Lessening the Impact of Severe Allergic Reaction

Anyone who cares for someone with a life threatening allergy, whether to food, insect stings, latex, etc., carries a fear of a fatal anaphylactic reaction. When I send my food allergic child on the school bus each day or drop him off for a play date, I always have the thought, "Please let him be safe". Living with anxiety over a mix up with a cup or a snack is exhausting. Knowing that one wrong sip or bite could lead to a rapid onset of symptoms that may lead to death is terrifying.I'm encouraged by a new discovery at the University of Glasgow. They've discovered that an immune hormone, IL-33, plays a key role in the development of anaphylaxis. Patients with high levels of IL-33 had more severe anaphylactic reactions. The researchers believe that a decrease or elimination of IL-33 will...

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Cycling to Meetings - a Progress Report

The month of July is drawing to a close. Here's a report on my experiment to replace car travel with bike travel for a month.What did I find?*There is no place in the city of Boston that is faster to reach by car than bike. I average 15 miles per hour on bike and 10 miles per hour by car. A car on Fenway Red Sox days can be a painful 5 mph experience. *My Harvard and CareGroup offices are 1.2 miles apart. I can go from desk to desk in 6 minutes, since my Strida folding bike travels in and out of the building with me. Car travel is between 15 and 30 minutes, depending on traffic.*Parking in downtown Boston runs about $30 for the first hour. I saved more than the cost of the bike in one month of cycling.* The streets of Boston are narrow, the potholes are deep, and the drivers are...

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Tom Sawyer Bull Calf born to Wanda Mae

A wonderul British White cow is my Wanda Mae. She was one of my original heifers and she was nicknamed for a childhood friend who wasn't the most popular or the most beautiful girl in my neighborhood - she was more importantly the most trusted. Wanda Mae gladly took in my Midge doll for safe keeping forever and always when a very bad lady was going to throw her away. I will always remember her fondly for taking care of my Midge. My cow, Wanda Mae, is as equally unforgettable as my childhood friend. Wanda Mae is a fertile myrtle, a feed efficient femme fatale, a carcass queen, and the most gentle British White cow I've ever encountered in...

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Woo-Hoo: A $433,100 grant to Study Food Allergy Causes

I love this kind of news! The University of Chicago and Northwestern University will share a grant of $433,100 to try to pinpoint the key immune factors that lead to food allergies. The Environmental Protection Agency (EPA) funded this study through their Science to Achieve Results program (STAR). Check out the article here and read the description and approach of the study here.I'll keep an eye on this and report the results when they become available. I'm intrigued with the idea that researchers plan to assess whether pesticides produced in genetically engineered plants can trigger food allergies. There's got to be something causing this spike in food allergies. Could pesticides be the k...

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Next Steps for the HIT Standards Committee

At the July 21 meeting of the HIT Standards, we approved an initial set of standards for quality, clinical operations and security/privacy. We were told to refine these initial efforts by the next meeting of the Committee, August 20, so that ONC and CMS can incorporate the work into the interim final rule. Here's an update on the deliberations of the workgroups.Privacy and SecurityWe received several public comments about our selected privacy and security standards - those used for authentication, authorization, auditing, encryption, and secure transmission. It's important to note that the sending and receiving of transactions for healthcare information exchange is part of the scope of the Privacy and Security Workgroup. Clinical Operations specifies the vocabulary/codesets/value sets...

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The Making of the Third Generation Prius Ad

It's Summer, so time for some lighter fare (don't worry, more news from Washington is coming later this week.)I'm a Prius driver and will likely be replacing our older Toyota Highlander with another Prius, which will be my wife's and my daughter's car.The Third Generation Prius advertisement features a unique combination of people, amazing graphics, and digital assembly - over 1,000,000 people were created from 200 extras.Here's a You Tube Video that explains how the entire commerical was created. Incredible....

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Are You Walking for Food Allergy?

Check out FAAN's calendar and find the closest food allergy walk. Click on the link which will take you to the associated web page. Even if you can't walkwith a group, consider the virtual walk listed under Dec. 5, 2009. Tell grandparents, aunts, uncles, schools, sports teams, doctors affices about this easy way to help a great cau...

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A Glossary of the Data Center

I'm serving as a subject matter expert for a panel studying the IT capabilities of the Food and Drug Administration. In preparing our report, the team recognized that many FDA stakeholders are not well versed in the terms used to describe data centers. Here's the glossary that the team developmented, which I thought you might find useful for your own reports and presentations.Classification of Data Centers (Tier 1 � 4). The Telecommunication Industry Association (TIA) has published the TIA-942 standard for classification of data center capabilities.Tier 1 � Basic: 99.671% AvailabilitySusceptible to disruptions from both planned and unplanned activitySingle path for power and cooling distribution, no redundant components (N)May or may not have a raised floor, UPS, or generatorTakes 3 months...

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Bagel Day

We love to make bagels. This is what they look like after boiling them for 30 seconds and just before baking them for 20 minutes. The smell of hot bagels as they're pulled out of the oven...Yum! This recipe is safe for those with allergies to dairy, egg (no need for the egg glaze the recipe calls for), peanut, tree nut and sesame seed. It does contain wheat. We first saw the bagel recipe in Family Fun magazine. Give it a try this week-e...

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Fox Hill Farms - New York

Larry Lampman is a successful boutique beef producer in upstate New York, where he is now primarily working with British White and Murray Grey cattle. Larry uses lots of Artificial Insemination in his breeding program, and J.West Cattle has been pleased that he has chosen to work with semen from our herd as well, including our senior herd bull, J.West's Elvis, pictured here. The following article is found at CountryFolks.com , and Larry Lampman was as well featured in the past April issue of the Stockman Grassfarmer. Larry's approach to cattle production and marketing of his product is a lesson in perseverance and success. The following are...

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Documents and Messages, a Guest Blog

Yesterday on a call of the HIT Standards Committee Privacy and Security Workgroup, we had a great discussion about Common Data Transport and Health Information Exchange. This is a guest blog describing that conversation by David McCallie at Cerner, a member of the Committee."These are some principles that we try to follow in our work.*Be aware of the difference between a document and a message*A document should ideally contain data that is assembled to represent a specific clinical context � the data in the document should cohere in some meaningful way. For example, a document (e.g., a CCD) could represent a summary of an encounter, or a response to a query for a current_medication_profile, or you could have a CDA representing a radiology report with structured findings, etc.*A message communicates...

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The SNOMED-CT Problem List has arrived

As promised in my earlier blog, the National Library of Medicine has created a "best practices" subset of SNOMED-CT which is highly usable by clinicians for documenting the symptoms and conditions used on a typical Problem List.I've discussed previously the hazards of using ICD-9 as problem list vocabulary. It's an administrative billing vocabulary, not a clinical observation vocabulary.You need a free SNOMED license (if you're in one of the countries that has licensed SNOMED, such as the US) to retrieve the SNOMED Problem List document.The present subset is based on datasets submitted by 7 institutions - Beth Israel Deaconess Medical Center, Intermountain Healthcare, Kaiser Permanente, Mayo Clinic, Nebraska University Medical Center, Regenstrief Institute and Hong Kong Hospital Authority.We're...

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Gear Review- Kata HB-205 hiker backpack

This blog is on the kata HB-205 hiker camera backpack, which I purchased recently for my last shoot in Uganda.I did quite alot of research and ended up choosing the kata 205 and am glad I did. It worked really well for the shoot and was the perfect size to fit in the overhead locker on the airplane. I also purchased the trolley wheels that came in handy on the massive journey from New Zealand to Uganda. My Panasonic AG-HVX-202EN fit perfectly as well as spare batteries, microphones, and camera rain cover. I am sold on having a backpack vs. a shoulder bag as I was able to shoot with the backpack on my back and didn't worry about having to leave...

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Have You Taken The Food Allergy Survey?

If you're a FAAN member (and if not, why not?), be sure to take their survey. It's 56 questions long, but many of those are "yes" or "no" answers or responding to a question on a number scale. It appears that FAAN is gathering info about how their members use them as a resource, as well as what other ways members get food allergy information.I hope to see the results at some point. I think that for many years, FAAN was the only game in town for food allergy information. Now there is a great deal of information on the web. FAAN remains one of my most trusted sources, thou...

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BIDMC's Red Flags Policy

I recently wrote about the FTC's Red Flags Rule that must be implemented by August 1, 2009.Here are the completed BIDMC Policies needed to support this rule. Feel free to use them as inspiration for your own policies.Red Flags Policy PV-01 Designation of Organized Health care arrangement PV-11 Designation of Privacy Officer PV-14 Mitigating the Effect of an Unauthorized Use or Disclosure of Protected Health Information PV-17 Business Associate Agreements PV-19 Opt Out PV-20 Authentication Policy Appen...

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The HIT Standards Committee Deliverables

Over the past 60 days, the HIT Standards Committee and its workgroups have been hard at work mapping standards to meaningful use. Here are their deliverables:Clinical QualityThe Clinical Quality Workgroup Report describes the approach used to specify the 27 performance measures for 2011 which support meaningful use. The Clinical Quality Workgroup Recommendation matrix includes all the detailed EHR data types used to compute quality measures plus a matrix of sites of care and relevant specialties. This matrix will be expanded to reflect the readiness of measures for implementation and proposed levels of performance expectations (i.e. what threshold constitutes good performance for each measure)Clinical OperationsThe Clinical Operations Workgroup Report describes the approach used to...

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Why You Should Choose British White Cattle

Click on the title link above to visit this blog found at edublogs.org.EXCERPTS: "A breed of beef cattle know as British White Cattle has made a remarkable transition from being status symbol in medieval Britain to a mainstream purebred beef breed.. .""A British White Bull is very hard to beat in a crossbreeding program. If you are wanting to follow the experts recommendation and keep your herd half British and have a preference to white he is the bull for you. He will instill easy calving into your herd and the calves will have lots of grow in them. British Whites are know to have strong genetic traits and the ability to pass them on to their...

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Great Site for Young People with Food Allergies

Studies have shown that young people with food allergies may take unnecessary risks so they aren't viewed as "different" by their peers. They just want to fit in. Perfectly understandable, but this is something that strikes terror in the heart of parents of food allergic kids everywhere.That's why I love this new Canadain site: Why Risk It. Sponsored by Anaphylaxis Canada, the site allows teens and young adults to share their stories about life with food allergy. Covering everything from school to dating to dining out and more, people share their stories and learn from one another. It appears to be quite appropriate for younger kids as well. Well done, Anaphylaxis Cana...

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Securing our Blackberries

New Massachusetts Data Protection regulations require us to secure mobile devices.At BIDMC, we have nearly a 1000 Blackberries and hundreds of iPhones. The Blackberry has well developed enterprise control features, so we're starting our mobile security effort with them.In the interest of sharing our experience with the IT Community, you'll find our proposed policies here. It's a work in progress and we're still fine tuning our approach. To better under the impact on users, several IT staff including me will be testing these new settings.There are an amazing array of settings to secure Blackberries - you'll find the complete configuration guide here.It's clear that organizations are finding the balance between security and ease of use to be challenging. Here's a few describing others...

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Client Testimonials

�I just finished watching your Soft Power Health film and I think its great - I really like it and I think you touched on everything that's important for us and did it in a really good and effective way. The filming is also really beautiful! I am excited to watch it again too! I think you did a fantastic job and I am really psyched about the piece.� � Jessie Stone - Founder Soft Power Health...

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An Update to Meaningful Use

On June 16, I wrote about the release of the draft definition of meaningful use.Today, at the HIT Policy Committee meeting, the final definition of meaningful use was released and adopted. What was changed?1. For inpatient CPOE, only 10% of orders must be entered electronically2. For problem lists, ICD9 or SNOMED must be used3. Advanced directives must be recorded4. Smoking status must be recorded5. Quality measures must be reported to CMS6. Clinicians and Hospitals must implement at least one clinical decision rule relevant to a high clinical priority7. Administrative transactions, including eligibility and claims, must be completed electronicallyAlso, the timing of meaningful use was clarified in this presentation on Slide 12 and 13 The Meaningful Use Workgroup recommended use...

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Film making on a shoestring part 2

This blog is a follow up on film making on a shoestring.A question got asked about editing.I recommend using Final Cut Pro as your editing program, and definitely on a MAC.A really great website that teaches Final Cut Pro along with other creatively orientated programs is:http://www.lynda.comI highly recommend this way of learning and it has been invaluable for me, and wish I would have found it years ago!have fun and good lu...

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Asthma and Food Allergy Camps

Since 1988, the Consortium for Children's Asthma Camps has actively coordinated the activities of asthma camps across the US. Through these camps, children have a typical camp experience with the added benefits of quality medical care and asthma education as part of the camp routine. What a wonderful opportunity for kids to be surrounded by other kids who deal with the same specific issues they face every day. How comforting for parents to send their child with asthma to a safe environment. That got me thinking. Is there a similar opportunity for kids with food allergies? I did find a "Family Session" available at the Center for Courageous Kids, in Kentucky. Specifically, they are offering a Family Fall Retreat week-end Sept. 11-13, 2009. I'd love to see a consortium of camps nationwide...

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Going Home Again

Last weekend, my wife and I flew to Northern California with my daughter to connect her with a group of students traveling to Japan for intensive language study this summer. After dropping my daughter off on her flight to Tokyo, my wife and I drove to every site that played a role in our 30 year relationship.We met in 1980 at Stanford in the dorm complex next to Lake Lagunita. I was in Granada, she was in Eucalypto. We visited our old dorms and found the forests we walked in replaced with construction over the past 30 years.In 1982, we served as live-in companions to Dr. Fred Terman, the former provost and Dean of engineering. We visited...

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Dispatch from Washington

Today I was in Washington attending two important meetings - an Institute of Medicine gathering to discuss healthcare information exchange and the HIT Policy Committee Certification/Adoption Workgroup.The Institute of Medicine meeting brought together 30 experts from computer science, informatics, and the health information exchange community to discuss the applications of grid computing technologies to health information exchange.I presented an overview of the HIE work in Massachusetts and Indiana using these slides. Ken Buetow from NCI presented an overview of the major concepts from Grid Computing efforts to date.We discussed the possibility of using Grid Computing methodologies in healthcare clinical care, population health, and research. Here's an overview of the vision (NCHI) presented...

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Food Allergy Movie

Are there people in your life who just don't get food allergies? Check out this 83 minute documentary all about food allergies. Produced, directed, and edited by Kevin J. Lindenmuth, "I'm Not Nuts: Living With Food Allergies", clarifies the misinformation people commonly have about food allergies. Interviews with medical professionals and families bring a realistic viewpoint to dealing with food that can be dangerous to those allergic to it.It would make a perfect gift for grandparents, teachers, doctors, child care workers and others who need to hear about food allergy issues from someone other than y...

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Device Convergence

My daughter is spending the summer in Japan and needed a platform that includes:* A comprehensive English/Japanese dictionary with support for hiragana, katakana, and kanji* Support for flashcards, tutorials, and other types of interactive educational multimedia* 3G Wireless with an option for WiFi (WiFi is not widely available in Japan because Wide Area Wireless is so good)* Browser support including Facebook, which her class is using as a kind of groupware* Music support* Camera/video support* Compact size with reasonable battery lifeAs the home CIO, I have access to many platforms - Windows, Linux and MacOS laptops, subnotes, netbooks etc. She tried many devices.In the end, she chose an iPhone 3GS, retiring her existing cell phone, iPod, netbook and camera.My wife is also studying...

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Youth Raises Money for Food Allergy Research

A 12-year-old food allergic Pennsylvania girl is raising money for food allergies by selling singing e-mail grams. Emily Z. created www.ezgreetings.org, as a bat mitzvah project. Through the site, customers can order a $5 singing email gram for any occasion. When an order comes in, Emily records a singing gram and sends it to the designated recipient with a personal message from the customer. "EZgreetings combines my love of singing and graphic arts into my project, and it supports a cause that matters tremendously to me, food allergy research," says Emily.Her site, has raised over $1000. You go, girl!Why not give it a try? Just a note...the links didn't work in Firefox. Go to Internet Explorer to check it out. Also, it only works on PC's, not Ma...

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Filmmaking on a shoestring

I recently got asked if I had any advice on filmmaking on a shoestring and thought it was a good topic to write about here.I think that the bare essentials in terms of gear are:Broadcast quality camera- why bother making a movie and investing all of that time money and energy if you don't have a quality result. You never know who may like your film and you may even be able to onward sell footage after your done shooting. Good microphones- sound is essential to a good film. It is imperative that you invest in good mics. I recommend Sennheiser wireless lavelier microphones and also sennheiser shot gun mic. http://www.sennheiser.comTripod- nothing is worse than a shaky shot. (unless that's the look you are after). But using a tripod is key when possible.I know all of this will add up to a few...

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Cool Technology of the Week

In an era of ubiquitous WiFi, many meeting rooms have guest wireless connections available for visitors.However, some government agencies, some larger firms and some healthcare facilities are concerned about the security implications of uncontrolled wireless access points and do not offer connectivity to visitors.How do you solve this problem? The Verizon Intelligent Mobile Hotspot (MiFi) brings a WiFi network wherever you need it.I recently had the opportunity to test it in a meeting. I put the MiFi device (about the size of a pack of cards) in the room, turned it on and a few seconds later 5 people in the room had 802.11 b/g WiFi at 1...

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Food Allergy Death: Camp Held Liable

It's such a sad story...A 13-year old Australian boy died from anaphylactic shock after eating a food pouch that contained peanuts. The boy was a cadet on a 3-day training camp. His parents had informed the appropriate authorities about their son's peanut allergy. As a matter of fact, SEVEN of the cadets were known to have a peanut allergy. The medical information provided by the parents was not distributed to those who handed out food to the cadets. So what can we learn from this experience? Never worry that you are being too over-protective. Make sure you've spoken to every adult who will have direct contact with your child.Insist that your child wear a medical bracelet or other identifier at all times. Consider providing safe food and instructing your child to eat only provided food.Ensure...

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Blog Spamming

As folks who visit my blog may have noticed, I have activated Word Verification for comments. This prevents automated systems from adding comments to my blog, since it takes a human being to read the word graphic and interpret it. I also turned on Comment Moderation for comments older than 14 days.A few weeks ago, blog spammers posted advertisements to every one of my 400+ blog entries. I've not found a way to bulk delete comments, so I've been reviewing every previous comment and deleting the spam.With the new settings, I can bulk reject dozens of spammed comments that are posted to my blog each day.It's a shame that spammers believe junk comments on blogs are an effective means of advertising. I apologize for the Word Verification and the Comment Moderation, but its the only way I...

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It's the Era of ARRA

Today at the HITSP Panel meeting, we approved the work our Tiger Teams completed over the past 60 days to support ARRA:*EHR-Centric Interoperability Specification*Exchange Architecture & Harmonization Framework Technical Note *Data Architecture Technical Note*Access Control Service Collaboration*Security Audit Service Collaboration*Patient Identification Management Service Collaboration*Knowledge and Vocabulary Service Collaboration*Healthcare Document Management Service Collaboration*Query for Existing Data Service Collaboration*Administrative Transport to Health Plan Service Collaboration*HL7 Messaging Service Collaboration*Emergency Message Distribution Service CollaborationWhat is a Capability?A HITSP capability is an implementable business service that specifies interoperable information...

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ZEER: The Easy Way to Find Better Food

Have you heard about ZEER? Created in early 2008 by Mike Putnam, ZEER is a continually updated food information resource for people who want to know ingredient and nutrition information in the foods they eat. Perfect for those who deal with food allergies and/or intolerances.This week, ZEER launched ZEER Select, a gluten free database full of information for those who need to avoid gluten. The company plans to offer a similar experience for other food allergies and intolerances in the future. In the meantime, with over 30,000 food items (and 500 products added or updated every week) it's easy to search for a wide variety of foods.I had the opportunity to get a sneak peek into ZEER Select, which is offered by subscription at $14.95 per month. Users can search foods by name, category or UPC...

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A Single Point of Disclosure

The American Recovery and Reinvestment Act of 2009 (ARRA) states that the HIT Policy Committee shall make recommendations on standards, implementation specifications, and certifications criteria in eight specific areas (the ARRA 8) including "Technologies that support accounting of disclosures made by a covered entity" .The first draft of meaningful use includes three requirements for Population and Public Health data disclosure:-Submit electronic data to immunization registries where required and can be accepted-Submit electronic reportable lab results to public health agencies-Submit electronic syndrome surveillance data to public health agencies according to applicable law and practiceHow can Massachusetts enable these data exchanges and at the same time document disclosure?The answer lies...

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Update Food Allergy Bill

Below is a note I received about Pennsylvania's efforts to make schools safer for food allergic children. Thank you to all of you who wrote letters on behalf of this bill. I hope it continues forward through the PA House Appropriations committee and becomes law providing a model for other states and countries. We need to make schools everywhere safe for all children!Please forward to your membership and friends who assisted with our efforts on HB 1148.The bill was unanimously passed by the Education Committee. Thank you one and all for your support of HB 1148!!The bill will now move to the PA House Appropriations Committee. As the legislature is now engaged in producing a budget, we will wait for the budget to be passed before we begin our communications with the Appropriations Committee...

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International EHR Adoption

I was recently asked to compare EHR adoption in the US to other countries. Based on my own experience and the comments I received from colleagues, there are three aspects to consider:* Use of Ambulatory EHR* Use of Inpatient EHR* InteroperabilityAmbulatoryThe most widely implemented are England, Denmark, Netherlands, and certain regions of Spain which are close to 100%. Sweden, Norway are at 80% and behind and Germany/France are at 50%. The US is somewhere between 2 and 20%, depending on how you classify a comprehensive EHR. Based on my definition - codified problem lists, e-prescribing, and decision support, the US is below 10% adoption.InpatientTeaching institutions are generally well equipped, although less sophisticated on average than the US. Coverage in mid-low tier hospitals is...

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Swine Flu Vaccine Safe for Those with With Egg Allergy?

The swine flu vaccine has been on my mind. A post I read originally on Life With Food Allergies Blog has given me hope. Reportedly, drug company Novartis, has created a swine flu vaccine that will be safe for those with egg allergy. I stil have a bunch of questions, though. It seems that other companies will be manufacturing swine flu vaccine that wouldn't be safe for those with egg allergy. How will distribution be handled? People who can't have the egg-based vaccine should certainly be the top priority for the new vaccine. Also, will the FDA cause this vaccine to hang up in the US? If it is available in Europe, can we go there to get the vaccine for our egg allergic family members? It seems there are no clear cut answers to these questions yet.Does anyone else know anything about...

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The Joy of a Local Hardware Store

Let me describe two experiences:I walk into a big box home improvement store and ask for advice about screens for storm windows that were popular in Wellesley, Massachusetts in the 1960's. No one has any idea what I'm talking about. Not just about my storm windows, but any storm windows. The store is 40 aisles of 20 foot high racks without an easy to navigate map. Oddly, screens are not in the Windows section, they're in the Building Materials area. No one knows what tools I need or how much screen I should purchase, so I make several trips back and forth from home to store. I spend hours in the process and throw away an entire roll...

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The HIT Symposium at MIT

This morning I joined a panel discussion about Standards at the HIT Symposium at MIT.We had a great panel discussion, moderated by Janet Marchibroda (Chief Healthcare Officer at IBM) that included Christine Bechtel (Vice President, National Partnership for Women and Families Patrick Gallagher (Deputy Director at NIST) and me.Patrick provided an overview of NIST and the work the government is doing to ensure selected healthcare standards perform as advertised, are implementable, and usable.Christine described the role of the HIT Policy Committee and its workgroups.I described the current HITSP Tiger Team work, the standards committee/workgroups including their charge, purpose, milestones.Here's my presentation that describes all the latest standards work for the country.On the last slide,...

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Food Allergy TV Show

A TV Show called "You Won't Even Miss It" is cooking up some great recipes for those with food allergies.You can check out their episodes online by clicking the link above and then clicking on "TV Show". Learn how to make allergy friendly dishes such as Mango Creamsicle Smoothies and Asian Chicken Salad.My mouth is watering...What do you thi...

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