Thursday, July 7, 2011

HealthIT standards Maturity vs Adoption

This week the HIT Policy committee had a meeting with an agenda item where Doug Fridsma and John Halamka gave a Briefing on HIT Standards Committee. I have been following these meetings closely, so it was rather surprising what this Briefing contained. As always I encourage everyone to participate, this is one of the only Transparency mechanisms that these FACA committees have (They claim to be Open with the open public comment at the end of each meeting, but these comments seem always to fall on deaf ears). John Halamka blogged his summary of this testimony.

One slide has come up over and over in discussions, slide 24. This slide seems to have appeared out of nowhere. I know that none of the groups I participate in were asked for input to it. There is no explanation of the axis, but they were verbally explained. Not too surprising. Maturity is related to how solid the specifications are and includes if there are implementation guides available.

The concern I have is with the Adoption definition. I am hearing the same concern from others as well. The problem is that the Adoption measurement don't seem to be being applied equally to each item. The REALLY BIG PROBLEM is that there seems to be no way to correct the chart. Now that the chart has been presented to the HIT Policy committee, it will now be considered fully correct. Now, I don't have too much in the way of corrections, but I would like to see an OPEN and TRANSPARENT analysis.

I understand how "Direct Transport" is being looked at as "SMTP", and easily agree that SMTP is very mature and widely adopted. But if we look at how a Direct ecosystem is built, this is not enough of a picture. We must also think about the support transport for all of the Direct Specifications and specifically how well these are implemented in Healthcare workflows. Saying that "SMTP" is highly adopted doesn't mean that "Direct" is highly Adopted. Until the transport is integrated into Healthcare workflows we must recognize this as pure pilot projects and pure pilot use.

I really don't understand how the "Direct Security" is put into this space. The HIT Standards, HIT Policy, S&I Framework, and others are still arguing over certificate distribution; something that will take a long time to argue over due to the need to have the certificates before you communicate.

Where as the NwHIN Exchange specifications seem to be split all over the pace. I am surprised at how the Query could be less adopted than the Retrieve; especially since the only way to Retrieve something is to have previously Queried for it. Thus one must implement Query at the same rate as Retrieve.  I and others on the NwHIN Exchange calls expressed surprise at the NwHIN Exchange evaluation. Somehow all the participation in the NwHIN Exchange is discounted as LOW:

From the NwHIN Exchange site -- Participants (as of 6/13/11):

And that list is short, as GE Healthcare participates through my direct participation and indirectly through a set of State based Health Information Exchanges such as KeyHIE.

Please give us a way to provide input. Please allow us to participate in an open and transparent process. There is such positive movement, why is it always ignored?

1 comment:

  1. I agree that the comment period at the end of the meeting is (unfortunately) useless. That's too bad because the process is really not working, or working up to what one expect given the goals, which is painfully obvious to any outside observer.

    7/7 is a great long term wrap up of strategies that have been largely documented elsewhere, but are all in one place.

    Do the charts really make any sense? There's probably only a few people trying to parse them, and that one should be redone.

    What's that say?, it's the conversation that counts.

    Direct Transport, and Direct Security, setting "National Standards"? High Adoption/High Security?

    That was completely ruled out of scope for Direct Communities/Rules of the Road. +1 for your reality check in that corner of the chart.

    Your comments in 6/10 also ranks as one of the reality checks, "Reinventing the Internet".

    Arien's comment on 06/10 "DNS is highly decentralized"? Huh? Distributed maybe, but it is clearly not decentralized, exactly the opposite.

    Not using DNS will lock in someone to manual methods? At least Arien was looking into the "chain of responsibility pattern" long term in which all these protocols could comfortably co-exist, even as he presented this spin on DNS on 6/10 as an economic argument.

    Ah so much tech spin...reality as spin, but with actual nuggets of truth that if you didn't really know what was what, might make sense.

    Perhaps one of the values of TC-215 is that identity is only used for identity, and attribute certificates are used at the Policy Enforcement, Policy Decision points.

    Blogging is probably the only logical way to communicate this process failure.

    Still, it's good to go back and listen to the meetings (06/10 Standards is a classic!)to see how the crowd adopts information/misinformation, that might seem logical...then corrects itself with reality, then goes off track again.

    I'm a big fan of the recordings, because they display many assumptions.

    Maybe there's some kind of software that shows how these ideas.

    Keep up the reality checks, otherwise once this stuff gets out the public, they are going to wonder about the obvious deal that has been struck behind the scenes to avoid a real IETF technical discussion of valid operational characteristics/issues which have to come out at some point to make this work.

    For example, how does one turn on auditing, (without utterly crushing a server's performance) or even want to turn on auditing for all certificate searches on a "national basis"? What use will that serve for a patient or provider?

    Note how Arien at the end pushes for the "updated charter" for S&I Framework to slow it down while the Policy Committee on 06/10 mulls over requirements, (that unfortunately aren't actually traceable requirements but a collection of assumptions btw), and making note of the fact that they needed to be careful in forming that charter...

    (Thanks operator, we don't have any comments at this time).