Can healthcare IT be like the railroads?

To be most effective, standards should be used by everyone; but must everyone pay for those standards?

For most U.S. railroads, variability in rail gauge—the distance between the rails—is no longer a barrier it once was to the interoperability of rolling stock. With passage of the Pacific Railway Act in 1863, the federal government adopted 4 feet 8 1/2 inches as the U.S. standard gauge for the transcontinental railroad, thus promoting its widespread adoption and facilitating the movement of goods and passengers from one rail line to another.

But neither the federal government nor the rail industry needed to spend a lot of money maintaining our national rail gauge standard, largely because 4 feet 8 1/2 inches is the same distance today as it was 149 years ago.

Would that the healthcare IT industry be so lucky. Its multiple standards cost money to maintain because they must be updated frequently to keep pace with the changes in medicine and technology. That requires a process to propose those changes, vet, adopt and promulgate them.

So, who should pay for that process?

Should the federal government pay? After all, the feds are promoting the use of standards in their push to create an interoperable Nationwide Health Information Network. And the feds have paid in the past, for example, with financial support for the use of the Systematized Nomenclature of Medicine Clinical Terms, or SNOMED.

Should the private sector pay?

These are questions Dr. Charles Jaffe is posing as the standards development organization he heads, Health Level Seven, embarks on a noble experiment: Offering a selection of its standards for healthcare data transmission free of charge.

“The pilot is starting with some key specifications around domain models and the profiles to support them,” Jaffe said in a recent interview. “If that goes well, we'll make it more things.”

Is this pure altruism by HL7? Not exactly. It's more like self-enlightenment.

“We believe that it will create interest,” Jaffe said. “More people will come into the fold and it will increase broader adoption and we'll get more domain expertise. People will have recommendations for enhancing it, and that's what we want.”

Jaffe's hope, too, is that groups or IT vendors will like HL7's standards and profiles and say, ‘We want to create an electronic solution based on them,' and then become paying HL7 members.

“We're not a profit-making organization, but we have to sustain the organization,” Jaffe said.

“Half of the certified (electronic health records) are created by companies that are not HL7 members in violation of copyright law,” he grumbled. They use HL7's intellectual property without paying for it. Membership costs for some of the largest EHR companies, he said, would run about $19,000 a year.

Will the new model work? Who knows? Not even Jaffe.

Follow Joseph Conn on Twitter: @MHJConn.