Monday, February 28, 2011

Cries for Help

One of the disturbing aspects of the HL7 phenomenon is the degree to which so many of those who have strong critical views are reluctant to express these criticisms in public. Here a sample criticism of the HL7 RIM, by a leading healthcare IT specialist in Asia who has given me permission to quote from his email communications, as follows:

It is abundantly clear that V3 is an unnecessarily complex, incoherent and confusing messaging standard while V2 is simple, workable, elegant and deployed at more than 95% of healthcare institutions wherever HL7 is used.

Why not scrap V3 and simply work on improving the V2.x standard (say V2.7)?

I am concerned about the growth and proliferation of a meaningless standard because it is fraught with danger and is leading to:
(a) Increase in the cost of Hospital IT implementation
(b) Making coding complex which could lead to errors and thereby lower care of (and even endanger) patients
(c) Increasing the cost of software
(d) Increasing the cost of training and implementation
(e) Forcing the use of two standards in parallel when one could have sufficed
(f) Diverts funds from useful IT apps to feed V3

The only people/groups that could possibly gain from this are:
(a) HL7 org and their collective egos
(b) Trainers who will make money from teaching this "complex" 'new' standard
(c) IT companies that make money from pushing newer versions and widgets to "upgrade" to V3

SADLY, it is finally the patient who pays (even if it is a govt or insurance run system) while the doctor, who is already overstressed, is made to learn 'new and improved' processes. As a doctor with more than 30 years of practice, this situation is clearly not acceptable to me.

We need to put together a strong official lobby consisting of sane minded people, organisations and vendors to be heard by the US govt and to forcefully close down such (criminally) wasteful activities.

Here is another example of a desperate push through a back door: Pushing and converting a perfectly good CCR to a CCD by unnecessarily insisting on a RIM based approach (where none was required) shows desperation to push the RIM, come what may.

It is my personal opinion that there should be no shame in accepting that a certain approach has failed. We are doctors and scientists and accept, humbly, that we do not always succeed. The real shame and loss would come from stubbornly trying to flog a dead horse putting time, money and people at stake, just so as not to declare failure. I say, be brave enough to move on and use the excellent collection of thinkers at HL7 to develop a fresh, focused and simple solution. To try and capture the complete medical domain (present and future) into one core model is not only foolish but also unachievable. We as doctors know that and therefore only focus on our core specialty.


David said...

I agree. Often it is the folks who are in love with the concept of standards and who have not done any real world computing that push the envelope in directions it need not go.
I have often wondered why move from 2.x? This model works! Why force everyone to assume the cost of moving to 3.x? If I were a vendor I would resit it to the very end.

Alvin Marcelo said...

Hi. I'm from a developing country (aka late adopter). No HL7 discussions, no inter-operability frameworks too. What should countries like ours do? v2.x or v3? There are no legacy systems (or so I think).