Wes Rishel

A member of the Gartner Blog Network

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

Coverage Areas:

HL7′s Position on CIMI

by Wes Rishel  |  December 15, 2011  |  7 Comments

Gary Dickinson raised an important issue in commenting on my post. He said:

A fact check might have better served your endorsement of CIMI.

First Stan makes the statement that “the group agreed on [CIMI] principles and approach” and later lists a group of organizations. While these organizations may have participated in formative discussions at one point or another, they did not in fact all agree to CIMI principles and approaches.

Here are the specific facts.

HL7 attended the meeting in London where a consensus was developed that represents a draft of the statement that CIMI issued. Upon seeing the final draft HL7 specifically requested that its name be placed on the list of signatories to the document.

The document was carefully worded with respect to commitment. The specific wording is “Representatives from the following organizations participated in the construction of this statement of principles and plan.” Neither HL7 nor any other signatory SDO specifically endorsed the plan or give any indication that it would participate in preparing detailed clinical models or use them.

As I included this wording in my original post I don’t think that Gary’s implication of a factual error is well-founded.

Here is my  opinion.

After 14 years of working the current basic model of the RIM, HL7 has not effectively addressed a huge percentage of the detailed clinical models that CIMI undertakes to address. (Blood pressure is but one specific example. All HL7 says is that blood pressure should be sent as an observation.) There is reason to believe that CIMI will create that content tout suite because it is really about consolidating existing work that has been done over the last twenty years and used operationally in a few important venues. It would be appropriate for HL7 to suspend judgement until it sees whether CIMI actualy can get through “storming, forming and norming” rapidly and produce a body of work that is valuable because it (a) covers a lot of material, and (b) is available to all parties in an electronic form that can easily be adapted to the tools used to build standards.

Once CIMI has had a chance to produce tangible models, HL7 (and other SDOs) can choose among these options:

  • bend the modeling approach and governance a little in order to take in this big gulp of specific detail needed for interoperability
  • decide that the gulp is really not that big, not worth giving up any control by bending, or
  • redouble its efforts to independently arrive at the same body of work.

I strongly urge HL7 NOT to take a preemptive, doctrinaire “not invented here” position until the actual value of CIMI work product can be evaluated.

As an old-timer, who remembers when HL7 was much more about producing results than methodology, formal governance or standards-world diplomacy, I admire the CIMI approach. It will produce its better mousetrap first and let the world decide whether to beat a path to its door.

7 Comments »

Category: Uncategorized     Tags: , , , , ,

7 responses so far ↓

  • 1 Gary Dickinson   December 16, 2011 at 9:31 am

    Wes,

    I didn’t mention HL7 in my comment. Maybe you could also offer your take on the other 21 organizations Stan listed.

    As I’ve read notes from the London meeting it turns out that 14 of the listed organizations were “eligible” to vote. (I have not been able to decipher the actual criteria for eligibility.) Four of the “eligible” did not attend the London session (in person or via teleconference). This leaves ten including HL7.

    Of those ten, there was not unanimous agreement with the “principles and approach” Stan outlines (as you noted in relating HL7′s position). I also note the following statement from London meeting notes: “Some attendees at the London meeting were nervous about their ability to speak on behalf of their organization”.

    It’s a little hard for me to appreciate the merits of an organization whose first public statement is misleading if not deceptive.

    Regards,

    Gary

  • 2 Wes Rishel   December 16, 2011 at 12:04 pm

    For those who aren’t on the main HL7 List Server, Gary’s comments there have indeed been specific to HL7 but otherwise similar to his replies to my blog in that they argued that having a list of organizations on the document was misleading since those organizations weren’t 100% committed to cooperation with CIMI.

    Just to be clear all organizations whose names were listed received a final draft of the statement and specifically requested that their name be added to the list. If HL7 feels that it was improperly represented I would urge its leadership ask Stan to remove its name.

    The “advice” section of my post was specifically targeted at HL7. Indeed this sentence was conceived in reaction to Gary’s list-server postings. “I strongly urge HL7 NOT to take a preemptive, doctrinaire “not invented here” position until the actual value of CIMI work product can be evaluated.” Nonetheless I think the advice would be applicable to any SDO or, for that matter, any other organization that has the potential for a win based on the big gulp of detailed clinical models that CIMI expects to produce.

  • 3 Gary Dickinson   December 17, 2011 at 9:25 pm

    Wes,

    An honest account is needed – an account which sets forth the basic facts – without equivocation, without puffery.

    When the “principles” state that “CIMI is committed to transparency in its work product and process”, it should be so (from the outset).

    When only ten organizations attending London were eligible to vote on the “principles and approach”, this should be stated explicitly. When there were unresolved differences (among the ten) on the specific “principles and approach”, this should be stated explicitly.

    When it is declared that “the group agreed on [CIMI] principles and approach” and a group of 22 organizations is listed, the clear inference is that all are in full agreement and that the individuals representing those organizations are authorized to make such commitment.

    Initially I thought perhaps facts surrounding the initial CIMI “public release” and the actual agreement on CIMI “principles and approach” were as obscure to you as to many of the rest of us (thus my suggestion for a “fact check”). Your subsequent posts suggest a much earlier and fuller awareness of the CIMI scheme.

    (Until your CIMI endorsement and our subsequent exchange, I had never before considered that the famed Gartner Hype Cycle could actually be a self-induced phenomena – complete with Gartner-employed hype-meisters.)

    Regards,

    Gary

  • 4 Wes Rishel   December 18, 2011 at 2:33 pm

    Since Gary has raised the issue of Gartner’s integrity, I feel the need to respond one more time.

    All of Gartner’s published research is peer reviewed, reviewed by management and reviewed again for any inflammatory tone. So, when I wrote about detailed clinical models in last year’s Hype Cycle I had to defend my analysis of the potential value and current market position to four other analysts, three of whom are involved in healthcare IT. Where I have a specific history in an area (for example in our ratings of HL7 work products) we frequently go a step further and have another analyst be the primary author of the note. Gartner clients who read the hype cycle may have noticed that each item is described using a very rigid template with concrete definitions of the the positions in the hype cycle, the current level of maturity of the technology and the potential value. This methodology enables the most objective creation and review of material possible given the futuristic nature of the topic.

    Gartner blogs are intended for the analysts to express their own opinions and participate in the rapid-fire conversation enabled by the Internet. The interactivity of these conversations often advances knowledge about topic, although it is never subject to the level of objective review associated with paid publications.

    Gartner blogs are free to all. They represent the opinion of the analyst not the official Gartner position.

    (Revised 18 Dec 15:08 GMT-8: A previous version of this reply had pointers to documents that are only available to internal Gartner users.)

  • 5 Gary Dickinson   December 18, 2011 at 5:15 pm

    Wes,

    Nice spiel to deflect the issues at hand. I hope your inside track at CIMI will elicit a forthright account.

    Regards,

    Gary

  • 6 Gary Dickinson   December 18, 2011 at 5:35 pm

    Wes,

    On further reflection and given that you perceived an “issue of Gartner’s integrity” in my previous comments…

    I kind of thought Gartner would maintain a bright line between an analysis of industry trends and becoming an organ/trumpet to itself promote those trends – i.e., analyzing hype vs. promoting hype.

    Keep your blog up and Merry Christmas!!

    Regards,

    Gary

  • 7 Wes Rishel   December 18, 2011 at 6:01 pm

    Responding to Gary’s “Nice spiel to deflect the issues at hand.” I saw no reason to repeat the issues at hand since I addressed them before, but I will succumb.

    I am not aware of any consensus process that has been universally attended by all possible participants or resulted in a 100% concurrence of all attendees. I doubt that anyone who has participated in these processes understands these processes any differently.

    I can’t fathom why it would be surprising that there were some “weasel words” about the degree of participation. This method of deferral of some issues worked well for the Panama Canal Treaty and is certainly common in all agreements among organizations. I especially think the working was appropriate since I am advising SDOs and others to defer decisions about CIMI until there is some proof of the value.

    The main point, however, is that whatever happened in London each signatory received a final draft and individually requested that its name be affixed. This was accomplished within the last day before I published the information. Whatever deception that Gary is alluding to must be shared by all those organizations.

    However, Gary’s using the phrase “to deflect the issues at hand” leads me to add one more thought. We have two choices in blog-land: to discuss issues or devote time and space to procedures and the integrity of individuals and organizations. As Gary’s HL7 list server emails and comments on my blog have been entirely focused on the latter, I have to wonder if the comments don’t represent a deflection from the issues at hand.

    I would say the important issues at hand are

    Do detailed clinical models represent an important, currently unavailable resource for interoperability?
    Can CIMI get it together to produce “big gulp” of them?
    Can SDOs handle the methodology, governance and culture issues necessary to make use of the CIMI effort?

    I see that as I type this Gary has added yet another comment repeating the aspersion on Gartner. As there is nothing new there it is not necessary to repeat my reply.