Tuesday, September 14, 2010

The Healthcare Standards Interconnections

Somebody recently asked me for information about collaborations between the different standards organizations and gave me a spreadsheet they had started.  Well, a spreadsheet might be a good way to gather this data, but it wasn't the best for visualization.  I spent about half a day putting together something that I think works based on a very small data set based on what I knew and could find out quickly.  It really works out to two tables:

SDO/Profiling Organization   Type of Organization   URL

Types of organizations include SDOs like HL7 and IHTSDO, Profiling Organizations like Continua and IHE, and could include other kinds of organizations like government agencencies and medical professional societies, but I skipped these latter two.  The problem is already pretty complex.  I did separate Vocabulary from other sorts of SDOs, and general rather than healthcare specific SDOs.

Source   Destination  Relationship Type  Relationship Description   URL

Relationship types included governance (like JIC or the SCO Summit), joint work products/ballots, MOUs and Collaborations, Memberships of one organization to another, or liaison relationships of one organization with another.

The best visualization I've been able to come up with is using FDP with GraphViz.  FDP uses a node placement strategy based on weights associated with edges between nodes.  It then minimizes the energy or force exerted in the graph.  I'd love to have added an image map with this, but it seems my version of GraphViz generates empty maps.  This was a brief side project so I haven't tracked it down, but you can if you want.  The source file for the image below is on Google Docs using the DOT Langauge.

Color Key
Profiling Organizations are in brown ovals.
Healthcare SDOs are in black ovals.
Healthcare Vocabulary SDOs are in cyan ovals.
General IT SDOs are in magenta ovals.

Red arrows are Joint work products.
Blue arrows are MOUs.
Green arrows are Memberships.
Purple arrows are Liaison Relationships.
Yellow connections are between SCO Summit Organizations
Orange connections are between JIC Organizations


This graph shows one view of the community, and a pretty well connected one at that. But I'm still missing a LOT of data (this is really about a four-week long research project with direct contacts to each SDO).  I know there are relationships I don't know about and don't even know how to find.  I've also pruned the graph some.  I have omitted two treaty organizations (IEC and ITU) and a few other SDOs because they had only one other connection.

I also have NOT dealt with use of standards across these workgroups (e.g., IHE use of HL7 CDA or DICOM WADO, or HL7 use of W3C XML, et cetera).  That would be an even bigger data set to gather, and would put IHE, Continua, W3C and IETF right in the middle of all the action.

If you like, download the data file, add your own connections, and play around.  GraphViz is pretty easy to use.

What you DO NOT see on this graph are the connections made because of the people involved. Cross membership of individuals would overwhelm this simple diagram. But in many cases, it's that same cross membership of key individuals that brings SNOMED CT or LOINC expertise into IHE or HL7, or NEMSIS to HL7, or ...

Cross leadership is probably something worth figuring out (but not on my time). Cochairs of IHE Committees are often cochairs of DICOM committees or HL7 workgroups, or leaders of ISO TC 215 workgroups or ASTM committees or ... and visa versa.

There's also a few very strong connectors in that cloud above worth identifying. They are pure gold mines of information (I aspire to be one of them someday).

It was the people more than anything else that ensured that IHE, HITSP and HL7 coordination was as good as it was.  I can even point to a perfect example, because that individual was the recipient of the first Ad Hoc Harley, and he made sure that the three organizations stayed connected.
As I think about it, looking at the graph above, what it tells me is that I don't need one more place to go to deal with standards and harmonization.  I need a couple fewer.  I need a place where I can work on several of these activities at the same time, with the ideal being that I'm just working on one thing at that time.  I'll say it again, I'd love to see something like the Canadian model here.


  1. See "The Standards Value Chain: Where Health IT Standards Come From" http://f00.in/1m

  2. LOL, Who in charge.

    Looks a bit like the HIE(s) connections

  3. Thank you for your information.
    but i can't access the Google Docs... :(
    Can you check the link address?

  4. Google Docs will not display it (because it doesn't understand the format), but you should be able to download (it is a plain text file). The links seem to work for me.