Voting on ballots

For voting on ballots (the first issue up for discussion) this means that all persons (representing either themselves or an organizational member), regardless of whether they're a member of HL7 Inc. or an HL7 Affiliate, have the right to vote when it comes to balloting HL7's standards.

• Currently the maximum number of votes for an affiliates is 8 (representing all members of that affiliate) - regardless of the size of its membership. This means that organizational members of HL7 Inc. have more votes than entire countries. This is percieved as being an unbalanced way of allocating votes.

Expressed as a HL7 v3 model

Note: HL7 (the Organization) encompasses both HL7 Inc. as well as its affiliates.

Starting with the HL7Member entry-point: the Role HL7 Member is played by either an Organization or a Person entity.

• If it's a Person entity, then that Person entity plays the role of BallotVoter (qualified by HL7 to vote in ballots).
• If it's an Organization, then the Organization has X Agents (which in turn are Person entities) to vote on its behalf. Each of those playing Persons plays the role of BallotVoter (qualified by HL7 to vote in ballots). ["An organization has multiple votes"]

How many "Voting Agents" an organization is allowed to have depends on the type of organizational membership (with HL7 Inc., or of an Affiliate). It is still up to the Affiliates to decide how they wish to organize their organizational membership types - all this diagram is saying that no organizational membership type (in whatever realm) shall be allowed to have more than 12 votes (or whatever the maximum currently is for HL7 Inc. Benefactors). To me a Benefactor is simply one type of organizational membership.

The OPOV constraint means that even if multiple organizations assign Person A to be their voting agent, Person A will still only have exactly one vote. All voting is based on persons (as entities), not on roles. (Note that the current voting mechanism is based on Roles.)

Q&A

• Question: In this model each organizational vote must be assigned to a specific, named individual. Why is this important?
• Answer (Rene): This something this group could discuss. To me, true equality means that we talk about individuals. Organizations don't have votes - I think the HL7 Bylaws nor the GOM talk about 'Organizational votes". It's all about individuals - who may, or may not, be voting in cohort with, or on behalf of, other individuals within that organization. An organizational membership means one has the right to designate a list of individual voters.
  • Let's assume we allow organizations not to name individuals, but we'll have voters called 'Siemens #1' up to 'Siemens #12'. That means all organizations (even if they -theoretically- only have one single knowledgable expert) will be able to exercise all of their votes. [some already do this by just naming 12 individuals, some of which may have no clue about HL7].
  • Naming individuals is also an ANSI requirement as far I'm aware - but I could be wrong.
  • Naming individuals is also the basis for OPOV - one person, one vote. Not to do OPOV would mean that one person may have 10, 20 or 50 votes. And that's not what we want - it's certainly what I'd like to see.

• Question: defining what an HL7 member is without discussing how one becomes a member seems pointless
• Answer (Rene): to me, it is up to each HL7 organization (HL7 Inc. or an Affiliate) to decide a) what membership categories suit their particular context, b) whom to accept as an individual/organizational member. My reasons are that it will be near to impossible to create a global process for determining who may become what type of member - we'd loose the ability to create context specific rules to deal with whatever the local economic or political landscape requires.

• Question: wouldn't members choose to become a member 9and thus acquire votes) by becoming a member of the cheapest HL7 country organization?
• Answer: No. It is true that some countries charge much higher fees than others. Now why is that? All goods have value as precieved in a particular setting. If HL7 is fairly unknown, the price will be low. If HL7 is mandated by government and everybody has to use it, you can afford to increase the prices. If healthcare spending (as a % of GDP) is 50% higher in one country than in another (compare 15% of US GDP versus 10% in most European countries) that is yet again another factor. If we were to increase membership fees in the Netherlands, most hospitals would cancel their membership because the current fee is just below a certain level which needs an additional complicated approval process. There are too many highly unpredictable local factors.
  • Why do people become a member of a country HL7 organization? Because it provides them with advantages a) in their own language, b) access to localized/translated country specific documentation/implementation guides, c) access to country level meetings. [This is certainly the reason why I'm a member if multiple affiliates - it's the only way to keep abreast of what's being created, developed, etc. in a particular country. For the same reason I'm not -and won't ever be- a member of HL7 US. I have no business interest in the US].
  • It is therefore highly unlikely, even if it's somewhat cheaper, that the US DoD would become a member of HL7 Australia instead of HL7 US. Siemens would be cheaper of if they just were a member of HL7 Germany (which they are), and yet they're also a member in HL7 US. And HL7 UK. And many other affiliates. That again shows that the country HL7 organizations have a value proposition that's different from that of the current HL7 Inc.
  • To me a way of lowering the risk (if it really exists - which I doubt) of organizations moving their membership to the cheapest country would be along the following lines: (using the terms of the World bank, see http://en.wikipedia.org/wiki/High_income_country):
    • The HL7 organization of country X, if it is categorized by the World Bank to be in a lower or equal income class than country Y of (the HQ of the organization of) a membership applicant, shall not accept the membership request, unless A. the membership applicant has physical offices in country X, or B. the membership applicant already is a member of the HL7 country Y organization, or C. there is no HL7 country organization in country Y.
  • These are relatively simple rules without attempting to overly regulate membership fees. This would allow Uganda to ask for an annual $5 membership fee, without there being any risk that members located elsewhere (e.g., in the US) would move their membership to Uganda.
  • Paying the "same value" for a 'vote' (not in numbers/dollars, but expressed in perceived value for money) is the thing to go for. But I can't think of a way to standardize it in monetary terms: we'd need a PPP (http://en.wikipedia.org/wiki/Purchasing_power_parity) based on a basket of goods consisting of things like {healthcare expenditure, GDP, use of IT in healthcare, political stability, etc.}. We simply don't have the numbers to make any sensible statement about it.