Monday, October 12, 2009

Is Thomas Beale Really Onto Something that NEHTA and Standards Australia Have Missed?

A week or so ago Dr Sam Heard of Ocean Informatics alerted me to the fact that the technical architectural lead of openEHR had started a blog to provide commentary on Health IT standards among a very diverse range of other things.

The blog can be found here:

http://wolandscat.net/

Tom describes his blog thus:

About

“Greetings. My real name is Thomas Beale. As a Leo, I naturally gravitate to cat-like personalities, and there is no better exemplar of such in the literary universe than Woland’s cat, Behemoth, from Mikhail Bulgakov’s ‘The Master and Margarita’.

I have some thoughts to share in various areas, ranging from my current domain of work (e-health standards, systems, and related technology) to philosophy (particularly of science), to linguistic and other amusements. Anything I say is meant in the spirit of debate, if not dialectic engagement, and no matter how controversial, is offered with the idea that we may still have a beer* together afterwards.”

What Tom is saying about Health IT Standards setting I believe is pretty important as he is a smart, well informed and pretty committed insider to all this.

In the two long posts he has put up so far there has been a lot of material. To let him speak for himself here is his summary of where he has got to.

The crisis in e-health standards II

In my last post I made three basic points:

  1. that the committee-based process used by official standards organisations is not designed to be used for standards development and will not generate the required outcomes in e-health;
  2. that the process of ‘choosing standards’ by governments (or anyone else) will not result in an integrated set of specifications on which widespread e-health interoperability can be based.
  3. a new way of producing standards for e-health is needed.

Although for most engineering and other technical people, these points are obvious, it is nevertheless reasonable to present some evidence.

And at the end of the same very long post he says the following.

Conclusions (so far)

What does the above teach us? I would suggest that the evidence is clear for my points at the top of the post: developing standards inside SDOs doesn’t work; choosing a selection of standards to create a generalised ecosystem doesn’t work, although carefully engineered ‘profiles’ can be made to work for specific use cases. From the above we can see some of the features needed of an organisation(s) that can try to solve the problem of a standards ecosystem for e-health.

To my many colleagues in this field, I will simply finish this post with a comment an Australian colleague made some years ago, when he told me he had stopped putting ‘with hope for progress BIR’ (before I retire) at the end of emails in his health organisation, and instead was putting ‘BID’.

In the next post I will look more closely at what might be needed to ‘really solve things’ in the future.

----- End Quotes.

Also mandatory reading is found in the comments to Tom’s first post found here:

http://wolandscat.net/2009/09/17/the-crisis-in-e-health-standards/

From my observation of the Australian and International Standards setting processes over the last decade or two I cannot but agree that there has to be a better way to get real working outcomes that serve the needs of patients and clinicians. We are simply not getting stable, clear, future proof standards available and implemented in anything like the time frames that are needed. This is not to blame anyone but more to say that the task is ‘brain snapingly’ hard and it is just possible the complexity is such that, at the level of achieving genuine interoperation and semantic preservation it might approach being just ‘too hard’.

As I believe I have said in the past – ‘If this stuff was reasonably easily doable it would have been done long since’ – and I still think that is right.

With the number of years it has taken for NEHTA to deliver much that is actually operational and useful, and the ongoing strain the workload from IT-14 is putting on the volunteers I cannot but agree we had better figure out a better way and quick.

I await with some anticipation the third post when we are to be told ‘what might be needed to ‘really solve things’ in the future’.

As to the solution to all this all I can do is quote another blogger (Paul Roemer) well out of context and say “Here’s where I leave my pay-grade and need your help to see if this dog (of a new paradigm) can hunt.”

See here:

http://healthcareitstrategy.com/2009/09/18/how-about-552446474061128648601600000/

When you consider how long it seems to have taken to have SNOMED CT, HL7, openEHR and others to have an impact compared with the standards developed by the W3C (the WWW Consortium) , IETF and OMG there is at least a prima facie case for a change in approach! One has to ask is it the problem we are trying to solve that is too difficult or the way we are going about it?

I can’t wait to see what Tom (and others) are able to come up with!

David.

1 comment:

Paul Roemer said...

A friend of mine from Ocean Informatics shared your post with me. It's a professional treat being included with Thomas Beale.

I spend a fair amount of time ranting about those who take a "What me worry?" attitude about healthcare IT and moving healthcare from a 0.2 business model to H2.0.

The clearest articulation I've read about the magnitude of the difficulty of the issue of developing HIT standards comes from Mr. Beale.

That we have more than one group developing standards means we don't even have a standards group.

Instead of throwing money at artificial ways of implementing a national EHR roll out, I suggest the government take several hundred million, mandate that the top few EHR vendors use the funds to retool their systems along a single standard, and then retrofit their installed base.

All the best from the states, Paul