More on standards

I’m really enjoying the comments from my last post on Health IT. I could respond to many of them individually, but it’s probably worth it to batch them here.

I know that there have been organically derived standards in many other areas. One commenter even brought up HTML, which has gone through a number of revolutions, and has reached a reasonable amount of consensus without any guiding hand from the government. But it’s important to remember that, with respect to the web, everyone wants you to see their stuff. Any company with a website wants their information to be as accessible as possible. When it comes to medical data, the opposite is often true. Each EMR company does not want to share data with others. Moreover, each hospital or practice doesn’t want to share its data. So there’s no impetus for most of the stakeholders to try and find a common solution.

On the other hand, HTML shows exactly why having the standard works. Once the stuff is in a common format, many browsers have cropped up to compete for transmitting and presenting it. They are cheap, they have different pros and cons, and they are mostly interchangeable. I wish EMRs functioned like that.

I’m also not some starry-eyed believer that we will have one true standard, that encompasses everything. Waiting for that will leave us immobile forever. But there should be some consensus on how certain data (demographics, past medical history, allergies, medications, labs, visits, hospitalizations, etc.) could be housed in a common format, or easily translated into that format. I think it’s reasonable that all EMRs be required to export and import data in that format in order to be certified for “meaningful use”. That alone would make sharing data across providers much easier. It would also promote competition, since the barrier to changing EMRs would be significantly reduced.

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