On April 21, 1864, William Sellers launched the first standardization battle of the industrial era. He addressed a room full of engineers and machinists in the lecture hall of the Franklin Institute in Philadelphia to gather support for standardizing thread counts on screws.
At the time, engineers and machinists were producing steam engines, boats and trains that were ushering in a new era of commerce. Back then, everyone created their own custom bolts and screws. If a train made in Philadelphia broke down in Wichita, it couldn’t be repaired unless it carried spare parts.
Mr. Seller’s idea of standardizing screws generated much hue and cry from the members of the Franklin Institute. Each member believed their approach was superior and there was a lot of debate over which one would become the standard.
Fast-forward 150 years and walk down the bolt and screw aisle at any Home Depot, where you will see an enormous array of different screws, all designed to meet different needs. You can buy screws with thread counts that are better for working with wood, others for metal. You can choose from different lengths and diameters, different types of materials and heads.
So what happened? Did William Sellers’ dream of standardization fail? No, quite the contrary. Within all of those different categories there are standards governing each attribute (head type, thread count, length, etc.). His goal was achieved. A car made in Mexico can be repaired anywhere in Canada, or indeed anywhere in the world.
The theme of this year's World Standards Day is "Standards build trust". People often tell me the opposite, that they’ve lost faith in health information standards. Their reasons tend to fall into one of two categories: 1) there are too many standards, and thus our industry doesn’t have a standard; or 2) they expected a particular standard to solve all their problems and it didn’t.
The reality is, of course, just like the myriad of screw options at Home Depot, there are different Health information standards to meet different needs. Complicating matters further is that standards don’t work in isolation. Messaging and document standards work in collaboration with terminology standards. Trying to get all health information systems in Canada, let alone the world, to use a single standard is as unrealistic as saying that all trains must be constructed with a single type of screw.
We can't expect a single health information standard to meet all our needs. One person will love FHIR for its flexibility, another will hate it for the number of ways it can be implemented. The point is that people need to understand the differences between standards and set their expectations appropriately. If you use a machine screw to secure a book shelf to your drywall, don’t blame the screw when the shelf falls.
Do standards build trust? Yes, but only if people have the right expectations about what those standards do.
Editors note. The William Sellers picture is from Wikipedia and the material in the opening paragraphs was sourced from a great article written in Wired Magazine: https://www.wired.com/2002/01/standards-2