Sunday, June 14, 2015

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.

Email 1: sent March 13, 2015
Subject: The time is ripe for action and collaboration on interoperability


As you're aware, ONC released the Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0  last January and is looking for feedback by April 3. We finally have a coherent -- and crucially, a national, not a federal -- Roadmap. It offers a goal toward which we can aim, and multiple interim targets. Working backwards from the requirements of a learning health system gives us a framework for clarifying and sequencing the steps and interdependencies. Think of the Roadmap as the table of contents for the "How to Build Interoperability & Exchange" manual. 

Most operational complex "systems of systems" (the power grid, railroads, the interstate highway system, air traffic control) have a commonly understood design and architecture. The Roadmap provides cartographic tools for defining the digital landscape of health data. Critics who complain about the Roadmap current lack of specificity on many items or nit-pick the timelines miss the point.The Roadmap extends an invitation to all of us to co-create the definition, implementation, and maintenance of interoperability. The Roadmap's greatest offer is the governance Call to Action. That is why I'm writing to you all today. 

There is a lot in the 3 attached documents, so I won't repeat it here. The attachments include:  

  - a 19 page strategic analysis of the Roadmap's opportunities, taken from a version I first wrote for the Strategic HIE Collaborative (SHIEC) and have subsequently modified for broader use/distribution;
  - a 2 page distillation of the longer document's key points; and 
  - a single page "logic model."

I've been saying for a while now that "HIT is a like lunar mission where we forgot to build Mission Control." What I recently realized is that the solution to that problem is closer than I realized, because of course these days, NASA is very much a public / private partnership, with outfits like SpaceX building rockets linked to Mission Control. So instead of making a joke about it, or complaining about it, it's time for us to come together to build Mission Control for HIT.

We can leverage all of the great activity people are doing to implement delivery and payment system, research, and all the other HIT-enabled use cases across the nation. We need to orchestrate -- in a public / private partnership -- activities of the digitization and sharing of health, healthcare, research and human services data in the same way NASA leverages the disparate resources that, collectively, comprise our national space program. There too, the Roadmap provides guidance in its suggestions of basing an approach to governance / Mission control on use cases.  The feds are doing a lot, states are doing a lot, private organizations, institutions, and companies are doing a lot.  With the right model of coordination, we can collectively accomplish more as we accelerate change.
Three final process points
  1. There are a series of events when we can meet in person listed on the one-pager. (e.g., Sunday, March 22, in Baltimore the night before the HIT Connect Conference. Dutch treat dinner starting at 6:30 for anyone who'd like to come.  Let me know if you're interested in attending; location tbd based on numbers.)
  2. If folks are interested in setting up a conference call or calls to discuss as a group or in sub-groups, I'd be happy to take the lead on setting that up. I could also set up a Basecamp, but will only do that if there's desire/demand. And to be clear, my role in launching this campaign for collaborative allies is an independent one, not on behalf of ONC. 
  3. As you're considering submitting comments on the Roadmap, it would be wonderful if you echoed this call for governance as a collaborative, public/private Mission Control of HIT.
This is a call for more than "getting comments back to ONC." This is collaboration for implementation. A lobbyist who'd been in the game a long time once advised: "Don't complain; solve problems!" The most effective path for having an impact on the final Version 1.0 of the Roadmap is to being doing things that ONC will want to recognize and encourage. So that's the model for success: we find a way to act in concert to respond to the invitation and opening the Roadmap provides to us all.

Thank you for your time, and for giving this a look.  Please be in touch if you want to talk about how you would like to participate. And please refrain from "Reply All" responses.

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