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Health Level 7 International is two things: a standard for exchanging data in health care contexts, and an organization for developing, certifying and promulgating that standard. Charles Jaffe, M.D., has headed the latter since 2007. (In January the organization added "International" to the end of its name to reflect its global focus and members from 55 countries.) Before taking his first full-time health informatics job in 1999, Jaffe had a long career working on the immunologic implications of cancer, doing research for pharmaceutical companies and taking care of patients. He also had a parallel informatics career that grew out of his medical training at Duke.

On keeping up with the evidence

The lag time between scientific knowledge and its application in medical care is at least 15 to 20 years. If you have an X-ray where they inject a contrast agent, the tech will ask if you're allergic to shrimp, even though evidence in 1971 showed that reactions to that agent aren't related to shrimp allergy. It drives me up a wall, as an immunologist and someone who cares about information systems.

On consulting users

One technology innovator devised a brilliant means to test for a single tubercle bacillus. I came late to the table, and I asked them how they planned to get specimens for the assay. The strategy for obtaining a specimen had not even been considered. No one from the technology group had researched the clinical condition sufficiently to appreciate that patients must be very sick before the organism is plentiful in sputum. While the science was remarkable, the approach to the disease process was woefully under-informed. It is a lesson that crosses domains and scientific disciplines. All technologies should be vetted first by the individuals who will use them.

On useful EHRs

An EHR should provide decision support-if it doesn't, you've wasted time and money. We physicians aren't as good at our jobs as we should be because we're expected to keep everything in our heads. Imagine you're in sales, you have to interview a prospective customer in five minutes, you can't consult any other resource except the knowledge in your head, you have to do it 40 times a day, you have five minutes to document your meeting and you can never be wrong. That's how most primary care doctors work.

On degrees of interoperability

One promise HL7 made, to spur adoption, was that you can customize the output of the system to your own business needs by adding a suffix to the code. That means no one outside your system can use your data. One year, two hospitals in Manhattan won "most wired" awards, and the most efficient way to get data from one to the other was to print it out and put it in a taxi.

Charles Jaffe, M.D.

CEO, Health Level 7 International

* B.A. in Chemistry (Phi Beta Kappa) from Johns Hopkins University, Baltimore; M.D. and Ph.D. from Duke University, Raleigh, N.C.

* A senior global strategist for Intel, which pays his HL7 salary as part of its support for the organization.

* As a physician, has been the principal investigator for more than 200 clinical trials.