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?


First, all of those efforts demonstrate the essential ultra-large-scale systems nature of the Learning Health System. Each of them and the member organizations that they serve have a critical role to play. All of them represent the many different cuts through which we can view the LHS' networks of networks of networks. That is to say, the organizational paradigm of a modular, distributed network is that its component parts can (and will) be organized and combined (and reorganized and recombined) in multiple structures and relationships. There are many different technical and business reasons for interoperability structures, enablers, and arrangements, because the definition (and thus requirements) of interoperability is always context dependent. These are not "either/or" choices, they are "and/both." Given the extraordinary complexity of the LHS, it takes more than a WiFi Alliance-like structure to govern interoperability.

Second, as pages 28-31 of this document nicely describe, efforts to organize interop governance based in a technical orientation have had significant short-comings: "The result is a complex web of electronic health information sharing arrangements that create some degree of interoperability within specific geographic, organizational and vendor boundaries, but fail to produce seamless nationwide interoperability to support a learning health system."

Third, while the organizations and efforts listed above include providers and other customers of interoperability, they are all grounded in one of the eight domains of LHS stakeholders: "People and organizations that provide health IT capabilities." Moreover, many of them are focused on healthcare services and providers far more than on the broader LHS scope of health and well-being. CODA's premise is that we must take the governance conversation up a level, so that it reflects the requirements of all eight LHS domains and all of the constituencies necessary to build a culture of health.

Finally, how is CODA different from or related to the Learning Health Community? CODA's vision has been embraced by the LHC. A group of us met in Ann Arbor on June 5 to consider what a collaboration might look like, resulting in the plan to move forward with holding a Second Learning Health Summit this December. While not yet a formal initiative of the LHC in the way that ESTEL is, CODA may become that, or it may simply be considered part of the LHC's LHS Governance Initiative. That can be figured out over time. Right now, we're focused on the time-sensitive need to 1) respond proactively to the Shared Nationwide Interoperability Roadmap's Calls to Action, 2) provide stewardship for the creation of that public/private LHS governance process, and 3) shape a “container” for the work we need to do collaboratively to define and instantiate interoperability governance.