Memo to health IT planners: no need to reinvent standards

Columnist Mike Daconta helps clarify the President's Council of Advisors on Science and Technology's recommendation for a universal exchange language for health care information and explains why it is more than feasible today.

In a report to the president in December 2010, the President’s Council of Advisors on Science and Technology (PCAST) called for “the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records while strictly ensuring patient privacy.” 

For me, this was déjà vu given that in 2005, I launched the National Information Exchange Model in conjunction with Jim Feagans and Pat McCreary at the Justice Department as a method to integrate homeland security efforts across federal, state, local and tribal governments.

Through the continued focused efforts of the succeeding NIEM program managers — Kshemendra Paul and Donna Roy — and many hard working staff members, NIEM is working on a scale of millions of messages today. 

In direct contradiction to this success story, a working group of the Health IT Policy and Standards Committees has concluded that the PCAST recommendation is not feasible by 2013 and, even worse, that they “are unaware of any real-world environments (either in healthcare or other sectors) where the combinations of technologies envisioned for the end-state have been placed into operation.”

Are you kidding me? Given that I began training and implementing Extensible Markup Language standards and software to process them since 1996, that the Extensible Business Reporting Language has been extensively and successfully used by the Securities and Exchange Commission since 2008, that the Federal Aviation Administration successfully uses the Aeronautical Information Exchange Model, that the mortgage industry has many commercial implementations of its XML standards, that the Defense Department has hundreds of widely adopted XML formats and that Recovery.gov and E-Verify successfully use NIEM — the list of real-world examples just goes on and on and on. 

Standards misunderstood

So, although I could decry the lack of leadership, the meekness of its conclusions, the circling the wagons of industry representatives and possibly even throw in a greed-driven conspiracy theory or two — I won’t bother throwing out such red meat. Instead, I believe the root problem is a misunderstanding of the evolution of standards.

Your father’s data standards (pre-XML and pre-Web) were often overly ambitious (“let’s boil the ocean”), took far too long to develop (“if everyone would just do it my way”) and resulted in thick, paper volumes that sat on dusty shelves or became door stops.

Today, where Asynchronous JavaScript and XML-driven websites and service-oriented architectures are thriving, an XML-based standard can rapidly move from committee approval to system implementation in weeks.

Recently, I used a software utility to automatically generate all the parsing, marshaling and unmarshaling code for a complex OMB Exhibit 300 XML schema. By hand, such software development would have taken a month of boring, grunt-like coding. The bottom line is that during the past decade, there has been a sea change in the tools, techniques and understanding of how to develop standards for immediate adoption, implementation and use. 

Given that, standardization before mass adoption must be the rule and not the exception. Additionally, as evident by the plethora of XML-based cloud application programming interfaces, the cloud is well suited to take advantage of this new, rapid standards environment. 

An interesting, recent analogy that is testing this principle is the North American electric vehicle manufacturer’s agreement on a standard electric plug design. 

That effort and rapid consensus follows the same logic that is necessary for electronic health records: standardization before mass adoption is smart economics. If you think about the integration challenge ahead for EHRs to be effective — data flowing across organizations of every shape and size, from small mom-and-pop operations to huge multistate health conglomerates — it seems obvious that interoperability is paramount. 

Thus, for EHRs to be interoperable, a universal exchange language must also be standardized before widespread adoption. Simply put, the PCAST recommendations are feasible — today. 

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.