“Robustly“ Building the Business of Health Information Exchange

The week of Sept. 22 was a significant week in the ongoing effort to develop the myriad of pieces for a national health information infrastructure.  The Health Information Technology Standards Committee (HITSC) held their next public meeting to present more on the “summer camp” and several of the other important initiatives underway in the work groups.

Perhaps, most importantly, was one of the things FIRST said, which has been said before – sometimes things have to be repeated until everyone understands them.

Doug Fridsma, the Director of the Office of Standards and Interoperability, noted in opening remarks the need to consider “Postel’s Law,” or the Principle of Robustness. It is named after Jon Postel, who created the Transmission Control Protocol, or TCP, which along with Internet Protocol (IP), kinda make this whole big thing called ‘The Internet’ actually work.

The Robustness Principle simply says: be conservative in what you do, be liberal in what you accept from others. There is a certain philosophical truism here, but Postel was speaking to the use of protocols in transmission.  More specifically, protocols should allow for the addition of new codes for existing fields in future versions of protocols by accepting messages with unknown codes.

As it pertains to health information standards, the corollary to this principle is that health information exchange should reflect a discipline to adhere to standards in SENDING information, but should be tolerant in RECEIVING information that should proscribe to the same standards.

I offer there are two messages here – first, something Doug also offers, standards should adhere to the notion that “perfect is the enemy of good.” Since information exchange is based on ideas and business processes that are revolutionizing an industry – and progress must be incremental – we must start with what we have and move forward based on feedback and process checks.

Secondly, accepting messages with “unknown codes” can provide guidance as to other elements of information not accounted for in standards or delineated in interoperability. That helps drive “good” closer to that mythical “perfect.”

The challenge, unfortunately, is conflicting interests and opinions that,  as a fellow blogger noted, if they had been argued in the ARPANET days we never would have got TCP/IP off the ground, regardless of Postel.

On a final note, John Halamka’s blog featured this cool technology of the week, and I think it rocks – clinical sterilization of health IT devices is truly an important consideration (I think), and this was a neat test.