The following blog has just been published and makes some good and wise points.
eHealth – What is going wrong?
It’s clear that I am not a fan of Australia’s attempts to progress eHealth. It’s probably time to look at some details. The devil is in the details after all.
The first basic error of HealthConnect and NEHTA Mark 1 & 2 is a violation of a principle that I think is very important in this field. This comment from “Joel on Software” relates to Netscape’s decision to rewrite Netscape Navigator from scratch. The full post is worth a read and is available here
“making the single worst strategic mistake that any software company can make:
They decided to rewrite the code from scratch.”
This error has been repeated again and again by every NEHTA clone in the last 10 years. Despite declarations that Australia has decided on using HL7 V2 on several occasions, attempts have been made to “roll our own” standard. This has of course failed again and again but this lesson is continually forgotten. Even the UK NHS backed up with 30 Billion pounds and a draft HL7 V3 standard has failed dismally to achieve this and its time we decided to use what’s in place, proven and tried to improve the quality of implementations rather than somehow develop something new.
The fact is the HL7 V2 standards have been proven to work for a large variety of the indications we desperately need and there is actual support out there in existing local and international applications. The support may not be perfect but it’s a base to build on. The fact that its 20+ years old is often used against it, but code does not rust in my experience and something that’s been refined over 20 years is likely to be a far better bet than something shiny and new that has never been proven to work. Its ugly in places and has all the warts and battle scars of a standard that was, and never will be perfect, but has been proven in battle. This same idea of avoiding a rewrite from scratch is a lesson that HL7 has learned the hard way with HL7 V3, which despite good intentions and much work fails to be a viable replacement for HL7 V2 after 10+ years of work.
NEHTA, not having any real expertise in HL7 V2, have a blind spot to what is actually working in the landscape and how it works and treat the existing messages as some sort of “blob” and as a result fail to understand that the important business processes of healthcare are deeply embedded and supported in HL7 V2. Ignorant of this they have wasted precious resources in re-engineering the business processes in services that have come and gone and never been used in anger. These services were to use HL7 V2 but the details of this “blob” content was never understood and the defence was that the people they talk to didn’t want to use HL7 as they did not understand it. I assert that this is the problem. HL7 V2 supports the business processes in a proven manner, often in far more detail than these first draft services could ever hope to achieve. Overlaying 20 year old proven HL7 V2 services with naive first draft services that often conflict and overlap with the actual message is not a recipe for success. HL7 V2 needs only one service, and that’s a security wrapper to allow secure authenticated transmission. Duplicating a small percentage of the richness in the service only creates confusion. What do you believe the payload or the wrapper? The payload has been refined in over 20 years of real use and lack of understanding of the payload is not an adequate defence for producing a pale imitation of it.
The full, even more comprehensive and longer blog is here:
http://blog.medical-objects.com.au/?p=57
Read it carefully. There is some sensible commentary here and I want to make sure all can see and comment if they feel the need.
David.
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