Wednesday, January 19, 2011

The Connectathon Conference

It's a bit of a different experience being an attendee at the Connectathon Conference than it is being on the Connectathon floor.  For one, since I was speaking, I wore a suit.  Most of the people attending the conference don't know me, and I figure it makes it easier for them to accept me as an expert if I don't get too much in their face about it.  For another, its an opportunity to hear about how people are using IHE in the real world.

I missed Lisa Spellman's introduction, but I caught Elliote Sloane's (IHE International Board Chair) presentation.  Elliote talks about the history of IHE (going back to 1998), its growth, its newest (and oldest) international member (IHE USA - where he is also on the board).  He also talks about the growth of connecthon participation this year, where we have over 100 companies testing more than 55 IHE profiles.  Last year is was more than 80 companies and 55 profiles.  That's better than 20% growth.  At a dinner later in the evening, I was talking about IHE's growth since I first showed up on the scene.  It's pretty darn impressive.  Since 2001, the North American Connectathon has grown in participants at an average rate of better than 12% a year, and when I look at the total figures (Europe, Asia and other Connectathons), it is growing even faster, better than 15% a year.  I wish I was getting that kind of return on my investments.

Here's a chart of the data I dug up from the Connectathon results on connectathon participation.

Dr. Doug Fridsma, Director of Standards and Interoperability at ONC joined IHE at the Connectathon Conference as the keynote speaker.  Doug ran the audience through his current vision of the Standards and Interoperability Framework.  He highlighted some key points.  One was that specifications should be crisp, and include everything you need with nothing more, and they need to be extensible.  He also highlighted the three recently announced initiatives, one of which includes participation from 3 IHE co-chairs and one board member along with several other IHE members, that being the HL7/IHE/Health Story Consolidation project.  I also introduced several members of the IHE Lab workgroup to Doug and I believe we convinced them to participate in the Laboratory Interface Improvement project.

The Consolidation project is intended to address the biggest issue HITSP was never funded or contracted to address.  That is the creation of a one-stop specification for the implementation of CDA documents.  It goes just a bit further in that not only is there a specification, but also a UML model.  That's critical for future IHE/HL7 and ONC collaboration efforts.  If we all publish the necessary data in the UML model in a standard format like XMI (I just picked that one out of a hat), implementers of CDA would be able to:

1.  Use off-the-shelf tools to create software for reading and writing CDA documents.
2.  Create implementation guides based on the CDA standard.
3.  Share implementation guide data for use by others.

It restores what we tried to accomplish in the first years of IHE PCC by creating the content on the wiki, but in a much better way.  The MDHT CDA Tools project produces DITA output.  That can be transferred to proprietary formats like Microsoft Word, or standard formats like PDF, DocBook or even, heaven forbid, well-linked XHTML.  I'm eager to see what we can do with the tool, and hopeful that IHE PCC can begin to use it to develop profiles.  IHE Radiology is looking at MDHT as well, because they have some CDA templates to create this year also.

Mike Nusbaum gave his update on IHE Canada and how it now fits into the Canadian Standards Collaborative (until recently, IHE Canada participated indirectly, but wasn't part of the collaborative).

Lee Jones (formerly of the former ONC and HITSP) gave an update on the current health IT environment.  The most memorable phrase from his slides were "Meaningful Frenzy", which pretty much describes my life for the last year and the next two.  He also pointed out operational challenges seem to be more daunting than than the technology ones that the PCAST tries to address.  He notes that payers haven't until recently been engaged in mainstream interoperability, but that recent acquisitions of HIT by Payers may be signalling a change. 

After lunch, we heard from Dr. Keith Dreyer who is doing some truly cool things with image sharing in EHR systems at MGH.  IHE has recently developed the Image Enabled Office which looks very similar to the image integration capabilities in Mass General's LMR.  Dr. Dreyer also reports some amazing reductions in use of high cost imaging procedures using CPOE and Clinical Decision Support

Next I gave a workshop on creating IHE profiles, and again, we came up with a winner and three other proposals that will be forwarded to other IHE domains.  The winning submission which I will champion at the next opportunity in PCC is enabling information exchange from pre-surgical information systems to the hospital HIS system.  The American Dental Association is sponsoring a Dentistry Domain in IHE.  Several new IHE Denistry members joined in this meeting and developed their very first profile proposal.  The first meeting is later this week, so they'll already have something to discuss.  I didn't plan it that way and neither did they, but we've already ensured that domain will hit the ground running.  I've got another idea for IHE Eye Care on dealing with umpteen imaging devices, and I'll forward that to the cochairs.  Finally, my personal favorite will get a free ride simply because I like it.  The idea is to extend Request for Clinical Guidance (pdf) profile to enable providing feedback to a CDS Service.  The key idea here is that after providing some alternatives, the EHR can send back a response indicating what was done.  That will enable the supplier of the decision support to do a bunch of cool stuff, most notably benchmarking and metrics, but also use that feedback to improve CDS.

After all that, we gave the attendees a tour of the Connectathon floor, and Doug got a personal tour of the floor led by several IHE luminaries.  I tagged along for fun.

All in all, it was a good day.  I did manage to check in with my teams today, and they seem to be mostly on track.


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