How could AVMA help?
Heidi
Council on Veterinary Services, after taking a survey of the
veterinary informatics arena. They'd like to know what highly
leveraging action they might take to help move veterinary informatics
along in a direction we believe is best. I got the sense that they are
not prepared to commit big sums nor do they have the technical
expertise to execute specific tasks, but are willing to help
encourage, via official statements, white papers, veterinary college
recommendations, etc and use their influence to bring people together
to adopt consensus standards.
There are so many experts in various arenas that I am currently
assembling a list of people to contact that represent a broad view and
many perspectives. I would appreciate direct emails (to:
habu...@charter.net ) to suggest specific individuals to chat with.
Some of you are yourselves area experts- please don't be shy about
offering input. Please include the person's or your name (and some
contact info if sending directly to my email) as well as the arena of
influence.
This may take several attempts, but I can bang the standardization/
informatics drum forever if it will bring us closer to more efficiency
of data collection and enhanced patient outcomes. Rather than claiming
this effort is only going to benefit academia and researchers, the
AVMA may now recognize the potential better informatics has for
helping real veterinarians out in the trenches. Thanks in advance, all
of you!
Heidi Burnett (AAHA electronic health
records task force chair)
Michael K. Martin
One thing AVMA could do that wouldn't cost much at all would be to have
a web page on their site that would point to "officially recognized"
standards and standards implementation guides. These wouldn't have to
be mutually exclusive, but would be a subset of only those standards
that had received adequate scrutiny to be trusted. That endorsement
might both help potential adopters find the standards and also help them
have faith that their efforts wouldn't be wasted on a half-baked standard.
This begs the question of what group would do that endorsement. At one
time it was the AVMA Informatics Standards Committee. As I've stressed
on a number of calls and email threads, one of the most important things
an ANSI/ISO accredited standards development organization does is
enforce adequate representation of all sectors on its committees. While
AVMA may not have the expertise to do the vetting (pardon the pun) of
standards themselves, they could be an ideal organization to ask the
question, "does this committee really represent all of veterinary
medicine adequately."
Another place AVMA might be able to help is in the education "pipeline"
problem. We really need to be recruiting many more veterinary students
and new graduates to begin learning standards and the standards
development process. Our very few formal training programs will never
be able to supply enough graduates to replace us "old guys" as we wear
out. AVMA might be able to help developing the informal supply chain
by, if nothing else, recognizing the importance of this activity to the
profession. While I was off "learning the trade" I was constantly being
called a "former veterinarian." That doesn't help. And heaven forbid
we'd ever received CME credit for learning standards (except at the AVMA
meeting itself.)
Mike
--
Michael K. Martin, DVM, MPH, DACVPM
Clemson Livestock Poultry Health
PO Box 102406
Columbia, SC 29224-2406
email: mma...@clemson.edu
personal email: michael.mar...@gmail.com
phone: (803) 788-2260 ext 230
work cell: (803)312-1439 (no personal calls)
personal cell: (803)348-1879 (no work calls)
fax: (803) 736-0885
Pedantry and mastery are opposite attitudes toward rules.
To apply a rule to the letter, rigidly, unquestioningly,
in cases where it fits and in cases where it does not fit,
is pedantry... To apply a rule with natural ease, with
judgment, noticing the cases where it fits, and without
ever letting the words of the rule obscure the purpose
of the action or the opportunities of the situation,
is mastery.
GEORGE POLYA, professor of mathematics (1887-1985)
Matt Wright DVM DACVR www.animalinsides.com
Step 1: Like you said, you can bang the drum for years and you might
as well be banging your head against a very rough brick wall. Until
the vendors get on board with things it wont matter what website you
have, how much money you have, what standards you recommend, what
powers of influence the AVMA thinks they have, or anything else for
that matter. Step one is to either get a single powerful vendor or a
few vendors of any size to work with the AVMA or work together to make
some decisions and implement standards in their systems and market
those products to the veterinarians. At that point the AVMA can be a
cheerleader (and not a headbanger) and start educating the vets about
why these products are better for their clinics. Until that happens,
what vet has the time to worry about standards that nobody
implements?
This is what happened with DICOM. A few good vendors saw the light and
we were able to educate vets about DICOM and why non-DICOM systems
were not in their best interest. Once that happened the whole thing
snowballed and now DICOM is ubiquitous in the vet market.
Step 2: The informatics group and academics need to find a way to come
to consensus. They need to understand that whatever is ultimately
adopted in veterinary informatics will be a compromise. It will not be
perfect. No standard is perfect for every situation. Until, the
informatics folks can come to a practical consensus and actually
decide on something (anything?) as a best road map for veterinary
medicine, we will not be able to move forward. The AVMA should charge
a committee with deciding once and for all what standards we will be
using in veterinary medicine and be done with it. This committee
should be selected from academia, industry, and wherever else.
Whatever the committee spits out is what gets adopted. End of story.
Committee selection better be good. My recommendation is that this
committee fall under one of the human side groups (IHE) for guidance
and to help stomp out self interest and politics that will run amok
without big brother watching. We have proven time and time again that
we NEED outside influence as we do not have the ability to control our
self interests or be bullied by the "big guys" in vetmed.
FWIW
Matt Wright DVM DACVR
www.animalinsides.com
Dennis Ballance
Dr. Ron DeHaven requested that I draft a summary similar to this related to the meetings at WVC and NAVC. Should we put our heads together and plan to deliver a similar message?
Actions I can think of for the AVMA:
* Host a web page (mike's idea)
* Fund informatics roles with various standards bodies
* Recreate a council on informatics
* Seek out articles for the AVMA journals related to informatics, and otherwise provide additional exposure to the membership to informatics
* Consider joining ACVR in sponsoring an IHE domain
Are there more? In my case, I need to deliver this quickly, like yesterday, for use next week.
Dennis
> --
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> http://groups.google.com/group/veterinary-health-it-standards?hl=en
Michael K. Martin
I'm not sure that funding should be in the first set of ideas. If and
when AVMA really understands that they do have a significant interest in
the process it will be natural for them to fund part of it. But first
we have to get to that point. I'm afraid they will think--as they did
when they were funding HL7 through VMDB--that they are funding someone
else's interests.
It is great that Dr. DeHaven is taking an interest. As good as Dr.
DeHaven is at separating his current responsibilities from his past
experience, he can't help but have been impacted by the demise of NAIS.
USDA could mandate paper forms and get away with it because you always
had the margins. Their mandates have been much less durable in the
electronic realm because they haven't gone through the annealing process
that takes place in the blast furnace of a true SDO. The only viable
alternative to centrally mandated "standards" is the emergence of true
consensus standards. It seems obvious that AVMA has a role in finding
that consensus. And Dr. DeHaven can't help but understand the need in
the public practice domain for a wide range of standards. And, I would
hope, by extension the potential for those standards in clinical
practice as well.
The one bullet I would really add would be something about encouraging
young veterinarians to obtain training and experience in informatics in
much the same way AVMA has been trying to encourage increased interest
in rural and public practice. Informaticists "are veterinary medicine" too!
Oh, and "Host a web page" sounds so pedestrian. Any of us could "host"
it. The important part is for AVMA to have a public statement of
support for a set of standards that it recognizes as key to integrating
the profession. Only then does AVMA have something to host.
Mike
--
Matt Wright
Your comment "The important part is for AVMA to have a public statement of support for a set of standards that it recognizes as key to integrating the profession. " says it all.
The problem is that we keep going round and round and round and the informatics folks cannot come to consensus on what that set of standards they want to use. Every time a discussion gets started, there is a person/company in the crowd who finds some reason why this or that wont work. Until we come to consensus AVMA has nothing to do, nothing to support, nothing to put on a website, and no reason to get involved much less offer funding.
This is not (initially) an AVMA issue - it is an informatics issue and the academics have not been leading the discussion toward a meaningful end which is a statement that will direct the profession that the AVMA, ACVR, or anyone else can get behind.
Matt
Michael K. Martin
I agree about the person/company that objects. A big part of the value of an SDO is that it provides a managed environment in which to fight out those issues until either A. a solution can be found that meets the needs of both the majority and the objector. This is the ideal and is where most of the obscenely long incubation period of standards is used. Or B. the objector is convinced by the majority to accept what they see as less than the ideal solution. Or C. a super majority finds the objector's objection unpersuasive. This is obviously the least desirable outcome and doesn't happen very often in reputable SDOs.
I'm convinced that we could successfully have those battles if we had the necessary referee. But we can't even agree on that. And that is where I think AVMA could play a role by either providing the venue for the fight or by designating such a venue such as IHE. (I'm not endorsing the IHE option, just using it as an example.)
Mike
Matt Wright
Michael K. Martin
Mike
Jeff Wilcke
2) I'd like to remind everyone in this conversation that AVMA previously took an active role in the development of medical informatics standards for the profession. They are on record as supporting SNOMED, HL7 and LOINC as the viable standards that are, in fact, maintained by legit SDO's (for my part, the standards should have proper SDO homes). Earlier this spring, I encouraged the Council on Veterinary Services (the current bureaucratic home for standards at AVMA) to add DICOM to the statement they asked the executive board to ratify.
3) Speaking as an academic that turned a career on its head to take up the standards cause 15 years ago, I'd like to ask that "academic" not be used as a pejorative in these conversations. While the standards efforts have been dominated by academics because we have the time (and have doggedly stayed on the trail of funding to help produce viable standards), practicing veterinarians have never been excluded from participation (in fact the AVMA standards committee ALWAYS had representation from private practice). The vendor community has been invited to participate repeatedly during my tenure and earlier, but most have told us repeatedly that standards were unnecessary to their efforts (or that proper standards were too much effort and complexity). So could we have a bit of respect for those of us who have been trying to do the right thing for the profession and who may have a broader perspective on the subject than tends to be recognized in these conversations?
-Jeff Wilcke
Michael K. Martin
I'll leave #1 to its advocates.
On #2, the line between developing standards and designing implementation specifications gets weird sometime. HL7, an SDO, is currently busy doing implementation guides for the stimulus bill's "meaningful use" requirements. To me that is more an implementation spec than a standard. I don't see an IHE domain (or whatever venue we come up with) developing any new standards but more of the veterinary versions of implementation guides.
On 3#, it isn't just in informatics that what was "academic" (pejorative intended) 5 or 10 years ago always seems to be what is cutting edge now and taken for granted 5 years from now. It doesn't seem to matter when "now" is. That is true of surgical techniques, diagnostic modalities, you name it. While the "practical" world may not be ready for the parts you academics find interesting today, we definitely need to use the parts you are starting to get bored with and pay attention to your current work because it will be relevant before we know it. We really do need BOTH academics and vendors working together on our standards so we get things that both work today and last into the future.
And: I'm glad you are doing well enough to be back grousing at us ;-)
Mike
Jeff Wilcke
For those who haven't heard, I'm 6 weeks post motorcycle accident, recovering as well as possible considering the multiple compound fractures of my left leg and fracture of my hand. Thankfully I'm alive (which was not a sure thing when the helicopter lifted me from the rural piece of road where the accident occurred), I get to keep my leg unless something ugly happens, and I suffered nothing in the way of major neurologic trauma or road rash (thanks to good helmet and kevlar in all the right places). My wife, who was tossed out of the passenger seat on impact, suffered a relatively minor fracture of her ankle and should be back at work no later than July 1. Her helmet and jacket look worse than mine.
Anyway, my question number 1 is probably prompted by my experience with AMIA, HL7 and SNOMED. They have all been welcoming to veterinary medicine and they all have had much to offer; but in the end, they have not provided resources necessary to make standards work for US. So I remain slightly skeptical, though I do believe that IHE likely is an appropriate home for SOME of the activities required for implementation of veterinary information standards.
-Jeff
Kevin Grant
That news certainly puts everything in perspective...take care and
heal well.
Dennis Ballance
Jeff Wilcke
-Jeff
Dennis Ballance
William Hornof
Jeff
Things like lab results and reporting. IHE defines what doctors do, and what information they need in diagnosing and treating patients. To me it is what is lacking in standards development – practical application. IHE cannot work without standards, but standards efforts alone will not fix the problem of apathy in the community unless there is practical application. Adopting standards based workflows provides practical application. That doesn’t mean standards evolvement stops, it means everyday veterinarians can see the benefit.
To me the attempts at coding diagnoses was an attempt to accomplish the same thing. Additionally to me coding is not standards, it is an attempt to find practical application like IHE. Unfortunately, again to me, attempts at coding are bound for failure. Coding depends on a human to interpret data and reach a diagnosis or “code”. If I am going to use that code for research, how do I know what criteria were used to make that diagnosis? Every scientific publication that deals with diseases must have inclusion criteria of the patient population. If I just search a code, how can I say with any confidence the patient actually had that disease? There was a recent publication in JAVMA using codes, that was attacked by the scientific community, because the individuals selecting the codes my not have been using the same selection criteria, that the letters to the editor demanded.
All I’m saying is there is no shortcut. We need standards, but standards need a mechanism to be shared. If I am going to write a retrospective study and publish it, I need access to the factual information on that case. What were the lab results, the echo cardiogram report, the history, the signalment, the physical exam, etc (and oh yes, radiographic images that can be reviewed by my own set of boarded specialists)?
In my opinion, without something like IHE, we will be a long time getting scientists, let alone everyday veterinarians to see the benefits of standards.
Bill
William J. Hornof DVM, MS, DACVR
Chief Medical Officer
Sound- Eklin (a VCA Company)
email: who...@soundeklin.com
Cell: 530 220 2437
Julie Green
produce" question, but would I be correct to say that IHE work defines
something akin to what we would term "Use Cases" from which message
structures, software interfaces/workflows, etc would then be
developed? Because that I could definitely see as being helpful even
to us "academics" since one of the most vital parts of standards
development (which is often overlooked or underdone) is Use Case
Analysis that leads to the data models that leads to the data needs
and the message structures etc etc etc. Or am I oversimplifying IHE?
Michael K. Martin
Yes, that is part of what IHE does, and a very valuable part. They then
also take the HL7* standard, which is essentially impossible to do true
compliance validation against, and constrain it and define coding
systems, etc., to the point that implementations can be validated.
Finally, they run testing "connectathons" where vendors can demonstrate
interoperability. The part that is interesting to those of us doing
"real" standards development is that they inevitably find real world
"gaps" in the standards that they can take to the SDOs for development.
That is the completion of the circle that we are so sorely missing.
* I'm using HL7 because that is what I know. They do similar things
with other standards and workflows that cross standards. This might
become a big deal if the DoJ's NIEM "standard" really gets traction and
we need HL7/SNOMED/LOINC/NIEM workflows. (I just had to sign off on an
agreement that my electronic messaging would be NIEM compliant. Anyone
getting DHS money is probably going to see the same wording.)
So, I am a strong advocate of a function like what IHE provides. I'm
still agnostic as to whether IHE would be practical. Keep in mind that
"they" aren't going to be doing any of this work. That will still be up
to "us."
Mike
--
Michael K. Martin
The real problem with HL7 is that at the typical WGM meeting with 450 members in 15 or 20 committees there are one or two veterinarians. (One meeting we had three!) We can't hope to catch every discussion that could derail our efforts. And as of now we have ONE, me, doing the preparation of veterinary specific material. And as with the rest of us "academics" I have a day job (well two jobs/one paycheck due to state budget cuts.) We REALLY need more help.
All that said, it remains to be seen if IHE would be willing to make as many concessions as would be necessary for veterinary medicine to really fit. And that was Jeff's real point.
Mike
Jeff Wilcke
I'm still not convinced that IHE is the place to solve the 'which standards do we use.' From my perspective, selection of the actual standards (and by extension which SDO we partner with) go something like this:
DICOM: Is the obvious choice for imaging and (if memory serves) other digital information gathering. The choice was made for us when human imaging technologies companies and users created DICOM. From my perspective, it's naive to think that veterinary vendors had an actual choice.
LOINC: Is the correct choice for laboratory test identification, whether ordering tests or other. The choice was originally endorsed by AVMA, then AAVLD. It would also be the correct choice for clinical document architecture as specified by HL7 and now FDA (for the Structured Product Label). LOINC is not widely accepted in Europe so ultimately, we may need a translation for our VetXML friends... (I really can't speak to this particular problem rationally).
HL7: For its information model and for message structures. Again, as it's been endorsed by AVMA, AAVLD and is being put to use by NAHLN and at least one major laboratory corporation in the US (I'm pretty sure this is true).
SNOMED: For general medical terminology (problem lists, diagnosis coding, procedure coding). It has AVMA endorsement, and is the only actively maintained general terminology that has and can accommodate the breadth and depth of veterinary content for the job (across the depth and breadth of "all of veterinary medicine). If you once buy into the idea that a terminology has to be supported by an SDO (drink the KoolAid?) you quickly are backed into SNOMED. I recognize as well as any that this choice comes with a raft of problems, mostly in how to cut it down into useful pieces. I think AAHA has given us a boost in this regard. I'm also willing to bet that mapping AAHA to VeNOM is NOT a monumental challenge as VeNOM has roots in SNOMED and has attended to generally recognized principles.
Now what I think we need from political organizations like AAHA and AVMA is political backing for the choices that have been made already + financial backing (I don't care if they put up the money or just help us find it) to support the work that needs to be done in order to make the standards work for us... As an example: I think we have enough penetration into federal agencies (FDA, USDA, USGS, NOAA) that AVMA could help us in congress to get significant funding for the work that we need to do.
What I don't think we need from political organizations like AAHA and AVMA is "leadership in the area of standards." We're well down the path towards making this all work. We need their support, not their guidance.
-Jeff
Heidi
Let's have separate threads to address what AAHA (vs AVMA) might do to
support informatics? Since the constituencies and objectives of each
association are vastly different, it will be less confusing. (For
those who may not know it, AAHA espouses development of practice
standards or guidelines it believes make for healthier patients and
healthier practices; in this sense, it's a metaphor for an SDO
espousing standards for better data collection, processing and use.
AAHA understands how standards must be practical and consensus-driven
yet based on scientifically advanced principles to work.)
Jeff, by "needing their support, not guidance", what precise form(s)
would this "AVMA support" take?
How damaging would it be to test the IHE water? To just dip a toe in
and start out as a subgroup within IHE, representing some soon-to-be-
conceived collaborative SDO for veterinary medicine? What are the
costs dollar-wise? We know "we" will be the ones doing the work, but
are there dues, fees, meetings we "must" attend and report to and
from? If a veterinary domain forms within IHE, does anything prevent
us from taking on SDO type tasks? Our industry is too small and too
poor to endure _heel-digging_ divisiveness, (especially if we canot
even decide on a forum to _have_ the debates, but we will miss out on
high quality decisions if we develop complete intolerance of friendly
debates and agreeable disagreements. Perhaps an IHE domain will be a
good crucible for constructive criticism and productive group work.
Let's just get something rolling. We can tweak it as we go, no?
Here's a digest of your suggestions for how AVMA can do the most good
in informatics:
1. Endorse consensus terminology and communication/interoperability
standards (the ones Jeff listed above) (kindly alert me if there is
not considerable agreement on any of these),
2. Support forums (IHE? AVI meetings at Talbot?) allowing experts to
debate and develop agreement on various standards and terminologies
3.Educate the profession about how to select more powerful systems
that integrate consensus standards and applications
4. Influence the market (veterinarians and veterinary teaching
hospitals) to utilize applications
5. Encourage students to enter informatics research, or at least
volunteer as practitioners to help develop (and later use) workflow-
friendly applications that generate structured data.
6. Lobby government agencies for grants and contracts to support
common interests in veterinary informatics
Academics brainstorm, "think-tank," and test hypotheses and develop
theory, ("Theories" of Gravity, Relativity and Evolution come to
mind...);
Industry Vendors develop applications of theory to real world uses,
market them, and iteratively refine them;
Clinicians (hopefully) recognize benefits of and buy improved
products, giving constructive feedback to vendors.
The AVMA should be able to help to a variable degree with
all three categories.
Clinicians, using effective informatics, will someday improve their
outcomes and incomes, and vendors will get more successful selling
ever more powerful applications. All these folks pay taxes and support
nonprofits and alumnae funds, and maybe (like I try to do) appeal to
organizations with influence or money to invest in grants to support
the work of academicians. We are all interconnected in one sticky
multistranded web. (And, as icing on the cake, maybe our brilliant
kids will grow up wanting to be veterinary informatics researchers,
rather than firemen and ballerinas?)
So, now I'm done singing Kum-Bah-Yah. What's next? -- Heidi
PS Vonnegut seems apropos:
"Oh, a sleeping drunkard up in Central Park, And a lion-hunter in the
jungle dark,
And a Chinese dentist, and a British queen -- All fit together in the
same machine.
Nice, nice, very nice; Nice, nice, very nice;
Nice, nice, very nice -- So many different people in the same device."
Mike Fletcher
With regard to getting standards actually working for the profession,
when you say you need AAHA's / AVMA's support (political and/or
financial) on options as already indentified - rather than their
leadership / guidance thereon - how do you envisage them actually
(specifically) helping in attracting the significant funding (through
Congress?) that is so clearly required to adequately bankroll the
challenging task? It seems to me that the answer to this very
question, as raised by yourself on a number of occasions now since I
have know you, holds the key to unlocking the apparent current impasse
that exists within the standards development fraternity in terms of
pragmatically moving things forward, at least in the US.
PS: Hope you are recovering well from your accident.
Regards
Mike (Fletcher)
>
>
>
> > Medical document sharing, laboratory report distribution, laboratory device
> > automation, ... There are about a dozen domains other than radiology at this
> > time. The list of workflows is actually quite long. IHE workflows are one
> > of the cornerstones of most of the current US health informatics initiatives
> > such as NHIN, ELINCS (well, California), and HITSP.
>
> > Dennis
>
> > On Jun 3, 2010, at 5:19 PM, Jeff Wilcke wrote:
>
> > What "Workflows" have been developed through IHE that are NOT radiology?
>
> > -Jeff
>
>
> >>> I will leave "viable" to the group to debate. We've had lots of
> >>> discussion of the VetXML group, AAHA, AVMA creating a new or revived
> >>> committee, etc.
>
> >>> Mike
>
> >>> On 6/3/2010 11:34 AM, Matt Wright wrote:
>
> >>> Looks like we are on the same page then. Do we have a viable option other
> >>> than the IHE?
>
>
> >>>> Matt,
>
> >>>> I agree about the person/company that objects. A big part of the value
> >>>> of an SDO is that it provides a managed environment in which to fight out
> >>>> those issues until either A. a solution can be found that meets the needs of
> >>>> both the majority and the objector. This is the ideal and is where most of
> >>>> the obscenely long incubation period of standards is used. Or B. the
> >>>> objector is convinced by the majority to accept what they see as less than
> >>>> the ideal solution. Or C. a super majority finds the objector's objection
> >>>> unpersuasive. This is obviously the least desirable outcome and doesn't
> >>>> happen very often in reputable SDOs.
>
> >>>> I'm convinced that we could successfully have those battles if we had
> >>>> the necessary referee. But we can't even agree on that. And that is where
> >>>> I think AVMA could play a role by either providing the venue for the fight
> >>>> or by designating such a venue such as IHE. (I'm not endorsing the IHE
> >>>> option, just using it as an example.)
>
> >>>> Mike
>
> >>>> On 6/3/2010 9:57 AM, Matt Wright wrote:
>
> >>>> Michael
>
> >>>> Your comment "The important part is for AVMA to have a public statement
> >>>> of support for a set of standards that it recognizes as key to integrating
> >>>> the profession. " says it all.
>
>
> read more »- Hide quoted text -
>
> - Show quoted text -
Dennis Ballance
(I didn't include AAHA in that because I don't get the sense that AAHA has that particular skillset -- it is focused more on interacting with its member hospitals.)
PS The use of "collective" is intentional. ;)
Dennis
Jeff Wilcke
Although Heidi's points are well made, I'm not absolutely sure that separate threads for AVMA and AAHA are appropriate. I DO see their roles in this game is different but also believe there are areas of overlap and needs for cooperation (maybe I want a third thread in between :-))
AS for AVMA (to speak to Heidi's primary concern at the moment) I have three things for them to do (and these probably overlap as well).
I do believe that standards are (in large measure) the work of government. I would like AVMA to shed its reluctance to actively advocate for us in Washington. This activity includes advocacy with parts of USDA that do not know there are standards (like the National Ag Library). So you know, AVMA has rejected this idea in the past. Largely, I thiink, because money spent on Standards might be money NOT spent on other activities of interest to the AVMA membership.
Second, (and this is where I can't figure how to separate AVMA and AAHA) we need AVMA to advocate support for and interest in standards among constituent groups. AVMA establishes criteria for the specialty colleges (ACVIM, ACVS, ACVCP, ACVP, etc.). AVMA also seems the logical umbrella group for generating interest among "species oriented" organizations (AABP, AASP, AAEP, LAVA, etc.) Each of them has an interest in evidence based medicine and, by extension, standards. I think AAHA has some responsibility to approach the specialists that are AAHA members, I'm just not sure how to slice up this particular pie.
Finally, I think a second funding mechanism for standards, which has really been initiated by AAHA and now AAEP is something like a subscription model. AVMA should recognize these pioneering steps and push them forward to a wider veterinary audience. Take the full list of organizations that I refer to in the previous paragraph. Add in FDA, USDA, USGS and NOAA. Acknowledge that standards needs overlap to some degree but also have parts that make them unique. Then develop some magic formula that has each contributing according to its needs and ability. AVMA (and AAHA) can and should advocate for such a system such that users of standards bear some responsibility for the costs associated with maintaining the standards.
I think the electronic records vendors and imaging equipment manufacturers fit into the funding equation somewhere, but their motivations are tangential to the practicing veterinarian. They benefit from standards being delivered efficiently and effectively as much or more than they benefit from standards being employed in the first place. I do think they have a reason to support development of first class standards maintenance capabilities in veterinary medicine.
...and overall, the lion's share of support we're seeking is to facilitate deploying the standards in veterinary medicine NOT to develop the standards per se.
A little rough and a little tardy (life seems to take a lot more time during rehab...) but with some refinement, these are my notions of the role organized veterinary medicine should be taking in the standards effort.
-Jeff