Since I’m sick and lying in bed today, I’ve been making a few cosmetic changes to my blog. It really sucks to be me because it’s sunny and warm outside and I’ve got some type of bug. Okay, enough whining…
I’m working with MJ Suhonos to try and get my blog aggregated on the Journal of Medical Internet Research’s eHealth Blog page. Unbeknownst to me, there are dozens of different “site feed” formats. Until today, I’ve been happily using the Atom feed that Blogger has provided. But, I didn’t realize that Atom is a newer format. So, I’ve added a RSS2.0 feed from Feedburner (this is an interesting site). Anyway, the point is not to write about the different formats for syndication. But, this idea of a standards/format “war” makes me think about the current status in health care, specifically in terms of eHealth/health informatics.
Okay, so we all know that there is no easy way to share information. A “lack of standards” is the often given reason for the inability to send information back and forth between groups. In North America, HL7 seems to have taken the dominant role in terms of a standard to communicate. I must admit that HL7 is moving towards a more “pure” XML format, so this is good.
In general, I think we all recognize that “standards wars” are essentially struggles for power – the power to dictate the near future of an industry. Extended “wars” generally don’t provide benefits to anyone because of a paralyzing inability to “communicate”. When we look at some recent examples, we can point to the Beta Max vs. VHS battle, device driver issues pre-Windows’95, digital music format issues (i.e., MP3 vs. Apple’s AAC vs. Windows Media files and any other proprietary format), and the current DVD+/-/blue/red/green/rainbow battle. It would seem that consumers and users don’t benefit until a single dominant “standard” emerges. But, I wonder if it is necessary to go through a period of fierce competition before a dominant strategy emerges and/or is adopted.
On the one hand, this competition seems necessary to allow for a flurry of new ideas and alternative solutions to be considered. It would a shame to simply pick the first solution without seriously considering the strengths and limitations of a particular option. Think of it as ensuring a robust “gene-pool” if you think of it in terms of bio-diversity. The ensuing discourse on the merits of each potential standard provides an opportunity to consider the strengths and limitations of each standard as well as to really get a sense of the needs of users.
Back in 1999-2000, I would have said that HL7 should be adopted as the standard to facilitate electronic communication in health care. Today, I’m not so sure. When I look at the history of HL7, I see that it was developed to facilitate the processing of financial transactions by insurance companies. This, in and of itself, is not a bad thing, but do we necessarily want to have the communication standard limited by the original intentions of transaction processing? Also, we should also consider that HL7 is dominated by the American market’s needs and that any Canadian concerns would not necessarily be accepted or addressed without splintering off to create a separate spec (which seems to be the current course).
I wonder if there even is a need to create a unique health care standard for communication. In a post, long, long ago, I questioned the validity of comparing health care to other industries. Health care is unique and shouldn’t be compared to other industries using simple analogies. Health care is much more complex than a simple ATM transaction. Could we borrow from other industries and skip the paralyzing period of struggling with standards? When I think back on that post, I would probably have to say that the needs in health care are different and unique, so “no”, we can’t just copy from others.
So, how then do we facilitate cooperation and collaboration without a clear standard? There must be a way to distill the benefits of having multiple possible solutions without having to go through the paralyzing standards wars. I’m going to leave my philosophical thoughts on standards for another post. In this particular instance, I think I would disagree with Holly Witteman’s presentation arguing against a one-size-fits all solution in health care. When it comes to standards, we need at least a means of communicating. What you do after you get that information is up to you.