On Codes

Recently, a request came in to change some of the codes for an HL7 Vocabulary (specifically the < and > codes in ObservationInterpretation). The complaint was that these characters must be escaped in XML.  

This spawned the usual deluge of e-mails about proper ways to generate identifiers for codes.  The best practice according to the erudite vocabularists is to use meaningless (semantically void) code values.  This, everyone agrees, is the best practice for managing code systems.  Well sure it is, when you have thousands of codes and nobody is ever expected to have to interface with the code system directly through code values.  But when you have a small code set, or one like ICD where people are expected to interface with these identifiers directly, mnemonic, or at least easy to remember code identifiers make sense, at least for the people who have to use them.

The only absolute I ever learned that hasn't failed me yet is that there are no absolutes.

   Keith

P.S.  I've never had to escape those codes when creating XML, or any other special character for that matter.  If you have to worry about XML syntax in your code, you are doing it wrong.  Use a tool, don't write it manually.

Not necessarily an ePatient

There are days when I feel like an outsider to the ePatient movement.  An alien looking in.  I may show up in a list of e-Patients somewhere, but I'm not really a patient, because I get paid to work in healthcare (or so the theory goes). But I feel like a patient, and I act like one. In my day to day work, I think first like one. At the same time, I've been told in no uncertain terms that I can't be, because I work for "The Man", and am a cog in the wheel of the healthcare industry. Others, even more supportive of patients are thrown in the same boat, because they too are part of the system.  And God forbid you should be an MD, except with some very good supporters in the wings.

I've seen the healthcare industry be dumped on because it doesn't properly engage with patients.  Over the past year I've seen numerous conferences and industry events picked on because the don't respect patients enough in some way. They don't offer patients scholarships, or make the prices affordable for patients, or have patients on the organizing committee, or as speakers. Provider organizations, ACO's, HIE's, et cetera, are all at fault because patients aren't present.

At the same time, I know how to do things on a budget. I know of many organizations that I can join for free, and some for as little as $30 a year that provide me with a great deal of inside track information. Geeks like me don't get to go to every conference then want to.  I'd love to go to AHIMA, AMIA or MedX, but they are unlikely to be on a list of conferences I'm approved to travel to (maybe when I become Chief Geek). Yet, I know many ways to get into a conference that don't require me (or my employer) to foot  the bill. You want to get into a conference for free, the way the pros do?  Offer to speak, and not at the last minute (a couple of weeks beforehand), but 6-11 months before when the call for speakers or papers goes out, and have a good message. Or get someone to fund you to go. If you represent a stakeholder group and they cannot fund you, are you really representing them without any of their skin in the game? Or are you just pretending to?  If you have a message to send, and you aren't getting on the right agendas at the right time, whose fault is that? The organizers?  Or yours? If you aren't at a conference to provide a message, then you are there to take one back. If the take-away is something you cannot share, should you be expected to pay less for it than anyone else?  I'm not so sure about that.

Equipped, enabled, empowered and engaged is the motto. Be it. Don't ask for a free ride, or complain when it isn't given. Find a way; learn the landscape, and engage back. Figure out who to talk to and when to talk to them to be effective. Stop whining, and start doing.

In some ways, I think as an insider, my job is a lot harder.  I have to weigh every decision against what it means to take home a paycheck, and still figure out how to do the right thing, in a way that works for everyone.  A simple "patient" can argue that they should be supported, and everyone will clap, and nobody above them exists to care about the business impacts of that message.

But insiders like me, we've got to sell that to an audience that doesn't want to hear it, and make it march, and sound like a good idea for them, and the upper-ups.  Let's see, what was that message?  Oh yeah, "Spend less money on healthcare, and provide it better and cheaper". Back in the day when I sold computers out of a retail storefront, we had an expression that explained how that worked.  You see, we sold below cost, but we made it up on volume.

Now, I'm not saying the healthcare industry is right, or that things don't need to change.  But what I am saying is that it isn't whether you are an insider or not, or a patient or not, but rather what you do and the message that you send that matters.  And if you want to be tagged as a "Patient", go for it, but at the same time, work it like a pro would, you'll be far more effective.

Thank you

I get thanked an awful lot for my work on CDA, and it feels good to be thanked.   But my work wouldn't nearly be so meaningful (no pun intended THIS time) if weren't for all the people who are implementing the standards that I work on.  So, to all those implementers, thanks for doing what you do, and keep up the good work.  

Oh, and Happy Holidays to everyone!  And may you all have peace, at least for a week.  I promise that ONC won't release anything tomorrow [not that I have any control over what ONC does, I just know the FR will be closed].

BREAKING: Dr. Karen DeSalvo announced as new National Coordinator

This showed up in my inbox this afternoon.  You can read a recent interview with Dr. DeSalvo here.

---

From: Sebelius, Kathleen (HHS/OS)
Sent: Thursday, December 19, 2013 11:19 AM
To: OS - Political Staff; OS - ONC Feds (HHS/OS)
Subject: Important Staff Announcement

Colleagues,

I would like to announce that Dr. Karen DeSalvo, who currently serves as the City of New Orleans Health Commissioner and Senior Health Policy Advisor to Mayor Mitch Landrieu, will be the next National Coordinator for Health Information Technology here at the Department.

During her tenure, Dr. DeSalvo has been at the forefront of efforts to modernize the New Orleans health care system. Following Hurricane Katrina, for example, she led projects to increase access to care by augmenting the city's neighborhood-based medical homes for low income, uninsured and other vulnerable populations in the New Orleans area.

Throughout her career, Dr. DeSalvo has advocated increasing the use of health information technology (HIT) to improve access to care, the quality of care, and overall population health outcomes –including efforts post-Katrina to redesign of the health system with HIT as a foundational element. She served as President of the Louisiana Health Care Quality Forum, the Louisiana lead for their health information exchange and regional extension center grants. She has also served as a member of the Steering Committee for the Crescent City Beacon Community grant.

As the New Orleans Health Commissioner she has made the increased utilization of HIT a cornerstone of the city's primary care efforts and a key part of the city's policy development, public health initiatives and emergency preparedness. Further, she has led the planning and construction of the city's newest public hospital, which will have a fully-integrated HIT network. Her work as commissioner has led to positive changes to the way healthcare providers deliver care to their patients, improved accessibility and outcomes for patients, and improved the health of all New Orleanians. Dr. DeSalvo is a graduate of Suffolk University, Tulane Schools of Medicine and Public Health, Harvard School of Public Health.

Dr. DeSalvo's hands-on experience with health delivery system reform and HIT and its potential to improve health care and public health will be invaluable assets to the Office of the National Coordinator and the Department. I would also like to take this opportunity to thank Dr. Jacob Reider, the Acting National Coordinator for his leadership of ONC during this time of transition. I am pleased she is joining our committed team, and ask you to join me in welcoming her to HHS when she starts on Monday, January 13th.

Sincerely,

Kathleen Sebelius

A Catalog of Meetings

We all participate in far too many meetings.  I thought if maybe we could catalog and number the different kinds of meetings we participate in, it might help us prepare better for them.

1. About the Recent Crisis:  This meeting includes every possible stakeholder, and is called by leadership to yell about the current crisis, and scramble to try to solve it.  If you are busy solving this crisis, skip the meeting, because what you are doing is far more productive.  However, it is considered good form to send a nice e-mail to all involved letting them know why you won't be present.  To avoid a command performance, it helps if you misspell the meeting leaders e-mail address in your response.
2. The Weekly Status Meeting: Judy and Tom will spend half the meeting time having a conversation they should have had in the hallway before the meeting started, while the other six of you check your e-mail, read your RSS feeds and respond to urgent requests.  Tim's presentation which is planned to occur at the end of the meeting will have to be delayed until next week because we ran out of time. Everyone else, please be sure to respond to your manager's latest e-mail on being sure to complete whatever it was before the close of the quarter.
3. The Kickoff Meeting:  That new project that everyone has been preparing for over the last three weeks is now going to be officially kicked-off by management.  That means all time is now billable. We will have 45 people packed in a room (or on a webex) while the leaders present slides that those of us who have been around a while have all seen at least seven variations on.  This meeting is mandatory for everyone.  This is a good day to take some personal time off for that Doctor's appointment you've been meaning to have.
4. The 15-Minute Stand-up Meeting: Delayed due to technical difficulties, and for some reason, Mary didn't get the e-mail, so could someone go track her down?  Oh, and we need Jim today too, can you see if he is on Skype and let him know to dial in?  Oh yeah, the meeting number, isn't it in the e-mail?  Sure, let me read it off to you.
5. The Quarterly Report: Things are going OK (or getting better), we did about as well as could be expected in this market, and for the most part, senior leadership thinks they will earn their bonuses for the year.  Thanks to George and Liz who worked really hard closing that last really big deal we should have had at the beginning of the quarter, for saving all our butts.
6. Replanning: The sky is falling, the project is late, how are we going to deliver on the original schedule?  We need to double down our efforts and improve our efficiency to make this better and reassure management that we know what we are doing and that we won't be late.

If you should need to schedule any of these meetings with me, please simply order it by number, and I will respond appropriately.

WEBINAR: Learn More about ONC's Proposed Certification Timeline Join ONC on Wednesday, December 18 for a webinar discussion regarding the proposed regulatory timeline for EHR certification criteria for 2015. Web Conference Information Conference Line: 888-469-1748 Meeting Number: 243-89 ONC subject matter experts will provide information about the new timeline and then will be available for a question-and-answer session following the presentation. Agenda ·         Certification of EHR Technology: Proposed Certification Regulatory Timeline Steve Posnack, Director, Federal Policy Division, Office of the National Coordinator for Health Information Technology   ·         Q & A Steve Posnack and Nora Super Register Now! Sincerely, Nora Super Director, Public Affairs Office of the National Coordinator of Health Information Technology

Predictions on the MeaningfulUse 2015 Certification Criteria

You've all probably heard by now that there's going to be a change to the Meaningful Use Stage 3 roll-out. This new strategy allows ONC to advance on Stage 3 in a step-wise fashion, without the all-or-nothing commitment to new standards present in prior years.  So, what is in store?  I don't have any real inside track knowledge, just the same awareness that everyone else could have if they participate in standards development activities.  These are my guesses.

1. Blue Button Plus: Let's face it, with all the discussion going on around patient access, and the really close proximity of V/D/T to Blue Button Plus already, this one is just a no-brainer.  I'd be surprised if it wasn't included.
2. Laboratory Orders: The S&I Framework Laboratory Orders initiative has resulted in the HL7 Publication of a new implementation guide on Laboratory Orders.  It's a good bet they'll want to try this out before making it a requirement of stage 3.  I'd say this is a pretty solid bet.
3. HeD and VMR for Clinical Decision Support: Why kill yourself trying to get something done quickly if not to use it?  Thus I predict that HeD and VMR will be included in the 2015 criteria.  I'm fairly certain these two will make an appearance.
4. HQMF Release 2 for Quality Measures:  Quality Measures released by CMS have been structured using HQMF Release 1 since the start of the Meaningful Use program.  Release 2.0 of that DSTU makes them computable from within the EHR.  Another pretty solid bet, but tempered by the fact that I've got a lot personally invested in this project, and may be more hopeful than reality might otherwise suggest.
5. What is CCDA Release 2.0 for $357 Alex.  I'm somewhat dubious here.  Yes, I think ONC wants it, but I'd be very challenged to understand how it works alongside the currently selected work, especially as an optional certification.  You'd have to support the 1.1 version as well, because some systems will only work with that.  Yes, the structure is mainly the same, but the way that it is identified that makes it challenging. I'm hoping ONC treads carefully here, but I'd give this one even odds of being in the proposed rule, and some small chance it could drop out in the final rule.

My bets are placed.  How about yours?

On Influence

Recently, I was asked to explain my role in terms of the processes I use.  The idea seems almost as oxymoronic as the phrases "creative process", or "innovation process".

For example, what is the process for being influentual?

Looked at properly, as a process that takes some time to execute, it can be explained in part:

• Associate your self with activities that will be influentual (so that some of that rubs off).  figuring out what activities will be influential includes:
• guessing (in an informed manner)
• being lucky,
• and influencing others to think that it is important by your own behaviors (e.g. implementig, promoting).
• Take on influential leadership positions, and then do the work associated with them.  Note that many working groups are looking for cochairs and facilitators, and that those positions are basically there for the asking (and doing the work).
• Try something innovative and succeed (that may involve failing a few times first, try to minimize that, but don't avoid it)
• Repeat what works and refine it, even if it was unintentional or unplanned (like this blog),
• Don't expect immediate results, but always strive for them.

Does the process work?  Yes, it does, but following it does not guarantee success.  Sometimes there is just too much working against you to succeed.  In that case, just as in poker, you need to know when to fold 'em, and save your bets (and effort) for where they will be more beneficial.

Old Friends and New

This is the fourth time this year I've been to Riyadh.  Briefly, I'm working with the Ministry of Health on their National e-Health Strategy.  It's a huge initiative in this country, with a very long term vision and lofty goals. As part of this project, I've be doing workshops on standards, and how to use them to meet some of those goals with various physicians, nurses and other healthcare and IT professionals.  If you look at the first picture on the link above, and find the Enterprise Standards and Profiles component, I'm working right in the middle of that part of it.  It is extremely interesting and demanding work, especially as you see all of the the various timelines shown in the image below. Imagine having to herd all of those cats.

If I had one think to say about the team who is working with us, its like "Dude, we're getting the band back together."  I get to work again on a national program with many of my friends from HITSP and who have also been working on regional and national and international programs elsewhere.  But in addition to old friends, I've also made some new ones:

Me with the Saudi Healthcare Standards Team

Yes, that's me in a thobe in the middle wearing traditional Saudi garb, next to the Chief Architect also in the middle, with two of the Standards Specialists (a new role in the Ministry I imagine) on either side.  

You may wonder, especially those of you who work in standards where the Middle East and Africa are in Healthcare standards.  Well, they are coming, and these gentlemen are leading the way.  I hope to introduce you to them someday at an IHE or HL7 meeting.

Fhew!

This morning (at 3:00am), I finished my last class in my first term as an Informatics student at OHSU.  I have mixed feelings about it, although I would have to say that mostly, I am quite happy about it.  I'll miss poking fun at Bill at getting hammered by Paul (with homework and readings), and chatting in the forums with other students.

What did I learn?  Wow.

How to be a student again, and what a difference at a personal level wanting to succeed and do well does for learning.  How technology can help or hamper your efforts, and what it means to have to think about dealing with it when you aren't in control of your location.  For example, I was greatly challenged accessing video during the day here (limited hotel bandwidth), but fortunately for me, that didn't interfere with tonight's presentation. It's one of the reasons I didn't object to the time, trying to do a virtual meeting with three or four video feeds is tough on bandwidth.  Also, being prepared with the materials on my iPad helped, and I'd like to thank Bill for getting those Zipped up to make downloading them from home easier.  But those are not the things you probably care about, so let me get to them.

Dr. Paul Gorman's class on the Practice of Medicine was an awesome experience for me in many ways.  I got to look at situations from a different perspective (which is the intent of the class).  Interestingly enough, I was in a very small group of people who didn't have a clinical background.  Most of my classmates probably felt that this material was much easier for them, given that they already had it.  It made me push all the harder to keep up.  Here's a quote from the Syllabus (I would have pointed you to it online, but they are apparently updating it).

Course Description

This course introduces the medical informatics student to the clinical practice of healthcare including

• The underlying biology and manifestations of selected disease states;

• The information gathering and reasoning processes used to detect, understand, and treat diseases;

• The health professionals who provide and support care;

• The clinical settings in which care takes place.

The objective is to enable non-clinicians to understand the context, the vocabulary, and some of
the challenges for supporting clinical work in real settings with informatics tools.

Each week we look a new case.  Over the term, what you have to do for each case builds from the previous week's material.  We also here from other clinicians, including a PA, a pharmacist, and a nurse.  Be thankful you have the web for this class, I cannot imagine any other way to access information more readily.  The OHSU Library also makes some great online resources accessible to you as a student (I might just have to become a lifelong learner for that alone).

My brain is still trying to process all I learned from that class.  When it emerges and I start to synthesize that into my work, I know I'll be looking at things just a little bit differently.  Fortunately for me, I can also remember how things were before I learned something (although it takes a mental gear shift), so I don't expect that I'll go completely "Academic" on you.

Dr. Bill Hersh's Introduction to Informatics class is required material, but I would have taken it anyway.  It's pretty much the same content he uses in the AMIA 10X10 program.  I expect he'll be updating some slides after having me in class ;-), but even so, the material is very good, and valuable even for the Venerated Ancient (see the link under Academic above).  Some weeks I could just breeze through the material and the tests, and other weeks I really had to work at it.  Even so, I spent as more time on the unit on standards than I did on others (for reasons you might guess).  The last week, on Clinical Genomics was the toughest for me, even though I've had some exposure to the field, and work with experts in it in my standards work.  My main challenge was managing time for that last week, but the informatics challenges in that field are also immense.

I'm hoping to be in Riyadh when he teaches the last class of an i10x10 session being run here in person. Already I've run into at least three people who have graduated from the OHSU program, or are connected to it in some way. The first person I ran into (in Riyadh) had assumed that I had graduated from it already, about the same time as he did (14 years ago).  I laughed an explained my background to him.  He laughed as well.

I'm looking forward to next semester (to everything except the bill).  The only thing left inn the term at this point for me is to get my grades.  All my quizzes are complete, paper's finished, and finals are turned in, well in advance of the deadline.

Now I have to get back to work for my next deadline.

Timey-Wimey

I said it earlier, I'll say it again: Only ONC could figure out how to extend timelines and move them up at the same time.  This is in reference to the late breaking news article on changes to Meaningful Use deadlines.  Brian Ahier is of course on top of things, but so is Tom Sullivan over at Government Health IT.  The news that Meaningful Use stages are going to be extended to allow for adaptation to feedback is quite welcome in this quarter.  We've heard over and over again that what you cannot measure, you cannot improve.  It seems as if ONC and CMS have figured that out (actually, I'm quite sure they already had, it was Congress who really set the deadlines).

I don't know how this is going to affect reimbursement under the program, but I suspect there will be no change.  After all, the stick is coming, and that's an incentive too.  Also, it would likely take an act of Congress to change the HITECH act, and that doesn't seem any more likely this session than last.

At the same time, now we have the "optional" 2015 criteria to worry about.  Now I understand the rush to press on HQMF, HeD, and CCDA Release 2.0.  Really, though, I somehow wish there could be more transparency around regulatory planning. I'm sure this has been on the inside track for some time.  And that's the worrysome part for me, because instead of having to deal with regulations that would go final in 2016, I now have to deal with regs that are targeted for 2015.

Christmas anyone?  Not at the Office of No Christmas would be my guess.  Ah well.  I guess I have to take the bad with the good.

What is the purpose of XDS formatCode

There's a big discussion on the FHIR list serve about formatCode, and how to model it in the DocumentReference resource.  I thought I would take a few moments to explain its purpose.

There are a lot of different ways to classify clinical documents.  The first of these is to describe the MIME type.  This allows you to say that the document is in plain text (text/plain), RTF (text/rtf), HTML (text/html), XML (text/xml), PDF (application/pdf) and various other formats.  Back when XDS was written, many of the XML based formats hadn't yet started using or registering the various +xml MIME types following the new conventions.  So we had text/xml which wasn't distinct enough (and still today we have this problem with XML formats).

Document type (using LOINC), and document Class classifies documents in fine and coarse grained ways, the former for detailed classification, the latter for selection among pick lists.  A discharge summary could be in any number of MIME types, and still have the same document type code.

The purpose of formatCode was to distinguish between the cases where type code and MIME type still didn't give you enough distinction.  The problem back in 2004/2005 was very real, as a CDA and a CCR were using text/xml for MIME type, but the Schemas  were very different.  There are other cases where the Schema (big S) could be the same, but the schema (little s) is different, even when using CDA.  Today we have CCD, and two versions of it, the one in CCD Release 1.0, and the other in CCD 1.1 found in the CCDA specification.

One of the challenges with format code is that while we understood the need for it in IHE, it took us a while to figure out the correct use.  The correct use of formatCode is to present enough information to distinguish between two formats, but no more.  In CCDA, there are nine different document types, eight of which are CDA Level 1/2/3 and one of which (the unstructured document) is CDA level 1 only.

For format code, we'd want to be able to distinguish that the document complied with one of the eight document types, and might also conform to the ninth (yes, formatCode could be many -- we restricted it to one in XDS because at the time it was the right thing to do, the concept was new enough that people would have understood it even less if we allowed for many).  CCDA doesn't have a formatCode yet, and that's yet another discussion.  CCDA is an HL7 document, and so HL7 should specify the format code for it.

My recommendation on what that should look like will likely come up on an HL7 SDWG call or on the list serve. The idea is that somewhere within it, it will distinguish two flavors of CCDA, that with structured content, and that with unstructured content.  MIME type will already be the same, but typeCode is enough to distinguish between the nine varieties if we have format code, MIME type, and type code.

The best acts of coordination are invisible

Have you ever been in a room when someone talked about a project they were working on and you pointed them to someone they should talk to, or introduced them, or told them about some other activity they should connect with?

Did someone ever ask you a question that you didn't know the answer to, but went and found it for them?

Have you ever told someone about a project that they might (or should) be interested in?

After making the connection, did you walk away and let nature take its course?

I cannot tell you how many times I've been on either end of that transaction, and how valuable it has been. Often these are small investments of time, and sometimes they pay off big.  My career wouldn't be where it is today for the countless acts like these from many individuals I sometimes find difficult to remember, and sometimes I do recall how deeply I am indebted to that person.

These are invisible acts of coordination, and for those, I thank you.

I know I'm whining...

One of the unwritten rules of the Ad Hoc Harley awards is that I try to award them to people who would otherwise go unrecognized (which reminds me that I have one to do shortly).  It's an unwritten rule like many of them, because I do break it when I feel like it.

Today I saw this post over on Health IT News, and I thought to myself, not again.  Here's yet another case where the media really fails to recognize the real contributors to the advancement of Health IT.  I wasn't at all disappointed to see Regina and Dave on those lists.  However, I was disappointed to find that I couldn't just vote for them.  They represent the real men and women of health IT, undercompensated, overachievers, who've taken their passion to the trenches.  As for the others, they may have done some really cool things, but they are also in a position to do that, and to some degree, when you have C*O after your name, I expect greatness from you.

Maybe someday I'll be an executive and feel differently, but the real work in Health IT doesn't happen on the executive side.  Sure, they have have the vision, but they are also given the power and resources to achieve it.  The people I like to see rewarded are those with vision, and somehow find the resources to make it happen despite the lack of influence they might wield by their position.

It may sound like sour grapes, and in all fairness, I'm sure there is some of that sentiment involved.  But surely somewhere there could be a place where these folks get recognized in a way that is significant, and not just on this blog.  If anyone is interested in taking me up on the idea, I'll even be on the nominating committee.

Paying for Telehealth

This question came up in one of my classes last week:

What do you believe is/are the most likely and important applications of telemedicine/telehealth in the future?

I liked my answer so much, I thought I'd share it.  It's the sort of upside-down thinking that appeals to me.

I see a lot of attention for telehealth being focused on big ticket items, or on issues where distance is a real challenge. While I think these are areas that have a lot of value, I wonder about the smaller things.

I would have loved to be able to care for my daugher's ear infections using telemedicine, using something like this.

I really want to be able to remote home monitoring with an iHealth BP cuff, a Withings scale, or a smart-phone enabled glucose monitor for my wife and be able to communicate that information readily to my healthcare provider so that he can incorporate it into his EHR record.

I'd love to be able to remotely request prescription refills and schedule appointments. I'd love to be able to fill out forms online instead of spending an extra 10 minutes for that at the doctors office. I'd love to be able to pick referrals like I pick flights, with information about both time and cost readily available and comparable.

Yes, I think e-visits would be extremely valuable. A 30 minute consultation with a dietician over webex is something I'd do, whereas it requires a two hour time committment to get the dietician in my physician's practice. And a lot of the stuff I'd spend time as "pre-work" before we actually talked I could do via the internet.

I put a $ value on my personal time, for something I'm disinclined to like, it's more, and for stuff I like to do, less. I'd be willing to spend a bit more money to be able to have access to those services. The other value for these services is to employers. If insurance companies were willing to reimburse primary care providers for these fairly straight-forward telehealth implementations on an annual basis per patient, employers could likely see savings resulting from less use of personal time for healthcare related visits.

For some quick back of the napkin calculations, business receive from $50,000 to $1,000,000 of revenue per employee per year. That's a value of $25 to $500 an hour. Let's say a physician in general practice sees 700 patients a year whose insurers will pay him an annual "bonus" for providing simple telehealth services (half of the low end panel size from this article). Let's say that average revenue per employee is on the low side, but not at the bottom, call it $50 / hour. If telehealth can save two hours of a consumer's time, then the value to the employer is $100. Give up half that to the payers ($50/patient), and give a large chunk of that to the providers ($45). That results in a payment of $31,500 a year to providers. Employers save $100 of revenue a year that would be otherwise lost, pay out $50 of that to payers, and providers get a chunk of money that can go into the telehealth technology, and they'll save time and money too.

Adult Consumer Health Internet Access Trends 2000-2012

I was working on my term paper on Consumer Health Informatics for Bill Hersh's Introduction to Informatics class (it's overlong by about five pages, so I have to make some judicious cuts tomorrow night).  While I was perusing some of the data over a the Pew Internet and American Life Project that Susannah Fox is always promoting (and rightly so).  I wondered about year over year trends on this data set, and so I asked.

@SusannahFox Any data on year-over-year trends for health information access?
— Keith W. Boone (@motorcycle_guy) December 1, 2013

And shortly after, Arien Malec pointed me to the spreadsheet.  While I didn't absolutely have to have the data for my paper, it was just too intriguing to ignore.  I had to know what the trends were.  Now you do to.