Enhancing Health Information Exchange in Massachusetts

The HIT Policy Committee and its Meaningful Use Working Group will be defining meaningful use very soon. Although I have no inside knowledge of what meaningful use will be, I think it will likely include several elements of health information exchange.To me, health information exchange is three things1. Policies for exchange which protect confidentiality, ensure compliance with regulations, and meet the service expectations of stakeholders.2. Workflow which supports the business processes of payers, providers and patients.3. A technical architecture which implements the workflow.To achieve meaningfully useful health information exchange, Massachusetts has recently convened three committees under the auspices of the Eastern Massachusetts Healthcare Initiative. During May and June, we'll...

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I Had a Brain Freeze, but Brain Thaw Arrived in the Nick of Time

So we spent Memorial Day week-end at the shore. My son is taking Zyrtec daily for seasonal allergies. We ran out of his Zyrtec syrup during the week-end. No problem. We stopped at the closest CVS and picked up more. My brain freeze resulted in my thinking that we should get the children's chewable tablets instead of syrup. As I opened the package, my brain thaw occurred and I read over the inactive ingredients. Duh! I wrote a while back about Zyrtec tablets containing lactose monohydrate. I even sent a letter to them. It went unanswered.Today I called Zyrtec and chatted with Malika, Zyrtec Customer Service Representative. She confirmed that lactose monohydrate contains bovine milk. She went on to say that the manufacturer of the lactose monohydrate had issued a "Certificate of Suitability."...

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Cool Technology of the Week

In my recent blog about the Red Flags rule, GreenLeaves commented that biometric checking would help reduce errors by establishing identity and uncovering fraud.Using biometrics to verify identity seems like a good idea, so I met with Jim Sullivan from BIO-key, a leading provider of biometric solutions.In the past, I've been reluctant to adopt biometrics because of the expense of buying fingerprint or Iris scanners for each of my 8000 client devices.However, now that many laptops and hospital ready tablets include embedded fingerprint swipe scanners and that the price of USB fingerprint scanners has dropped significantly, it is realistic to consider biometrics.BIO-key has developed a next-generation algorithm that reduces the fingerprint to set of calculated unique identifiers. A person�s...

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Data Center Space in the Northeast

Yesterday I wrote my personal blog for the week, so today's blog is a return the typical issues of a CIO - building and renting data centers in the Northeast.I was recently asked about a report being published this week on health care data center costs in Boston compared with other U.S. metropolitan areas. The report claims that, although huge opportunities exist for data center providers to house growing amounts of health care data, the high costs of running a data center in Boston and other Northeast cities will drive providers to house their data in low-cost areas in the Midwest.Here's my view of the needs of healthcare CIOs for data center space in the Northeast.My sense is that most IT organizations are embracing virtualization which reduces server space needs. However storage needs...

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Teen Clinic - HEALTHSPACE!

 The Petersburg Health Department is home to a teen clinic - HEALTHSPACE! If you're a teen with a health concern, just stop by on Tuesday or Thursday and speak to a health care professional. No appointment necessary. Location: Petersburg Health Dept., 301 Halifax St.Hours: Noon to 6:00pm, Tuesday and ThursdayPhone: (804) 862-7...

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The Number 5

In the movie "The Number 23", the main character played by Jim Carrey is obsessed with the idea that all incidents and events are directly connected to the number 23, some permutation of the number 23, or a number related to the number 23.I'm not obsessed, nor do I have OCD in any way, but much of my life is neatly organized into groups of 5.Why 5?I find that 5 is the maximum number of tasks I can do simultaneously without losing track of the details. Here's my framework for my career and personal lifeCareer1. BIDMC - As CIO of BIDMC, I have 5 direct reportsa. Clinical Systemsb. Financial Systemsc. Infrastructured. Knowledge Services (includes medical library and all onlinee. Media Services2. Harvard Medical School - As CIO of HMS, I have 5 direct reportsa. Administrative ITb. Educational...

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As a Guest, I'm a Pest

As a follow-up to last week's post, "Hostess With the Mostest...Stress That Is", I must note that being a guest isn't easy either. This is something many of you pointed out in your recent comments.Both Jes and Sabrina K. commented that they think it's harder to be a guest in someone else's house. They prefer to host because they have more control over what foods come in.Nowheymama keeps everyone out of her kitchen to ease her stress. ChupieandJ'smama is already stressed about hosting an upcoming company Christmas party where traditionally shrimp and crab legs are served. Infant Bibliophile just starves her houseguests rather than dealing with the stress. Col has a list of rules for her guests. Liz uses red stickers to identify unsafe foods in her house and Karen keeps very few unsafe items...

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A Personal Reflection on Standards Harmonization

As HITSP prepares for the demands of ARRA by reorganizing its work around meaningful use rather than use cases, here is my view of the state of standards harmonization in the US. This is my personal opinion, not a statement from HITSP or ONC.1. Medication management and e-prescribingThis area is very mature and widely implemented.NCPDP Script 10.5 is the right messaging standard to support e-prescribing workflow in ambulatory and long term care settings.The National Library of Medicine's RxNorm is the right vocabulary to specify medication names.The Food and Drug Administration's Unique Ingredient Identifier (UNII) is the right vocabulary for chemical substances and is especially useful in allergy checking.Structured SIG, although still evolving, is good enough to describe the way to take...

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Friday Feature: The Food Allergy Coach

Meet Kim Hopkins, founder of Food Sensitivity Resources, a website dedicated to helping people live full lives despite having food allergies, intolerance, and sensitivities. Learn about Kim and how she coaches people with food issues through our interview below.What is your food allergy background? I thank my nephew. He has autism, and was really the "whistle-blower" in our family regarding food challenges and their effects. It was through my sister's research on his behalf that we all learned about our own food challenges.I have always suffered from environmental allergies, asthma, and being overweight. At one point, I was prescribed two inhalers, two nasal sprays, two allergy pills, and three weekly allergy shots! As a kid, I can remember leaving school via ambulance several times because...

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Cool Technology of the Week

Massachusetts Data Protection regulations require that data on portable devices be encrypted. As I've written about previously, we have encrypted all our laptops with McAfee Safeboot/EndpointHowever, it's commonplace for folks to backup their data on removable USB drives. How can we ensure portable drives are protected?The answer is hardware encryption. I tested the Maxtor BlackArmor 160GB Encrypted Portable Drive and it's my cool technology of the week.Here are the specs:� Hardware-Based Full-Disc Encryption: Prohibits access without a password, no exceptions-not even a professional data recovery service can access the data without the password.� KeyErase�: Permanent removal of encryption key allows secure redeployment of the drive.� USB Powered: Powers your drive and ensures fast data...

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Kayaking the Charles River

From Spring to Fall each year, I kayak 6 miles a day on the Charles River between route 128 and the Moody Street Dam. My general rule of thumb is that I kayak when the sum of water temperature plus air temperature is greater than 120. The risk of hypothermia is much less when the water temperature is above 55 and the air temperature is above 65. This usually occurs sometime in May and lasts until October. Today's water temperature was 65 and the air temperature was 75F with a very light wind - perfect conditions. The route I take passes through the "Lakes District" of the Charles - a wide, shallow, and particularly beautiful stretch for...

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The Adventures of an IT Leader

In January of 2003, F. Warren McFarlan and Robert D. Austin of Harvard Business School wrote a great case study about the CareGroup Network Outage.One of my blog readers, Brian Ahier, suggested that I read the new book by one of the same authors, Robert D. Austin, called "The Adventures of an IT Leader" .From the HBS website:"Becoming an effective IT manager presents a host of challenges�from anticipating emerging technology to managing relationships with vendors, employees, and other managers. A good IT manager must also be a strong business leader.This book invites you to accompany new CIO Jim Barton to better understand the role of IT in...

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The Hostess With the Mostess...Stress, That Is.

I fear that I'm not a very good hostess. If we have people over for a meal, I'm usually fine. I can prepare the meal in advance and take my normal kitchen precautions. The problem arises when we have guests who stay for a few days over multiple meals. Suddenly my kitchen isn't my own. Unfamiliar food arrives and concern over cross-contamination boils over."STOP! You can't dip that knife back into our dairy free butter after using it on that unsafe (read: poisonous) bread.""NO!" Don't cut into that dairy, egg and nut-free cake with that tainted knife you just used on that unsafe (read: poisonous)angel food cake."WAIT!You can't leave crumbs from that peanut butter and jelly sandwich (read: poisonous)all over the table. And please- go wash you hands- immediately. And I want to hear you...

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The ONC ARRA Implementation Plan

Yesterday, ONC released its implementation and operating plan in fulfillment of the 90-day deadline established by Div. A, Title XIII of ARRA.The plan is posted to the HHS Recovery Website.Here are a few highlights:$24 million is budgeted for enhanced privacy and security including $9.5 million for the Office of Civil Rights and CMS for auditing and for complaint resolution.$20 million is budgeted for NIST to test technical standards and establish a conformance testing infrastructure.$300 million is allocated for Regional Healthcare Information Exchange, but no details are provided about timelines for distribution.The plan for Standards is consistent with the charter of the HIT Standards Committee - HHS shall adopt and publish an initial set of standards, implementation specifications, and...

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Monday Review: Beyond a Peanut Flashcards

When my kids were really young, they loved flashcards. We used alphabet cards to learn letters and number cards to learn simple math. One enterprising mom has created special flashcards to teach people how to stay safe with food allergies.Dina Clifford created the cards after her children were diagnosed with a peanut allergy. This small packet carries a ton of information about reading labels, cross contamination and carrying emergency medications. The cards have four color-coded borders. Green cards show foods or situations that are relatively safe for someone who is peanut or nut allergic. They stress caution and introduce the idea of cross-contamination....

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The Red Flags Rule

You may have seen the recent headlines "FTC delays Red Flags Rule implementation until August 2009". What is the Red Flags Rule and how does it relate to healthcare?The FTC has a great website that it explains it all in detail.Basically, the FTC requires most clinical offices, hospitals, and other health care providers to develop a written program to spot the warning signs of identity theft - �red flags�If a patient's name on a photo ID and on their insurance card do not match, that's a red flag.If a patient visited last week as John Smith but today is Fred Jones, that's a red flag.If patient seems to travel from provider to provider seeking numerous expensive treatments, that's a reg flag.The law was initially designed to cover creditors and it seems odd for healthcare providers to...

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The First Meeting of the HIT Standards Committee

Today, Jonathan Perlin and I ran the first meeting of the new HIT Standards Committee. The members are:Jonathan Perlin, MD, Chair Healthcare Corporation of AmericaJohn Halamka, MD. Vice-Chair Harvard Medical SchoolDixie Baker, PhD Science Applications International CorporationAnne CastroBlueCross BlueShield of South CarolinaChristopher Chute, MD Mayo Clinic College of MedicineJanet Corrigan, PhDNational Quality ForumJohn Derr, R.Ph. Golden Living, LLCLinda DillmanWal-Mart Stores, Inc.James FergusonKaiser PermanenteSteven Findlay, MPHConsumers UnionDouglas Fridsma, MD, PhD Arizona Biomedical Collaborataive 1C. Martin...

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Closing out Food Allergy Awareness Week

Don't forget the Food Allergy Twitter Party at noon and 10:30 pm (Eastern Time) today! Go to tweetgrid.com and type in #foodallergy.As we wrap-up Food Allergy Awareness Week, check out this list put together by Linda Coss. She's right on target. In light of our experience this week, I must add a #11:Better Methods to Diagnosis Food Allergies- skin tests are unreliable in most allergenic children. Blood tests give too many false positives. Food challenges are filled with subjective evaluation and are traumatic for the allergic person and their family. We need some kind or x-ray or MRI-type machine to scan for food allergies in a non-invasive way.Is that too much to ask?Here's Linda's list...Top 10 Things Parents of Children with Life-Threatening Food Allergies WantBy Food Allergy Author...

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More Vegan Dining

Over the past two weeks I've been traveling up and down the Northeast Corridor from Boston to New York City to Philadelphia to Washington for various meetings related to healthcare IT. When I arrive in a city and check into a hotel, I Google "vegan" followed by the city name. I scan the Google map that appears and walk to the most appealing vegan restaurant nearby. Here are a few of my recent finds:PhiladelphiaMi Lah is a great mix of oriental vegan foods from Cambodia, Japan, and Thailand as well as classic ethnic dishes such as Greek butternut squash moussake and African peanut stew. I had the Cambodian Amok with spinach, eggplant,...

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Food Challenge: A Distress Signal

I'm still feeling damaged as I write this post. The trauma of Monday’s food challenge still lingers. It began innocently enough with the allergist saying, “Let’s do a food challenge for egg.” Great idea, thought the parents. Our nine-year old called the scheduled challenge “the day I’m going to die”.It’s hard to explain to a child that they should eat a food they’ve been told could make them very sick. We really worked hard to manage his anxiety. We’d been through food challenges with him before, but he’s too young to remember. We explained, and the doctor re-explained, the process. A tiny amount of egg would be given, with increasing amounts over five ingestions. We would wait 20 minutes between each ingestion to see if there would be a reaction.The hard part was separating the anxiety...

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The BIDMC Problem List Vocabulary

In several blog entries, I've been discussing the adoption of SNOMED-CT as the vocabulary to support BIDMC problem lists and our Google Health interface.The National Library of medicine has mapped 93% of BIDMC problem list terms to SNOMED. The International Health Terminology Standards Development Organization (IHTSDO) has given me permission to share the BIDMC problem list vocabulary and the SNOMED-CT codes on my blog via the following terms"The SNOMED CT� identifiers are posted with permission from the International Health Terminology Standards Development Organisation (IHTSDO). SNOMED CT is available for use under the terms of the IHTSDO Affiliate License Agreement, which is also Appendix 2 of the License Agreement for Use of the UMLS Metathesaurus. Use of SNOMED CT is free in IHTSDO...

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The First Meeting of the HIT Policy Committee

Today, the HIT Policy Committee met for the first time. Dr. Walter Suarez, CEO of the Institute for HIPAA/HIT Education, and the co-leader of the HITSP Education and Communication Committee, attended on my behalf. Here are his notes.The meeting began with an introduction by Dr. David Blumenthal. He highlighted six priority areas for the HIT Policy Committee* Meaningful Use* Certification* Infrastructure* Privacy and Security* Health Information Exchange* Public HealthA question was asked about the recent NCVHS meaningful use hearings. Dr. Blumenthal responded that the HIT Policy Committee will be the venue for discussion of the NCVHS report.A question was asked about the Office of National Coordinator (ONC) Strategic Plan. Dr. Blumenthal responded that ONC must revise its plan to reflect...

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Monday Review: A Look Back

After four months of Monday Reviews, I wanted to take a look back. Have you tried any of these products as a result of a review? Please share your experience. We can all help each other. Thank you! Home FreeManitoba Harvest: Hemp ProductsMary's Gone CrackersGo PicnicZenSoy Puddings and Evolve KefirThai KitchenNature's PathSimply Boulder Sauces"Matters of Faith", by Kristy KiernanHappikinsOlinda Ridge Olive OilsKettle CuisineSoftressStuck on YouGrill CharmsAllergy Alert Clothing"Flourishing with Food Allergies" by A.AndersonDon't forget the Food ALlergy Twitter Party to wrap up Food Allergy Awareness Week! Join us at noon and 10:30 pm this Friday, May ...

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The Healthcare Information Technology Expert Panel II

Last week, I joined an amazing group of colleagues at the National Quality Forum's Healthcare Information Technology Expert Panel to work on a next generation quality data set. They key breakthrough was the development of a universal terminology for the design of quality measures which captures process and outcome data from electronic systems.Elements which are captured include:Datatype (e.g., medication order)Data (e.g., aspirin)Attributes (e.g., date/time)Data Source (e.g., physician, patient, lab)Data Recorder (e.g., physician, lab, monitor)Data Setting (e.g., home, hospital, rehab facility)Health Record Field (e.g., problem list, med list, allergy) In the original HITEP work last year, 35 datatypes were defined such as encounter, diagnosis, diagnostic study, laboratory, device, intervention,...

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Happy Mother's Day

Fo the constant label reading, special ingredient cake baking, party planning (especially those you're not even hosting), teacher training, medicine carrying food allergy moms...Happy Mother's D...

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Cocci study group, Lupus scare

Denise continues to heal and we continue to enjoy her presence. As happens from time to time, we had a little point of concern. In the spring, Denise had some wacky liver labs that showed positive results that were consistent with lupus. More focused testing showed that she has mild case of a thyroid problem called Hashimoto's disease. Between the two, we'll take the Hashimoto's over the lupus.I attended the 53rd Annual Coccidiodomycosis Study Group in early April. This is an annual gathering of the leading professionals in the study and treatment of valley fever. This year it was held at Cal State University Bakersfield (yup, in a cocci-endemic region). As was the case for the last couple years, my aunt that's an RN went with me to explain the medical jargon, and we got to rub elbows...

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Friday Feature: The Nut-Free Mom

This Friday Feature is an interview with Jenny Kale, The Nut-Free Mom. Learn more about Jenny through our Q&A's.What is your food allergy background? My food allergy journey began 5 years ago when my then 4-year-old daughter had a bite of a peanut butter sandwich at preschool. She never wanted peanut butter when we offered it to her, but we didn't think much of it. On this day, I went to pick my daughter up at school after lunch and found her eyes swollen to 3 times their normal size. Her face was covered in hives. I got her home and called the doctor. She appeared to be asleep, but now I know she probably fainted from low blood pressure. She "woke" up when she began violently vomiting. Luckily her airway didn't close, though she began wheezing. I know now that she was having a full-blown...

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Followup on Dispute Resolution

In my earlier blog about Dispute Resolution, I described the planned gathering of computer scientists, electronic health record experts, and dispute resolution professionals called "Online Dispute Resolution in a Technology-oriented Healthcare World"I attended the event and enjoyed the multidisciplinary discussion, learning a great deal about possible disputes among the data stakeholders in healthcare - patients, providers, payers, employers, compliance organizations, public health, government, national security, research etc.Here are a few lessons learned1. There's a need to web enable dispute workflow in healthcare. As e-patient Dave pointed out, I did not hear about any data concerns regarding personal health records likely because there was no easy way to raise the issue. Hospitals...

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Your Karma Account Balance

It's a tough time for everyone right now.The economy is troubled, there's an H1N1 flu outbreak, and there's increased competition for scarce resources.This causes people to be edgy, angry, and impatient.I encounter a sense of frenzy when I board airplanes, when I search for parking, and when I commute on busy highways.It's time to dust ourselves off, make the most of each day, and strive for more good Karma.What do I mean?Conflict happens every day. I have always believed that the nice guy can finish first in any conflict by doing the right thing.1. By trying to win every competition you may win the battle of office politics but lose the Karma war. I've found that those who are Machiavellian live by the sword and eventually die by the sword. Thus, do not grandstand, take credit inappropriately,...

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We're Having a Twitter Party!

Okay, I'll admit, I'm not sure exactly what that means yet, but I'm learning. This party is being hosted by Jennifer of Food Allergy Buzz and Ruth of Best Allergy Sites.To join in the fun, on Friday May 15 at noon and again at 10:30 pm (Eastern Time), visit tweetgrid.com and type in #foodallergy. You can use another Twitter real-time dashboard of your choosing, but "tweetgrid" works and that's good enough for me.This will take you to the party where you will see streaming conversation. During the two party times, you can ask questions or make comments on anything food allergy related. I'm participating in the noon party and I plan to be sleeping during the 10:30 pm one- yeah, I know, quite the party animal. Anyway, I hope you'll join us. The participating panelists are:@chupieandjsmama@foodallergyassistant@foodallergymama@allergicgirl@nut_freemom@foodallergybuzz@bestallergysite...

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Next Steps on the HIT Policy and Standards Committees

Last week, ONC formally established the HIT Policy and Standards Committees via publication in the Federal Register. Here are the announcements:ACTION: Notification of the Establishment of the HIT Policy Committee.SUMMARY: This notice announces the establishment of the HIT Policy Committee. The American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5), section 13101, directs the establishment of the HIT Policy Committee. The HIT Policy Committee (also referred to as the"Committee'') is charged with recommending to the National Coordinator a policy framework for the development and adoption of a nationwide health information technology infrastructure that permits the electronic exchange and use of health information as is consistent with the Federal Health IT Strategic Plan and that...

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