Stages of standards development
September 15, 2014 in Medical Technology
One of the most amusing things (because if I didn’t laugh I might cry) about the meaningful use program is the way that executives who have never paid anything more but lip service to standards are now reporting as experts on their effectiveness (or lack thereof) and the related causes. Reports out of the HIT Standards committee about the need for improvement of CCDA are a perfect example of this. However, the problems being reported almost certainly aren’t the real problems that need to be addressed.
I have a theory about Stages of Standards Development that is fairly similar to Lohlberg’s stages of development, but applied to standards and interoperability.
- We used this standard because we would get punished (or not rewarded) if we didn’t.
- We used this standard because you told us too.
- We used this standard because everyone else is using it too for this problem.
- We used this standard because we are actually paying attention to interoperability.
In the first stage, the use of the standard is to avoid punishment. Application and understanding of the standard is low. The minimum work is done to pass the tests, and no thought or effort is put into the use of the standard to do anything more than to comply with the requirement.
The second stage is no much different, other than the user of the standard now recognizes authority, and may actually understand that there is a reason for being granted the authority. So they may pay a little bit more attention to the standard, but don’t really yet understand it.
The third stage is when the user of the standard looks around and sees that lots of other folks are using the same standard, and they could benefit from it as well. In this stage, there are some they can learn from who are at more advanced stages and others who are not. At this stage, they pay quite a bit of attention to learning as much as they can about the standard to make it work.
In the final stage, they stop worrying so much about the standard, and really start focusing on the intent and purpose of it, which is to enable interoperability between systems. They stop looking at all the slavish ways the standard can magically solve the interoperability problem for them, and start realizing that standards are a major component of interoperability, but that other things are needed to support it as well.
Meaningful use will only take us so far over time. Stage 1 and the 2011 criteria only enabled level 1 and 2 adoption behaviors. Stage 2 and the 2014 (Release 1 and 2) criteria starts to enable level 3 adoption behaviors, and creates an environment where level 4 behaviors can emerge. But they do nothing to support level 4 behaviors. The REC program supported some higher level behaviors, but it too really only stopped at level 3. The workforce education program may have contributed a bit more to higher levels. The Beacon program certainly tried to support level 4. However, most of the money for these programs is well past gone.
Interoperability is a journey. Standards are an important tool along that journey that are necessary. But most don’t even know how long that journey really takes. We had RFC-822 and before that RFC-561, and even today, after more than 4 decades, e-mail is still not perfectly interoperable. Remember Lao-Tzu: The journey of a thousand miles begins with a single step. We’ve taken a few so far, let’s keep going.