In April of last year VHA, a nationwide network of community-owned health care systems, published a viewpoint essay on their website called “The Track to Improving Health Care will be Built with IT Standards”. The posting was written by Mike Cummins, Chief Information Officer of VHA, Inc. In it, he draws a great analogy between the widespread adoption of a standard railroad gauge by railroad companies 150 years ago as part of the U.S. Transcontinental Railway (as set in motion by President Abraham Lincoln), and the potential benefits of widespread adoption of health care IT standards. Mike points out that some historians believe that the nationwide adoption of a single railway gauge accelerated the evolution of the greatness of the United States. It’s well worth reading.
I think the problem Mike sees is that there are so many incompatible IT standards in use in the healthcare industry, with different ones in use in different pockets of the industry. There are too many proprietary approaches in use, and too many standards in use in one segment of the industry that are incompatible with similar standards in use in another. In effect, it’s a patchwork, yet each user can claim to be using a standard. This was exactly the case with the railroads 150 years ago as Mike’s analogy implies. Each railroad company, or groups of companies, had their favorite “standard” gauge, but which standard was “the best”…the one worthy of becoming the national standard? I don’t know, but I do know they eventually figured it out and settled on a single gauge for the Transcontinental Railroad and that gauge become the defacto standard. That allowed the country to be connected and, as Mike points out, historians have dawn a direct line from that agreement to economic expansion and eventual greatness.
Mike makes several proposals that I interpret as ways to cut through the patchwork of standards and get the industry to settle, like the railroad companies, on a single standard for some key technologies like Electronic Medical Records (EMR), Health Identification Numbers and Personal Health Records (PHR). He calls for the broad, mandatory adoption of GS1barcodes, Global Location Numbers (GLN), Global Trade Item Numbers (GTIN) and accelerated plans by the FDA to mandate the usage of Unique Device Identification (UDI). He calls for the use of part of the federal economic stimulus money to be used for standards development.
SLEEPY PROPOSAL BECOMES HOT TOPIC
Fast forward to January 6, 2010. On that date, VHA issued a press release calling for actions by the FDA and the Obama Administration that were the same as the Cummins posting from last April. The title of the press release is “VHA Inc. and 12 of the Nation’s Largest Health Care Systems Call for Government to Mandate GS1 Data Standards to Improve Health Care”. The press release did not include Mike’s railroad analogy. While the Cummins essay didn’t appear to get any response on the internet, the VHA press release was widely copied by many news release websites.
The very next day, ModernHealthcare.com published a brief news article based on the VHA press release titled, “VHA, member hospitals push GS1 standards”. One day later the same website posted a comment from Ted Almon, President and CEO of Claflin Co., a Rhode Island based healthcare distributor, about the press release. The subject of Ted’s posted comment is “Why the rush for GS1 standards?”. In it, Ted, a veteran of past standards development efforts which led to the formation of the Health Industry Bar Code Council (HIBCC), reasons, “Many industries much smaller than healthcare have dedicated SDOs, and I’m not entirely sure a single set of standards would even present any advantage with today’s technology.” (SDO=Standards Development Organization.) He asks “…why all of a sudden is there this pressure to choose GS1, and eschew our own SDO, which we control?”.
Why indeed. I’ve grappled with questions similar to Ted’s for some time now. I’m not sure I have the answers—especially answers that Ted and others might agree with—but I have some thoughts on the subject.
ARE GS1 OR HIBCC STANDARDS THE RIGHT “GAUGE”?
I think Mike is on the right track (pardon the pun) when he sees similarities between the current standards situation in the healthcare industry and the railroad industry just prior to the adoption of a single track gauge for the Transcontinental Railroad. Sure, the industry has been able to make do with two different sets of standards, HIBCC and GS1, for quite a few years, but that does cause inefficiencies. To remove as much cost as possible from healthcare we need to remove as many inefficiencies as possible, thus, wide adoption of a single family of identification standards is important. In fact, I think adoption of a single family of identification standards in our industry will result in benefits well beyond simple cost reduction, much as the adoption of the single railroad gauge went far beyond it as well.
So which family of identification standards should the industry settle on, HIBCC or GS1? I don’t know enough about HIBCC standards to provide a full set of pro’s and con’s, but I think perhaps I can cut to the chase by pointing out the following critical differences:
- GS1 standards are truly global, are HIBCC standards?
Is there a HIBCC affiliate in China? Brazil? Slovenia? I don’t think so. GS1 has affiliates—boots on the ground—in over 100 countries. GS1 standards are receiving increased attention by governments in many places.
- GS1 standards are cross-industry, HIBCC standards are unique to the healthcare industry
Sure, GS1 is huge in the grocery supply chain, but it’s also huge in the general merchandise supply chain in which retail pharmacies and drug wholesalers participate in a big way. I think that’s a good thing.
- GS1 standards are more widely adopted than HIBCC standards, even in the healthcare industry
OK, I’ll grant you that HIBCC’s HIN is currently bigger than GS1’s GLN in the healthcare supply chain, but it’s just one of many location identifiers in use. GS1’s GTIN is more widely used than HIBBC HIBC for product identification in the healthcare supply chain. I don’t have an internet link for this bullet. This one comes from personal observation.
With just these three bullet points I think the picture is pretty clear. So clear, in fact, that I think, faced with these three points, even the railroadmen from 150 years ago would tell you that the GS1 family of standards are the better candidate for a U.S. standard than the HIBCC family. In fact, the HIBCC family of standards comes off looking more like just one of the niche railroad gauges that faded away 150 years ago.
SO GS1 WINS?
Does all that mean that GS1 wins and deserves to be selected as the sole family of standards in the healthcare industry? Maybe, but like many families, there are good relatives and there are bad relatives. The GS1 location and product identification standards, GLN and GTIN, are not bad, although in my view, there exist unacknowledged but important differences between the allocation rules of GS1 GTINs and those of NDC’s. I fear that there may be some gotcha’s when using GS1 GTIN’s to carry a regulated identifier, especially when there is no authority who can arbitrate and enforce conformance. GDSN, EPCIS and even DPMS have problems that need work. And we don’t know yet how GS1 will implement the Data Discovery Services standard whose development is just getting underway. Perhaps these are the kinds of things that Ted was talking about when he wrote of the benefits of having “our own” dedicated SDO.
Many people have a problem with the high fees that GS1 charges, making it look as if they are a for-profit company (they are not-for-profit). I’ve been one of those people in the past but, for the most part, I have come to terms with it and I now recognize that to get the benefits of a truly global family of standards, it’s going to cost some money. I hope someone is monitoring exactly how the money is being spent, but I now expect that standards development, along with encouraging adoption, is going to have some significant costs associated with it. The users of those standards should pay for it. A fully volunteer organization cannot accomplish what GS1 is doing.
So here is where we are.
- We need a single family of standards to maximize the efficiency of the healthcare industry;
- From a high level, the family of standards from GS1 seems to have the inside track;
- But GS1’s family of standards are not yet a perfect fit and some are currently insufficient for use in this industry;
- The pharma side of the industry is facing a pedigree deadline in 2015 in California where it will be paramount that the industry has this decision well behind them.
Why the rush for GS1 standards? At least on the pharma side, it’s because we’re behind schedule.