Standards for EHR, Part 2

In a previous post I noted a problem that arises from our not having an agreed-upon forum for setting standards for health information. To recap, computers have settled standard interfaces like USB ports, whereas health information has competing standards. In this post, I'd like to mention a couple of other issues.

The first issue is economic. Keyboards, for instance, would be a lot more expensive if there were no USB standard. Each keyboard and its computer would have to be custom made to fit each other. Among other things, this would mean that there would be no competition among keyboard makers, which would drive prices up. Keyboards aren't terribly expensive, so this might not seem like a big deal. But the EHRs that hospitals often buy cost millions--even tens of millions--of dollars. Both initial costs--in the broadest sense--and switching costs are low for a USB keyboard (or mouse or hard drive). But for EHRs, no standard means no competition. And no competition means astronomically high initial costs and generally prohibitive switching costs. Put another way, my doctor may not be able to afford to have his system talk to the hospital's.

The last issue I'll mention is that without an information standard we have a severely limited ability to compare the effectiveness of various treatments. For instance, it has taken more than 30 years to get a modicum of clarity about the relative efficacy of angioplasty vs. bypass surgery. Lacking apples-to-apples comparisons (or the willingness to do randomized controlled trials, which would mean some people would get no intervention after a heart attack) we’ll continue to have a devil of a time figuring out what works.

So, I'm hoping for an IEEE for health care information. But I'm not holding my breath--the IEEE took nearly 80 years to emerge as the standard for standards.