Post date: Nov 20, 2010 8:44:23 AM
In the November 2010 report Back to the Future: Healthcare Rebooted, Marlin & Associates say "Now, with the healthcare IT mandates in the federal healthcare reform bill, coupled with a stream of superior technologies, we are finally in a position for technology to have a measurable impact on the costs and the quality of care delivery." They also point to consolidation and these players setting standards - not the government. I'm not sure what they mean by superior technologies - most still don't work so well according to the studies reported on HCIT Effectiveness and the HCIT Failure page.
On standards, the report points to Microsoft, Intel, Apple, Google and Facebook as examples of standards setting companies. But are Microsoft-Apple operating systems (OS) or applications inter-operable? Yes - at the lowest common denominators such as a text or csv file but few if any advanced features are. One only has to look at the "standards" of e-prescribing:
Health data standards have primarily been created by a consensus process dominated by vendors. Vendors do not view standards as strategic to their future; they view standards as a controlling factor that potentially limits their market share. Standards permit users to change from one vendor to another with relative ease and lower costs. For vendors,working with a standard-developer organization is an exercise in damage control. Each vendor has a proprietary interest in the standard and is motivated to produce a standard that comes as close as possible to matching what that vendor currently does. The resulting standard is frequently a compromise, with the ambiguity one would expect, and each vendor then implements the standard as it favors its own system." (Hammond, 2004, p. W4-326)
I agree there are huge changes ahead and no one really knows what will shake out. The report is a start but limited by the uncertainties and limitations in HCIT as it currently stands. To say that vendors will set the standards seems to contradict current industry experience.
References:
Hammond, WE 2004, 'Perspective: The Role of Standards in Electronic Prescribing', Health Affairs, Vol. Web Exclusive, pp. w4.325-w4-7.