June 3, 2020

Past time for standards-enforcement agency


Public perception is often a largely fictionalized version of medicine found in Norman Rockwell prints and “Marcus Welby, M.D.” reruns: the genteel physician with a higher calling.

To be clear, medical providers’ work is important. But so, too, is the work of industries perhaps seen as “crass” in comparison to those practicing medicine and saving lives. Healthcare now represents nearly 20 percent of the U.S. gross domestic product.

Medicine is business. Big business. And yet the healthcare community holds itself apart as different – special – in some very important ways … to its detriment, at this point.

One glaring example is a national patient identifier. Banks figured out that issue a long time ago. They aren’t guessing about who their ATMs are dispensing money to. Healthcare should adopt that same technology. (Yes, there is still fraud. But it is easier to suss that out when there is a universal plan in place than when there’s not.)

Another example is the establishment of enforcement agencies with real teeth. The Office of the National Coordinator for Health Information Technology’s (ONC) recently implemented Final Rule is a good start in the right direction.

However, we argue that we need to have agencies that ensure the healthcare IT community uses broadly accepted standards and implements them in the systems and solutions they sell. There simply is no way to meet long-term, meaningful interoperability goals without doing so.

The financial-services industry (broadly) is accountable to several government, quasi-government and private agencies, including – and this is a short list – the U.S. Department of Treasury, the U.S. Securities and Exchange Commission (SEC), Federal Depository Insurance Corp. (FDIC) and the Financial Industry Regulatory Authority (FINRA).

You want to start a federally chartered bank? You have to adhere to an established routing-number system. You want to sell stocks and bonds? You need to pass a test that shows you understand the prevailing rules and regulations governing the industry.

Such systems help promote cooperation where it’s necessary, promote confidence among the public and importantly do not serve as a deterrent to making profits. At the same time, it prevents the two largest institutions from essentially forcing any related business to choose System A or System B in the marketplace. (Sound familiar?)

We have demonstrated that standards (e.g., FHIR, LOINC, SNOMED) do work and help healthcare providers and their teams deliver improved patient outcomes. It is time that there are regulatory agencies charged with ensuring that new products and services conform to those standards.

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