WASHINGTON, July 28 (UPI) -- There are currently more than 4,000 health IT standards in use, with hundreds of bodies responsible for them -- no wonder then, that doctors and other healthcare providers -- who are being asked to invest tens and even hundreds of thousands of dollars -- feel a little like they are putting their money on the roulette wheel.
The answer, advocates say, is a "national conversation" so that the waiting game can end and adoption of life- and money-saving health IT can proceed.
The problem is that there are different schools of thought on what role government and markets should play in deciding which standards pass the test of time.
"Why would I want to install a system that costs $30,000 per physician if in two years it's going to be obsolete, or the vendor is out of business, or it doesn't do what it says in the brochure?" Rod Piechowski, vice president of the National Alliance for Health Information Technology, told United Press International at a congressional briefing Friday.
"The problem is not that we need standards; it's that we have to decide what standards we're going to use."
Some movement toward solving the standards problem is taking place. Last week, the Certification Commission for Healthcare Information Technology -- the private organization contracted by the federal government to certify health IT products -- issued its first 20 certifications.
But none of those products can guarantee Level 4, the highest level of interoperability, which will eventually be needed for a fully effective national health IT network.
"If we're going to have any kind of national network ... the computer systems need to be able to talk to each other," Piechowski said.
The commission has said it plans to ramp up standards with the goal of having Level 4 interoperability in a few years, but that may be hard to do given current indecisiveness about the best way to whittle down standards.
One school of thought argues for de facto decision-making that results from market forces. In essence, the strong will eventually eliminate the weak and standard consolidation is achieved.
But sometimes the market does not select the best products, as former owners of Betamax video players know.
The alternative, short of government arbitrarily dictating standards, is a consensus process by which stakeholders come together and try to reach agreement about future standards.
This process, on the other hand, can be torturously slow as all sides must be persuaded before changes can take place.
In addition, participants in the talks are able to commit varying levels of resources, which can influence outcomes toward wealthier participants who can devote more staff time to the deliberation process.
And vendors are not always excited about agreeing to standards that effectively eliminate the market for their products.
Where stakeholders fall in the consensus versus de facto market forces debate is not necessarily as expected. Some of the strongest advocates of more government leadership are large software companies who bet that the federal government -- with the enormous buying power of programs like Medicare -- will be the prime determinant of what the health IT standards future holds.
The problem is that even within the government, several different sets of standards are in use, creating marketplace uncertainty. Vendors say they would prefer a clear path to government health IT standards decision-making so that they can move forward with product development.
But no matter who does it, Piechowski said, the issue must be addressed.
"A lot of cooperative work needs to be done to make all this work."
