Sunday, November 06, 2011

There May Very Well Be Something Important In This. Responding To Unreasonable Political Demands Is NOT the Way To Do Health IT Standards!

Grahame Grieve published an interesting blog a couple of days ago.
Essentially Grahame is pointing out that it may be that large scale national Health IT projects may cause some considerable stress on the National Standards setting frameworks for a range of reasons

National Projects and Standards

Posted on November 1, 2011 by Grahame Grieve
It’s something you can see all around the world: governments sponsoring large national healthcare projects of one form or another (EHRs, prescription systems, HIEs, etc), and the bodies running these projects getting very involved with international healthcare standards bodies (HL7, IHTSDO, IHE, etc) (yes, I know IHE isn’t a standards body. but everyone knows what I mean). I’m referring to ONC, Infoway, Connecting for Health, NEHTA, etc (btw, declaration: I’ve worked for nearly all of these – or still do – in their standards programs).
There’s a difference between the goals of the national project, and the value proposition of using standards, and this difference can create considerable tension.
These national programs are generally constituted by elected politicians who commit large sums of money to big goals that are difficult to achieve, and quite risky politically. In fact, these projects only happen because there’s such a huge pressure on the national programs in terms of getting more for less, and these projects appear to offer the prospect of delivering that – and they *will*, if they succeed. But these projects are difficult at every level – hard to make change, technically demanding, and at the limit of our knowledge of informatics, and how to deliver computing support in really well integrated ways to a wetware (very wet) dominated process.
So there’s real risks, and because of election cycles, short time lines run by risk averse sponsors. These projects have to succeed, and have to stick to their timelines. (Which does make me wonder, where do they make these timelines up from?)
The Standards process, on the other hand, doesn’t work like that. It’s a slow, consensus based process which emphasizes getting agreement to a common position, and voluntary participation from the community with gradual buy in. That’s its greatest strength. It’s not going to run out and transform a community prospectively. But gradually, incrementally, and surely, the presence of the standards transforms the community and empowers it. However you can’t rush the process – putting a timeline on it, or throwing money at the volunteers – that is a high risk option.
The full blog can be read here:
Clearly what Grahame is pointing out is that the slow, considered, consensus driven processes that have been the norm in Australian Health IT IT-14 Standards Committee are now seen as being politically and practically utterly inconvenient and in desperate need of being essentially bypassed (in the nicest possible way) by NEHTA and DoHA ramming through what they want into untested implementation and hoping later to get a ‘rubber stamp’ tick from IT-14 for what they have done.
Politics is driving a helter skelter rush to specifications which may, or may not, be workable or safe. As far as I am concerned this is not a good plan at all!
While on the area it does need to be said that as far as I can determine, despite the 31 October, 2011 deadline there do not seem to have been many NEHTA / DoHA Specifications (intended to be used by the Wave Sites and later to become standards) published. Have things already started to slip, or have I missed the documents and their hoped for insights.
Additionally there are all sorts of subterranean ructions going on within the NEHTA Certification and Conformance Program (CCA) which is meant to be part of the mechanism to have the Wave sites interoperate.
You can read about CCA here:
Right now it does seem to be in a little disarray!
While one can never be sure as to how things will play out overall, I would suggest that until real clarity on just what the plans for the PCEHR actually are, and how in detail it will actually work - and we have yet to see much in the way of actual public implementation plans from the Wave Sites - private software providers would be well advised to preserve whatever financial resources they have left. This is probably not a time to be investing in things that may turn out to be a mirage - like specifications that may never actually become Standards!
I plan to talk a little about clinical safety and Health IT a little later and this is another area where any progress is for some reason not being discussed all that openly. I wonder why that might be?
Frankly it really should not be this hard!


Anonymous said...

"The Standards process, on the other hand, doesn’t work like that."

Correct. Nehta and the politicians have been told this ad infinitum but they refuse to hear because they do not want to know. In their stubbornly stupid attempts to 'crash through' they will crash big time and we will all pay the price.

Anonymous said...

We already have lots of standards to choose from. Why do we need so many new ones? Why can't NEHTA use the existing ones?

Anonymous said...

Existing standards, you have to be kidding. They have never read them, let alone understood them. Anything that works has to be replaced by something that uses the latest buzzwords and creates the greatest complexity in doing the easy stuff. It then looks impressive, but there is no meat in this sandwich. In fact all we have is pretty pictures of imagined castles in the air. None of it has a hope in hell of working in the real world.

Why are we employing "Enterprise Architects" in an internet scale application? We are not trying to connect a few enterprises, using bloated java code, but actually connect real applications which are many and varied. What works at an internet scale is robust simple things like http, html, smime and rest, along with proven standards like HL7V2.

Even Google, who of course used this type of robust, scalable technology accessible from every programming environment failed with Personal Health Records. This group of turkeys are going to succeed with inappropriate technologies and IT illiterate managers??? I think not.