“I am not here concerned with intent, but with… standards, especially the ability to tell the difference between a fact, an opinion, a hypothesis, and a hole in the ground.” - Serge Lang, Mathematician
“The problem with standards, is that there are so many of them.”
-Anonymous
Most clinicians would agree that other than gross negligence, transition of care accounts for the greatest potential for medical error. If only there were standards, both clinical and technical, between venues of care. Isn’t that the fix we desperately need?
HL7 CEO Charles Jaffe has another opinion:
“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.”
And now we have ICD-10, due for roll-out in 2013. For those of you who don’t read the blog Better Diagnosis Coding, you should. This Anonymous Ontologist has an intelligent yet cutting view on the subject. His recent posts on the topic of ICD-10 are extremely insightful. Here’s a perfect example:
“The health care industry now has a little more than 4.5 years to find every usage of ICD-9-CM codes in all of its systems, and upgrade and test them to use ICD-10-CM. All the effort spent on that, will not be spent on adopting electronic medical records, devising and participating in pay for performance programs, improving patient safety, automating the reporting of notifiable diseases, chronic disease management, quality initiatives… and the list goes on.”
Several years ago, I was contacted by a lobbying group to solicit my opinion, as a family physician, on the value of ICD-10. Value is a relative concept, particularly when estimates of cost to a typical 3 member medical group for implementing ICD-10 were more than $80,000! I asked them what practical improvements it might make for me and my patients. They replied “in ICD-9, you can code for just a sports injury, but ICD-10 will allow you to specify whether they were struck by a baseball, a football or a basketball”. After I apologized for laughing, I confessed that they had not convinced me of their value proposition.
In my previous post, I made an analogy of HIT to roads and cars. The truth of the matter is that there will always be hundreds of different cars and trucks on our highways. Each of them suits individual needs for productivity and efficiency, or just plain human whim and fancy. Our roads and bridges must carry them all. Some standards are necessary, but mainly for safety and accessibility.
I believe that we must begin the more necessary work on infrastructure. Semantic interoperability is the foundation. To quote Charles Jaffe once more:
“Perhaps the most difficult challenge is to bind the standards to structured vocabularies to ensure that there is the unambiguous transfer of meaning.”
