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HL7 – not just for IT anymore. That thinking is the catalyst behind a triptych of recent moves designed to open the standards process to more health professionals, notably caregivers.
Ideally, pulling in a new group of professionals will open the feedback loop, particularly to those concerned with usability and workflow, but by no means limited to that. According to Charles Jaffe, HL7 CEO, tapping into their minds and, indeed, day-to-day work experiences will also yield specialist knowledge that bolsters decision support.
Government Health IT Editor Tom Sullivan spoke with Jaffe about those initiatives, very positive initial reactions, and what the future holds for HL7. Hint: Genomics, and mobile health.
Q: I’ll start by asking about HL7 recently opening up some of your intellectual property to the caregiver community…
A: We are going to make, at an absolutely nominal charge, a caregiver membership available immediately for health professionals – physicians, nurses, therapists, pharmacists and so forth, to broaden the base of HL7, increase domain expertise and, hopefully, a small percentage of them will actually become involved in the development of standards. And not simply usability, workflow, so on and so forth.
Q: So what’s the end-goal of this broadening?
A: It really falls into two categories. One is that it’s not an economic driver. In other words: I’m kind of hoping that we recoup enough to pay for the administrative cost, but if not, it’s an expense for outreach.
It certainly is in our interest to bring in a new group of people whose reason for interest in this is because of their concern about usability, workflow, domain content, and so forth. A really simple example is that a pediatrician needed an electronic health record that they thought more accurately reflected their specific needs for caring for children. But in another sense and across all domains so would the allergist and immunologist. The most incorrect diagnosis in a medical chart is allergy to some medication. The immunology community is very concerned about that because in the CCD there are lists of things that glibly are referred to as allergy which really fall into the category of ‘I think I don't like this medicine.’ If I had a dollar for every one of those, I probably could pay for you for lunch. The allergy community is up in arms over this nonsense.
Q: Any other communities with a similar sentiment?
A: We as the United States spend billions of dollars avoiding whatever it is that someone alleges they have an allergy to, when they absolutely do not. An example is the X-Ray Contrast injection which is called x-ray die, it’s not die at all. It’s clear as water. In a vile, you couldn’t separate out the two. They are opaque to x-ray and when injected into an artery they often cause some symptoms – not an allergy. It’s not related to iodine, shellfish, or shrimp. It’s not even the kind of immune reactions we characterize as allergy. And yet all of this information was known in 1971 and 40 years later we’re still asking the question about your food intolerance, which is totally unrelated.
This is the reason that you can get articles that are reproduced in all the big city newspapers that say ‘well, EMRs are not effective.’ So if electronic medical records are simply a substitute for paper, then there’s probably little benefit, other than you can read it. But if the definition of electronic medical record embraces decision-support, the tens of thousands of people who go into their family doctor today in the U.S. who have a diagnosis of strep throat when they really have Viral Pharyngitis to get a broad spectrum antibiotic even in lieu of the very narrow antibiotic that could be prescribed for a strep throat, we have bacterial resistance, we have antibody development, we have reactions to the medications, real or imagined and we have millions of dollars in cost. Decision support would really enable the caregiver to say – or perhaps to learn rather – I guess 40 year olds don’t get strep throat very regularly. Maybe I need to reinvestigate this. And if I have a strep test and it is positive, well then I’ll give them the appropriate antibiotic and not a broad one.