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.

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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?