The number of standard setting organizations (SSOs) from which specifications have been drawn to create Electronic Health Records (EHRs) are legion, due to the complex nature of these goal. Some of the standards utilized are generic, and common to any sophisticated Internet-enabled commercial system. Others are specific to science, but usable generally in paper as well as information technology (IT) based health care systems. Only a few SSOs, however, have taken up the challenge of developing the major components essential and unique to EHRs. One of the oldest and most important is Health Level 7, more commonly referred to as HL7.
HL7 has been at the center of global EHR development since 1987, as well as a key player in the more recent U.S. efforts to design and implement a national EHR system by 2014, a commitment made by President George W. Bush in his State of the Union Address in January of 2004.
With the Obama Administration's pledge to meet that commitment, and to direct massive amounts of funding towards ensuring its success, it is critical that the standards needed to support this ambitious goal are not only available, but the right tools for the job as well.
In this interview, HL7 CEO Charles Jaffe, M.D. shares his perspective on what's been accomplished, what remains to be done, and where the critical decisions that will lead to success or failure in creating a national EHR system must be made.
There are not a few commentators that would tell us that the latter half of the 20th century will best be remembered as the Computer Age, a time when advances in information technology truly transformed the way we live our lives. If medical science continues to advance at current rates, I believe that the first half of this century will as likely be recalled as the Age of Life Science — the time when our lives were transformed at the metabolic level. Indeed, on every front, whether it be genomics or oncology, neurology or stem cell research, reports of dramatic discoveries arrive almost daily, many suggesting the promise of cures that only a short time ago would have seemed little short of miraculous.
In the last issue of my eJournal, Standards Today, titled A Standards Agenda for the Obama Administration, I described the standards-based dependencies of the technology agenda earlier announced by president-elect Obama. That agenda provides for the creative use of technology to advance a number of important policy goals, such as achieving transparent government, equal access to the Internet, and reducing costs of healthcare. In this issue, I focus more closely on the significant role that standards will play in achieving one of (now) President Obama's greatest challenges — lowering healthcare costs, while at the same time keeping a campaign promise to provide universal health coverage.
As these words are being written, the US Congress is debating the final terms of a stimulus bill that will result in the expenditure of almost $800 billion of public funds on a wide array of initiatives intended to address an equally challenging goal: resurrecting an economy that seems inexorably headed towards its worst performance since the Great Depression. One of those initiatives included in the stimulus bill would make the final push towards national implementation of something called "Electronic Health Records," or "EHRs" - and spend $20 billion in the process. Whether that money gets spend wisely or not will depend a lot on open standards.
Here in New England, where I practice law and have been representing startups for thirty years, we have a mixed blessing. On the plus side, we have great universities, like MIT and Harvard, with professors and students that come up with great inventions that new companies can be formed to commercialize. We also have lots of folks that have done it before, that can act as mentors and role models. Those same successful entrepreneurs start more companies, and also act as angel investors for first timers. It's not quite as vibrant as Silicon Valley, but we always come in second on all meaningful measures - numbers of new companies formed and funded, and so on.
On the negative side, we've got a lot of venture capital firms that call the Route 128 area home. If that sounds like a strange statement to make, you might want to read my most recent column for Mass High Tech, which tells you why you might be better off launching a new startup in Omaha, Nebraska than in Cambridge, Mass.
The following is the text of the Editorial from the latest issue of my eJournal, Standards Today. You can find the complete issue here, and receive a free subscription here.
On January 20, a new show opened in Washington D.C. After eight years under one administration, the curtain cascaded down on one set of policies, and a moment later rose to unveil a new administration, with new ideas, new priorities, and a new agenda. Included in that agenda is a commitment to embark on a five year quest to dramatically decrease the cost of healthcare — by investing as much as $50 billion dollars of public funds in the design and deployment of something called "electronic health records," or EHRs.
Readers of this Blog, but not the public at large, will be immediately aware that the foundation for the EHR vision is standards.
I ask you to share with me today the majesty of this moment. In the orderly transfer of power, we celebrate the unity that keeps us free. Each moment in history is a fleeting time, precious and unique. But some stand out as moments of beginning, in which courses are set that shape decades or centuries. This can be such a moment.
When I was much younger, still in school, I was fortunate enough to receive a ticket to a Presidential inauguration. It was a good ticket, allowing me to stand not a hundred yards from the podium where the new president would stand as first he was sworn in, and then as he delivered his inaugural address..
Then, as now, it was a time of uncertainty, with wars both cold and hot raising tensions internationally and inflaming passions at home. The campaign just ended had been divisive, as had the primaries preceding it. There was much to weigh down the shoulders of a new president as he waited to take his oath of office, and many reasons to doubt his ability to deliver on the vision for the future that he would share.
The address that I heard that day was eloquent and high-minded. In it the new President asked:
Vietnam will ring in the Tet New Year on January 26 this year, and 2009 will be the Year of the Buffalo. For government servers, it appears that it will be the year of a few other animals as well, including the GNU and the Firefox.
This, according to Vietnam.net Bridge, which reports that yesterday the Ministry of Information and Communication issued an instruction to the State Agencies of Vietnam to move rapidly to open source software. More specifically, "by June 30, 2009, 100% of servers of IT divisions of government agencies must be installed with open source software; 100% of staffs at these IT divisions must be trained in the use of these software products and at least 50% use them proficiently." According to the article, the instruction is also applicable to provincial and municipal Departments of Information and Communications. By December 31, 70% of these offices must be in compliance.
Specific products mentioned for implementation include the following: OpenOffice, Mozilla ThunderBird and Mozilla FireFox email software, and Vietnam's own Unikey typing software. This would represent the 17th government to throw it's support behind ODF, based upon the count being kept by the ODF Alliance.
Yesterday I filed a pro bono amicus curiae ("friend of the court") brief with the United States Supreme Court in support of the Federal Trade Commission's petition for writ of certiorari in its suit against Rambus Technologies. I'm pleased to report that 19 standard setting organizations (SSOs), representing over 13,300 members, joined as amici curiae supporting this brief; the list of participants appears later in this blog entry. As noted in the brief itself, these SSOs:
...represent a broad range of SSOs that participate in the standard setting process, and each is greatly concerned by the adverse effects that it anticipates will result from the [lower court reversal of the FTC's sanctions of Rambus]. Those effects will reach virtually all aspects of modern society, commerce, education and government, because all of these interests rely heavily upon the efficient development and broad adoption of standards by the private sector.
The pervasiveness of standards, and of the potential reach of the decision on petition, is indicated by the range of focus of the amici curiae that have joined in this brief. They include SSOs that develop standards or support standards development in sectors as diverse as defense, consumer electronics, photography, on-line learning, geospatial information, credit “smart" cards and a broad array of computer system products and services.
In agreeing to be parties to the brief, these organizations demonstrated their concern over maintaining the integrity of the standards development process, as well as their belief that SSOs, their members, and non-members alike must be able to rely upon the support of the courts when they believe that SSO intellectual property rights (IPR) policies have been violated. (I outlined the facts and disputes underlying the Rambus case in this blog entry ten days ago.)
If you haven't already heard the news, long-term kernel developer and pillar of the open source community Ted Ts'o has been named the new Chief Technology Officer of the Linux Foundation. Ted is a great choice for a variety of reasons, one of which is that few people have been knocking around the Linux world longer than Ted - he was the first North American kernel developer (in 1991). And to the left, that's Ted receiving the FSF 2006 Award for the Advancement of Free Software from Richard Stallman.
I first met Ted about five years ago, when I began representing the Free Standards Group, and where Ted and I served as Board members. Ted had been part of FSG's efforts from the beginning, and he has continued to play a major role both at FSG as well as at the Linux Foundation ever since. Besides being present at the creation of the Linux Standards Base and nearly present at the dawn of the Linux kernel, he's also simply a great guy, both to work as well as to have a beer with. Those traits, as well as his technical prowess, will all be even bigger assets for the Linux Foundation in Ted's new role than they have in the past.
As CTO, Ted will lead all technical initiatives, oversee projects such as the ongoing development of the Linux Standard Base (LSB) and the activities of the Open Printing working group, serve as the technical go-between with Foundation members, and also act as the primary inteface between the Foundation and the its Technical Advisory Board, which represents the kernel community.
I first learned of Microsoft bringing suit against in-car navigation company TomTom NV when I got an email from a journalist asking for comment. He in turn, had gotten the news from Todd Bishop's Microsoft Blog. Why all the buzz? Because apparently several of the patent claims relate to TomTom's implementation of the Linux kernel - and while Microsoft has made noises publicly and threats privately for years alleging that Linux infringes multiple Microsoft patents, it has never actually brought a suit against a Linux implementer specifically alleging infringement by the Linux portion of their product.
The result is that across the industry, everyone is asking the same question: What Does it All Mean? For what it's worth, here's my take.