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Thursday, September 23, 2010

How to effectively vote on standards in HL7 at the last minute

Voting on the HL7 ballots for this cycle close on Monday.  If you are like many, you may have left this important task to the last minute, or you may simply not know what to vote on, and may also be overwhelmed by the number of things to ballot on.  There are 31 different standards and implementation guides listed on the HL7 Ballot site which you might have been able to vote on.

If you hadn't signed up to vote for one of these by Monday, you can no longer do so, as the ballot voting pools closed on Monday after being open for 30 days.  But let's assume like me that you signed up for a dozen or more of these.  Also, let's assume that your day job has overtaken events, and you aren't able to get to the materials until the last minute.  How can you vote effectively?  Well, to be truly effective, you should start sooner, and delegate work to others in your organization.  But again, just in case you haven't, here are some strategies you can use.

Prioritize your efforts.  Each ballot has a "ballot level", which will begin with the letter
N - Normative Standard
D - Draft Standard
I - Informative Document
O - For Comment

Following that will be a number indicating the number of times the specification has been balloted at that level.  So, somthing that says N4 is in its fourth voting cycle to beccome a normative standard, whereas something that says N1 is at its first.

Normative standards have the most intense consensus requirements.  To pass ballot, 75% of the pool voting either yes or no must vote yes on the ballot.  Also, at least 60% of the pool must vote yes, no or abstain to reach quorum.  Normative standards are also the closest to being in a position to be driving requirements, so I pay attention to those first.

Next are Draft Standards for Trial use (DSTUs).  These require 60% of the yes/no voters in the poll must vote yes, and there is no quorum requirement.  DSTUs are drafts that are eventually intended to become standards later through a Normative ballot.  These will often be held stable in draft form while the Healthcare IT community experiments with them to see where the holes (if any are). 

The requirements for Informative documents are the same as for DSTU ballots, but these documents are expected to be completed afterwards, rather than being taken normative.  Informative documents are not standards as defined by HL7, but that won't stop Governments from requiring them to be used (e.g., the CCD specification is an Informative document).  DSTU vs. Informative is a toss-up, since they are about equal in stature.  I focus on normative track before informative track unless I have an expectation that something on the informative track will become defacto a standard as CCD has.

Finally, there are for comment only ballots intended to draw early comments and feedback.  If I'm in a time crunch, I save these for last.

Next, I prioritize in the categories by ballot topic.  If you don't have a clue between two topics as to which is more important, you can look at the digit following the ballot level.  Something at its first normative ballot is not as likely to pass as something in its fourth.  Again though, this is a rule of thumb, not an absolute.

Now, for everything that you signed up for that you know you won't get to, simply Abstain.  This is a courtesy as it helps the pool make quorum for normative ballots, and at least shows that you made an attempt.

Next, check the vote counts.  A ballot that is dead in the water is not really worth voting affirmative on.  Anything with more than 50% negatives almost certainly won't place and certainly needs work.  Also, negatives come in the voting cycle later than affirmatives, so anything even close to 50% is very likely to do worse not better.  Negative voters who want to kill a ballot also know that supporters of a particular ballot can often get additional affirmatives at the last minute by making some phone calls, so they wait until it is too late for them to do it before giving other voters information about the number of negatives they have to overcome.  However, a single substantive negative can be enough to kill a ballot, or at least delay it until calmer and more experienced heads can look at it.  So, don't take the approach that if it's going to pass and you think it shouldn't, but you don't have enough "votes" to make it fail that you should avoid making a negative comment.  All negatives must go through the reconcilliation, and if at the end there are still negatives, will at least an administrative round of voting wherein you can make your cases to the voters in the pool one last time.

Another reason to check the vote counts is to see who has already found problems with a ballot and what problems they have found.  If someone spots a particulary egregious problem, simply pile on, using their comment as yours and move on to review other areas.  If a balloter finds a number of problems and seems to have done a thorough job, vote negative, reference their comments in your vote and move on.  If neither of these cases appear, get to reading.  There are two or three different ways people do this. You can print out the materials, mark them up with pen, and then go back and write your comments, or you can read online, copy/paste content into the ballot spreadsheet, and make your notes there.  Sometimes it is enough to skim, other times you must scan in detail.  Your product requirements will drive how deeply you look.

This particular cycle is pretty uncontroversial, looking at the tallies, and I've already started my review, so hopefully I won't need to use any of these techniques. 

Now, if you've been engaged all along in the development efforts, and you are quite familiar with the content, or you've voted on this ballot the last three times and know it well, get those out of the way quickly.  The former will likely be affirmatives, and the latter, assuming you've reconciled with the committee will also likely be affirmatives (but give it one more look just to be sure).  If you haven't of course, you are probably going to submit the same comment as last time.  Look out for that one.  If that comment has already been addressed previously, it won't work, especially if the committee understands the rules.  Also, some documents will go out for ballot to address ONLY substantive change since the last cycle.  As a committee chair, I often recommend this approach because it means that content that made it through the last cycle is frozen, which simplifies for many and reduces the content that needs to be reviewed.

Back to the ballot for me.

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