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Subject: RE: SV: [Fwd: Re: [xml-dev] Edi complexity, does ebxml really reduce it?]

 And to further develop the health care aspect, Mike, as you know, in the
United States, the use of the X12 standards is now mandated by federal
regulation as required under the HIPAA legislation.

What makes the use of ebXML and the Internet even more of an issue for the
U.S. health care market is that the largest payer of health care (Medicare)
currently prohibits any Medicare patient data to be sent over the Internet,
whether or not encrypted. Since the average health care provider derives in
excess of 50% of total revenue by providing health care services to
Medicare-covered patients, use of ebXML and the Internet is effectively

The second major hurdle is the HIPAA Security Regulation which requires that
HIPAA covered entities must **address** the use of encryption when using
insecure networks to transmit electronic protected health information
(ePHI). Given that more than 80% of health care organizations in the U.S.
can be classified as small businesses, they are totally reliant on their
application systems and other vendors to provide the enabling technologies
at an affordable cost. Without a **standard** interoperable encryption
solution that can be used by the hundreds of thousands of small healthcare
providers as easily as they use a fax today with diverse and disparate
systems, exploiting the Internet and ebXML will remain a dream and a vision
(although one that I've been dreaming of for years!!!)

Rachel Foerster & Associates, Ltd.
39432 North Avenue
Beach Park, IL 60099
Voice: 847-872-8070
email: rachel@rfa-edi.com

-----Original Message-----
From: Mike Rawlins [mailto:mcr@rawlinsecconsulting.com] 
Sent: Tuesday, July 13, 2004 11:25 AM
To: ebxml-dev@lists.ebxml.org
Subject: Re: SV: [Fwd: Re: [xml-dev] Edi complexity, does ebxml really
reduce it?]

At 05:16 PM 7/13/2004 +0200, Bryan Rasmussen wrote <snipped>:

>Then, reading
>"The EDI market can be split into two logical units: general-purpose 
>EDI and health-care EDI. For the most part, there is very little 
>interplay between these  two groups and their internal dynamics are 
>quite different from one another. For  example, the general-purpose EDI 
>area is made up of participants in many  different vertical sectors 
>that purchase EDI software and services from a group  of established 
>vendors that provide basic EDI functionality. This is by far the  
>largest segment of the EDI market. The smaller health-care EDI area is 
>unique in  that the vendors in this space do not sell EDI software, but 
>rather charge their  customers for access to hosted translation and 
>document exchange services that  are specific to the health-care 
>industry. This leads to differing technical  requirement skills between 
>these two groups as organizations in the  general-purpose area usually 
>have employees that understand the intricacies of  the EDI software and 
>the related data mapping processes (or hire consultants to  provide 
>this service), whereas in the health-care sector this function is  
>provided by the EDI service provider" it struck me that the second unit 
>of the market, which is a service-based model, might with ebxml come to 
>be pre-eminent (does this seem reasonable to anyone) one thing I 
>considered was that government organizations could perhaps provide ebXML
services so as to make it easier for smaller businesses to trade with larger
>Shielding the smaller businesses from the complexity and levelling the 
>playing field.

Two points here - First, I do not necessarily agree with this
characterization by the fine folks at Sterling.  The service provider model
is gaining ground among smaller, "general-purpose" EDI users as well.  This
is evident in the number of "web-based EDI" services that are available.
One thing that *is* different about health care is that the service
providers tend to do a lot more than what EDI VANs do.  Reformatting and
rerouting claims are just two examples of the added services.  They are
generally referred to as "clearing houses", and they were performing these
functions long before health care in the U.S. started adopting X12 EDI

Second - Although it might happen in other countries, having government
organizations in the U.S. provide ebXML services is a political non-starter.
A model which might be more likely is for larger hubs to assist smaller
partners in coming on board, in much the same way that they have with EDI.
However, the most significant hurdle is for the vendors who 
sell applications to smaller businesses to get on board.   So far, most 
have been dragging their feet on even implementing nonproprietary XML
documents, let alone things as complex as ebXML or web services.



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