Supply e-standards
Selecting health care e-standards is hard enough, but perhaps even more daunting is trying to persuade tens of thousands of providers, vendors and others in the supply chain to actually use the standards.
The Coalition for Healthcare e-Standards (CHeS), Ann Arbor, Mich., which made e-standardization its sole mission when it started five years ago, is hoping to move closer to that goal with one dramatic change. It will bring all segments in the health care supply chain onto its board. At its Sept. 15 meeting, the eight-seat CHeS board, most of whom are group purchasing organizations, voted to add six more seats.
The seats will be filled by not-for-profit trade associations, not yet named, representing hospital materials management departments, manufacturers, distributors, the pharmaceutical industry and software providers. There also will be one at-large seat, which has yet to be named.
With the board's expansion, "we're trying to reach out to more health care industry participants," says Dennis Byer, current chairman of the CHeS board and senior director of information technology at Consorta Inc., Schaumburg, Ill. "We want to include everyone."
E-purpose
The coalition has been pushing for acceptance of three standards that it says could save the health care industry billions of dollars a year.
The global location number (GLN), which CHeS endorsed recently, identifies shipping and delivery points in a health care organization. The United Nations Standard Products and Service Code (UNSPSC), endorsed by CHeS two years ago, organizes products and services into "families" for easy comparison. And a product data utility (PDU), still in the planning stages, would be a standard code for each product. Five founding GPOs have put their clout behind the coalition. In addition to Consorta, they are Amerinet, St. Louis; MedAssets, Atlanta; Premier Inc., Charlotte, N.C.; and Novation, Irving, Texas.
These GPOs have always collaborated with other groups. CHeS has long included representation from the Department of Veterans Affairs, Washington, D.C., the U.S. Department of Defense, Washington, D.C., and Neoforma, an Internet exchange in San Jose, Calif.
Byer and other CHeS leaders hope that the six new board members will shift the balance of power further still, broadening acceptance of the group's standards. Once the new organizations are selected, CHeS leaders plan to make it easy for them to become full-fledged members, perhaps in time for the November board meeting. While current members pay $36,000 a year in dues, the newcomers will not have to pay any dues, Byer says.
Aiming for critical mass
James Van Drasek, system director for materials management at three-hospital HealthEast Care System, St. Paul, Minn., says he hopes that the governance changes will get health care e-standards closer to a critical mass of acceptance.
"The more stakeholders in the health care supply chain," he says, "the more quickly we will be able to implement standards as an industry."
He says HealthEast has already selected GLN codes and expects to implement them in the next six months. "The implementation of standards in health care is a journey," Van Drasek adds. "It is going to take some time for them to be totally adopted and implemented. But it is important to get going on that journey."
Even before the board's decision, CHeS was on the road to bring in other constituencies. AHRMM has been an ex-officio member of the CHeS board. The current representative, Frank Fernandez, associate vice president and corporate director for materials management at five-hospital Baptist Health South Florida, Miami, attends meetings but doesn't vote or pay dues. Meanwhile, five companies have joined as nonvoting affiliate members, each paying $500 a year in dues. They are: Agfa-Gevaert N.V., an imaging company based in Mortsel, Belgium; Alcon Inc., an eye care products company based in Hünenberg, Switzerland; Becton, Dickinson and Co., a maker of syringes and other infusion devices in Franklin Lakes, N.J.; and ECRI and IMS Health, data and research companies that are both in Plymouth Meeting, Pa.
Suppliers have also participated on CHeS standards committees. In addition to Becton, Dickinson, they include Owens and Minor, Glen Allen, Va.; Abbott Laboratories, Abbot Park, Ill.; Cardinal Health, Dublin, Ohio; McKesson, San Francisco; Baxter, Deerfield, Ill.; and Fisher Scientific, Hampton, N.H.
"We've had good representation from the manufacturers," says Joe Pleasant, a past CHeS chairman and chief information officer at Premier. But he adds that designating a board seat is "a way to communicate to manufacturers industrywide."
Group effort
The board's expansion could also answer criticisms that GPOs have been using CHeS for their own purposes, a charge that the GPOs adamantly deny.
The criticisms focus on the coalition's selection of GLN, which is administered by GS1 US, formerly the Uniform Code Council (UCC), Lawrenceville, N.J. The new standard would replace the health industry number (HIN), which was developed by the Health Industry Business Communications Council (HIBCC), Phoenix.
HIN was introduced in 1990, but reportedly still is not widely used. A CHeS committee, consulting other stakeholders, selected GLN after analyzing HIN and several other standards, including the DUNs + 4 numbering system developed by the business information company Dun & Bradstreet, Short Hills, N.J.
While HIN is only used in health care, the CHeS study notes that the GLN is already used in other industries, including companies that have a strong health care presence such as Abbott Laboratories; 3M Company, St. Paul, Minn.; McKesson; and Johnson & Johnson, New Brunswick, N.J.
"Health care is not an island (unto) itself," CHeS explained about its choice.
Recently, CHeS members Amerinet, Consorta, Novation and Premier have begun to create GLNs for their members, and an unnamed fifth GPO is expected to follow suit soon, according to Byer.
However, HIBCC President Robert O. Hankin has argued that CHeS chose GLN for less generous reasons.
In a letter to the editor appearing in the August issue of Materials Management in Health Care, he called CHeS "a GPO advocacy group" and argued that the GLN initiative "reflected the desire of the GPO community to further control the contract administration process." Hankin notes that while HIN is free, GLN will cost hospitals a fee.
CHeS responds that the fee would be "probably less than $200 a year," and GPOs will pay the fee for their members for the first two years.
Pleasant, the former CHeS board member, insists that GPOs have everyone's interests at heart in their push for standardization.
"This is an industrywide initiative; this is not a GPO initiative," he says. "I don't think we [CHeS] ever viewed ourselves as a GPO organization," he says. Though, he adds, "the industry may have seen us that way."
But CHeS has found that its choice of GLN has put its role as neutral facilitator into question in the eyes of some players in the industry.
For example, the choice prompted Global Healthcare Exchange (GHX), Westminster, Colo., which also participates in HIBCC, to drop its core membership and pursue affiliate membership in CHeS.
"CHeS has transitioned from an organization that educates and facilitates the adoption and use of industry standards, to one that is endorsing which specific standards are right for the industry," reads a GHX statement, prepared for this article. CHeS leaders say they still have good relations with GHX and are pushing for GLN dissemination.
Pleasant says many hospitals still don't know they have been assigned GLNs and vendors are not asking for them yet.
To broaden awareness, CHeS has been sponsoring a series of GLN seminars with GS1 US, the GLN administrator.
The two groups organized four seminars in the Northeast this spring, and
are swinging through the rest of country this fall. There are only two sessions left--one in Los Angeles on Oct. 26 and the other at San Francisco Airport on Oct. 28. Byer, the current CHeS chairman, sees the entry of other health care constituencies onto the board as critical to the coalition's new push for standardization.
"If we are to succeed with these standards," he says, "we have to build a consensus."
Leign Page is a freelance writer based in Oak Park, ILL
Enriched representation
To expand consensus on standards for electronic data transmission, the Coalition for Healthcare e-Standards has expanded its board from eight to 14 seats. Voting members now represent:
- Five GPOs: Amerinet, Consorta, MedAssets, Premier and Novation
- U.S. Department of Veterans Affairs
- U.S. Department of Defense, Defense Supply Center
- Neoforma
The six new seats will be filled by not-for-profit trade associations, as yet unnamed, representing six key constituencies in the supply chain. They will have full voting powers and are expected to take their seats at the board's November meeting. The new constituencies are:
- Hospital materials management departments
- Manufacturers
- Distributors
- Pharmaceuticals industry
- Software providers
- One at-large seat
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