Standards that are not free are a monopoly in disguise.

If, for example, the AMA's Current Procedural Terminology (CPT) codes become the national standard for documenting medical procedures, then HITSP will give the AMA a permanent franchise on the codes. The AMA effectively will have permanent license to charge exorbitant rates for access these codes -- which it already does.

Using expensive codes for industry standards is unheard of in the software industry. You can charge for high-end development tools like Visual Studio, you can charge for server licenses, or you can charge for data like a mailing list, but standards are generally free.

The argument that these standards need to be maintained by expensive, full-time staff doesn't hold. It's stovepipe, Rust-belt, Big Three, you-don't-know-shit-who-are-you thinking.

Open source software is developed by a meritocracy of highly motivated, highly redundant teams of developers. If a developer gets too busy to maintain an important piece of software, someone else will step in to maintain it. In the proprietary marketplace, that piece of software is upgraded when the manufacturer sees financial opportunity -- not necessarily when the market needs it.

The AMA has hundreds of thousands of members that are highly qualified physicians and medical students. Some of them have to be technically savvy enough to be able to maintain portions of the CPT code. With Web 2.0 tools and a major recession, it's actually absurd not to open up and democratize the code. You can still have review by an appointed consortium, but the practicing public is not locked out.

SNOMED, CPT, HL7 and CCR are not software -- they're evolving standards. They're the equivalent of a common language like XML, HTML, or CSS, all of which are managed by the World Wide Web Consortium (W3C). These standards are built into the core of all web-related software and are free for all to use. Manufacturers are free to charge for software built on these standards, but the standards themselves are free.

Even with proprietary technologies like Microsoft's .NET and Adobe's Flex, software companies ensure that developers have free access to the technology. It's common practice to make a software development kit (SDK) available for free, but charge for more feature-rich development tools like Visual Studio or Flexbuilder. This model allows for manufacturers to profit, but also lowers the barrier for developers to enter the field.

HITSP's pay-for-standards approach will almost completely shut out innovation by small boutiques (such as my design firm) and individual developers. It paves the way for all sorts of anticompetitive behavior and costly monopolies.

We'll all end up footing the bill, with a health information backbone that could have been better and far less expensive.