A few days ago I had an e-Mail from Professor Barry Smith letting me know about a new post on his HL7 Watch Blog.
I was pleased to see our recent discussions and comments got a substantial airing.
Saturday, March 26, 2011
The Australian Health Information Technology blog has posted here a valuable discussion of the item headed Cries for Help published earlier in these pages. This discussion is interesting not least because of the large number of contributions it contains which -- unusually -- are signed by their authors. It seems that, in Australia at least, there are individuals who are willing to commit themselves publicly to a critical position as concerns the HL7 project (where the vast majority of my US informants are willing to have their views communicated only anonymously).
As David More points out in his introduction to the discussion, the implementation success of V3 thus far (and this means after some 14 years of development work) "has been somewhat patchy, with at least some proponents scaling back their enthusiasm for full adoption of the V3 Standard as some see it is lacking the necessary robustness and internal consistency for ongoing use." Dr More goes on to point out that, "While I am not sufficiently across the details of some of this to be able to form a trustworthy opinion a number of very smart people I have chatted with have expressed similar concerns."
In a comment, Grahame Grieve writes on behalf of HL7:
There's no reason for anyone to be afraid to comment. HL7 is not a police state, and there's an endless list of people who criticise and carp. They can expect a vigorous in kind response, but nothing more.
v3/RIM is not perfect. But it's not intended to be an ontology of everything. If only Barry would understand. It's just a model that has some use for interoperability. It's got some go-down-with-the ship type supporters, of course.
As does v2 (and all the other standards - they all have the folks who are going to go down with the ship). It's not enough to say it's simpler. There's more to it than that. The discussion is being had elsewhere, and here is not the place for it. HL7 continues to produce v2 (v2.7 is coming) but the community that is HL7 is switching to v3 because of it's power.
v3 itself does have a patchy record. I'm on record as saying that there won't be another full v3 implementation. People will cherry pick the parts that work - like CDA - and use them as they want.
I've got more to say but it's starting to rain and I'm out in the bush camping. Have a good weekend."
Lots more here:
A correspondent on the blog offered all sorts of interesting and provocative comments that followed on from the initial excerpt I have provided and makes some interesting points that are well worth browsing.
As I was digesting all this I noticed that Dr Eric Browne has also been busy.
Fortunately, I’m now almost old enough to have forgotten the christmas pudding ritual – helping my father cut up the suet, spread out on sheets of newspaper on the dining room table. In those days, I was then already tall enough to also be able to peer down into the saucepan my mother used to boil clean the threepences and sixpences. And then when the pudding was finally mixed, it boiled away for hours and hours. The whole pudding making ritual seemed to take forever. All that effort for a minute morsel of pudding, that eventually arrived at the very end of an endless christmas lunch!
About this time last week, whilst reviewing the Australian Standards for pathology messaging, the smell of suet returned, reminding me of those yules of yesteryear. If, like me, your brain addles when presented with hundreds of acronyms squirming out from reams of paper, you may have some understanding of my state of mind. I really struggle when presented with bowls of suet that look something like this:-
(Apologies for the truncations!)
I thought that there had to be a better way for humans to deal with this – some easier way to interpret each arcane piece of HL7 v2 in context. I looked around, but could find nothing that met my requirements. So I have spent the past week writing an online message validator for Australian pathology messages. It is available at pathology.healthbase.info/hl7-test , and may be of some use to anyone dealing with pathology messaging, whether in the standards arena, or even if merely wanting to understand what some of the issues might be. There are a number of sample messages that can be explored. The validator also includes checking against LOINC and SNOMED terminologies.
I think it is important that such a piece of altruism gets due publicity.
Last we had a ‘Cri du Coeur’ from an obvious expert lamenting the difficulties of the implementation of messaging standards (among other things) most especially in the Lab sector - and just how much pain and effort this was costing all involved.
| 17 February 2011
At the heart of a modern Pathology laboratory is a complex set of Information Technology (IT) systems that are critical to its operation. Users are often frustrated and disappointed at the difficulties they experience when systems fail, when requesting changes or seeking new IT functionality. Having worked in a number of industries before coming to Healthcare four years ago, I have tried to make some sense of why IT is so hard in Pathology.
We’re talking normal, run of the mill Pathology, not bio-informatics databases, leading edge cell imaging or shiny, ground breaking test developments. So why is it so hard to get some seemingly simple functionality from your IT Department? Why do all those small things that would make life a bit easier turn into long, drawn out projects that are around so long they become part of the family?
I'm sitting here at my desk massaging my temples. As the IT Manager, I've been handed the unenviable task of replacing the Laboratory Information Management System (LIMS), a job that will earn me no awards, applause or praise. We already know from past experience that it will be a difficult and traumatic project for my team as well as the whole organisation. We will grapple with new technology, interfacing and new ways of performing old processes. And for all that, we are not even expecting new functionality. We are not alone in this dilemma. At this time the IT managers of major Pathology providers in NSW, VIC, SA and WA are actively investigating replacing their LIMS. Some to modernise and consolidate, others, like ourselves, as a result of a pullout from the Australian market by a significant LIMS vendor. None will get any major new functionality. It may be easier to maintain, interface or get better reports, but it is unlikely that any new pathology breakthroughs will come as a direct result of these efforts.
Pages more here:
We are now over $350 Million and six years into the NEHTA experiment and still all this basic infrastructure messaging is not even agreed let alone actually implemented and operational in the way NEHTA is suggesting is vital.
Now I make no claims to fully understand what has and is going on here, but one has to suspect the award of a ‘gold star and Koala stamp’ for good behaviour to those involved is very unlikely.
Again we all know it is not beyond the wit of man to sort this out. What it is beyond is a National E-Health Governance Framework that is deeply dysfunctional and simply a fiasco.
To be clear the lack of leadership, governance and pursuit of an agreed strategy is just killing us!
We need to sort all that out and then with good will the rest can be sorted. This simply won’t happen in the present environment.
I recently had an e-mail from a colleague analysing the current motivators of the various actors. It was put this way:
- DoHA – politics and money
- NeHTA – power and self-preservation
- SAI – cost mitigation
- IT14 members (volunteers) – compromise, consensus, stubbornness
Until we have a break out of common sense and rationality the current situation will persist I fear!