In September, Health Level Seven (HL7), a healthcare IT standards development organization with broad international representation, announced the appointment of John Quinn as CTO. Accenture (New York) and HL7 (Ann Arbor, Mich.) reached an agreement that Quinn, who is CTO of Accenture's U.S. Provider Practice, would also take on the HL7 role.
In his new job, Quinn will implement HL7's product and services strategy in conjunction with the CEO, oversee the timely delivery of standards, and report on progress of key initiatives and specifications to the membership and stakeholders. He will lead HL7's Technical Steering Committee, support the harmonization of standards with other standard development organizations, oversee the work of staff project managers and ensure the quality of ballots and specifications.
Recently, HCI Senior Associate Editor Daphne Lawrence chatted with John about his new duties.
Q: John, congratulations on your appointment. Is the role of chief technology officer (CTO) a new one at HL7?
A: Yes it is. It's part of a reorganization that's been going on in HL7 going back about two years. For the past 18 years my title has been technical steering committee chair — and the organization is only 20 years old.
Q: And you will continue as CTO of Accenture's U.S. Provider Practice?
A: Yes, Accenture has decided to fund my participation with HL7 at a full time level. HL7's endeavors are sponsored in part by benefactors such as Accenture, Intel, and many others.
Q: John, what exactly does the CTO role at HL7 entail?
A: The CTO is responsible for managing and understanding the technology itself — the architecture and how the technology of products aligns with designs is associated with the overall business strategy of the entity. The function of the role is to understand the technology, understand the architecture, understand what's going on inside of the products being developed at HL7, and how they align and are kept in line with the business strategies of HL7. The role can be looked at as the transparent, two-way portal between the board and the working groups the produce the product.
Q: So you basically have to speak both languages?
A: Yes, and I also have to keep track of resources, especially anything that has to do with money. I'm responsible for specifying but I'm not responsible for getting the funds. My role is more reporting than controlling.
Q: What was your first challenge at HL7?
A: The reorganization of HL7 itself, and I was also filling dual roles at the time because we are in a transition phase. The transition processes should be finalized in January, with new bylaws, new policies and procedures in place.
Q: Can you speak to the reorganization a little?
A: We started a couple of years ago. It was funded by the Robert Wood Johnson Foundation, which came to us and said, "You could really benefit from a strategic review of your goals in the organization, and we're willing to fund that."
Q: What's going to be different in the new structure?
A: What's going to be different is how we govern and run the technical production of HL7. It has been very bottoms up-driven in the past. We got survey feedback from consultants that said members were frustrated that there wasn't good direction from the top and that we were working at cross purposes. All the reorganization really occurs at the top. The basic committees are unchanged.
Q: So what's the first goal in your new role at HL7?
A: The first goal is to develop that transparency necessary between the HL7 board and the technical steering committee — this issue of business goals and objectives making it into the technical steering committee and the technical steering committee responding back and making its needs obvious and transparent to the board.
Q: Is there any change in the strategic vision?
A: Yes, in the sense of how we relate to governance and how the inputs come into HL7 and how our stakeholders communicate their needs to us is far more organized and focused.
Q: You have significant global involvement, correct?
A: We've been global since 91, with at least 28 international affiliates. HL7 is an ISO standard used by many countries.
Q: Is there any legislature coming down the pike that HL7 is poised to be responsive to?
A: Well actually it's a little closer in than legislative. The Department of Health and Human Services created a group called Health Information Technology Standards Panel (HITSP) a few years ago. HITSP really is the clearinghouse for what standards are going to be used in electronic processes in healthcare. HL7 plays a very large role in that.
Q: In what way?
A: Many of the standards specified are HL7 standards. The industry relies on us because of the work we've done over the last 20 years.
Q: You mean things like the new claims attachment from CMS?
A: The claims attachment is actually a part of the 2.6 standard that's in the process of being published right now. It's the CCD, or continuity of care document. For several years we had the CCR, (the continuity of care record), a functional description of what should be sent between physicians and patients as a patient record summary. It boiled down to the fact that HL7 was creating the clinical document architecture — that's not CCR, it's a general electronic document for healthcare information. So it's the analog to a document. It behaves like a document with coded clinical information in it. The ASTM (American Society for Testing and Materials) wanted to create the syntax with moving that data, then HITSP moved in and said to us we want a CCR, not a whole new technical syntax — so they asked us to create a CDA implementation guide for CCR. We did that, and it's called CCD, and it's really a collaboration between ASTM and HL7.
Q: So what about your collaborations with other standards organizations?
A: For every major standards organization one or more people in HL7 are the designated liaisons.
Q: Anybody with whom you think HL7's involvement will increase?
A: We work with them as the needs demand. There are formal memos of understanding with every one of these organizations, DICOM, X12, and the list goes on. It's 12 to 18 groups.
Q: How is the new HL7 responding to the evolving needs of healthcare today?
A: Directly or indirectly there are at least four or five senior members of HL7 that participate in HITSP and industry meetings. So we have a lot of connection between those groups. HITSP is constantly coming up with new definitions of areas where we need new standards, or to enhance our standards, or defined new areas where they want to use our standards. We find ourselves heavily involved in supporting what is coming out of the U.S. government, and around the private sector around the U.S. government.
Q: Do you see any IT trends that you think will be very dependent on HL7?
A: The area that's less defined and continues to be less developed is the use of coded vocabularies. HL7 supports a large number of those and in general we use other code sets when they're available like CPT and SNOMED, etc. There's an awful lot of information that needs to be codified. So we find ourselves highly involved in that area and to be honest, highly dependent on that area.
Q: Highly dependent? In what way?
A: We're really not going to achieve the goals we need of moving clinical information around reliably unless we're all using these code sets and they're all kept synchronized and the mappings between them are developed. The overlaps in code sets are numerous and we have to manage that — the mappings between ICD-10 as it comes out and SNOMED are one example. That's a challenge to the industry as a whole and a challenge to the federal government if we're going to have reliably moveable electronic information. That continues to evolve and is quite a challenge.
Q: Any other areas that present challenges?
A: How do we constrain into templates the subsets of clinical information that are the byte sized pieces of information that we use for making decisions? That continues to be developed.
Q: Is there anything CIOs should know about the new reorganization in the new HL7?
A: I think it's probably important that they understand we are in the process of going back and having a two day session with our formal stakeholders and asking them to help align our priorities. A lot of this has to do with international and with pharmaceuticals and with vendors who supply HIT. That's going on right now. That's a direct result of and one of the first initiatives coming out of this reorganization at a strategic level.
Q: And so for hospital CIOs?
A: All hospital CIOs work with their vendors. And so they should be able to ask their vendor, "What are you doing with HL7, what changes should I be expecting in my architectures over the next few years?" And they should be able to get clear answers. If they don't, they should ask their vendors why not.
Q: Is there any way they could get involved directly?
A: Any organization can get involved directly by coming to an HL7 meeting.