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Wednesday, July 13, 2011

Starting new Religion?

I spent some time yesterday on a call regarding yet another government agency's interest in interoperability in Healthcare IT.  It seems, with the advent of meaningful use, interconnected healthcare IT applications and devices, that Interoperability has become the new religion.  As with any new "fad", a lot of previously uninvolved organizations are trying to see how they can capitalize upon it and the existing stakeholders are looking at how they should do so also.

There are a few things that I would hope by now we all realize, but they bear repeating, because quite honestly, I don't think some of the newcomers are aware of this yet.

  1. The industry doesn't need another definition of interoperability.  There is a standard one (actually several).  If your organization doesn't know what it is, it should definitely reconsider getting involved in a leadership position, because it hasn't been paying attention.
  2. The industry doesn't need another organization in the US to work under (unless it is an umbrella organization like the Canadian Standards Collaborative).  On the International front, there is already the Joint Initiative Council
  3. There are already more initiatives than any one person can reasonably keep track of.  If you cannot fit what you are trying to do in one of the existing initiatives, see what can be done to change that with the organizations sponsoring the existing work.  Many of them provide opportunities to create projects, including HL7 and IHE which are pretty easy to initiate.  You just need to find the right champions.
  4. In healthcare IT, the number of "experts" in the field is pretty limited (and thus, so is bandwidth).  This is evidenced by how you see most of the same faces over and over again at Healthcare IT standards (and related) meetings.  It's a pretty tight community, and most of us are connected either directly or indirectly through just a few hops.  Little goes on that we don't find out about pretty quickly.  The number of little birds that tweet (or mail, or plus, or call or ...) about this stuff just makes it impossible to keep anything under wraps for too very long.
Some strategies to think about for newcomers into Healthcare Standards:

  • Partner with existing players in the space.  Find out who they are and what they are doing.
  • Do some research and find the thought leaders already in the space.  Get them engaged and through them, get your projects moving forward. If you don't know who to ask, ask me.
  • Don't be afraid to enter into the development process with existing organizations.  If you truly have leadership potential, you will soon find yourself in that position. 
  • If you have critiques about the organization, share them directly with thought leaders in that organization in a constructive fashion.

Some strategies to think about for the existing stakeholders (e.g., IHE, DICOM, HL7, ASTM ...)

  • When you hear about a new "initiative", engage (and encourage them to engage) in a way that takes advantage of existing organizations, processes and expertise.
  • Be ready, willing and able to form coalitions with other organizations, and to engage with them in ways that meet their needs.
  • Listen to outside criticism, whether it is constructive or not (organizations that don't listen to criticism eventually don't survive).

Forming a new initiative is costly in time and effort.  You need to develop processes, governance, and infrastructure to make it work.  It takes time to develop these, and that's time that could be better spent solving the real problems. Starting a new project under already well established processes and governance with an organization that has the infrastructure to make it work is much easier, and you will find a ready pool of engaged volunteers from which to draw expertise.


  1. Amen! (This is a post about religion, right?)

    We don't need more initiatives. We need to make the existing plethora of initiatives (federal-level, state-level, SDO-level, etc.) work better.

    "There are already more initiatives than any one person can reasonably keep track of." I would go a step further to say "there are already more initiatives than most ORGANIZATIONS can reasonably keep track of" even large companies with multiple people involved in interoperability efforts. Each initiative typically spawns many parallel workgroups each meeting weekly with its own set of homework, etc. From being involved, I have observed that the coordinators struggle valiantly to get the participation (reading the materials, participating in votes) of those who have signed up, and it's a constant struggle. That indicates the already overloaded state of affairs.

    ONC S&I Framework was not really an "additional" replacement in that it replaced the void left by HITSP's discontinuance, and I think that the "standards harmonization" effort did need to occur through an open process that was not beholden to any one SDO. So there was subtraction of HITSP and addition of S&I. Admittedly, S&I goes well beyond HITSP in its inclusion of pilots and reference implementation (open source code).

    But if there are yet other initiatives being proposed, then I have trouble seeing how further piling on is going to be helpful to the industry. Let's do a few focused things well rather than many things poorly.


  2. you writing is so impressive but the concept about start new religion its not practical
    its too difficult for work