Federal Government Leads By ExampleFederal Government Leads By Example

The federal government, through the Department of Health and Human Services' National Health Information Infrastructure initiative, is doing its part to foster collaboration among health providers. While the government isn't mandating the use of any particular technologies or standards, it's trying to be a role model by embracing de facto standards that will encourage the sharing of information among federal health-related agencies, departments, and programs.

Because the federal government, through its Medicare and Medicaid programs, is the nation's largest payer of health-care services, its hope is that private-sector health-care companies will follow its example. "We're adopting standards within 20 government agencies, and that influences what goes on in the industry," said Jared Adair, director of the Centers for Medicare and Medicaid Services' Consolidated Health Informatics program, during an August conference call with health-care providers.

Recent moves by the federal government to incorporate select standards into the information systems of health agencies may ultimately improve the sharing of patient information in the private sector. Among the key standards adopted by the feds are the Health Level 7 messaging standard and the SnoMed common clinical vocabulary. Under a deal between the federal government and the College of American Pathologists, the nation's health-care community can use the SnoMed system without having to pay licensing fees.

Having a common medical vocabulary among health-care providers is key in order to share information, electronically and through human interaction. One organization might call high-blood-pressure hypertension, while another may call it elevated blood pressure. "There's no set clinical vocabulary," and that's been a major hurdle in collaboration and integration involving clinical data, says Randy Thomas, VP of implementation services at health-care systems integrator and IT services provider HealthLink Inc. The adoption of a common language such as SnoMed will help facilitate the accurate exchange of clinical information.

But even the federal government's attempt to fuel the creation of a national electronic health-record system through its embrace of standards is running into problems. Health and Human Services has asked for feedback from industry groups and providers for a plan to improve the Health Level 7 format and other standards that would be involved, with a national electronic health-record system, and, at press time, those involved had yet to agree on a final design proposal, which was due in mid-September.

Nonetheless, Dr. John Halamka, senior VP of IS and CIO at hospital operator CareGroup Healthcare System, says the government's ongoing adoption of key standards for health-care information systems is critical to the development of a national health information infrastructure. "Never before has there been this alignment of technology and politics to foster information sharing in health care," Halamka says.

Still, an even more basic, yet important, change--that of a competitive mind-set--is needed before there's a major shift toward sharing clinical information, says Dr. Carol Diamond, chairwoman of Connecting for Health, a public-private collaborative of more than 90 health-care organizations working to improve health care through technology. Says Diamond, "Hospitals and other health-care providers need to compete on quality of care, not on the data in their databases."

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Illustration by Brian Stauffer