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LeRoy Jones is as involved as anyone could be in trying to create an effective national infrastructure for health information. He started his technological career in defense contracting. He fell into health care through a 1996 relocation from Washington to Philadelphia, where his most interesting opportunity was with a company called Care Management Science (later CareScience), which did quality measurement software for hospitals. "It was good to go from creating things that at least indirectly hurt people to creating things that healed people," he says.

The company's name may ring a bell: it was founded by David Brailer, M.D., who in 2004 became the first National Coordinator for Health Information Technology. At that point, Jones went along as a senior advisor, and he's been playing key roles ever since. He has managed the Healthcare Information Technology Standards Panel for the American National Standards Institute and he worked on the design of both the New York eHealth Collaborative and the Statewide Health Information Network for New York.

On standards reconciliation

I think that people are willing to have consensus on standards for health I.T., but consensus is just one part of it. Standards organizations can get people in a room to agree on how something should be done, but it's a long way to commercial products that are interoperable en masse. If there isn't movement of a significant kernel of the market at once, it's difficult to say that any standard is indeed standard. Also, you need to standardize processes and interplay between entities. We may both agree to use HL7, but have different policies on privacy and security.

On taking things slow

The industry has moved ahead aggressively with standards, and has built up so much agreement on so many broad things, without implementing them along the way, that it looks intimidating to people trying to start now and do it all. You have to be strategic on how you try to move the ball forward. That's the intention of something like the Direct Project [a federally funded initiative to develop free e-mail software for exchanging clinical information]: to demonstrate that you can do something very specific, and then put that specification into the meaningful use requirements so that people can act on it.

On government involvement

The government has been trying to spearhead a model of defining specific use cases that we can all agree on, and then saying, "Let's solve the technology issues and the policy issues, and let's present incentives for people to adopt [the standards] in a certain time frame, and then let's measure how well it's worked." That's why the government role is so important. I doubt the government will ever fully pull back, but as adoption happens, prescriptive things like three stages of meaningful use won't be needed. If the government provides the initial inertia to get everyone moving in the same direction, the market will then take over.

The difficulty with meaningful use and certification is to be specific enough that you can eliminate the variation that creeps in when there are too many degrees of freedom. Some of the tests for moving information might not be rigorous enough to prevent two vendors from meeting the criteria but not doing it in quite the same way. Rigor is the biggest contribution that the government can make.