Sunday, July 31, 2011

The Wreck of HL7

An interesting ditty by Jean-Henri Duteau, reposted from the ever excellent Health Intersections Pty Ltd (after: The Wreck of the Edmond Fitzgerald)

The legend lives on from ANSI on down
of the SDO they called “HL7.
Health Standards, it is said, never gives up her dead
when the skies of November turn gloomy.
With a load of designers twenty-six thousand tons more
than when HL7 started early,
that good SDO was a bone to be chewed
when “Semantic Interoperability” came early.
The SDO was the pride of the American side
coming back from some place in Ann Arbor.
As SDOs go, it was bigger than most
with a crew and CEO well seasoned,
concluding some terms with a couple of projects
when they left fully loaded for Orlando.
And later that night when the supper bell rang,
could it be the north wind they’d been feelin’?
The wind in the wires made a tattle-tale sound
and a wave broke over the railing.
And ev’ry man knew, as the CEO did too
’twas witch of Interoperability come stealin’.
The dawn came late and the breakfast had to wait
when Semantic Interoperability came slashin’.
When afternoon came it was freezin’ rain
in the face of a hurricane west wind.
When suppertime came the old Board chair came on deck sayin’.
“Fellas, it’s too rough t’feed ya.”
At seven P.M. a main hatchway caved in; he said,
“Fellas, it’s bin good t’know ya!”
The CEO wired in he had water comin’ in
and the good SDO was in peril.
And later that night when ‘is lights went outta sight
came the wreck of HL7.
Does any one know where the love of God goes
when the requirements turn the minutes to hours?
The searchers all say they’d have made Normative
if they’d put fifteen more miles behind ’er.
They might have split up or they might have capsized;
they may have broke deep and took water.
And all that remains is the faces and the names
of the wives and the sons and the daughters.
In a musty old hall in Ann Arbor they prayed,
in the “Health Informatics’ Cathedral.”
The church bell chimed ’til it rang twenty-nine times
for each man on the HL7 Board.
The legend lives on from ANSI on down
of the big SDO they call “HL7.
“Health Standards” they said, “never gives up her dead
when Semantic Interoperability come early!”

Saturday, July 23, 2011

HL7 and the Services Aware Interoperability Framework

Jobst Landgrebe is formerly Enterprise Architect at the International Institute for the Safety of Medicines
(ii4sm) and Co-Chair of the HL7 Vocabulary Workgroup. He and I recently collaborated on a paper entitled "The HL7 Approach to Semantic Interoperability" which was presented at the 2nd International Conference on Biomedical Ontology. The abstract is as follows:
Health Level 7 (HL7) is an international standards development organisation in the domain of healthcare information technology. Initially the mission of HL7 was to enable data exchange via the creation of syntactic standards for point-to-point messaging. For some 10 years, however, HL7 has increasingly conceived its mission as one of creating standards for semantic interoperability in healthcare IT on the basis of its 'version 3' (v3) family of standards. Unfortunately, v3 has been marked since its inception by quality and consistency issues, and it has not been able to keep pace with recent developments either in semantics and ontology or in computer science and engineering. To address these problems, HL7 has developed what it calls the 'Services-Aware Interoperability Framework' (SAIF), which is intended to provide a foundation for work on all aspects of standardization in HL7 henceforth and which includes HL7's Reference Information Model as general purpose upper ontology. We here evaluate the SAIF in terms of design principles that must be satisfied by a semantic interoperability framework, principles relating both to ontology (static semantics) and to computational behaviour. We conclude that the SAIF fails to satisfy these principles.
A video of Dr. Landgrebe's presentation is available here, and contains a number of interesting side remarks, including this (at 13:20):
The SAIF does not meet the needs of an interoperability framework. It can’t overcome the crisis of HL7 – and that’s a big problem because for example the IHE, the big organization that the government agencies are looking at to create interoperability in healthcare – it’s called "Integrating the Healthcare Enterprise" – is telling industry that it should use HL7 for everything in healthcare exchange .. , but if industry would do this nothing could work … My theory is that the IHE is set up exactly to make sure that nothing can work (but that’s – you know – conspiracy theory) … 
Update August 6, 2011:
I received the following comment:
Anonymous has left a new comment on your post "HL7 and the Services Aware Interoperability Framew...": 
I am not certain why your paper was accepted, other than the provocative subject matter. Much of what you state as fact is unsubstantiated opinion. Several of your premises are also faulty.
I am concerned, as this paper is quite misleading and/or misguided. 
You make sweeping generalizations without evidence of data or analysis. Many of these read more like bias rather than factual. Your paper contains several dubious citations. Many of the citations of your assertions don't logically support your argument. Some of the authoritative sources you cite are non-retrievable (404) URLs. Others simply not true. 
You often get tied up in knots in your logic, often based on a trifle (or misunderstanding). The line of reasoning is not clear and is encumbered by jargon, which seems to obscure rather than clarify. 
I can understand why correspondents who provide HL7 Watch with evidence of problems with HL7 request that they be allowed to remain anonymous -- criticizing HL7 can still, I am told, cause career problems in the health IT world. But why would someone who is taking the side of HL7 elect to remain anonymous in this way? Jobst Landgrebe and I provided arguments, and we provided an extensive list of references to support these arguments. (We regret that HL7 seems to have removed from the web some of the items for which we cited URLs since our contribution was first circulated.) Anonymous himself, however, provides assertions, which we would be more than happy to discuss. Perhaps he will reveal himself in order to allow such discussion to proceed.

Update August 18, 2011
One intriguing element of the SAIF literature is that it reveals that HL7 is now promoting the use of the word 'ontology' in application to the RIM. While in other circles there is increasing clarity as to the difference between an information model and an ontology (e.g. here and here), HL7 here seems to be once more muddying the waters.