Ramblings: A lack of Standards for Interoperability… in Communication Applictions

Ok, I confess, this post is not about Standards enabling Interoperability in eHealth but it will highlight the problems on the lack of Standards in Healthcare.

To cut the story short, I’ll share two points pertaining to me (well, somewhat pertaining);

  • I depend heavily on Outlook and my smartphone to organise my schedule and maximise productivity.
  • I am using an Android Phone (a very good one – Samsung Galaxy S2)

Well, here is my problem, there is no native or easy way to synchronise Microsoft Outlook and Android devices – none by any reasonable measures.

To make things worst, even when I ‘resign to fate’ and ‘adhered religiously’ to the¬†irrational methods of synchronising data (trust me, there are tons of official methods that doesn’t work well), I lose data – every single time I tried to¬†synchronise¬†the data.

Now this has been causing me minor inconveniences like a missing phone number or appointment that  (random numbers and scheduled appointments just simply disappear after syncing the data).

The final straw came when bulk of my calender got wiped out, rendering me helpless, trying hard to figure out what the schedule appointments are – for the entire month (so I’m sorry if I missed / will miss an appointment, I have to blame it on the lack of standards).

The only good thing is, I bought an application – Android-Sync that seems to work decently. Well, not 100% but I’ll live with the minor hiccups, at least my contacts and calenders seems to be in place even after a few synchronisation attempts.

Now imagine the above problems in healthcare. Sounds scary?

Well, be afraid, be very afraid.

The good news is, there are people working towards provision of good standards (that ensures semantic interoperability) but please support our efforts because it is not an easy journey!

Ramblings: Health IT Standards – What went wrong where?

I had an interesting conversation with some individuals on Health IT  Standards recently, in a setting where we were discussing a few  selected standards.

Firstly, it’s on XDS (Cross Enterprise Document Sharing) from IHE and the topic was why it was not suitable for handling non-DICOM images.

The first red flag that went off the top of my head was ‘perversion of the XDS standard’.

XDS is not mean for ‘handling of non-DICOM images’, it is meant to “register and shares electronic health record documents between healthcare enterprises,¬†ranging from physician offices to clinics to acute care inpatient facilities it is meant for cross whereas the conversation was about using it“.

In other words, its meant to be used in an EMR/EHR environment for sharing of documents (I came to realised that the same individual ¬†didn’t really understand what the XDS was meant for because he was trying to explain XDS to someone else ¬†the next day and he stumbled for quite a while before I stepped).

Now this guy can go on and complain about the how “XDS has failed for him” and he will be ‘correct’ because it has indeed ‘failed’, since XDS has been made to serve a wrong purpose (no¬†surprises¬†here).

Its like complaining that planes has failed because they are terrible when one try to drive it like a car, thinking both are transportation devices hence it should serve the same purposes Рa case of plain cognitive failure.

As an advocate of Standards (I am the Vice-Chair of HL7 Singapore and a strong supporter of relevant standards in the right context), I tried to first highlight that if they are looking at imaging, then it is XDS-I (Cross-enterprise Document Sharing for Imaging).

(This part will take abit of explaining to illustrate the context, they were talking about ‘DICOMising’ non-DICOM images, hence they should look at XDS-I since everything would be in DICOM but this will be another story for another day, I think it’s a great example on not looking into the context before adopting a particular standard).

Before I could take arrive to my point, I was shot down (well, its 3 versus 1, I’m not going to waste too much time on a lost cause)¬†by a comment saying there is one¬†report off the internet citing how a physician was trying to access a patient’s medical records and he had trouble locating what he needed because he had to open every single document to find out what it was.

Now I was half amused and half worried at this stage.

Half amused because there he was describing a half-attempt adoption of XDS in order to support his point that XDS failed to support a workflow that it was never meant to (see the irony here).

Half-worried because there will be people in the audience who will be walking out spewing the same misguided information.

To describe the concept of XDS in a very simplistic manner, XDS¬†¬†manages a federated document repositories and a document registry to create a longitudinal record of information pertaining to a patient (in a given ‘clinical affinity domain’).¬†These are distinct entities with separate responsibilities.

  • A¬†Document Repository¬†is responsible for storing documents in a transparent, secure, reliable and persistent manner and responding to document retrieval requests
  • A¬†Document Registry¬†is responsible for storing information about those documents so that the documents of interest for the care of a patient may be easily found, selected and retrieved irrespective of the repository where they are actually stored

The example he quote verbally has obviously the Document Registry¬†part missing and the implementation was not adopted in compliance of the XDS specification but somehow, XDS got blamed for it. (Its like saying ‘work is going to kill you’ because there are incidents of KarŇćshi in Japan).

Further attempts to set the context right were met by rebuttals claiming that;

  • Standards looks¬†nice on paper but fail in real world implementation
  • He is from the industry and he ‘knows’ better

Well, I pointed out that Standards bodies like¬†HL7 and IHE are made up of volunteers from the industry (myself included, I am¬†practitioner¬† first, ¬†academian second ) and Standards ‘failed in the real world’ due to ¬†implementers¬†(like himself) not understanding the standards being implemented, thus implementing it half-right or just plain-wrong.

To put his ‘argument’ into another context, its akin to saying that;

  • The traffic light system of Red = Stop, Amber = Caution and Green = Go has failed because motorist are ignoring them or that in some places the colour has been changed
  • Because he has been driving in a such a massively chaotic environment such as above, he is¬†convinced¬†that his opinion is the only one that matters. Well the world is a very big place and even traffic rules differs from places to places (speeding rules, left hand drive versus high hand drive), let alone healthcare systems

It is important to understand that the Standards has not failed, the implementation and enforcement has, there is a huge difference. If one cannot see the different then one cannot fix the problem. It is that simple.

Now don’t get me wrong, Healthcare IT are by no means perfect (and nothing is), hence there are people volunteering their time on Standards Development (there is a huge difference between Standards Development and Standards consumption) and it doesn’t help that healthcare itself is not a standardised / ‘procedurised’ industry.

However, spreading misguided information (such as the above) in a loud confident manner while cutting off attempts to clarify (and an opportunity to actually learn the real stuff) is not doing anyone any favour.

There were also a comment from the same individual about HL7 v2.x is all the same plus it’s not backward¬†compatible etc.¬†I tried to educate him but before I can explain the concepts of HL7 v2.x and why it is in such a chaotic state (due to the lack of lack of semantic¬†interoperability), he became really defensive.¬†Well, I just didn’t have the mood and energy¬†any more¬†but I¬†hope he reads this so he can sound more intelligent the next time he tries to talk about HL7 v2.x).

I guess I need to spend more time¬†advocating on standards (I also ‘have the solution’ on enforcement and¬†governance of Standards but that is another story for another day).

Ramblings: Discounts for books (and more) at Lulu.com

I received this great promotional code from Lulu and I thought I’ll share it with all of you.

Coupon Code: LULUBOOKAU305
Coupon expires 31 January 2012
25% off any  books
$50 Max Savings (on a single transaction)

I believe one can use the coupon code for any purchases off Lulu.com (not just with my books) so do utilise this offer if you are looking to purchase something from Lulu.com (they have some great titles there).

Happy New Year

Goodbye 2011 and Hello 2012!

A new year has started and I took the opportunity to rest (well, a little) during the December 2011 period  (although I had a few ongoing engagements throughout them month) .

More importantly, I pampered myself with ‘gifts of festive cheers’ – books!

That’s right, I got myself a couple of books, 6 books to be exact;

  • 3 books on business topics (I’ve resumed my MBA Studies)
  • 1 book on healthcare (I’m doing a MPH at the moment)
  • 2 books on Health Informatics (on Standards)

Ok, I admit, I didn’t really buy books ¬†the books for Health informatics, they were sent to me as a ‘gift’.

While I am happy to have an addition of 6 new books to read (I love reading useful stuff), I am somewhat a little irk that they are not ebooks (all the books have no ebook options) but happy in a way because I love reading hardcopy books (the feeling is just different, especially if you need to do referencing and research on it!)

Regular¬†readers of binaryHealthCare’s blog will remember that I bought a Kindle 3 (Amazon now calls it the Kindle Keyboard 3G) back in November 2010 and I absolutely love my Kindle,¬†which I utilise for reading of journals, books, reading materials for my MBA and MPH (both programs involves a lot of reading and thinking which is great), work related documents, and misc stuff for research projects I am involved in.

The Kindle is fantastic because I can access my ebooks / materials in a jiffy (no hassle, no bootup, very light, non-reflective eInk etc) ¬†on ¬†planes, during train rides (I sold my car, going green), waiting for people, in between meetings. It basically helped me squeezed that extra time that would have been otherwise spent on ‘people watching’ (which I like to indulge on at times, it provide insights on social aspects of things).

Now Amazon recently launched a series of new Kindles, including a tablet version but what really caught my eye was the¬†Kindle Touch. Imagine all the greatness of Kindle 3 (mentioned above) plus a touch screen – sounds perfect, except that my Kindle 3 is in perfect condition and there is no really reason to change it (it’s a great device)

Well, as luck would have it, my younger brother got himself a Kindle Touch and I played around with the device for a while. My assessment is to stick with my Kindle 3. Here are the reasons why.

The Kindle (most of them) are designed to be used with just one hand (they have buttons positioned strategically so no matter which orientation you flip them, you still only need one hand to use it).

This means I can read my book while having a cup of coffee at the cafe without putting my Kindle down (there are many more scenarios where its handy to read with one hand but I’ll leave it as that).

With the Kindle Touch, I need to use both hands, one to hold the device, the other the flip the page – not so ideal.

The real problem however is that with the Kindle Touch, you cannot change the orientation (I reckon Amazon will fix this later but as of now, it can’t). This is a big no-no as I read a lot of files in PDF (too lazy to convert every single document into the Kindle format) and to read them properly, I need to read them in landscape.

So in a way I’m glad I didn’t changed my Kindle (I’m trying to live as ‘green’ as possible) and I do have the best Kindle in the range (the tablet doesn’t count, it doesn’t use eInk).

However, to read my new books, I’d have to carry them around – wish I had them as ebooks, I’d just load all of them in my Kindle and read whichever I like, whenever I like. Sigh.

Ah well, I guess I have lots of reading to do for the next few weeks (or even months… lol) .

One other thing I did notice – after buying so many books, I realised I am selling my books (the ones I wrote) too cheaply!