I'm on TV

Well, not yet actually, but I soon will be.  TipTV to be exact.  Last week I video-taped about 6 hours of training on CDA, CCD and XDS at our TipTV studios.  The studios are located in the GE Healthcare Institute where we hold many of our training and education activities just outside of Milwaukee.

The training groups works with eMedia Studios and Services to do the filming.  Jim was my director, and Keith the camera operator.  I was Mr. Boone, or "the other Keith" for the two days while filming.  A description of the studios appears on eMedia's web page here, and you can even take a walkthrough tour.  I was in Studio B (the first studio your see on the tour).

Taping for the day started out scary.  I had just finished putting the polishing touches on my presentations the night before and saved them.  But, an innappropriately placed coke bottle ended up bathing my laptop on the way to the studio.  I managed to recover the presentations by swapping the hard drive into another computer before that hard drive finally did go belly up.  So in the first two hours we put twenty minutes of CDA training into the can.  It took me a bit, and some prompting from the director to get back into my groove.  We polished off the CDA class and the XDS class that same day.

Thursday morning, I dropped my computer off to be replaced, and we video-taped the CCD presentation.  In 12 hours, we put 12 hours of video "in the can".  They taped both me and what I was projecting on my laptop, so 6 hours of training became 12, all of it filmed in HD.  I finished in time to pick up the replacement laptop before I headed back to Boston.

The taping they did of me used a green screen ("chromakey") background, so who knows, I could show up in Paris, or Hawaii, or with the pyramids behind me in Egypt in the final production.  We are hoping to have this finished sometime in the next six weeks, but have to fit it in with other productions that are being edited.  The studios include advanced editing equipment, a graphics department, and lots of other "Cool toys".

Although I've acted in theater before, and had some stage productions video taped, I never taped in a studio before.  This was a new and interesting experience for me, and one I hope can be repeated.  TipTV has quite a bit of continuing education on the use of diagnostic imaging equipment, but this is the first time they've put effort into developing training on standards.  I hope it's successful.  The lead for this project feels that it will be, because as she says, where else can you get it, but from the horse's mouth.

My response?  Whinny

News from IHE Europe

The dust has finally settled (literally), and most attendees of the IHE European Connectathon have succecssfully made it home. Air traffic after the Connectathon was disrupted by an unpronouncable volcano's eruptions in Iceland, to the point of disrupting IHE meetings in the US in the beginning of May for some.

In the meantime, two IHE National Deployment committees have joined IHE International, bringing the total number of regional deployment committees to nine.  IHE Suisse was created in March of this year, and IHE Turkey in November of 2009.

A recent press release from IHE Europe (the Regional Deployment organization for the European continent), observes that "that several IHE profiles were endorsed for national programmes in several countries where IHE national initiatives are active."  Some of those initiatives can of course be found on the Where in the World is XDS map, and others will be added when they become known.

At this year’s European Connectathon, a total of 2,250 interoperability tests were carried out and of these 1,950 passed. 80 profiles and 94 systems were tested in five domains (Radiology, Cardiology, IT Infrastructure, Laboratory and Patient Care Coordination) by 66 companies bringing together over 250 engineers.  Also occuring with the event were meeting of DICOM working groups and other interoperability activities.

Peter Kuenecke was re-elected cochair of IHE-Europe back in April.  He reports that "we have seen a significant shift from a testing platform to a true European Forum on interoperability.”

IHE Europe has created a new role, Director of Interoperability, to monitor EU projects where IHE is involved, including the European Patient Smart Open Service (epSOS), the Healthcare Interoperability Testing and Conformance Harmonisation (HITCH) and Calliope.  Past user Co-Chair Karima Bourquard has been appointed to that newly created position of Director of Interoperability.

The 2011 Connectathon will be held at Leopolda Storica in Pisa from April 11 to 15.

-- Keith

P.S.  The post is an amalgamation of information found in 3 recent press releases from IHE Europe.  For more information, please contact:

Peter Künecke
IHE-Europe Vendor Co-Chair

vendor.cochair@ihe-europe.net


Jacqueline Surugue

IHE-Europe User Co-Chair
user.cochair@ihe-europe.net

You are being watched

When I started this blog almost two years ago, I almost immediately hooked it up to Google Analytics.  Google Analytics provides an amazing amount of data about you, my readers.

I recently did a little study about who reads this blog using that tool.  I gathered up information about the top 500 network sources hitting this blog, and then segmented those sourced into 9 categories:

Network:  These sources are communications companies providing internet services to the general public.  Included in this category are also hotels, libraries and other methods of public access that I could clearly identify.  About 55% of all visitors come from these sources, and account for about 70% of all visits.  After figuring this out, I threw out all these sources, since this pretty much tells me nothing about the readers as I cannot tell where they readers are employed.

Vendors:  This includes anyone remotely identifyable as selling IT products for the healthcare industry.  Vendors account for approximately 40% of the remaining visitors, and also for about 40% of all visits.

Universities and Research Organizations account for about 20% of non-network visitors, and 15% of all visits.

Healthcare provider organizations include about 15% of the visitors, and 15% of the traffic.

Governmental agencies include a little less than 15% of the visitors, and a little more than 20% of the traffic.  There are fewer readers in government than elsewhere, but they seem to be paying more attention.  I am certainly heartened by that statistic.

Payers, Quality Organizations, and a few odd ducks account for about 10% of visitors, and a little less than 10% of visits.

The smallest group are consultants, and these range in size from 5-10 person organizations all the way up to 1000+ person organizations.  They account for 5% of the visitors to this site, and about 2% of the traffic.  Basically, the consultants are not paying much attention to me.  I'm not sure of what to make of that.  Some of them get quite a bit of my feedback directly, and don't necessarily need to read this blog to know what I think.  The rest probably don't care.  I'm not sure what to make of that, but I'm not losing any sleep over it either.

If you've done the math, you realize that my percentages don't quite add up.  There are rounding errors (I rounded to nearest 5%).

Many, many years ago, when I worked for a "free magazine", we used to have to publish annually a Controlled Circulation report.  This blog is "Free media", so you can consider this my controlled circulation report. Magazines produce these reports so that their advertisers can be aware of who the audience is.  I'm producing this report not so that I can advertise (see the new policy page), but so that both you and I know who is reading this blog.

     Keith

P.S.  An amusing anecdote:  While reading through the list of networks being used to access this blog, I discovered that a couple of governmental agencies reading it are in the intelligence business.  It seems it was my turn to watch the watchers ;-)

Tranmitting Attachments using XDR

I encountered an act of Healthcare IT Coordination that deserves mention this morning.  I spent about 30 minutes with a team from the Centers for Medicare and Medicaid Services discussing with them capabities of XDS and XDR.  They want to be able to use NHIN CONNECT to allow providers to submit medical records to them in response to a case where CMS is auditing claims.  What is truly remarkable here is the reuse of existing work from the NHIN project to share documents for clinical use, moving it towards the financial realm.

It seems possible if this pilot succeeds that others could use this same process in support of claims attachments.  In a world with too many standards, could this be a case where we see fewer rather than more? 

Also notable is that CMS has been working with SSA, who has a very similar use case, and is leveraging as much as possible the work that organization has done.

Meaningful Interoperability is not defined by Meaningful Use

I spent an hour today on a call with NIST (along with many other HL7 leaders) regarding the testing framework they are presently developing for meaningful use.  One of the the issues that NIST correctly identified is that the standards selected for meaningful use are not sufficient to support interoperability.  They pointed out to ONC that the SDOs have spent many person-years developing implementation guides that ensure interoperability.  Because these were not selected by the IFR, NIST has been directed to fill the gaps in a few short weeks.

To resolve this problem, NIST is working with HL7 and other SDOs to identify what is enough to ensure interoperability.  They are in fact, creating "baby" implementation guides.  I would not want to be stuck in between their rock and hard place right now.  The danger here is that years of consensus building and implementation efforts could be completely irrellevant if the wrong choices are made. Hopefully the choices that are made by NIST and the SDOs will enable use of and not conflict with existing guides; without requiring their use.  Yet those same choices need to be strict enough to ensure interoperability.

If you look at the schedules that NIST has to commit to, this is insanity.  HL7, IHE and HITSP spent years developing standards and implementation guides that do exacly what is needed for various use cases in the IFR (immunizations being one of those). The number of person-hours spent developing and refining these guides and building concensus around how they should look is immense.

The EHRA also recognized this as a problem, and is currently reviewing a set of recommendations to its members on what implementation guides should be used.

My recommendation to NIST is to implement NO MORE than what is in the rules in their testing framework, even if it doesn't guarantee interoperability.  Then, to ensure interoperability, the next part of the process would be to verify products DEMONSTRATE interoperability with other systems using those standards.  The vendor community has been doing this at IHE Connectathons for years.  Demonstration is one of four ways to validate conformance (The other three are Test, Inspection and Analysis).  Combining a demonstration of interoperability with verification that the product is correctly implementing the base standard would be an effective way to meet the goals of the IFR and the Certification process.

In this way, we can use the standards specified in the IFR, and the implementation guides that we chose to support, without concerning ourselves with reinvention, insane schedules, and introduction of incompatibilities.

The end of an ERA

Started with ARRA.  I just hope none of it is in error.

HITSP closed its doors quietly last Friday.  The web site will be retained at least until such time as the new Harmonization process is announced, and I have my own copies of all the content as I've mentioned previously.  I've heard that we could hear something in the next month on the new harminization process, and by my lights, that's soon enough.  I will point out again that better continuity of care could have been established by the coordinators caring for our nation's healthcare IT.  They knew the planned discharge date and could have executed accordingly.

My chief concerns right now are whether the new harmonization process will be as open to input from interested parties as in other consensus based standards models, and whether they will address the time, scope, and quality triangle that weren't addressed in assigning HITSP deliverables.  Consensus takes time to establish.  Processes being experimented with in other initiatives (e.g., NHIN Direct) seem to be more open in some ways, and more closed in others.  Time will tell whether they work. 

Whatever that new process will be, I intend to participate.  At the same time, I've used the HITSP hiatus to get more involved in local activities around Healthcare IT.  That's introduced me to new people and places where there's still a great need for education about standards. 

In the last few years in HITSP, I've written or edited more than a ream of paper's worth of text, and read ten times that. Most of it has been useful, some of it more than others.  I've met scores of really bright, really energized people.  One thing that I've learned about all of them is that they are all extremely passionate, and really care about healthcare.  It's not hard to understand why when you start listening to their personal stories.

Volunteers (and leaders) will always get credit for the work that was done in an organization like HITSP.  But there is one group of people that really deserves special mention: The contractors that kept HITSP going through thick and thin.  Thanks to people like Cindy, Don, Lori, Gila, Anna, Bob, Suzi, Sarah, Gene, and Allyn (to name a few), HITSP was able to deliver as much as it did.  Yes, they got paid for it, but frankly, there were times when they didn't and they still kept plowing.  Most of us were funded to do this work on company time. They were on their own time and often weren't compensated nearly as adequately as they should have been based on the hours they put in.
The allocation of work to the allocation of hours never computed for many of them.  They often signed up for a 20 hour stint and sucked up 40 and 60 hour weeks (I've got the Skype chats and e-mail trails to prove it). 

There are a few volunteers who I also think deserve a special mention.  Thank you Scott, for teaching more about medications than I ever thought I wanted to know, and also to you Rachel, who did the same for X12N transactions. 

Finally, I want to thank the many nurses who participated in these activities.  Nothing is more tenacious than a nurse caring for a patient who feels that the patient isn't being cared for right.  Yes, the doctors and the geeks will always be there, but the job won't be done right until the nurses finish and bless it. 

Bless you all, and I hope to see you in the next phase.

Get out and Educate

I spent last Thursday and Friday at the Governer's Conference on Healthcare IT hosted by Deval Patrick.  It was a very interesting conference, and a bit eye opening.

I was impressed by two things at this conference:
1.  The overall desire to improve healthcare.
2.  The lack of knowledge about the status and availability of healthcare IT standards.

It appears to me that Standards do not exist in the minds of most of the attendees of this conference unless they are recognized by the Federal Government.  The lack of awareness of standards was apparent in many sessions.  Few people were aware that the basic standards used in several New England HIE initiatives were the same.  Fewer still understood what would be needed to close any gaps to make these initiatives be able to communicate with each other.

I attended one session where a consultant from Accenture reported to the attendees: "There are no standards."  I expect that sort of response from organizations that lack critical awareness of standards, but not from those that fund a CTO role in an Healthcare Standards Organization like HL7 International.  That response by the way, follows statement earlier in the day from John Halamka reporting the exact opposite.  Rest assured that I had a followup comment on that remark.

A more accurate statement would be that current regulation does NOT recognize the existing standards for many of the functions required under meaningful use.  There's a reason for that, as elaborated upon from Dr. David Blumenthal the day before.  We lack a great deal of knowledge about deployment experiences necessary to determine which standards should be selected for one.

At the whole conference, there were perhaps four people who've been involved in healthcare standards activities that I recognized.  That includes HITSP, WEDI, HL7, IHE and others.  If we want national and regional policy to make sense with regard to technology, then more of us who have some notion about what that technology can do need to be involved.  It's time to get out of the cube or the basement office and into the public eye to educate those making decisions.

The challenge for Standards organizations is that our efforts are done on a volunteer basis.  That includes marketing.  We need to rethink that.  If you want someone to use your products, you need to make appropriate investments to ensure that decision makers are aware of them and their benefits.

 My mantra for this year: Get out and educate.