Standardizing the unstandardized health care industry: A case study of two health care standards development processes.

摘要

One health policy initiative to encourage the prevention of medical errors, reduction of health care costs, improvement of health care quality, and production of greater value for health care expenditures is the development of uniform standards to simplify the process by which electronic data is exchanged in the U.S. health care system (Report to the Chairman, Committee on the Budget, House of Representatives, 2005). To require such standardization through the force of law, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) (P.L. 104-191). Subsequently, the Executive Branch established the Consolidated Health Informatics (CHI) initiative for purposes of establishing a portfolio of existing health information interoperability standards that would enable all agencies in the federal health enterprise to "speak the same language" and ultimately create the foundation for a universal electronic medical record (Executive Office of the President of the United States, April 2003). The CHI initiative is distinguishable from HIPAA as it does not hold the force of law which is applicable to the entire health care industry. Rather, clinical standards were developed using a different decision process---an intergovernmental consensus-based approach.This dissertation investigates the proposition that elements of process, such as those identified in Fair Process Theory, are important to the development of health care standards. Fair Process Theory hypothesizes a direct link between the perception of fairness in processes and the resulting trust, commitment, and active cooperation in organizational behavior (Kim and Mauborgne, 2003). This study considers how health care standards development functions from a decision-making perspective and why shifting the health care system toward standardization has been difficult. The case study method was utilized to examine the context surrounding the processes in which HIPAA and CHI standards have been developed. Use of the case study method is appropriate when the inclusion of context is a major part of the study and when that context is so rich that multiple sources of information are necessary (Yin, 1993). One of the strengths of the case study method is its capacity to allow consideration of varied evidence, including documents, artifacts, interviews, and observations (Yin, 1994).Data analysis included the synthesis of interviews with health care informatics experts, relevant documentation, and non-participant observations of organizational behavior. Findings emerged to illustrate the significance of 'fair process' in health care standards development process. For example, if common themes of Inclusion, Engagement, Explanation, Expectation Clarity and Outcome Satisfaction were perceived, then support for the resulting standards was also likely to be perceived. Other important findings included the acknowledgement that decision-making occurs at the highest levels of government without the inclusion of frontline workers and that the government and large health care entities have the capacity to shift the entire industry toward standardization. Ultimately, this study contributes to our understanding as the first examination of health care standards development to illustrate the significance of fair process. Recommendations are made to include and engage frontline workers, assemble stakeholder support, and implement elements of a newly developed Enhanced Fair Process Management Tool Theory Management Tool in ongoing health care standards development. Such a shift would increase the likelihood that the public will benefit from the advantages offered by health care standards through supportive standards development and resulting accurate implementation of those established standards.