I was conversing with my prof. about Standards on FB the other day, and made an offhand remark about him demonstrating that FHIR is at level 4 in my seven levels of standards adoption. It was an off the cuff remark based on certain intuitions I've developed over the years regarding standards. So I thought it worthwhile to specify what the levels are, and what they mean.
Before I go there, I want to mention a few other related metrics as they apply to standards. One of these is the Gartner Hype Cycle with Innovation Trigger, Peak of Inflated Expectations, Trough of Disillusionment, Slope of Enlightenment, and Plateau of Productivity and Grahame Grieve's 3 Legs of Health Information Standards, and my own 11 Levels of Interoperability (which is really only 7). There's a rough correspondence here, as shown in the table below.
Before I go there, I want to mention a few other related metrics as they apply to standards. One of these is the Gartner Hype Cycle with Innovation Trigger, Peak of Inflated Expectations, Trough of Disillusionment, Slope of Enlightenment, and Plateau of Productivity and Grahame Grieve's 3 Legs of Health Information Standards, and my own 11 Levels of Interoperability (which is really only 7). There's a rough correspondence here, as shown in the table below.
| Phases | Description | Hype Cycle | Grahame's 3‑Legs | 11 Levels of Interoperability | Time (y) |
|---|---|---|---|---|---|
| -1 Struggling | At this stage, not only does a standard not exist, but even awareness that there is a problem that it might solve is lacking. | 0 Absent | |||
| 0 Aspiring | We've identified a problem that standards might help solve and are working to solve it. |
Trigger
|
1
|
1 Aspirational
|
1-4
|
| 1 Testing | The specifications exist, and are being tested. |
Peak
|
1 & 2
| 2 Defined |
½-1
|
| 2 Implementing | Working prototypes have been tested and commercial implementations are being developed. |
2 & 3
| 3 Implementable |
½-1½
| |
| 3 Deploying | Implementations are commercially available and can be used by end users. |
Trough
|
2 & 3
| 4 Available |
1
|
| 4 Using | Commercially available implementations are being used by real people in the real world. |
Slope
|
3
| 5 Useful |
2-3
|
| 5 Refining | The standard, and it's implementations and deployments are being refined. |
Plateau
|
3
| 6‑10 (not named) |
2-4
|
| People are happy with the implementations, and should the question arise about what standard to use, the answer is obvious. | 11 Delightful |
?
|
How are my seven levels of standards any different from the 11 levels of interoperability? Not by much really. What's different here, is that I've given phases instead of milestones.
Why this is important is because each phase occurs over time, and is entered into by different kinds of stakeholders according to a technology adoption lifecycle, and can have innovators, early adopters, majority adopters and laggards in each phase.
Time is interesting to consider here, because standards and technology has sort of a quantum nature. It can exist in several of my phases described above at once, with different degrees of progress of in each phase, with the only real stipulation is that you cannot be further along in a later phase than you are in an earlier one.
If entry and exit to each phase was gated to completion of the phase before, the timelines for reaching refining stage would take about 5 years, but generally one can reach the starting point of the next phase by starting after the start of the previous phase by 3 to 6 months. You may have more work to do to hit a moving target, but you'll wind up with a much faster time to market.
As Grahame points out, getting to the end of the cycle requires much more time in the market driving stage of his three-legged race than it does in the initial parts of it.
Anytime I've done serious work on interoperability programs, I'm always working on 2-3 related projects in a complete program, because that's the only way to win the race. You've got to have at least one leg in each place of Grahame's journey. Otherwise, you'll reach a point of being done, and simply expecting someone else to grab the flag and continue on without you.
Why this is important is because each phase occurs over time, and is entered into by different kinds of stakeholders according to a technology adoption lifecycle, and can have innovators, early adopters, majority adopters and laggards in each phase.
Time is interesting to consider here, because standards and technology has sort of a quantum nature. It can exist in several of my phases described above at once, with different degrees of progress of in each phase, with the only real stipulation is that you cannot be further along in a later phase than you are in an earlier one.
If entry and exit to each phase was gated to completion of the phase before, the timelines for reaching refining stage would take about 5 years, but generally one can reach the starting point of the next phase by starting after the start of the previous phase by 3 to 6 months. You may have more work to do to hit a moving target, but you'll wind up with a much faster time to market.
As Grahame points out, getting to the end of the cycle requires much more time in the market driving stage of his three-legged race than it does in the initial parts of it.
Anytime I've done serious work on interoperability programs, I'm always working on 2-3 related projects in a complete program, because that's the only way to win the race. You've got to have at least one leg in each place of Grahame's journey. Otherwise, you'll reach a point of being done, and simply expecting someone else to grab the flag and continue on without you.
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