Tuesday, December 21, 2010

And Now For an Interesting Point of View on E-Health Standards. Tom Beale Ruminates!

Thomas Beale let me know he had posted a new piece today.

Ruminations on ‘design’ in e-health

I have often bemoaned the state of standards for the e-health sector. Earlier posts provide details. The main argument is that the key specifications the sector needs are for interoperable data, information and knowledge, but that the main approach to getting these is via standards agencies, whose processes almost guarantee failure. Hence the ‘standards crisis’ in health informatics. The failure is not innate in standards agencies as such; it is just that standards agency committees in the e-health sector are doing the wrong thing. They are acting as de facto R&D fora rather than as a choosing mechanism on proven designs from industry. In my view (and experience) this is because among the members and leaders of those committees are almost no engineers, i.e. people who understand a) how standards actually work in other industries and b) that design is an essential element of what is being standardised. The consequence of the situation in e-health standards is ‘design-by-committee’.

Read the full blog post here:


The full post is well worth a browse.

The paragraph I have italicised I have to say I have an especial fondness for. If only we could be developing Standards on the basis of proven implementations I have the feeling we might have a smaller collection of Standards, but that collection would be trustworthy and reliable.

As some other sites often finish a post.

What do you think?


1 comment:

Hercules said...

I think Thomas raises some very good points. We have worked in Australia for many years on "standardisation", and for an organisation such as NEHTA to come along and present a "solution" by creating "new" standards is both as ludicrous as it is insulting.

When I look around the world I see a whole load of work that has been done which we could reuse in Australia. Why on earth do we need to spend time and effort re-creating what already exists? (either Home or Away!)

Down here in South Australia, we have some pretty rich, standards based functionality already in place, and we do constantly innovate more. We do this by working out WHAT it is we want to achieve, looking at the various mechanisms of HOW to do it, choosing one (and it's not always the best one in retrospect) and getting on with it. If we make a mistake, we fix it later, rather than looking for an academic purity which is simply unobtainable in the real world. We've learnt from the various professional services organisations we have engaged over the years and seem to have a pretty good approach for delivering working products.

Why doesn't DoHA take over this defining of WHAT, ask the wider Health IT industry HOW do it using NEHTA standards that have been produced / decided upon to date. Commission several of the professional services providers to build this federated PCEHR "model" that NEHTA have (at a very high level) defined. Get the professional services companies to iron out the wrinkles of the HOW based upon WHAT we want to achieve. Then NEHTA can simply act as the operational body that holds the "solutions" once they have been produced. Yes, it will mean some change in direction for NEHTA, but it should be apparent after so long that delivering really isn't what they are good at. If they start changing now, then by the time the solutions are built then they might be able to operate them.