Pick A Standard, Any Standard…

For many executives the process of selecting standards can feel like being set up for a card trick; uncertain how to analyze the options laid out in front of them and questioning if they are really being given free choice that will impact the end result.

This is not a new problem. One that goes as far back as 1864 to one of the great standards selection debates of modern history – the standardized screw.1   At the height of the industrial revolution manufacturers of everything from buggies to boats made their own screws. It  was the railway tycoons who realized they couldn’t have a train made in Philadelphia break down in Wichita if it required custom made screws.

It may seem silly, but this of course had an immensely positive impact on global productivity and commerce. Especially in the years that followed where world wars had all sorts of machines made in one country only to be used in battle in another. Manufacturers today no longer compete on who has the best custom made screws and anyone who needs to replace one can go to a hardware store anywhere in the world.

Similar debates about selecting interoperability standards were held throughout the early 2000’s. Selecting national interoperability standards was supposed to have the same impact as standardizing the thread count on  a bolt. Looking back, it’s easy to see how over simplified our analogies and expectations were. The proliferation of interoperability standards today is no different than the hundreds of choices available in the screws and fastener aisle at your local big box hardware store. The good news is that if you’re struggling with a standards selection challenge you’re not alone and there are resources to help.

Keith Boone, author of the CDATM Book provided a pragmatic framework in his blog that can help people  choose any interoperability standard.2 The framework provides some basic principles such as “Tried and True” and corresponding guiding questions such as “Has it ever been used in a real world environment?” For the most part, the 5 guiding principles could be applied to almost any standard selection, from picking clinical quality measures to programming languages.

eHealth Ontario developed a comprehensive standards selection guide that uses similar principles (e.g. Fit for Purpose, Quality, etc.) and provides further elaboration  of the different evaluation criteria by introducing more questions and an explanation of why they are important to analyze.3 The eHealth Ontario standards selection guide also includes some questions specific to messaging and content standards (e.g. the HL7 family of standards) as well as terminology standards (e.g. SNOMED CT).

Calculating the financial costs of implementing one standard over another is the question executives want answered most. Unfortunately there doesn’t appear to be a one size fits all methodology. The IHTSDO report titled Building the Business Case for SNOMED CT provides an adoption maturity model  coupled  with cost and benefit quantification techniques that can help organizations justify investments in SNOMED CT.4 While some of the quantification techniques are very specific to SNOMED CT, the formulas and estimates offer a framework that could be applied to other standards.

The SNOMED CT adoption model in the IHTSDO report offers an interesting way to look at the costs of standards selection decisions over time.

The act of selecting a standard lies in quadrant one of the model, typically with a few implementers and a few experts to provide some support. Benefits of the standards selection are fairly limited initially but the goal is to maximize the value provided by the standard by increasing the scope of implementation.

The adoption model identifies areas of complexity or hurdles that can impede adoption of a standard as the scope of implementation grows and provides tactics to help, organizations avoid over commitment and instability as they meet rising demands for support. It is a useful framework for considering the services needed to make a standards implementation successful, which is a significant component of implementation costs.

The three resources described in this article range in purpose and complexity to implement. Executives can remove some of the mysticism associated with standards selection decisions by directing their staff to pick and choose the key principles and criteria that work best within their organizational context. As Gene Wolfe said, “There is no magic. There is only knowledge, more or less hidden.”

1 http://archive.wired.com/wired/archive/10.01/standards.html

2 http://motorcycleguy.blogspot.ca/2014/02/principles-for-healthit-standards.html

3 http://www.ehealthontario.on.ca/images/uploads/pages/documents/eHealth_ Standards_Selection_Framework_en.pdf

4 http://www.ihtsdo.org/snomed-ct/why-should-i-get-snomed-ct/business-case