IT debates unplugged medical standards

The medical community is already embracing mobile and wireless healthcare technologies, but the transition is not without challenges. One issue is whether existing medical standards are sufficient to cover new mobile devices.

The question sparked the formation of a special task force at the recent ISO (International Organization for Standardization) meeting in London - the ISO TC215 Ad Hoc Task Group on Mobile Health - to determine whether new standards are needed, and, if so, where they should be developed.

Mobile healthcare technology promises a revolution. Providers will have the ability to instantly update patient records to ensure that they reflect the most current information. Armed with this information, physicians stand to make more informed treatment decisions, prescribe more accurately, and eliminate redundant and potentially inaccurate paperwork. All of this tends to improve patient care.

"There are technological differences that need to be addressed from a standards point of view for any mobile device," said Don Newsham of Sierra Systems Consulting in Edmonton, Alberta, who convened Working Group 1, Medical Records and Modeling Coordination, of ISO TC215.

Security requirements in a wireless environment and safe communications within a healthcare and hospital environment with various pieces of medical equipment nearby require standards, he said. In some cases, the existing ones will suffice.

"The standards that are already being developed to operate within any environment need to be adhered to within the mobile world," Newsham said. "I don't see a different results or order standard working at the mobile device level."

Proponents of new standards hold the opinion that different standards for mobile health are needed in such areas as e-prescribing, order entry, results management, information capture, point-of-care applications (clinical documentation, alerts, disease management, drug-to-drug interaction, guidelines and protocols, decision support), and systems integration.

The suggestion of technology-driven standards has inspired strong opposition.

"I'm skeptical about whether mobile health requires any specific health informatics standards," said Dr. Peter Schloeffel, managing director of Trident Health Australia and director of the openEHR (Electronic Health Record) Foundation, Asia-Pacific branch.

"In my view, health informatics standards should be, as far as possible, independent of technology," he said.

Schloeffel, who is cochair of the new ISO ad hoc EHR group, is also trying to ensure that EHR standards are a "technology-free zone."

Aside from technology-based standards probably being unnecessary in health informatics, there is always the danger of introducing incompatibilities with broader-based nontechnology standards, he said. According to Schloeffel, this is already a potential problem with the ISO Health Card working group, which is making EHR standards specific to health cards.