An article published in yesterday’s Canadian Medical Association Journal notes that “confusion and disarray appear to be the only form of national standards in operation within health information record-keeping circles“. Why does this situation exist? Dr. Alexander Jadad, Canada Research Chair in ehealth innovation at the University of Toronto, is quoted as saying, “We don’t really have any federal governance” and “governments have to figure out how to make people comply with these standards“.
While I have been making a similar plea for national standards in various forums, I think that people need to keep in mind the political realities. To start, and perhaps most importantly, healthcare, along with many other matters, is a provincial responsibility. This division of responsibilities drives many aspects of federal / provincial relations and makes it very difficult for the federal government to take an active role in anything related to healthcare. Indeed, Infoway is a creative response to this dilemma that attempts to direct federal money in a manner that respects provincial responsibilities. Any attempt to drive national standards must consider the federated nature of Canadian laws and politics.
So …. where should the leadership about which everyone is yelling about come from? Infoway? Health Canada? A new organization? Or, do we start at the provincial level? Maybe the new eHealth Ontario CEO, Greg Reed, should cease work on provincial eHealth standards and immediately work with Infoway to adapt Pan-Canadian standards instead. As the largest province such a move not only sends a strong signal to other provinces but also creates a market of sufficient size for vendors to come on side.
I was pulling together some background information on eHealth standards development in the US for a client when I came across the following presentation by Douglas Fridsma,Acting Director, Office of Interoperability & Standards ONC
I thought that Mr. Fridsma’s “lessons learned” from his standards development experiences are worth sharing:
- Standards are not imposed, they are adopted
- To improve adoption, solve real problems, not abstract ones
- Engage the community for a sense of ownership
- Standards should be harmonized and commissioned based on clearly articulated priorities
- Governance is necessary to coordinate and prioritize
- Adoption is accelerated by tools including vocabulary registries and easy to use sources for implementation guidance.
- Tools improve adoption
- Make implementation specifications easy to use and, well, specific
- Keep it as a simple as possible but no simpler – the parsimony principle
- Don’t boil the ocean
- Solve real focused, problems
- Perfection is the enemy of the good
Today I am listening to the webcasts for two different health IT standards initiatives, one in the US and one in Canada. I was struck by a fundamental difference in approaches. The US is working hard to develop national health IT standards whereas Canada appears to be more focused on provincial standards.
eHealth Ontario, for example, has started the review process for an eReferral standard. On the webcast today eHealth Ontario noted that a pan-Canadian standard exists but, for various reasons, a distinct Ontario standard is needed. Do we really need multiple pan-Canadian standards for eReferrals? Perhaps I am missing some fundamental driving factors and would very much like to be enlightened if I am. I just can’t see that the cost of developing and maintaining multiple standards is worth the benefit but stand to be corrected.