Health Information Technology Standards

[T]here seems to be a big choice here about how assertive the Federal government; the government in general, but we’re talking here about the Federal government; should be in setting the rules of the road for information exchange. Can you characterize this? Are there camps or viewpoints on this? Could you take us back to an overview of the sort of pros and cons of the two views? One view might be let the market do this. The other view might be at the other extreme. The Federal government should create an exchange capability, organize it, govern it and encourage everyone to participate in it. Then there are probably many variations in between, but what do you see as the trade offs between those? I use those as caricatures that are more for heuristic purposes than actually necessarily real choices. — David Blumenthal, HHS/Office of the National Coordinator for Health Information Technology, July 16, 2009

While doing research for a conference call today, I happened to come across the above summary (see Slide 71) by Mr. Blumenthal of a presentation to the Federal Advisory Committee created by this year’s stimulus bill to promote electronic health records. It looks like they’re thinking about the same issues the SEC grappled with in choosing a middle ground for electronic financial records.

The middle ground was this: The SEC picked an industry standard and used all the leverage it could muster to drive accounting firms, technology firms, and investor representatives to develop it to the point where the SEC could mandate its use. In the even higher profile world of health records, driving stakeholders toward a usable standard may be even more challenging. But with the right leadership, and perhaps crowdsourcing tools such as the one used for the SEC’s financial reporting standard, leadership by the government in choosing a particular industry standard and delegation to a non-profit industry consortium like XBRL US, which finalized the financial reporting standard, may be the best hope for success. It’s certainly a model that the HIT Policy Committee should study.