Interoperability advisory to a US federal health programme

The programme

A US federal health programme responsible for delivering care to a very large enrolled population of veterans and their dependants was mid-flight in a multi-year interoperability initiative. The programme needed independent architectural advice on standards trajectory, vendor engagement, and the governance of cross-agency data-sharing.

The role

Ron served as an independent expert advisor to the programme’s architecture leadership. The scope was deliberately narrow:

• assessment of the standards trajectory (HL7 v2, CDA, IHE profiles, emerging FHIR) against operational and cross-agency requirements;
• advice on the balance between in-house architecture capability and prime-integrator dependence;
• governance recommendations for the cross-agency data-sharing council.

The craft

Two things worth naming:

1. A candid trajectory paper, not a re-plan. The deliverable was a short paper, under thirty pages, recommending a rebalancing of the standards trajectory toward FHIR-based patterns while preserving in-flight investments in CDA and IHE. It was written to be read by an executive, defended in an oversight forum, and referenced in subsequent procurements. It was not a wholesale re-plan; the existing plan was mostly sound.
2. Governance as the load-bearing recommendation. The most consequential recommendation was not technical. It was about the decision rights of the cross-agency data-sharing council: who chaired it, who could bring items, how disputes were resolved. That recommendation was accepted and implemented.

The outcome

The recommendations were adopted by programme leadership. The trajectory paper became one of the reference documents cited in subsequent programme decisions and procurements.

What it teaches

The engagement is a case study in the value of a short, sharply argued independent paper at the right moment in a large programme. Sometimes the deliverable is not a re-plan; it is a page count small enough that an executive will actually read it.