I had the privilege of working with Dr. Peter Levin as an outside technology strategy adviser while he was the Chief Technology Officer (CTO) of Veterans Affairs during the first Obama Administration. Peter’s a hard-charging, fast-moving, take-no-prisoners style senior technical executive; he was an entrepreneur, professor, and engineer long before he came into government so it was no surprise that he was able to accomplish a great deal during his tenure as the CTO of VA. Two of his most enduring accomplishments that affect healthcare world writ large are his deployment of the Blue Button at the VA and helping spin out the VistA EHR source code into OSEHRA. He’s too modest to say it himself but I like to refer to him as the “father of the Blue Button” because I don’t think it would have taken off as fast as it did without his design leadership and his ability to knock heads together (including mine) both in and outside the VA to make it happen. Recently I asked him why he thought, beyond the obvious reasons of high value to veterans and other patients, that Blue Button took as fast as it did. Here’s what Peter had to say:
One of my favorite books is “Too Big to Know”, by Harvard University’s David Weinberger. If you have a chance, jump to page 145, under the heading “when scientists disagree with scientists”, which is a brilliant exposition on the enormous technical impact and societal (yes, I mean everybody’s) benefit of a very simple concept called “the namespace”.
While Veterans Affairs was struggling with the nuances of the implementation of the Blue Button personal health record, and while the VA and the Pentagon are wrestling the Health Data Dictionary to the ground, we lived – and lived through – the hell of multiple rigid conventions described in Weinberger’s book.
The rock soup of medical databases is born of three bitter ingredients: first, the natural human tendency, especially among scientists and technologists, and fully bloomed in the healthcare industry, to a) believe you’re right at all times and b) to defend your turf at all costs against all comers, including those just meandering by, with no intention of spending the night.
Second, the “standards bodies” were more corporeal than standard. In contrast to, say, the world of semiconductor manufacturing (which created a multi-hundred billion dollar industry based on standard lithography techniques) and electric power distribution (the plug-and-socket distribution system that has worked so well) to name just two of my many favorites, there is scant little agreement between hospitals, between vendors, and between systems about how to get medical data from one place to another. Still. Today. And let’s save for another time about what we’re doing – and not doing – to keep the digital pipes clean of cybersnoops and other digital detritus.
Finally, we had not heard of, and were a little slow …read more