An Opened Upwards Missive Of The Alphabet (Part 2) To The Novel National Coordinator For Wellness It: Opening The Aperture Of Innovation
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Title : An Opened Upwards Missive Of The Alphabet (Part 2) To The Novel National Coordinator For Wellness It: Opening The Aperture Of Innovation
link : An Opened Upwards Missive Of The Alphabet (Part 2) To The Novel National Coordinator For Wellness It: Opening The Aperture Of Innovation
One of the of import decisions earlier Dr. Blumenthal in addition to his colleagues at ONC in addition to HHS is whether the national wellness information network volition live 1 of unopen appliances that bundle together proprietary hardware, software, in addition to networking technology, or 1 of opened upwards information telephone commutation in addition to management platforms inwards which the element parts required to practise medical computing tin transportation away live assembled from dissimilar sources. If the onetime management is chosen, powerfulness in addition to command volition live concentrated inwards the hands of a real few companies. If the latter, nosotros could catch an unprecedented flare-up of disruptive invention every bit novel products in addition to services are developed to create the side past times side generation of e-health services inwards this country.
Separating the information from the devices in addition to applications, in addition to maintaining a sure grade of independence of both from the networks used for transmission, is far to a greater extent than than a technical quibble. It tin transportation away determine the economic science of engineering scientific discipline inwards stunning ways.
A familiar illustration may aid here. On Apr 10, 2009, As the New York Times engineering scientific discipline weblog observed, "Fizzy pints of virtual beer, lightsaber simulators in addition to ancient flutelike instruments [and several wellness in addition to medically related applications] all convey 1 affair inwards common: they’re flight off the digital shelves of Apple’s App Store for the iPhone in addition to iPod Touch." Apple has created a website alongside a counter showing the actual numbers of apps every bit they download, in addition to a listing of the go past times xx most pop apps at the iTunes store. No 1 knows for sure what has been the size of the economical stimulation that resulted from opening upwards Apple's iPhone platform to third-party development, but it must live many hundreds of millions of dollars in addition to maybe fifty-fifty billions, in addition to sure as shooting thousands of jobs convey been created.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
*****
What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see BusinessWeek reported that Apple was approaching a milestone: 1 billion iPhone Apps downloaded. This is an amazing number inwards that it occurred inwards less than a year, but fifty-fifty to a greater extent than surprising because it powerfulness never convey happened at all. Prior to July, 2008, the Apple iPhone was a unopen appliance that could alone offering upwards applications developed for the iPhone past times Apple; for example, the iPhone offers a calendar in addition to contact management app, but these are Apple products. Third-party developers in addition to programmers had no agency to brand their apps run on the iPhone, in addition to Apple powerfulness convey kept it this way.
Then, inwards the summertime of 2008, Apple released an upgrade of the software that runs the iPhone in addition to iTouch which included an SDK (software evolution kit) that allows third-party developers to create software that tin transportation away live downloaded in addition to run on the iPhone in addition to iTouch; roughly of these apps are costless in addition to others cost upwards to a few dollars. Whamo! Suddenly the iPhone became the hottest evolution platform on the planet. As the New York Times engineering scientific discipline weblog observed, "Fizzy pints of virtual beer, lightsaber simulators in addition to ancient flutelike instruments [and several wellness in addition to medically related applications] all convey 1 affair inwards common: they’re flight off the digital shelves of Apple’s App Store for the iPhone in addition to iPod Touch." Apple has created a website alongside a counter showing the actual numbers of apps every bit they download, in addition to a listing of the go past times xx most pop apps at the iTunes store. No 1 knows for sure what has been the size of the economical stimulation that resulted from opening upwards Apple's iPhone platform to third-party development, but it must live many hundreds of millions of dollars in addition to maybe fifty-fifty billions, in addition to sure as shooting thousands of jobs convey been created.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
*****
What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see "Patient Records Inch Into 21st Century," New York Times, Apr 5, 2009 , in addition to "As the New York Times engineering scientific discipline weblog observed, "Fizzy pints of virtual beer, lightsaber simulators in addition to ancient flutelike instruments [and several wellness in addition to medically related applications] all convey 1 affair inwards common: they’re flight off the digital shelves of Apple’s App Store for the iPhone in addition to iPod Touch." Apple has created a website alongside a counter showing the actual numbers of apps every bit they download, in addition to a listing of the go past times xx most pop apps at the iTunes store. No 1 knows for sure what has been the size of the economical stimulation that resulted from opening upwards Apple's iPhone platform to third-party development, but it must live many hundreds of millions of dollars in addition to maybe fifty-fifty billions, in addition to sure as shooting thousands of jobs convey been created.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
*****
What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see CVS joins Google Health Rx network: millions tin transportation away access medication records online," Apr 6, 2009), the traditional wellness information technology manufacture seems to live declaring itself unable to costless the information from its proprietary applications in addition to devices quite in addition to hence easily. Instead, they desire a certification procedure to attach to the software applications from a lead grouping of vendors BEFORE nosotros larn interoperability, based on the products' features in addition to functions, alone 1 of which is the powerfulness to grip the information layer. In the process, nosotros believe they are acting to a greater extent than similar the old AT&T than the novel Apple iPhone.
Congress inwards its wisdom attached incentive payments to the social interaction layer of the network: "meaningful uses" are past times Definition the outcomes of the deployment of networked technologies in addition to information exchanges, non necessarily referable to specific applications in addition to devices themselves. This is existent progress. Having done that, the side past times side layer down, the information layer, is where attending ought to live paid inwards monastic enjoin for successful in addition to widespread meaningful uses to snuff it along in addition to economical stimulus to live unleashed inwards the health information technology economy.
The authorities tin transportation away in addition to should facilitate the soul sector's arrival at understanding nearly the content of clinical information that it wants to snuff it accessible to providers in addition to patients over the network; it tin transportation away likewise determine inwards what structures those information elements are formatted or packaged; in addition to it tin transportation away sure as shooting prepare expectations in addition to specifications for the protection of privacy of the packages in addition to their contents, whether coded data, text, images, audio, or video. With a express prepare of available in addition to good tested standards, this could live done rapidly in addition to easily, in addition to would similar a shot live seen every bit advancing implementation of the "meaningful uses" that Congress in addition to HSS wishing to see.
Here is where the Gordian knot of HITECH needs to live untied. There is no demand for ONC to regulate the side past times side layers, the applications, device layers or networks, or to link its specifications for the information to specifications for those products in addition to services that volition usage the data. They demand to know when to halt tying the knot, inwards other words.
*****
Here's the risk: limiting the kinds of devices in addition to software applications that tin transportation away grip standardized wellness tending information to a few authorities (or authorities agent)-certified products would dramatically stifle invention in addition to utility spell raising (or at to the lowest degree maintaining) costs. Imagine if the authorities told consumers they had to purchase a Dell figurer to connect to the Internet, or an iPod to psyche to digital music recordings, or computers running Microsoft Vista to usage email. Worse still, imagine nosotros all had to usage a modern-day version of the soul network Prodigy inwards monastic enjoin to telephone commutation wellness information of whatsoever kind. By locking inwards the usage of information to a specific product/device/application or fifty-fifty a specific shape of products/devices/applications, consumers endure past times non having the choice that an opened upwards marketplace permits. Nor practise they practise goodness from invention in addition to contest that arise from comparisons of service, features, usability, in addition to price. And lodge doesn't larn the economical stimulus, or, rather, it goes to a few large corporations only.
Physicians are, mostly speaking, fearful that they volition catch their EHR choices express to the expensive in addition to difficult-to-implement products that CCHIT at nowadays certifies. David Blumenthal is quite correct to worry that doctors volition "rebel" if given alone the choice of a pocket-size number of products that are notoriously non "user-friendly" in addition to non designed to run into the goals of "meaningful use" prepare past times Congress.
But nosotros don't believe that the deeper work is CCHIT or the dubious politics of hiring a vendor-run arrangement to certify the vendors' products. That existent or apparent conflict of involvement is an issue, but it's non the major one. Rather, it is the potential linkage of incentive payments to a certification procedure that would require specific applications to deal wellness data. That is the rootage of the the dilemma that Dr. Blumenthal et al. at nowadays face; this is the Gordian knot that needs to live undone.
As the New York Times engineering scientific discipline weblog observed, "Fizzy pints of virtual beer, lightsaber simulators in addition to ancient flutelike instruments [and several wellness in addition to medically related applications] all convey 1 affair inwards common: they’re flight off the digital shelves of Apple’s App Store for the iPhone in addition to iPod Touch." Apple has created a website alongside a counter showing the actual numbers of apps every bit they download, in addition to a listing of the go past times xx most pop apps at the iTunes store. No 1 knows for sure what has been the size of the economical stimulation that resulted from opening upwards Apple's iPhone platform to third-party development, but it must live many hundreds of millions of dollars in addition to maybe fifty-fifty billions, in addition to sure as shooting thousands of jobs convey been created.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
*****
What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see Click here to read Part 1 of the Kibbe & Klepper series: An Open Letter to the New National Coordinator for Health information technology - Untying HITECH's Gordian Knot. Their collected collaborative columns may live constitute at Kibbe in addition to Klepper on Health Care.
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Title : An Opened Upwards Missive Of The Alphabet (Part 2) To The Novel National Coordinator For Wellness It: Opening The Aperture Of Innovation
An Opened Upwards Missive Of The Alphabet (Part 2) To The Novel National Coordinator For Wellness It: Opening The Aperture Of Innovation
by DAVID C. KIBBE in addition to BRIAN KLEPPEROne of the of import decisions earlier Dr. Blumenthal in addition to his colleagues at ONC in addition to HHS is whether the national wellness information network volition live 1 of unopen appliances that bundle together proprietary hardware, software, in addition to networking technology, or 1 of opened upwards information telephone commutation in addition to management platforms inwards which the element parts required to practise medical computing tin transportation away live assembled from dissimilar sources. If the onetime management is chosen, powerfulness in addition to command volition live concentrated inwards the hands of a real few companies. If the latter, nosotros could catch an unprecedented flare-up of disruptive invention every bit novel products in addition to services are developed to create the side past times side generation of e-health services inwards this country.
Separating the information from the devices in addition to applications, in addition to maintaining a sure grade of independence of both from the networks used for transmission, is far to a greater extent than than a technical quibble. It tin transportation away determine the economic science of engineering scientific discipline inwards stunning ways.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
These [legal] decisions [against AT&T] paved the agency for advances invented in addition to distributed past times 3rd parties, advances that were the exceptions to the comparative invention desert of the telephone system. Outsiders introduced devices such every bit the answering machine, the fax machine, in addition to the cordless telephone that were rapidly adopted. The most of import advance, however, was the dial-up modem, a crucial slice of hardware bridging consumer information processors in addition to the basis of figurer networks, whether proprietary or the Internet.The separation of devices that powerfulness utilize data, from the information itself, eventually made it possible for millions of computers of all kinds, makes in addition to configurations to connect alongside 1 roughly other over the Internet. Today, sound information inwards many dissimilar formats go freely over the Internet, in addition to these are consumed, interpreted in addition to set to usage past times many thousands of devices in addition to the applications running on those devices. If nosotros transportation you lot an MP3 file of a vocal or a conference recording, nosotros don't demand to specify the device or application you lot volition usage to decode in addition to "play" that file. If nosotros telephone yell upwards you lot on the telephone today, you lot powerfulness reply on a cellular phone, a solid soil line-connected phone, or a figurer running Skype. Each of these needs to "understand" the information inwards cracking detail: no 1 dictates which device the consumer has to use.
With the advent of the modem, people could larn evidently terminals or PCs in addition to connect them to fundamental servers over a telephone line. Users could dial upwards whichever service they wanted: a telephone yell upwards to the bank’s network for banking, followed past times a telephone yell upwards to a to a greater extent than generic “information service” for interactive weather condition in addition to news.
*****
What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see BusinessWeek reported that Apple was approaching a milestone: 1 billion iPhone Apps downloaded. This is an amazing number inwards that it occurred inwards less than a year, but fifty-fifty to a greater extent than surprising because it powerfulness never convey happened at all. Prior to July, 2008, the Apple iPhone was a unopen appliance that could alone offering upwards applications developed for the iPhone past times Apple; for example, the iPhone offers a calendar in addition to contact management app, but these are Apple products. Third-party developers in addition to programmers had no agency to brand their apps run on the iPhone, in addition to Apple powerfulness convey kept it this way.
Then, inwards the summertime of 2008, Apple released an upgrade of the software that runs the iPhone in addition to iTouch which included an SDK (software evolution kit) that allows third-party developers to create software that tin transportation away live downloaded in addition to run on the iPhone in addition to iTouch; roughly of these apps are costless in addition to others cost upwards to a few dollars. Whamo! Suddenly the iPhone became the hottest evolution platform on the planet. As the New York Times engineering scientific discipline weblog observed, "Fizzy pints of virtual beer, lightsaber simulators in addition to ancient flutelike instruments [and several wellness in addition to medically related applications] all convey 1 affair inwards common: they’re flight off the digital shelves of Apple’s App Store for the iPhone in addition to iPod Touch." Apple has created a website alongside a counter showing the actual numbers of apps every bit they download, in addition to a listing of the go past times xx most pop apps at the iTunes store. No 1 knows for sure what has been the size of the economical stimulation that resulted from opening upwards Apple's iPhone platform to third-party development, but it must live many hundreds of millions of dollars in addition to maybe fifty-fifty billions, in addition to sure as shooting thousands of jobs convey been created.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
These [legal] decisions [against AT&T] paved the agency for advances invented in addition to distributed past times 3rd parties, advances that were the exceptions to the comparative invention desert of the telephone system. Outsiders introduced devices such every bit the answering machine, the fax machine, in addition to the cordless telephone that were rapidly adopted. The most of import advance, however, was the dial-up modem, a crucial slice of hardware bridging consumer information processors in addition to the basis of figurer networks, whether proprietary or the Internet.The separation of devices that powerfulness utilize data, from the information itself, eventually made it possible for millions of computers of all kinds, makes in addition to configurations to connect alongside 1 roughly other over the Internet. Today, sound information inwards many dissimilar formats go freely over the Internet, in addition to these are consumed, interpreted in addition to set to usage past times many thousands of devices in addition to the applications running on those devices. If nosotros transportation you lot an MP3 file of a vocal or a conference recording, nosotros don't demand to specify the device or application you lot volition usage to decode in addition to "play" that file. If nosotros telephone yell upwards you lot on the telephone today, you lot powerfulness reply on a cellular phone, a solid soil line-connected phone, or a figurer running Skype. Each of these needs to "understand" the information inwards cracking detail: no 1 dictates which device the consumer has to use.
With the advent of the modem, people could larn evidently terminals or PCs in addition to connect them to fundamental servers over a telephone line. Users could dial upwards whichever service they wanted: a telephone yell upwards to the bank’s network for banking, followed past times a telephone yell upwards to a to a greater extent than generic “information service” for interactive weather condition in addition to news.
*****
What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see "Patient Records Inch Into 21st Century," New York Times, Apr 5, 2009 , in addition to "As the New York Times engineering scientific discipline weblog observed, "Fizzy pints of virtual beer, lightsaber simulators in addition to ancient flutelike instruments [and several wellness in addition to medically related applications] all convey 1 affair inwards common: they’re flight off the digital shelves of Apple’s App Store for the iPhone in addition to iPod Touch." Apple has created a website alongside a counter showing the actual numbers of apps every bit they download, in addition to a listing of the go past times xx most pop apps at the iTunes store. No 1 knows for sure what has been the size of the economical stimulation that resulted from opening upwards Apple's iPhone platform to third-party development, but it must live many hundreds of millions of dollars in addition to maybe fifty-fifty billions, in addition to sure as shooting thousands of jobs convey been created.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
These [legal] decisions [against AT&T] paved the agency for advances invented in addition to distributed past times 3rd parties, advances that were the exceptions to the comparative invention desert of the telephone system. Outsiders introduced devices such every bit the answering machine, the fax machine, in addition to the cordless telephone that were rapidly adopted. The most of import advance, however, was the dial-up modem, a crucial slice of hardware bridging consumer information processors in addition to the basis of figurer networks, whether proprietary or the Internet.The separation of devices that powerfulness utilize data, from the information itself, eventually made it possible for millions of computers of all kinds, makes in addition to configurations to connect alongside 1 roughly other over the Internet. Today, sound information inwards many dissimilar formats go freely over the Internet, in addition to these are consumed, interpreted in addition to set to usage past times many thousands of devices in addition to the applications running on those devices. If nosotros transportation you lot an MP3 file of a vocal or a conference recording, nosotros don't demand to specify the device or application you lot volition usage to decode in addition to "play" that file. If nosotros telephone yell upwards you lot on the telephone today, you lot powerfulness reply on a cellular phone, a solid soil line-connected phone, or a figurer running Skype. Each of these needs to "understand" the information inwards cracking detail: no 1 dictates which device the consumer has to use.
With the advent of the modem, people could larn evidently terminals or PCs in addition to connect them to fundamental servers over a telephone line. Users could dial upwards whichever service they wanted: a telephone yell upwards to the bank’s network for banking, followed past times a telephone yell upwards to a to a greater extent than generic “information service” for interactive weather condition in addition to news.
*****
What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see CVS joins Google Health Rx network: millions tin transportation away access medication records online," Apr 6, 2009), the traditional wellness information technology manufacture seems to live declaring itself unable to costless the information from its proprietary applications in addition to devices quite in addition to hence easily. Instead, they desire a certification procedure to attach to the software applications from a lead grouping of vendors BEFORE nosotros larn interoperability, based on the products' features in addition to functions, alone 1 of which is the powerfulness to grip the information layer. In the process, nosotros believe they are acting to a greater extent than similar the old AT&T than the novel Apple iPhone.
Congress inwards its wisdom attached incentive payments to the social interaction layer of the network: "meaningful uses" are past times Definition the outcomes of the deployment of networked technologies in addition to information exchanges, non necessarily referable to specific applications in addition to devices themselves. This is existent progress. Having done that, the side past times side layer down, the information layer, is where attending ought to live paid inwards monastic enjoin for successful in addition to widespread meaningful uses to snuff it along in addition to economical stimulus to live unleashed inwards the health information technology economy.
The authorities tin transportation away in addition to should facilitate the soul sector's arrival at understanding nearly the content of clinical information that it wants to snuff it accessible to providers in addition to patients over the network; it tin transportation away likewise determine inwards what structures those information elements are formatted or packaged; in addition to it tin transportation away sure as shooting prepare expectations in addition to specifications for the protection of privacy of the packages in addition to their contents, whether coded data, text, images, audio, or video. With a express prepare of available in addition to good tested standards, this could live done rapidly in addition to easily, in addition to would similar a shot live seen every bit advancing implementation of the "meaningful uses" that Congress in addition to HSS wishing to see.
Here is where the Gordian knot of HITECH needs to live untied. There is no demand for ONC to regulate the side past times side layers, the applications, device layers or networks, or to link its specifications for the information to specifications for those products in addition to services that volition usage the data. They demand to know when to halt tying the knot, inwards other words.
*****
Here's the risk: limiting the kinds of devices in addition to software applications that tin transportation away grip standardized wellness tending information to a few authorities (or authorities agent)-certified products would dramatically stifle invention in addition to utility spell raising (or at to the lowest degree maintaining) costs. Imagine if the authorities told consumers they had to purchase a Dell figurer to connect to the Internet, or an iPod to psyche to digital music recordings, or computers running Microsoft Vista to usage email. Worse still, imagine nosotros all had to usage a modern-day version of the soul network Prodigy inwards monastic enjoin to telephone commutation wellness information of whatsoever kind. By locking inwards the usage of information to a specific product/device/application or fifty-fifty a specific shape of products/devices/applications, consumers endure past times non having the choice that an opened upwards marketplace permits. Nor practise they practise goodness from invention in addition to contest that arise from comparisons of service, features, usability, in addition to price. And lodge doesn't larn the economical stimulus, or, rather, it goes to a few large corporations only.
Physicians are, mostly speaking, fearful that they volition catch their EHR choices express to the expensive in addition to difficult-to-implement products that CCHIT at nowadays certifies. David Blumenthal is quite correct to worry that doctors volition "rebel" if given alone the choice of a pocket-size number of products that are notoriously non "user-friendly" in addition to non designed to run into the goals of "meaningful use" prepare past times Congress.
But nosotros don't believe that the deeper work is CCHIT or the dubious politics of hiring a vendor-run arrangement to certify the vendors' products. That existent or apparent conflict of involvement is an issue, but it's non the major one. Rather, it is the potential linkage of incentive payments to a certification procedure that would require specific applications to deal wellness data. That is the rootage of the the dilemma that Dr. Blumenthal et al. at nowadays face; this is the Gordian knot that needs to live undone.
As the New York Times engineering scientific discipline weblog observed, "Fizzy pints of virtual beer, lightsaber simulators in addition to ancient flutelike instruments [and several wellness in addition to medically related applications] all convey 1 affair inwards common: they’re flight off the digital shelves of Apple’s App Store for the iPhone in addition to iPod Touch." Apple has created a website alongside a counter showing the actual numbers of apps every bit they download, in addition to a listing of the go past times xx most pop apps at the iTunes store. No 1 knows for sure what has been the size of the economical stimulation that resulted from opening upwards Apple's iPhone platform to third-party development, but it must live many hundreds of millions of dollars in addition to maybe fifty-fifty billions, in addition to sure as shooting thousands of jobs convey been created.
*****
It is non coincidental that the Internet itself was made possible past times several legal cases that lost AT&T its monopoly seat mandating the usage of a specific device - an AT&T telephone - to grip phonation data, on AT&T's soul network. As Jonathan L. Zittrain writes inwards his remarkable majority "The Future of the Internet in addition to How to Stop It:"
These [legal] decisions [against AT&T] paved the agency for advances invented in addition to distributed past times 3rd parties, advances that were the exceptions to the comparative invention desert of the telephone system. Outsiders introduced devices such every bit the answering machine, the fax machine, in addition to the cordless telephone that were rapidly adopted. The most of import advance, however, was the dial-up modem, a crucial slice of hardware bridging consumer information processors in addition to the basis of figurer networks, whether proprietary or the Internet.The separation of devices that powerfulness utilize data, from the information itself, eventually made it possible for millions of computers of all kinds, makes in addition to configurations to connect alongside 1 roughly other over the Internet. Today, sound information inwards many dissimilar formats go freely over the Internet, in addition to these are consumed, interpreted in addition to set to usage past times many thousands of devices in addition to the applications running on those devices. If nosotros transportation you lot an MP3 file of a vocal or a conference recording, nosotros don't demand to specify the device or application you lot volition usage to decode in addition to "play" that file. If nosotros telephone yell upwards you lot on the telephone today, you lot powerfulness reply on a cellular phone, a solid soil line-connected phone, or a figurer running Skype. Each of these needs to "understand" the information inwards cracking detail: no 1 dictates which device the consumer has to use.
With the advent of the modem, people could larn evidently terminals or PCs in addition to connect them to fundamental servers over a telephone line. Users could dial upwards whichever service they wanted: a telephone yell upwards to the bank’s network for banking, followed past times a telephone yell upwards to a to a greater extent than generic “information service” for interactive weather condition in addition to news.
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What practise these examples convey to practise alongside health IT in addition to HITECH? Just nearly everything. They illustrate the layers of standards that operate on a digital network: physical wires/cables (or wireless) components of the network; devices connected to the network; applications running on the devices; information of diverse kinds created in addition to used past times the applicaitons; in addition to hold upwards in addition to most importantly, the social interaction based upon the content - that is, the purpose in addition to pregnant - of the whole past times users.
The futurity of today's health tending information technology systems seems to live converging on a handful of enterprise-run networks that practise non interconnect, in addition to a dozen or in addition to hence wellness information technology applications from companies that convey the powerfulness to determine who tin transportation away connect, what tasks they tin transportation away accomplish, nether what terms, in addition to at what cost. The irony hither is that spell Microsoft in addition to Google look eminently capable of finding ways to telephone commutation wellness information securely over the Internet inwards partnerships alongside New York Presbyterian Hospital in addition to CVS Pharmacy, amid others (see Click here to read Part 1 of the Kibbe & Klepper series: An Open Letter to the New National Coordinator for Health information technology - Untying HITECH's Gordian Knot. Their collected collaborative columns may live constitute at Kibbe in addition to Klepper on Health Care.
Thus the article An Opened Upwards Missive Of The Alphabet (Part 2) To The Novel National Coordinator For Wellness It: Opening The Aperture Of Innovation
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