Good Heavens! It seems there is some sanity in the bureaucracy. Maybe they should act on their anonymous musings!
This was posted a few hours ago, but was so far down among the 32 comments I thought it was worth highlighting!
The original blog is here:
What very very interesting comments by Andrew McIntyre said... Tuesday, December 28, 2010 12:35:00 PM.
Hopefully they will be widely read and hopefully others equally well informed will support or counter these views.
I am not deeply enough involved in the issue to enter the argument but as a senior manager in health and heavily involved in setting directions and strategies for eHealth nationally I have to make my judgment calls on the advice of my 'techo' experts who each have their own biases and differences of opinion.
Having said that as I contemplate Andrew's comments I ask myself (a) will we ever get 'there'? (b) why aren't we drawing more on the expertise of people like Andrew with years of experience at the coalface? (c) how can I rely on the advice I am given by so-called 'experts' in my organisation who are relatively new to the field? (d) how can I better direct the large sums of money available to get better results and outcomes and working interoperable systems in the field?
Questions like these are at the forefront of my mind every day of the week - in short - are we approaching the problem the right way or should we be doing things differently and in what way?
Thank you Andrew for your very interesting comments.
This was in response to this post from Dr Andrew McIntyre.
Andrew McIntyre said...
While it is common for people from other parts of the IT industry to look for an xml solution I am not sure that xml solves much.
HL7V2 predates xml and its very terse and efficient and this can be an advantage wrt storage and latency and the data is much better being machine readable rather than human readable. HL7V2 is at least text and can be read by humans but I almost never do that.
The bigger problem is the modelling required once the encoding issue is dealt with and in reality this is 99% of the problem. HL7V3 was started in 1992 and HL7V3 messaging would have to be called a failure after 18 years of effort with no results. However HL7V2 continues to grow and prosper and can be enhanced to carry high level semantics in a backward compatible way and this is the path I still think is the most likely to succeed.
CDA is xml but offers little advantage over good HL7V2. You may not need to write a xml parser but the advantages mostly finish there and you just get a document and no messaging semantics, so it cannot replace V2 alone!!!
There is nothing that can't be done with HL7V2 done well and I think it’s the tortoise in this race. Its functionality is quite mature in many areas and combining it with Standards based Archetypes leads to a very solid solution that is backward compatible. The issue is that new people tend to read the V3 specs and ignore V2, and then deride it out of ignorance. It’s a solution that keeps growing while V3 is the playground of Ivory Tower Architects with virtually no implementations of V3 messaging that actually work on any scale.
And moments ago we had this devastating stuff from a senior ex-NEHTA employee who also sees the need for some pretty radical change:
Eric Browne said...
Anonymous of Friday, December 31 2010 9:12am asks a number of good questions at the forefront of his/her mind every day of the week.
If similar questions are reflective of the e-health management community more broadly, then I would contend that we have the wrong people making such decisions. Such decisions require a deep technical knowledge and considerable engineering knowledge and experience.
I think the principal reason why more isn't made of the experiences and knowledge of the likes of Andrew McIntyre is due to the closed nature of NEHTA. Instead of providing a forum where important technical approaches could be debated and evolve, we have had a situation, initiated under Reinecke, but continued under the present regime, whereby parts of the e-health infrastructure are developed behind closed doors and announced by decree, in the absence of a comprehensive and coherent strategy that can address all the missing pieces. And without a realistic timeframe and strategy for adoption.
There is clearly a shortage of technical skills in e-health in Australia and very little money is going into addressing this skills shortage.
As to the specific issue Andrew raises in support of HL7 v2, I would contend that both v2 and v3 have fundamental shortcomings that inhibit interoperability. In both cases, they rely extensively on external vocabularies to label nearly every data node in message or document. In the Australian messaging standards that have been produced to date, the vocabularies have not been satisfactorily agreed; the vocabularies that have been mandated (e.g. LOINC and SNOMED CT) have major shortcomings; there has been no adequate distribution mechanism established for incorporating and updating these in clinical systems; there has been no adequate conformance and accreditation regime put in place; very little attention has been given to developing agreed clinical models, to the point that there is NO STANDARD way of even representing blood pressure in HL7 v2 or V3.
In short, I think we should be doing things differently. And I, too, would welcome further views on the issues Andrew raises.
So what we have here are bureaucrats being advised by people they don’t trust and who they suspect are pushing very narrow barrows, while the real experts are just sidelined and disempowered.
Great isn’t it?
The present structures will never deliver and need to be changed. Additionally all the bureaucrats who are responsible for e-Health but are being bamboozled by 'techies' need to do something, and quickly, about their sources of advice. The inevitable failure of the PCEHR is not something that would look good on the resume!
Suggestions as to how that may be made to happen welcome.
Look out early in the new year for a blog highlighting the abysmal and now fully documented failure of the NSW HealtheLink project!