Jaffe was interviewed by Andy Updegrove of the Consortium Info Standards Blog and the post was linked to the Linux Foundation Web site. Jaffe came to HL7 from Intel and previously worked at Astra-Zeneca.)
Here is the key graph, as Updegrove edited it:
There is not a lack of standards, there are, in fact, too many standards and too many organizations writing them. There are some standards that are easy to implement or easy to understand, but which lack coherence, scalability, or broad adoption, while others are difficult to understand or cumbersome to write code for implementation. Some organizations write specifications or artifacts that are useful but painfully limited. Some are built on strict models and development frameworks to improve interoperability. Others meet the needs of the specific domain but are incapable of being used to share data with our healthcare environments. Some are meant to be international while others are simply realm-specific. Perhaps the most difficult challenge is to bind the standards to structured vocabularies to ensure that there is the unambiguous transfer of meaning. And as always, most lack the tools to adequately facilitate implementation.
Jaffe identified six main standards stakeholders beyond HL7 itself:
- The International Standards Organization (ISO), still a critical arbiter of standards despite last year's Microsoft Office fiasco.
- The Clinical Data Interchange Standards Consortium (CDISC), the pre-eminent standard for clinical research.
- The Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT), the most important English-language medical vocabulary standard.
- The International Classification of Diseases 10 (ICD-10), the global standard for disease classification.
- Logical Observation Identifiers Names and Codes (LOINC), widely used in exchanging medical data within the U.S.
- National Council for Prescription Drug Programs (NCPDP), used for pharmacy interchanges of data.
Building technology on U.S. standards alone would leave us with essentially a non-standard EHR platform. The sophistication of global standards, however, lags behind that of the U.S.
Jaffe also acknowledged a criticism made here by Scot Silverstein of Drexel University, namely that the EHR implementations of Canada and England, both of them with single-payer health systems, has been poor. How is the U.S., with its multiplicity of payers and stakeholders, to do better?
For all these reasons Jaffe thinks five years is too short a time to expect a total health IT transformation. Even HL7 itself is not equipped to the task, relying as it does on volunteers and dues for its work.
Lastly, we must rededicate ourselves to responding to the needs of the government agencies that rely so much on the productivity of our organization, whether or not these requirements are consistently and clearly articulated.
In other words, don't look for clarity from government. Deal with it. That's why transformation will take time.