Tuesday, June 30, 2015

Guest post from 2nd LHS Summit Collaborator, Josh Rubin

I'm pleased to partner with Josh as co-director of the Second LHS Summit Planning Committee. - HB
Realizing the LHS vision is a sociotechnical challenge: it is as much a challenge relating to people and policy as it is a technical one. It's about galvanizing a profound paradigm and culture shift in how healthcare and health are done. The Second Summit offers the Learning Health Community a venue to prioritize its work overall and to refine a prototype for collaborative testing of a single aspect of a data-sharing framework for large-scale, cross-sector governance. It creates opportunities to advance all of the pieces of the multi-faceted puzzle beyond meaningful use and adoption and interoperability that are needed to collaboratively (and disruptively) transform health.

The Second Summit will build upon work of the Learning Health Community of the past several years. That work includes two grassroots multi-stakeholder initiatives: mobilizing diverse stakeholders to collaboratively develop frameworks to address LHS policy and governance issues as well as Essential Standards/Structures to Enable Learning (ESTEL). More generally, as a catalyzing force spreading the urgency and the vision to mobilize and empower multiple and diverse stakeholders to work together to realize the nationwide (and ultimately global) LHS none of us can realize alone, the Learning Health Community will seize upon this Second Summit as an opportunity for all of us to make pledges to ourselves and to one another to engage in action to rapidly advance this transformative vision.

If the LHS Core Values are in a sense a Declaration of Independence -- catalyzing the start of a movement (building upon the work and thought of so many others including the Institute of Medicine and the Office of the National Coordinator for Health IT) -- then the Declaration of Interdependence issued from the Second Learning Health System Summit will be a concrete commitment to action. A commitment from stakeholders to drive this collaborative effort forward in leaps and bounds. Though there is broad agreement that realizing the LHS is in some ways more challenging than the moonshot, the Declaration of Interdependence can nonetheless be one small step for the stakeholders involved, but one giant leap for the LHS movement (and for human health).

Sunday, June 21, 2015

The Time for Action is Now

We are the people to take that action. If not now, then when? If not us, then who?

Some folks have greeted the CODA "big tent" response to the Roadmap with understandable skepticism. This is hardly the first time many of us have considered solutions to the interoperability governance problem. That said, even the most cynical observers admit, when pressed, that the need for solving this is critical.

Three things make now different from previous trips around this track:
  1. A profound sense of urgency. Many, many organizations, state governments, federal programs, and private industry expect, want, need, and require a functional information supply chain. 
  2. Motivation and a corresponding bias for action. Many, many efforts are now in flight that depend upon an infrastructure that does not yet fully exist. 
  3. Recognition of the need for collaboration. Whatever fractal level of the LHS you want to consider, the lift is too big to do the work in isolation. Public and private organizations, state and federal government, providers, purchasers, all of the customers of interoperability must work together or we will not succeed.
CODA is all about "going with the goers." There is a critical mass of individuals and organizations who agree: the time for waiting, for planning, for holding back is over. We don't know everything we need to know, but we know we'll never learn what we need if we don't get started bringing this work to nationwide scale.

Join CODA's collaboration team. We're not going to get where we want to go without us all working together to build the information supply chain.  Be a collaborator in building the transparent, accountable digital infrastructure of the LHS, governed with a commitment to open and unbiased exchange, organized and operated for the public good.

CODA's Interop Narrative Project

The power of narrative is essential to the alignment required for shared understanding.

Over and over, experts agree the problem with interoperability “isn’t the technology, it’s cultural and social, 'human engineering,' not computer hardware and software engineering.” Yet we persist in focusing on technology and technical standards, expecting different results.

It’s time for a smarter approach, building on work being done by organizations and individuals in communities across the country to improve the quality of care, enable delivery system transformation and payment reform, conduct research, and empower individuals through access to their own data.

Through a carefully-structured, nimble process, CODA will build a set of narratives that all illustrate cross-boundary, multi-sector, multi-organization, multi-disciplinary coordination and communication requirements. That process itself, like CODA, like the Learning Health System, is iterative and agile. It begins with the people gathered together at the 10th Annual Stewards of Change Institute Symposium, as we start to compile the stories, personas and actors implicated in the cross-sector narratives.

We will continue it via the Collaborative Health Network and other in-person convening opportunities, such as the Medicaid Enterprise Systems Conference in August and the Strategic HIE Collaborative's first Annual Meeting in September. (Speak up if you would like to host a CODA-conversation to consider cross-boundary narratives from the perspective of your organization, association, or constituency! Simply use the contact form on the right side of the blog.)

What goes into these cross-boundary narratives? What are they about?

What's in a name?

The question of what to call this effort is itself another example of the agile nature of the process. In April, I gave what I've been calling "the big tent" project a name: the Open Interoperability Consortium.

It became pretty clear, pretty fast that there were two problems with that name. First, "consortium" implies more of "a thing," of an organization, than we want to attach to the work at this stage. We are in the "bringing together and aligning organizations" phase. We don't need a new organization at this stage because if we're honest about it, we don't know yet what that organization's structure or function should be. What's needed is an overarching theme that brings us all together to have the conversation about what a "coordinated governance process" should be. Second, and even more important, was the wise counsel not to have the word "interoperability" in the name. Hence the evolution to CODA, Collaboration for Open Data Alignment, which actually describes the thing we're trying to do.

A related point: given the assertion that "we don't need another organization," how is CODA different from Healtheway (and its initiatives Carequality and eHealth Exchange), Commonwell, NATE, and DirectTrust? Or from CIMI, SMART, the Argonauts, or HSPC? Or from the eHealth Inititiative, SHIEC, or HIMSS?

Sunday, June 14, 2015

CODA: the back story, part 5

Last post of prologue...

On April 26, after the adrenaline rush of stepping out into mid-air and hoping a bridge would appear had faded, along with the inevitable second-guessing ("oh my, what have I done?"), I decreed the launch of the "Open Interoperability Consortium," as my hobby-turned-vocation needed a name somewhat more descriptive than "the big tent alliance."  Of course, ever agile, the name has evolved one step further, to CODA as the "big tent" effort is now known.  The last big email I sent out was the last I will send out, replaced going forward by short headline update emails, this blog, and a few other channels.

CODA: the back story, Part 4

By mid-April, with responses to the call to action about the Roadmap's governance Calls to Action taking up an increasing proportion of my time, I had a choice to make.  I could either renew a contract to support ONC's work with SIM grantees and other states implementing delivery system reform while trying to do the governance response coordination as "a hobby," or I could step away.

It so happened that the end of the contract/opportunity to renew fell on days (April 21-22. 2015) that I was speaking to a National Governor's Association convening of state health policy leadership. Their sense of urgency and motivation was palpable.  Their bosses, the governors, wanted to know why they were still waiting: why after all the time and money invested, the promise of HIT still eludes us.

Simply put, like lots of leaders in America in 2015, governors can't understand why they don't have better instrumentation to monitor and manage what is, for most of them, one of the top three spends for state government, between Medicaid, state and other public employees, and retiree health plan costs.

That sense of urgency, coupled with motivation (aka "a bias for action"), came together with a third element that made me strongly suspect that this could really be the time for success. The state leaders expressed it, and I've heard it echoed in many other settings. People have come to realize that this stuff, getting HIT-HIE to work correctly, is a huge, huge undertaking, too big to be done alone. A willingness, even a desire, to collaborate is that third critical success factor.

With that inspiration, knowing that there is a broad and growing cadre of people who want to work together on solutions, I stepped away from ONC.

CODA: the back story, Part 3

As the deadline for public comments passed (on April 3), I began to focus more directly on what steps could be taken to actually take advantage of all of the positive feedback I'd been getting since launching on the process.  A third email went out, to an increasingly large list of prospective collaborators.

CODA: the back story, Part 2

A second email went out a little over a week later, with an updated "logic model."

Email 2: sent March 21, 2015
Subject: Update on the Emerging Interoperability Alliance

Colleagues & allies:

It has been an incredible week. Dozens and dozens of you have stepped forward to say you'd like to be part of this effort. Even without a formal name or structure, many of you are volunteering to form a community of people who recognize the mission-critical need for agnostic coordination of interoperability.  Three quick updates and short requests:

CODA: the back story, Part 1

Back in March, I became increasingly concerned about the response lots of folks had to  Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0  Having advocated for a Roadmap since 2009, shortly after the passage of the HITECH Act, I didn't want the fact that ONC finally produced one go to waste!  I worried that all the complaints I was hearing: "it's too long...," "it's too short...," "it's too detailed...," "it's not detailed enough" were missing the point.

On March 13, I wrote the email included below, accompanied by a kind of exhortation. It was my call to action about the Roadmap's Calls to Action. I called it Launching Mission Control for HIT: Roadmap Response Possibilities, an Invitation to Collaborate. It was attached to the email, in both an executive summary and longer version. I also attached the first of a series of "logic models," using the Roadmap's iteration of governance interdependencies to start to chart a path toward what a conversation about a "coordinated governance process" could look like.

At the time, I was still working for ONC as a contractor and advisor, doing this work in off hours, as an independent pursuit. I didn't know exactly where it would lead, but I didn't want to blow the chance to make the best use possible of the opportunity and invitation that the Roadmap provides.