John's recent post on my "medical office mashup" comment is, as my colleague Paul would say, "spot-on." What I learned from his discussion:
- Long ago in a Minnesota far-far away .. where Gopher was born .. and professional wrestlers were still wrestling … John used to look up at that cold sky and dream of medical mash-ups.
- In a weak moment – you can still see that little kid in John – but he's been hangin out with the suits lately – and they make him say things like this:
"Building a 98% reliable solution from x integrating parts requires (1- x*y*z…) reliability from each component."
Of course – he's right. That's the problem with the CIO types that he hangs out with — they're usually right. Too many points of failure, too many dependencies on "foreign" systems, etc. Gotta do it the "enterprise" way.
But we've got to be able to dream these dreams – because they are the right ones to have. Sure – Google's calendar API will change and I'll zig with their zag – because for a user base of 1 person – this software is neither "mission critical" nor 100% reliable.
If we did everything the enterprise way – there would be no Internet. TBL's vision was that by connecting things – we can derive enormous value. Consider this section of one of his most famous essays:
… For all these visions, the real world in which the
technologically rich field of High Energy Physics found itself in 1980 was one
of incompatible networks, disk formats, data formats, and character encoding
schemes, which made any attempt to transfer information between dislike
systems a daunting and generally impractical task. This was particularly
frustrating given that to a greater and greater extent computers were being
used directly for most information handling, and so almost anything one might
want to know was almost certainly recorded magnetically somewhere.Design Criteria
The goal of the Web was to be a shared information space through which
people (and machines) could communicate.The intent was that this space should span from a private information
system to a public information, from high value carefully checked and designed
material, to off-the-cuff ideas which make sense only to a few people and may
never be read again.The design of the world-wide web was based on a few criteria.
- An information system must be able to record random associations between
any arbitrary objects, unlike most database systems;- If two sets of users started to use the system independently, to make a
link from one system to another should be an incremental effort, not
requiring unscalable operations such as the merging of link
databases.- Any attempt to constrain users as a whole to the use of particular
languages or operating systems was always doomed to failure;- Information must be available on all platforms, including future
ones;- Any attempt to constrain the mental model users have of data into a
given pattern was always doomed to failure;- If information within an organization is to be accurately represented in
the system, entering or correcting it must be trivial for the person
directly knowledgeable.
Lots of what TBL said in 1996 (about physics in 1980) still applies to healthcare in 2007. shame on us!
So my tiny project (total time invested <2 hrs) is an example of how we might start thinking about the parts fitting together. It's 2007 and there are companies out there that have already started to develop and deliver webservices that provide important parts of the EMR infrastructure. They work today – and will do more tomorrow.
Of course I've been wrong before … a professional wrestler as Governor? Never. 🙂
