As The Beatles song aptly states, healthcare data standards will be a ” long and winding road”. After my last post about taking a long time to enable wide-spread health information exchange, I keep seeing validation all over the place.
Just on the healthaffairs.org website, there are three separate articles about related topics:
- An August 7 article describes how organizations are still challenged with meeting Meaningful Use 2 criteria. While this is not necessarily a direct affect of the lack of data standards, it continues to show that healthcare organizations will be focused on other priorities for some time. Many healthcare organizations want more standardization, but can’t devote the time and energy
- Also on August 7, an article on health information exchange stated that only 14% of providers shared information with other providers outside their organizations. Clearly, health information exchange is very spotty and non-existant in many areas of the country. Therefore, it will continue to take alot of time and effort to educate those who are new to health information exchange about data standards and interoperability.
- …and finally…on August 11, an interoperability policy brief was published and ended with the statements: “…While considerable investments in health IT have been made, advancement of interoperability and electronic information sharing across systems has been slow. Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”
That last sentence really bothered me. It’s basically just stating the obvious: more needs to be done. yeah…and????
So here goes: Here is a possible strategy (backed up by thoughts from some smart people) to drive data standardization without “trying to boil the ocean”.
- EHR Certification – It seems that the federal government is learning and improving its certification. Many healthcare organizations – since they have to deal with all kinds of mandates (e.g., the continued move to ICD-10) – just want to implement the EHR that is certified and not really think about all the details. They want someone else to “just handle it”. This could be used for data standards by mandating a subset of very commonly used codes.
- Small Subset of Standard Codes – Way back in 2007, some smart people from Indiana made a pretty good case that a small sub-set of data makes up a majority of the data. So instead of getting caught up in ALL of the possible codes, using scarce resources to focus on only a small subset will create the greatest value (BTW, kudos for using the word “parsimonious” in the title!).
- Critical Mass of Agreement Needed – The concept laid out in this March 2014 essay that focused on public health that advocates “…collaboratively develop a strategic plan with data sharing partners…” could be taken beyond public health. I think agreement could happen on a small sub-set of codes that could be enforced by certification. The idea is that public health as well as HHS all want the same thing: data standards to drive interoperability. It seems reasonable that the CDC and state public health organizations could team with HHS and other stakeholders (e.g., HIE’s, EHR vendors, etc…) to create a critical mass of codes to be standardized. That could influence the certification process and then healthcare organizations could then receive the benefit of the standards as they implement certified EHR’s.
Now I certainly realize that this may be a pipe-dream and any strategy will truly be a “long and winding road”. However, it’s at least a fairly specific plan instead of just saying something like: “…Additional action is needed…” (eye-roll!) Feel free to add comments if you believe you have a better approach..crowd-sourcing could generate a good idea!