Ioana, Thank you for your comments... and I heartily agree with them. I think we need to be careful, however, not underestimate the enormity of this task. I'm not sure that I can see how one person from AMA could solicit and review provider input representing the business needs of 300,000 small providers... in 30 specialty domains... in the context of 4 principle care settings.
Another problem that I have run into with associations... somewhat related to their minimal cash resources... is their propensity to focus exclusively on the needs/wants of their dues-paying members. While a member-focus is entirely understandable in the context of continuing medical education and legislative advocacy... the technical advocacy that we are speaking of here would have to include *all* providers in each care domain. I believe around 40-50% of providers have either dropped out of or chosen not to join these associations... but they are still members of "the industry" and they still deserve a robust voice at the SDO table. Most provider associations are NOT presently members of HL7... so that would seem to be Job #1: Recruit a couple dozen high-profile provider specialty organizations as full-fledged, voting HL7 members. Then, within HL7, provider representatives should review the EHR Collaborative/NAHIT "town meeting" experience and agree on the scope of this key task: obtaining provider input from "the trenches" around the essential requirements of care delivery in each specialty domain. This will be an on-going task... not a one-time operation... requiring a robust and permanent communication infrastructure and a committed/competent "vetting pool". But you are absolutely right... we must approach doctors via their trusted associations. I have never envisioned "regular doctors" voluntarily attending HL7 meetings as "individual members". Best regards, -Chris Christopher J. Feahr, O.D. Optiserv Consulting (Vision Industry) Office: (707) 579-4984 Cell: (707) 529-2268 http://Optiserv.com http://VisionDataStandard.org ----- Original Message ----- From: Ioana Singureanu To: Christopher Feahr ; ehrmodelwg at lists.hl7.org ; ehr at lists.hl7.org ; openehr-technical at openehr.org Cc: HL7_Abdul-Malik Shakir ; HL7-Gartner_Wes Rishel ; Victor Connors ; AAO_Steve Kamenetzki ; viceprez at massmed.org ; HZMD at aol.com ; karenvan Sent: Thursday, August 21, 2003 9:37 AM Subject: Proposal to strealime voting for providers Hi Chris, The issue of voting on the EHR Ballot document (for Sept. 5th) came up very forcefully during the EHR Collaborative Field Meeting in Boston. I came to the same conclusion as you that the most effective way for individual providers (such as yourself) to vote would be to channel their input through their professional societies, which are probably already HL7 members. This way providers will have the opportunity to express their views without paying any fees and the EHR SIG co-chairs will receive a more structured input from several organizations rather than hundreds of individual providers. For instance, an organization such as the Massachusetts Medical Society or the AMA can appoint one contact person to receive the input from all its members. This person will be responsible for organizing the comments from physicians (presumably eliminate some duplicates in the process) and submit the ballot to HL7. Remember that each vote may have a long list of included comments. HL7 will have to address all negative ballots and all comments. This way each provider will be heard, the cost to them will be nil, and the job of the EHR SIG co-chairs of reconciling the ballot will become more manageable (they work so hard already...). I attached a more formal proposal document (complete with a colorful diagram) for clarity. Kind regards, Ioana Singureanu Principal Consultant Eversolve, LLC 603-548-5640 ----- Original Message ----- From: Christopher Feahr To: ehrmodelwg at lists.hl7.org ; ehr at lists.hl7.org ; openehr-technical at openehr.org Cc: HL7_Abdul-Malik Shakir ; HL7-Gartner_Wes Rishel ; Victor Connors ; AAO_Steve Kamenetzki Sent: Thursday, August 21, 2003 11:25 AM Subject: HL7, SDO operations, and EHR convergence (re-post to openEHR list) (I did not see this posted to openEHR... trying again. please pardon if duplicate) I am addressing the important issues raised on the openEHR listserve around HL7 membership/participation costs, ability to contribute/comment on standards vs. "vote" on them, license to examine/review vs. "implement" standards, etc. These issues directly impact the ability of the provider and small PMS vendors to participate. In my opinion, the basic funding, project-management, technical review, user-vetting, harmonization, and final product distribution processes... are in need of review in all health-related SDOs... not just HL7. It is also a problem that there is so much duplicated and occasionally conflicting effort... particularly under the banner of "EHR". AT THE END OF THE DAY, HOWEVER... ... there remains a boatload of hard, technical work that must be accomplished at the SDO level... on behalf of the global community of provider organizations, over 80% of whom are "small" by SBA guidelines. This SDO effort requires vision, leadership, project management, and a reliable funding mechanism... just like any other worthwhile enterprise. Membership dues and license fees are two possible sources of SDO revenue, but there are others. The present funding/labor model, however, is lopsided and does seem to discourage input from small-to-medium-sized organizations. I am confident that it can be fixed, because accredited standards bodies have an *obligation* to listen to their constituents... both individually and as a community... and to adapt their processes, policies, and procedures to meet the needs of their constituent-communities. If the needs of a half-million smaller providers can somehow be brought to a single SDO table, I am confident they will be considered fairly... because ANSI accreditation requires that all important agreements be reached by strong and provable consensus among *represented* stakeholders. NEXT STEPS FOR HEALTHCARE PROVIDERS: Therefore, I suggest that the most important Next Step for the provider community and other under-represented health information users, is to GET YOURSELVES REPRESENTED within ONE accredited standards body. Given the huge, multi-pronged US govt. push to position HL7 as the lead SDO for the US Healthcare Industry (CMS, DHHS, e- Gov/CHI, NCVHS recommendations, etc.), I would suggest that the global provider community consider driving a stake in the ground, declaring HL7 to be "home base" for now... at least for articulating and registering the core requirements and core process models for care delivery... in all major specialty domains and care settings. NOTE: I feel the need to point out that UN/CEFACT (specifically, TBG-10) feels to me like the more politically "right" organization for something as important to mankind and as blind to geopolitical boundaries as Healthcare. But... convergence of this work with the UN's "International Trade and Business Process Modeling Group" can always be accomplished at a later date, if that is the wish of the global healthcare industry. For the moment, it makes more sense to "follow the money" and the larger vested interests to the most recognized and FUNCTIONAL standards table... for providers to essentially bring their requirements to the table that large, vested interests have already created and partially funded. Remember... the HL7 table is "ANSI accredited". No matter how unpalatable or expensive provider business requirements may be, HL7 is bound by rules of accreditation to listen and respond. The consensus process requires that all sustained, reasonable objection to important (i.e., balloted) items... by any duly represented stakeholder... be resolved. How to make "the money part" work in the SDO layer remains open for discussion. But all that is needed to make an accredited SDO "work" for the healthcare industry is to BRING PROVIDER REQUIREMENTS TO THE TABLE. regards, -Chris Christopher J. Feahr, O.D. Optiserv Consulting (Vision Industry) Office: (707) 579-4984 Cell: (707) 529-2268 http://Optiserv.com http://VisionDataStandard.org ---------------------------------------------------------------------------- --- To access the Mailing List archives, go to: http://lists.hl7.org/lyris.pl?enter=ehrmodelwg -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030821/ee867223/attachment.html>
