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.

Tuesday, February 18, 2014

Your Highest Priority doesn't even Hit my Radar Screen

Sometimes I run into someone, or read something about how someone says that XYZ is a problem, and we should fix that, and if only we made every ___ do it this way, the problem would be solved, and think of all the money that would be saved.

Except that while XYZ is a problem, it isn't a priority for me.  I've got a ton of problems, and XYZ isn't one of them.  It affects 1/10 of one percent of the smallest group of activities that my customers engage in, or I ever need to deal with.  And, yes, in that very small set of cases, there's an improvement that could be made.  But it will cost you some number of $$$ or resources, or time and effort.  And those same $$$ or resources or time and effort are something that won't be spent on higher priority issues that my stakeholders really care about.

I could wish that we could keep agency X's agenda from agency Y's rule making process.  Health care touches everyone, but that doesn't mean it should be a slave to everyone's agendas.  Remember the purpose, it's actually in the two words: Health Care.  It's not primarily about law enforcement, taxes, fraud, abuse, education, the military, veterans, education, or any other special issue.

When your special issue has a priority that affects health care, such that the value of the special issue is greater than the impact trying to squeeze that into the development of systems for health care, then it will pop up on my radar screen and make sense to apply myself to it.

I think the only way to make it apparent is to create a real prioritization process, where someone can assess a) the value of an intervention to its stakeholders, b) the cost of it to the implementers, and c) the value of that same intervention to those who must use it.  When c) exceeds b), it should be considered.  I don't care how big the value is to you, if isn't worth it to my customers, it probably isn't valuable to me either.  When a) exceeds b), but c) is too small, consider sharing some of a) with those who do b) and it might, just might become worth doing, and hit my radar screen again.

Until then, please save me from somebody else's priorities.


  1. The person who pays your $$$ sets the priorities. 2 corollaries:
    * The only way to saved from somebody else's priorities is to pay yourself
    * if someone else wants to make something your priority, they should be prepared to consider the $$ question. In standards, too many people aren't

  2. This does not apply to political processes, which are strongly influenced by factors that often have little to do with cost:benefit of stakeholders. Appeasement of those who have little practical knowledge and/or minimal direct stake seems to be the norm.