One of the joys of my job, and also its biggest challenge, is that I truly do get to work with the best and the brightest Health IT experts in the world.
I spend a good bit of time traveling to standards events, at least some part of two weeks every month on average. This is a huge investment by my employer, and I recognize it. Many others that I know don't travel quite as much, but the investment is still pretty significant, especially for those sole proprietors of their own consulting businesses. Attending an HL7 working group meeting in the US can range from $1.5K - $3.5K for the week, depending on venue, distance traveled (inside the US), and add-ons (e.g. training and certification), and an IHE event can range from $800 to $2.5K for an individual participant, again depending on venue, distance traveled, and add-ons (e.g., Connectathon conference). I've attended an HL7 meeting on my own dime, it's not something I'm likely to do often, especially since I don't have my own consultancy to fund it. For participants coming from abroad, it's even more expensive, and I truly admire the ones who manage to fund themselves.
Having said that, one of the results is that the people who DO attend these meetings are the best and the brightest. They are present at those events because their employers believe in them strongly enough to fund their participation, or they are successful enough in their own business to fund it. The cream naturally rises to the top here, and so when you find yourself in a room filled with 50 or 500 people working towards the same goal, it turns out that these are also the best 50 or 500 you could ask to be present.
With that kind of expertise present, things tend to work just a bit differently than they do back in the everyday world. There's certainly plenty of ego to go around (although some of it exhibits itself in a very id-like manner), and academic games of dominance certainly take place. But I don't want to focus on the dysfunctional side really, other than to acknowledge it exists. What is so much better are the opportunities for much better relationships. In the world of business, I've had one or two mentors, and been a mentor once or maybe twice. In the world of standards, that's happened to me so much more frequently. Most people are fortunate to have one or two mentors in their life, but in standards, this is an environment that is simply ripe for developing those sorts of relationships. You could have two or more mentors in the same organization at the same time, even. I know I have. Imagine that!
Attending one of these meetings for the first time is like drinking from a fire hose, especially if you haven't been involved in activities before attending. It's not for the shy and retiring, but you need not be a raging extrovert either (in fact, I'm simply a well-trained Introvert myself). The volume and quality of information you'll be getting is huge and valuable.
Managing a group like this (e.g., as a workgroup or committee co-chair) requires a set of skills that is often quite different from your usual work-a-day stuff.
When I get back from IHE and/or HL7 meetings, I find myself both invigorated and exhausted. Invigorated by new ideas, exhausted by the pace, and excited all over again about what I do for a living.
You are truly, the best and the brightest. Thank you.
Wednesday, July 31, 2013
IHE Call for Proposals begins
Crossed my desk this morning...
Greetings IHE Community and Industry Partners,
It is with great pleasure we announce the IHE annual planning cycle has begun! The IT Infrastructure (ITI), Patient Care Coordination (PCC) and Quality Research and Public Health (QRPH) Domains are soliciting work item proposals for the 2013-2014 Publication Cycle. The Call for Proposals opens July 29 and concludes September 29, 2013 Interested parties are invited to submit a brief proposal (form attached) for new IHE Profiles and/or White Papers to be considered for development in the new Publication Cycle.
This e-mail describes the annual planning cycle process from August – December 2013. Please continue reading for more details or visit the IHE Wiki for more information. For any additional support surrounding the proposal process, please contact Nancy Ramirez, IHE Coordinator, at nramirez@himss.org.
Help Promote IHE Call for Proposals:
All IHE members and industry partners are invited share this announcement with their committee mailing lists and other interested parties. Additional information is maintained on the IHE Wiki.
All Proposals must follow the structure and format of the attached Brief IHE Proposal Template, specifically addressing the following:
- What is the problem you propose to solve by this proposal, and how is that problem expressed in practice (e.g., a use case)?
- How would fixing this problem improve health care in practice?
- What specific components of standards could be used to solve this problem?
- Your proposal should identify one or more potential editor(s) in the event that the proposal is selected for further evaluation and possible development. If possible, please include some indication of the business and/or clinical case surrounding the situation when describing the problem. For example, is there an economic motivation for addressing this problem immediately?
Summary of IHE’s Multi-Phase Proposal Process:
- Submit Brief Proposals by September 29, 2013
· QRPH, PCC and ITI Domain’s Call for Proposals Open July 29, 2013 and close on September 29, 2013.
· Submit a Brief Proposal using the attached form to the domain email listed below.
· If your proposal is accepted you will be required to attend IHE’s regular teleconferences and meetings where membership is required. Apply for IHE International’s free Organizational Membership today!
- Planning Committee’s Proposal Review Webinars- Decision Meetings:
Save the Date! Webinars are held during the weeks of September 30, 2013 and October 7, 2013 on WebEx.
· All Proposal authors are required to present a 15 min. summary of their Brief Proposal on one of these Webinars.
· Exact dates for each domain will be announced in August 2013. Join the committee newsgroups to receive regular updates. See links at end of the announcement.
· Please anticipate participating on 1-2 webinars. These Webinars will be decision meetings, join IHE to exercise your IHE voting privileges!
- 2013-2014 Planning Proposal Evaluation Kickoff:
· We urge those who submit proposals or white papers to attend the Planning Proposal Evaluation Kickoff Meeting in person or phone. In-person advocacy has proven to be the most effective way to ensure your brief proposal are understood and accepted by the committee.
- 2013-2014 Technical Committee Proposal Evaluation Meeting:
· Proposals that are accepted at the Planning Proposal Evaluation Kickoff Meeting and given to the IHE Technical Committee for review are required to write and present a detailed proposal during the Technical Proposal Evaluation Meeting.
**Deadline: September 29, 2013 at 11:59 pm CDT**
Email the completed brief IHE Proposal template to the corresponding domain email address below before September 29, 2013 at 11:59pm CDT.
Committee | Domain Email | Planning Co-Chair 1 | Planning Co-Chair 2 |
PCC Planning Committee | Laura Heermann-Langford | Tone Southerland | |
ITI Planning Committee | Eric Heflin | Karen Witting | |
QRPH Planning Committee | Didi Davis | Landen Bain |
We look forward to working with you during the IHE 2013-2014 Publication Cycle. Please contact the IHE secretary at ihe@himss.org if you have any additional questions or need further assistance.
Apply for IHE International’s free Organizational Membership today! If your proposal is accepted you will be required to attend IHE’s regular teleconferences and meetings where membership is required.
Join the IHE Google Groups and stay informed on the 2014 Call for Proposals process!
· IT Infrastructure (ITI) Domain Google Group: https://groups.google.com/d/forum/itiplan
· Patient Care Coordination (PCC) Domain Google Group: https://groups.google.com/d/forum/pccplan
· Quality Research & Public Health(QRPH) Domain Google Group:https://groups.google.com/d/forum/iheqrphplan
If you have any additional questions please contact Nancy Ramirez, IHE Coordinator, at nramirez@himss.org, or the Domain Planning Co-Chairs listed above.
Thank you,
IHE Quality Research & Public Health, Patient Care Coordination and IT Infrastructure Planning Committee Co-Chairs
IHE Quality Research & Public Health, Patient Care Coordination and IT Infrastructure Planning Committee Co-Chairs
Tuesday, July 30, 2013
Lessons from a Collaboration
Charles Jaffe, CEO of HL7, writes a periodic news brief, which goes out to all HL7 members. He discusses his viewpoint of the the recent HL7 and IHE Collaboration in the following, which appears below with his permission.
-- Keith
Integrating the Healthcare Enterprise (IHE) and HL7 have worked together (and apart) trying to make interoperability a reality. At the best of times, we’re partners, working to solve the same equation. To some observers, we go about it very differently. But, partners we are and we have proven it time and again. The collaboration on Consolidated-CDA® was a tribute to the willingness of idealists to put aside process difference and achieve a critical goal.
Last year, the Board of IHE agreed, in principle, to venture well beyond the road less traveled. This spring, after a year of negotiation, HL7 and IHE began a pilot to ballot IHE artifacts with the HL7 consensus process. Purists on both sides of the table shouted foul. Fortunately, the potential benefits to each organization were too great to ignore.
To date, the results are mixed. After all, it’s difficult. The participants from IHE know the outcome they want, but learning the process is not easy. Some of the more patient souls from the HL7 are doing a lot of hand-holding. The most important part is that it’s being accomplished…warts and all.
After the initial pilot, there will be a careful post-mortem about the best and the worst of this partnership. It was a challenge to IHE loyalists to take the first step toward reconciling processes. There have been moments of rancor and disbelief and times of great sensitivity and caring, characteristics of an honest and productive relationship. Almost certainly, we will move forward with another ballot on a far more challenging problem. It’s critical that we succeed. The healthcare IT world is depending on us to develop standards by a process that compresses our typical timeline and enhances their quality.
-- Keith
Integrating the Healthcare Enterprise (IHE) and HL7 have worked together (and apart) trying to make interoperability a reality. At the best of times, we’re partners, working to solve the same equation. To some observers, we go about it very differently. But, partners we are and we have proven it time and again. The collaboration on Consolidated-CDA® was a tribute to the willingness of idealists to put aside process difference and achieve a critical goal.
Last year, the Board of IHE agreed, in principle, to venture well beyond the road less traveled. This spring, after a year of negotiation, HL7 and IHE began a pilot to ballot IHE artifacts with the HL7 consensus process. Purists on both sides of the table shouted foul. Fortunately, the potential benefits to each organization were too great to ignore.
To date, the results are mixed. After all, it’s difficult. The participants from IHE know the outcome they want, but learning the process is not easy. Some of the more patient souls from the HL7 are doing a lot of hand-holding. The most important part is that it’s being accomplished…warts and all.
After the initial pilot, there will be a careful post-mortem about the best and the worst of this partnership. It was a challenge to IHE loyalists to take the first step toward reconciling processes. There have been moments of rancor and disbelief and times of great sensitivity and caring, characteristics of an honest and productive relationship. Almost certainly, we will move forward with another ballot on a far more challenging problem. It’s critical that we succeed. The healthcare IT world is depending on us to develop standards by a process that compresses our typical timeline and enhances their quality.
|
Charles Jaffe, MD, PhD
CEO, Health Level Seven®
International
|
For Once and for All
I think I've finally discovered how to explain the difference between functional requirements of a system and requirements of an instance of data produced by that system. The distinction is based on the different between the logical qualifiers ∀ and ∃. Given that we (IHE, HL7 and others), express requirements on content of the document (or message);
To express a constraint that is true for all instances of every document,
∀ documents: X shall/should/may Y.
And to express a constraint that must be true for at least one instance of a document,
∃ document: X shall/should/may Y.
To express a constraint that is true for all instances of every document,
∀ documents: X shall/should/may Y.
And to express a constraint that must be true for at least one instance of a document,
∃ document: X shall/should/may Y.
This is fairly clear to engineers who have not been trained in "standards terminology" such as the distinctions between mandatory and required. For a document X and data element Y: To say that Y is mandatory in X is the same as saying: ∀ documents X: X SHALL contain Y. To say that Y is required in X is the same as saying ∃ document X: X SHALL contain Y. To test the system for the first case, you must verify that Y is present in all cases. To test the system for the second, you must verify that Y is present in at least one case.
In both cases, the system MUST be able to produce Y, the distinction is whether is must do so all the time, or just some of the time.
If I'm right, then I've managed to explain it for once ∃ and for all ∀. [ouch]
Keith
Monday, July 29, 2013
What does BlueButtonPlus / FHIR provide that CCDA doesn't have?
I joined the NwHIN Power Team last week. I was asked likely due to my experiences with Blue Button Plus Pull and HL7 FHIR. Today on a join call with the Privacy and Security workgroup, the question came up about what FHIR and/or BB+ provides that isn't available with C-CDA. I always struggle here because I'm involved in the SDO activities, and get this. Yet many C-levels who are reviewing the work of these groups are don't yet. The communications from one to the other is always a challenge. SDOs typically don't spend whole lot in targeted marketing to the C-suite on their work, and this is especially true during the development time frame. I'll try to approach the question from a C-level perspective:
Let's start with this qualification: FHIR and Blue Button Plus are related but not identical initiatives. The former is an HL7 International standards effort. The latter is a US initiative that is using parts of FHIR to enable consumer access to clinical data.
What is different with BlueButtonPlus / FHIR from what I'm doing today?
What Blue Button Plus (pull) provides is access to a FHIR-based resource by which you can query for CCDA documents in a RESTful manner, and subsequently download them. It doesn't ask you to aggregate your content differently, or use some new format to describe problems, medications and allergies. So, content is structured the same, but metadata is structured and queried RESTfully.
The mechanism by which access is granted via BB+ Pull makes use of OAuth 2.0, which is the same thing that FaceBook, Twitter, Linked In, and other services on the web enable other applications to access your data stored in those services.
Why is BlueButtonPlus / FHIR good?
This is good because it vastly simplifies the way that consumer applications can access health data, making it possible for smart phones, tablets, wearable devices, et cetera, to participate in consumer data access and use of healthcare data. It also prepares sources of consumer data to move towards an architecture that can support more granular access in the future (but doesn't require it today).
Does Blue Button Plus / FHIR eliminate the need for CCDA?
Blue Button Plus is not eliminating CCDA, but rather building from the use of it. Blue Button Plus REQUIRES the use of CCDA.
You've probably heard about "Green CDA" and I've said in the past that FHIR is to HL7 V3 what Green CDA is to CDA. FHIR greens HL7 Version 3, and so EVENTUALLY, there will be a new Document resource in FHIR that is a composite of clinical resources (like problems, allergies, medications, lab results, et cetera). But we (HL7 Structured Documents) aren't working on that right now. Eventually this will occur, and those resources will be key components of it.
How is Blue Button Plus / FHIR retaining compatibility with CCDA?
CCDA and Green CDA and content from similar efforts are being used to help define FHIR resources. The document resource enables access to "FHIR-based" documents as well as those that existed prior to the development of FHIR (like CCD or CCDA documents). Present efforts in Blue Button Plus focus on the latter.
Let's start with this qualification: FHIR and Blue Button Plus are related but not identical initiatives. The former is an HL7 International standards effort. The latter is a US initiative that is using parts of FHIR to enable consumer access to clinical data.
What Blue Button Plus (pull) provides is access to a FHIR-based resource by which you can query for CCDA documents in a RESTful manner, and subsequently download them. It doesn't ask you to aggregate your content differently, or use some new format to describe problems, medications and allergies. So, content is structured the same, but metadata is structured and queried RESTfully.
The mechanism by which access is granted via BB+ Pull makes use of OAuth 2.0, which is the same thing that FaceBook, Twitter, Linked In, and other services on the web enable other applications to access your data stored in those services.
Why is BlueButtonPlus / FHIR good?
This is good because it vastly simplifies the way that consumer applications can access health data, making it possible for smart phones, tablets, wearable devices, et cetera, to participate in consumer data access and use of healthcare data. It also prepares sources of consumer data to move towards an architecture that can support more granular access in the future (but doesn't require it today).
Does Blue Button Plus / FHIR eliminate the need for CCDA?
Blue Button Plus is not eliminating CCDA, but rather building from the use of it. Blue Button Plus REQUIRES the use of CCDA.
You've probably heard about "Green CDA" and I've said in the past that FHIR is to HL7 V3 what Green CDA is to CDA. FHIR greens HL7 Version 3, and so EVENTUALLY, there will be a new Document resource in FHIR that is a composite of clinical resources (like problems, allergies, medications, lab results, et cetera). But we (HL7 Structured Documents) aren't working on that right now. Eventually this will occur, and those resources will be key components of it.
How is Blue Button Plus / FHIR retaining compatibility with CCDA?
CCDA and Green CDA and content from similar efforts are being used to help define FHIR resources. The document resource enables access to "FHIR-based" documents as well as those that existed prior to the development of FHIR (like CCD or CCDA documents). Present efforts in Blue Button Plus focus on the latter.
Friday, July 26, 2013
When the stars align
I don't know what to say. I've just been one a whirlwind tour of the globe, and not quite back again. All the stars seem to be aligned, and everything is going my way.
My IHE profile work on CDA Harmonization is getting closer to being done, and will go out for a second round of public comment. The data driven content was generated just in time for the IHE meetings in Oak Brook, and I'm quite happy with where it is at. I've got a ton of editing to do, but it's mostly just that, editing. All of my outstanding questions have been addressed, and I'm no longer struggling with how I'm going to do it, now I just have to finish it.
I just had an outstanding HL7 board meeting.
I was invited to join the NwHIN Power Team today.
I just heard back on a book chapter, and it looks like I'll be given the time I need to finish that.
I've got an opportunity to reuse CDA Book and blog content that may work to my advantage.
I heard from my new advisor that my admission was approved to enter a master's program in Medical Informatics. It's a part time, remote program that I can do while I remain employed doing what I love. That ends a three-year search and I look forward to starting that in the fall.
The ABBI work I've been doing is getting the attention in the right places.
That's about it. I need to go find some wood to knock on.
My IHE profile work on CDA Harmonization is getting closer to being done, and will go out for a second round of public comment. The data driven content was generated just in time for the IHE meetings in Oak Brook, and I'm quite happy with where it is at. I've got a ton of editing to do, but it's mostly just that, editing. All of my outstanding questions have been addressed, and I'm no longer struggling with how I'm going to do it, now I just have to finish it.
I just had an outstanding HL7 board meeting.
I was invited to join the NwHIN Power Team today.
I just heard back on a book chapter, and it looks like I'll be given the time I need to finish that.
I've got an opportunity to reuse CDA Book and blog content that may work to my advantage.
I heard from my new advisor that my admission was approved to enter a master's program in Medical Informatics. It's a part time, remote program that I can do while I remain employed doing what I love. That ends a three-year search and I look forward to starting that in the fall.
The ABBI work I've been doing is getting the attention in the right places.
That's about it. I need to go find some wood to knock on.
Thursday, July 25, 2013
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.
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.
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