highlighting the fact that the healthcare of yesterday is changing, and a new healthcare experience is emerging, Helen Disney discussed the challenges facing us in ‘the post-bureaucratic age’. New technology can revolutionize the way in which governments and citizens interact and move towards a bottom-up approach; but this requires the development of standards to build trust in new systems. Interoperability is one of the main challenges we are facing as companies are set to compete on delivering eHealth services. More open, network systems will benefit patients but at the same time it will be less easy for governments to intervene, argued Disney. This will ultimately affect which standards are going to be widely used. Further, Disney raised the question whether some of the poorest patients, who lack internet access, face a risk of being left behind in the eHealth-age.

Keith W Boone provided valuable input on US eHealth policy. He expressed concerns over the shotgun approach taken by recent US initiatives and called for more coordination in standardization efforts. Further, Boone was critical to the fact that there is no US ‘national program’, rather conflicts within government and between SSOs are impeding developments. Governments can help by offering a consolidated voice, setting national goals and driving standardization efforts. Unified efforts across the ICT spectra is needed to look after national interests.

Denise Silber expressed her optimism over Health 2.0 services as a driver of eHealth innovation and development. She drew the attention to existing services; blogs, wikis, search engines etc, and pointed to the fact that these are available by computer or mobile phone and contributing to participatory medicine. Lack of standards is not the issue, Silber argues, web to web synchronization is already possible. Security should not be an impediment either, online banks have succeeded and so should healthcare. Rather, the obstacle lies in data not being electronically available or safely portable. Silber called on doctors and laboratories to digitize their information and leave the rest to participatory medicine.

Recognizing that seamless access to information is important in eHealth, and that standards are vital in achieving this, Jay Kesan expressed concern over the likeliness of governments’ early involvement in the standardization process, choosing winners (and losers) prematurely. The reason for this, he said, is because the governmental role in healthcare is not as challenged as that in other sectors. Kesan argued that it is the ICT private sector that are the domain specialists and that they must be allowed to work towards standardization, jointly developing standards within private SSOs. Thus, competition should be fostered among private firms developing downstream, innovative, proprietary technologies relying upon ICT standards. Learning from past behavior, Kesan also argued that US authorities are more likely to focus on spectrum management and setting power ratings to avoid interference, while letting different industry solutions and standards compete with each other, European authorities will be prone to mandate interoperability.

Also, prior to the forum Talkstandards conducted an exclusive interview with David Ingram, Founding Chairman of openEHR. Ingram spoke of the difficulties of gathering all challenges of eHealth under one common umbrella, and expressed concern over governments sometimes being excessively enthusiastic. It is vital that governments appreciate the scope of ICT standardization and development, as to handle the challenges properly. The approach to eHealth should be practical and empirical, Ingram said, and welcomed the fact that practical progress toward interoperability is actively sought. Although difficult barriers to eHealth implementation exist in Europe which might be hard to overcome, Ingram is optimistic with the direction developments are taking. Ultimately, Ingram said, implementation is the best way to achieve progress since it offers a sense of learning-by-doing.

The discussion around these topics is bound to continue. Please visit the Open Forum Event Page for further reading.

Current US regulation and funding will dramatically increase the use of ICT standards in healthcare. More than 100 new initiatives were just announced at a cost of around $750 million US dollars. Without coordination there will be a lot of new invention, much of which could ignore standards. This is a shotgun approach that needs more focus to be successful.

My own experiences with the US Federal initiatives around eHealth are mixed. My chief complaint is that we do not have a “national program” the way other countries do. We have a loosely agglutinated collection of initiatives that do not communicate. The lack of a Federal eHealth strategy on standardization has been getting in the way, even inside the government itself. Competition between standards organizations is also a problem.

The diversity of organizations and initiatives where one must participate is daunting. There needs to be a way to communicate across these initiatives and the standards organizations. The Health Information Technology Standards Panel (HITSP) formed by ANSI four years ago helped to drive communication for the US. However, HITSP’s contract with the Federal government recently expired, and a request for proposal to replace that organization has been delayed, but is expected in the next couple months. A more unified effort should be sought which includes representation of national interests to standards bodies.

Where governments can truly help is insuring that there is a consolidated voice across the ICT spectrum, and setting national goals that can be driven into standardization efforts.

Biography Keith W Boone
Keith W. Boone is a Standards Architect for GE Healthcare. In this role he represents GE Healthcare to standards organizations such as HL7 International, Integrating the Healthcare Enterprise, ANSI/HITSP, ISO TC 215, ASTM and Continua. Keith cochairs committees in HL7, IHE and HITSP, and is also an instructor for the Continituity of Care Document tutorials given by HL7. Keith entered the field of healthcare in 2001 and has more than 25 years experience in software development. He brought his extensive background in Internet and document markup standards to healthcare, and quickly became a leader in the use of standards such as the HL7 Clinical Document Architecture. He lives just south of Boston, Massachusetts and writes regularly about standards at motorcycleguy.blogspot.com.