HL7 sees more government involvement in interoperability standards

Membership in the standards development organization Health Level Seven International (HL7) is available to anyone "interested in the development of a cost-effective approach to system connectivity." The members of HL7 play a significant role in shaping the development of its health IT interoperability standards. According to John Quinn, the organization's chief technology officer, its members have changed in the last few years. What's new, Quinn says, is more involvement in HL7 from governments, including some U.S. organizations.

In this video, Quinn talks with SearchHealthIT.com editor Don Fluckinger about the challenges of working with an evolving membership base that offers many resources but brings new problems to be solved. See what else this CTO has to say about the people who are helping develop health IT interoperability standards.

Let us know what you think about the video; email editor@searchhealthit.com.

Read the full transcript from this video below:  

HL7 sees more government involvement in interoperability standards

Don Fluckinger: Hi. I'm Don Fluckinger, with SearchHealthIT.com. As you know, the meaningful use rules are out, and the mad rush for compliance has already begun. HL7 Standards played a big role in shaping those meaningful use rules. In fact, five of them, guidelines or standards, are mentioned by name in the 800 page meaningful use document. We sat down with HL7 CTO, John Quinn, at the recent SOA and Healthcare show in Washington D.C. to ask him what physicians and CIOs need to know about HL7 standards as they relate to meaningful use.

John Quinn: The clients of HL7 have changed dramatically over the last decade. I am going to say 7 years, to be exact. I have been with HL7 since we started in March of 1987. I was in Philadelphia on Monday, and I was mentioning to the group of people, I said, 'Do you see Penn Tower hotel over there? In March of 1987, that was where we held the first HL7 meeting.' Nobody in the room realized that they actually lived just a couple blocks away from where we started; that is my piece of trivia. The point is that when we first started HL7, vendors and hospitals were the clients who showed up at the meetings, who helped write the standards, who came with the issues that needed to be solved in the standards process, really, those were the same thing. If you are a very large hospital and you do your own development work, infrastructure work at least, and you have a large best-of-breed environment like Mass General, then you might actually send people to HL7.

If not, if you are a hospital or an IDM that buys product from Siemens, et cetera, then they become your proxy in the HL7 process. What has changed since 2003 is, less and less do I see individual hospitals and IDMs. I still see strong vendors, I see more vendors, but that goes along with the fact that there are a lot more people that are trying to build these systems now that the US has the program now. What I really see that's different is that I see governments, I
mean, one of our board members is the guy in charge of interoperability for the NHS. Another one is the guy in charge of interoperability; Dennis is in charge of interoperability for Canada. We have some representation on the board from the US government, not in any, it is almost an indirect way at this point, has kind of worked into it. Linda Fasetti from VA, she has been on the
board for quite some time, but she came to HL7 and got on the board because of the VA's interest in HL7. That has now blossomed into overseas interest. Doctors tell us that Linda, at this point, makes perfect sense on the board, from HL7's perspective. We would like to fill out the three, at least, because I also have an option, I can get someone with NEDO, which is the Australian counter project or parallel project that we do that.

Those members, from what we basically call government sponsors, they represent, basically, a 15th of the population, about a sixth of the size of the United States, and Canada, a percentage of Canada. They come with particular architectural requirements, similar functional requirements, slightly different architectural problems, but when they come to me and say, 'We need HL7 to do this,' then they come with resources to do it, as well; both people they send to the meeting, that sponsor the committee, people that go to the meeting because they are consultants or work for vendors, who do business in those countries. HL7 makes progress, not by what I do, but when I have a meeting Like we have a meeting in Cambridge in October - Cambridge, US, not Cambridge, UK - and the reality is, I will have probably somewhere close to 500 people at that meeting. That has been our typical over the last three or four years --
our US meetings have held about 500 people. That is a lot of resources that have to be properly directed. Some people come for training; a lot of people come to learn the standards.

Don Fluckinger: It is interesting that HL7 brings together some international representatives. What kinds of things can the US wing of HL7 learn from other health systems that are maybe a bit more advanced?

John Quinn: This is a question we ask all the time, and I have asked this of folks overseas, as well. I recognize the ONC’s got a lot on their plate, and minimum resources to do it. It appears, from what I have heard, directly from what I am seeing, what is obvious looking at the law, I want to see who is giving between, last year and this year, something short of $40 billion to manage. They were not given any money to manage it - the best we can figure out. And it was a
relatively small organization under Rob Kolodner during the Bush administration. Now, suddenly, huge responsibilities, no obvious means of growing the organization or growing them on some sort of accelerated ramp where you could run out of money or something like that,
seems to be what they are facing right now. I guess my perspective is, I don't know what it would take.

The problem here is, the way I see it, is that the political climate has changed quite a bit since ARRA was released. At least Congress is less generous to block the checkbook, and I don't imagine that the White House is real interested in someone from within their administration going up to The Hill and saying, 'Oh, by the way, you forgot to give us the money we need to do what you asked us to do.' Politically, that probably does not play well in an election year, right now, so I can understand. I am not a politician, but I can understand that. It is a conundrum, a real paradox right now for the folks, and I do have sympathy for that, as well.

Back to your question. There is a huge amount of things that have been tried and failed. I am not talking about HL7, I am talking about just general healthcare IT architecture, or how do you link together a country with 30 million or 20 million, much less 300 hundred million people. Every country has got a different playing field. There are things in the US that are as important, but they are handled in a different way, and privacy security is a perfect example of this. The Data Security Act in Parliament passed somewhere in the '90s, because when I first looked at it was 2003, and Canada's approach, as well. It is far more - with HIPAA we have all these rules,
the rules are linked to policy, this that and the other thing - it is kind of indirect, so we are constantly debating, 'How do we handle privacy?'

In the UK and Canada, it seems to be far more clear-cut. You do something, you violate a patient, a person's right to privacy – which is not a formal right here in the US -- you go to jail, or you get a significant fine. If you want to put up an IT infrastructure in Canada, the data cannot virtually leave Canada. You are saying, 'No problems. We will host it in India or China.' Their perspective is, 'Well, if we let you do that and somebody breaks the law, we have no way of enforcing it, so we do not want you to do that.'

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