Wednesday, October 01, 2014

Can We Ask The Same Important Question For Australia? I Think So.

This appeared a few days ago.

Where's the plan for interoperability?

Posted on Sep 22, 2014
By John Loonsk, MD, CGI Federal
It is a simple question: “Why doesn’t electronic health information flow after the nation spent $26 billion on electronic health records?" Suggesting a 10-year timeframe or arguing that there is progress if you look hard enough just doesn’t answer it.
Congress does not think so either. Despite the HITECH funds’ accomplishing a significant degree of EHR adoption there is still a large amount to do to achieve modest interoperability. And the question posed above is going to politically fester until something significant is done.
Part of the interoperability problem is that only a limited amount of the HITECH meaningful use leverage has been used to encourage data exchange. Interoperability took a back seat to adoption of EHRs and other things in meaningful use plans.
But another part of the problem is that there is no real technical plan. From a health IT perspective, the kind of “plan” that is needed would describe high-level functional needs, identify important technical elements, and show how they all fit together. It would be an architectural blueprint to guide technology in the very complex, loosely coupled system that is the health sector. And it would strategically articulate critical, but limited, pieces of the national health IT infrastructure. It would also show how what exists needs to be supplemented and changed to achieve the future state. It would be, in short, more of a high-level technical architecture than a roadmap.
A roadmap can help too but the nation needs to know where it wants to go in order to use a map for how to get there. Some, who not infrequently would rather go their own way, attack the word “architecture” as meaning “top down control.” So call it a “technical plan” or a “framework,” call it a “design pattern,” a “schematic” or whatever you want; interoperability will suffer until we have a picture that helps articulate and guide where we are going.
Without such a plan, the multiplicity of approaches makes for bad interoperability math. Each participant has too many variations with which they need to integrate. Software vendors can’t pick one approach and sell to the whole market – they need to pick them all or narrow their opportunities. Without a plan, we cannot communicate well about specific needs and how they fit together. Critical elements will be missing. Without a plan, funds and mindshare are invested in dead-ends that will take years, or decades, from which to escape. Without a plan, we will be highly susceptible to the whims of changing personalities, politics, and administrations. Without a technical plan, many of the health outcomes that assume information liquidity and on which HITECH was “sold” will be elusive.
External reports from notable experts including the President’s Council of Advisors on Science and Technology, or PCAST, and the JASON group have said that a technical plan is necessary. PCAST was ignored. The more recent JASON report is now being picked apart for flaws in its sample architecture. But the plea both reports share is to develop an architectural plan not necessarily their specific one.
So, to substantiate the need for a technical plan, here are six barriers to interoperability that are the result of not having one. It is our hope that discussing these issues will help us constructively move forward to having a technical plan that resolves these issues now and prevents similar issues in the future.
Lots more here with some salutary warnings and insights.
In Australia we have this document:

eHealth Interoperability Framework - Framework v1.1

Size: 0.84 MB
Type: PDF
NEHTA-1024:2012 eHealth Interoperability Framework - Framework v1.1
Published Date
End Product
"This document describes a standards-based set of concepts, structuring rules and approaches for use in specifying and building interoperable eHealth systems. It includes guidelines for:
  • structuring specifications
  • recommended document components for an eHealth specification
  • defining the capability of healthcare organisations to interoperate.
The framework and specifications identified in this document are intended primarily for use in cross-organisational contexts but some of the core principles and approaches may be applicable in an individual organisation or unit. Interoperability is one of the key factors that should guide the specification, development, acquisition, implementation and use of eHealth systems.
This document is intended to be read in conjunction with the eHealth Architecture Principles."
This is found here:
According to the release note it is no longer supported:
eHealth Interoperability Framework v1.0 is retired and will be supported through to 2 December 2013.
As a minor release to v1.0, eHealth Interoperability Framework v1.1 will be supported through to 2 December 2013.
To obtain support please contact
A planned review of the Framework in April 2014 does not seem to have happened so I have no idea where we are.
As for what the actual plan is - no idea? Does anyone else?


Anonymous said...

No-one should be surprised to learn that we are where we always were - nowhere.

Anonymous said...

A great example of how NEHTA has let the nation down, when they should have been investing in brain power to build on this work so as to be able to take the nation forward, they wasted the opportunity and now more than ever it will be a hard slog to get the pieces working. Who ever was running that part of the show is obviously a dimwit with the vision of a blind lab rat. I would guess there has also been many a victim during the past five years resulting in NEHTA being hamstrung with a reputational delemia, where it is not an attractive place for talented minds to come together and solve difficult problems.
I can only hope there are still a few working away in the background that can make a difference

Anonymous said...

Ask "The Head" of Architecture, and if he/she doesn't have an answer, ask his/her boss what on earth are they doing in that role??

Anonymous said...

Like Dilbert they will answer: "We are making a difference"