Many different organizations develop standards for various aspects of electronic health information exchange. The use of existing standards to accomplish any significant health data interchange between independent entities increasingly involves implementation of multiple standards developed by different organizations. Some efforts (e.g., claim attachments, authorization of electronic prescriptions, and the HITSP use cases) require the use of standards from multiple bodies simultaneously, posing yet additional challenges to automating the healthcare data flow.
The different standards development organizations working in the health information space have developed their individual standards in response to different stakeholder groups and needs, with the result that standards developed by different organizations are built on different views of the world (either implicit or in an explicit information form/model); use various data types, data elements, syntaxes, and vocabularies; are explained using different styles of documentation; and, in some cases, have overlapping scopes.
These differences in standards that must be used throughout the healthcare community in similar manners substantially increase the already significant challenge of implementing interoperable health information systems. They also increase the level of effort required by the (largely volunteer) standards development workforce. As a result, interoperable health information standards take longer to develop, test, and implement. This slows the adoption of standards and delays the development and deployment of interoperable health information systems that can improve patient safety, improve cost-effectiveness of healthcare operations, and facilitate research, public health surveillance and intervention.
Standards development organizations (SDOs) have long recognized the problems created by lack of consistency in their products, but significant previous efforts to create a broad solution (e.g., ANSI HISB and its predecessor, ANSI HISPP) failed from a lack of commitment and funding in both the public and private sectors. More narrowly focused initiatives (e-prescribing pilots) have been more successful due to the commitment and resources made available. Today, most SDOs working with health information have multiple collaborations with other SDOs to improve interoperability, including those identified by AHIC for the Healthcare Information Technology Standards Panel (HITSP). Unfortunately these collaborations further increase demand for the relatively limited amount of resources available for standards activities.