Growing Pains

I think the September Working Group Meeting is when I'll have a new ribbon on my HL7 badge.  I joined HL7 as an individual member either late summer or early fall in 2003, and became an organizational member later that year.  That means I'll get to wear the 10-year member badge if they are still using those.  I guess that makes me an HL7 old-timer, although I must say, that I still feel quite young.  HL7 has a few 30-year members, which still makes me feel like the baby in the room.

Even so, I've been through a lot of HL7's history.  When I joined, HL7 was considering how to become a more international organization.  I seem to recall they even had a grant to work on that, I think it was from RWJF. One of the outcomes from that effort was a board decision to have one working group meeting every other year in an international setting.  Up until that time, all working group meetings for the 19 years prior had been held on the North American continent if my understanding is correct.

In 2005 I worked on my first HL7 specification, called the Care Record Summary (CRS).  It was clear at that time that HL7 V3 was troubled and delayed.  Ballots were taking forever to pass and we needed to clean up that process. The CRS was conceived of in February, launched in March 3, and went out for ballot in the beginning of April. I spent most of March working on, and writing the text of that document, with a copy of another specification sitting open beside me to use as a model.  That was the e-Medical Summary created by Vancouver Island Health Authority, that they had freely shared with HL7 members.  Schematron became the way of doing things because I learned it first from there.

The CRS has now been superseded thrice in HL7, once by CCD, a second time by CRS Release 2, and most recently by C-CDA. However, the CRS is one of the intellectual ancestors of the C-CDA, and for that I am quite proud.  It took almost another year to get the CRS ballot approved.  We went for three more ballots, and had a bit of a bother with ASTM over alleged IP misappropiration.  I may never get over that accusation, but while I freely admit reusing ideas from eMS (with permission), and harmonization (before we called it that) in CRS of Claims Attachments with the then notional sections of CCR, there was no "theft".  But perhaps few believed that someone in HL7 could write a hundred page specification and have it ready for ballot in a month without copying from somewhere, given it's challenges with V3 at the time. It used to be that it could take years to get something through committee.  Today, a project that takes longer than 18 months is the exception rather than the rule.

In May of 2005, my wife and two children joined me in the Netherlands for the first European Working group meeting, where we reviewed that ballot.  Not only was that HL7's first experience off the North American continent it was also my first and my children's.  My wife and children had a blast on that trip, and we've tried to do something international every few years since.  CRS was the first step in a two step collaboration with IHE on what became XDS-MS, and I wrote that specification in short order as well.  The first edition of XDS-MS was produced for Trial Implementation in August, having started sometime in July, also quite a record.

In 2006, HL7 held its 20th annual plenary meeting, and the organization was still changing.   In the January WGM I'd been handing out resumes to a few select folk. At the May WGM I was gainfully unemployed but starting my new job doing standards full time the week after.  It was fun being the last person in the Claims Attachments workgroup, standing up, identifying myself, and indicating a complete lack of affiliation with any company.

That was the year I'd finally put CRS to bed, became a cochair in Structured Documents, and later kicked off the Continuity of Care Document later.  It took most of that year for HL7 and ASTM to bury the virtual hatchet.  Over the next year, the two organizations worked together to produce what is now the most widely implemented CDA Implementation Guide in the world.  And at the same time IHE PCC and HL7 did their second collaboration, which resulted in the development of XPHR.  And the Bush-era ONC was born.  Back then, they had the short-lived acronym ONCHIT (say it with a soft CH and you'll understand why).

The CCD finished in January of 2007, HITSP adopted it shortly thereafter, and IHE had to play quite a bit of catch-up on use of the CCD standard in the C32. Oh, and I had to rewrite XDS-MS to support CCD now instead of CRS.  HL7 standards had taken on several of the lead roles in the US National program.

At the same time as HL7, ASTM, IHE and HITSP were all working together on what would eventually become the C32, I participated in another collaboration with IHE, HL7 and HITSP on the XD-LAB specification.  The former was chaotic, filled with personalities, and quite hectic.  The latter was chaotic, filled with personalities, and also quite hectic, but fortunately I wasn't leading that charge, so I think I remember it more fondly.  In the XD-LAB work, I recall having a T-Con with Francois Macary (located in France), the HL7 O&O Workgroup, and I think we listened to it in a hotel in Washington DC while at HITSP meeting.  Now that was a collaboration.  We would follow each other from one organizational meeting to the next polishing off the next chunk of the XD-LAB specification.  I think I was the only person who was involved as a member of all three contributing organizations.  It was a grand collaboration, and I recall how impressed I was with HL7 O&O for being so open to it.

As April 2007 rolled around, I found myself in Germany, in the City of Cologne, at HL7's second international WGM.  The international meetings piled on after that, as HL7 moved into an every year plan. There was Vancouver (2008), then Kyoto (2009) and Brazil (2010).  HL7 truly had become much more international in flavor.

Along the way, the balloting process got much cleaned up, and the HL7 Governance process changed, new intermediate steering divisions were formed, and the TSC took on a much more aggressive role in organizational governance.  At the same time, ballots got a lot shorter.  Instead of taking three years or more, we were averaging less than 2, and there were some special cases where work was run through the process in 6 months.

Brazil was my first international meeting as a member of the HL7 Board, and I was about to learn what little progress we had made on the business planning we had made since the original grant back when I started.  I joined the Internationalization Workgroup, and then moved on to the new business planning workgroup as a member the board.

Through two years of effort on the board, we wavered from one extreme to another, first considering the IHTSDO model of selling HL7 to national governments as a way of supporting the organization (starting with the US), and subsequently thinking about alternative structures.  Somewhere in the just past middle of all that (in the summer of 2012), we realized that to remain competitive in both the US and international markets, HL7 standards would have to become free for non-members to implement.  Now business restructuring was critical.  With IP not being the dominant reason to join HL7, the board was now in a position where we needed to put up or shut up.  We needed to deliver new value to members, or could expect the membership growth we had been experiencing as a result of organizations needing to acquire access to the CCD specifications as a result of Meaningful Use to dry up.

Here we are a year later, and tonight I got to retweet the following tweet from HL7:

Today the #HL7 Board approved new membership benefits to be announced at the September Plenary meeting. More details to follow. #HealthIT

We've been working on this since September of last year.  I won't steal @HL7's thunder by telling you the details of the new benefits, but what I can say is that they do create more value for existing members.  And they provide a reason for new members to join the organization.  There are a number of new programs we'll be piloting or initiating as part of this benefit package, and we'll be working hot and heavy to roll many of those out in time for the 27th September Plenary.  Keep your eyes on @HL7 in the coming weeks to learn a bit about what's in the package, and join me and the HL7 leadership at the Wednesday morning business meeting of the working group to learn the full details.

It's been a long haul from my first HL7 activity to today, and I expect I still have many more miles to go.  But I think HL7's going to be headed for a better future.  We aren't all grown up yet, but we've certainly made quite a bit of progress in the last two years.  There are still issues to address (e.g., one member one vote, a US Affiliate, and still more challenges to come), but I think we have the will to pursue these.