Monday, October 16, 2017

AMA Integrated Health Model Initiative - A 15th Standard? Should we be very afraid?

Short version: Do we need yet another Data Standard Framework? After CPT, can the AMA be trusted not to monopolize and monetize? Who is pulling the strings behind the scenes?

Long Version.

Perhaps I am too much of a cynic, and hardly a day goes by without an announcement of some new "initiative", but ...

Today the AMA announced that they would Unleash a New Era of Patient Care (no hyperbole there) in the form of the Integrated Health Model Initiative (IHMI) with the assertion that a "a common data model ... is missing in health care".

Oh right, I guess we don't have enough standards already. Cue obligatory XKCD cartoon.

Indeed one might wonder if the AMA should be in the standards business in the first place.

And do we trust them to make this an open standard, free to access and free to use?

The AMA's own announcement makes no mention of license or fees or the lack thereof, as far as I could tell.

This cheery Forbes article by Bruce Japsen, interviewing AMA CEO James Madara, asserts that "there are no licensing fees for participants or potential users of what is eventually created", which sounds promising, though it does not necessarily translate to unequivocally open, and hints of hedges.

But if one actually goes to the AMA's IHMI site and then attempts to "join", one can't get in without accepting a burdensome agreement, which does not specify what the IHM's licensing terms actually are, but does explicitly warn "some features may require payment for subscription services associated with or in support of the use of IHM". It is not clear whether this applies to just the web site itself, or the IHM, and whether those features will be required for actual use of IHM.

Since I am not willing to agree to terms without know what they actually are, I declined, and I guess I will never know what IHM actually is, or whether I could have usefully contributed.

Given AMA's track record as a selfless, sharing entity (not; see the CPT copyright misuse lawsuit, this appeal, and commentary), can they ever be trusted? Are we really to believe this a new kindler gentler AMA?

A conspiracy theorist might suggest the AMA is seeking to impose yet another tax on every healthcare transaction, this time every electronic one.

Or that there is some disillusioned major player with their own plan for world data model domination who isn't getting satisfaction from HL7, FHIR, ONC, et al, and is seeking a new umbrella organization to foist its own approach on everyone else.

One might wonder who is pulling the strings. With IBM Watson, Cerner and Intermountain Healthcare involved, according to Forbes, is this just an end run around Epic?

Personally, I would not draw such cynical conclusions in the absence of further information, but oops, I can't get to any because of that click through agreement.

Here's hoping their motives are genuine and their efforts are not duplicative, divisive or anti-competitive.

But I can't help wonder if we should be afraid, be very afraid.


1 comment:

Grahame Grieve said...

Well, given AMA's consistent past practice in regard to openness and collaboration, what could the actually say to give anyone any assurance? For sure what they are saying is completely consistent with their existing/past approach. And also, once again, we have a comprehensive modeling effort that is purely based on a single jurisdiction... it seems some people will never learn