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). 

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