tag:blogger.com,1999:blog-733074358901582680.post1268324979717152259..comments2024-03-23T05:28:35.472-04:00Comments on Healthcare Standards: Thoughts after a Standards MeetingKeith W. Boonehttp://www.blogger.com/profile/16883038460949909300noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-733074358901582680.post-55358568507465165462011-06-16T11:23:02.931-04:002011-06-16T11:23:02.931-04:00Thanks Keith. When explaining what happened to oth...Thanks Keith. When explaining what happened to others back at the farm, it helps when I can give them a link to your blog and not have to rewrite it all. Despite the "ripping to shreds" of the Architecture/RI scope, I think we came out still afloat with a more accurate scope statement by the end. As to Steve Waldren's question about the "solution" coming out the end, I think that the ToC reference implementation will include open source code to take discrete data (provided via an API) and create content in the form of the "ToC information packages" described in the use cases. Examples: Discharge Summary (in my world, people still want this context, not just isolated components of data), Consultation Referral Request, and two others. And also code to take an inbound information package and decompose it into standardized data elements, which an EHR could then import and reconcile (though the import and reconcile are not in the scope of the ToC RI). Xxisting EHRs would need "adapters" to be able to use this code, though a EHR built from scratch around the Clinical Information Model might need less adaptation. ToC content needs to be secured and transported, so I foresee the ToC Reference Implementation as one piece of the puzzle that would be complemented by other pieces such as Direct Project or IHE XDR. If using Direct (which is, wisely, content-agnostic), then the ToC Information Packages would be encrypted via S/MIME and securely transported to the intended recipient. Reference Implementations, or pieces thereof, from both the Direct and ToC projects could be used. <br /><br />I think one of the challenges is how many EHRs will adopt reference implementations since most are already "well down the road" in some of these ToC content creation functions. Will they say "it's just as easy to create the package myself, as to map to the CIM and to have the RI do it?"Davidhttps://www.blogger.com/profile/13251393010554964308noreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-47561837798322876662011-06-15T12:25:44.298-04:002011-06-15T12:25:44.298-04:00Well, if I knew there would be sushi involved…….
...Well, if I knew there would be sushi involved……. <br /><br />I wish I would have been able to attend, a lot going on in health IT these days and they have still outlawed cloning. Thanks for the update on the activities Keith. <br /><br />Regarding your analogy of the motorcycle and car; I would agree but I think the CDA/CCD is more like a kit car (still working on Lvl 3 templates and requires a lot of learning by developers). If one can get all the pieces together and get it running well, then the top speed will be higher. In the meantime the bike is well down the street. Of course, the general computer industry is using rocket power! I get reports from several people that the CCD doesn't seem up to the job either.<br /><br />I think the real issue is not CCR or CCD but rather documents or data. It just seems, people cannot let go of the old paradigms. A discharge summary is not important, rather the list of current and d/c'd med; list of active and resolved issues; list of results, etc. is what is important.<br /><br />The nice thing about the Direct Project was that there was a requirement to create a reference implementation - e.g. there must be a solution at the end of the work. I am struggling to see what the "solution" will be at the end of the S&I ToC.<br /><br />Anyway, it would of been nice to see you. We see things differently and have different experiences and it always fun to learn and debate cordially with you.<br /><br />Best,<br />StevenSteven E. Waldren, MD MShttp://www.linkedin.com/in/stevenwaldrennoreply@blogger.comtag:blogger.com,1999:blog-733074358901582680.post-76535647589433936712011-06-15T10:37:01.298-04:002011-06-15T10:37:01.298-04:00Oh, this is sounding so familiar!
You're not ...Oh, this is sounding so familiar!<br /><br />You're not the first to suggest that the Canadian Model might be something for ONC/S&I to look into more closely (see http://motorcycleguy.blogspot.com/2009/12/canadian-perspective-on-standards.html). It's evolved quite a bit in the last couple of years, and has provided a model that has been deployed in a number of other countries.<br /><br />As I've said in the past, being a participant in IHE (actively) and HL7 (occasionally), and having worked as staff at HITSP, I am willing to help my US colleagues understand this model and how it might fit into the US context. My door is always open, and I can be compensated with Sushi!!!! :)Mike Nusbaumhttp://mhnusbaum.comnoreply@blogger.com