informatics for efficiency

If the NHS is to save 4% a year for four years that means that there is a great deal to be done to improve the clarity of what is being asked for and what is being done - all of which will require better ways to manage and use information.
http://bbc.in/gMawYC

are precise semantics the top priority?

I have been getting increasingly uncomfortable with the assumption in interoperability standards work that we are working to acheive semantic interoperability.    Information systems need to be useful, and shared information needs to be well enough understood to do the job - written notes are not very precise, or universally understood/interpreted in the same way --  they are created when there is something useful to do with them.
I suggest that as we look at interoperability standards, we should not always be looking for global consistency across all of healthcare around the world, but looking for where there is a role for lingua-francas that will share enough information to be useful, with enough consistency and clarity to be useful.
This means far more focus on what the intended use is - and moving away from assuming that because it is information, it must be expressed in a way that can be understood by every machine and every clinician.
Greater clarity as to what the purpose of sharing the data is, will help to clarify both the business case for making it happen, and the rules and agreements around the appropriate uses of the information that is shared.

Standards promote commodity products

A recent report [1], [2]  by The Network for the Post Bureaucratic Age calls on the government to use commodity products and services wherever possible.  This will help to control costs, quality and responsiveness by encouraging platforms upon which commodity services can be sold.  The "Innovate, Leverage, Commoditise" model recommended proposes something beyond the NHS "Do once and share", as it recommends that small scale investments be encouraged, and successful reuse be tracked and promoted, within an overall open ecosystem.  This is consistent with a "fail early, fail often" approach encouraging small commodity innovations.  Those that do succeed can then be rolled out across the standard platforms.
This vision assumes that there is a network of standards providing the fabric for the platforms - so that successful products really can be rolled out.  That in turn is something that HL7UK, HL7 international  and the other standards bodies can contribute to.
The document assumes that open source is the key to success here.  That basis for that is not clear to me.  There is a strong case for commodity - but there also needs to be a business model that sustains the development and maintenance of the commodities.  Those business models should not be restricted to open source.

[1] http://bit.ly/exzhcN
[2] http://bit.ly/dJBxCm

dementia

Did you know that dementia is one of the three main causes of disability in later life, ahead of cancer, cardiovascular disease and stroke. One in three people over 65 will die with dementia.
http://alzheimers.org.uk/tv

what micro-credit has to teach Healthcare IT standards developers

The account by Muhammad Yunus of how he started the Grameen Bank has many lessons for those of us trying to improve health through the development and promotion of interoperability standards. 
Yunus saw a local problem - the need for small amounts of credit to get small businesses off the ground.  He devised a local solution that was repeatable, adaptable and scalable. 
Scalability is important because the local problem/opportunity that he saw is repeated everywhere, and the rapid growth of Grameen and similar micro-credit schemes has shown that the solution he developed could be replicated.
To better support the scalable use of IT in healthcare we need an information sharing framework that allows local projects and trust relationships to be quickly and easily established, with the information requirements easy to define and implement, yet consistent with broader national information needs, and using commodity information management tools as much as possible. 
The requirement to be able to develop implementation guides that work for local projects quickly and cheaply is vital to the successful uptake of interoperability standards - taking this as a core requirement will change the sort of standards that we develop, and help us to deliver something truely useful.

Specification Development Organisations need Strategic Methodology

Looking through the ITIL Service Strategy document it is clear that SDOs such as HL7 would greatly benefit from using the ITIL methodology to define and maintain a set of services that they deliver to their membership and other customers and stakeholders.  As a membership organisation that creates standards, HL7 has been delivering valuable services for years - but these have never been well defined, and their value has therefore not been demonstrated or managed.
Taking on such a methodology would also open up the interoperability space to those who work on delivering other services to support healthcare - who happen to be major stakeholders who will benefit from effective healthcare interoperability standards.
This is a critical part of broader stakeholder engagement by the Standards Development Community

Microsoft article on DSLs

An interesting article from the Microsoft site posted in Jan 2010 on the use of DSLs in C# -- a resource worth looking at when thinking about how this approach can be used to simplify the implementation of HL7.  Patterns in Practice - Internal Domain Specific Languages http://bit.ly/bYyhI5

Specifications available online

The availability of the HITSP specifications at http://bit.ly/9VOxGC is a great example of how  making the specifications freely available simplifies evaluation and adoption.  We need to establish a business model for SDOs that makes this an affordable norm for standards publication.

UK Deparatment of Health strategy on Global Health

The UK DoH strategy on Global Health is interesting in the priorities that it does identify, and those that are not mentioned.  There is no direct reference to the need for international healthcare information standards, but it does identify a set of strategic objectives that could usefully be compared with those of BSI-IST35, HL7UK and other UK health informatics groups that face outwards.  http://bit.ly/bV65eB

What does HL7 do?

When thinking about what HL7 does, what it is paid for, who gets the value, and who provides the resources, I have come up with the following headings for the things that HL7 does. 
The last two are delivered through meetings that are funded by registration and sponsorship, and through electronic services to members (telcons, website, mailing lists, newsletters etc).
The first three are far more interesting - while HL7 does create a lot of value in these areas, there is no real link between who pays for that value to be created, and who benefits from it.  Only recently has work stared to look at quantifying what the value is, who realises it, and how HL7 can capture a portion of that value for reinvestment.  Something for a future post...

The headings are:

•Publish and distribute standards

•Facilitate standards development

•Maintain a Specification Development Methodology

•Networking for healthcare interoperability and informatics business

•One stop shop for healthcare interoperability issues

Promoting standards

It is clear that writing standards is not enough - they need to be used, and to be easy to use.  That means they have to be easy to find, and easy to digest.  A great example of this is http://www.rfc3881.net/, a healthcare audit information standard.  The documentation is freely available, there is a summary table view that shows you quickly what information items need to be supported, and there is even a facebook link to help promote in social media.

Semantic Interoperability

As a phrase this "Semantic Interoperability" is charmingly incomprehensible and empty. 
The best definition of "Semantic" that I have found is "All that there is in language except syntax" (http://bit.ly/c44hvy).  This is a negative definition -- and so we are little better off than if we had just talked about language.  What we have done is lost the half of the audience who admit that they dont know what it means, and want to live a life without such complex vocabulary.  I suggest that wherever "semantics" is said "language" should be used instead
"Interoperability" really needs to be qualified to be clear what or who are interoperating, and to what end. While you can interoperate without language, you cannot use a language without interoperating (private languages being of doubtful utility).
So - those of us who have been saying that we are interested in "semantic interoperability" would do better to say that we are interested in "language" and be done with it.
Those of us interested in semantic interoperability of healthcare information between IT systems, would be better off saying that we are interested in "machine readable languages for healthcare".

Language Implementation Patterns

Having seen that HL7 specifications look and act very like Domain Specific Languages, it seemed sensible to look at the book "Language Implementation Patterns" by Terence Parr to see whether it could help with the implementation of healthcare interfaces.
After a quick scan things are looking positive - a discussion of language parsing strategies reminds me of discussions within HL7 on schema simplification.
The benefit of talking about languages rather than models is that languages ask to be used, whereas models ask to be understood. I am hopeful that the switch to talking about making useful languages will sidestep some of the rather religious discussions about modeling style.

Specifciations available on the internet

One of the lessons that I took from the quick dischage letter specification activity was that no specification stands alone -- there is always a need to reference underlying specifications. Where these are available online (ie within hyperlink range) it is FAR easier to provide something useful, and also to maintain and update the specifications and examples as they progress. This has refreshed my desire for standards specifications to be available online as this greatly increases their value. The challenge of seeing how some of that value can be captured by the Standards Development Organisations to cover their costs remains...