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Healthcare Interoperability and Standards Rules

Posted on September 11, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Dave Winer is a true expert on standards. I remember coming across him in the early days of social media when every platform was considering some sort of API. To illustrate his early involvement in standards, Dave was one of the early developers of the RSS standard that is now available on every blog and many other places.

With this background in mind, I was extremely fascinated by a manifesto that Dave Winer published earlier this year that he calls “Rules for Standards-Makers.” Sounds like something we really need in healthcare no?

You should really go and read the full manifesto if you’re someone involved in healthcare standards. However, here’s the list of rules Dave offers standards makers:

  1. There are tradeoffs in standards
  2. Software matters more than formats (much)
  3. Users matter even more than software
  4. One way is better than two
  5. Fewer formats is better
  6. Fewer format features is better
  7. Perfection is a waste of time
  8. Write specs in plain English
  9. Explain the curiosities
  10. If practice deviates from the spec, change the spec
  11. No breakage
  12. Freeze the spec
  13. Keep it simple
  14. Developers are busy
  15. Mail lists don’t rule
  16. Praise developers who make it easy to interop

If you’ve never had to program to a standard, then you might not understand these. However, those who are deep into standards will understand the pitfalls. Plus, you’ll have horror stories about when you didn’t follow these rules and what challenges that caused for you going forward.

The thing I love most about Dave’s rules is that it focuses on simplicity and function. Unfortunately, many standards in healthcare are focused on complexity and perfection. Healthcare has nailed the complexity part and as Dave’s rules highlight, perfection is impossible with standards.

In fact, I skipped over Dave’s first rule for standards makers which highlights the above really well:

Rule #1: Interop is all that matters

As I briefly mentioned in the last CXO Scene podcast, many healthcare CIOs are waiting until the standards are perfect before they worry about interoperability. It’s as if they think that waiting for the perfect standard is going to solve healthcare interoperability. It won’t.

I hope that those building out standards in healthcare will take a deep look at the rules Dave Winer outlines above. We need better standards in healthcare and we need healthcare data to be interoperable.

Learning About Interoperability from Other Industries

Posted on September 21, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my recent post about DeSavlso suggesting we needed a common interoperability standard, Karl Walter Keirstead offered the following comment:

Finally, someone in government agrees that MU has not had a focus on the right things.

It’s amazing to me, coming from the industrial process control domain where interconnectivity across multiple systems and applications has been routine for 70 years, to see healthcare fussing over interconnectivity.

Their is no need to standardize.

Each set of trading partners the publisher needs to format data for easy posting to a generic data exchanger and the subscriber needs to be able to read data at the data exchanger for easy import to the subscriber environment.

The design criteria are that each partner be allowed to read/write using their own native data element naming conventions (i.e. I post “abc”, you want to be able to read it as “def”, a 2nd subsriber may want to read “abc” as “ghi”.

Of course, a long name is required per publisher data element so that subscribers are able to figure out what they are subscribing to and the other requirement is that a publisher be able to share on a need-to-know basis.

And, yes, since the usual setup will be “pull” instead of “push” each subscriber needs to be able to retain a cursor position at the exchange so they know the last line item they read.

I always learning from other industries and I think the way Karl frames it is really valuable. There are a few challenges that are unique to healthcare. First, we’re talking about 300 different EHR vendors. I guess you could argue that there are even more suppliers in industry for say something like a car or a computer, so they understand integrating with a lot of vendors. However, I think it’s slightly different since all 300 EHR vendors are trying to do more or less the same thing. Still doable, but it does add some different dynamics.

Second, I think that healthcare data is an order of magnitude more complex than much of the data that’s being shared in other industries. I still feel like that’s an excuse as opposed to a real reason for it not to happen. I know this because for years we’ve seen this data being shared at the HIMSS interoperability showcase. It’s more about will than it is about the complexity.

This all reminds me of the time I asked Judy Faulkner, CEO of Epic, if she knew the opportunity she was sitting on. She gave me a blank stare and asked what I meant. I then proceeded to tell her that if she opened up Epic to other people she’d effectively create a standard that everyone would adopt. That’s essentially what I think Karl is saying when he says:

Each set of trading partners the publisher needs to format data for easy posting to a generic data exchanger and the subscriber needs to be able to read data at the data exchanger for easy import to the subscriber environment.

Yep. Epic, Meditech, and Cerner could create a standard for EHR interoperability and everyone would start to use it. Good standard. Bad Standard. It wouldn’t matter, their “trading partners” would adapt to whatever they set as the standard.