Monday, November 30, 2015

Just in time for Christmas, an Armor Class upgrade

My first motorcycle jacket was made of ballistic cloth and padded, with plastic plates beneath.  It worked just fine, looked OK but not great, and protected me for the one accident I ever had, but on hitting the pavement the jacket ripped, and I've worn it rarely since.  My second was simple black classic leather.  It looked great but has a couple of flaws for winter riding: The zippers are wicked difficult to open with gloves on, and getting it all the way closed in for cold riding was difficult, and uncomfortable.

Recently I was offered a jacket to try out a review, and since I needed I new jacket, I chose this one to check out from Motorcycle House.

A couple of things attracted me to this jacket:
  • The pockets. 
    For some reason, I like having lots of pockets.  This jacket has a ton of pockets. The outer ones fit my riding gloves (something I couldn't say about the classic leather jacket I was using).  The inner ones are accessible even with the liner installed.  And the zippers can all be operated with gloves on.

  • The reflective stripes.
    My bike is black.  My jeans are black.  My chaps are black.  Riding in the dark means that pretty much I'm an otherwise invisible headlight or taillight with a black jacket on. The built in reflective trim makes it possible to see me, which makes me feel a bit safer.
  • It looks good.
Two things I discovered I like about this jacket after I tried it out:

  • Comfort. The jacket fits me well, and is comfortable around the neck when I close it up.  And it's warm in the cold.  I had planned to write this review sooner, but it's kinda hard to write a review about a jacket that you are going to use for cold weather riding when you haven't had any cold weather to ride in.  What cold weather we've had recently has also overlapped with travel. Finally we got some today, so I took a half-hour for a good ride over lunch.  It fits my final criteria, it's warm.
  • It's also armor.  Padded leather is about AC 8 on a DnD scale, but I'd give this jacket a +1 for ease of movement in it.  It has armor at the back, shoulders and elbows, but I didn't even notice it until I hung the jacket up.  You simply don't feel it.
While I was given the jacket in exchange for this review, the price is also pretty good, at $99.99. And given that today is Cyber Monday, you can also get it on sale.

I don't usually do reviews except for books, and this is my first review for something that most of my usual audience might not appreciate.  I'm probably not going to make a habit of it, but then again, I won't rule it out completely either.  After all, what good is to have a blog if you don't try something different every now and then.

Monday, November 23, 2015

Passion is the Midi-clorian particle for HealthIT Jedi

What does it take to become a Health IT Jedi?  Do you have to have some special skill?  Is there some genetically contributed factor, some Health IT midi-chlorian particle that you need large quantities of to really succeed?

I think not.  The critical factors are, I think, in this order:

  1. Passion
  2. Opportunity
  3. Persistence


If you have a passion for your craft, you will have an appetite, a curiosity, perhaps even a voraciousness to learn more about it. The more you learn, the more you can do.  The more you can do, the more others will recognize you for your ability. At some point, you too will recognize it (often a long time after others have).


Passion unspent leads to frustration.  It needs an outlet, a doorway, an escape, in order to be realized fully.  Opportunity is that means of egress.  Opportunities come in thousands of ways.  A new software component needs to be developed, will you invent it fully yourself, or learn from the work of others and spend your creative energy adding new value? A group of people need help, will you pitch in and make some time to help them, and at the same time learn more, or will you sit by the wayside and wait for them to do the heavy lifting?  When you don't understand, will you ask the question that may lead to better understanding?  Or will you be silent and hope that someday you will get it?  

What if you have no opportunities?  Then you aren't looking hard enough.  Be creative.  Let that frustration inspire you.  Take a chance.  I guarantee that if you do look closely, you will find a way, which leads to the final attribute.


Practice makes perfect.  Doing leads to learning.  I often tell my students that the best thing that they can do for themselves after taking a class is to DO something with it, and the best time to take a class is just before you need to use the material it teaches, or perhaps just a little bit later than that (so that you learn what you need to learn).  Your first opportunity will lead to learning, but probably not stellar success. Along the way you WILL fail.  If you don't or haven't, you aren't trying hard enough.  
Passion helps here, because it gives you the drive to try again ... and again and again and again.

I have failed.  I have found opportunities -- sometimes even the slimmest of chances.  I care deeply about what I do.  As a result, I have one of the most rewarding of careers I could have ever imagined. 

You could too.  It starts with passion -- the midi-clorian particle for a Health IT Jedi.

   -- Keith

P.S. Thanks to Rene Spronk, and the Furore FHIR DevDays team for the great photo above.

Friday, November 20, 2015

Just Proud

What is it about age that makes us proud of our youth?  Over the last week I've had several opportunities to be proud of the accomplishment of others.

I'll start first with my youngest daughter, who overcame several setbacks this summer to brave her way through 20+ hours a week for several months of practice and rehearsal and 2-3 competitions each weekend to finally win (along with her classmates) the title of USBANDS National marching band champions.  That's just a proud dad talking.  To the left is a video of the band arriving home from their victory.

Then there's the team of students I taught Interoperability and Standards to this summer; whose class project sailed through IHE Patient Care Coordination for implementation in the 2016 - 2017 season. That's just a proud TA talking.

Then there's the team of students (see image at the right) from Heilbronn University who won the FHIR DevDays student competition.  I have no reason to be proud of them except that they did something cool with FHIR. That's just a proud co-developer talking.

Then there's the team of OHSU Informatics students who won the AMIA student competition, giving OHSU two wins in two years.  That's just a proud alum talking.

Then there's the four high school students who presented at AMIA.  I have no excuse to be proud of them, other than I see something in them that maybe I had at their age, or perhaps just wished I had at that age.   I guess I'm just proud to see others succeed.

Thursday, November 19, 2015

Preaching to the Converted

I'm on day 8 of 12 days of travel, having arrived in Amsterdam yesterday for the start of FHIR Dev Days.  My presentation this morning covered some of what we've learned in IHE "Profiling FHIR". The presentation is entitled "Preaching to the Converted" because at this event I don't have to explain what FHIR is, or why people should use it.

The presentation is below.

Thursday, November 12, 2015

OHSU Student Project Approved for IHE PCC 2016-2017 Cycle

As I mentioned about a month ago, several OHSU students created an IHE Profile proposal which went (at this stage) before both the planning and technical committees.  The profile was approved by the Technical committee today to move forward as a 2016-2017 work item.


FHIR Best Practices or Everything I needed to know about FHIR profiling that I learned in Kindergarten

  1. Rules are good.
    When profiling, set up your conventions, so that you don't have to think about it.
  2. Explain what you are doing and why.
    Description fields explain what you are doing.  Requirements fields explain why.  Use full sentences.
  3. Show is better than tell.
    You need to have examples, plan for it.
  4. Don’t do any more than you have to.
    When profiling, don't profile stuff you don't care about (and don't profile out stuff just because you don't care.  It makes it easier for others to reuse resources they may already have).  That may mean using slices to make sure that you have "one like this."  That may be hard at first, but your implementers will thank you.
  5. Make the biggest one do the heavy lifting.
    Make the server be the one to implement all the options, and let the clients choose when there is more than one way (e.g., GET/POST, JSON vs. XML), et cetera.
  6. Don’t expect to be great at it at first.
    We're all learning this stuff, even Grahame makes mistakes.

Monday, November 9, 2015

The Medical Industrial Complex

I belong to a lot of different mailing lists.  The obvious ones are HL7 and IHE workgroups, but other lists relate to S&I Framework activities, AMIA informatics workgroups, and the Society for Participatory Medicine.  One of the things I find most interesting, and also the most frustrating about these lists is the sometimes ethnocentric bias commonly found.  Nobody is exempt from this (even me).

A recent term showed up on one of these lists: Medical Industrial Complex

Usually this term is used disparagingly. I find that each different list thinks about this term somewhat differently.

  • Some think about it as "the vendors", referring to sellers of medical devices, software, et cetera (e.g., like my employer).  This often shows up from the perspective of providers, and sometimes the government.
  • Others think about it as "the payers", referring to the health insurance industry.  Many times, this shows up from either perspective of providers, or patients. 
  • Others think about it as "the healthcare providers", referring to doctors, hospitals, et cetera. This is most often the perspective of patients, although sometimes the perspective of individual providers dealing with institutional providers (hospitals or groups).
  • Others think that a significant chunk of the Medical Industrial Complex is sponsored and controlled by "the government", a perspective espoused often by any group other than "the government".
The Medical Industrial Complex, or its constituents as an aggregate group (all of the above) are easy targets.  They are motivated by money (profit or savings depending on the role), not saving lives. They have no interest in the concerns of any other stakeholder, including the patient.  

The medical industrial complex is in fact too easy a target.  We oversimplify the situation in ways that rarely result in any problem being solved.  Claiming, for example, that "____ are against interoperability because it is not in their best interest." is simply divisive, and not useful.  Oh, and I've seen that sentence filled out at least three different ways.

Presently, the Medical Industrial Complex is a multi-player, zero-sum game.  That means where one group gains, another loses.  All of us reading this blog are players in this game in some way.  If the game isn't fun, what we need to do is change the rules, but that's going to require all of us in this thing that people call the "Medical Industrial Complex" to work together.  Yes, that means you.  What are you going to do about it?


Wednesday, November 4, 2015

FHIR Dev Daze

Yep, I did say daze.  As in deer caught in the headlights, glassy eyed, OMG, is that happening to me?  Shortly I'll be about and abuzz on FHIR, on a ten-day whirlwind tour.

In Amsterdam, I'll be at Dev Days, along with Grahame Grieve, Ewout Kramer, Lloyd McKenzie and Josh Mandel -- basically the Who's Who of FHIR.  It's an honor to be there, and I'm glad to have been asked to present.

I'll be talking about some of the work we did last year in IHE using FHIR, some of the challenges we ran into, and some of the solutions we came up with. Included in my discussion will be an overview of:

  • Guideline Appropriate Ordering (GAO) - A profile to support clinical decision support that adds an operation on the Order resource.
  • Clinical Mapping (CMAP) - A fairly straightforward profile of an operation on the ConceptMap resource.
  • Reconciliation on FHIR (RECON) - Adaptation of the RECON profile to support exchange of reconciled lists in FHIR.
  • Mobile Access to Health Documents (MHD) - Essentialy a FHIR-based implementation of XDS (shh... don't tell anyone that, its a secret).
  • Patient Demographics Query for Mobile and Patient Identifier Cross-Referencing for Mobile (mobile in IHE speak is a code-word for FHIR).
  • RESTful Queries in ATNA - Adding a query capability to the ATNA profile.
I'll be building some of this talk from material I'll be using the week before, where I'll be explaining FHIR profiling to IHE profile developers.  The focus of that talk will be more on what you need to know to profile FHIR, and some best practices that we've discovered thus far.

In between the two of these events, I'll be attending the IHE technical committee meeting where I expect we'll be talking about FHIR in Care Planning, and following that, headed off to AMIA, where I expect to hear a number of people buzzing around about FHIR, sort of like moths to a flame.

   -- Keith

Moth and candle image via Ray MacLean

Tuesday, November 3, 2015

Help HL7 improve clinical information exchange

If you are a healthcare provider (physician, physician assistant, nurse practitioner, nurse or other licensed provider), HL7 would like to hear from you about the information you think is relevant and pertinent to exchange in support of continuity of care.  If you want to participate, all you need to do is take a short survey.  You will need to act quickly. We are trying to gather this data before the end of the year, and due to the volume of provider responses, we are expecting to close the survey at the end of November.

We are planning on using your responses to develop an HL7 informative publication on what sort of information should be included in clinical summaries.

The slide presentation below explains the purpose of this project in more detail.  If your organization would also like to participate more deeply, there is another opportunity as well.  We have a separate engagement process for governance groups such as your organization's Informatics steering committee to allow them to provide input as a consensus body.  If you want more information about that opportunity, contact me via e-mail.