Implementation Really Matters!

In the article before this I wrote:

“A unifying flaw in all these documents is the lack of any reference implementations to confirm any of this is useful or valuable to even the minutest extent. Standards organisations have, I believe, a responsibility to prove what they propose works and can be successfully implemented before expecting it to be adopted. All this is a long way from passing that test.”

I feel this point is so important that it should be expanded upon.

Over the last decade or so we have seen the apparent emergence of a range of specifications in the Health IT area which have progressed through various standards processes and organisations but which have yet to achieve significant numbers of real-world implementations.

Major international examples include the original and later CEN/ISO EN13606, HL7 V3.0, openEHR, possibly SNOMED CT and I am sure there are others.

It is not clear just why these processes are so slow – but in part it must be related to issues of complexity, resourcing and other less obvious factors such as change management etc.

On the other side of the coin we have groups such as Integrating the Health Enterprise (IHE), the Object Management Group (OMG) and the Internet Engineering Task Force (IETF) whose processes emphasise that real world, fully scaled, implementation is vital to final acceptance of a standardisation proposal.

The practical implication of this stance is that theory does not get too far ahead of practice so that evolutionary, rather than revolutionary, change is achieved. Also, of critical importance in the health sector, is the fact that the intangible issues (user resistance, impracticality etc) and unanticipated consequences are recognised early and managed.

An invaluable model that brings together and demonstrates all these approaches is the Healthcare Services Specification Project (HSSP).

Details can be found at http://hssp.wikispaces.com/

In essence this project is bringing together health and hard technical skills in a planned way to deliver a set of web services which will powerfully enable and facilitate projects such as US National Health Information Infrastructure and Australia’s HealthConnect should it ever get properly off the ground.

A hallmark of the work being undertaken is the approach of developing Draft Standard(s) for Trial Use (DSTU). Only once it has been shown that the standard works as expected and achieves it stated goals does it become a formal standard.

Those interested should visit the following URL for a comprehensive range of explanations and information.

http://hssp.wikispaces.com/HSSP.Navigator

It seems clear to me that the structured engineering approach being adopted here is much more likely to solve the issues around having effective standardised solutions than the non-implementation and non ‘proof of concept’ focused approach being presently adopted by NEHTA.

I wonder how aligned NEHTA’s yet to be released technical detail in areas like identity and terminology services is to the HSSP Project?

The Health Informatics Association of Australia (HISA) is also to be congratulated for working to extend the practical approaches used by IHE into Australia. This step will also help to move Health IT from the theoretical into the operational phase in Australia.

Can I suggest we are only ever going to see significant progress in E-Health space when the discipline of real world implementation and operation is applied to the worryingly large number of current Health IT Standards proposals and specifications which seem to be overly complex and out of practical control.

David.