Adding the Per to Forming

One of the challenges with the ONC Standards and Interoperability Framekwork initiatives is that these are new activities with a new organization.  So, you have the usual group dynamics present in any standards activitity, compounded by the fact that there's still a lot of unknowns.

If you've been paying attention here for a while, I've mentioned the Tuckmans stages of group development before: Forming, Storming, Norming and Performing.  Every group has to go through them, and they take time. 

The CDA Consolidation workgroup moved off the mark pretty quickly because of the engagement with HL7 and IHE.  Those organizations have a pool of existing participants who are already familiar with the respective organizational processes, and they already have developed some of the group norms.  The Transfers of Care Workgroup is still struggling, and have moved from the Forming to Storming stage at this point, but the norms are just now being established.  

Also, the three differrent S and I initiatives are being led by different people, who have different styles for accomplishing things, which leads to different group norms.  That's also challenging for people who are participating in the different workgroups.  As S and I develops further, I'm certain that some of the groups practices will bubble up to become initiative norms, but that is still happening.

The time it takes to go through these stages can be very frustrating, especially to some who want to "start getting things done".  If you've been involved in standardization in the past, you want to go straight to "performing". There seems to be no way to eliminate these stages.


While there's no way to completely eliminate them, there are ways to make them less painful.  The key is to work with organizations that already exist, so that you can avoid some of the forming, storming and norming that goes one. It won't be completely eliminated because any new project will attract new participants who need to go through these stages on their own, but it could certainly help.  The S&I framework may be a good place to start things, but the outputs are going to need a permanent home to support ongoing maintenance.  I'm almost certain that S&I isn't going to be that home.  Just look at what happened with HITSP that's left us in a few binds that S&I is trying to fix.

I've been involved in many of these activities, and am able to relate the norms: processes and terminology of one group to those of another, which gives me a "norming" advantage.  I can quickly relate one group's "ballot" to another's "public comment" or Canidate Recommendation, one's "trial implementation" to anothers DSTU to anothers Panel Approved or Proposed Recommendation, and from Standard to Final Text to Recommendation to Recognized.  I'm still struggling with "call for concensus" in S&I and Direct though, because there seems to be no separate stage for "final" to say we're done.

It might be helpful for someone to create a thesaurus of terms that spans these organizations, and to publish that relating S&I stages and processes to that of other SDOs.  Hmm, maybe I'll put that into the topic hopper for another post.