I've described the taxonomy that we're using in the HIT Standards Committee to characterize "deployability":
Category I- Known/Certain for 2011
Standards are well-accepted and generally seen as deployable
Category II- Known/Certain for 2013
Standards exist, are determined, but are not in the market yet
Category III- Work In Process for 2013 or 2015
Need to converge/refine standards for 2013 or develop for 2015
Category IV- Standards to be determined
“Gleam in the eye,” some concepts exist but no clear path
Providing 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 implementation experience to date, known costs of implementation, and trading partner willingness to implement.
Dr. Jim Walker MD, Chief Healthcare Information Officer of Geisinger Health System, summarized the discussion as:
I. Mature – Implemented in 20% (inspired by Gartner's metric that 20% represents a tipping point of acceptance) of relevant healthcare organizations. Implementation methods and costs well specified. Success is dependent on factors external to the implementing organization at most minimally.
II. Ready for Introduction – Widely agreed on and thoroughly tested in detail. Implementation methods and costs are variable and difficult to predict. Ready for widespread implementation in production health IT. Success is largely dependent on internal factors.
III. Well Developed – Widely agreed in concept. Needs detailed specification and testing. Implementation methods and costs are largely unknown. Success is largely dependent on factors external to the implementing organization.
IV. In Development
Over the next month, the HIT Standards Committee will ensure that the concept of deployability accompanies each standard in the meaningful use matrix. This consensus assessment will enable the HIT Policy Committee, ONC, and HHS to make the final decision on meaningful use implementation phasing after weighing the impact of deployability Although it is likely that 2011 meaningful use criteria will be Category I's, there may be a few Category II's if the value/impact of early implementation justifies the effort.
As David Blumenthal said at last HIT Standards Committee meeting, stimulus dollars and the urgency to change may accelerate the ability of all stakeholders to deploy health information exchange and we should not set the bar too low.
Selasa, 30 Juni 2009
Senin, 29 Juni 2009
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, secure, virtualized environment. At HMS we use Drupal and Wordpress for content management. They also work well for hosting institutional web sites.
Interactive features - The Corporate Communications folks at BIDMC really wanted to highly interactivity. We built and bought the components they needed as follows
Blogs - Uses a SiteCore provided blogging module
Chat - a commercial application called Cute Chat from CuteSoft.
BIDMC TV (news and information videos produced by BIDMC)- Hosted by BrightCove.
Medical Edge (videos about innovation produced by BIDMC)- Hosted by BrightCove.
Podcast Gallery - Hosted on BIDMC servers.
Health Quizzes - created using a commercial application called SelectSurvey.NET from ClassApps.
Social Networking - entirely hosted by outside service providers (Facebook/Twitter/You Tube).
Secure patient web pages for communication with their families - a commercial application provided by CarePages.
Conditions A-Z - a web-based encyclopedia branded for BIDMC using commercial reference provided by Ebsco.
Search Engine - We're using a Google Appliance
Thus, the combination of SiteCore plus purchased interactive applications and externally hosted streaming video has worked very well to provide our patients with an information rich, interactive experience.
I hope this is useful to you as you implement your own hospital websites.
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, secure, virtualized environment. At HMS we use Drupal and Wordpress for content management. They also work well for hosting institutional web sites.
Interactive features - The Corporate Communications folks at BIDMC really wanted to highly interactivity. We built and bought the components they needed as follows
Blogs - Uses a SiteCore provided blogging module
Chat - a commercial application called Cute Chat from CuteSoft.
BIDMC TV (news and information videos produced by BIDMC)- Hosted by BrightCove.
Medical Edge (videos about innovation produced by BIDMC)- Hosted by BrightCove.
Podcast Gallery - Hosted on BIDMC servers.
Health Quizzes - created using a commercial application called SelectSurvey.NET from ClassApps.
Social Networking - entirely hosted by outside service providers (Facebook/Twitter/You Tube).
Secure patient web pages for communication with their families - a commercial application provided by CarePages.
Conditions A-Z - a web-based encyclopedia branded for BIDMC using commercial reference provided by Ebsco.
Search Engine - We're using a Google Appliance
Thus, the combination of SiteCore plus purchased interactive applications and externally hosted streaming video has worked very well to provide our patients with an information rich, interactive experience.
I hope this is useful to you as you implement your own hospital websites.
Jumat, 26 Juni 2009
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 for all my Boston city commuting.
I've investigating many folding bicycle technologies - Bike Friday, Brompton, and Dahon, but none is light enough, small enough, or quick to fold enough to just toss in and our of car/office/train in a few seconds. The Strida is.
The Strida was invented by Mark Sanders in the UK in the 1980's as part of his graduate work. It's use case is not long distance travel or hill climbing. It's a greaseless, chainless, gearless bike that folds in 10 seconds and is perfect for Park and Bike or Train and Bike travel.
My goal in July is to leave the car 2 miles from the Longwood Medical area in a place that's easy to commute to/from, then bike to all my remaining destinations. Admittedly our unusually wet Summer this year in Boston will make this a bit challenging, but my rayon and linen clothes drive fast. I have a messenger bag for my Macbook Air and meeting materials.
So if you're in Boston, look for me on a Strida, dressed in black and carrying a computer on my back. My only reservation is that rock climbing, ice climbing, and kayaking are completely safe compared to bicycling in Boston. My Mort level may go up a bit during this experiment. Those disc brakes on the Strida are likely to come in handy.
A lightweight, folding, greaseless bike to solve your commuting nightmares. That's cool!
Kamis, 25 Juni 2009
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 world from folks who are actively working on Personal Genomics science, policy, and education.
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 world from folks who are actively working on Personal Genomics science, policy, and education.
Rabu, 24 Juni 2009
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 2011
Standards are well-accepted and generally seen as deployable
Category II- Known/Certain for 2013
Standards exist, are determined, but are not in the market yet
Category III- Work In Process for 2013 or 2015
Need to converge/refine standards for 2013 or develop for 2015
Category IV- Standards to be determined
“Gleam in the eye,” some concepts exist but no clear path
David Blumenthal noted that the stimulus may motivate stakeholders to adopt data exchange more quickly than the past, making stretch goals possible. As a group we discussed the challenge of the healthcare ecosystem - motivating just one segment of the industry may not be sufficient to achieve data exchange i.e. standardizing EHRs to accept specific lab data standards is not sufficient unless the labs also agree to send data in a single standard format.
Janet Corrigan presented the work of the Clinical Quality Working Group. Her group is building on the work of the National Quality Forum's Health Information Technology Expert Panel to identify the Quality Data Set needed to support measurement and reporting. They are not choosing new standards or vocabularies, instead they are developing a framework of datatypes that enable the measures to be expressed in terms of EHR capabilities. For example
% of Hypertensive Patients with BP under Control [OP] requires EHR datatypes for
Age
Hypertension diagnosis
Ambulatory encounter
Systolic blood pressure result
Systolic blood pressure result
The Clinical Quality Workgroup will spend the next month specifying the precise measures in terms of datatypes that will meet the quality measurement requirements of meaningful use. They will work closely with the Clinical Operations Workgroup to ensure the needed data exchanges supporting collection of these datatypes are included in the standards chosen.
Dixie Baker presented the work of the Privacy and Security Working Group. Her group identified three categories of standards and best practices supporting security:
1) Products that can be purchased (certified by CCHIT outside the real-life setting)
2) IT infrastructure necessary to enable the product to be meaningfully used
3) Operational environment in which the product will be used meaningfully
She also described recommended wording improvements to the meaningful use matrix items that will be forwarded to the HIT Policy Committee.
Their work over the next month will be to name the security standards and best practices for each meaningful use item and the ARRA 8 items.
The entire Committee discussed some of the existing gaps in standards. These included
-Standards for ordering including lab orders
-Standards for supporting electronic reporting of some of the meaningful use measures i.e. what percentage of prescriptions were written electronically - how do you calculate the number of prescriptions written manually?
-Standards supporting some of the patient/family engagement provisions of meaningful use
Our plan is to complete the efforts of our 3 Workgroups by the next meeting of the HIT Standards Committee on July 21. The end result will be a matrix of standards, an estimate of the readiness for deployment of each standard, quality measures, and privacy/security best practices for each meaningful use objective.
This work will give ONC and HHS the lead time they need for legal review, budget impact, and rule writing by the appropriate federal agencies.
The next month will be a whirlwind of activity. My thanks and appreciation to everyone involved!
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 2011
Standards are well-accepted and generally seen as deployable
Category II- Known/Certain for 2013
Standards exist, are determined, but are not in the market yet
Category III- Work In Process for 2013 or 2015
Need to converge/refine standards for 2013 or develop for 2015
Category IV- Standards to be determined
“Gleam in the eye,” some concepts exist but no clear path
David Blumenthal noted that the stimulus may motivate stakeholders to adopt data exchange more quickly than the past, making stretch goals possible. As a group we discussed the challenge of the healthcare ecosystem - motivating just one segment of the industry may not be sufficient to achieve data exchange i.e. standardizing EHRs to accept specific lab data standards is not sufficient unless the labs also agree to send data in a single standard format.
Janet Corrigan presented the work of the Clinical Quality Working Group. Her group is building on the work of the National Quality Forum's Health Information Technology Expert Panel to identify the Quality Data Set needed to support measurement and reporting. They are not choosing new standards or vocabularies, instead they are developing a framework of datatypes that enable the measures to be expressed in terms of EHR capabilities. For example
% of Hypertensive Patients with BP under Control [OP] requires EHR datatypes for
Age
Hypertension diagnosis
Ambulatory encounter
Systolic blood pressure result
Systolic blood pressure result
The Clinical Quality Workgroup will spend the next month specifying the precise measures in terms of datatypes that will meet the quality measurement requirements of meaningful use. They will work closely with the Clinical Operations Workgroup to ensure the needed data exchanges supporting collection of these datatypes are included in the standards chosen.
Dixie Baker presented the work of the Privacy and Security Working Group. Her group identified three categories of standards and best practices supporting security:
1) Products that can be purchased (certified by CCHIT outside the real-life setting)
2) IT infrastructure necessary to enable the product to be meaningfully used
3) Operational environment in which the product will be used meaningfully
She also described recommended wording improvements to the meaningful use matrix items that will be forwarded to the HIT Policy Committee.
Their work over the next month will be to name the security standards and best practices for each meaningful use item and the ARRA 8 items.
The entire Committee discussed some of the existing gaps in standards. These included
-Standards for ordering including lab orders
-Standards for supporting electronic reporting of some of the meaningful use measures i.e. what percentage of prescriptions were written electronically - how do you calculate the number of prescriptions written manually?
-Standards supporting some of the patient/family engagement provisions of meaningful use
Our plan is to complete the efforts of our 3 Workgroups by the next meeting of the HIT Standards Committee on July 21. The end result will be a matrix of standards, an estimate of the readiness for deployment of each standard, quality measures, and privacy/security best practices for each meaningful use objective.
This work will give ONC and HHS the lead time they need for legal review, budget impact, and rule writing by the appropriate federal agencies.
The next month will be a whirlwind of activity. My thanks and appreciation to everyone involved!
Selasa, 23 Juni 2009
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 Wikipedia:
"Copyleft is a form of licensing and can be used to modify copyrights for works such as computer software, documents, music and art. In general, copyright law allows an author to prohibit others from reproducing, adapting, or distributing copies of the author's work. In contrast, an author may, through a copyleft licensing scheme, give every person who receives a copy of a work permission to reproduce, adapt or distribute the work as long as any resulting copies or adaptations are also bound by the same copyleft licensing scheme. A widely used and originating copyleft license is the GNU General Public License. Creative Commons provides a similar license called ShareAlike."
Creative Commons licenses contain four major permissions:
* Attribution (by) requires users to attribute a work's original author.
* Share-alike (sa), which is a copyleft requirement that requires that any derived works be licensed under the same license,
* No derivatives (nd), which requires that the work not be modified.
* Non-commercial (nc) requires that the work not be used for commercial purposes.
There's an automatic license generator on the Creative Commons site. I entered my preferences as
Allow commercial uses of your work - No
Allow modifications of your work - Yes, as long as others share alike
And it generated the License that now appears in the upper right hand corner of my blog - "Life as a CIO Blog by John D. Halamka MD is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License."
Now you can feel free to use my blog under Creative Commons license. Help yourself.
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 Wikipedia:
"Copyleft is a form of licensing and can be used to modify copyrights for works such as computer software, documents, music and art. In general, copyright law allows an author to prohibit others from reproducing, adapting, or distributing copies of the author's work. In contrast, an author may, through a copyleft licensing scheme, give every person who receives a copy of a work permission to reproduce, adapt or distribute the work as long as any resulting copies or adaptations are also bound by the same copyleft licensing scheme. A widely used and originating copyleft license is the GNU General Public License. Creative Commons provides a similar license called ShareAlike."
Creative Commons licenses contain four major permissions:
* Attribution (by) requires users to attribute a work's original author.
* Share-alike (sa), which is a copyleft requirement that requires that any derived works be licensed under the same license,
* No derivatives (nd), which requires that the work not be modified.
* Non-commercial (nc) requires that the work not be used for commercial purposes.
There's an automatic license generator on the Creative Commons site. I entered my preferences as
Allow commercial uses of your work - No
Allow modifications of your work - Yes, as long as others share alike
And it generated the License that now appears in the upper right hand corner of my blog - "Life as a CIO Blog by John D. Halamka MD is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License."
Now you can feel free to use my blog under Creative Commons license. Help yourself.
Senin, 22 Juni 2009
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 software
2. The Open Source community
3. The Health 2.0/iPhone as application platform/multiple thin web-application combined to provide EHR-Lite functionality community
CCHIT 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 certified, not the specific implementation at a specific site. EHR-C products should be able to meet all meaningful use criteria if implemented properly. The cost to the vendor for certification is $30,000-50,000 per product. EHR-C is for providers who seek maximal assurance of EHR compliance and capabilities.
EHR-M The Certification of a Module such as e-prescribing, lab ordering/resulting, clinical charting and data exchange. A clinician could assemble multiple modules and be certified regarding the specific functions they perform. Integration of data between modules is the clinician's responsibility. Meaningful use may be possible, but depends upon how the modules are used together. The cost to the vendor for certification is $5000-$35,000 per module. EHR-M is for providers who prefer to integrate technologies from multiple certified sources.
EHR-S The Certification of Site for the functionality that can be achieved using the software installed there. A screen capture function is used to document capabilities and this capture will be reviewed by an expert remotely. The cost is $150-300 per licensed provider. EHR-S is for providers who self- develop or assemble EHRs from non-certified sources.
In addition to these three paths, “version lockdown” is no longer needed or relevant. For EHR-C and EHR-Mcertifications, updated or enhanced versions of a code base would inherit certified status without need for CCHIT approval. For EHR-S sites, updates or enhancements would not require recertification.
I've heard a great deal of positive feedback about this new approach. The work of CCHIT to enhance its approach, the work of the HIT Standards Committee to define the certification criteria needed for meaningful use, and the work of the HIT Policy Committee to review certification in general will result in a comprehensive certification plan aligned with ARRA by the end of of 2009.
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 software
2. The Open Source community
3. The Health 2.0/iPhone as application platform/multiple thin web-application combined to provide EHR-Lite functionality community
CCHIT 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 certified, not the specific implementation at a specific site. EHR-C products should be able to meet all meaningful use criteria if implemented properly. The cost to the vendor for certification is $30,000-50,000 per product. EHR-C is for providers who seek maximal assurance of EHR compliance and capabilities.
EHR-M The Certification of a Module such as e-prescribing, lab ordering/resulting, clinical charting and data exchange. A clinician could assemble multiple modules and be certified regarding the specific functions they perform. Integration of data between modules is the clinician's responsibility. Meaningful use may be possible, but depends upon how the modules are used together. The cost to the vendor for certification is $5000-$35,000 per module. EHR-M is for providers who prefer to integrate technologies from multiple certified sources.
EHR-S The Certification of Site for the functionality that can be achieved using the software installed there. A screen capture function is used to document capabilities and this capture will be reviewed by an expert remotely. The cost is $150-300 per licensed provider. EHR-S is for providers who self- develop or assemble EHRs from non-certified sources.
In addition to these three paths, “version lockdown” is no longer needed or relevant. For EHR-C and EHR-Mcertifications, updated or enhanced versions of a code base would inherit certified status without need for CCHIT approval. For EHR-S sites, updates or enhancements would not require recertification.
I've heard a great deal of positive feedback about this new approach. The work of CCHIT to enhance its approach, the work of the HIT Standards Committee to define the certification criteria needed for meaningful use, and the work of the HIT Policy Committee to review certification in general will result in a comprehensive certification plan aligned with ARRA by the end of of 2009.
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