In Healthcare Standards development, there is a natural ebb and flow between development and implementation. IHE has this embedded in their annual 18 month cycle. HITSP did to in its annual cycle. HL7 doesn't have it embedded quite so much, but since they ballot three times annually, there's still a cycle of intense development followed by a cycle of intense review, and then it repeats.
Sean Nolan comments now on an issue I raised 9 months ago. It's really about sustainability of initiatives, and the bandwidth of the HIT community. Summer was one of the periods I had to think about new initiatives. Not any more with the ONC Summer Camps and Concerts and new initiatives. Sean's post was topic 1 of last nights #HITsm chat (see the transcript).
I've gotten used to the constant pressure on SDOs. What I haven't yet gotten used to is having the standards efforts of our industry being so forcibly driven by one agency in US Federal government (ONC). The challenge for me is one of governance. In each of the SDOs that I participate, we make plans, address dependencies, and identify gaps that need to be filled before some projects will come to the fore. Those plans, dependencies and gaps used to be identified by the stakeholders involved in the work of those SDOs, but are now externally forced, and the plans mostly inaccessible to those performing the work. This has the same chilling effect on innovation in Health IT from within those organizations as the pre-HITECH mechanisms for certification of EHRs had on product innovation. The challenge that the external pressure brings is how to fit it into existing stakeholder demands on the SDOs. One could argue that ONC is presenting the right demands, and I won't argue that. My point is that they aren't presenting those demands to the SDOs, but are rather setting up a competing mechanism to do what the SDOs already exist to support.
In the case of the S and I Framework, and in the preceding activities of HITSP, instead of the planning being done by the volunteers doing the work, the planning and requirements for use cases was largely directed by Federal agencies and their advisory committees. Yet, most of them aren't subsequently present and available to discuss their requirements when the work commences. This has gotten a little bit better in the S and I Framework programs, in that there are representatives (even if not the instigators) available to discuss requirements (something learned well from the Direct Project). But even today, the SDOs are not yet engaged as participants in the planning process. In fact, the plans and schedules for future S and I projects are not known outside a very small circle of people.
What I'd really like to see is ONC open up the discussions of what they feel they need, and engage with the various SDOs to encourage innovative thinking, development and planning for the future. Rather than driving from without, they could have a much better effect driving from within. By acting with, and as part of the SDO, they participate in the planning, encourage innovative thinking, but can also develop a better understanding of the current environment, and what might be possible today that they aren't even aware of.
IHE recently opened up its annual request for proposals for three domains: IT Infrastructure, Patient Care Coordination, and Quality, Research and Public Health. I would encourage ONC to take advantage of this process and submit a proposal or three. Then come to a meetings and webinars and listen to the discussions around the proposals that we receive, and see how we can help, and visa versa. I would also suggest that they look into what is happening at HL7 and present a project or two for consideration.
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