The golden rule of health IT?

The golden rule of health IT?

Summary: So long as hospital computing systems remain proprietary islands of information, with proprietary drivers and minimum interoperability, the big winners here are going to be vendors, no one else.


eHealth Initiative blueprint document coverMembers of the eHealth Initiative, a collection of vendors, insurers, hospitals and other stakeholders, are thrilled beyond measure that the Obama Administration will step up to the plate and make health IT a high priority.

(You can get the group's own roadmap for eHealth technology here.)

I just hope they don't forget the golden rule. He who has the gold must make the rules.

There is a reason why the IT infrastructure of hospitals and insurers is far more mature than that in clinics. Hospitals and insurers gain bottom line benefits, while doctors do not.

It is presumed that the government will gain enormous benefits from buying more IT gear, and this will allow businesses to cut their health care costs.

Is that a reasonable presumption?

Not without standards.

So long as hospital computing systems remain proprietary islands of information, with proprietary drivers and minimum interoperability, the big winners here are going to be vendors, no one else.

Laws like HIPAA are the excuse for a lack of standards, and things like identity and audit trails must exist to assure privacy and protect security.

But an eHealth revolution, like the PC and Internet revolutions, requires adherence to real standards maintained at minimum cost to vendors and customers.

In the PC world this meant the Microsoft standard. The market waited years for this standard to emerge, using DOS windows instead of Apple's point-and-click Macintosh, because the Windows standard would be universal.

In the online world this meant the TCP/IP and WWW standards. Only when questions of financial advantage were taken out would networks interconnect and become ubiquitous.

My 25-year career in computer reporting has been spent following these trends, and the lessons are second nature to me now.

But vendors lose control of customers when they adhere to standards. This makes them reluctant to adopt standards. Something must make them into a business necessity. Someone must demand them.

So far the marketplace has not done this regarding health IT. Peripherals have too much value. Media and networks are overwhelmed by data loads before their standards become universal.

If government is going to step up to the plate, and mandate equipment purchases for doctors and hospitals, it also needs to support structures under which standards can be ratified, and advanced, in an organized way.

The standards effort, as well as the purchasing effort, must become self-sustaining, and as independent of outside forces as the Internet Society and W3C, for this to happen.

It is those structures I will be looking toward over the next year as I follow the money here. And you should look that way too. Because it's likely to be your money that is spent. You deserve a say in how that happens.

Topics: Health, CXO, Enterprise Software, Software, IT Employment

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  • Glen Tullman, CEO of Allscripts

    Yesterday, Glen Tullman, CEO of Allscripts, told Bloomberg reporter Alex Nussbaum that he thinks that future federal spending should be tied to physicians? use of the system, and perhaps come in the form of loans, ?to ensure doctors have some skin in the game.?

    D. Kellus Pruitt
    D. Kellus Pruitt
  • RE: The golden rule of health IT?

    There is no question about it, standards are the required and previously missing component in driving improvements in both quality and cost of healthcare. I don't agree, however, that these standards do not exist. We have made tremendous strides over the past 8 years in progressing the development of real-world implementable standards. John Halamka, one of the nation's leading authorities on healthcare IT, recently addressed this in his blog ( And as is rightly pointed out here, what is needed is a clear incentive structure for adopting those standards across the healthcare ecosystem.

    I also don't agree with the idea that vendors are reluctant to adopt standards. This idea has been propagated for years as a means of introducing conflict into an otherwise bland topic, and it simply does not hold water (with a few notable exceptions) when you look at the level of investments software companies make in the standards organizations (people, money, and time). I've worked for the largest software companies in the world, and I can tell you they are extremely motivated to adopt standards. Why? Because standards

    - allow them to lower their development costs
    - give them a point of alignment with their customers
    - allow them to offer more compelling solutions by integrating with other vendors that offer complementary technologies
    - allow them to move away from focusing on mundane aspects of software development and re-focus their efforts on areas that offer real software innovation
    - reduce criticisms of vendor lock-in and proprietary systems

    So if that is the case, why is it that we don't have more interoperable systems today? Because standards take a lot of time -- time to develop and then time to implement in software systems. And that is why it comes back to incentives. Until there are incentives in place to encourage the RAPID implementation of these standards, we will see uptake in an "as we are able to" level of speed. No vendor wants to build or sell software that customers are not prepared to adopt, and no customers want to buy software that does not reflect the real-world state of their business. So we need to change the real-world state with incentives, and as is pointed out, those incentives need to be organized and reflect public priorities.

    Jason Burke
    Jason Burke
  • Standards can't be the same

    What's important to the safe operation of a hospital that produced maximum patient happiness is not the same for a clinic, or a physician's office.
    • Droopy socks

      Ah! There's the rub. Dr_Zinj says it all in "Standards can't be the same."

      From the standpoint of a solo dentist in private practice, like 85% of the other dentists in the nation, HIPAA fits like socks on a rooster. D. Kellus Pruitt DDS
      D. Kellus Pruitt