convergence of formal standards and search engine optimization

Formal healthcare information standards organisations are always working to engage effectively with the communities that they serve, and also to discover where their standards are being used, and what issues are being encountered.  Standards that work and meet a need are successful, but it is often hard to discover how to improve specifications that have not got traction. 

Standards Organisations excel at establishing clear definitions, and providing frameworks and specifications against which conformance can be asserted, and which can be included by reference in contracts.  Crucially they also provide a forum where those specifications can be discussed and issues resolved at arms length from the contracts that depend upon them.

Search Engine Optimization (SEO) is the rapidly growing profession of presenting data on the web in a way that results in appropriate placement in search results.  Here there is no problem with engagement - those following "best practice" get to the top for the search terms that they care about.  The process is policed by a combination of published rules and private algorithms, both controlled by commercial search engine organisations, who are in turn motivated (controlled) by commercial drivers to attract and retain users, advertisers, and other revenue streams.

While SEO practitioners do not care about the precise definition of the terms that they are optimising for, they do care about which terms effectively express the relevance of their sites, and which terms the potential users and customers of that site will use.  There is a virtuous circle here of users looking for information that meets their needs, site maintainers making their sites easier to find, policed by the search engine companies and their algorithms who are looking to maximise successful search experiences for their customers.  The search engine companies provide tools to site maintainers to help them improve the relevant ranking of sites - and the site maintainers have business reasons to use these.  There is not the same strong feedback loop in the development of formal standards.

Similar searches are done within organisations using business intelligence engines to extract management and marketing information from the raw data that the organisation holds or has access to.  Here some of the data may have been created for human readers, but much will also have been created conforming to specifications or standards that enable machine processing, albeit not necessarily for the purposes of business intelligence.  This is often transactional data, and changing it requires changes to the workflow processes and the information systems that support them - which is very different to changing the way that websites are structured and populated.  However those of us interested in translational research and innovation in healthcare need to learn from the drivers that are effecting large-scale change in the way that the web looks and functions.

Childish Simplicity

The recent post by Keith Boone suggesting that healthcare information topics should be taught in schools is part of a wider recognition that healthcare IT is far too insular.  We certainly do need to make healthcare information topics available in schools - partly because its useful stuff to understand, and partly because its interesting and challenging.
Another way of doing this that I have been looking at is joining healthcare IT project outreach activities with providing material for existing school courses.  The idea would be to provide "background" material for exercises and coursework that could be used in existing lessons.  What is clear is that the benefits would flow in both directions - more interesting materials for schools, and better public engagement by the healthcare services.  The background material may not be used directly in the classroom, but could be taken home ans shared with the family - this is a well established way to get effective public information out.

Cleaning up the HIT environment: Reduce, Reuse, Recycle

"Reduce, Reuse, Recycle" is a mantra that works for the environment, but how does it play out in the healthcare IT ecosystem? 

Reduce: Stopping the routine collection of needless information has resulted in significant savings in cost, time and frustration.  This requires active review of information flows and uses, but is a very low cost and low risk way to improve things.  It also creates the goodwill and confidence that will sustain other change initiatives.   Focusing on specific Collaborations where information needs to be shared for a particular purpose is also a way to avoid the collection of precise data when something simpler is good enough.
Reuse: Finding ways to reuse existing information systems and infrastructure rather than assuming that it must be replaced makes sense.  This applies to software and networks, but it also applies to paper forms and processes.  Using architectural frameworks and standards-based interfaces to support incremental change, and a collaboration-based strategy that focuses on the human and systems issues that support specific collaborations allows for strategic improvements to be introduced with minimal change.  
Change management is hard - leveraging the reuse of infrastructure, processes, skills and ideas is a good way to increase the benefit:change ratio - and so the return on expensive and risky change management effort.
Recycle:  Healthcare data is full of "toxic" confidential information that prevents it being made available for purposes other that those for which it was collected.  However we get value out of scrap metal and glass by dramatically denaturing it and throwing away much of the structure that was painstakingly designed in for the initial use.  We should be getting value out of de-identified healthcare data.   Some recycling is better than none - so even if much of the semantic value has to be lost to avoid perceived or actual risks to confidentiality - in the interests of health we should be recycling more.  The next step will be to make our healthcare data more recyclable in the first place, just as has been done with physical packaging.  How to promote recyclable healthcare information is a topic for another day.

There is nothing new or radical in this post - other than reusing an idea from one area where widescale and dramatic change is needed (the environment), and applying it to another (health).