Help is Needed Again for Food Allergy Bill in PA

I wrote about house Bill 1148 last Monday. The bill was sent to PA Education Committee members Weds. June 24. It was tabled. Here's the latest information from Rep. Murt's office about the future of this important bill:The PA House Education Committee met on 6/24/09 and discussed HB 1148 - Food Allergy Guidelines. This bill directs the Pennsylvania Department of Education to research and publish guidelines for the successful management of food allergies in our schools. The committee raised questions regarding how the legislation would impact existing laws and no bill vote was taken. Since last Wednesday, the legislation was re-written. We choose to clarify the impact on exiting school code by clearly illustrating the changes to the existing code. Changes to the Local Wellness Policy...

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Standards Deployability

I've described the taxonomy that we're using in the HIT Standards Committee to characterize "deployability":Category I- Known/Certain for 2011Standards are well-accepted and generally seen as deployableCategory II- Known/Certain for 2013Standards exist, are determined, but are not in the market yetCategory III- Work In Process for 2013 or 2015Need to converge/refine standards for 2013 or develop for 2015Category IV- Standards to be determined�Gleam in the eye,� some concepts exist but no clear pathProviding a measure of vendor, clinician, lab, pharmacy, hospital, and HIE ability to implement standards is just as important as naming the standards to be used in support of meaningful use.During our recent HIT Standards Committee meeting we discussed other interpretations of deployability including...

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Implementing a Modern Hospital Website

Over the past two years, I've witnessed a transition in modern website design from plain text and static information to multimedia centric and interactive. I've written about the new BIDMC website we implemented to meet patient expectations for a modern website.Many healthcare organizations I work with are considering content managed, new media, highly interactive web 2.0 sites. I thought it would be useful to describe how we approached the BIDMC website so you can leverage our experience.Content Management - BIDMC has a great deal of .NET expertise, so we wanted a content management system that worked well in our .NET/SQL Server 2008 environment. SiteCore has been ideal for us, providing content templates, distributed content management, and publishing workflow in a load balanced,...

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Update on Food Allergy Bill in PA

Here's the latest on HB 1148. According to my contact at PA State Representative Thomas Murt's District Office,"HB 1148 was tabled because several Education Committee members were concerned about the wording on the the bill and it's impact on existing laws. The bill was tabled to allow for further research and clarification. We are working with the Harrisburg legislation unit to resolve the concerns. We may have a vote as soon as July 1."I just sent a response asking if they needed any help from families who deal with food allergies every day. I believe in the power of the moms and dads who know what kind of help they need when trying to manage their child's food allergies in a school setting.I'll keep you posted if there are ways we can he...

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Cool Technology of the Week

I work in the Longwood Medical Area - a former cowpath that is now the only access to the center of biomedical research, healthcare, and informatics. It's a very challenging place to commute, especially on Red Sox games days. I carry a red sox schedule in my wallet to help me plan commutes - leaving an hour earlier in the morning or an hour later at night.There must be a better way than trying to drive through a nightmare of red sox traffic, commuters, and road construction.In July I'm going to try a bold experiment with a cool technology. I'm going to park my car away from the madness and use a foldable bicycle that weighs under 20 pounds...

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Avoid Certain Allergy Medications if you Have Food Allergies

I've said it before, I'll shout it again:If you have a dairy allergy, do not take certain tablets of Zyrtec, Benadryl and Singulair. Do not use the inhaler Advair. All contain dairy. They're not labelled clearly, but a call to the customer service departments of these drugs confirms that those with a milk allergy should not take these forms of the medications.Allergists, other doctors and pharmacists I've spoken to were unaware of dairy in these tablets and in the inhaler. Do not take samples of medications in the doctor's office until you have checked all medication ingredients through a label, company website or contacting the company direct...

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The Future of Personal Genomics

I recently participated in an panel discussion at Bio-IT World on the future of personal genomics.As one of the PGP-10, I'm a passionate supporter of full genome sequencing as a means to empower patients to work with their clinicians in formulating a plan for lifelong wellness.You'll find my personal comments in this webcast.Within the next year, the $1000 per person genome will be a reality. Our next challenge will not be the science but the need for robust patient decision support tools which translate base pair variation into probabilities for pathology. Further, we'll need to provide the educational materials which will enable patients to turn these probabilities into informed decisions about proactive lifestyle changes and therapies.I hope you enjoy the hour long discussion from Bio-IT...

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Food Safety News

Phyllis Entis, a food safety microbiologist and author of "Food Safety: Old Habits, New Perspectives" and "Food Microbiology - The Laboratory", maintains a very informative blog about food safety. She wrote a thorough discussion about the TollHouse Cookie dough re-call and provides a food recall round-up each week. Her blog isn't necessarily directed toward food allergies, but it is helpful for anyone who eats food.Take a look. Also, check out her discussion about the Food Safety Enhancement Act of 2009. There's even a link if you want to read all 116 pages of the act. Wouldn't it be wonderful to live in a world where all foods must be labelled with their country of origin and where food manufacturers can't refuse the FDA's request to recall foods. Oh yeah, and how about out-of compliance...

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The Second Meeting of the HIT Standards Committee

Today, Jonathan Perlin and I ran the second meeting of the HIT Standards Committee. Here's a report on presentations and the work ahead.Jamie Ferguson presented the work of the Clinical Operations Working Group. There are three major threads of effort - Clearly define the standards work to be completed by the Clinical Operations Workgroup and the Clinical Quality Workgroup, since quality measures depend upon clinical operations data- Select the specific standards and certification criteria supporting Meaningful Use Objectives and Measures- Create a taxonomy for standards maturity and industry readiness to deploy standards. The draft taxonomy we discussed is:Category I- Known/Certain for 2011Standards are well-accepted and generally seen as deployableCategory II- Known/Certain for 2013Standards...

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Copyleft, All Rights Reversed

I want my blog to be used for education, training, and research. I hope that its contents appear in derivative works such as other blogs, websites, and wikis. I'd prefer that these derivative works be openly shared.I would also ask that any material that is repurposed has attribution to me as the author.Content from my blog should not be sold. Charging for access to that which I make freely available seems wrong.How do I express these preferences legally?There are a variety of licensing approaches that enable the author to declare preferences beyond "(c) copyright all rights reserved". In my case, I want "some rights reserved".I recently me with the CEO of Wikidoc, a community supported medical reference, and he handed me a presentation with the term "Copyleft".What is Copyleft? From...

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House Bill 1148

Even if you don't live in PA, please consider copying and pasting the following e-mail addresses and letter into an e-mail and send it to our PA Reps. There is power in numbers and if all of us band together, no matter where we live, we can make all of our schools safer for those with food allergies. Just copy, paste and put your name and address at the bottom of the letter. The vote is this Weds. June 24, so please do this today or tomorrow. Thank you.Send to:JRoebuck@pahouse.net, ksmith@pahouse.net, LCurry@pahouse.net, JYudicha@pahouse.net, bsmith@pahouse.net, mcarroll@pahouse.net, sconklin@pahouse.net, RGrucela@pahouse.net, pharkins@pahouse.net, mlongietti@pahouse.net, MOBrien@pahouse.net, JPallone@pahouse.net, cwagner@pahouse.net, JWheatle@pahouse.net, RYoungbl@pahouse.net, Pclymer@pahousegop.com,...

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Rough Recovery

It's been a hard week for my little guy (and the rest of the family) as he recovers from tonsillectomy and adenoidectomy. The doctors are very nice, but quite casual about the whole recovery process. We wound up going to the emergency room Thursday night. He had been having such a hard time swallowing he needed fluids, morphine for pain and a steroid to shrink the swelling. There was talk of admitting him as he still wasn't swallowing easier after several hours. We decided to go home (for reasons explained below) and we had an okay week-end. Still not out of the woods yet. Dr. said we may need to take him back again for more fluids- ugh!So we opted not to stay overnight...here's why. When we walked into the ER, we saw signs posted- "If you've been to Mexico, Texas or New York City recently...

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A New Approach to Certification

Last week I spoke with Mark Leavitt, the CEO of CCHIT, about his best thinking regarding certification in a post-ARRA world. In the past there have been 3 groups who have requested improvements to existing certification criteria:1. Self developers who achieve a high degree of functionality through continuous improvement of home built software2. The Open Source community3. The Health 2.0/iPhone as application platform/multiple thin web-application combined to provide EHR-Lite functionality communityCCHIT held 2 Town Halls, each with 500 people, to publicly discuss a new approach to certification.Mark's slides are available online The New path to certification has three branches:EHR-C The Certification of a Comprehensive EHR. This is what has been done to date. The product itself is...

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Free Pretzels! Really Yummy Pretzels!

Check out this fun contest sponsored by RFAK.com (Raising Food Allergic Kids). RFAK author, Lissa, is celebrating her birthday by giving a gift. Enter to win a 10 Pretzel Gourmet Sampler Gift Set from Kim and Scott's Gourmet Pretzels.Good Lu...

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Cool Technology of the Week

Several very innovative healthcare applications were shown last week at Apple�s Worldwide Developers Conference 2009.One was from a company called Air Touch that offers secure, patient data in real-time to smart phones. Their products were FDA approved in April 2009.Here's the description from their website:�The development of the AirStrip Technologies platform was driven by the desire to improve the speed and quality of communication in healthcare.The AirStrip Technologies platform securely delivers critical patient information, including virtual real-time waveform data, directly from hospital monitoring systems to a doctor or nurse�s smart...

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My Favorite Wines

In my recent blog about staying healthy, I mentioned that I drink a glass of wine with dinner each night.My history with wine, that not many know, is that my wife and I ran a winery called Woodcliff on the Marin/Sonoma County Border from 1986-1993. We planted Syrah grapes (grafts from Randy Graham at Bonny Doon vineyard). I learned that you can make a small fortune in the wine business...as long as you start with a large fortune. It's challenging agricultural work. I served as a winemaker and chemist, tending barrels and doing chromatography to ensure malolactic fermentation proceeded appropriately. Running a winery taught me a great deal about the industry, grapes, and wine tasting. I learned that the price of wine and the quality of wine are rarely related. Drink what you...

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Holy Cow Food Allergy News

Tech savvy Saffie Farris is the mother of a child with a severe milk allergy. She created a site that uses RSS feeds to pull articles from online sources and places them in a "custom e-newspaper." In other words, no need to surf for food allergy news, websites and blogs. This site contains it all. I don't know how she did it, but I love it! Check out the site and sign up for the newsletter. Contact Saffie to add your website and/or blog. One-stop shopping...it's a beautiful thi...

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Our Storage and Backup Strategy

Over the past year, Harvard Medical School has worked with research, administrative, and educational stakeholders to develop a set of storage policies and technologies that support demand, are achievable in the short term and are affordable.I recently gave a keynote at Bio-IT World where I described the HMS storage strategy to ensure scalability, high performance, and reliability.Since that presentation, we've refined our strategy for replication/backup/restoration of data for disaster recovery. In many ways backup is a harder problem to solve and a more expensive project than data storage itself.Our best thinking (a strawman for now that we are still reviewing with customers) is outlined on this slideFor databases and Microsoft exchange, we're using Data Domain appliances to replace tape...

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Meaningful Use has Arrived

After months of anticipation, the definition of Meaningful Use has arrived.Today at the meeting of the HIT Policy Committee, the Workgroup on Meaningful Use presented its work, as a preamble and a matrix.The meaningful use matrix is organized into specific meaningful use goals to be achieved by 2011, 2013, and 2015. It also lists metrics for these goals to evaluate hospital and clinician progress in meeting them.Over the past 60 days, HITSP Tiger Teams have been hard at work simplifying the HITSP Interoperability Specifications by creating a small set of services which we call Capabilities. You'll see that these capabilities support all the data exchanges needed for meaningful use, including clinical operations (lab, rad, eRx, clinical summary), clinical quality (quality/performance measures,...

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Update: Food Allergies and Surgery

Today was the big day- surgery to remove tonsils and adenoids. Rather than a hospital, the surgery took place at an outpatient surgical center. I really weighed the pros and cons of doing the surgery in this location instead of a hospital, but after touring the facility, I felt good about this choice. So far so good, as my son is recovering nicely at home.During the tour, I asked to see ingredient labels for all medications. They were very accommodating. Some I had to check at home on-line as the ingredients weren't available on the container. I also checked out the labels for the popsicles and water ice they offer after the operation. The labels looked fine, but we decided to bring our own. When we arrived, my son received a special red band with all his food and medication allergies...

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Being There, Virtually

In several blog posts, I've discussed my desire to travel less but still stay connected to all my colleagues, the industry, and government via technologies that support virtual meetings. Last week was a great example of all these technologies in action. I did not set foot in Logan Airport on a single day, yet I traveled all over the world. Here's how I did it:Monday - Madison, Wisconsin via Webex. Patty Brennan led an interactive planning teleconference and presentation with 20 people to prepare for evaluation of nearly 150 proposals as part of Project HealthDesign. We had a great dialog about Patty's presentation using only a phone...

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Another Key to the Food Allergy Puzzle?

A study recently released indicates that black male children have an increased risk of food allergy compared to other groups. The study involved over 8200 participants ages 1-85. Peanut and shrimp were the most common food allergies and a study of demographics revealed that blacks, males and children, especially black male children, were found to have higher levels of sensitization associated with clinical food allergy. I don't know what that means, but I don't feel too dumb since the researchers don't either. I just appreciate that studies are being conducted and hope that somewhere there's a big room with notes, scribbles and arrows all over the walls as scientists try to unlock the mysteries of food allergy.Here's the full report from the Academy of Allergy, Asthma and Immunolo...

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The First meeting of the Privacy and Security Workgroup

Today, the HIT Standards Committee Privacy and Security Workgroup met for the first time to discuss our charge, our deliverables, and our workplan.The broad charge to the workgroup is to make recommendations to the HIT Standards Committee on privacy and security requirements for standards, implementation specifications, and certification criteria.The specific charge is to make recommendations to the HIT Standards Committee on specific privacy and security safeguards that should be included in the definition of Meaningful Use, with a specific focus on the eight (8) areas listed in Section 3002(b)(2)(B), within two (2) months of the workgroup�s first meeting.Dixie Baker from SAIC and Steve Findlay from Consumer's Union co-chair the workgroup. Dixie began the meeting with a few remarks that...

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The First meeting of the Clinical Quality Workgroup

Today, the HIT Standards Committee Clinical Quality Workgroup met for the first time to discuss our charge, our deliverables, and our workplan.The broad charge to the workgroup is to make recommendations to the HIT Standards Committee on quality measures that should be included in the Meaningful Use definition and for future EHR requirements. Also to make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification related to EHRs and clinical quality.The specific charge is make recommendations to the HIT Standards Committee on specific quality measures that should be included in the definition of Meaningful Use for 2011 within two (2) months of the workgroup�s first meeting. The workgroup will also take into consideration...

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The Mother of all Food Allergies

Now, I know when you're going through something, it doesn't help much to hear, "if you think you have it bad, listen to this one...". But if food allergies are getting you down, you gotta listen to this one...A California teen is allergic to ALL food. Her symptoms of difficulty breathing, weight loss, extreme fatigue and facial swelling, baffled family and doctors alike. As her health continued to deteriorate, an answer was finally found. The teen was diagnosed with Eosinophilic gastrointestinal disorder or EGID. This condition causes eosinophil (one of the body's white blood cells) to treat food as an invader, causing an allergic reaction.In order to get nutrients into her body, she was given the choice of a stomach pump, or drinking a foul-smelling, foul-tasting liquid. She chose the...

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The First Meeting of the Clinical Operations Workgroup

Today, the HIT Standards Committee Clinical Operations Workgroup met for the first time to discuss our charge, our deliverables, and our workplan.As I discussed in Monday's blog, the broad charge of the workgroup is to make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification criteria related to EHRs and clinical operations. The specific charge is to make recommendations to the HIT Standards Committee on the role of EHRs and e-prescribing, clinical summaries, laboratory and radiology report functionality within two (2) months of the workgroup�s first meeting.That means that by August 9, we must complete our initial work.What will that work be?On the call we discussed that the HIT Policy Committee will review a draft...

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My Top 10 Tips for Staying Healthy

My blogs for the remainder of the week will cover the first meetings of the HIT Standards Committee Workgroups - Clinical Operations, Clinical Quality, and Privacy/Security. Thus, I'm doing my more personal blog of the week today.Now that I'm 47, I'm learning to appreciate the challenges of staying healthy as I age. Based on my personal experience, here are my top 10 tips.1. Maintain a normal Body Mass IndexA Body Mass Index between 18.5 and 24.9 is ideal. An ideal BMI is more about lifestyle than diet. It takes effort!For me, the combination of daily exercise, a vegan diet, and green tea for the past 8 years has worked well to keep my BMI in the mid-normal range at 21.72. Exercise dailyI try to exercise every day through a combination of Kayaking on the Charles River, Cycling...

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Biking for Food Allergies

I love this story! Bill Arendt (Willie) is pedaling for food allergies. Willie left Los Angeles on May 10 and he plans to bike to Boston- 3415 miles to benefit FAAN (Food Allergy and Anaphylaxis Network). He charts his progress online every night. Make a monetary pledge or just leave a note of encouragement. Check out the full story.How cool is that?...

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The National HIT organizations - How it all works

Several blog readers have asked me to take a fresh look at all the organizations related to ARRA and explain how it all works. Here's my understanding:Office of the National CoordinatorThe Obama administration's ONC is different from the Bush administration's ONC in several ways. It's now funded with $2 billion to accelerate healthcare IT adoption. Its new leader, Dr. David Blumenthal has a policy focus, so we'll see broad policy guidance and specific healthcare outcome goals rather than technology for technology's sake. It has regulation - ARRA is law and there are several new privacy, standards, and implementation requirements that were only voluntary or market-driven previously. You can expect that ONC will have a major role in coordinating federal agencies' use of healthcare IT...

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Cool Technology of the Week

Today's Cool Technology blog entry is not about a product, but a concept.I've had numerous companies (more than 5) approach me in the last 90 days with a product in development that I'll call "Image Exchange in the Cloud".One of the great challenges we have in healthcare is that radiology/cardiology/GI/pulmonary/Ob-Gyn images are not easily sharable between organizations. Although DICOM is a generally accepted standard, there is not an easy to use health information exchange in most communities to send DICOM data from place to place. Sure, we could engineer numerous point to point solutions i.e. one organization's imaging modalities push DICOM images to another organizations image archive. However, such an approach is complex. Who owns the medical record? How long should the image be...

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Food Allergies in the Hospital

We're making plans. Tonsils and adenoids need to come out, and we'll be in the hospital with food allergies. This is something I've thought about, late at night, when all is quiet and I should be sleeping. What if my son ever had to be hospitalized? How would we deal with his food allergies in the hospital? I guess the good news is that we have some time to plan. I can talk to someone in patient dining services at the hospital in advance and find out what they can offer. We can bring in safe foods. With a tonsillectomy, we're probably just looking at juices, popsicles, safe ice cream and jell-o anyway. Of course then there's all the medication to worry about. What's in it? Are there any inactive ingredients he may be allergic to? I see another sleepless night coming on...Any experience...

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Our Garden

In New England, you never know what the weather will bring, so my family and I are always conservative about planting our garden. Every year for the past 13 years we've planted on Memorial day weekend.When we first moved to New England, the first thing we did was remove much of our lawn - it wastes water, uses chemical fertilizer, and various herbicides/insecticides to keep it green. Instead we planted a variety of perennials and native shrubs.Our five mini-gardens are:1. Japanese Garden - filled with Japanese ferns, bamboo, cedar, a Shinto Shrine, a meandering river of rock, and a Jizo statue.2. Vegetable Garden - we grow many of our own...

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Service Level Agreements

I was recently asked about our approach to Service Level Agreements (SLAs) at BIDMC.We develop customer facing SLA's for every new infrastructure and application as part of our standard project management methodology. We work collaboratively with the application owner and subject matter experts to develop a mutually acceptable process for support escalation, with defined availability and response times. The end result is a series of documents which outline customer and IS responsibilities, as well as provide enough detail about the application to understand its scope and uses.Customer Facing Documents:1. Customer Project and Post Project Responsibilities - This document serves as a foundation for each project and sets customer expectations for support roles and responsibilities.2. Service...

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School Carnivals, Picnics and Parties, Oh My!

The school carnival is this week. I'm in charge of food this year, because I figured if I organized it, I'd be in the know. Yeah, not so fast. "We must have popcorn", I was told because the smell of the popcorn popping is "so carnival-like". Okay, I rented the machine and got the popcorn. Does artificial butter flavor contain any dairy? "No" says the popcorn company representative. Of course I have no way of knowing what else has been put in the rented machine and no idea how well it's been cleaned. Confidence level on a scale of 1-10 with 10 being totally confident?- a 2. I'll bring safe popcorn.We're also serving water ice which is basically sugar, high fructose corn syrup and dyes. Our school has started distributing, via e-mail, ingredient lists of foods served to students at these...

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An Update to the National eHealth Collaborative

Today I'm in Washington presenting a HITSP update to the National eHealth Collaborative. My slides are available.A few highlights:1. HITSP has "turned on a dime" to focus on meaningful use and ARRA's 8 priorities:-Technologies that protect the privacy of health information-A nationwide health information technology infrastructure-The utilization of a certified electronic record for each person in the US by 2014-Technologies that support accounting of disclosures made by a covered entity-The use of electronic records to improve quality-Technologies that enable identifiable health information to be rendered unusable/unreadable-Demographic data collection including race, ethnicity, primary language, and gender-Technologies that address the needs of children and other vulnerable populations2....

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