Adoption Of Standards

You need to be aware of efforts to promote the adoption of standards to know in advance which standards will ultimately be adopted and thus which standards to use in your system.

Ultimately, users of information systems drive adoption of standards. They adopt a standard when there is a strong incentive to do so. In the retail industry, manufacturers, distributors, and retailers developed and implemented the GTIN standard to reduce the costs of conducting business. By contrast, hospitals, health insurance companies, and physicians have not put standards high on their priority list because until recently they have not had sufficient incentive to adopt standards.

In the United States and other countries such as Canada, the United Kingdom, and Australia, national efforts to promote exchange of healthcare data to improve decision making in health care (and the desired side effect of reduced healthcare costs) are changing the dynamic. Because standards can greatly reduce the effort required to exchange data, standards are a key focus of these national healthcare information infrastructure efforts.

In the United States, the federal government is actively promoting the adoption of standards. The Consolidated Health Informatics initiative seeks to ensure that all healthcare-related information systems owned by the federal government are compliant with industry standards. CHI has named many of the standards discussed here as standards with which systems should be compliant. The idea behind this initiative is that the private sector often adopts standards used by the federal government to reduce the difficulty of communicating data to government systems. The hope is that the CHI effort drives adoption of healthcare information technology standards such as LOINC and SNOMED-CT.

The Medicare Modernization Act of 2003 mandates that the Secretary of Health and Human Services create the Commission on Systemic Interoperability. The act charges this commission with developing a strategy for promoting the adoption and implementation of healthcare information technology standards. The commission held its first meeting in January 2005, and its final report is due in October 2005.

The private sector is collaborating with the federal government to identify and promote important standards for adoption. The Certification Commission for Healthcare Information Technology is a voluntary, private-sector initiative to certify that healthcare information technology products comply with standards. It began meeting in September 2004 and released for public comment its first work products, which include an assessment of existing standards and the state of the industry in adopting them.

The CDC have been recommending standards for adoption by public health information systems, including those that perform surveillance. The CDC terms this standards effort the PHIN. We have already discussed the PHIN data model standards, but the CDC is also recommending standards that enable surveillance systems to report notifiable diseases to CDC information systems. The implementation guides for these standards all specify the use of standards that we have already discussed, including HL7 version 3.0. To our knowledge, these implementation guides are the only existing standards for communication of data from one biosurveillance system to another.

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