ISO/TC215 Health Informatics Working Group on
Electronic Medical Records

Berlin, 12-15 April 1999

Report by Michael Mair, Head of Delegation and member Working Group 1, Modelling and Coordination, and
Ian Nottage (Delegate and member Working Group 2, Messaging)

Contents:


back to contents page

Introduction

Previous reports in this series have described the ISO/TC215 process at its inception at the Orlando meeting in August 1998, and at the 'Modelling' working group meeting in Sydney in January of this year. At this conference, which was also attended by Ian Nottage, the process continued with the submission of draft work items from the four working groups (modelling, messaging, content and security), and the refinement of the scope statements and terms of reference of the four working groups. The work item submissions are now at stage '00', but final versions must be submitted for voting by the first of June. At the November meeting in Japan their adoption or otherwise will be confirmed, and then the serious job of designing and implementing the ISO standard will begin.

top of page

The Working Groups

The meetings for the four working groups were held at different times in the two days preceding the plenary sessions. These were smallish meetings, and were very variously structured and composed, depending on the actual personnel involved. In this document, those meetings and the discussion that came out of them at the plenary session, and the resolutions which resulted, will all be continued together, for simplicity. These reports follow after the next section.

top of page

The Plenary Session

This meeting was laid out on a grand scale, and took place in a huge, light meeting chamber on the ninth floor of the DIN building. There were four long columns of tables in the room, with the US and Japanese on one side of the room, and many of the larger European delegations (the UK, Sweden, Denmark) and Canada on the other. New Zealand and a few other nations were on the sparsely populated tables in between. At the raised podium at one end were seated Peter Tresseder and the Secretary, Teresa Cendrowska (see illustration). As the meeting settled and the presentations began, there was a further change in the light, and a glance at the windows showed that a snow storm had enveloped the building and obscured the stark local skyline. Like the rain in Sydney, the snow appeared to alter the mood, a change in focus, with the ethereal light giving a transparent quality.

The structure of the meeting was that first the working group conveners would present their reports. These would then be discussed and votes taken on the work item definitions that they contain. The work items would then be formally defined by 1 June, and then distributed to the different P class members (of which New Zealand is one) for comparison with National Interest and other considerations. They would then be voted on to become fully fledged work items which would then be completed within a specified time span. The development of the definitive standard is a 'one-way ticket', and default on the timetable will result in the whole process having to begin again.

top of page

WG1 Meeting Report

The Second Meeting of the ISO/TC215/WG1 took place on Monday 12 April 1999 at the DIN (Deutches Institut für Normung) building in Berlin.

My flight had been delayed by bad weather in the US, and I arrived literally minutes before the meeting was due to begin. There were familiar faces from the earlier meetings from Japan, the US, the UK, Australia, and Canada, but new people from those countries as well, along with delegates from Norway, Sweden, and the Netherlands, and France. As before, Asian and African countries were completely unrepresented on this working group, a situation which gave rise to some subsequent comment. Brazil, which had been enthusiastically represented before, was absent from this meeting.

One significant presence was David Lloyd from the Chime institute in London (part of University College), who leads the 'support action' group which advocates the Good European (or Electronic) Health Record project. Stephen Kay from the UK was representing the CEN point of view, and for the US as well as Peter Waegemann (Delegation Head), there was Robert Mayes of the US Healthcare Funding Agency. In his introductory remarks, Peter Williams, the Australian convener, suggested that the next twelve months would be the 'hard part', and that the work so far, of work item definition, was comparatively easy.

After the introductions and adoption of the meeting agenda, the first matter discussed was the endorsement of the Scope Statement and Terms of Reference. These are to be found in my earlier reports, but were slightly modified and the new versions are to be found in Appendix 1 below.

Scope and Terms of Reference Statements

Generally, the 'Scope Statement' and 'Terms of Reference' were accepted without debate. Two matters were discussed in some detail. The scope statement said that unique identifiers would: '...enable the unique identification of the parties involved, the processes, services, products, time and location pertaining to all events in the healthcare domain.'

There was debate about the word 'unique' and whether that implied a unique identifier number, which many countries did not have. Members from the US and Japan wanted the word removed, but David Lloyd and others argued for its inclusion because of a practical need for it in records. It was retained because it was recognised that 'uniqueness' could be achieved by the combination of a number of features and would not rely on an 'identifier' per se. 'Outcomes' was a word that was suggested to be included as well as 'products'.

I raised the issue of 'Third World' participation in the proposed standard. This was felt to be an unfortunate term, so I changed it to 'poorly resourced'. I said that it had not been adequately addressed at the Sydney meeting, and that resorting to 'paper records' was not the solution. I pointed out that access to the 'web' was becoming universal, and that the important concession to poorly resourced participants was rather that the standard should be 'simple', not involve complex information technologies necessarily (although it would also need to cater for those). This could still be electronic. Initially this stance was argued to be included in the wording, but later Peter Williams included an addition to the statement.

The final version had the words 'should not be limited to electronic records or highly developed record environments' in recognition of the need for standards to be applicable in developing countries.

This third world advocacy was supported by some remarks made at the very end of the meeting by Robert Mayes of the US HCFA (see below).

Then we moved to the discussion moved to the 'work items' themselves. I will list them again here.

Proposed Work Items:

Against each is the person or persons who were meant to be developing the work item definition for the group, and Ian Nottage and I had done this for the matters of Ownership and Access guides to the Record. Some of the delegates who had not been present in Sydney were curious about where the list had come from, and Peter Williams said it was from a 'brainstorming' session. Only seven items were maintained to go through to the plenary session as 'defined work items', the others were deferred until the September meeting, which might mean they were dumped altogether. I will work through them and recall some of the discussion which went with each. The full wording of the official minutes of the meeting is available at the end of this report.

1. A General Conceptual Model for health information

A distinction was made in the discussion between Health Information, and a model for the Health Record. Peter White, who worked on this, was responsible for the Australian Data Model, a set of 'useful pots for putting things in' (see my earlier report) which has gained wide acceptance in the US as well as Australasia. In his work item definition, he says:

'Whilst the processes and systems that use health information vary between jurisdictions, the underlying information structure that the processes and systems exploit is relatively stable and common across jurisdictional boundaries.'
'Access to such a model would considerably reduce the cost of producing context or jurisdiction-specific models...'

He concludes that the establishment of such a model would transcend different modelling approaches.

Since the model was not stated in this work item definition, the wording of it, like so much of the material in the meeting, read like a pious hope. Nevertheless, a group of delegates from five countries was assembled by Peter Williams to work further on the wording of the work item definition. The inclusion of the American, CEN, Japanese and David Lloyd along with the Canadian Trevor Hodges in this group was a disparate mix and it will be interesting to see if a substantive statement comes out of it.

2. The Emergency Data Set

This work item made it through to the plenary session. In it, Peter Waegemann had said it: 'should cover the identification of the information that is necessary to document emergency medical care. It would "not instruct care givers how such information is collected or recorded", and "will not address issues of how emergency care is delivered".'

David Lloyd pointed out that in the very action of producing a guide for data elements to document the types of emergency medical information that should be included, there was inevitably some 'guidance' being offered. This point was somehow ignored. Later, in the discussion of Health Cards, the relevance to an Emergency Data Set was pointed out. It will be interesting to see what the document says!

3. Country Identifier Mechanism

This one also 'got through'. There already exist a number of mechanisms for identifying countries, one of them an ISO standard. There are also telecommunications standards for this. It was nevertheless felt that this work item needed to be included, and representatives from the usual five countries were needed to advance the matter. We were volunteered for this by Peter Williams, who promised the task would not be onerous. As it subsequently transpired, this could be an important role. To actually implement a universal unique identifier (or set of identifiers) would be the 'first cut' at a universal record, and the way it was done could be very influential in the formation of the 'substance' of the record.

4. Ownership and Access

This was the one we had worked on in New Zealand. I addressed the issue, and said that at the Sydney meeting it had generally been thought to be 'too hard'. I had felt that rather than simply state in pious fashion how it would be good if it were solved, I had tried to actually produce a model of the process, which involved attestation, security, as well as Ownership and Access rules. I outlined how Ownership might be decomposed into rights and obligations. I tried to indicate how a generic model of these could avoid specifying what these were around records for any particular user group, while specifying a shared framework which would permit their definition.

I brought up the third world question, and pointed out that inherited 'rights and obligations, privacy and access' properties of objects could apply to a simple free-text sheet or box, and that for most of the world's population such simple records might be the norm for some time to come.

The first response was from Robert Mayes who said the discussion sounded very similar to one he had heard recently about the music industry. Had I considered the matter of 'intellectual property' in relation to records? The arguments were similar. I had admitted I had not and did not have competence in that area. Later, Robert sent me the web address of the Indecs project which addresses this (see Ownership and Accesss Attachment). Peter Waegemann then said how dangerous this ground was to get into. The Norwegian contributor said we should stay well out of this whole area since it was too controversial and dangerous for an ISO standard. Stephen Kay said that I had just been raising the issues as far as he could see, but that I had also proposed an actual model, hadn't I? I agreed that I had, and that I had felt I needed to do that if I was to do more than simply make pious wishes. He said there was a real problem with including attestation in this. Attestation is a concept that the new CEN model is very strong on, and in which it differs from the different flavours of the GEHR model.

David Lloyd was supportive of the ideas I had expressed. In particular he said that the 'obligations' side of the 'rights and obligations' dyad was one he had not considered in depth. He could see that if a record was 'transmuted' by my global mechanism between cultures with different definitions of rights and access rules, there might be 'obligations' entailed by the recipient toward the definitions in the source record. Ken Toyoda said he simply did not understand my ideas, and that ownership of the record was important and needed to be addressed, but appeared not to connect in at all to what I was suggesting. However, later at the 'social', and also confirmed by an e-mail since the meeting, Horishi Takeda of the Japanese Delegation has expressed 'agreement' with the point of view we have developed, and also declared themselves most interested in the New Zealand privacy laws. He said he thinks Japan has a lot to learn from New Zealand in these matters, and has proposed we conduct a survey in both countries about privacy and ownership practices with Electronic Medical Records.

Peter Williams concluded that it could have been anticipated that this would be the most controversial of the work items, and that the consensus view appeared to be that it should be deferred. He suggested there should be a 'technical report' prepared of the issues in this area, perhaps so that the work item could be further defined perhaps for the next meeting in November.

However, later in the Plenary session he said in his summary that I had:

'...introduced this topic which led to discussion of a range of issues including its relationship to intellectual property matters and also to the activities of Working Group 4. There was support for the conceptual representation of rights, obligations, security and access. It was agreed that it may be appropriate to develop a technical report to progress this issue. It was further agreed that in the first instance an approach be made to Working Group 4 to consider the joint development of a discussion document for review at the London meeting of WG1 in September.'

By the next morning, it was back on the 'work item' list with New Zealand as the proposer.

5. International Eligibility in Reimbursement
This was seen to be related to the emergency data set. It was postponed until September.

6. Attestation
As no draft had been prepared prior to the meeting, there was no discussion on this item.

7. Patient Identification Certification
It was agreed to reconsider this item at the September WG1 meeting.

8. XML DTDs for Specific Document Types
Ken Toyoda noted that any standards in this area should take account of MML, the Japanese variant. It was agreed that a small group should meet with representatives of Working Group 2 to progress the matter.
[Note: in the discussions held subsequent to the meeting it has been proposed that Working Group 2 will take responsibility for this task and liaise with WG1.]

9. Health Information Inventory
Peter Waegemann and Ken Toyoda advised that following further consideration they had come to the conclusion that this was not a standards activity. Nevertheless this did get included, with the suggestion that the inventory could be classified according to the kind of 'meta data' assumptions it made.

10. Product Identification
Peter Williams introduced this topic. David Jones noted the current US/UK collaboration on this issue and that it may be appropriate to defer consideration of this proposal pending the outcome of that initiative. Ken Toyoda noted that Japan is also examining the potential use of EAN (2-dimensional bar codes). It was agreed to defer further consideration of this draft work item until the September meeting.

11. Authentication of Source of Consumer Information
This was generally felt to be more appropriately within the scope of Working Group 4.

12. Electronic Healthcare Record

No progress was made on a generic electronic healthcare record architecture, which was a great disappointment for the Europeans. It was forced on the meeting by a veto against the inclusion of any architectural considerations by the US delegation head. The implications of that veto have been variously represented as an anti-European stance on principle, a reflection of a genuine US scepticism about the architecture enterprise in general, or a 'delaying tactic' on the part of the US delegation, to postpone these developments until their own software industry had 'caught up'. This latter point of view was enthusiastically disseminated by European and Australasian software developers and impresarios. It would appear that 'as things stand', WG1 is denied any actual theory or model content, despite being the 'modelling' work group.

Peter Williams report was a positive as it was possible to be in the circumstances. The agreed statement read:

'Given the current state of development and volatility of some major regional developments (eg, CEN TC251, HL7 RIM) it was considered inappropriate to propose a new work item in this area at this time. However, the Working Group is strongly committed to establishing a pathway towards a common framework for the electronic healthcare record and health records generally. Given its fundamental importance WG1 recommends that TC215 encourage all parties involved in regional development work to undertake an active programme to educate users internationally on those developments.'

At the end of the meeting, Robert Mayes returned us to the third world issue. He said that he considered it really important to have third world awareness in the TC/215 process. Peter Williams reminded him that we had agreed to modify the terms of reference, at my suggestion. As the meeting broke up, he came up and said that we should show we could implement something. He was enthusiastic about the concept of a cellular phone network which could be an instant health communication infrastructure for a developing country. He said that such countries in some ways might have an advantage in the implementation of health information technology because they did not have a legacy ware infrastructure, and so one would be able to go straight to the most advanced concepts. He was, he said, going to have a word with Ms Hammer, the South African delegate, to suggest implementing it there.

I had the opportunity to talk to Lyn at the plenary, and she was enthusastic about the concept of instant free ISO accredited health records for the developing world. At the very end of the Plenary Session, Robert Mayes again raised the question of Third World participation. He suggested that one of our meeting should actually be in a Third World Country. He mentioned that modern communication technology might allow health sectors in such countries to easily implement advanced concepts. Lyn Hamer replied that in principle South Africa would be glad to host a conference, but she was sorry she could not give any committments at that time. She mentioned that the southern African group of nations, RSA, Mozambique, Angola, Botswana, Lesotho had an alliance for such matters, and might very well be a sujitable first 'target group' for such an implementation of a global plan for health. (I have paraphrased the argument here).

At the plenary session, Peter Williams presented his report.(insert link to WG1 report) He produced the list of Scope Statement and Terms of Reference. In the discussion, the 'catch all' clause in the original scope statement that would make WG1 the repository for all matters that that not found a home was challenged by the UK delegation, and that term was deleted. He alluded positively to the point of view on ownership that Ian and I had developed. We gathered that it should form the subject of a 'technical report' rather than a work item at this stage. There is a requirement that work item definitions should be in the end of June, and there was a technical problem therefore getting such an definition for ownership and access in for this round (see above on work structure for ISOTC215).

Later, at the 'social' for the meeting, Peter Williams mentioned this difficulty and said it might be necessary to have the next WG1 meeting by the end of August so that the work item definition which would be discussed then could be presented the requisite two months before the next formal plenary session (November in Japan). I pointed out that I would not be able to attend since the date of a September visit to the UK was already set for me by family considerations.

When the resolutions were presented on the following day, New Zealand was voted in to the proposer for a reinstated Ownership and Access work item, the outcome of which was to be a technical report. The Working Group One meeting would stay in London in September 1999 as planned previously. This is a significant role for New Zealand, and it was agreed by simple majority with no contrary votes, and just one abstention, France. Apparently the French abstained because they considered the topic to be part of Security rather than modelling.

I later questioned Peter Williams seeking clarification of New Zealand's role. Alvarez from Canada joined our discussion, and when I said that I was trying to find out what I should be doing, he asked why I should be so different. He clearly implied that 'finding out what we should be doing' was a predicament for many of us!

Mike Mair

top of page

ISO/TC215 Working Group 2 Report (Messaging Standards)

For me the meeting started inauspiciously. I had not been sent the agenda and consequently turned up late, which meant I had to sit at the back. A missing document theme ran through the entire four days. Just when you thought you had tracked down all the relevant publications someone would refer to another document that you didn't have. It wasn't just me - ISO have recently changed the names of some of the document deliverables and subtly altered the process, without telling anyone on the Technical Committee.

In Working Group 2 there were strong contingents from the UK and the US. Although I expected tension between the European and US camps, there was a lot of co-operation. There was especially a desire to not go over old ground - for example, CEN, the European standards body, have been working on health information standards for years and have already made plenty of mistakes and pursued a number of blind alleys. This meant that a delegate who wasn't up with the play in both HL7 and CEN was faced with a steep learning experience.

To assist non-Europeans with understanding the CEN process, David Markham gave a short presentation on the story so far in CEN/TC251. The structure of CEN/TC251 is very similar to the structure of ISO/TC215. This is probably no accident.

WG2 divided into Breakout Groups to decide on the work items to be submitted to the Technical Committee for approval.

Breakout Group 1 looked at the Point of Care medical device communications. Five work item proposals had been circulated prior to the meeting and these were largely unchanged. This is a field that benefits from some prior work by CEN and IEEE. The processing of draft standards from these bodies into an ISO standard should be quite straightforward.

Breakout Group 2 looked at the message system architecture. It started with three proposed work items. These were to inventory messaging standards, to model communication flows and, more nebulously, to describe the essential characteristics of message flows. These characteristics include privacy protection, authentication and data integrity - the things which needs to be in place prior to a message being sent.

Back at the Working Group there was little consensus around the first two items. There was a view that these endeavours would add little to the sum of human knowledge. The first item, if completed, would require maintenance, and this is not an ISO function. The second item is potentially enormous in its scope, and has kept HL7 and CEN/TC251 busy for some time. There was also some concern that item three would encroach on work being done in Working Group 4 (Security). In the end none of these work items was submitted to the Technical Committee.

Breakout Group 3 looked at the creation of an extensible markup language (XML) message development framework. This is one area where CEN and HL7 have been working closely - CEN have adopted the HL7 version 3 Message Development Framework (MDF). A delegate from the UK demonstrated some software that would create an XML document type definition (DTD) from an Access representation of a hierarchical message description. XML is likely to be the technology implementation of choice for information exchange. The Working Group derived two work items from the work of BOG3. These items were to standardise a method for developing specifications or standards for healthcare information exchange and to recommend ways in which hierarchical message descriptions can be mapped into XML.

On the Tuesday the working group had to dispose of the national submissions. These were dealt with quickly, especially as even the protagonists of the submissions thought that we had moved on from there. The submissions represented old or not-very-international environments. A Russian delegate spoke of the need to have a non-US, non-EU standard. There was a distinct feeling that the past was irrelevant, except that we should be keen to learn from the mistakes of the past. There was more 'we tried it and it didn't work' rather than 'we did it this way, so should you'.

Finally we looked at the work that had been done by the other working groups. There was frequent reference to 'turf wars' - where one working group tried to do work in an area covered by another. WG1 was frequently cited as the group most likely to have overlap with others. During the Monday there were some in WG2 who tried to avoid all 'modelling' as this was the domain of WG1. When it became clear that WG1 saw themselves as the coordinators of other people's models it got a bit confusing. If all WG1 do is liaise with other groups, what is the point of it? These issues will doubtless crop up throughout the future meetings.

WG2 decided its future meeting timetable. It was:

22-23 July 1999 - Indiana
15-19 November 1999 (with TC215) Japan (this is the first meeting at which work items can be formally approved)
7-8 February 2000 - London
July 2000 (with TC215) - Sweden

Ian Nottage

top of page

ISO/TC215 Working Group 3 Report (Health Concept Representation)

This working group is concerned with term sets and nomenclatures. An example of a nomenclature is Read Codes. ICD-10 is an example of a classification. However, WG3 is not concerned with the contents of the detailed terminology contents. For more details of the scope please refer to document ISO/TC215/WG3/N011.

One interesting piece of information that emerged around the time of the Berlin meeting was that the NHS Executive will discontinue development of the Read Codes and are seeking to incorporate the work done by the NHS Centre for Coding and Classification (CCC) with SNOMED, a US term set. It would seem that the efforts of WG3 are ancillary to events in the wider world. The expense of maintaining a term set will lead to a natural decline in the numbers of those term sets. As a term set becomes more international it will become harder to justify a national set. Perhaps the role of WG3 will be to act as an arbitrator on the creation of international term super-sets.

Later, at the 'social' I had the opportunity to discuss the role of Snomed further with one of its representatives. I mentioned how employment of a proprietary product in the Standard whose use attracts a charge might exclude third world access. I pointed out that 80 percent of the world might thereby be excluded. His response, that this would not be 80 percent of the delivered healthcare, is a classic. We return to this question later.

top of page

ISO TC/215 WG4 Report (Security)

The report to the Berlin meeting from WG4 is document ISO/TC215/WG4/N25. The scope for WG4 is "defining standards for technical measures to protect and enhance the confidentiality, availability and integrity of health information, and also accountability for users, as well as guidelines for security management in healthcare". WG4 will be drawing on existing work, particularly from ISO/IEC and the Internet Engineering Task Force (IETF). It has proposed a work item to produce a technical report on pubic key certification infrastructure (PKI). There is some debate in New Zealand around the type of PKI that New Zealand requires - a single certification authority or a self-signed paradigm. International opinions may well usefully inform this debate.

From the floor, there was a brisk discussion of the relationship between accountability, auditability and 'non-repudiation'. Attestation was not discussed, but is obviously involved. It was clear from the discussion that despite the Europeans being secure in their definitions, and with their fully worked out CEN model, these are still active questions. At the end of the meeting, I approached Gunnar Klein, the Swedish delegate who heads the security group in CEN and ISO/TC215, and gave him my work item definition documents with the 'square' portrayal of rights, obligations, privacy and access. He found for me the security and distribution rules sections of the latest CEN251 document which I have referenced.

Mike Mair

top of page

ISO/TC215 Ad-hoc Working Group on Health Cards

Part of the ad-hoc group's remit was to determine if it should become a normal working group. This turned out to be more controversial than you would think. There is no international agreement on how useful health cards are. The room quickly divided - the Europeans were keen on health cards and the US was not. The US position was that, technically, the information held was redundant. Networking implementations would make physical healthcards redundant. They were concerned that there was a dilution of effort - the issues in the health cards forum were a microcosm of the issues in the rest of health informatics.

The pro-cards position was that 1) there were particular problems in health cards, mostly linked to the technology (or its limitations); and 2) as the cards were in use in several EU countries it was only right that there should be an ISO standard. The New Zealand position, unexpressed at the meeting, was that if the health cards WG wanted to meet then that was fine by us. We discussed it and concluded that the integration of a 'summary' of the arguments and processes in health IT was required for health cards, combined with the review of specific and changing technologies. We felt that these together constituted sufficient reason for separating out this field into a separate working group.

On a vote the TC voted 6-4 for forming the health cards working group. New Zealand voted for.

top of page

ISO/TC215 Ad-hoc Working Group on Biomedical Imaging

This group was able to fairly quickly decide that it wanted Dicom to become an official international standard. Dicom agreed, through its representative. Later on discussion with him I learned more about the Dicom standard, which is mainly about information surrounding imaging, the 'what, where, who, how' of an image rather than the pixels. However, Dicom is also doing work on image standards required for different specialties. Ophthalmologists should note that we share our imaging specification requirements with endoscopy.

top of page

The New Zealand Proposition for Ownership and Access Rights

It was discussed with Nelson Proctor from Standards New Zealand, and members of the Health Information Standards Committee at a meeting in Wellington on 12 May 1999. Nick Manson suggested we put in an introduction stating that the purpose of the paper was to explore the ethical dimension of the electronic healthcare record. He suggested the wording that is in italics at the beginning of the 'attachment'. He also suggested that the word 'medical' be replaced by 'clinical' in the penultimate paragraph of the piece. Again, I was happy to change this, since if medicine did not exist it would have to be reinvented at the very next clinic. We also discussed the implications of a suggested 'take over' of the disease coding system by a proprietary product. Nick Manson suggested that no proprietary product should form a necessary part of the Standard. I agreed, and mentioned that it had been on the tip of my tongue to present a Resolution to that effect at the next plenary session in Japan, for voting on by the delgates. The group thought it might well be appropriate for New Zealand to do this at the next plenary session.

Now we await comments, first from other WG1 members, and if they agree, by the vote of the member nations ('P'class). If that vote is favourable, we would from November on be engaged in some serious research in an attempt to actually build first the technical report, and then the global model.

top of page

Conclusions

Ian and I finally met up on the evening after the WG1 session. Ian was late for his meeting because of misinformation and my own eventful arrival was only five minutes before the meeting was due to begin, direct from the airport. I thought that the ownership issue had just been 'bounced', and we had just had the American veto on 'Architecture'. Our mood was rather sour about the prosects for benefit from this meeting. Over a few beers, we wrote off the ISO process, and were going to recommend as such in our report.

However, the mood of the Plenary Session was different, and we ended up feeling very positive about the process. Representatives of most countries that I talked to (US, Canada, Denmark, South Africa, Japan) see the ISO process as crucial to the standards effort in their own countries. However, there is a need in all countries for standards now. It is now that the wave is breaking for the implementation of electronic records and data exchange in medicine.

Information Technology could give the solutions we are all looking for in accrediting, tracking, and paying for medical practice, as well as greatly facilitating that practice itself, and assuring clinical governance. We must find a better way of dealing with each other and our clients. Too much of our effort is directed to keeping the political ball afloat, on a field with changing goal posts.

For New Zealand, we have secured at least for the present the 'proposer' role for the Working Group One work item of 'Ownership and Access' to the record. Our participation at this level not only ensures that we are 'current' in this argument, but give us the opportunity to actually help mould the developing standard. Health Information Technology in New Zealand is internationally acknowledged to be alert and creative, and New Zealand has a privileged position almost because of its small scale, non-aligned status and history of espousing environmentally friendly causes. On some sensitive matters, such as Ownership and Access, New Zealand can walk where others fear to tread.

We should continue to support the ISO process because our contribution is valued and necessary to the process, because it keeps the evolution of our own IT contemporary and maybe helps to promote market viability of our industry. Also, like many other nations, because we need a new approach to our own health sector urgently, and this may be the best vehicle to achieve it.

top of page

Where to from now?

The timetable for this process is brisk indeed. The new work item definition had to be posted to Working Group One members by this evening (12 May 1999), so that it can be commented on by WG1 members by the end of this month. Then it will be circulated to the entire committee for a vote. If we defaulted on these deadlines, we could still present it as a work item for the November meeting ourselves, which could be higher profile for New Zealand, but not so certain of success. We now wait to see if our definition of 'ownership and access' is considered good enough for us to be given the task of working with WG4 to make an actual proposal for consideration in London in September, and then in Japan in November. This will be decided by vote of 'P' members. We must also at this stage comment on the Canadian proposal for the Country Identifier.

As so many aspects of the world's business converge upon the web and information technology, we should play our part where we can, and here is a place where we can make a difference.

Mike Mair, Ian Nottage, May 1999

top of page

Future Meeting Agenda

WG2 Meetings
2-23 July 1999 - Indiana
15-19th November 1999 (with TC215) Japan (this is the first meeting at which Work Items can be formally approved)
7-8 February 2000 - London
July 2000 (with TC215) - Sweden
WG1 Meetings
September 16-17 1999 - London
15-19th November 1999 (with TC215) Japan
February 1999 - Toronto
July 2000 (with TC215) - Sweden