Overlapping Clinical Integration Standards
December 5th, 2006 by Dave Shaver
(1 votes, average: 4 out of 5)
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Competing healthcare integration standards cause much confusion for users. The HL7 clinical data standard has been growing and changing for a very long time and it continues to do so with new releases of HL7 of 2.X (”recently” 2.5 and “soon” HL7 2.5.1 and even 2.6) and “soon” the HL7 3.0 messaging standard and reference information model.
Blair Heath wrote a blog posting in response to a formal journal article by Ed Hammond. Although not precisely referenced by Blair, I think the article by Ed was published in 2005: The Making and Adoption of Health Data Standards in Health Affairs, vol 24, no. 5 (2005).
Why HL7 users should care: Ed has been a member of HL7 since its formation and has been a deep advocate for getting standards in place for moving clinical data between different applications.
I thought Blair’s comments regarding the standards development process were interesting. Quoting his reaction to Ed’s article:
Competition among SDOs have led to further issues in [adopting] health data standards. The competition forces implementers to choose between the competing SDOs. There is also overlapping in some areas. For example, the scripting standard created by the NCPDP (National Council for Prescription Drug Programs) and the medication messaging standards defined by HL7. This causes conflict.
Hammond states, “New versions of standards are coming out even before older versions reach the final ballot stage. This process results in confusion and instability and creates a moving target for standardization.”
Both points can be summed up by this famous quote: “The good thing about standards is there are so many to choose from!”
I think the key is that no standard is ever “done” nor is it comprehensive. The HL7 standard has been growing and changing for a very long time. While most applications implement some flavor of HL7 2.3 or 2.3.1, they all have the ability to customize the version to whatever meets customer needs. The features than come in later releases of HL7 (2.5 and 2.6, for example) are rarely used for a long time. This is related to Ed’s comment that as users of standards we are always dealing with a moving target.
With the addition of HL7 3.0 to the mix, things will be very interesting in the land of HL7 for quite awhile.
Last 5 posts by Dave Shaver
- HL7 Working Group Meeting Includes Strong International Attendance - September 16th, 2008
- Integrating EMRs with Reference Labs - September 3rd, 2008
- Massachusetts Hospitals Must Have CPOE by 2012 and CCHIT-Certified EHRs by 2015 - August 13th, 2008
- HL7 Dates and Times - July 25th, 2008
- HL7 Time Zone Qualification - July 25th, 2008
One of the reasons for the overlap is mentioned in Blair’s example itself: NCPDP is a US-only standard, whereas HL7 is a worldwide standard. One is localized to suit local (US) requirements, the other is not.
One could create one single standard to cover all data exchanges in healthcare - but it would be so flexible (e.g. HL7 v3 CDA) one would have to create implementation guides for each and every country - resulting yet again in incompatibilities and competition between (the organizations that created the) implementation guides.
Competing standards may not end up being fully harmonized, but elements of the competing standard will surely be incorporated in the other standard - if only because the volunteers/stakeholders are involved in both organizations.
No standard is ever done - to qoute the blog posting. If the opposite is true, new inventions or ideas could never be incorporated in a standard, and we’d still be living in a stone age society .. where all things would be standardized 100%. Unfortunately we generally wouldn’t see that situation as a desirable one..
-René