I missed the HL7 VMR call last week because I was somewhere else. The discussion that week was on how to procede to fill in the class models. One suggestion proposed was to use the work that had already been done CCD, but apparently others felt that they needed to go back through HL7 Version 3 models and constrain them down to what should go into the classes, following the HL7 process.
So, I was surprised to see that proposal, because from my perspective, we have already been there and done that. The next step should be to adopt that work that was done in CCD using the HL7 process and methodology and start working on subsequent steps.
The real challenge from my perspective, is NOT the static models. We can build static models until we are blue in the face, and the HL7 tooling will give us, depending upon your point of view, beautiful or deadly ugly XML schemas. But static models don't tell the real story behind what the VMR needs to do, and it's not about the XML. In fact, its so not about the XML that the original draft put that out of scope. The reason being that the VMR should be a way to access information that comes from any number of sources, including HL7 Version 2 messages, Version 3 messages, CDA documents, and even NCPDP SCRIPT and X12 messages. It's not about messaging, which seems to be a difficult concept to get away from because the HL7 development process seems to bring so much attention to the messages and models associated with them.
Given a particular piece of knowledge, the VMR needs to be able to navigate to clinical statements accessible from there, and to be able to filter and locate other knowledge that needs to be attended to. This is a model of dynamic behavior. HL7 is still working out some of the dynamic behaviors, and I'll note that dynamic behavior is NOT about message content. It's about what happens between systems and the responsibilities between them.
In the longer term, it points to another problem that we need to address, not in VMR, but through HL7, which is how to advance our methodology to bring attention to dynamic behaviors. I'll just put it on my punch list, and maybe someday, I'll be able to punch out.
Friday, October 29, 2010
Thursday, October 28, 2010
A schedule for Stage 2 and more on Public Health Surveillance
Rita Altamore dropped these tidbits in my inbox. I thought I'd share them.
First, the draft timeline for MU Stage 2 is below.
MU Work Plan Timeline
http://www.surveymonkey.com/s/F9FR2CY
I appreciate that they've provided an opportunity for the public to comment, but the process is still lacking balance as I've mentioned previously. Balance is the principal the consumers, users and producers of stuff that must meet a standard are represented in a standards making process. At the moment, public health has undue influence in this process. But hey, at least we get to provide comments. Can you guess what my first one will be.
Here is the text to comment on.
My feedback will also include some information based on what I found out in this comparison between what they did and what HITSP did. Analysis of Proposed ISDS Standards for Disease Surveillance
Keith
First, the draft timeline for MU Stage 2 is below.
MU Work Plan Timeline
- Oct 20, 2010: directional guidance from HITPC
- Dec 13, 2010: present draft MU stages 2/3 criteria
- Jan, 2011: release draft MU criteria RFC
- Feb, 2011: analyze RFC submissions and revise MU draft criteria
- Mar, 2011: present revised draft MU criteria to HITPC
- 2Q11: CMS report on initial MU submissions
- 3Q11: Final HITPC recommendations on stage 2 MU
- ~4Q11: CMS MU NPRM
Opportunity to comment on New Disease Surveillance Standard
Next, and of a bit more immediate importance. The ISDS Recommendation has been posted on their web site. You can see the current draft below. If you'd like to comment on it, they have started a survey for feedback here:
http://www.surveymonkey.com/s/F9FR2CY
I appreciate that they've provided an opportunity for the public to comment, but the process is still lacking balance as I've mentioned previously. Balance is the principal the consumers, users and producers of stuff that must meet a standard are represented in a standards making process. At the moment, public health has undue influence in this process. But hey, at least we get to provide comments. Can you guess what my first one will be.
Here is the text to comment on.
Keith
NHIN UNIVERSITY NHIN 202: November 4
Crossed my desk just now...
Dear NHIN University Student:
Don't miss NHIN 202 – NHIN Governance Authorities on Thursday, November 4, 2010! Designed to compliment National eHealth Collaborative's ongoing series of stakeholder discussions on the development of governance for the Nationwide Health Information Network, this NHIN University class will focus on the Phase I recommendations recently made by the Health IT Policy Committee's Governance Workgroup. Participants will have an opportunity to share your opinions on the recommendations directly with key representatives from ONC and the Governance Workgroup.
LEARNING OBJECTIVES: By participating in this NHIN University class, students will:
- Gain insight on the governance rulemaking process, including the opportunity for broad public input via the Health IT Policy Committee's Governance Workgroup
- Understand the key points of the Governance Workgroup's Phase I recommendations to the Health IT Policy Committee on October 20, 2010
- Functions and Objectives of Governance
- Principles of Governance
- Scope of Governance
- Understand "next steps" in the governance development process
- Have the opportunity to submit reactions and questions to the Governance Workgroup and ONC regarding the Phase I recommendations
NHIN 202 – NHIN Governance Authorities
DATE: Thursday, November 4, 2010 (add to your calendar) TIME: 3:00 – 4:00 pm ETFACULTY:
- Mary Jo Deering, PhD – Senior Policy Advisor, Office of Policy and Planning, Office of the National Coordinator for Health IT (ONC)
- John Lumpkin – Chair, Health IT Policy Committee Governance Workgroup; Senior VP and Director, Robert Wood Johnson Foundation
- Michael Matthews – Chair, NHIN Exchange Coordinating Committee; Member, Health IT Policy Committee Governance Workgroup; CEO, MedVirginia
AUDIOCONFERENCE: (866) 699-3239 or (408) 792-6300
(Please join the event with a computer system first and follow the audio instructions on the screen.)
ACCESS/EVENT CODE: 665 557 547
ATTENDEE ID: You will receive this number when you join the event first with a computer connection.
Review the full Fall Semester Course Catalog: www.NationaleHealth.org/NHIN-U
Did you miss any of the NHIN University 2010 Spring Semester?
Recordings and transcripts are available here.
Recordings and transcripts are available here.
Self-Displaying CDA
The HL7 Structured Documents Workgroup today approved a proposal to create a Draft Standard for self-displaying CDA documents. I created this project proposal in response to several perceived problems about CDA:
These same arguments apply to CCR as well as CDA just in case someone wants to make these arguments for the use of CCR.
On #1, I would argue that it isn't that ASCII Text is the lowest common denominator. It's that consumers will nearly always be able to do something with ASCII Text, and that for them, something is better than nothing (which is what most have now).
#2 is a legitimate argument, especially for consumers who don't have broadband access. I've had some experience with that concept this summer, and it is extremely frustrating to not be able to get to the web. If the consumer could get to the web, they could readily access a web-based stylesheet that a CDA document included to make the information accessible.
#3 is only partially true. Everyone who has downloaded free software that is widely available, or paid for a commercial product, or had a viewer installed for them on their computer can view a PDF. I carry around a small computing device that couldn't view PDF until I found an app for it.
After some evaluation, I came to the conclusion that the real requirement is "self-contained" display without use of any outside resources other than what you might have installed on your computing device.
Interestingly enough, there are four different standards already in existence that allow us to converge on a solution.
The first of these is the W3C Associating Stylesheets with XML Documents standards. This standard tells you how to associate a stylesheet with an XML document, and is the basis for most existing CDA display solutions. The second of these is the W3C CSS 2 standard, which indicates how structured content can be formatted for display. It is perhaps not widely known, but you can style an XML document using CSS and most browsers have some support for this (how much is something I get to find out). Then there is the IETF URL specification (RFC 1738) which tells you how to resolve a relative URL into a resource. The last of these is a W3C Note on XML Fragment Identifiers that references XPointer.
If you put all of these together, here is what you get:
1. A small CSS (< 4Kb) stylesheet that can be included in an element in a CDA document
2. An XML Stylesheet processing instruction that can be used to render the CDA document by referencing the element by its ID attribute.
3. A CDA document that can be displayed in any browser.
I've verified that this is at least feasible using the CDA sample document that was built for the original Care Record Summary Implementation Guide and Internet Explorer 8. I'm still having trouble getting IE to recognize the box-model display formats in the stylesheet, but may be able to address that, and if not, produce an OK workaround. Firefox works just fine. Chrome and Safari just do not seem to like referencing a CSS stylesheet via an internal resource URL. I haven't tried Opera yet, and given the success and failures I've had so far, I think I'm going to limit the scope to desktop display for the moment.
Keith
- ASCII Text is the lowest common denominator for consumers, and CDA is too complicated for them. (i.e., Blue Button)
- The CDA XML will not be able to displayed by consumers.
- Everyone can view PDF.
These same arguments apply to CCR as well as CDA just in case someone wants to make these arguments for the use of CCR.
On #1, I would argue that it isn't that ASCII Text is the lowest common denominator. It's that consumers will nearly always be able to do something with ASCII Text, and that for them, something is better than nothing (which is what most have now).
#2 is a legitimate argument, especially for consumers who don't have broadband access. I've had some experience with that concept this summer, and it is extremely frustrating to not be able to get to the web. If the consumer could get to the web, they could readily access a web-based stylesheet that a CDA document included to make the information accessible.
#3 is only partially true. Everyone who has downloaded free software that is widely available, or paid for a commercial product, or had a viewer installed for them on their computer can view a PDF. I carry around a small computing device that couldn't view PDF until I found an app for it.
After some evaluation, I came to the conclusion that the real requirement is "self-contained" display without use of any outside resources other than what you might have installed on your computing device.
Interestingly enough, there are four different standards already in existence that allow us to converge on a solution.
The first of these is the W3C Associating Stylesheets with XML Documents standards. This standard tells you how to associate a stylesheet with an XML document, and is the basis for most existing CDA display solutions. The second of these is the W3C CSS 2 standard, which indicates how structured content can be formatted for display. It is perhaps not widely known, but you can style an XML document using CSS and most browsers have some support for this (how much is something I get to find out). Then there is the IETF URL specification (RFC 1738) which tells you how to resolve a relative URL into a resource. The last of these is a W3C Note on XML Fragment Identifiers that references XPointer.
If you put all of these together, here is what you get:
1. A small CSS (< 4Kb) stylesheet that can be included in an
2. An XML Stylesheet processing instruction that can be used to render the CDA document by referencing the
3. A CDA document that can be displayed in any browser.
I've verified that this is at least feasible using the CDA sample document that was built for the original Care Record Summary Implementation Guide and Internet Explorer 8. I'm still having trouble getting IE to recognize the box-model display formats in the stylesheet, but may be able to address that, and if not, produce an OK workaround. Firefox works just fine. Chrome and Safari just do not seem to like referencing a CSS stylesheet via an internal resource URL. I haven't tried Opera yet, and given the success and failures I've had so far, I think I'm going to limit the scope to desktop display for the moment.
Keith
Wednesday, October 27, 2010
In which I retire
The following missive crossed my inbox this morning. As you can see, my term as cochair of the HL7 Structured Documents workgroup is up for election in January. I will not be running for re-election, and that decision deserves some discussion.
I've been cochair of Structured documents for the last four years. It is time, at least for me, to make way for new leadership; for a couple of different reasons.
First and foremost is that I have now been elected to the HL7 Board. While I don't see it as being a conflict of interest to be both a board member and a workgroup cochair, I do see it to be a conflict of time committments for me. I do not feel that I can be as effective a board member as possible and still be a workgroup cochair. I know other board members, and even some officers do it, but I simply cannot. My attention simply needs to be too many places at once, and that certainly detracts from my ability to lead the Structured Documents workgroup with my other cochairs.
I have also found that as my interests in HL7 broaden, so does my desire to be involved with other workgroups. Being able to give those groups time is even more important now that CDA Release 2.0 is on very firm ground. I'm involved in projects in at least four different workgroups, and will continue my involvement with those projects. I will as of January be able to devote more of my time to them, both as a contributor, and as an intersted member of the HL7 Board. I will also continue my involvement in the Structured Documents workgroup. I don't need cochair access to be a very strong influencer in the activities of that particular workgroup.
Finally, as a mentor told me many years ago, if you cannot be replaced, you cannot be promoted. Well, from an HL7 perspective, I've been "promoted", and so now I need to be replaced. I do want to continue to grow, and to do that, I will need to focus on my newest role.
At the Cambridge working group meeting, I recruited a couple of people who have many years of experience in HL7 and specifically in Structured Documents to run for the open seat. I have nominated two people already that I think could play that role well. I did my best in nominating to ensure that the current balance in leadership would not be altered to given any one membership category dominance in leadership roles. There's a whole nother post on that topic that I might take some time to write if needed.
So, speaking into the future to the next Structured Documents co-chair, I give you in advance, as tradition demands, both my congratulations and my condolences.
Keith
October 27, 2010
I've been cochair of Structured documents for the last four years. It is time, at least for me, to make way for new leadership; for a couple of different reasons.
First and foremost is that I have now been elected to the HL7 Board. While I don't see it as being a conflict of interest to be both a board member and a workgroup cochair, I do see it to be a conflict of time committments for me. I do not feel that I can be as effective a board member as possible and still be a workgroup cochair. I know other board members, and even some officers do it, but I simply cannot. My attention simply needs to be too many places at once, and that certainly detracts from my ability to lead the Structured Documents workgroup with my other cochairs.
I have also found that as my interests in HL7 broaden, so does my desire to be involved with other workgroups. Being able to give those groups time is even more important now that CDA Release 2.0 is on very firm ground. I'm involved in projects in at least four different workgroups, and will continue my involvement with those projects. I will as of January be able to devote more of my time to them, both as a contributor, and as an intersted member of the HL7 Board. I will also continue my involvement in the Structured Documents workgroup. I don't need cochair access to be a very strong influencer in the activities of that particular workgroup.
Finally, as a mentor told me many years ago, if you cannot be replaced, you cannot be promoted. Well, from an HL7 perspective, I've been "promoted", and so now I need to be replaced. I do want to continue to grow, and to do that, I will need to focus on my newest role.
At the Cambridge working group meeting, I recruited a couple of people who have many years of experience in HL7 and specifically in Structured Documents to run for the open seat. I have nominated two people already that I think could play that role well. I did my best in nominating to ensure that the current balance in leadership would not be altered to given any one membership category dominance in leadership roles. There's a whole nother post on that topic that I might take some time to write if needed.
So, speaking into the future to the next Structured Documents co-chair, I give you in advance, as tradition demands, both my congratulations and my condolences.
Keith
October 27, 2010
TO: HL7 Membership
FR: Linda Jenkins
RE: Call for Nominations for Upcoming Co-Chair Elections
The following HL7 work groups will be conducting co-chair elections at the HL7 working group meeting January 9-14, 2011 in Sydney, Australia. The deadline for nominations is COB, Friday, November 26, 2010. Nominations submitted after the deadline will not be accepted; however, write-ins will be accepted during the January WGM.
· Clinical Genomics - electing two co-chairs to fill the positions currently held by Kevin Hughes and Mollie Ullman-Cullere (both of whom may be re-elected)
· Clinical Interoperability Council- electing one co-chair to fill the position currently held by Steve Bentley (who may be re-elected)
· Clinical Statement - electing two co-chairs to fill the positions currently held by Hans Buitendijk and Rik Smithies (both of whom may be re-elected)
· Electronic Health Records - electing three co-chairs to fill the positions currently held by Don Mon and John Ritter (both of whom may be re-elected) and one new
· Modeling & Methodology– electing one co-chair to fill the position currently held by Lloyd McKenzie (who may be re-elected)
· Orders & Observations - electing two co-chairs to fill the positions currently held by Hans Buitendijk and Patrick Loyd (both of whom may be re-elected)
· Patient Safety - electing one co-chair to fill the position currently held by Ali Rashidee (who may be re-elected)
· Structured Documents - electing one co-chair to fill the position currently held Keith Boone (who may be re-elected)
· Templates - electing one co-chair to fill the position previously held by Richard Kavanagh (who resigned)
· Vocabulary - electing one co-chair to fill the position held by Russ Hamm (who may be re-elected)
The formalized process for electing co-chairs is as follows:
1. Written announcement is made to members conveying that a 30-day period for receiving nominations for co-chair position(s) has started. This communiqué serves as that announcement to all of the work groups listed above. Please forward all co-chair nominations via e-mail to NOMINATIONS@HL7.ORG or fax to 734-677-6622 no later than COB Friday, November 26, 2010. Please specify the work group for which you are nominating a candidate.
2. A list of candidates will be announced to the membership electronically. At least two candidates should be nominated for each open position. Note that co-chairs serve for two years and may be re-elected without limit. When possible, co-chairs terms should be staggered to ensure continuity of leadership. Candidates will be asked to supply a brief (one paragraph or less) statement of their credentials, reasons and vision for seeking election to the work group for which they are nominated.
3. Per the following sections of the GOM, the January co-chair elections shall be conducted as follows:
05.02.04 Voting at the Working Group Meeting - Work Group co-chair elections shall be announced at each general session and shall open on Monday of the Working Group Meeting and continue through the following Wednesday. Work Group co-chairs are encouraged to also announce the co-chair election in their opening comments. The polls shall open with the general session and close at 5:30 PM Monday through Wednesday.
Anyone in attendance at the WGM whose badge holder, issued at registration, identifies them as Members and who are subscribers of the Work Group’s primary list server as of the Wednesday preceding the WGM may pick up and complete that Work Group’s co-chair ballot at the HL7 registration desk any time during the polling hours Monday through Wednesday.
The ballots shall be controlled by reference to a list of subscriber email addresses to the Work Group’s primary list server. A polling site shall be established in proximity to the HL7 registration desk to allow voters to expeditiously complete the ballot and return it to the ballot box on the registration desk.
05.02.05 Tally and Announcement - The ballot box shall be secured by HL7 staff when the polls close each day. The Associate Executive Director shall oversee the tally, including absentee ballots. If this tally results in a tie, the decision will be made by drawing lots, unless one of the candidates involved wishes to defer to the other. The results of co-chair elections shall be announced during the Thursday general session, posted on the announcement board near the registration desk, and provided to the Work Groups. All ballot materials shall be retained for one month from the close of the WGM in case of a call for recount.
A copy of the GOM suitable for download and printing is available on the web site at:http://www.hl7.org/permalink/?GOM
This document can also be retrieved from the HL7 website with the following link:
Tuesday, October 26, 2010
If you want them to read, YOU must communicate
I spent the latter half of last week at a small (about 150 attendees) conference in Valley Forge, PA. One of the points that I was there to make at the conference is that attendees can assert some control of the national agenda. Right now more local organizations and smaller practices don't seem to be a) aware of what is going on around them or b) know (or trust) that they can provide feedback that MUST be addressed. Barbara Connors, Chief Medical Officer for CMS Region III made that last point rather strongly after I spoke. If you comment on pending regulation, then the regulator must, BY LAW, address those comments. (By the way, if you have an opportunity to get Barabara to come speak at your event, DO IT. She presented information about the Incentives rule that even I didn't get from READING it twice. You can find her contact information here. On my suggestion, they may even present these slides on video, as you really need someone like Barbara to make sense of it)
The Meaningful Use agenda being set in Washington, and the standards being developed to meet that agenda are both open processes that anyone can participate in. Glen Marshall's recent post RTFM complains that it isn't really about lack of opportunity. I would agree, the opportunity is certainly present, but frankly, very little is being done to make that opportunity either known, or in some ways available to those constinuencies that are going to be the hardest hit by Meaningful Use. One of the audience members complained, and rightly so, that participating in these efforts is a daunting challenge, especially for smaller practices.
I would imagine that other countries have had the same issue, but given the differences in our healthcare systems, it's probably less of a problem. In countries like Canada or much of Europe or Asia where healthcare is provided by the Nation, communication to healthcare providers is probably a bit easier. There would also seem to be a tendency away from "large" IDNs like we have in the US. But I don't live there, so I'd love for my non-US readers to chime in.
There are two separate issues. The first is communication. There needs to be some way to communicate to these constituencies to get their input. That input needs to be actively sought out by ONC. Find me anyone on the HIT Policy or Standards committee that IS a small provider, rather than someone who claims to be "representing" them. I think it is incumbent on the larger standards community to seek out that input and bring it forward, but I also want ONC and the SDOs to hear from them directly.
So, we need a way to make that happen. One thing that I might suggest is to provide a larger budget for communication to make these providers more aware of what is happening. The second is to create opportunities designed to get their input. Those opportunities need to be something other than "come spend a day in Washington", because frankly, even if the travel is covered, that's an investment of time that many cannot make. There should be some way to bring the "national experts" to the local events to gather input.
The second piece is to encourage participation, and again, I have some concrete thoughts here. If you want my pediatrician's input, you need use the forums where she is already engaged. Focused questions would seem to be best to get very specific answers, but I also find that very broad questions elicit some very interesting responses. They often address issues that may not be "national priorities", but are fundamental if national priorities are ever to be addressed. But the other part of this is to somehow address the cost of participation. There are a couple of thoughts here. One of them capitalizes on the fact that participation in these activities is an education, and providers already have a responsibility for ongoing education. It sounds like there might be an opportunity here to set up a CME program where providers get credit for participating in the process. That would probably need to be structured in some way. Another possibility are "micro-grants" which would offer smaller providers grants to participate in some of these activities in exchange for bringing their knowledge back to their communities. Another possibility would be to provide some sort of "scholarship" mechanism for smaller providers. And speaking of scholarship, why don't we connect with the educational centers and let them know of the opportunities to participate in these processes.
I routinely recieve 2-3 e-mails a month from people who have students who want to learn more about standards, and I put them in touch with the different organizations. But the SDOs and ONC could certainly do more outreach here.
Still thinking...
The Meaningful Use agenda being set in Washington, and the standards being developed to meet that agenda are both open processes that anyone can participate in. Glen Marshall's recent post RTFM complains that it isn't really about lack of opportunity. I would agree, the opportunity is certainly present, but frankly, very little is being done to make that opportunity either known, or in some ways available to those constinuencies that are going to be the hardest hit by Meaningful Use. One of the audience members complained, and rightly so, that participating in these efforts is a daunting challenge, especially for smaller practices.
I would imagine that other countries have had the same issue, but given the differences in our healthcare systems, it's probably less of a problem. In countries like Canada or much of Europe or Asia where healthcare is provided by the Nation, communication to healthcare providers is probably a bit easier. There would also seem to be a tendency away from "large" IDNs like we have in the US. But I don't live there, so I'd love for my non-US readers to chime in.
There are two separate issues. The first is communication. There needs to be some way to communicate to these constituencies to get their input. That input needs to be actively sought out by ONC. Find me anyone on the HIT Policy or Standards committee that IS a small provider, rather than someone who claims to be "representing" them. I think it is incumbent on the larger standards community to seek out that input and bring it forward, but I also want ONC and the SDOs to hear from them directly.
So, we need a way to make that happen. One thing that I might suggest is to provide a larger budget for communication to make these providers more aware of what is happening. The second is to create opportunities designed to get their input. Those opportunities need to be something other than "come spend a day in Washington", because frankly, even if the travel is covered, that's an investment of time that many cannot make. There should be some way to bring the "national experts" to the local events to gather input.
The second piece is to encourage participation, and again, I have some concrete thoughts here. If you want my pediatrician's input, you need use the forums where she is already engaged. Focused questions would seem to be best to get very specific answers, but I also find that very broad questions elicit some very interesting responses. They often address issues that may not be "national priorities", but are fundamental if national priorities are ever to be addressed. But the other part of this is to somehow address the cost of participation. There are a couple of thoughts here. One of them capitalizes on the fact that participation in these activities is an education, and providers already have a responsibility for ongoing education. It sounds like there might be an opportunity here to set up a CME program where providers get credit for participating in the process. That would probably need to be structured in some way. Another possibility are "micro-grants" which would offer smaller providers grants to participate in some of these activities in exchange for bringing their knowledge back to their communities. Another possibility would be to provide some sort of "scholarship" mechanism for smaller providers. And speaking of scholarship, why don't we connect with the educational centers and let them know of the opportunities to participate in these processes.
I routinely recieve 2-3 e-mails a month from people who have students who want to learn more about standards, and I put them in touch with the different organizations. But the SDOs and ONC could certainly do more outreach here.
Still thinking...
Cogitating on Standards Harmonization, S&I and Canadian Collaboratives
Just for fun, and so you can keep up, go back and read the following posts.
I've been thinking on this out loud for a while. That first post is in July of 2009. I still don't have all the answers, and I suspect I never will, and in fact, I'm still thinking...
Where I'm focused right now is trying to figure out what the governance model should be.
I was listening to David Riley's presentation on CONNECT last week. The idea that FHA came together as a way to represent the entire Federal government in CONNECT was interesting, because, yeah, the Feds have way to much weight for an agile organization if every agency gets involved. And the same problem happens with SDOs, and payers, and ...
And yet the HITSP model left me wanting too, because if only X gets to elect X, then all X's will be the utmost in X and well, nobody different will ever get heard from, and the small ANYTHING will be completely drowned out.
And it shouldn't be about any one kind of anything...
So, what should happen here?
And then I think about the current election cycle here in the US, and I think about casting dice instead of votes in some races...
Which leads me to think that random chance might have some role to play...
And then there's the case where we made a leadership role in an association I'm a member of specifically to address a part of the group not usually heard from...
So, if the US were to have a new HITSP, or something like it, how should it be governed and who should do the governing?
I know one thing that desperately needs to change. It needs to be able to say NO, and set its own schedules. The people doing the work need to have that control. Somebody else may be able to set priorities, but I don't care what you do, 9 men still won't be able to birth a baby in one month.
You need to have the right resources, and the right amount of time in place to make it work.
Still thinking...
Maybe if I sleep on it, I'll wake up with the answer...
- Hello again, it's me, stirring up the pot
- A Canadian Perspective on Standards Harmonization
- What happens to HITSP Now?
- In which I have something positive to say about ONC
I've been thinking on this out loud for a while. That first post is in July of 2009. I still don't have all the answers, and I suspect I never will, and in fact, I'm still thinking...
Where I'm focused right now is trying to figure out what the governance model should be.
I was listening to David Riley's presentation on CONNECT last week. The idea that FHA came together as a way to represent the entire Federal government in CONNECT was interesting, because, yeah, the Feds have way to much weight for an agile organization if every agency gets involved. And the same problem happens with SDOs, and payers, and ...
And yet the HITSP model left me wanting too, because if only X gets to elect X, then all X's will be the utmost in X and well, nobody different will ever get heard from, and the small ANYTHING will be completely drowned out.
And it shouldn't be about any one kind of anything...
So, what should happen here?
And then I think about the current election cycle here in the US, and I think about casting dice instead of votes in some races...
Which leads me to think that random chance might have some role to play...
And then there's the case where we made a leadership role in an association I'm a member of specifically to address a part of the group not usually heard from...
So, if the US were to have a new HITSP, or something like it, how should it be governed and who should do the governing?
I know one thing that desperately needs to change. It needs to be able to say NO, and set its own schedules. The people doing the work need to have that control. Somebody else may be able to set priorities, but I don't care what you do, 9 men still won't be able to birth a baby in one month.
You need to have the right resources, and the right amount of time in place to make it work.
Still thinking...
Maybe if I sleep on it, I'll wake up with the answer...
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