Discussions of the ONC Policy Committee and Standards Committee of recent have included a variety of references to metaphors in the hopes of “connecting the dots” of many different moving parts related to EHRs and HIT Infrastructure. This is particularly interesting to me, as I grew up with consistent use of metaphors—and even endured the good-natured ribbing from colleagues at a hospital many years ago. It seemed that I regularly used metaphors (a figure of speech used to represent something else) and idioms (an expression whose meaning is not predictable from the usual meanings of its constituent elements.) Being that I am usually attracted to those with a sense of humor (this is a recurring theme), my birthday card one year was a personal “summary” of all the metaphors and idioms my colleagues could recall. It was priceless:
“We do not want to be “behind the 8-ball” (in trouble) being that collaboration within our group is much like “herding cats” (have you ever tried this?) so are writing to wish you…”….you get the idea!
Such examples are quite helpful to me as I try to understand all of the pieces of health information technology and the necessary infrastructure for success. Being from the south, I had just chalked it up to one more unique characteristic of southern heritage. Apparently, this is not so. I am so glad. ONC staff and committees consistently utilize metaphors to understand the relationship. I hope the metaphors keep coming, as it allows us to understand the critical analogies we need to draw. One of the most moving was a presentation by Farzad Mostashari, Deputy National Coordinator for Programs and Policy at ONC, who while building the case for health care standards and vocabulary harmonization, showed a single electrical box (such as the kind behind your light switch). He then went on to show that a variety of different results can be built off of the electrical junction box, but that if we did not have standards for the many components necessary to provide electricity, we would not have widespread electrical connectivity throughout the US. I personally have a great appreciation for our sea of metaphors and hope they continue—so that widespread appreciation for EHR and HIT adoption will continue to evolve.