What needs fixing in e-health?

01/05/2011

or, e-health seen through the prism of an ancient pantheon of gods…

Grahame Grieve’s recent blog entry on the HL7 Fresh Look Task Force seems a good excuse for me to have another big picture look at e-health. The fact that HL7 is doing this indicates two things at least: that it thinks something is wrong in the HL7 organisation, and that it thinks something is not going right in e-health in general. That’s good to see. HL7 has been the single most influential standards body in e-health for at least 15 years. It has spent massive effort in the last decade on an effort called HL7v3, or ‘version 3′. This effort has not been a resounding success, indeed the evidence indicates the opposite. I have historically been one of the strongest critics of the technical architecture of this effort, so my statements here won’t come as any surprise. To give credit where it is due however, I have come to see that HL7 was trying to the right kind of thing, just that they lacked the appropriate expertise to do it. Solving the challenges in the area of e-health is no mean feat, and maybe some of them are unsolvable, so take that statement as a commiseration rather than a criticism. Read the rest of this entry »


The crisis in e-health standards III – solutions

18/10/2009

Prev: The crisis in e-health standards IIa

Stakeholder Aspirations and Needs

Before going so far as to offer a solution to the e-health standards problem, I want to have a look at what we consider to be the requirements that such standards, and indeed health informatics in general is meant to address.

The most typically repeated aspirations I hear regularly from government e-health programmes (which are usually staffed by ‘believers’ in e-health) include the following: Read the rest of this entry »


The crisis in e-health standards IIa

13/10/2009

Prev: The crisis in e-health standards II
Next: The crisis in e-health standards III – solutions

Unfinished business

I promised pointers to a solution for how to get out of the standards mire in which we find ourselves today. But first, I will intervene with a short post on missed items, pointed out to me by various (justifiably) miffed people.

The Object Management Group (OMG)

For many people in the clinical arena, the OMG is probably quite peripheral, like the IEEE or W3C. They know that it exists, and that it probably does something important they don’t really understand. What many don’t know is that it has been a major innovator in the ‘standards business’ and also been active in the health vertical. The first is relevant because it is an organisation we can learn from. The OMG started in 1989 and created a standard called CORBA (Common Object Request Broker Architecture), which was essentially about making ‘objects’ talk to each other across the network, or in today’s speak, ‘services’. Indeed today’s favourite mantras, Service-Oriented Architecture (SOA) and ‘web services’ owe a lot to the work done by the OMG. Corba is supposed to be dead, but Richard Soley (OMG CEO) once told me that it is quietly whirring away on hundreds of thousands of machines around the world. Companies like Progress Software also seem unaware of its demise.

In more recent times, the OMG has become the organisation that manages the UML standard, business process and workflow-related standards, and a growing ecosystem of ‘MDA’ (Model-driven Architecture) and software quality standards. The OMG standards of greatest importance to the ICT industry are these infrastructure standards, although there are many in vertical domains as well. Read the rest of this entry »


The crisis in e-health standards II

01/10/2009

Prev: The crisis in e-health standards
Next: The crisis in e-health standards IIa

In my last post I made three basic points:

  1. that the committee-based process used by official standards organisations is not designed to be used for standards development and will not generate the required outcomes in e-health;
  2. that the process of  ‘choosing standards’ by governments (or anyone else) will not result in an integrated set of specifications on which widespread e-health interoperability can be based.
  3. a new way of producing standards for e-health is needed.

Although for most engineering and other technical people, these points are obvious, it is nevertheless reasonable to present some evidence. Read the rest of this entry »


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