Touring Boston

Now that Spring has arrived, many folks in the country are planning their vacations. I've had numerous requests about the best places to see in Boston. Here's my top 10 list1. Boston Museum of Fine Arts - check out John White Alexander's "Isabella and the Pot of Basil" (the photo above) and explore the Japanese Temple Room2. Isabella Stewart Gardner Museum - check out John Singer Sargent's "El Jaleo" in the entryway. Stop for lunch at the Cafe.3. The Institute for Contemporary Art - check out the Shepard Fairey exhibit4. The New England Aquarium - check out the jellyfish 5. The Museum of Science - check out the Electrical wing6. ...

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Rock-O, the Peanut Sniffing Dog

The Obama family choose a Portuguese Water Dog for a pet. The Mers' family has one for a very different reason.Hats off to Sherry- one creative mom! She noticed dogs sniffing luggage at an airport customs counter. They were searching for fruits and vegetables being brought into the country illegally. Then, light bulb moment...why not use dogs as a service animal to sniff out allergens for severely allergic children like her daughter Riley?It turns out that this idea has been floating around for several years. In 2005, a Jacksonville FL teen hoped her peanut sniffing dog would enable her attend school. The price tag is high- $12,000-$15,000 for a dog. Several communities have begun fund raising efforts to help severely allergic children in their town afford a dog.For more information,...

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NCVHS Testimony about Meaningful Use

Yesterday, I attended the NCVHS public hearing about meaningful use. Here's the agenda and my presentation.I've described the importance of meaningful use in prior blog posts.Much depends on the definition of meaningful use, including the characteristics of the EHRs which will qualify for stimulus dollars, the kind of interoperability we'll implement regionally/nationally, and the policies that will be required to support health information exchange.My specific testimony included an overview of the interoperability needed for quality.I highlighted the work of the NQF Health Information Technology Expert Panel (HITEP) which selected 84 metrics supported by 35 data types as an initial minimum dataset for quality measurement in 13 care processes. HITEP II will meet next week to further...

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Point to Point Messaging and Persistent Document Exchange

In a recent letter to the HITSP panel describing the interoperability needed for meaningful use, I discussed point to point messaging and persistent document exchange. Here are a few additional details about these approaches.Point to point does not imply that one EHR is communicating with one recipient via a specialized interface for that interaction. Requiring a custom interface for every connection between two stakeholders would not be scalable. Point to point simply implies that a transient message is sent from a data source such as a cloud computing EHR hosting center to a data recipient such as an e-prescribing gateway, a healthcare information exchange, or payer.In Massachusetts we use interface engines, gateways such as NEHEN, and community-based health information exchanges...

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Dispute Resolution in Healthcare

At the recent Health 2.0 conference, I was asked an interesting question. If there is a dispute about any data in healthcare - PHR, EHR, or Health Information Exchange, how is it resolved?eBay does millions of transactions via the internet and it has automated, web-based dispute resolution workflows. Can healthcare learn something from eBay?On May 5, I will be attending a workshop in Washington called "Online Dispute Resolution in a Technology-oriented Healthcare World.�The attendees are evenly split between representatives of the Healthcare, Dispute Resolution and Computer Science communities.The goals of the meeting are:*Identify the key risks of disputes in the networked health information technology environment.*Identify the best practices in avoiding and resolving such disputes and...

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Monday Review- Allergy Alert Clothing

This week's Monday Review is brought to you by Alert Clothing Company. Summer camps and changes in caregiver schedules are right around the corner. Protect young children with Alert Clothing. Company founder, Rebecca Nelson, has three children- two with severe food allergies. In an effort to keep her children safe, Rebbecca designed several colorful t-shirts for her kids to wear to preschool. The shirts were a big hit and in 2005, Rebecca launched the Alert Clothing Company so that food allergic children everywhere can be identified and protected.What do I love about Rebecca's designs? The sweatshirts, t-shirts and tote bags are bold, colorful...

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Friday Feature: Raising Food Allergic Kids.org

This Friday Feature showcases Lissa, the founder of Raising Food Allergic Kids, a website packed with information to help raise your food allergic child. As you'll see in our interview below, Lissa's site is a must-read if you're planning a Disney World trip.What is your food allergy background?My daughter, Caroline, had her first reaction shortly after she turned one. It was her second exposure to egg. I had no idea that it’s very common for a sensitivity to manifest not in a first exposure, but in the second. I was taken completely by surprise. When I plopped a hard boiled egg on her high chair tray about a week after her first scrambled egg, I thought nothing of it. Within five minutes even the whites of her eyes were red and we were on our way to the doctor in a panic. In the year...

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Cool Technology of the Week

The New England Health EDI Network (NEHEN) and MA-Share are completing their merger over the next month into a new non-profit LLC called the New England Healthcare Exchange Network. The resulting merged organization will provide a single appliance for exchange of benefits/eligibility, referral/authorization, claims/remittance, the full suite of e-prescribing functionality (eligibility, formulary, history, routing, refills), and clinical summary exchange of continuity of care documents.Many recent articles in the popular press have questioned the cost savings of health information exchange. Here's more data from our experience in Massachusetts.The quantifiable savings are different for each provider organization depending on what their starting point is, however here are some example...

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My Work Spaces

I've written about the technologies I use personally, but I've not written about the places I use them.I have three primary workspaces - my Harvard office, my BIDMC office, and my home. Since being a CIO is a 24x7x365 lifestyle, I do not store paper, supplies or technologies in any of my offices. I can work equally well wherever I am. Here's the overview of where I work:Harvard office - I'm in Vanderbilt Hall, built by George and Cornelius Vanderbilt in 1927. Everything in my office is from that era. In my twenties I collected Arts and Crafts/Mission furniture from flea markets and estate sales. Back in the 80's no one really wanted...

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Food Allergy Thrive Expo

Chicago hosted the Thrive Allergy & Gluten-Free Expo on Saturday and Sunday (April 18 and 19). More than 3,000 tickets were sold. Check out this Chicago Tribune article listing many of the vendors Did you attend, or hear any news about it? I thought this would be big news among bloggers and I haven't seen much. Am I missing somethi...

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Enhancing our Problem Lists

In my recent posts about the Limitations of Administrative Data and the Lessons Learned, I've concluded that clinical observations of symptoms and conditions coded in SNOMED-CT are the most relevant problem list data to share with patients and use for data analysis.We have a 3 step approach to implementing SNOMED-CT in BIDMC clinical systems1. Our existing problem list dictionary was developed in 1998 and hence it's called BI-98. We contributed it to the National Library of Medicine and it was incorporated into the Metathesaurus.About 70% of the terms we used are easily mapable to SNOMED-CT Codes. The National Library of Medicine will send us a BI-98 to SNOMED-CT mapping in the next few days and we'll incorporate it into our existing dictionary, giving us a SNOMED-CT vocabulary for 70%...

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Apologizing with Candor and Grace

As readers of my blog know, I've adopted many aspects of Japanese lifestyle in my household - food, music, and clothing.Learning to apologize is also something I've learned from the Japanese. You'll find a great description in the Etiquette Guide to Japan by Boye De Mente.A typical corporate apology in Japan is accompanied by a low bow, a sincere apology, and a possible resignation.Atoning for a mistake in the US does not require the loss of your job (or anything more extreme).As I mentioned in yesterday's blog about being a public figure, bad things can happen. You may or may not be able to control them.When bad things happen, here is the approach I use:1. Encourage openness and transparency in your staff i.e. do not shoot the messenger. By empowering every person to communicate the...

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The Challenge of Being a Public Figure

Although I'm not really a public figure, I do enough presentations in my roles at BIDMC, Harvard, NEHEN, and HITSP to appreciate the challenges of highly visible corporate and government public figures. Here are my top 10 observations:1. There is no downtimeWhile on a plane, train, or in any public space, you cannot be freewheeling with your opinions. Your communications must be thoughtful regardless of venue. Emails must be written with the assumption they will appear in The New York Times. While going about the activities of day to day living, you must always be "on". I've had deep conversations about IT strategy and government policy at the Wellesley Dump.2. You must be a good listenerPublic figures are assumed to have power and there will be many opinions about how to best...

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Monday Review- Grill Charms

This Monday Review is brought to you by Grill Charms- think wine charm for your grilled meats. Founder and mom, Leslie Haywood, had an "A-ha moment" when her husband mistakenly gave her the extra-hot Jamaican grilled chicken, instead of the mild chicken she requested. Leslie created Grill Charms to help barbecuers everywhere identify different preferences and dietary needs.Back in February, Leslie sent me a Grill Charm from her Pink Collection (these charms benefit breast cancer research- love that!). Finally a balmy week-end arrived and we pulled out the grill. I must admit to feeling skeptical at first that these little charms would stay...

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Food Allergy Guidelines for PA schools

This article is of particular interest to me. I spent many hours working with our school district so my child could be safe at school. As I've said before, he's carried an Epi-Pen around his waist since his first day of kindergarten. If the school had denied us this right, it would have been a deal breaker resulting in a search for alternative educational opportunities. Every child and every situation is different, but schools and parents need to have some basic understandings and rights when it comes to food allergies. I fully support State Rep. Tom Murt in his efforts to require Pennsylvania to develop food allergy guidelines for schools. I'm going to write to him right now and see how I can help.How is your school handling food allergi...

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Lessons Learned from e-Patient Dave

I started the week with a blog about the Limitations of Administrative Data, so it's fitting to end the week with lessons learned and next steps.e-Patient Dave, his doctor Danny Sands, Roni Zeiger from Google, and I spent many hours in online and phone conversation about the data elements in healthcare that are of greatest use to e-patients. Since the American Recovery and Reinvestment Act requires patients be given access to their electronic data, I have wanted to share all data with patients, both clinical and administrative. It's clear from our discussions that sharing billing data with patients is unreliable for clinical history, and it was a mistake to do that.Administrative data is a coded summary of the clinical care that lacks perfect specificity and time references i.e. just because...

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A Winter's Tale

Recently, my friend John Winship was caught in poor visibility, strong winds, freezing rain/snow and was missing for two days in New Hampshire's White Mountains. I asked him about his lessons learned and this is what he wrote (published with his permission). I think you'll find it meaningful and profound."Solo expedition to Mt. Rainier in May: Cancelled.Solo expedition to Mt. Cook/NZ winter 2010: Cancelled.Although I did not request a rescue, I know that the damage to my body would have been exponential with one more overnight. I have already made a gift to New Hampshire Fish and Game for double the estimated rescue cost. I have also commended them to Governor Lynch for their selflessness and heroism.This had to happen. I was addicted. I have been pushing the envelope for two years...

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Food Allergies? Discounts and Coupons

Uno's Chicago Grill now offers a gluten-free pizza. Here's a coupon. Check out their entire gluten-free menu.Softress Body Oils perfect for those with food allergies, sensitive skin, eczema. 15% discount with code: "FOODALY". Good until Dec. 31, 2009.Olinda Ridge Oils- if you sign up to receive their newsletter, you'll get a 15% discount on your order.Go Picnic Snackboxes- 25% discount for your first order. Just use coupon code "GPTHANKS"Ener G's poundcake, free of gluten, wheat, casein, dairy, yeast, soy, and nuts, is 15% off.Do you know you can order Ener G and other food allergy safe foods through Amazon.com? Free shipping with your $25 order- not to hard to spend $25!Any other coupons or discounts we should know about? Let me know.What are you waiting for...get shopping...

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Combating Malware

Every day we're reading about new viruses, trojans, spyware and other malware on the internet. I was recently asked about the need to reinstall the operating system from scratch on a virus infected machine. Here is the answer from Security Officer at BIDMC:Is there a valid technical reason for requiring a rebuild? The answer to this is yes. The thing to focus on here is the Anti in the title of Anti-Virus. These applications are intended to stop an infection. Most of them also include a cleaning component and there are many products marketed solely as cleaning products - spybot-SD is a good example. The problem with these products is that malware is constantly morphing. You see this often in the names of the malware , they will contain .a, .b. .c etc. The longer the malware...

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A Followup on Wal-Mart's EHR effort

I've recently written about Wal-mart's effort to reduce the cost of EHR acquisition. Many folks have asked for more details about how the product will be promoted and sold. Here's the answer based on followup calls with the Wal-mart folks running the project.Sam's Club currently has "feet on the street" visiting with small business operators. In particular, there are individuals from the Health and Wellness business group that are currently calling on physician members. In the past, they would have spoken to physicians about the $4 Pharmacy program and office supplies. That same group will also be used to promote the EHR Solution. However, that is not enough to spread the word.In partnering with eClinicalWorks and Dell, Sam's Club will be leveraging their "feet on the street"...

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The Limitations of Administrative Data

The data issue described in the Boston Globe this morning is really unrelated to Google, Microsoft, or any Personal Health Record (PHR) provider. In the US, there are two kinds of healthcare data - clinical data in Electronic Health Records (EHRs) and administrative billing data that is used by payers, researchers, and the government. Billing data is imprecise, but it is a starting point to describe the care given by a doctor or hospital. The only thing that's new in 2009 is that PHRs now enable patients to see the kind of billing data that's been used for 20 years for reimbursement, quality measurement, and population health. Blue Cross of Massachusetts and Medicare (in a few pilot states) share billing data with patients via Google Health, so this is not just a BIDMC implementation.As...

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What is Meaningful Use?

The definition of "Meaningful Use" in ARRA is one of the most critical decision points of the new administration's healthcare IT efforts. That definition will influence the types of products that will be implemented in clinician offices and the types of standards used for healthcare exchange to qualify for stimulus dollars.For example, if meaningful use is defined as e-prescribing, then standalone products such as Dr. First's Rcopia could be used as part of a clinician's office compliance in lieu of a complete EHR.If meaningful use is defined as the basics of ordering/viewing labs, then products like 4medica could constitute meaningful use.If meaningful use requires sophisticated quality measurement, decision support, and workflow redesign to enhance efficiency, then a CCHIT certified comprehensive...

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Monday Review- Stuck on You

This Monday Review is brought to you by "Stuck on You", a company specializing in labels and organizational tools to help parents and teachers keep children healthier and more organized. Couldn't we all use a little more organization?They now offer a special line of allergy-free labels to help create zones to prevent inadvertent exposure to substances that can be dangerous to children with allergies. Stuck on You offers customized labels and wristbands for any allergy. The brightly colored vinyl labels, stickers, and wristbands are waterproof, as well as microwave and dishwasher safe.I love these labels. Our first, and fortunately, only (knocking...

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Happy Holiday!

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Randall Cattle Breed

I stumbled across an interesting breed of cattle this past week - Randall Cattle. The following is an excerpt from the breed association's web site:The Randall Cattle Breed "Randall cattle are a rare breed of purebred cattle developed in Sunderland, Vermont, on the farm of the late Everett Randall. They are considered to be a landrace breed, descended from the indigenous landrace cattle common in New England in the nineteenth century. Randalls have historically been used as a dairy breed, although they also possess meat and draft qualities. Randall cattle are variable in size and conformation and have a constitution that is...

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Friday Feature: Linda Coss

This Friday Feature showcases Linda Coss. I am not exaggerating when I say that Linda's food allergy books were a lifesaver for us when our son was first diagnosed with multiple food allergies. Her recipe books taught me how to make safe foods our whole family could enjoy. Linda's "Practical Tips" book guided us through many situations related to school, travel and holidays.Learn more about Linda through our recent interview:How did you first become involved in food allergies? Eighteen years ago I shared a bowl of ice cream that changed my life. I dipped a taster spoon into the melted bit at the bottom of the bowl and let my 8 month old son lick it off. Then I went home and put him down for a nap. A little while later, that “mother’s intuition” voice told me to go check on him. He was beet...

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Cool Technology of the Week

Although Google does not generally share the details of its infrastructure, Google's hardware architect recently shared the secrets of its servers, data centers and power management.Having been involved on the advisory council for Google Health, I know that Google runs hundreds of thousands of servers. What I did not know is that it designs and builds its own. The real innovation - each server has a 12 volt battery attached the motherboard to keep the CPU running in case of power failure. Google does not use centralized uninterruptible power supplies. Building the power supply into the server means costs are matched directly to the number...

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Vegan Dining in Chicago

While at HIMSS, you can munch on the usual gourmet convention center cuisine - Hamburgers, Cappuccino, Pretzels, or Jumbo dogs. Or you could a walk a mile or two and enjoy Vegan Chicago. Most folks think of Chicago as deep dish pizza, ribs or steaks. However, there are a remarkable array of Vegan friendly restaurants and delis.I walked from the Convention Center to Opera at 1301 S. Wabash to sample their vegan specialties. On Friday night I had a starter of a Vegan Corn fritter, followed by Spicy Shitake Wontons surrounding an asparagus salad, and then an entree not on the menu but made by the chef for me as a experimental future addition...

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Food Challenges

Did you get to see Nightline last week when they featured food allergies and food challenges?It's a heart-wrenching story about a 5-year-old who has been fed through a feeding tube for the past 2 years since he seemed to be allergic to everything. The piece implies that food challenges offer a new way to control food allergies, which is a mis-leading portrayl. Hopefully people will read the article and watch the video to understand what a food challenge is, and what it isn't.We're visiting the allergiest Friday for an egg challenge. We haven't done a food challenge in over 5 years. There are many emotions associated with a food challenge-excitement in possibly being able to introduce a new food, fear that something will go wrong, anxiety about the process...I'm making scrambled eggs and...

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The Data Elements of an EHR

I've recently been asked to provide a list of the data elements of an EHR which might be used as part of the ARRA mandate to exchange data as part of meaningful use. There are a nearly infinite number of actors, actions and events for data exchange, but in the interest of getting "data liquidity" in healthcare, here are the elements that are most commonly used and represent a great starting point for healthcare information exchange. I always strive for parsimony of standards - the fewest that we need for the purpose. Below you'll see that I've included the standards that support the systems we have in place today as well as the XML/Web-based standards that support newer web-centric systems and healthcare information exchanges.DemographicsContent: HL7 2.x for messaging, CCD for document...

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Dispatch from HIMSS

Every year, I walk the floor of HIMSS and summarize the broad trends I see in the industry. Here are my 2009 observations1. The Stimulus - There's energy and optimism at HIMSS this year caused by the prospect of $34 billion dollars of stimulus funding for Healthcare IT. Since the current healthcare IT annual spend is somewhere between $15-25 billion, this could double the entire industry. 2. The Economy - the euphoria of the stimulus is tempered by the challenging economy - downsizing, wage cuts, and the collapse of 401k's are a stark contrast to the hope of new EHR rollouts.3. Software as a Service - It's clear that all these new EHRs are not going to be hosted in the offices of rural solo practitioners. Web-based software as a service hosting centers for EHRs are being discussed...

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Saving the Boston Globe

I've joined a dozen other bloggers in posting this message simultaneously:"We have all read recently about the threat of possible closure faced by the Boston Globe. A number of Boston-based bloggers who care about the continued existence of the Globe have banded together in conducting a blog rally. We are simultaneously posting this paragraph to solicit your ideas of steps the Globe could take to improve its financial picture."We view the Globe as an important community resource, and we think that lots of people in the region agree and might have creative ideas that might help in this situation. So, here's your chance. Please don't write with nasty comments and sarcasm: Use this forum for thoughtful and interesting steps you would recommend to the management that would improve readership,...

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Monday Review: Softress

This Monday Review is brought to you by Softress body oils. Nina Birnbaum was dissatisfied with the options available to treat her daughter's eczema. She developed a body oil made from whole, food-grade oils and a blend of antioxidant vitamin C and natural vitamin E. Her company, Softress, Inc., now manufactures a full line of vegan-certified, fragrance-free, preservative-free moisturizing oils for dry, sensitive skin.I applaud Nina's efforts to create a safe alternative to treat her daughter's eczema. Over the years, doctors prescribed many steroid creams to treat my son's eczema. We used them as directed and he now has white patches on...

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My Telepresence Experience

I returned to Boston from HIMSS to spend the day with my daughter on her 16th birthday. We had a great day cooking, hiking, and enjoying a fabulous Japanese meal as a family. However, I was also in Chicago for 2 hours, speaking with the press about the Stimulus Bill, Interoperability, and Decision Support.The press gathered at the Cisco booth on the floor of HIMSS and I welcomed them to my basement via Telepresence. We chatted for an hour with full life-sized 1080p real time video. Truly, there was no difference from sitting in a room together, other than the fact that my basement had a bubbling fish tank and 2 rabbits running around.My...

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