Wes Rishel

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Wes Rishel
VP Distinguished Analyst
12 years at Gartner
45 years IT industry

Wes Rishel is a vice president and distinguished analyst in Gartner's healthcare provider research practice. He covers electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards. Read Full Bio

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Can Consumer Friendly Terms Ever be Standardized?

by Wes Rishel  |  September 11, 2011  |  2 Comments

Some involved in the search for an Entity Level Provider Directory are advocating for an approach that relies on search engines like Google and Bing and a modest approach to standardizing data using microdata while others are arguing for a more structured and rigorous approach based on a highly federated use of LDAP.

The federal policy version of “who will bell the cat” is “who will fund the service.” The LDAP approach assumes that some larger number of LDAP service providers can make a business out of gathering, auditing and maintaining identity data or that the government dole for HIE will continue unabated. This approach assumes we can pay enough to drag this information out of practices even though we have heard testimony that docs are notoriously reluctant to provide one additional datum about themselves over and above what is necessary to be licensed and credentialed.

The other approach puts the onus on practices to create their own identity information, either directly or with help from their health information service provider, electronic health record vendor, affiliated ACO, or professional society. The payment for the rather nominal requirement to create a web page comes from the practice, although it is likely buried in fees they pay practice management of other IT services. Likely sources of the Web page support include for health information service providers  (HISPs), EHR and HIE vendors that incorporate a consumer-facing portal into their products, medical professional organizations, and IPAs.

A microcosm of this “big system” vs “individual” approach can be found in our ongoing discussion on how to represent the practice areas on such Web sites. There are two lists available, the provider taxonomy constructed her HIPAA and a federated list maintained by specialty organizations and coordinated by the A.M.A. Both are designed to support the arcane distinctions necessary for billing or accreditation. We are not aware that either has a consumer-friendly semantic mapping.

To achieve semantic interoperability and consumer-friendliness we need two things.

  1. a “golden” taxonomy — one or the other, available free
  2. a free semantic mapping from golden terms to consumer-friendly terms — and free updating. “Government-paid” would counts as free.

However, I question whether semantic interoperability is a requirement here. If we follow a consumer search engine approach to ELPD, why not let the practices describe their specialties however they like, as they do now? We might define a data item that contains free text and is semantically described as “consumer-friendly declared practice area (free text, repeated items separated by commas).”

This advice will be better from some source than from others. The sources will compete in the marketplace in terms of overall effectiveness of practice Web pages including but not limited to proper identification of specialty areas. Some might even collaborate to establish and maintain a common list of consumer-friendly terms likely to be effective in consumer-entered searches. Other entrepreneurs might spider through web sites and build up more sophisticated and effective search products.

Some practices might inadvertently or slyly cheat by self-describing practice areas for which they are not licensed or competent. This is not desirable but there are many other methods of regulating the actual provision of care; we do not need to build that into the burden we pay to begin to use Direct more widely.

The whole point of keeping it simple is to get a useful dollop of work done, put it into action and see how economics and innovation shapes the next step.

If we keep it simple we could get this dollop done in a year. If we entangle it in state-by-state programs to mount (and inter-federate) LDAP servers who knows how long it might take, and whether the services will be economically sustainable?

2 Comments »

Category: Healthcare Providers Interoperability     Tags: , , , , ,

2 responses so far ↓

  • 1 John Moehrke   September 12, 2011 at 8:57 am

    I wonder what Presidential Hopeful Rick Santorum would say about the alternative of using google search to find information about a person vs using an authoritative directory? I don’t disagree with your assertions on how quickly to deploy, I just don’t see how this helps either the Provider or the seeker to provide authoritative and quality information. I have stated publicly, on my blog, that I think there is room for both. That there is a logical progression from one to the other as organizations mature. This post was way back in May. We have been wasting time doing political fighting. http://healthcaresecprivacy.blogspot.com/2011/05/broadly-usable-hie-directory.html

    All I am hoping for is a consistent schema, so that when someone wants a e-mail address they know exactly where to look, when someone needs a mobile phone number they know exactly where to look. This does not mean these things must be published, simply that if they are published that they are published in a specific way.

    Note that the technical terms used do not forbid the presentation from using more friendly terms. Surely no one would find the LDAP iNetOrgPerson attribute ‘userSMIMEcertificate’ to be used as a display string. Smart applications will not, they won’t even display the value, they will display the value found inside the certificate. This is similar to the fallacy around OIDs. My point is that user friendly terms and interoperability values are not at the same level of abstraction.

    Note, there is no reason why Google/Bing can’t index a publicly accessible Provider Directory. So, best of both worlds? The S&I Framework has a working group on this topic. Why won’t you and your friends come discuss this in the open? We are wasting time.

  • 2 Pete Gilbert   September 13, 2011 at 8:31 am

    I think that some sort of natural language processing front end that converts from patient-ese to doctor-ese would be more useful than trying to come up with a formal cross-walk between the two languages.