The federal government's decision to throw its considerable weight behind a common set of healthcare technology standards finally sets in motion a campaign to obliterate longstanding barriers to the exchange of clinical information among providers.
HHS and the departments of Defense and Veterans Affairs agreed earlier this month to use common standards for electronic health records, communication with pharmacies, clinical laboratory results and transmission of data from medical equipment to information systems (See chart).
"It's important for the federal government to lead by example by selecting and adopting these standards," said HHS Secretary Tommy Thompson. "But we cannot do it alone. The private sector will be crucial to the widespread diffusion of these standards."
Clinical standards advocates said the commitment to adopt a single computer format for such objectives as building medical records and transmitting a variety of patient data will make it easier for healthcare providers to share relevant information and for officials to identify emerging public health threats.
"The federal government is showing leadership that has the potential to save lives in the nation's hospitals," said Herbert Pardes, executive vice chairman of Connecting for Health, a coalition of more than 90 private and public healthcare organizations supporting the widespread adoption of clinical standards.
"Computers that have medically critical information can only be linked at great expense, often beyond the means of many hospitals," said Pardes, president and chief executive officer of New York-Presbyterian Hospital. "Yet if these computers could be linked and share data, we would vastly reduce potential errors."
The active roles of three federal departments significantly involved in healthcare delivery provide the authoritative push that the coalition and other advocates had been seeking. A series of HHS advisory reports dating back to 2000 had stressed that the healthcare industry was unlikely to muster the momentum for clinical standardization on its own.
For example, a November 2001 outline for building a national health information infrastructure identified federal leadership as "the most important missing ingredient" in a strategy to accelerate and coordinate progress.
In the early 1990s, the same lack of progress in getting the healthcare industry to embrace consensus-building efforts for insurance-related electronic transactions prompted leaders of that movement to enlist the federal government in mandating consensus standards as part of the Health Insurance Portability and Accountability Act of 1996.
That solution, however, subjected the standards-setting campaign to a long regulatory process that still isn't over-the transactions championed in 1992 won't be required until later this year. And a politically sensitive Congress added privacy-protection provisions that became the first order of regulatory business; those regulations become final April 14.
This time around, federal involvement is aimed at creating de facto standards adoption in the marketplace, said William Yasnoff, HHS' senior adviser on the effort to develop a national health information infrastructure.
"It's a nonregulatory approach. We're not going to be mandating things. We're not going to be telling people what to do," he said.
But healthcare organizations "would be remiss not to take note of it" when planning for new information technology and "should not make decisions counter to it," said Mary Jo Deering, HHS deputy director for e-health and management.
"The implicit message is we're a pretty big gorilla in all of this, and if this is the way we're going ... well, you complete the sentence," Deering said.
Groups such as Connecting for Health, sponsored by the Markle Foundation, and the Healthcare Information and Management Systems Society already have pledged support.
In September 2002, a steering group of Connecting for Health's coalition of clinicians, hospitals, employers, third-party payers, suppliers of information technology and other healthcare interests reached general agreement on the same set of standards identified by the federal departments.