ICT standards in the health sector: current situation and ... - empirica

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ICT standards in the health sectorproblems arise when computerised systems within hospitals and between hospitals andother organisations are meant to communicate with each other, competing standardsmay hamper systems interoperability on a regional or national level, the interoperabilityproblems prevent the full exploitation of data exchange opportunities, and publicauthorities may need to become more active in standardisation processes.A premature market for e-health standardsReferring to the economic phenomena of switching costs and network effects describedabove in section 2.1, the overall situation in the health sector appears to be thatproducers and customers are free to choose between different ICT standards because formost applications there are no standards widely used by others. Therefore, the market forICT standards in the health sector can be considered as premature. A mature market forstandards would be characterised by well-established, i.e. commonly used standards incore areas. This is not the case in the health sector. Notwithstanding there are de factostandards for a few health functions, e.g. DICOM for digital image transmission (seesection 2.3.7).2.2.2 Barriers to developing the e-health standards marketOverviewA question following from the description of the status of e-health standards is why thesituation is as unsatisfactory as it is. Why are there so many conflicting e-healthstandards? Why are e-health standard specifications so complex? Why are there notmore well-developed and commonly used e-health standards? Answers to thesequestions are particularly important with regard to policy implications. One may attributeparticular barriers to promote and adopt widely used standards to stakeholders of the e-health standards market and their rationales, i.e. the reasons for the way they act:governments, SDOs, industry, and ICT users. This sequence is not meant to indicate aranking of importance; it rather goes from general to specific issues.Political barriers: different health systems and often low support forstandardisationThere are two principal barriers to developing the market for e-health standards on thepart of governments: many different national and regional health systems with differentstandards and standardisation approaches on the one hand but low support forstandardisation on the other.Firstly, Member State health systems are highly determined by state entities and thereare many different national and regional health systems, traditions and regulations. Thishas also led to different national standards and standardisation approaches in e-health.EC health policy is limited to “narrow responsibilities and weak tools relevant to marginalareas of policy”, 21 for example issues of public and occupational health, but not provisionof healthcare and finance. However, the European Commission is stimulating and21Greer (2006), p. 134.18
ICT standards in the health sectorsupporting cooperation across the Union, and thereby gaining more influence on thehealth services of Member States.Secondly, although governments are important stakeholders in the health sector, theysupport international standardisation issues at a varying degree. In the SeBW e-healthexpert survey, 88% of the respondents stated that national governments should becomemore involved in e-health standardisation processes – the largest percentage mentionedfor all types of stakeholders (see section 3.2.5).Governments may support e-health standardisation directly and indirectly. Directsupport may take place by regulating the use of particular standards and by supportingSDOs with experts and funds. As regards standards regulation, some EU Member Stateslike Denmark, the UK, France, Germany, the Netherlands or Slovenia establishedplatforms or organisations in charge of standardisation at the national level onimplementing large scale e-health projects. 22 The US Department for Health and Humanservices recognised certain interoperability standards which federal health agencies haveto use when implementing, acquiring or upgrading health ICT systems. 23 Since federalhealth agencies constitute an important part of the US health systems, this regulationmay accelerate the adoption of certain e-health standards in the US. As regards supportby experts and funds, some of the members of the International StandardisationOrganisation (ISO, see section 2.4.2) have a mandate from national governments.Another example is the newly formed International Health Terminology StandardsDevelopment Organisation (IHTSDO) that manages the SNOMED-CT standard and haspresently nine country members (see section 2.3.4). However, many large countries didnot yet join.As regards indirect incentives, governments can for example make electroniccommunication between health service providers economically viable by regulating thereimbursement of related costs. The health sector is a laggard in ICT and e-business usein general and in electronic communication in particular. 24 Demands and attempts tointerconnect health service providers such as hospitals and general practitioners byelectronic networks are a fairly recent phenomenon. Indirect incentives could help spursuch communication. However, few governments have yet provided such indirectincentives. In the SeBW expert survey, 72% of the respondents said that hospitals mayhave little financial incentives to communicate electronically with other health serviceproviders (see section 3.2.6).SDO barriers: seeking returns from an expensive standardisation processThere is a large number of SDOs defining and publishing ICT standards in the healthsector, thus contributing to a large and continuously increasing number of conflictingstandards. The main reason why SDOs do not simply agree on a confined number of222324An example is the establishment of the gematik GmbH (see http://www.gematik.de (October2007)) in the course of preparing the introduction of a nation-wide health card in Germany.Gematik is in charge of defining common standards for the health card infrastructure so thatnationwide interoperability of card-related information systems is assured.See Department of Health and Human Services (2008).See the e-Business Watch reports about the health sector of 2002 and 2004 as well as thereport about hospitals in 2006.19
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ICT standards in the health sector: current situation and ... - empirica

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