The questions listed above highlight the issue of standards for designing hardware and software so that (a) different components of a telemedicine or other information and communication system work together (both within and across institutions) and (b) users can select compatible components from different vendors. Such standards cover a wide territory. For example, as characterized in one recent National Research Council (NRC) report,
Standards describe low-level electrical and mechanical interfaces (e.g., the video plugs on the back of a television …). They define how external modules plug into a PC. They define the protocols, or agreements for interaction between computers connected to a common network. They define how functions are partitioned up among different parts of a system, as in the relationship between the television and the decoder now being defined by the FCC. They define the representation of information, in circumstances as diverse as the format of a television signal broadcast over the air and a Web page delivered over the Internet. [NRC, 1996, p. 151]
More than 400 private, mostly industry- or profession-specific organizations that develop standards are at work on information technology and telecommunications standards (NRC, 1996). In health care, a number of voluntary standard-setting groups and accrediting organizations for such groups have worked to develop standards in different areas including medicine, nursing, dentistry, and pharmacy. Figure 3.3 displays the array of messaging standards applicable to hospitals (OTA, 1995). Several organizations including the American Society for Testing and Materials (ASTM) and the American National Standards Institute, accredit standard-setting groups and also seek to coordinate the development of common approaches for messaging standards.
One major ongoing effort, Health Level Seven (HL7), which dates to 1987, develops standards for exchanging clinical, administrative, and financial information among hospitals, government agencies, laboratories, and other parties.1 The HL7 standard covers the interchange of computer data about patient admissions, discharges,