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Friday, April 15, 2011

Some thoughts for ONC Head Dr. Mostashari on IHE XDS for HIE

For most of you, this post qualifies as "preaching to the choir".  In this particular case, I hope I'm preaching to the Bishop.

The other day the new ONC Coordinator, Dr. Farzad Mostashari, spoke briefly with members of the HIMSS EHRA at the all-member call.  One of the things he said struck me:

One thing will not change [at ONC], and that is Listening.

The reason is struck me was that we had been discussing that very same topic the night before on the #HITsm tweetchat.  I do know that Dr. Mostashari is listening to some of us.  My evidence is his recognition of me at HIMSS by my twitter handle.  I'm pretty certain that Dr. Mostashari is lurking on twitter (I have that from a very good source that works with him).  I even DM'ed my source to tell Farzad to check the twitter/chat stream.  That particular statement appears to have been stated in a number of other places as well.

Another interesting comment he made was on ONC's emphasis.  They will be emphasizing patient engagement.  If you read further into the stream, you'll see that I made a similar suggestion.  Was I prescient and great minds simply think alike or was he listening and responding?  Either way, I'm happy to hear it.

We do have one point of disagreement, which on on how standards should be developed.  It's pretty clear from the way he answered my question about existing standards and innovation that he feels that if a standard is not gaining traction it is because it isn't ready.  Readiness of a standard requires three things:  A good standard, customer demand for what it provides, and the technology to implement it.  "If we build it they will come" is not a good reason to implement.  There must be demand for it.  For most organizations looking at adopting new features and standards, the demand needs to be apparent or the vision something that can be promoted.  Sometimes promotion of that vision, especially if the technology is novel needs time.  If you've been tracking healthcare technologies, you are probably familiar with the Gartner Hype Cycle.  Many items on the hype cycle spend at least a year in each phase -- at least when I look at Healthcare IT.

When we worked on what would become Cross Enterprise Document Sharing (XDS) for the joint IHE/HL7 demonstration, we saw a great deal of customer excitement about the possibilities, but the market barely even existed!  We knew it would take time.  Over the following years we've seen the explosion of eHealth and HIEs as a market, one that I heard being sized at over $12 billion annually (see previous link).  There have been a number of different technologies put into play, and large number of vendors across all different sizes with a wide variety of products.  Much of the technology is proprietary and doesn't work with other solutions.

The XDS family of standards does stand above the rest:

XDS is just exiting the first half the the Hype Cycle (now climbing the slope). Not every solution takes off virally like Direct.  In fact, in healthcare IT,  time frames have been quite different   Technology like the iPads (proprietary) and Direct (standards based) are exceptions rather than the rule.  I appreciate Dr. Mostashari's desire to change the adoption curve, and I too would like to see that change.  Where I remain concerned with is the assessment of readiness.  If we are nearly ready, but go back to reinvent the wheel, we could find ourselves back where we started.  We will also have lost a great deal of momentum and investment that the industry has built up around this particular solution.

So, if you are still listening Dr. Mostashari, I have a couple of follow-up question to ask: What would readiness look like?  How would you assess existing HIE standards against it?  What are the gaps?  Let's have a dialogue.

As a quick reminder, the opinions represented in this blog are my own, and not that of my employer or the respective standards organizations that I work with.


  1. What would be interesting to know is how many patients do these efforts currently have the potential for the exchange of information using XDS? How many facilities and clinicians, currently have access to this enabling technology? How many facilities are using XDS for interoperability? Not just within their organization, but between organizations.

    This type of information might help making the case for readiness for Dr. Mostashari.

    I would even ask the same questions of Direct. It looks viral, but no real metrics.