Jan 292013
 

Es gibt in den Vereinigten Staaten viele Organisationen und Behörden, die die Entwicklung und den Einsatz verschiedener Standards in dem Gesundheitsbereich fördern. In diesem Artikel findet sich eine kurze Zusammenfassung, die allerdings viele Details außer Acht lässt. Da Politik eine große Rolle spielt kann sich die Situation natürlich jederzeit ändern. Grundsätzlich ist das Gesundheitswesen ist in den USA gesetzlich geregelt und vom Bund und den Bundesstaaten finanziert.

Ich habe diesen Artikel zuerst auf Englisch geschrieben und erst danach übersetzt; vielen Dank an Gerry Beuchelt, der viele Verbesserungsvorschläge machte! Vielen Dank auch an Bob Yencha, der für die englische Version Verbesserungsvorschläge machte. Für etwaige Fehler bin ich natürlich zuständig.

Office of the National Coordinator for Health Information Technology (ONC; http://healthit.hhs.gov/): ONC ist ein Teil des US Bundesgesundheitsministeriums, dem Department for Health and Human Services (HHS). Es wurde 2004 gegründet. ONC soll die Nutzung geeigneter EDV-Standards im Gesundheitssystem unterstützen und fördern, und auch EDV-Produkte nach den Standards zertifizieren. Das ONC finanziert auch andere Aspekte der EDV im Gesundheitswesen wie zum Beispiel die ‘Meaningful Use’ Vorschriften.

Centers for Medicare and Medicaid Services (CMS; https://www.cms.gov/): Die CMS verwalteten verschiedene öffentliche Krankenversicherungen: Medicare (Krankenversicherung für ältere Leute sowie jüngere Leute mit Behinderungen), Medicaid (bedürftigkeitsgeprüfte Krankenversicherung) und das Children’s Health Insurance Program (CHIP, Krankenversicherung für Kinder). Die CMS legen zwar keine Mindeststandards für EDV in der klinischen Betreuung fest, verlangen aber eine detaillierte Berichterstattung über die Einhaltung von Qualitätsnormen.

Meaningful Use (http://www.healthit.gov/policy-researchers-implementers/meaningful-use): Meaningful Use (MU) ist ein HHS Förderprogramm in der Gesundheitswesen-EDV, welches unter anderem die Nutzung von zertifizierten IT-Systemen für Patientenakten fördert, um die Qualität der Krankenpflege zu verbessern. Im Rahmen von MU werden auch die passenden EDV-Standards identifiziert, die von den Systemherstellern implementiert werden müssen. Für diese Funktion nimmt ONC eine leitende Stellung ein. Das gesamt MU Programm wird stufenweise über einige Jahre hinweg eingeführt. Stage 1 (Stufe 1) wird auch “2011 Edition” genannt und wurde vor zwei Jahren eingeführt. Die Anforderungen für Stage 2 (Stufe 2) wurden vor kurzem unter dem Titel “2014 Edition S&CC final rule” veröffentlicht. MU Stufe 2 ergänzt die “CMS Stage 2 Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs”. Jenseits von 2014 gibt es konkrete Pläne für Stufe 3; weitere Stufen werden mit Hinsicht auf Politik und geschätztem Bedarf vorgenommen.

Health Level 7 International (HL7; http://www.hl7.org, http://www.hl7.de): HL7 ist eine ANSI-akkreditierte internationale Organisation, mit Mitglieder und Tochterorganisationen in vielen Ländern. HL7 erstellt EDV Standards für das Gesundheitswesen auf der Basis einer umfassenden Gesamtarchitektur. HL7 Standards können als ‘normativ’ oder ‘informativ’ eingestuft werden. Normative Standards untergehen eine Phase, die als ‘Draft Standard for Trial Use’ (DSTU) (Entwurf-Standard zur Probenutzung) bezeichnet wird, in der sie getestet werden können, bevor sie normative Standards werden. Es gibt eine Liste der DSTU-Standards unter http://www.hl7.org/dstucomments/. Die Liste der ANSI-anerkannte HL7 Standards ist hier zu finden: http://www.hl7.org/implement/standards/ansiapproved.cfm, und die Liste der ISO-anerkannten HL7 Standards ist hier: http://www.iso.org/iso/search.htm?qt=HL7&sort=rel&type=simple&published=on. Nicht-Mitglieder von HL7 müssen für Kopien der Standards bezahlen, aber HL7 hat angekündigt, die meisten Standards im Laufe des Jahres 2013 kostenlos zur Verfügung zu stellen. Die Meaningful Use Vorschriften beziehen sich sowohl in Stufe 1 als auch in Stufe 2 direkt auf eine Vielzahl von HL7 Standards.

Integrating the Healthcare Enterprise (IHE; http://www.ihe.net/, http://www.ihe-d.de): IHE ist ein Industriekonsortium in dem Profile verschiedener EDV-Standards erstellt werden, damit der kompatible Austausch von Gesundheitsdaten optimiert wird. IHE ist ebenfalls eine internationale Organisation mit vielen Mitgliedern, wobei viele IHE Mitglieder auch Mitglieder bei HL7 sind. Jedes Jahr veranstaltet IHE ein ‘Connectathon’, in dem EDV-Hersteller die Kompatibilität ihrer Produkte testen können. Auch die IHE-Profile und IHE Technical Frameworks (technische Rahmenwerke) werden in den Meaningful Use Vorschriften benutzt.

Dec 222012
 

There are a number of organizations in the US trying to encourage the use of various standards in healthcare, buttressed by US Federal funds. Here’s a brief summary of some of them, which glosses over many details. All of this is subject to change at any time depending on both federal and state politics (in the US, some parts of the healthcare system are funded and managed federally, others at a state level). I wrote this for a friend in Germany, and then thought others might also find it useful.

Office of the National Coordinator for Health Information Technology (ONC; http://healthit.hhs.gov/): part of the US Department of Health and Human Services, the National Coordinator has the job of encouraging the adoption of healthcare IT and appropriate standards. It’s a relatively new department, founded in 2004. It certifies health IT products according to the standards it adopts, and provides funding for various aspects of healthcare IT, for example as part of Meaningful Use.

Centers for Medicare and Medicaid Services (CMS; https://www.cms.gov/): runs Medicare (health insurance for the elderly as well as younger people with disabilities), Medicaid (means-tested health insurance for those on low incomes), and the Children’s Health Insurance Program. CMS doesn’t set the standards for the clinical care itself, but they do set standards for reporting the quality metrics for clinical care, as well as dealing with payment for their programs.

Meaningful Use (http://www.healthit.gov/policy-researchers-implementers/meaningful-use): the US version of Meaningful Use is a health IT program that’s meant to promote the spread of electronic health records to improve health care in the United States. There are a number of aspects to this program. CMS provides financial incentives to physicians and other eligible professionals, as well as hospitals, to use certified electronic health record (EHR) systems, for example. The other part of the program is deciding which standards are the appropriate ones for the EHR systems to use. This is where ONC plays a role. The project is being rolled out in stages across a number of years. Stage 1 is also called the 2011 edition. Stage 2 was just released; the Stage 2 Meaningful Use set of standards is also known as the 2014 Edition S&CC final rule and complements the CMS Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. There are concrete plans up to Stage 3; any further stages depend on politics and perceived needs.

Health Level 7 International (HL7; http://www.hl7.org): an ANSI-accredited standards developing organization that has members and affiliates in many countries. HL7 creates healthcare IT standards based on an overall architecture. Standards can be normative or information, and go through a period of trial use (Draft Standard for Trial Use; DSTU) before becoming full standards. The list of standards in the DSTU phase is at http://www.hl7.org/dstucomments/. The list of ANSI-approved HL7 standards is at http://www.hl7.org/implement/standards/ansiapproved.cfm, and the list of ISO-approved HL7 standards is at http://www.iso.org/iso/search.htm?qt=HL7&sort=rel&type=simple&published=on. People who are not members of HL7 do have to pay for the standards, but HL7 has committed to making them free of charge in early 2013. Several HL7 standards are quoted in the meaningful use regulations that have been published so far, both Stage 1 and Stage 2.

Integrating the Healthcare Enterprise (IHE; http://www.ihe.net/) is an initiative to create profiles of various standards to improve the way healthcare IT systems share information. They are an international organization with many members and run connectathons to test interoperability of healthcare IT systems both in the US and in Europe. Many IHE profiles and technical frameworks are cited for Meaningful Use. There is significant cross-membership between HL7 and IHE.

Thanks to Bob Yencha for review and suggestions for improvements. Any errors, of course, are mine. After writing this, I do find myself wondering whether there is some rule about three-letter acronyms in healthcare IT. And no, there is no meaning to the ordering of the descriptions.

Sep 072007
 

O’Reilly is publishing a series of articles this month, all written by various women working in technology. For some reason they asked me to take part; I no idea what the criteria were. In fact I carefully didn’t ask who else was invited, so I’ll be as surprised as the rest of you to see whose articles are published. So far the authors have been Leslie Hawthorn, Maria Klawe, Nelly Yusupova, Shelley Powers, and Dru Lavigne. Anyway, they published mine today at Working for Standards. Hope you enjoy it!

Jul 122007
 

Rick Jelliffe, who’s been in the middle of lots of standards efforts, writes on the subject at Is our idea of “Open Standards” good enough? Verifiable vendor-neutrality. Worth reading, although he does make the assumption that the term “open standards” means “created by some standards organization”. Although that’s a tempting definition, and the one used by a lot of people (and the one I happen to prefer), it’s not the only definition that I’ve seen. I’ve seen three main categories of definitions of the term “open standard” when applied to some specification:

  • Anyone can read the specification (usually without paying); often applied to proprietary specifications which are treated as de facto standards.
  • Created in a standards organization that allows anyone to take part who has relevant expertise or can pay the appropriate dues.
  • Able to be used in any open source projects (i.e., there are restrictions on the types of licenses that can be used).

Recognising that lots of people use the term “open standard” to mean different things, the Liberty Alliance recently published what that term means in the context of Liberty Alliance specifications and guidelines. It’s called the Liberty Alliance Commitment to Open Standards and it’s a very brief document outlining a set of conditions for those specifications and guidelines (yes, the document talks about technical specifications but really it applies to other types of documents as well). The top item in the list of conditions to be an open standard, to answer Rick’s main point that rather than talking “open standards” we need to be talking as much of “verifiable vendor-neutrality”, is cannot be controlled by any single person or entity with any vested interests.

I disagree with Rick when he says that only ISO is truly vendor-neutral since only national bodies vote, as those national bodies could in theory be swayed by vendors. What you really want is to balance the needs of all parties (vendors, users, governments), but that’s difficult to attain in any organization. You need not only an organization that is set up to allow for input from all those stakeholders (to produce standards that are evolved and managed in a transparent process open to all interested parties and approved through due process by rough consensus among participants) but you also need to have enough participants who are interested in the end result, and have the appropriate expertise. And you need a competent chair for each committee, of course.

Nov 282006
 

I have the good fortune to work with Pat Patterson at Sun and one of the things we discussed quite a lot shortly before I went on maternity leave was how to make it easier for people to use Liberty protocols for their identity needs. One of the complaints I’ve heard is that there isn’t enough sample code in the world showing how to use and implement SAML. Given that Sun’s Access Manager does implement SAML, along with various other Liberty Alliance standards, it seemed like it should be possible to put together some sample code that uses Access Manager. And, given that Access Manager is now open source as part of OpenSSO, it made sense to create another open source project. But, this project should use languages other than Java, to give the LAMP (or MARS) developers and implementors some code that they can use, tweak, and further develop. And put back into the project of course <grin>. I came up with a bunch of useless names, and Pat came up with Lightbulb (goes with LAMP). Then as I waddled off into maternity leave, Pat did the programming and came up with a way to implement a SAML 2.0 service provider in pure PHP, without even needing the OpenSSO or Access Manager code.

Pat’s giving a webinar on this tomorrow morning Pacific time; you need to register for it first.

We’re hoping that other people will contribute relevant code, in any language, for people to use when they want to implement or integrate SAML capabilities into their systems, whether they’re blogging systems, wikis, or anything else where identity management is useful. The project is located here; it’s easy to join, add a sub-project, and commit some code. Or just browse and see what’s there and what’s useful. Have fun!

Oct 162006
 

We’re planning on travelling to Australia for a vacation, and since the baby will shortly need a new car seat anyway, I was hoping to get one that matches Canadian and Australian standards. Britax makes car seats in each country but when I called them they said the Canadian car seats did not meet Australian requirements (hard to believe they can be all that different, I assume she meant that the car seat isn’t certified in both countries).

Does anyone know of a car seat that can be used for a big infant under the age of 1 (in Canada, that means rear-facing) in both countries? Or have suggestions? When we’re in Australia we’ll mostly be with friends rather than driving rentals, hence the desire to take our own car seat.

This is one place where true international standards would be helpful… I wonder why every country needs its own?