Health Data And Information Capability Framework standards open for public review

This is a good document and reiterates topics that have been mentioned in the past. It was nice to see the mentions of clinical decision support and analytics. I think that this is a good starting point but it is the next steps that are the ones where things have failed over and over in the past. Having participated in many health information projects, whenever there was an attempt to do a deep dive the discussion was always halted as being 'out of scope' or that there was no desire to "get into the weeds". It is the next level of detail where knowledgeable experts need to be involved. Then the next step is to get those expert developed recommendations implemented. This is where things stall. One example relates to EMR requirements. In BC about 10 years ago EMR requirements were developed for PITO. Important details about specific requirements for implementation were not defined and vendors developed their own idiosyncratic solutions that resulted in a mess with regard to data exchange and interoperability. Eventually, the EMR 2 EMR project was started and this produced detailed specifications as to what should be in an EMR. This could have served as a roadmap for developers. It is my understanding that EMR vendors did not like these detailed specifications. Instead they preferred the Ontario specifications that were devoid of the level of detail that was in the BC specification.

Another example relates to terminology which should be considered as an absolutely necessary foundation for high performance computer based patient records. Yet, there is unwavering support for an obsolete and not fit for purpose system that came out in 1976 and is still in use, which is ICD-9. This was designed to collect mortality statistics for health system use. It was NOT designed for use at the point of care. Physicians have been struggling with ICD-9 since it first came into use 45 years ago. Reference sets of concepts have been developed but implementation has been stalled for years. Decision makers continue to have a preference for continued use of the obsolete and dysfunctional ICD-9. There is a general disinterest among front line providers for good diagnosis coding because of the inherent difficulties in using ICD-9. EMR vendors seem reluctant to do anything to replace ICD-9 with a system that is up to date and designed for point of care use.

It is really difficult to understand why obvious solutions are basically mothballed in preference for continued support for problematic legacy systems. Even simple changes are not done and this adds to the frustrations that EMR users have to contend with. It has become evident that EMR use is a significant contributor to physician burn out. EMR use has been stalled at the Gartner documentation level and there is no hope of getting to the mentor level. Don't people understand that EMRs could be far more than just expensive replacements for paper records.

The link is: ciostrategycouncil.com/standards/public-review/

Sharing this link for those who are interested in reviewing the Health Data And Information Capability Framework standards which is open for public review till October 29, 2021.


This Proposed First Edition Standard aims to provide guidance on the depth, diversity and complexity of capabilities, including criteria to assess the degree to which the capability is mature and consistently applied across an organization’s data assets and processes; and
The framework also aims to help networks of organizations (e.g., multiple agencies within a jurisdiction) understand the alignment required within the network for a given Health Data and Information (HDI) capability through:
• Identifying the need for and extent of alignment required of their HDI principles, practices and content where it is practical and beneficial toward achieving common aims; and
• A common language for multi-organizational collaboration as a basis for exchange of leading practices and lessons learned in a meaningful and constructive way that fosters improvement and alignment.
The framework is not intended to prescribe how these capabilities and related processes should be implemented. Individual organizations will need to design or refine their own policies, processes and practices given their scope, mandate, priorities and legislative authorities.