I am rocking along on my way from Boston to New York City aboard the Acela Express. This train will glide through Massachusetts, Rhode Island and Connecticut before arriving at Penn Station in Manhattan. It should be a smooth, uninterrupted trip thanks to railroad conformance—all tracks are standard gauge.
The history of standard gauge
Uniform interstate rail travel isn’t how the U.S. rail system started. I am not a true “rail fan,” but I recall the history of the impact of standard-gauge rails. If you remember, U.S. railroad construction started in the early 1800s and everything was local. In the south, in particular, short rail lines were designed to ferry crops from farm to port. The rails were not interconnected in a network, which became a big problem during the Civil War when the southern states needed to work together. Local variability resulted in decreased usability and functionality of the rail system.
In contrast, the western expansion of the U.S. railroad in the mid-1800s was supported by the U.S. federal government; in large part, by the donation of vast acres of land. Compared to steamboat, stage-coach and horse travel, railroads were lower cost and more cost effective, so the federal government supported rail for passengers and freight. The First Transcontinental Railroad was completed in 1869 as a unified rail system using a standard gauge track. In 1886, post-Civil War, the southern railroad system was converted to standard gauge track in a 2-day conversion blitz to complete the standardization and interoperability of most of the U.S. rail system. Today the same standard 4’8 ½” or 1,435 mm track is used in 60% of the rail lines around the world to allow “interconnectivity and interoperability.”
Tracking with HIT
Conformance and interoperability are still the federal government focus, but today instead of railroads we’re building Health IT infrastructure. Just like the rail system of the 1800s, the U.S. government has an interest in connecting the healthcare network in the U.S. in a seamless way. The goal is to supersede basic interconnectivity and achieve true interoperability. This means pushing local healthcare providers and EHR vendors past the luxury of local customization to a common set of standards that enable true data sharing across a broad healthcare system. The provider may be able to maintain some local user interface, but the EHR backend must comply with health information exchange standards.
USA Today published an article on January 7 about the Rand Corp. survey of doctors’ feelings about EHRs. Based on the survey results, it is clear that doctors still see plenty of shortcomings from EHRs and not as much benefit as they would like. Federal incentives through MU and the looming reimbursement penalties have pushed doctors further along EHR adoption than they wanted to go. Everyone hopes that a leap forward in interoperability will heap on value for doctors.
Laying the final miles of track in MU3
Washington DC sees interoperability and interconnectivity as necessary to achieve healthcare quality and cost-effectiveness. This month congressional committees have added bill amendments to instruct the Office of the National Coordinator of Health IT (ONCHIT) to require interoperability of EHRs certified under MU3 in 2017. The Energy and Commerce Committee specifically requested that ONCHIT create standards that “allow every healthcare provider to access and use longitudinal data on the patients they treat to make evidence-based decisions, coordinate care, and improve health outcomes as quickly as possible”.
Acumen has just completed certification for MU2, but at Ethernet speed MU3 is just around the bend, being powered by a big diesel engine of interoperability. ONCHIT has begun to gather stakeholders to lay the groundwork for setting interoperability standards that will be core to testing and certification for MU3.
The U.S. federal government has been donating acreage to the unification of electronic health systems for years through the incentives of the HITECH Act. MU3 may be the last push to provide the final miles of track to link us all together. Granted the standard gauge of Health IT is much more complex to define and test, but hopefully down the line we will realize the value of being networked.
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