Have you ever been walking around barefoot on a great summer night just looking up at the sky with all the stars thinking wow this is really beautiful and then wham you stub your toe on a rock and now you see stars much closer? This is a good analogy to where we as an industry might end up with a severely stubbed big toe. Why, because with Meaningful Use burning like a supernova and 5010/ICD-10 showing the potential to be a black hole sucking in every resource within the program’s reach (and not letting go) – we have the potential to get caught looking in the star field of standards and standards development organizations (SDOs) and smack our collective big toe on a big ‘ol rock.

HL7 V2.x, HL7 V3.0, XML, SNOMED, PIX/PDQ, EMR, HIT, ONC, CCHIT, IHE, eHI , LOINC, ICD, CPT, DRG - we are caught in an alphabet soup of standards and vocabularies that seemingly should have or will quickly need to be in place. The challenge for us is that in groups like HITSP and AHIC (yes we have expanded far beyond the TLAs), that are recommending industry level standards, the leadership is usually from extremely well funded medical centers, academia and academic medical centers. Now don’t misinterpret this, these folks do spectacular work and have been wildly successful in moving the need for healthcare standards forward – their efforts simply stated are herculean. The challenge is for the majority of care delivery that genuinely do not have the budgets or funding sources, the deluge of required standards needing to be implemented so quickly will result in stretched or broken funding strategies, mistakes and missteps and unfortunately too many people and careers ran over by the standards bus.

The majority of care delivery does not have an exclusive on challenges with the standards - even within the SDOs there is jostling, negotiating, tension and healthy doses of politics. These groups also tend to issue many redefinitions, tweaks and modifications as things move forward. This is where these organizations can stumble while looking at the stars – they are volunteer organizations and regression testing and/or impact analysis of the modifications/tweaks get a bit shortchanged.

So with all this said, what are the key organizations (to name just a few):

• HL7 (Health Level Seven) provides a framework (and related standards) for the exchange, integration, sharing and retrieval of electronic health information.
• NCPDP (National Council for Prescription Drug Programs) uses the NDC (National Drug Code) number to identify drug products and medical supply items for the purpose of transmission and reimbursement of claims.
• ASTM (American Society for Testing and Materials) is the grandfather of all standards. ASTM issues standard in six categories
  • Defining Standards
  • Testing Methods
  • Practice Standards
  • Guideline Standards
  • Classification Standards
  • Terminology Standards
• HITSP (Health Information Technology Standards Panel) is a partnership between the public and private sectors tasked with harmonizing and standards that will meet clinical and business needs for sharing information among organizations and systems
• DICOM (Digital Imaging and Communications in Medicine) standard has several levels of support, or different dimensions. The most fundamental and primary level of support is the support for image exchange for both senders and receivers. Other dimensions deal with image management, patient scheduling information, image quality, media storage, security, etc.
• IHE (Integrating the Healthcare Enterprise) re-uses existing standards such as DICOM and HL7 as the building blocks for assembling larger integrated solutions

So while these SDOs are swirling around looking to form some new constellations, we have to be careful to not stub our toe while watching the formations grow. How can we do this – some basic blocking and tackling and maybe we put on a pair of shoes? Based on experience, here are a few key things to consider:

• Things constantly change; final standards are never quite final, emerging standards that must be harmonized. The result – there are only temporary interfaces. Budget for this
• Assess your current environment:
  • Current systems documentation in place and up to date?
  • Will your equipment handle the inevitable increase in volume?
  • Has your environment been optimized?
  • Have you had an outside objective assessment of your current environment?
  • Are you on the most current level of software, system and operating?
  • Built enterprise standards for development and system assessments?
  • Create repeatable testing processes and plans for future integration activities?

When things begin to coalesce, the new constellations will be great to look at; the sky could be filled with some great new stars. Until then, we could be walking around with a huge bandage on our big toe. Don’t get caught looking and waiting – there are so many things going, get that pair of shoes on your feet, then look up a little and enjoy the view, watch the ground a little so you don’t trip and enjoy the shoes.

Santa Rosa Consulting is highly experienced in finding the right pair of shoes for you. Allow our experienced associates to help you watch the stars, watch the ground and protect your feet.

Request an experienced Santa Rosa associate to contact by logging on to our web site at www.santarosaconsulting.com.