Convert your FHIR JSON -> XML and back here. The CDA Book is sometimes listed for Kindle here and it is also SHIPPING from Amazon! See here for Errata.

Saturday, November 30, 2013

Connecting Standards with Academia

I've been outside of academia for most of my career (although that changed recently).  One of my complaints about "academics" is that they are disconnected to some degree from the implementation work that goes on in the real world.  In my own classwork, I find that some of the value I bring to the classroom is that implementation work (with standards for me), and that is also true of many of the students who have been in the field (on other topics) that I'm studying with (be they healthcare professionals or Health IT geeks like me).

In retrospect, I've probably been a bit to hard on "academics" in general (but probably not in specific).

The challenges are interesting.  Academics are interested in developing knowledge.  Standards geeks are interested in taking existing knowledge and producing standard ways of doing things with it.  It's the innovation vs. standards juxtaposition all over again.  Good software developers are trained to reuse or build on existing work.  Academics are too.  However, what is missing here is the intersection of knowledge spaces so that Academics can discover what is going on in Health IT standards development (but not so much in the reverse, as there are enough academics involved in standards development that we get that input).  I think the challenge is that there aren't enough standards geeks in academia for the necessary cross-fertilization of information.

This has been a perennial challenge for standards organizations like HL7 and IHE for quite some time.  ISO seems to be a bit less challenged here, but then, I also find ISO standards to be somewhat less influential in the implementation space, more so in the process space.

Where do academics go for information? Academic journals. Yet, when I search PUBMED for recent articles related to standards implementation, I have a hard time finding them if I don't already know the name of the standard.  They don't naturally float to the top even when you include the term "standard" in the search and use appropriate terms to find them.  In looking through the various ways I could search, I don't find an easy way for these articles (few as they are) to show up where they might be relevant.  Compare this search targeted to find CDA or like standards, with this one that does much better.  You basically have to know who creates Health IT standards to find them.  Otherwise, those books simply aren't in their library.

The literature on standards is certainly lacking (see these searches related to CDA, QRDA and HQMF), but there is also no way to even give it some prominence in the search should someone even have interest in the topic of health IT standards.  It's like going to the automotive parts store and being told that you need the part number in order to get the part, but all you have is a description of it.  It might actually be helpful to add the standards to PUBMED, and to classify them and articles about them in MeSH in a way that makes them more accessible to people who might benefit from that knowledge.

Thanks to Bill Hersh for making me think about this a bit differently, and to Aaron for making me do some work that got me to analyze the issue.


  1. Keith - I enjoy reading your blog posts and tweets about class. This is a nice post, and I can't resist making some comments.

    I do understand the tension between academia and the "real world." I am glad you recognize the need for both. Even though I am firmly entrenched in the former, I try my best to immerse myself in the latter. I don't occupy an ivory tower.

    I am less worried that there is not much content on standards in Pubmed. As you know, Pubmed is a search system focused on the scientific literature of biomedicine (including informatics). Maybe it can do better with standards, such as adding their names to MeSH, but the reality is that if you really want information about implementing standards, you would not go to the scientific research literature. (Though maybe as they are evaluated and/or used for clinical advances, they will show up more there.)

    But the best sources for standards are in sources like reports, tutorials, implementation manuals, etc., and of course your blog. :-) Those are certainly the places I go to get information for my teaching about them. Also, of course, articles written about them will show up in full-text search engines (such as Google, or even Google Scholar, which you may also want to evaluate as a source).

    Finally, I do hope we get more standards geeks in academia, especially those who can incorporate the lessons learned i the trenches into their academic activity.

  2. There is a challenge to including abbreviated names of standards (e.g. CDA, ORDA, HQMF) in MeSH, which would allow indexing of related articles, leading to simpler retrieval in PubMed. The challenge is that short acronyms are in general ambiguous, and for that reason are not included in MeSH.

    These searches, developed by one of our medical librarians, may be helpful:

    Health it standards
    searches in PubMed as: ("health"[MeSH Terms] OR "health"[All Fields]) AND ("standards"[Subheading] OR "standards"[All Fields] OR "reference standards"[MeSH Terms] OR ("reference"[All Fields] AND "standards"[All Fields]) OR "reference standards"[All Fields])

    Searches in PubMed as: ("biomedical technology"[MeSH Terms] OR ("biomedical"[All Fields] AND "technology"[All Fields]) OR "biomedical technology"[All Fields] OR ("health"[All Fields] AND "technology"[All Fields]) OR "health technology"[All Fields]) AND ("standards"[Subheading] OR "standards"[All Fields] OR "reference standards"[MeSH Terms] OR ("reference"[All Fields] AND "standards"[All Fields]) OR "reference standards"[All Fields])

    health/standards AND (cda OR orda OR hqmf)
    searches in PubMed as: "health/standards"[Mesh Terms] AND (cda[All Fields] OR orda[All Fields] OR hqmf[All Fields])