Health Care IT

A friend of mine recently pointed me to this article on Electronic Medical Records.

My experience comes from years working in the telecommunications industry and then later moving into computer networking.  When I started, AT&T (not the current company but the old Ma Bell) was firmly in control of the telephone industry.  They set the standards and decided what services were available in the marketplace.  Life was simple.  As a designer, all you had to do was make sure your product provided one of the authorized services and met the appropriate standards, and you could be assured you could sell the product anywhere in the US and it would work. Internationally, it was more complicated.  There you had the CCITT setting the standards and government organizations regulating services and rates within each country.  The CCITT was made up of representatives from the government regulatory bodies and from industry manufacturers, AT&T, Siemens, etc.  This model worked to the extent that standards were uniform within a country and between countries, but it also allowed the large manufacturers to control the pace of innovation and was stifling the introduction of new technology.

By the time the cell phone as we know it arrived on the scene, AT&T's monopoly had been broken up.  In the US, the mantra was "let the marketplace decide", so the result is the hodgepodge of cell phone systems and market segmentation that allows the cell phone companies to keep prices artificially high.  Europe and Japan at least had the good sense to dictate the standards and force companies to compete within the same market segments.  Unfortunately, in the US, the health care industry seems to be following the cell phone model of segmenting the market and artificially driving up costs.

Later on in my career, I moved from telecommunications to computer networking.  There I came face to face with the power of open standards and Moore's law.  I, Cringely has an interesting insight into SBC's (now AT&T's) understanding of Moore's law.

“SBC had a corporate purchasing culture based on the idea that everything gets more expensive over time. I guess that is an example of people who should know better investing in things they didn’t understand. In this case they had an entire building full of people who did understand the technology but were either not consulted or were ignored."

I will go so far as to claim that Moore's law would not exist without open standards, standards that create a level playing field, encourage competition, prevent market segmentation, and stimulate innovation.  Cisco and Intel grew from tiny companies to dominant positions in the electronics industry by embracing open standards.  IBM had to re-invent itself to stay competitive while other, once dominant companies, have faded away.

The open question is "How can we harness the power of open standards in the health care industry, while ensuring that standards are applied uniformly and fairly?"