AAHA Consortium
John Albers
a veterinary industry consultant (Albers Veterinary Strategies, LLC).
I have been retained by AAHA to facilitate the creation of a
veterinary informatics consortium. I would like to briefly outline the
key elements of the consortium and the reasons that AAHA has chosen
this path. I welcome questions and comments.
(1)The AAHA Consortium will be an independent non-profit organization,
with membership open to all individuals and organizations with a
legitimate interest in the work of the consortium.
(2)The consortium will NOT be controlled by AAHA. AAHA will be a
consortium member equal to all other members. The members will elect
the Board and the Board will set the priorities and the agenda of the
consortium, and will appoint committees.
(3)AAHA will propose that it be the managing member (for logistical
purposes only, not control) because AAHA believes that the effort, to
be successful, will require infrastructure and related resources.
(4)The diagnostic code project of AAHA is now complete. The
approximately 6,000 terms have been mapped to SNOMED by Jeff Wilke's
lab at VA Tech.
(5)AAHA proposes to donate its intellectual property (the mapped
diagnostic codes) to the consortium for the perpepual use of the
profession, even if AAHA were to withdraw at some point from
consortium membership.
(6)The bylaws and member agreements will provide for the licensing of
the diagnostic terms and any other standards developed by the
consortium to be licensed under open-source licensure, without any
licensing or royalty fees.
(7)Since open-source licenses provide for the possibility of licensees
creating derivative works (the so called "freedom to fork") the
licenses will be RECIPROCAL. That means that any licensee creating a
derivative work will be required to also make the new work available
under an open-source license. In other industries, the existence of
reciprocal open-source licenses has effectively prevented the creation
of derivative works that become proprietary.
(8)The consortium (NOT AAHA) will determine what other standards to
create or adopt. AAHA assumes that communication standards will be
high on the list of priorities. It is further assumed that the
consortium members will consider existing standards (presumably
including those already in place in human medicine as well as those of
the vetXML Consortium) rather than re-inventing the wheel.
(9)AAHA is contributing its resources, and is currently seeking
additional support from interested industry parties, for the
establishment of the consortium. Once the consortium is formed it will
be up to the members to approve a dues structure sufficient to cover
the on-going costs of the consortium's efforts.
Why is AAHA pursuing this course? At the vetXML meeting at NAVC there
was considerable discussion, and some controversy, regarding AAHA's
plans. There were those that felt that AAHA should simply join in the
efforts of the vetXML consortium. Here are the principle reasons that
AAHA has chosen its path:
(1)AAHA believes that it is in the best position to provide leadership
in standard setting and, importantly, drive adoption of diagnostic
codes and other standards in companion animal practice in North
America.
(2)The efforts will require significant infrastructure as well as
clear organizational documents and organizational structure. None of
these currently exist in the vetXML Consortium.
(3)AAHA has been encouraged to form this consortium by a number of key
players in the North American pet health insurance industry, practice
mangement software vendors, and other organizations. There is nothing
that precludes participation in BOTH the AAHA and the vetXML
consortia.
Again, questions and comments are welcome.
John Albers
Matt Wright DVM DACVR www.animalinsides.com
John,
NOTE: The following comes from a long time AAHA supporter. I would be
willing to be that there are few (if any) radiologists who have done
more free radiograph evaluations in an effort to support what AAHA is
trying to do. That said..
It seems to me (and everyone else I have talked with) that you have
just drawn a line in the sand and stated, in no uncertain terms, that
it is "AAHA way or the highway!"
Assuming that is correct, that approach is counter to any standards
movement which is usually a compromise between all parties. I contrast
your approach with the approach of the vetXML group who is willing to
explore all options including modification of their current schemas to
fit into broader standards organizations. Furthermore, I would contend
that the reason we are all here is because of the work that the vetXML
folks have done and because they have the rudiements of a working
schema while AAHA has no more than a list of codes.
It is great to see that AAHA retained you to create a consortium.
Unfortunately, it does not work that way. Any standards group must be
supported 100% by it's members. Without broad support it will fail.
In your post you say "The efforts will require significant
infrastructure as well as clear organizational documents and
organizational structure. None of these currently exist in the vetXML
Consortium. " I contend that none of that exists in AAHA as you also
state in your post that you are just planning on starting the
consortium. I contrast that with the clearly defined structure of the
human IHE - an organizational body that vetXML has already stated they
would be willing to work with and you have stated that you would not
work with.
Finally, in your post you state "AAHA has been encouraged to form this
consortium by a number of key players in the North American pet health
insurance industry, practice mangement software vendors, and other
organizations. There is nothing that precludes participation in BOTH
the AAHA and the vetXML consortia." Again, this statement shows that
you fail to grasp a key concept of what a standards organization is
all about. We are looking to create one single standard that ALL
veterinary practices around the world can use. I offer you the case of
DICOM. Currently, any veterinary practice any where in the world can
send me images for review because DICOM is a worldwide standard.
Creating two standards bodies is exactly what we are trying to avoid
here.
So, my question to you is whether AAHA has in fact drawn a line in the
sand and has stated that it is your way or the highway or is AAHA
willing to work together (as the vetXML folks are) with all of the
companies, organizations, and standards bodies in an effort to explore
our options and develop a SINGLE standard that is best suited for the
veterinary profession whatever that standard will be and whomever that
governing body turns out to be? We are here for the veterinarians and
we all must put aside our own personal interests and make this happen
FOR THEM!
Thanks.
Matt
Stephen Joslyn
John Albers
I'm happy to respond to your concerns, but first I must take exception
to your statement that AAHA has "no more than a list of codes." The
list was designed to be a workable list for companion animal practices
and contains approximately 6,000 terms. The terms have been completely
mapped to SNOMED and are in an XML format. AAHA has gotten to this
point after literally years of work by committed volunteers, aided by
considerable financial and staff support from AAHA.
As good as the list is, it will be of no value if it is not adopted
and used by private practitioners. It's amazing that as sophisticated
as veterinary medicine is today in North America, and in spite of the
passion of a number of individuals (such as yourself), we still don't
have a good idea about disease incidence. The only data base in
general use is that used by 7-8 colleges, with limited value because
of the nature of the cases seen in a VTH setting. So some organization
with resources and infrastructure has to play a leadership role in
getting these codes into broad use. That was and remains a key
interest of AAHA's. Additionally, the association would like to see
development of electronic health records standards and complete
portability of those records across all practice management systems.
Beyond that, I regret that my post and AAHA's intent is still unclear.
I fully understand that standards require the support of 100% of its
members. It has been AAHA's intent to encourage membership and
participation by a wide range of individuals and organizations, and
then to let the members determine the appropriate standards. By
contributing it's diagnostic codes and suggesting that they be
available under open source licensing, AAHA recognizes that the
members of the consortium may ultimately decide that the AAHA codes
can and should be modified or even scrapped if there's a better
option. That would be for the consortium to decide.
As I and others from AAHA have tried to convey (albeit maybe
unsuccessfully) AAHA does have the structure and resources to help
drive the initiative. By contrast, Mike Vaughn (the vetXML chair)
stated publically in Orlando that he has a full time job (other than
vetXML) and with 15 or so members paying roughly 800 US dollars per
year, there certainly don't appear to be a great deal of financial
resources available. (If that's an incorrect assumption, I'd invite
vetXML to offer more transparency.) Mike further stated that a
constitution for the organization is currently being developed.
Additionally, we also stated publically in Orlando that we could
foresee the two consortia coming together at some future point. I also
do not believe that either I nor anyone else from AAHA has stated that
it's our way or the highway.
In fact, since my post on Tuesday, I've had two off-line chats with
folks about IHE and about the idea that AAHA could possibly drive the
formation of a vet med working group under IHE, and provide support to
the working group in a manner similar to that provided by RSNA. While
I must state that a decision about that can only be made by the AAHA
board, I personally think the idea has merit and should be explored.
Further, I believe AAHA would be open to considering that as well.
Matt, I sincerely believe that AAHA has made and is making a big
contribution to the profession through the promugation of diagnostic
codes. Beyond that, AAHA doesn't want to "own" anything and is not
seeking revenue of any kind from this effort. On the other hand, AAHA
deserves (in my opinion) recognition for its efforts, and legitimately
does not want to see those efforts go to waste. I reiterate my earlier
comment that this effort to drive standards takes a lot more than
simply a group of interested individuals or even AVI.
I admit to a lack of in-depth knowledge about IHE, but I would be
interested in the thoughts of others regarding the possible creation
of a vet med working group under IHE.
Thanks for stimulating more discussion!
John
Matt Moravek
After reading and considering your points, I have to say that I still
see no value in trying to create another consortium run by AAHA. The
facts as I see them are as follows:
-VetXML has created standards for passing data
-VetXML has specified data requirements and have documented them for
different lines of business such as eclaims and even medical records
if I am not mistaken
-The standards are proven to work today!
-There is tremendous momentum behind the VetXML Consortium and I
witnessed key companies pledge their support of VetXML in Orlando
The support from these industry leaders typically does not come on a
whim. Much effort and time was placed into evaluating what the VetXML
Standards offer and decisions were made. The fact is much can be
accomplished immediately from what VetXML can offer.
Further, the more I learn about VetXML the more I realize that VetXML
is not going to make decisions in a vacuum. Moreover, they are
flexible and open to making decisions based on the best technology and
information available and will not close any doors or make any
decisions without the proper evaluation.
Finally, your comment on not having the leadership to see this through
is neutralized by the fact that they already HAVE a standard and it
works.
I think you need to take a step back from this and look at the bigger
picture. A proven, reliable, and working standard is worth a lot to
the stakeholders. What we have essentially is what I refer to as a
COTS (Commercial Off The Shelf) solution for a pressing need. Why
would anyone want to reinvent this wheel when it is already there?
Who has the time? Further, there is serious risk to consider:
-Will you get the support you need from the proper entities?
-Time to market is elongated as you really have to start over. If its
not there, its 'vaporware'.
-There is a risk of failure. What happens then?
How can you or AAHA mitigate any of those risks? The answer is
simple. You cannot and what happens to AAHA's reputation then?
I'm not trying to be flippant or disrespectful to AAHA in anyway. It
is a great organization that has provided so much to the Veterinary
Community. I have a great deal of respect for it's members including
Dr. Mark Russak who is on your Board of Directors and whom I have
known professionally for 15 years. Again, I think AAHA is wonderful
but I feel it is not seeing the big picture here and we need to move
forward.
My suggestion: Join the VetXML consortium, give your code list to the
group and get the recognition you are looking to obtain for AAHA. As
you noted in your post, AAHA wants the recognition and this is not
about money.
If that is the case, I think it only makes sense to support the VetXML
consortium.
Regards,
Matt Moravek
Matt Wright DVM DACVR www.animalinsides.com
Thanks for the reply, let us know what AAHA says about working under
the confines of the IHE. You might also send them Matt Moravek's
response as failure to play nice in the sandbox will lead to more
emails like that :-)
Remember - we are really on an exploratory mission to determine what
is best for the veterinary profession. I do not think that any of us
know what the best route to take will be at this point and we can say
for certain that none of us know how it will play out. We all just
hope that AAHA is there with their support no matter what the group
decides.
Thanks again for your reply.
Matt
Matt Wright DVM DACVR www.animalinsides.com
Please smack me down if I am out of line here as I was not at the
Orlando meeting so I do not know the answer to the question I am about
to pose. However, I am reading between the lines in your posts
(probably not a good idea) but you keep coming back to the codes in a
way that is out of sync with what we are trying to accomplish. So,
here is my question:
Do the vetXML folks have their own set of codes that they use? My
corollary question is...Is the reason AAHA wants to take charge here
to make sure that their codes are adopted and used?
Again, spank, smack, and slap-chop me if I am out of line but if that
is the main (or even a secondary) issue for AAHA we really have 2
separate issues here.
1. Whose codes do we use?
2. What is the best method of developing a universal communication
standard for the veterinary profession.
Again, if I am even remotely correct in my logic, could you go back to
AAHA and convince them that the 2 issues are unrelated and allow us to
work on the communication piece for now. I think it goes without
saying that a list of codes without a way to communicate them is like
a stick of deodorant without a stinky armpit to wipe it on. It has no
use.
Matt
Dennis Ballance
Dennis
On 1/28/10 6:30 PM, "Matt Wright DVM DACVR www.animalinsides.com"
Mike Fletcher
Thank you for your thoughts.
I'm disappointed that you feel that the Vet-XML Consortium appears not
fit for purpose and that you feel you need to start a separate group
to accomplish your aims. For the record, the Vet-XML Consortium has
been operating very successfully for over 4 years, and in that time
has matured into a lightly-governed self-regulating open body, gaining
significant support from all quarters of the veterinary profession and
industry. Indeed, it now has well over 60 members, including
commercial companies as well as academic and regulatory bodies. Some
of these members are international companies, like IDEXX, Bayer, AVID,
Hills, Petplan, PetHealth, Butler Schein Animal Health, etc, and
others are American based, such as AVImark and VPI.
When Mike Vaughan said he does not have the time to run the US
contingent of the Consortium in addition to the UK one, he meant
personally. He was being truthful and pragmatic, and that is why at
the meeting we appointed an American-based acting Chair, Dennis
Ballance, who is more than capable of taking the reins and
representing all interests in North America, including the academic
fraternity too (thereby assimilating other approaches like HL7 and
IHE, as deemed appropriate consensually by the group) as well as
commercial bodies. It simply is a misrepresentation to say the Vet-XML
Consortium will not have the support or resources to run in North
America, as it is already gaining the traction it needs to do this.
Indeed, this can only be bolstered by support from bodies like AAHA,
which it openly welcomes to join the group and to play a significant
role in its development, as it was invited to do at the meeting in
Orlando (along with everyone else there). You have nothing to fear and
everything to gain. If, as Matt Wright has suggested, you are fearful
of the AAHA codes being subsumed by the VeNom codes, then I would
suggest that the opposite is more likely. Regardless, the goal surely
here will be to derive a single universal set that can be used
globally, and I'm confident through the close collaboration that
you're already making with the RVC that this will be mutually
achievable.
John, I would also like to reiterate the tremendous progress that the
Vet-XML Consortium has made over its 4 year history in developing a
communication platform and suite of robust data schemas, including
ones for the electronic transfer of data for insurance claims
(eClaims), microchip registration, lab service requisitioning and
report delivery, catalogues and product ordering, case referrals and
succession (Animal Record), benchmark data, and dietary advice. Some
of these (e.g. eClaims and Lab reports) have been in successful
commercial deployment for well over a year, with others about to go to
trial. This is a great time then for the Consortium to be taking stock
of its achievements to date and how other bodies and new members from
North America can influence its future direction, particularly among
those proposed data schemas like the Animal Record which have not gone
to trial yet but where it knows bodies like AAHA are keen to develop a
standard too. It just makes sense, doesn't it, to bang heads together
here on this and create the one single global standard that will be
right for all? I'd urge you to be part of this, and indeed would
welcome AAHA's critical feedback on the proposed schema for the Animal
Record that is already in place on the Consortium's website at
http://www.vetxml.org/StandardDataFormat.aspx. Perhaps AAHA would like
to deliver its views on this to the other members and prospective
members at the next proposed meeting of the Cosnortium at the WVC in
Feb? I, among others, would look forward to hearing them.
Regards
Mike (Fletcher)
Dennis Ballance
labeled as such.
Dennis
Mike Fletcher
On Jan 29, 4:17 pm, Dennis Ballance <dwballa...@gmail.com> wrote:
> Mike, which of the items on that page is the Animal Record? It isn't
> labeled as such.
>
> Dennis
>