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Wednesday, September 7, 2011

The Pace of Query Health

I'm still on the Query Health technical call.  It is very clear that there is a push from on high to move Query Health full speed ahead.  They want the project charter,  requirements, and use cases done by the end of the month.

Never mind that:

  • Next week begins the HL7 Plenary meeting where many folks involved will be attending.  
  • Our first work group calls were today
  • Work group calls were pre-scheduled without any regard to the participant's calendars.  
  • Or the conflicts between of the summer concert series and the CDC Public Health Informatics conference.

I've talked a lot about work group development processes.  The number of times that I've linked to this article is escalating.  Work groups need time to get started, to form and storm, and figure out what they are going to do.  Expecting them to generate a charter, use case and requirements in three weeks is a bit extreme, especially given that there are other healthcare standards activities happening that overlap.

Yes, there is a lot of material already supplied.  In fact, I applaud ONC for making them available.  But the volume is overwhelming, and spending some time getting us all on the same page would be very useful.  If you want original ideas, people need time to get acclimated to the work groups and to start participating.  Strawmen are good, but the work group needs to be in a place where they feel comfortable throwing tomatoes (or stones) at them to improve them.

This is really interesting project, but I'm very concerned that we are moving extremely fast, and that syncing up will really cost us later.  The technical work group will clearly need review use cases drafted by the clinical work group before they can cut their teeth on requirements.  Starting too soon on requirements will involve a good bit of rework.

There are a lot of technical decisions that the project team have referred to, but the technical work group hasn't yet bought into the publish-subscribe model.  It may in fact be the right model, but without having had the same background as the project team, they aren't ready to agree to that.  In fact, two points made in the kick-off meeting are that the summer concert projects described are mostly supported by organizations with healthy IT resources, and that publish-subscribe would seem to require more infrastructure.  It may well be for large IT, publish-subscribe is the right model, but for other smaller provider organizations, a different model is better.  It really is to early to tell.

ONC has used the phrase Do-ocracy so many times (perhaps even overused).  They've also talked about the fact that these efforts are designed to support participation by the "little guy".  The real challenge of deadlines like this is that the volunteer expertise is already out there "doing"; keeping businesses, healthcare IT projects, and healthcare in general going.   Unless you are backed by an organization with the resources to commit to several hours of calls and activities, it's very difficult to DO at this pace.

One thing that I am very glad about is that the work groups will be able to take advantage of face to face time early in the project.  There will be an SI Framework face to face meeting mid-October.  That kind of meeting does quite a bit to help work groups get through the forming and storming process.  The effectiveness of the TOC Work groups after the last face to face increased greatly after it occurred.