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Trusting the other Party

Publication date: Nov 01, 2002

The other night I watched a debate between the two main candidates for chancellor of the German Bundesrepublik. You must be familiar with that type of debate: two men in suits standing behind desks in exact equal height making brief statements about issues that are likely to influence the voting behaviour of the electorate. There actually isn't much of a debate, it's a series of intertwined monologues aimed at the viewing audience. The situation reminded me of a curious project I was recently involved in.

One of the NHS trusts in the northern part of England had decided to build an entirely new hospital; and to equip the new hospital with all kinds of new diagnostic modalities and software applications. The hospital dated from the 1880s and most of the IT solutions from the early 1980s; the new investments made available by Tony Blair's government were clearly well spent here. Before the start of the project the various vendors involved met to discuss the overall integration strategy.
The hospital in question hadn't created an overall integration strategy; it was left up to the various application vendors to maximize the reuse of data by exchanging as much data as possible. Most application vendors are keen to send data to other systems and considerably less so to receive data. They can't guarantee the integrity of the data that has been received; the data may corrupt whatever data was entered into their own application. Mostly there's a balancing act going on between the need for certain information on one hand, and the risks in accepting data sent by other systems on the other hand.
Standing at the whiteboard I drew a series of rectangles representing the various applications. Each vendor made a brief introduction of the application and its integration requirements. During the series of introductions I added arrows indicating the various flows of data as supported by the applications. Slowly a very strange picture emerged: they all wanted to receive data, but none of them were able to send data.
They were willing to trust the data as sent by other systems, but weren't willing to accept responsibility for having to send reliable data to others. Obviously this problem isn't a technical one at all. The NHS trust should have properly analysed their business processes to make sure that the set of newly acquired applications would cover those processes. The fact that none of the vendors was even willing to be a provider of basic patient demographics information shows that such an analysis had not taken place.

It just goes to show that having a listening and a speaking party isn't enough to achieve true communication or integration. Each party has to take responsibility to transmit reliable information, and to trust the other party to send reliable information as well. Just like in politics this is unlikely to happen in the field of systems integration. Trust me.


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Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
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Rene's Column (English) Rene is the Tutor-in-chief of Ringholm.