John Halamka’s Stunning 180: “Dogs and Cats Should Live in Harmony”

The King of the Cats has just acknowledged that indeed cats and dogs should co-exist peacefully.

Dr. John Halamka — Vice Chair of the HIT Standards Committee of the ONC and one of the most vocal and influential figures in health IT — writes a blog post this morning entitled “The Genius of AND”. Halamka reasonably summarizes the essence of the debate about standards and interoperability as being between “the healthcare informatics crowd” (cats) and the “Internet crowd” (dogs):

He notes that the debate shouldn’t be about one or the other POV prevailing (“either/or”), but about integrating both points of view (“and”):

..we need to embrace both approaches – the right tool for the right job depending on what you want to achieve.

For provider to provider communication which requires the exchange of documents with non-repudiation as the medico-legal record for direct clinical care, the CDA/CCD has great metadata and the ability to support structured data as well as free text discharge summaries/operative notes/history&physicals.

For a summary record that represents a snapshot in time of problems, medications, and labs for transmission between EHRs and PHRs, the CCR and other formats such as Google’s CCRg or PDF can do the job.

I’m absolutely stunned…and speechless.

Many people — including me — have seen Halamka as a leader of the healthcare informatics crowd (cats).  As Chair of HITSP, he was relentless in pursuing harmonized standards far beyond practical value — to the point where my colleague Steven Waldren MD, MS and I wrote “Please don’t make us all speak Latin.”

So, now what?

While I applaud Dr. Halamka’s new direction and leadership, I hope he isn’t in denial of his feline roots.

On the one hand, my Mom raised me with the notion that when someone offers you an olive branch and tries to meet you half way, the right thing to do is graciously to accept.

On the other hand, the world of health IT would be a different place had the head cat expressed and embraced this POV four years ago.  The years of cat/dog fights around health IT standards and interoperability have been exhausting and counterproductive.

You should read the entirety of John’s blog post…it’s pretty much what dogs have been asking for.

As one example, last year I wrote specifically around the complementarity of the HL7 CDA/CCD  and ASTM CCR standards:

…the CCD and CCR are suited to become de facto standards in different environments — implemented by different types of organizations and used in different applications.

The CCD standard is more likely to be used:

• By organizations that have already adopted HL7 (e.g., large delivery systems)
• To support existing business models
• In non-disruptive applications that achieve costs savings and/or quality improvements by automating EXISTING processes that are INTERNAL TO THE ORGANIZATION (or with existing trading partners), e.g., hospitals sending test result information to doctors.
• Where implementers have already incurred significant fixed costs to adopt HL7 as a broader enterprise standard

The CCR standard is more likely to be used:

• By organizations that have not yet adopted any standard (e.g., early stage companies)
• To support new business models
• In disruptive applications that achieve costs savings and/or quality improvements by creating NEW PROCESSES, often involving parties that are not currently exchanging information, e.g., improving patient chronic care management with the goal of avoiding ER visits and hospitalizations.
• Where the implementers are highly sensitive to incremental costs of IT resources and view the CCR as a “better, faster, cheaper” alternative. 

Again, I wish Dr. Halamka success in this new direction leading to bring together the heath informatics crowd (cats) and the Internet crowd (dogs). [Edited for clarity, 1:50 pm, 11/10/09]


5 thoughts on “John Halamka’s Stunning 180: “Dogs and Cats Should Live in Harmony”

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  2. Vince, I have to say a big thank-you for keeping tabs on all this. It’s SUCH an important subject, one I’d love to follow closely, but my other obligations keep me from doing it. I’m deeply grateful for your following it and for your always clear reports. Thanks so much.

    Not only do you make the issues clear, you make the significance clear.

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