Keep health IT standards simple, says chief technology officer

The Health and Human Services Department plans to issue proposed standards for health information technology systems in December, and the government's chief technology officer told an advisory committee on Thursday that policymakers should push for adoption of simple criteria that can evolve.

The department should not let "the perfect be the enemy of the good enough," in its effort to meet the goal, Aneesh Chopra, told a meeting of the Health IT Standards Committee. John Halamka, chief information officer of Harvard Medical School and vice chairman of the standards committee agreed, saying HHS standards should be simple enough to meet the business needs of the health industry.

HHS needs to develop standards that will govern the exchange between clinicians and hospitals of complex health care information about a single patient which, depending on the mobility of that patient, could be located in one place or scattered across the country.

Chopra suggested that HHS must design easy-to-understand standards for the "little guy" clinician. Halamka pointed out that is not the case for the current Health Level 7 benchmarks, which govern the exchange and retrieval of health information, and was developed by a global nonprofit group of the same name.

A person attempting to comprehend, let alone use the current Health Level 7 standards, would end up with "17 documents on their desk that all point to each other," Halamka said. They need to be simplified and posted online, he said.

During the meeting, Chopra said benchmarks already developed for the Web should guide the exchange of health information, and he suggested creating a "health Internet" based on that work.

Vinton Cerf, vice president and chief Internet evangelist for Google, said in a Standards Committee blog post that "getting the standards right can have [a] major positive benefit. Getting them wrong will have major downside consequences."

Cerf, known as the father of the Internet, said from his perspective there appears to be a "creeping, monolithic character in development of health IT standards in which protocols lump together many functions in such a way that implementation, testing and change will be extremely difficult."

Health IT standards, like Internet standards, should be modular, Cerf said. In Web terms, that concept is known as layering. Taking a layered approach to health IT standards means that a measure such as strong authentication, which requires a password and a hardware or software token to transmit information over a network, can be applied to multiple applications without tweaking every application that needs to use it.

Cerf suggested that HHS enlist the help of a panel of protocol architects to review its standards and agreed "simplicity is our friend here, as has been evidenced in the Internet. The stable interfaces between layered protocols have permitted stability while accommodating remarkable changes [in the Internet]."

Nancy Orvis, director of Health Standards Participation for the Defense Department and a Standards Committee member, said during the hearing that health IT standards must keep in mind patients, so they can relay personal information to multiple clinicians. "Each individual needs to know what they need to communicate about themselves," Orvis said.

The only criteria that matter to individuals are those governing privacy and security of their health care information, said Anne Castro, also a Standards Committee member and chief design architect of Blue Cross Blue Shield of South Carolina. She told the group that the ambitious effort to develop a nationwide health IT system with $20 billion in stimulus funds "won't work if people don't trust where their data is stored. The want to know their data is secure."