Monday, May 13, 2019

Terminology Drift in Standards Development Organizations

I used to work for a company that published dictionaries, and one of my colleagues was a dictionary editor.  As he related to me, the definition of a term doesn't come from a dictionary, but rather from use.  A dictionary editor's job is to keep faithful track of that use and report it effectively.  By documenting the use, one can hope to ensure consistent future use, but languages evolve, and the English language evolves more than many.  I've talked about this many times on this blog.

It also happens to be the common language of most standards development organizations in Health IT (of course, I, as an English speaker, would say that, but the research also reflects that fact).

The evolution of special terms and phrases in standards is a particular challenge not only to standards developers, but especially to standards implementers.  As I look through IHE profiles (with a deep understanding of IHE History), I think on phrases such as "Health Information Exchange", "XDS Affinity Domain", and "Community", which in IHE parlance, all mean essentially the same thing at the conceptual level that most implementers operate at.

This is an artifact of Rishel's law: "When you change the consensus community, you change the consensus" (I first heard it quoted here, and haven't been able to find any earlier source, so I named it after Wes).

As time changes, our understanding of things change, and that change affects the consensus, even if the people in the consensus group aren't changed, their understanding is, and so the definition has changed.

We started with "Health Information Exchange", which is a general term we all understood (oh so long ago).  But then, we had this concept of a thing that was the exchange that had to be configured, and that configuration needed to be associated with XDS.  Branding might have been some part of the consideration, but I don't think it was the primary concern, I think the need to include XDS in the name of the configuration simply came out of the fact that XDS was what we were working on.  So we came up with the noun phrase "XDS Affinity Domain Configuration", which as a noun phrase parses into a "thing's" configuration, and which led to the creation of the noun phrase "XDS Affinity Domain" (or perhaps we went the other way and started with that phrase and tacked configuration onto it).  I can't recall. I'll claim it was Charles' fault, and I'm probably not misremembering that part.  Charles does branding automatically without necessarily thinking about it.  I just manage to do it accidentally.

In any case, we have this term XDS Affinity Domain Configuration, which generally means the configuration associated with an XDS Affinity Domain, which generally means some part of the governance associated with a Health Information Exchange using XDS as a backbone.

And then we created XCA later, and had to explain things in terms of communities, because XCA was named Cross Community Access rather than Cross Domain Access.  And so now Affinity Domain became equivilated (yeah, that's a word) with Community.

And now, in the US, we have a formal definition for health information network as the noun to use in favor of how we were using health information exchange more than a decade and a half ago (yes, it was really that long).

So, how's a guy to explain all this means the same thing (generally) to someone who is new to all this stuff, and hasn't lived through the history, and without delving into the specialized details of where it came from and why?  I'm going to have to figure this out.  This particular problem is specific to IHE but I could point to other examples in HL7, ISO, ASTM and OpenEHR.

The solution it would seem, would be to hire a dictionary editor.  Not having a grounding in our terminology would be a plus, but the problem there is that we'd a need a new one periodically as they learned too much and became less useful.



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