Touring Granville Island in British Columbia

A friend and collegue in healthcare standards turned me onto this place the last time I was in Vancouver.  I didn't have time to go then, but I did today.  Granville Island is small, and it's not really an Island.  It's a small peninsula just south of downtown Vancouver.  The place was created by filling in two sandbars in the early 1900's and was originally home to a number of factories.  In the mid to late 1970's, Granville Island was converted to an Artistic and Cultural center and is the home of a number of low-rent studios that now reside in the former factory buildings.  There are several theaters, rows of art studios representing all types of art, a public market that has just about any kind of fresh food you can imagine (I picked up some elk and bison pepperoni), and plenty else to look at and spend money on.  I spent probably more than I should have, but felt it was well worth it.

I headed over to Granville Island to go see the Artisan Sake Maker's studio in Railspur Studios and to experience their locally made Osake Junmai Ginjo Nigori Genshu.  I also tried several varieties of their Junmai sake, including the Junmai Nama Genshu, the Junmai Nama, and Junmai Nama Nigori.  I purchased a couple of bottles of the Sake to take home.  The premium Nigori has just a bit of carbonation, and so has a little more bit to it than your usual nigori sake.  It was a bit surprising but also very good.  Osake is now growing their own rice in Canada and expects to be making Sake with it next year.

Here's just a bit of Sake terminology for you:
Sake: Wine made from water, rice, yeast and koji
Koji: A mold used to turn rice starches into sugar that the yeast can then turn to alcohol.
Junmai:  Pure, the Sake is made only with traditional ingredients and there is no added alcohol.
Nama:  Micro-filtered rather than pasturized.
Nigori:  Unfiltered sake.  Includes particulates which are stirred up into the wine when serving.  Usually a little bit sweeter and full bodied because of the rice particulate.
Ginjo:  The rice is milled finer than for regular Sake, and contains only 60% of the grain (the outer part is milled away).
Daigingo:  Even more of the outer grain is milled away leaving 50% or less of the grain.
Genshu:  An undilluted strength of about 18-21% alcohol (note: Sake is usually more alcoholic that the equivalent volume of wine).

Just like there are wine and scotch regions, there are also "Sake" regions in Japan.  I'm not well enough versed in Sake to know the various regions -- but I'm learning.

Off to Canada

While most of my friends will be enjoying the long weekend, tommorrow I'm headed off to Canada to help set up one of our systems for yet another interoperability demonstration.  This demonstration will be at e-Health 2010 in Vancouver, BC.  If you happen to be in the area, stop by at the Interoperability Showcase booth.

Following that, I head to Milwaukee to help teach a course on IT standards, and then head down to our Barrington office outside Chicago, IL.  Then it's back to Boston.  This follows traveling to Rio, so in three weeks I'll have racked up more than 20K miles, which is about 3 times as much as I've racked up in the first quarter.

The May HL7 Working Group Meeting

The May HL7 Working Group Meeting was held at the Hotel Windsor Barra in Rio de Janeiro, Brazil.  Getting to the meeting was a challenge for many HL7 members.  United Flight 861 from Dulles Airport in Washington DC was rescheduled due to a mechanical problem, leaving several hundred travelers waiting nearly 15 hours for a new plane.  The replacement flight stopped in Saõ Paulo and did not go on to Rio, which required rebooking for those headed to Rio.  I was one of those travelers and had already spent 6 hours waiting for the plane.  US Air Flight 800 out of Charlotte, NC had issues with navigation instruments and turned back after getting not quite half way their.  They fixed the problem after a while and turned around, only to realize that they had been in the air too long (read: not enough fuel), and then turned around again to land back in the US.  A flight from Puerto Rico had weather problems landing in Texas, and had to land at another airport to refuel, causing that contingent to miss their connection to Rio.  Most of us eventually arrived, safely I might add.  The meeting was not as lightly attended as Kyoto, but not as heavily attended as meeting in the US.  I'm told that there were more than 200 in attendance in Rio.

I spent Monday with the Structured Documents Workgroup.  We reviewed the weeks agenda, approved an updated mission and charter for the workgroup which will be posted on the SDWG site once approved by the TSC.  We also updated our governance (which again requires further approval).  The Structured Documents workgroup follows the usual workgroup processes with one exception:  Quorum is 5 members (with balance), and must include two cochairs. We also updated our three year plan.  That completed the first half of Monday.  The second half was consumed with hearing about Template tooling and template registry efforts.  The template tooling pilot ran an example template through three different technologies to develop templates.  The first of these are the Model Driven Health Tools that several HL7 tooling developers have been writing in Eclipse.  This is a very cool tool, and you can find out more about it at the website.  I recommend taking a look at it.  The second was an illustration of template development using the Static Model Designer being developed by HL7 UK members as a replacement for the current Visio tooling.  This is also pretty cool stuff, but requires more experience in HL7ese.  Both tools were up to the job of developing the templates in the pilot.  The last prototype wasn't discussed due to a mixup in scheduling.

I also gave a report out to the SDWG on progress on the Templates Registry Pilot.  If you've been following me, you know my hard drive had an unfortunate meeting with a coke bottle a few weeks ago.  I don't back up installed software because it inevitably has to be reinstalled again, so I lost several days work and haven't been able to catch up because there was other (more urgent) software to be reinstalled.  I'm back on that this week.  We did review the platform configuration and the Data Model for the registry.

I spent part of Monday with the Marketing Committee discussing the HL7 Ambassador program.  We will be putting together a set of Ambassador talks around Meaningful Use (which includes the CDA/CCD talk that I give), and promote that session for the Cambridge Working Group meeting in October.  We also discussed the new Ambassador webinars (see earlier press release today).  I will be giving one on CDA and CCD later this year (and in other venues sooner).

Tuesday early morning was the Education Breakfast.  I slept miserably the night before (a bit of Montezuma's revenge caught me), but managed to attend and was better by Q2.  We reviewed classes and education schedules for the Cambridge WGM, and talked about some new content that needs to be developed (specifically around SOA).

I spent some time Tuesday afternoon with the ITS Workgroup, discussing hData activities and the MicroITS.  We reviewed the current set of requirements for a Micro-ITS and the Micro-ITS tool developed by Robert Warden (building from the MDHT work if I remember correctly).  At that meeting we agreed to move the Micro-ITS work forward as a ballotable item to set contraints around what a Micro-ITS is and isn't, and how they relate to the HL7 RIM. 

I tried to join the Security workgroup later in the day, but ran into problems since I hadn't brought my Skype headset downstairs.  It was hard to follow the meeting when everyone else in the room was using Skype and several others were present (but not in the room).  After about 5 minutes we had a network problem and that meeting effectively broke up.  I spent the rest of my time that day slightly misplaced, thinking I was going to the ARB meeting on SAIF Tuesday Q4 (turns out that I was supposed to be at Wednesday Q4).  It was fine anyway, because I got to hear the ARB address Lloyd's comments on SAIF, many of which were well made.

Wednesday morning a couple of members of the SDWG (including me) met with the EHR workgroup to review the current status of the mapping of interoperability requirements from CDA based on the EHR Functional Model.  There were two formal proposals to CDA Release 3 (Audit and Access Controls) whose status were reviewed.  The first was rejected by structured documents as it covers a feature of a medical records management system, not a clinical document.  The latter was accepted to support marking of the sensitivity of a document with multiple sensitivity codes (these are found in the misnamed "confidentialityCode" attribute in the clinical document).

During lunch I was "interviewed" by the chair of the Patient Care workgroup, who was gathering data on use of the Care Provision messages developed by that workgroup.  I'm the author of several IHE profiles, including Query for Existing Data, Care Management and Request for Clinical Guidance that use these, as well as having developed a prototype implementation for one of our products.  So, he got an earful from me, and I owe him a followup e-mail.

Early Wednesday afternoon I again met with the ITS workgroup, and we reviewed again the requirements of a MicroITS.  Charlie McCay had a number of good questions and as a result I nominated him to help me write up the MicroITS requirements that we agreed would be balloted next cycle.

Late Wednesday afternoon I met with the TSC to review progress on the respelled SAIF (See previous posts on SAEAF Revisted and Demystifying SAEAF ... Maybe).  We talked about the feedback that the ARB and TSC has recieved on SAIF so far, and reviewed a presentation by the technical services workgroup that explained how HL7 artifacts could map into the framework.  This is where TSC chair Charlie McCay uttered the now famous: "The resolution to that [issue] is that I'm stuffed and I still have work to do" in response to a query for people who could help him finish up some SAIF deliverables.

Thursday morning I spent with the Templates workgroup, and we repeated the discussions that we had jointly with them in Structured Documents Monday afternoon on platform configuration and the data model.  I really must get back to work on the build environment, and get those parts and documentation loaded into GForge or OHT, so I'll sign off with that.

Health Level Seven Offers New Webinar Series

This must be the week for press releases.  This also crossed my desk this morning (for noon release).  Note, I happen to be one of several HL7 Ambassadors.  I deliver Ambassador presentations on the HL7 Clinical Document Architecture Standard and Continuty of Care Document Implementation Guide.  These presentations are about 20 minutes each with 10 minutes for questions (30 minutes total), or they can be combined into a one hour presentation. 

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Health Level Seven, Inc.

Contact: Andrea Ribick

+1 (734) 677-7777

andrea@HL7.org

Health Level Seven Offers New Webinar Series

The first webinar is an introduction to HL7’s role in developing interoperability standards to bring together the world’s disparate healthcare systems.

Ann Arbor, Michigan, USA – May 26, 2010 – Health Level Seven® (HL7®), the global authority for interoperability and standards in healthcare information technology with members in 55 countries, today announced the first in a series of HL7 Ambassador Webinars - “The HL7 Healthcare Connection.”

The HL7 Healthcare Connection is a free webinar that will be held on Tuesday, June 8 from noon to 1 pm ET.

Grant Wood, senior IT strategist with Intermountain Healthcare’s Clinical Genomics Institute, HL7 ambassador and member of the HL7 Clinical Genomics Work Group, will discuss how the implementation of HL7 standards and messaging architecture solves the problems of disconnected healthcare systems and serve as a vehicle for interoperability with disparate healthcare IT systems, applications and data architectures.

HL7’s healthcare standards play a key role in the exchange of electronic data in much of today’s global healthcare community and represents some of the most widely implemented healthcare standards in the worldHL7 comprehensive standards provide a comprehensive framework that improves healthcare delivery, optimizes both clinical and administrative workflow, creates a shared language, and enhances knowledge transfer among all healthcare stakeholders, including healthcare providers and their patients, government agencies, the vendor community, and other related standards groups.

This webinar is free and open to anyone interested in healthcare IT, and is the first in an ongoing series of HL7 Ambassador webinars in development. To register, please visit http://www.hl7.org/.

HL7 Ambassadors present standardized presentations about HL7 as speaker volunteers. They are available to present at local, regional or national conferences. Please contact HL7 at +1 (734) 677-7777 if you would like to schedule an HL7 Ambassador for an upcoming event.

About HL7 International
Founded in 1987, Health Level Seven International is the global authority for healthcare Information interoperability and standards with affiliates established in more than 30 countries. HL7 is a non-profit, ANSI accredited standards development organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. HL7’s more than 2,300 members represent approximately 500 corporate members, which include more than 90 percent of the information systems vendors serving healthcare. HL7 collaborates with other standards developers and provider, payer, philanthropic and government agencies at the highest levels to ensure the development of comprehensive and reliable standards and successful interoperability efforts.

HL7’s endeavors are sponsored, in part, by the support of its benefactors: Abbott; Accenture; Booz Allen Hamilton; Centers for Disease Control and Prevention; Duke Translational Medicine Institute (DTMI); Eclipsys Corporation; Eli Lilly & Company; Epic Systems Corporation; European Medicines Agency; the Food and Drug Administration; GE Healthcare Information Technologies; GlaxoSmithKline; Intel Corporation; InterSystems Corporation; Kaiser Permanente; Lockheed Martin; McKesson Provider Technology; Microsoft Corporation; NHS Connecting for Health; NICTIZ National Healthcare; Novartis Pharmaceuticals Corporation; Oracle Corporation; Partners HealthCare System, Inc.; Pfizer, Inc.; Philips Healthcare; QuadraMed Corporation; Quest Diagnostics Inc.; Siemens Healthcare; St. Jude Medical; Thomson Reuters; the U.S. Department of Defense, Military Health System; and the U.S. Department of Veterans Affairs.

Numerous HL7 Affiliates have been established around the globe including Argentina, Australia, Austria, Brazil, Canada, Chile, China, Colombia, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Hong Kong, India, Italy, Japan, Korea, Mexico, The Netherlands, New Zealand, Romania, Russia, Singapore, Spain, Sweden, Switzerland, Taiwan, Turkey, United Kingdom, and Uruguay.

For more information, please visit: http://www.hl7.org/

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The College of American Pathologists becomes IHE Lab Domain Sponsor

This press release crossed my desk this morning:

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	NEWS RELEASE CAP STS 500 Lake Cook Road Suite 355 Deerfield, IL 60015 800-323-4040 847-832-7700 www.capsts.org www.cap.org/DIHIT
	CAP STS CONTACT Candace Robertson 847-832-7764 crobert@cap.org IHE CONTACT Chris Carr 630-368-3739 secretary@ihe.net

FOR IMMEDIATE RELEASE

May 25, 2010

CAP BECOMES IHE LABORATORY DOMAIN SPONSORING ORGANIZATION

CAP and IHE Collaborate to Advance Health Information Interoperability

Northfield, Ill. and Oak Brook, Ill. May 25, 2010—Integrating the Healthcare Enterprise International, Incorporated (IHE) has named the College of American Pathologists (CAP) as the primary Sponsoring Organization of the IHE Laboratory Domain.

Healthcare and industry professionals globally initiated IHE to improve the way computer systems in healthcare share information. IHE brings together healthcare information technology stakeholders to implement standards for communicating patient information efficiently. The CAP, a leader in the practice of pathology and laboratory medicine, includes a division devoted to assist clients pursuing semantic interoperability for electronic health records (EHRs) and other applications.

The IHE-CAP collaboration will accelerate the process for defining health IT standards and promote health IT interoperability for the laboratory—complementing efforts in many countries to create national EHR systems.

"We are thrilled to have the CAP becoming a sponsor of the IHE Laboratory Domain," said David S. Mendelson, co-chair of the IHE International Board and professor of Radiology and chief of Clinical Informatics at Mount Sinai Medical Center, New York. "The clinical laboratory has been a critical part of IHE's expansion across the spectrum of care and it will be very beneficial to have such an important stakeholder organization driving the adoption of interoperability standards in that domain."

The CAP, as the primary Laboratory Domain Sponsor, will be responsible for supporting domain operations, including the development, publication, and maintenance of IHE Technical Frameworks. Technical Frameworks are globally recognized specifications for the implementation of standards to achieve effective systems interoperability. One issue the Laboratory Domain will address in 2010-2011 is the next generation of Laboratory Device Automation.

The CAP has more than 40 years of experience in healthcare terminology standards development, resulting in the creation of SNOMED Clinical Terms® (SNOMED CT®). Its SNOMED Terminology Solutions Division (STS) leads CAP’s standards and health IT initiatives through its Diagnostic Intelligence and Health Information Technology (DIHIT) team. CAP members and DIHIT staff will represent the CAP in the IHE collaboration.

“The CAP’s clinical and technical expertise in health IT, paired with our long-standing relationships with key stakeholders worldwide, will greatly enhance the development of the Laboratory Domain,” said Kevin Donnelly, CAP STS vice president and general manager. “Our goal is to ultimately improve patient outcomes through interoperable health IT systems that provide data to assist in diagnoses, clinical decision support, and improvements throughout the healthcare system.”

“We are pleased to support the IHE in the Clinical Lab Domain. This emphasizes the importance of pathologist stakeholders’ input to improve quality of care in supporting the pathologist’s role as being central to the patient care team,” said David L. Booker, MD, FCAP, chairman of Pathology, Trinity Hospital, Augusta, Ga. Dr. Booker is a member of the DIHIT Committee, CAP liaison to the IHE Anatomic Pathology Technical Committee, and the co-Chair of the Health Level Seven International (HL7) Anatomic Pathology Work Group (APWG).

The IHE works to promote interoperability in health IT through coordinated adoption of appropriate standards and supports the activities of other domains, such as Cardiology, Radiology, and the Laboratory and IT Infrastructure. The Healthcare Information and Management Systems Society (HIMSS), the Radiological Society of North America (RSNA), and the American College of Cardiology (ACC) sponsors IHE.

About CAP STS
SNOMED Terminology Solutions™ (STS), a division of the College of American Pathologists (CAP), is the leading organization in pursuing semantic interoperability for electronic health records by offering customized best-practice terminology implementation and education services. Our goal is to ultimately improve patient care through supporting the pathologist’s role as chief diagnostician/clinical care advisor and advancing interoperable EHRs. The Diagnostic Intelligence and Health Information Technology (DIHIT), a department within CAP STS, is committed to advancing health IT standards, practices, and tools, such as the CAP Diagnostic Work Station initiative; and standardized electronic reporting, including the CAP electronic Cancer Checklists (CAP eCC). The CAP is a medical society that serves more than 17,000 physician members and the laboratory community throughout the world. It is the world’s largest association composed exclusively of board-certified pathologists and is widely recognized as the leader in laboratory quality assurance. The CAP is an advocate for high-quality and cost-effective patient care. For more information, visit www.cap.org/DIHIT or write to snomedsolutions@cap.org.

About IHE
Integrating the Healthcare Enterprise (IHE) is a global initiative dedicated to advancing health information technology by achieving standards-based interoperability. IHE brings together stakeholders to implement standards to address critical information sharing needs. Through its proven process of collaborative development, testing, demonstration and implementation, IHE accelerates the real-world deployment of effective electronic health record systems. For more information, visit www.ihe.net. SNOMED CT® is a copyrighted work of the International Health Terminology Standards Development Organisation. ©2002-2010 International Health Terminology Standards Development Organisation (IHTSDO®). All rights reserved. SNOMED CT® was originally created by the College of American Pathologists. “SNOMED,” “SNOMED CT,” and IHTSDO are registered trademarks of the IHTSDO. All other trademarks used in this document are the property of their respective owners.

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IHE Community,

The IHE IT Infrastructure (ITI) Technical Committee has published the following supplements to the ITI Technical Framework for Public Comment:

• Cross-Enterprise User Assertion - Attribute Extension (XUA++)
• Deferred Document and Dynamically Created Content (D3S)
• Healthcare Provider Directory (HPD)
• Query Enhancements to Sharing Value Sets

The documents are available for download at http://www.ihe.net/Technical_Framework/public_comment.cfm. Comments should be submitted by June 24 to the online forums at http://forums.rsna.org/forumdisplay.php?f=198.

Governance, SDOs, PEOs and NHIN Direct

Next week I head to Vancouver and then to Milwaukee. In Milwaukee I'll be teaching a generalized course on Interoperability standards to Masters students in software engineering, along with one of my collegues. As part of that course, I teach how to work with standards organizations, and the need for consensus based standards in industry.

As I review the course materials today, I'm looking at some potential disconnects between what I teach, and where I participate. Where I spend most of my time now is in IHE, HL7 and NHIN Direct, and last year, you could replace NHIN Direct with ANSI/HITSP. 

Not too long ago, I spent about an hour getting my ear bent about the governance, processes and status of some of the organizations that I particpate with. IHE International was incorporated in 2009 and its Principles of Governance can be found here.  Anyone who wants to participate in IHE can do so without charge, and after becoming a member, can vote on and participate in any activities.  ANSI/HITSP, while no longer under Federal Contract still maintains its web site.  Documentation about HITSP processes can be found on that site.  When it was active, anyone who wanted to could join HITSP and can vote on and participate in any activities.  HL7 is an accredited ANSI Standards Development organization, and publishes their bylaws and Governance and Operations Manual on the web.  Membership is by fee, but anyone who wants to participate can become a member and can vote on and participate in any activities.  Non-members can also participate in committee discussions on standards and in the HL7 Mailing lists.  HL7 standards can also be voted on by non-members for a modest administrative fee.

HL7 is a Standards Development Organization. IHE and HITSP are (or were in the case of HITSP) Profiling and Enforcement Organizations (PEOs -- an acronym I believe to have been invented by Wes Rishel).  But NHIN Direct is the oddest duck of the lot. 

NHIN Direct is an "Open Government" project.  There's some detail about the NHIN Direct project on their FAQ page.  I have not been able to find detailed documentation about governence or process on the NHIN Direct pages.  Some of it is there, but other parts are missing. 

For example, there are three ways to participate:
1.  By being a member of the core group (which I happen to be).
2.  By joining the wiki and e-mail lists and participating there (which I also do).
3.  By passively participating using the resources provided by NHIN Direct.

Someone from a large research organization that does quite a bit of government work asked me last week how you get into the first group (his organization wasn't able to, but had tried).  I didn't and still don't have an answer.  I know it's by invitation, don't know what the qualifying criteria are, and I have yet to find anything other than what is stated on the FAQ.

Recently, NHIN Direct announced a new co-chair to one of the workgroups.  I wasn't aware that A) there was a vacancy, or B) what the process would be to "run" for that vacancy.  Apparently the process for the selection of leadership NHIN Direct is not documented either.  I didn't see any call for a vote either on the new leadership.  BTW:  I'm not against this particular leader, I think he's a pretty good leader, even though we disagree on several issues of substance.

Back to the class that I will be teaching:  I describe six key features of concensus standards bodies.  These features are derived from the HITSP Tier 2 process (word document), US Federal Law, and a circular published by the Office of Management and Budget describing policies on Federal use and development of voluntary consensus standards and on conformity assessment activities.  Here are my six features, accompanied by an analysis of how NHIN Direct stacks up:

• Open -- Membership should be open to all affected parties.  In NHIN Direct, there are two classes of membership, contributors and decision makers.  Decision making isn't open to all affected parties.
• Balanced  -- Members should come from providers, suppliers and consumers of affected products.  I see some balance in the membership of NHIN Direct, but no documentation of it.
• Process Oriented  -- The organization should have a defined process.  A very weak link here, as there is little documentation of any process in NHIN Direct.
• Appeals -- Decisions should be able to be reviewed and appealed.  I don't see any documentation, nor would I know what those processes would be in NHIN Direct.
• Consensus Based -- Decision making should be based on a consensus of the organization members.  This is one of NHIN Direct's strong points.  It's very clear that everyone has a chance to be heard, and I've actually learned a number of ways to improve consensus building in other organizations where I participate from the NHIN Direct work.
• Maintenance -- Specifications produced need to provide for ongoing maintenance.  Because there's very little documentation about NHIN Direct, and because it is a "Project" of ONC rather than an organization, it's not clear what the ongoing maintenance process will be.

I very much support the activities that NHIN Direct is working on, because I think that they will enable smaller healthcare providers to exchange clinical data between themselves and other providers.  However, NHIN Direct has quite a bit of work to do before I would even consider putting them into the category of a consensus based standards body.

Which leads me to my final questions:  What should be done with the NHIN Direct specifications when they are complete and implemented?  Should they be run through a Standards Development Organization ballot or voting process?  Should NHIN Direct try to become an SDO or PEO (Profiling and Enforcement Organization)?  What do you think?