Clinical Informatics Standards

Nov 16, 2011

While I was in Singapore, there was a panel discussion of the degree to which clinicians need to be involved in the formation of healthcare IT standards. I was somewhat surprised to hear that the outcome of the discussion was that there is no need for clinicians to be involved in them at all. Now while there were particularly local factors involved in the context of the discussion, and it’s resolution, I’ve been thinking about that a lot since. If, by Healthcare IT standards, you mean exchange and persistence infrastructure and base level logical models, then there is no particular reason for clinical users to be involved in the standards development process. Obviously, you need to properly gather requirements from clinically knowledgeable users - and that includes, but is not confined to, clinical users. But these standards are primarily engineering constructs, and clinical users bring no value, or negative value, to this process because they do not understand the nature of the thinking required at this level. (On the other hand, clinical users who have also learnt to think this way are more useful - it’s not the clinical knowledge that is negative, but the lack of knowledge of how to build systems).

I’m watching the price of giving clinical users too much influence over the exchange and system standaards in a couple of contexts right now, and it’s not pretty - they are standing in the way of their own goals.

But there is a real place for real clinical users in healthcare IT standards, and that’s in Clinical Informatics Standards. In this context, clinical informatics standards means things such as which coding systems are used, how clinical concepts such as blood pressure are used, how clinical obligations fit into the workflow. As long as clinical users don’t agree about these things, then the lower level implementation standards will have to cater for the higher level clinical disagreement, and they’ll be looser, more open to interpretation, and harder to implement. Which will reduce their clinical utility.

So the message for clinicians regarding involvement in standards is relatively straight forward: the more you all agree on clinical informatics standards, the more bang for your buck you’ll get from the supporting exchange and system standards.

HL7 saw this a long time ago, and has been reaching out to clinician user groups (colleges, professional associations etc) for several years, but this is a relatively new and slow process. And openEHR has been doing this for along time.  The new CIC process from HL7/IHTSDO/etc is trying to address this problem as well. But none of these things can really achieve their goals until general clinical users are prepared to buy into the value proposition of standards: if I give up something over here, then I’ll gain something over there. Clinical Informatics standards aren’t meaningful unless they constrain how a clinical user operates.