In the early 1800's a fire damaged much of downtown Baltimore, Maryland. The blaze was so fierce that firefighters and equipment from the neighboring towns of Washington and Philadelphia were recruited to battle it. Much of their aid was futile, however, since fire hoses from other cities would not fit the fire hydrants in Baltimore.
 
Today the situation is much different. We travel and transact business on a national and international basis. We assume--correctly--that the toaster we buy will fit the electrical outlets in our kitchen, and that bank machines in other states will be able to read our instant cash card and for a fee dispense emergency funds. Mechanical and manufacturing standards in general use allow us to take these matters for granted. But venture too far and this assumption of compatibility starts to break down. If we travel to Europe or to Africa we find that different standards apply.
 
In the last few decades the health care industry has been forced to confront these same standards issue. A discipline that recently centered around a local community is becoming regionalized. The commerce of medicine now involves not only patients and providers but payers and regulators at state and national levels.
 
Physicians can empathize with those out of town firemen hauling their useless hoses through a burning town full of strange hydrants. One of health care's major resources is its wealth of information -- information about specific individuals and their maladies (patient charts) and general knowledge about health and disease (clinical database). Today this information is usually in a format useless beyond simple record keeping to anyone but the original provider.
 
Standards would simplify patient billing and file transfers, and enable us to create a common clinical database to monitor medical costs, outcomes research, and QA and performance measures. Standards can provide order and stability to an enterprise. Reliability can improve from having a consistent way of doing things.
 
But whose way will and should be adopted? Will adopting one standard now freeze out further technological progress for the sake of compliance? Will meeting the standard divert time and effort that could have been focused on solving other problems? Will special interests try to shape standards in order to stifle competitors or distort the market for their services? Sometimes, yes.
 
Health care standards are presently full of (standardized) definitions and classifications, used in organizations with the cryptic names ACR/NEMA, ASTM, HL7, IEEE, NCPDP, and X12N. Creating medical standards is not without controversy, both in methodology and philosophy. No matter how desirable standards may be, they don't happen automatically, nor are they uniformly beneficial.
 
We can begin by studying standards that already exist, such as in aspects of health claims and prescriptions. True, controversies still dominate some issues such as the selection of a standard identifier for each patient and policies for protecting confidential data. But by examining the process responsible for already successful standards, it should become clearer where compromise and consensus can be achieved in solving present controversies in health care standards.
 

of other articles
 
 
Other Musings
 
Other MCToday articles on Standards:

• Two Perspectives on HL7
• Why Does Medicine Need Standards?