Wednesday, October 29, 2008

Random thoughts on Vocabulary

I've had all to many and numerous discussions regarding vocabulary over the last week, some related to "terminology standards", others to "definitions of terms" , and yet others to how we think.

Over the course of the last few weeks, here are some of the random observations that I have related to the topic:

1. Implementation guides for financial transactions seem to include all vocabulary choices necessary for implementation. Clearly if $ are involved, specifications need to be implementable, and a few organizations have figured out how to ensure that.

2. This simple idea could be very useful: Instead of "creating and maintaining" specific Federal vocabularies that are simply flat or simple hierarchical value sets, why wouldn't Federal agencies:
a. Work with appropriate SDO's to ensure that vocabulary terms necessary for Federal specifications are present with appropriate hierarchies in these vocabularies
b. Manage value sets from those vocabularies.
The benefit could be rather large, especially on the HIT side, where vocabulary maintenance from umpteen sources is extremely tedious and expensive.

3. The US may be a world economic leader, but it's economic impact often works against it in International standards efforts, especially in the area of vocabulary standards. Often the US just chooses to invent its own lists of terms, instead of working with other organizations.

4. Paying for what is done and diagnosed seems to make sense, even to representatives of payers that I've talked to over the last few months, but few seem to know how to implement it if it doesn't begin with the letters ICD. They need to come up to speed on vocabulary, it's not just a list of terms any more.

5. Everyone seems to think that its important to define terms, but few are willing to work with someone elses definition.

6. We can easily spend $100,000 and hours of a gold ribbon panel to redefine four terms, but try to find funding to fix the way hundreds of pages of documents are produced, in part to list out the terms needed for interoperable ELECTRONIC health records...

7. "All the good words are taken", An engineering complaint often heard during design when trying to identify a new object, also applies to standards.

8. We need a new way of norming (see Forming-storming-norming-performing) that includes informing. That way, when start to use and define terms, we can be consistent with what others have learned before (and avoid some of the same mistakes). As someone recently said to me: "Research is not the first instinct of the terminally innovative". I would add, "but it should be."

9. One of the greatest barriers in interoperability to overcome is the "Not Invented Here" syndrome. We need, as developers and users of standards, to avoid that syndrome in our own thinking.

10. You say potato, I say potato. It's all in the inflection. Often its not in what is said, but how it is said that has the impact. In other words, the actual words aren't important.

So, smile when you say that.