New IHE Radiology Profiles Released for Trial Implementation

The IHE Radiology Technical Committee has just published the following supplements to the IHE Radiology Technical Framework for trial implementation as of May 30, 2014:

• Digital Breast Tomosynthesis (DBT)
• Mobile Access to Health Documents for Imaging (MHD-I)

The documents are available for download at http://ihe.net/Technical_Frameworks.

Open Data vs. Data Exchange Standards

On the NwHIN Power Team call, we were talking about HPD+ readiness for Meaningful Use.  There was general consensus on the call that this specification was too new to be consider readied for prime time.  If compared against the teams readiness criteria (recently published here in JAMIA), it likely wouldn't make the grade.

One of the discussion points was to have ONC explore the following:

1. Capture Direct addresses with other publicly accessible data currently stored in the NPI database.
2. Making that data part of the open NPI data available to developers to innovate with.

From the perspective of the need for directory information, this seems to be the most likely and best pathway to ensure that the "Directory" problem reported by users of The Direct Protocol would be available for those who need directory information to be readily available to support Direct implementations in 2014 and 2015. It also enables innovation and resolution of the problem without necessarily mandating the final solution in regulation.

I like this answer.  Maybe we should consider the problem we are trying to solve, not the solution.  After all, not every data interchange problem need be solved with a standard (whoops, did I actually say that?)

    Keith

The Customer is always Right

One advantage to working in the context of standards development is the ability to have discussions with stakeholders in standards that can be open and honest.  Could you imaging having some of the conversations that occur in Standards development in a vendor/customer context?  The only relationship more challenging that I can think of is the regulator/regulated relationship.


    Keith

Thinking Beyond Change

One of the challenges with the US Healthcare System [sic] is not in figuring out what needs to change, but rather how to implement such a change without completely tearing down everything and starting over from scratch.  Yes, tearing it all down would be very satisfying -- except to those who lost their lively-hood in the course of it.

That is the challenge.  Because any initiative to tear down a 30-year-old infrastructure will be opposed by those who are part of that infrastructure.  Any workable change strategy has to include everyone, and not write off any stakeholder.  It must provide for a mechanism to transition from one state to the next.  It isn't about figuring out the best way to do things, but rather, figuring out a better way to do things given where we are, and where we'd like to be.  This is not an engineering challenge, or not so much.  It's much more a political challenge.

Yes, you can be a great innovator and tell us how we should rebuild everything from scratch.  That's not going to be practical, nor is it likely to be implemented.  What I want you to do is show me how to get to a better place that just about everyone can support.  That's effective change, and damn it, that's really hard. It's very easy to design from a clean slate.  Our's has 30 years of chalk dust on it, and permanent marker, and chips and smudges that just won't come out.  Make it work with what we have.  That's where the real challenge is.  I love being able to deal with green fields.  But mostly we have today aren't just green fields, but cow pastures.  Be careful where you step.

   Keith

Pedaling Backwards to Move Forwards

If you guessed that this post was about the most recently released proposed rule on Meaningful Use, you would be correct (The hashtag may have helped).

The key to the whole rule is summed up nicely in one table, which I reproduce below:

If you were scheduled to demonstrate:	You would be able to attest for Meaningful Use:
	Using 2011 Edition CEHRT to do:	Using 2011 & 2014  Edition CEHRT to do:	Using 2014 Edition  CEHRT to do:
Stage 1 in 2014	2013 Stage 1 objectives and measures*	2013 Stage 1 objectives and measures*                 -OR- 2014 Stage 1 objectives and measures*	2014 Stage 1 objectives and measures
Stage 2 in 2014	2013 Stage 1 objectives and measures*	2013 Stage 1 objectives and measures*                 -OR- 2014 Stage 1 objectives and measures*                -OR- Stage 2 objectives and measures*	2014 Stage 1 objectives and measures*                  -OR- Stage 2 objectives and measures

*Only providers that could not fully implement 2014 Edition CEHRT for the reporting period in 2014 due to delays in 2014 Edition CEHRT availability.
While I could have said I told you so about crazy deadlines, I always understood that the deadlines for meaningful use stages weren't ONC's to control, but were rather set by Congress.
What I'm hoping that we all learn is that MU should be using standards that are ready for prime time, and should set the bar at the right place for success.  If we want to promote use of new standards, maybe that should be a menu option, and there should be a way to those who pilot test new standards that ONC wants to see used a way to certify based on pilot testing rather than lab testing.
I can tell you based on any pilots I've been part of, that pilot testing is certainly a higher bar than any lab-based testing I've seen for Meaningful Use or any other standards program.

Status Quo Post

Something occurred to me as I looked at how we respond to change.  We can project forward to some degree what will happen as the status quo ante becomes the status quo post, but only to a certain point.  It is very hard to imagine what things would be like if nobody ever remembered the way things were before.

Remember analog music?
... life before e-mail?
... traveling without a GPS?
... pay phones instead of cell-towers?
... slide rules?

Some of you reading this don't (I forgive you for being young).  Could you have imagined at the time these things entered our lives what life would be like when these things became so pervasive to the point that our children grew up never knowing a world without them?

So it is with change.  Not only can we not really imagine what it would be like to do this different thing, but it is very hard to imagine a culture where this new idea is the new baseline, the new normal, and our old way is completely forgotten.

As hard as it is for a technologist to do this, think again about how conservative we are in healthcare with respect to change in process, which makes it even harder to think this way.  But this is what we have to do every day.  Or will will just be the status quo ante, and then, the forgotten.

Not on my Radar Screen

Some folks have asked me why I'm not at Conference X, or what it would take to get me to Workshop Y.

When I started working as a software developer many decades (ouch) ago, one of the things that I looked
forward to was going to various conferences and workshops.  Initially, I'd get to go to about one a year.  As I grew more experienced (and older), I was able to get to maybe two a year.  Then I began speaking at some conferences, and the number increased, but the ones I spoke at weren't necessarily the ones I would have chosen to go to for career development purposes (in other words, to have fun and learn something new).  And as I went to more, the number I got to got to for "career development" actually grew shorter.

These days I get to travel to more than a dozen events annually, but the number of events which are "just for fun" (in other words, selected by me to learn something I wouldn't otherwise get in my day job) is still around one annually.

If it doesn't have to do with any of the topics to the right as related to Healthcare Standards or Interoperability, then it is likely not part of my day job responsibilities.  It might be fun, but it fits into the 1-2 that I get to go to for career development every other year or so rather than doing my day job.  And getting into that list is difficult.

Conferences that fall into this category include things like:

• Medicine X
• TedMed

Mostly I work on standards, not software.  Yes, I still use (and write) software in my day job, but that demonstrates implementation of standards, not code.  So you likely won't find me at things with names like (even when it might overlap with my day job):

• ____ Code-a-thon
• ____ Hack-a-thon

I'm not a policy wonk except where Healthcare Standards intersects with Healthcare Policy.  So you'll not usually find me at policy related events, unless they are totally focused on Healthcare Standards.  And that list is rather short and mostly on an emergency basis.

I'm not an Academic (but I am in school).  You won't likely find me at AMIA for anything work-related.  I might show up this year and next, but if I do, it may well be on my own (educational) dime.  I'm trying to fit this one into my current travel plans as my one career development conference, but when you go to as many conferences as I do, slipping in an extra one is actually harder.

My "standards portfolio" includes EHR and departmental interoperability, it doesn't include imaging, monitoring devices, pharmacy, or payer-side stuff (even though I know a bit more than a little bit about each).  I do cover public health to some degree, as well as quality.  So you won't usually find me at the interoperability showcase at RSNA, will find at HIMSS and am catch as catch-can for various public health events (depending on who you can get to drag me in).

My zone is International, but mostly focused in North America, and specifically US-based activities.  So if your conference is right in my sweet spot, but happening in Europe or Asia, one of my colleagues may likely be there, but not me unless there is another reason for me to appear.

I'm not running a Startup nor employed by one. Somehow, that also seems to rule me out as an innovator, but I don't worry about that too much.  So you won't find me at conferences devoted specifically to startups, or at innovation (unless it intersects with standards).  That's actually OK.  Innovation and Standards are actually two different tracks which have some overlap.  I also don't do "Hype of the Week/Month/Year" club stuff.  So you won't see me at things like:

• Healthdata Palooza
• Big Data Anything

Where you will find me:

• Health Level 7 Workgroup Meetings
• IHE International Events (including the upcoming IHE World Summit)
• ONC S&I Framework Activities

Note:
This doesn't mean I'm not interesting in seeing your conference, or even in attending or presenting, but it likely means that I don't have budget (and may not have the time) to attend it.