Let’s do it like the Internet

There is much talk about “Standards” following the publication of the NIB Framework “Personalised health and care 2020: a framework for action”.

Standards are of course a self-evidently good thing, but only if you do them right which is far from the way the NHS has traditionally done them or looks like doing them in the future.

I ask those who challenge this view the three questions:

  1. Do you think the Internet has had a significant transformative impact over the past ten years?
  2. How does the Internet do standards?
  3. Why doesn’t the NHS do standards like the Internet?

So far only Mrs Trellis from North Wales has answered “No” to question 1 for the rest is the reaction is a resounding “YES – Why would you even ask”.

In relation to question 2 the answer is generally “I’m sorry I haven’t a clue” and certainly those who really do and know how the Internet does it are not those driving policy on standards in the NHS.

The answer to question 3 is usually “Well we probably should – Why don’t we?” for those who do raise an objection their answer can often be more honestly be restated as “because I’d be out of a job if we did”

I written a lot about standards and I explain my view in more detail in my blogs “Farewell to ‘Ruthless Standardisation” and “Standards are a Barrier to Innovation”

But the short answer is: The Internet does standards on an agile, collaborative, voluntary basis as a trailing edge activity with those who use the standards doing them. Internet innovation doesn’t wait for standards, they simply follow to secure it as business as usual. The process and outcomes are messy and like much of the Internet in theory can’t possible work, but do in practice.

We must follow the way IETF and WC3 do technical Internet and web standards and need look no further than Wikipedia for a model for clinical content development.

Finally, to those who are worried about their jobs if they support these new ways of working I say, that given the shortage of those with skills in health informatics you need never worry about being out of a job as long as you are willing to change, learn and embrace new opportunities. If you’re not the sooner you go the better for us all, maybe you can get a job walking in front of cars with a red flag?

We really do need to do things like the Internet does.

One thought on “Let’s do it like the Internet”

  1. A thought provoking piece. One of the challenges with internet standards, in its earlier days in particular was the adoption of standards even once agreed. The big players in the browser market tried to implement proprietary non-W3 standards to hold and grow market share. This led to multiple branches of CSS/DHTML to accommodate browser behaviour and the rise of Flash as a proprietary non-W3 standard. This is an area where Healthcare sees some analogous behaviour by large multi-system vendors trying to lock customers into their sometimes limited ecosystem. In the end (I think I looking back) the Browser wars subsided by some regulatory intervention on IE bundling and new entrants like Chrome, Safari and Firefox. The principles of developing as needed, using a Request for Comment (RFC) agile approach all seem the correct way to proceed. There is a role for regulation though as status quo sometimes needs breaking a la the ITK. I am not sure internet paradigm alone is the panacea without some sort of regulatory push. Can the standards really trail the delivery of integrated care for example? Isn’t there a risk of a thousand flowers blooming, and some weeds taking over the garden and restricting all growth outside of a health W3 organisation

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