Overcoming the Learning Curve

Introduction

Approaching a new subject area when implementing a complex project can be quite a daunting prospect in any situation, but what if that subject area is an emerging standard such as HL7 V3?

Over the years since its inception, HL7 V3 has developed an aura of mystery and impenetrability which is little helped by the fact that a large proportion of HL7 V3 knowledge and expertise is held in the heads of a relatively small number of specialists.

The information on this page was collated by a newcomer to HL7 for a presentation given at the IHIC in Cologne, August 2006. (The presentation is available in PDF format here.) It addresses some of the problems caused by the lack of educational accessibility to the standard, as seen through the eyes of someone who has recently faced the HL7 V3 learning curve (or vertical ascent :-) and emerged virtually unharmed on the other side...

Investigation

As part of the investigation for the aforementioned presentation, a number of HL7 newcomers (as well as veterans) within the UK NHS CFH (Connecting for Health) project were interviewed about their first exposure to HL7. The aim of the interview questions was to establish the following (amongst other things):

• When and how were they first introduced to HL7?
• Were they thrown in at the deep end, or were they given training?
• What kind of resources (e.g. literature) were available, and how useful were they in the learning process?
• What were their first impressions of HL7 V3 and the HL7 community?
• How useful was peer knowledge transfer (e.g. learning from others) in gaining an understanding of the standard?
• In retrospect, what alternative resources might have been useful in easing the transition from complete newbie to establishing relative comfort with key concepts?

First Impressions

Those interviewed for this research indicated that on the whole, very high-level information about HL7 was fairly easy to locate (e.g. what HL7 is for, why it is needed, what it is intended to achieve). However, it was far more of a challenge to find coherent mid-level information on the internet. Two of the CFH interviewees (and the presentation author) had to look into HL7 in preparation for their CFH job interview, and all found it more difficult to establish what they might be doing on a day-to-day basis. The more detailed information available online, they said, lacked context. They did all agree though, that perhaps some measure of mystery and confusion was only to be expected at this early stage.

Resources

Literature

Those interviewed for this study agreed that although literature is unlikely ever to be as helpful as hands-on experience and learning from peers, it is very helpful in terms of topic familiarisation and as an aid for learning the basics. Many interviewees cited 'Understanding Version 3: A Primer' as being a helpful introductory resource. Those who started working with HL7 before the primer was available agreed that they would have benefited a great deal from such a resource. The primer is a good introduction to the basics, but it doesn't contain enough detail to be very helpful in terms of actual message design and implementation. Such a level of detail is out of scope for that document, but a more practical follow-on artefact would be very useful for message developers. The HL7 ballot was also cited as an important resource, although most did not find it terribly useful in the early stages of learning; it is not a 'beginner's guide' and is not intended to be such. However, as newcomers did start to use it more frequently, they did note that the lack of a search function made it quite hard to navigate if you didn't already know what you were looking for. Having access to the members-only content of the .org and UK affiliate websites also provided a lot more literature to read through (presentations, papers, etc) but a lack of a coherent structure for these artefacts - the fact that they are just presented 'as is' without context means that many of them aren't terribly useful to newcomers.

Hands-on Experience

Hands-on experience was agreed by all study participants to be the most effective way to learn quickly and to retain the knowledge. Having tasks to complete from an early stage, and having people around (or at least easily contactable) who know V3 and can provide advice and guidance to newcomers regarding design decisions, tooling 'features', standards compliance and so forth is more valuable than mountains of literature. It is, however, much harder to come by - thereby emphasising the need for the mountains of literature that we do have to be reviewed and enhanced for future learners.

Further notes

Kindly compiled by René Spronk:

HL7 v3 is generally seen as having a steep learning curve.

The following is some advice from those that have implemented v3 on how to overcome the learning curve:

• Make sure to invest both time and resources in the initial phase. The cost to entry is significant, however once you know the basics it is relatively easy to extend. The HL7 object model introduces complexity for simple messages on the one hand, but provides a unified model for complex clinical messages.
• Use the introductory presentations on the HL7.org website (although these are fragmented at the moment, have inconsistent design/presentation, are confusing when read "out of context", and some are quite old)
• Read Understanding Version 3 (the primer) - Go to the HL7 Bookstore
• Use a (Framework-) Implementation Guide (one single domain within the implementation guide) as a starter document for those new to v3, and not a Normative/Development Edition. The implementation guide describes a relatively small and selfcontained subset of the standard and is implementation oriented, which makes it easier on the reader. The Normative/Development Editions are useful at a later stage.
• Have one or more HL7 v3 experts on your team. They play the role of catalyst and keep the rest of the team on track through peer review and collaborative design.
• Attend HL7 training outside of normal peer-based learning
• Use the contents of the HL7 Wiki, especially for areas such as Lore. It presents a consensus of ideas in plain English (as opposed to standards-speak).
• Familiarity with healthcare workflows, as well as messaging in general is a plus.
• HL7 is an open community, which allows for Peer Knowledge Transfer, between countries/organizations. Avoid re-inventing the wheel.