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Wednesday, December 2, 2009

A Canadian Perspective on Standards Harmonization

Today I have a special guest post from Mike Nusbaum.  Mike's a great guy and knows quite a bit about participating in multiple standards organizations.  He has been in leadership positions to my knowledge in ISO TC-215, HL7 and IHE, and also facilitates and writes for ANSI/HITSP here in the US.  Mike helped establish the Canadian framework for standards harmonization, and I asked him to write a guest post on the topic.  Here's Mike:

Guest contribution by: Michael Nusbaum, BASc, MHSA, FHIMSS
(a Canadian healthcare IT consultant who also works with HITSP in the US)
A Canadian Perspective on Standards Harmonization
As the US health reform freight train continues to roar down the tracks, the IT standards imperative becomes increasingly critical.  The government's well-funded priority to stimulate reform through the establishment of an interoperable nationwide health information network (NHIN) has put incredible pressure on standards harmonization activities over the past 6 months. Clearly, interoperability is achieved through the implementation and use of standards, and funding directed towards state and regional health information exchange (HIE) initiatives is contingent upon the adoption of those standards within all stakeholder communities.

Keith has written extensively in the blog about the fractured system of standards development and maintenance in the US, and despite incredible progress over the past 3 years towards harmonization, there is still so much to be done. Standards, of course, must be developed and used in a global context, as no one country [not to mention a large multi-national vendor community] can afford to tackle this alone.  That's why standards organizations like ISO/TC215, IHE, HL7, IHTSDO and others are all focussed internationally, while required to co-exist and link to initiatives being undertaken domestically (ANSI/HITSP, CCHIT, US/TAG, etc.).  In the US, there is no "umbrella" to formally coordinate domestic and international efforts.

As a Canadian who is also working extensively in the US healthcare IT community, I have had a unique opportunity to become involved in the governance and management of standards development/maintenance in both countries.  While I normally stay quiet on Canadian successes (and failures) with my US colleagues (respecting the need of each country to undertake their own voyage of discovery), there has been a recent flurry of enquiries asking the question "how does Canada do that?".  One of these enquiries recently came from Keith, who asked me to respond to his recent Call to Action posted to his blog last summer, describing the need for the US to not only harmonize standards development, maintenance, certification, vocabularies and implementation support... but to also harmonize governance through the establishment of some kind of "national organization".

[OK, here it comes...]  In fact, Canada has done exactly this, with the establishment of the Standards
that operates under the custodianship of Canada Health Infoway (the not-for-profit corporation that has been empowered by Canada's federal and provincial governments to coordinate and fund e-health initiatives). I was fortunate to have worked with Infoway a few years ago on a consulting contract, and was one of the team that developed and implemented the Standards Collaborative.  At the time, it was a radical concept to bring together all standards organizations operating in Canada, and link these to the standards development/maintenance activities that were being undertaken by Infoway to facilitate the interoperability of the national EHR "infostructure".  Now, some 4 years later, the Standards Collaborative has proven to be a model that has really worked well towards harmonizing standards (and by extension, interoperability) activities in Canada.

I won't repeat all the information that can easily be found online (e.g. see this fact sheet), except to say that just about all of the former, fragmented, standards organizations and initiatives have been brought under the Standards Collaborative "umbrella", which now includes HL7-Canada, ISO/TC215 Canadian Advisory Committee, IHTSDO liaison, DICOM liaison... and soon to be IHE-Canada).  Each of these "constituencies" operate in concert with one another, and while governance is harmonized, each constituency has a "head of delegation" supported by a SIG-like interest group.  The big benefit is the communication and harmonization between all of these initiatives, as well as a cohesive Canadian presence both internationally as well as domestically.  The "clients" (jurisdictions, health authorities and vendors) find this consolidation to have removed one of the most significant barriers towards the adoption of standards and the implementation of interoperability.

Would this work in the US?  Definitely.  However there must be amassed a significant and trusted leadership (like Infoway has done in Canada), together with a fair amount of political will (which ONC is in a good position to provide, I expect).

As I continue to monitor the evolution of the healthcare IT reform agendas in both countries, I will most certainly respond to any questions (like Keith's request) that foster more synergy between the US and Canada.  Those of you who were able to attend the recent Canada-US "HIE Summit" in Philadelphia were able to observe first-hand the tremendous bi-lateral potential of such synergy.  I remain optimistic.  If anyone is interested in an offline conversation about this, you can contact me at

Thanks for the opportunity to weigh in on this, Keith!!

-- You are welcome Mike, and thanks for taking time to do it!