HITSP(医疗信息技术标准委员会)冲击着融合
HITSP Hits Harmonization
http://blog.hittransition.com/2005/10/hitsp_hits_harm.html
Posted by Martin Jensen on October 06, 2005 in HIT Policy, Harmonization, Standards Development
茅海萼 译 http://www.gold-sign.cn/news_detail.asp?id=169&pid=7
The American National Standards Institute (ANSI) has been awarded the contract to lead the harmonization effort in healthcare IT, along with partners Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI) and Booz Allen Hamilton. The contract is one of three awarded by HHS under the sponsorship of David Brailer's Office of National Health Information Technology Coordinator. The contract goes under the moniker ONCHIT1.
美国国家标准局(ANSI)，与医疗信息与管理系统学会(HIMSS)、先进技术研究所(ATI)和Booz Allen Hamilton一起，赢得了领导医疗IT融合发展的合同。由全国医疗信息技术协作办公室ONCHIT(Office of National Coordinator for Health Information Technology, HHS下属机构)的David Brailer科赞助、并由HHS (US Dept. of Health & Human Service，美国卫生与福利部)授予的三个合同中，该合同是其中之一，是在ONCHIT1项目名下实施的。
The first order of business is the development of a body to be known as the Healthcare Information Technology Standards Panel or HITSP. Perhaps in anticipation of winning the contract, ANSI claims that this panel already includes 100 members. A core group of 18 organizations will constitute the Standards Harmonization Collaborative.
The Evaluation of Standards Harmonization Process for Health Information Technology Program (ONCHIT1) is a unique and unprecedented opportunity to bring together the intellectual assets of organizations with a stake in health data standards. With the oversight and backing of the National Health Information Technology Coordinator, ONCHIT1 guides the collaboration of these organizations toward a healthcare information technology (HIT) standards harmonization process.
其业务的第一项要求是建立一个称为HITSP (医疗信息技术标准委员会，Healthcare Information Technology Standards Panel)的团体。也许估计到能赢得该合同，ANSI宣称该团体已经拥有了100名成员，其中18家单位构成的核心小组将组成标准融合协作体(Standards Harmonization Collaborative)。
《医疗信息技术项目的标准协调程序之评估》(ONCHIT1)是一个独特且前所未有的机会来把各个单位有关医疗数据标准的智力资产集合到一起，在ONCHIT的监督和支持下，ONCHIT1将引导这些单位的合作，致力于医疗信息技术(HIT)标准的融合程序。
ANSI provides additional details on their website: http://www.ansi.org/standards_ac ... hitsp.aspx?menuid=3
While the 100 HITSP members are not listed on the ANSI website, one suspects that the list is similar to the attendee list at an "Inaugural Meeting" which took place in DC in late September.
There is also a HITSP Public Document Library on the ANSI Website.
ANSI在其网站上提供有细节： http://www.ansi.org/standards_ac ... hitsp.aspx?menuid=3
由于ANSI网站上并没有列出其HITSP的100个成员的名单，有人怀疑这个名单其实是上年9月在华盛顿特区召开“成立大会”时的参会人名单。ANSI网站上还有一个《HITSP公共文件库》。
My Spin
我的转念
HIT Harmonization is not for wimps. It's one thing to "come out with a standard" and quite another to come out with an upgrade to that standard. Managing interoperability between standards adds a layer of complexity that few really seem to grasp at this point. They certainly understand that it's going to be really hard, but they don't necessarily appreciate that the way to do it requires a much different and more sophisticated approach than just asking existing Standard Development Organizations to work harder and talk to each other more often. Fiefdoms need to fall and hierarchies need to give way to hyperlinks.
医疗信息技术(HIT)的融合，不是属于弱者的。它一方面是“宣布一个标准”；尤甚的是另一方面，宣布对那个标准的升级；而管理各个标准之间的互操作，又增加了一层复杂性，这一点似乎极少有人切实地掌握了。他们当然懂得将会非常艰难，但实现这一点的途径要求相当不同的和更为复杂的方法，而非仅仅是要求各现有的标准开发组织(SDO, Standard Development Organization)更努力地工作和更频繁地互相沟通，对此他们不见得会赞同。封地会减少，等级制要为超链接让路。
The whole SDO business model needs to be questioned, and, in my opinion, overturned. The basic approach relies on getting highly-paid volunteers to do the work, then charging them for membership, work products and meeting attendance. It makes a limited amount of sense from an SDO perspective, but from a national healthcare perspective, it guarantees that participation and access to key work products will be limited to a very few, adding billions of dollars and years of effort to any rollout, "harmonized" or not.
SDO的整个业务开发模式需要质疑，而且以我的意见，需要颠覆。其基本方法依赖于：招到高支付的志愿者来做工作，然后向他们收费——会员、工作结果、和参加会议。这从SDO的视角来说，还有一定的意义；但从全国性医疗的视角来说，这保证的是参与和有权使用关键工作产品的人将限制为极少，任何成果须增加成十亿的美金和数年的努力——还不知“融合”了没有。
I use the analogy of the Interstate Highway system. Eisenhower saw first-hand how the Nazi Autobahns gave a huge strategic advantage to a country fighting a war on two fronts. So as president, he pitched the Interstate system as a national security project, even though its immediate benefit was felt in terms of interstate commerce. He didn't wait for states to figure things out one by one, or ask volunteers working in isolation to come up with the architecture.
我可以用州际高速公路系统来类比。艾森豪威尔直接看到了纳粹高速公路对于一个国家两线作战的巨大战略优点，所以作为总统，他把州际高速公路系统视作为一个国家安全项目，虽然其直接效益是展现为州际商务。他并没有等待各个州来逐个地把事情弄好，或要求隔绝分离着工作的志愿者来产生他要的架构。
HIT standards are nothing if not a national security issue: Not just in terms of bioterrorism or infectious disease control, but in terms of our national competitiveness. SDOs are building the intellectual infrastructure for better healthcare at lower cost, the success of which will determine whether the nation continues to prosper or falls on the sword spiraling healthcare expense. The funding for the SDO effort should be coming from the federal government in bucketfuls, managed by private organizations with enough autonomy to guarantee stakeholder representation and buy-in. ONCHIT1 is a drop looking for a bucket to fall in.
HIT标准，如果不是国家安全事宜，那就什么也不是：不仅仅依据于生物恐怖袭击或传染病控制，还依据于国家竞争力。各个SDO正在以较低成本建立服务于更好医疗的智力基础，其成功与否，将决定国家将继续繁荣，还是将倒塌在旋风般上升的医疗费用之剑下。对SDO努力的资金支持，应该满钵满桶地来自于联邦政府，同时由私人组织足够自主地管理，以保证利益相关者的意见表述和标准采纳。ONCHIT1是一个正等待着某个桶来落进去的水滴。
Participation in the SDO process should not only be free, it should be easy -- through the deployment of collaborative tools to establish communities of interest, working together with a minimal amount of administrative friction. And, in order to qualify for this funding, the resulting work products -- not just pdf implementation guides and white papers, but code lists, machine-readable edits and test beds -- should be free to all who need to build the resulting systems.
SDO程序的参与，不仅应该是免费的，还应该是容易的——通过利用合作工具，来建立利益/兴趣社区，一起工作，使管理摩擦最小化。而且，为确保投资的使用质量，产生出的工作产品——不仅仅是PDF文档式的实施手册和白皮书，还应有编码表、机器可读的编辑器和测试床——应该对所有需要建设实用系统的人，免费。
Anything less only forces each stakeholder to "understand" what their role is in the larger effort at harmonization and interoperability, and make substantial investments for the public good with no clear payoff in sight. And that supposition is a recipe for failure.
任何弱化，不过是强迫各个利益相关者“理解”了在更大的融合与互操作努力中他们的作用是什么，并使得为公共福利所做的巨大投资没有清晰的回报前景。而前述推想，是为失败开的处方。
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发表于 2007-4-27 14:10:01