Not sure what the tune is to go with this, but it's sort'a semi-RAP with lots of attitude.
I wanna be an e-Patient
To be a patient like Dave
Give me my damn data!
'Cause it's my life to save
I want to be an e-patient,
Under Meaningful Use
you can have my consent
to share without abuse
REFRAIN
Send me my damn data,
in a Patient Summary
You can use a CCR
But I'd prefer a CCD!
REFRAIN
I got my healthcare Inbox
You can send it DIRECT
To my HIE
XDS with CONNECT
REFRAIN
Hey I'm an e-Patient
Measurin' your quality
I'm gonna share my data
with other patients like Me
REFRAIN
Hey I'm an e-Patient
and you can be to
Just need ask your doctor
for your C32
REFRAIN
This blog post constitutes my formal submission for entrance to the The American College of Medical Informatimusicology. I now return you to your normal weekly broadcast. Enjoy the long weekend.
Keith
^
e-Patient
Updated 6-26-2011 with the video taken at #HealthFoo
Friday, September 3, 2010
Top O' the Week
Top post of this week is the ONC Interoperability Framework. For those of you who liked that one, you might also be interested in anohter post that didn't get quite as much attention on the same topic: ONC Interoperability Framework. Part II.
Top of the month hasn't changed since two days ago, but if you are interested, take a peek.
Top of the month hasn't changed since two days ago, but if you are interested, take a peek.
A Change of Mood Revisited (by a professional linguist)!
A few days ago I wrote a post called "A Change of Mood", describing HL7 Mood Codes and comparing them to some existing linguistic moods, mostly for fun. It looked like book fodder, except that I didn't know what I was going to do with it. Now I do, so I had a professional linguist review and comment on my post.
I've known Dr. Win Carus since 1992 when I joined the Software Division at Houghton Mifflin to work on spelling correction. He was the brains behind much of the linguisting technology we developed there. All I really had asked Win for was a little feedback. This is what I got, in his rather normal expansive manner. It was too good to keep to myself.
Win's comments appear below.
(a) Etymology: The term "mood" -- like many other incomprehensible English grammatical terms -- has its origin in Latin grammar (Latin 'modus', measure, manner). This is the same etymology for the term "modality" as used in logic. English has borrowed a lot of terms for linguistic and literary phenomena, especially from Latin and Greek, but you will find many French and German technical terms, and even Sanskrit here and there.
"Mood" is a technical linguistic term, so saying "it doesn't make sense" is a bit over the top. Yes, it has an unfamiliar sense, a sense with which your readers are probably not acquainted.
(b) Conflation: This term is used in the Wikipedia article you provide a link to, but I think it needs some clarification.
First, it is not at all uncommon for linguistic forms to carry multiple pieces of linguistic information. A simple example in English: the 's' ending of verbs indicates "third (person) singular (number) present (tense)". Keep in mind, however, that this phenomenon is found rather regularly in "fusional" or "inflecting" (more generally, "synthetic") languages, such as Indo-European languages.
Conflation of this sort is far less common in "agglutinative" languages such as -- Finnish, Hungarian, and Turkish -- in which the grammatical information of a lexeme is constructed by stringing together sequences of grammatical morphs.
And there's another linguistic phenomenon often at play in synthetic languages: "syncretism". This is where a single form can have multiple grammatic functions. For example, the "bare" English verbal form performs the functions of an infinitive and a non-third-person-singular present tense form (for example, the Brown Corpus tag set uses a single "VB" tag for both of these functions while the Penn tag set uses "VB' and "VBP", respectively).
"Unmarked" grammatical categories (such as the indicative mode; see the discussion in the next section) are by their very nature syncretic.
(c) Definitions of "mood": The great linguist Roman Jakobson gave an interesting way of thinking about mood years ago in his "Shifters, Verb Categories and the Russian Verb". He starts by distinguishing between three things:
(1) the narrated event (basically, what the speaker is talking about, the unadorned "just-the-facts-m'am")
(2) the speech event itself (the speech event occurs "here" and "now"; this is clearly a fundamental frame of reference for all sorts of ["deictic" and "indexical"] grammatical and semantic categories such as tense, locational prepositions and personal pronouns)
(3) the participants in the speech event (the speech event is produced by "me" and is directed to "you" and sometimes talks about "him", "her", "it" and "them")
Jakobson describes mood as how the speaker presents the narrated event to the listener, the speaker's overlay on the more or less objective facts of the narrated event. Mood presents the facts from different perspectives, divided most prominently between "real" ('realis') and "unreal" ('irrealis'). The "indicative" form is the basic "real" mood sub-type. (Jakobson also considers the indicative to be a semantically "unmarked" category: indicative forms can be used when speaking about both real and unreal narrative events, such as in the English "I hope that Johnny eats his vegetables.")
There are a wide range of "unreal" mood sub-types: imperative (which can be viewed as a demand or request that a narrative event come into being or be realized); conditional (a counterfactual or hypothetical narrative event); optative (a narrative event we wish or hope to be come the case or be realized); interrogative (asking about the truth of the given narrative event); potential (a narrative event that is considered probably or likely); jussive (requesting or exhorting the listener to accept the narrative event as true and possibly act on that knowledge); and so on (there are lots more, as you've learned already).
Most languages make a grammatical distinction between real and unreal; most languages don't have a large number of grammatical sub-types.
(Intellectual History Note: Jakobson's view on grammatical categories was strongly influenced by both C.S. Peirce's theory of signs, de Saussure's theory of linguistic signs and the Shannon-Weaver theory of communication.
(d) How mood is expressed: As you noted, mood is a property of verbs. But this is really a simplification. It's really a property of verbal linguistic expressions and more generally predications. Mood may be expressed:
(1) by a verb form (for example, indicative and subjunctive forms in Spanish)
(2) by a syntactic pattern (for example, English inverted interrogative word order ["Can you help me?"])
(3) by verb modifiers (for example, "particles" such as the Russian particle "by" used with preterite verb forms to express the subjunctive);
(4) periphrastically (for example, "[I would be very pleased if you would] help me"); and
(5) by differences in verbal intonation ("HELP me!" "Help ME?")
Many grammatical phenomena can be expressed in multiple ways (think, for example, about the ways you can express plurality in English).
American English has almost entirely lost purely morphological mood. Mood is now usually expressed by syntactic pattern, periphrastically or by intotation.
(e) What's the value of grammatical mood to your discussion of HL7 mood? In my opinion, the range of sub-types of grammatical mood does give you starting frame of reference about distinctions between real and unreal narrative events. But you must keep in mind that the distinctions talked about are about how languages have *grammaticalized* mood. You can see this wide range of grammaticalized mood in the two main Wikipedia articles on mood (Grammatical Mood and Eventive Mood). But you must always remember that this is just what it is: a list of grammatical categories.
The grammar of a language enforces certain ways of expressing certain kinds of information (this is what we think of as its grammar; and, of course, you really don't speak the language correctly or even intelligibly if you don't follow these grammatical prescriptions). But, by its very nature, language provides the linguistic tools to express notions that are not enforced or required by the grammar. There's a wonderfully clear discussion of this point in a recent New York Times article: "Does Your Language Shape How You Think?" by Guy Deutscher.
This is a very condensed presentation of his soon-to-appear book, “Through the Language Glass: Why the World Looks Different in Other Languages". This idea is not really that new. It was already apparent to Peirce that a sign has the property that it can be used as the basis to generate more complex signs (what's called "infinite semiosis").
Outside of the grammatical moods prescribed by a language, there are essentially unlimited and arbitrary ways to express moods in a language.
The discussions of grammatical mood can be used to identify a rich "starter kit" of narrative "moods" in HL7. However, what's most important should be a HL7-specific goal: What are the most useful sub-types (and these will undoubtedly fall into the "unreal" bucket) for describing medical narrative events? Keep in mind that the most important distinction is between "real" and "unreal" moods; and that you can define -- at will and entirely arbitrarily -- how many sub-types you wnat to use. What these grammatical mood descriptions help you to do, in addition, is to determine how one mood sub-type can be distinguished from another.
There is no reason to shoehorn the definitions you make for HL7 moods into grammatical moods. Note that you gave some one-to-many and many-to-one mappings in your attempts. My opinion is that grammatical moods per se don't matter for this work. Your goal should be to make sure that you've set up reasonable distinctions for characterizing medical assertions.
(f) Some Observations about HL7 moods:
(1) Actor/Patient Roles Unspecified: Reading through the list of HL7 moods (http://www.hl7.org/v3ballot/html/infrastructure/vocabulary/ActMood.htm), it is unclear who is the actor and who is the acted-upon of these assertions. For instance, a physician proposes a drug to treat the patients disorder and a patient proposes to be more diligent in taking his medications. Is it assumed that only medical staff can be an actor? Is only the physician case allowed?
(2) Heterogeneity: the HL7 moods are extremely heterogenous. (Many clearly could never be matched by something like a grammatical mood.) Take, for instance, OPT and ActMoodPredicate. These are not moods; they are organizational labels for relating moods.
(3) Name/Description Mismatch: ActMoodPromise is characterized thoroughly as a "commitment". Why not call it ActMoodCommitment?
(4) Temporal and Locational Intermixed: The specification of some moods (e.g., EVN, SLOT and APT) have temporal or locational constraints.
(5) Contextual Dependence: Some moods (e.g., ActMoodActRequest) depend on other moods.
(6) Definitional: The mood DEF is a definition (probably some kind of communally accepted and mandated description) that holds independent of time, place or event. This seems to something that stands apart from act-oriented moods.
(7) Act as Uniform Basis for Moods: It seems very odd to base moods uniformaly on an "act". For EXPEC, for instance, how is the prognosis of a condition interpretable as an "act"?
I could write much more about the HL7 moods.
Suggestion:
(1) Operational Rules: With respect to distinguishing one type of mood from another, I would suggest that you use "operational" questions for making these distinctions. These are questions that can be answered "yes" or "no" about how a narrative event is being viewed, to place it in one mood or another (sometimes in more than one). For instance, to determine that you're dealing with hortative mood, you could ask: "Is the physician or medical staff [speaker] speaking to the patient [listener] and strongly asking or requesting the patient to do something?" (Here "speaking" stands for communication in general; and there are a wide range of medical "exhortations" -- stopping smoking, taking medicines regularly, and so forth.) Similar formulas with examples could be constructed for each type of mood.
(g) And to help you think more about how we communicate, I'd suggest that you also think about two further subjects:
(1) "speech acts"
To quote from the Wikipedia article on "Speech acts":
"Speech acts can be analysed on three levels: A locutionary act, the performance of an utterance: the actual utterance and its ostensible meaning, comprising phonetic, phatic and rhetic acts corresponding to the verbal, syntactic and semantic aspects of any meaningful utterance; an illocutionary act: the semantic 'illocutionary force' of the utterance, thus its real, intended meaning (see below); and in certain cases a further perlocutionary act: its actual effect, such as persuading, convincing, scaring, enlightening, inspiring, or otherwise getting someone to do or realize something, whether intended or not (Austin 1962)."
This work arose from a short book by J.L. Austin, "How to Do Things With Words".
Thinking about "speech acts" shows how complex the underlying act of communication really is; and that there are a lot of unstated inferences we can draw and implications we can make from even apparently very simple statements.
(2) Grice's Conversational Maxims
Grice is interested in the link between our utterances and what we're talking about. Here's a short description from the Wikipedia article:
"The Maxims are based on his cooperative principle, which states, ‘Make your conversational contribution such as is required, at the stage at which it occurs, by the accepted purpose or direction of the talk exchange in which you are engaged,’ and is so called because listeners and speakers must speak cooperatively and mutually accept one another to be understood in a particular way. The principle describes how effective communication in conversation is achieved in common social situations and is further broken down into the four Maxims of Quality, Quantity, Relevance and Manner."
These maxims give a different way to analyze how the medical information for an encounter is constructed.
Win
Win Carus is the President and Founder of Information Extraction Systems. InfoExtract has developed a suite of high-performance, multilingual, adaptive, platform-independent natural language and semantic processing tools which they license and use to develop applications that combine structured, semi-structured and unstructured information. Their medical informatics application suite includes applications for physician referrals, patient selection, medical terminology servers, and patient problem list processing.
I've known Dr. Win Carus since 1992 when I joined the Software Division at Houghton Mifflin to work on spelling correction. He was the brains behind much of the linguisting technology we developed there. All I really had asked Win for was a little feedback. This is what I got, in his rather normal expansive manner. It was too good to keep to myself.
Win's comments appear below.
(a) Etymology: The term "mood" -- like many other incomprehensible English grammatical terms -- has its origin in Latin grammar (Latin 'modus', measure, manner). This is the same etymology for the term "modality" as used in logic. English has borrowed a lot of terms for linguistic and literary phenomena, especially from Latin and Greek, but you will find many French and German technical terms, and even Sanskrit here and there.
"Mood" is a technical linguistic term, so saying "it doesn't make sense" is a bit over the top. Yes, it has an unfamiliar sense, a sense with which your readers are probably not acquainted.
(b) Conflation: This term is used in the Wikipedia article you provide a link to, but I think it needs some clarification.
First, it is not at all uncommon for linguistic forms to carry multiple pieces of linguistic information. A simple example in English: the 's' ending of verbs indicates "third (person) singular (number) present (tense)". Keep in mind, however, that this phenomenon is found rather regularly in "fusional" or "inflecting" (more generally, "synthetic") languages, such as Indo-European languages.
Conflation of this sort is far less common in "agglutinative" languages such as -- Finnish, Hungarian, and Turkish -- in which the grammatical information of a lexeme is constructed by stringing together sequences of grammatical morphs.
And there's another linguistic phenomenon often at play in synthetic languages: "syncretism". This is where a single form can have multiple grammatic functions. For example, the "bare" English verbal form performs the functions of an infinitive and a non-third-person-singular present tense form (for example, the Brown Corpus tag set uses a single "VB" tag for both of these functions while the Penn tag set uses "VB' and "VBP", respectively).
"Unmarked" grammatical categories (such as the indicative mode; see the discussion in the next section) are by their very nature syncretic.
(c) Definitions of "mood": The great linguist Roman Jakobson gave an interesting way of thinking about mood years ago in his "Shifters, Verb Categories and the Russian Verb". He starts by distinguishing between three things:
(1) the narrated event (basically, what the speaker is talking about, the unadorned "just-the-facts-m'am")
(2) the speech event itself (the speech event occurs "here" and "now"; this is clearly a fundamental frame of reference for all sorts of ["deictic" and "indexical"] grammatical and semantic categories such as tense, locational prepositions and personal pronouns)
(3) the participants in the speech event (the speech event is produced by "me" and is directed to "you" and sometimes talks about "him", "her", "it" and "them")
Jakobson describes mood as how the speaker presents the narrated event to the listener, the speaker's overlay on the more or less objective facts of the narrated event. Mood presents the facts from different perspectives, divided most prominently between "real" ('realis') and "unreal" ('irrealis'). The "indicative" form is the basic "real" mood sub-type. (Jakobson also considers the indicative to be a semantically "unmarked" category: indicative forms can be used when speaking about both real and unreal narrative events, such as in the English "I hope that Johnny eats his vegetables.")
There are a wide range of "unreal" mood sub-types: imperative (which can be viewed as a demand or request that a narrative event come into being or be realized); conditional (a counterfactual or hypothetical narrative event); optative (a narrative event we wish or hope to be come the case or be realized); interrogative (asking about the truth of the given narrative event); potential (a narrative event that is considered probably or likely); jussive (requesting or exhorting the listener to accept the narrative event as true and possibly act on that knowledge); and so on (there are lots more, as you've learned already).
Most languages make a grammatical distinction between real and unreal; most languages don't have a large number of grammatical sub-types.
(Intellectual History Note: Jakobson's view on grammatical categories was strongly influenced by both C.S. Peirce's theory of signs, de Saussure's theory of linguistic signs and the Shannon-Weaver theory of communication.
(d) How mood is expressed: As you noted, mood is a property of verbs. But this is really a simplification. It's really a property of verbal linguistic expressions and more generally predications. Mood may be expressed:
(1) by a verb form (for example, indicative and subjunctive forms in Spanish)
(2) by a syntactic pattern (for example, English inverted interrogative word order ["Can you help me?"])
(3) by verb modifiers (for example, "particles" such as the Russian particle "by" used with preterite verb forms to express the subjunctive);
(4) periphrastically (for example, "[I would be very pleased if you would] help me"); and
(5) by differences in verbal intonation ("HELP me!" "Help ME?")
Many grammatical phenomena can be expressed in multiple ways (think, for example, about the ways you can express plurality in English).
American English has almost entirely lost purely morphological mood. Mood is now usually expressed by syntactic pattern, periphrastically or by intotation.
(e) What's the value of grammatical mood to your discussion of HL7 mood? In my opinion, the range of sub-types of grammatical mood does give you starting frame of reference about distinctions between real and unreal narrative events. But you must keep in mind that the distinctions talked about are about how languages have *grammaticalized* mood. You can see this wide range of grammaticalized mood in the two main Wikipedia articles on mood (Grammatical Mood and Eventive Mood). But you must always remember that this is just what it is: a list of grammatical categories.
The grammar of a language enforces certain ways of expressing certain kinds of information (this is what we think of as its grammar; and, of course, you really don't speak the language correctly or even intelligibly if you don't follow these grammatical prescriptions). But, by its very nature, language provides the linguistic tools to express notions that are not enforced or required by the grammar. There's a wonderfully clear discussion of this point in a recent New York Times article: "Does Your Language Shape How You Think?" by Guy Deutscher.
This is a very condensed presentation of his soon-to-appear book, “Through the Language Glass: Why the World Looks Different in Other Languages". This idea is not really that new. It was already apparent to Peirce that a sign has the property that it can be used as the basis to generate more complex signs (what's called "infinite semiosis").
Outside of the grammatical moods prescribed by a language, there are essentially unlimited and arbitrary ways to express moods in a language.
The discussions of grammatical mood can be used to identify a rich "starter kit" of narrative "moods" in HL7. However, what's most important should be a HL7-specific goal: What are the most useful sub-types (and these will undoubtedly fall into the "unreal" bucket) for describing medical narrative events? Keep in mind that the most important distinction is between "real" and "unreal" moods; and that you can define -- at will and entirely arbitrarily -- how many sub-types you wnat to use. What these grammatical mood descriptions help you to do, in addition, is to determine how one mood sub-type can be distinguished from another.
There is no reason to shoehorn the definitions you make for HL7 moods into grammatical moods. Note that you gave some one-to-many and many-to-one mappings in your attempts. My opinion is that grammatical moods per se don't matter for this work. Your goal should be to make sure that you've set up reasonable distinctions for characterizing medical assertions.
(f) Some Observations about HL7 moods:
(1) Actor/Patient Roles Unspecified: Reading through the list of HL7 moods (http://www.hl7.org/v3ballot/html/infrastructure/vocabulary/ActMood.htm), it is unclear who is the actor and who is the acted-upon of these assertions. For instance, a physician proposes a drug to treat the patients disorder and a patient proposes to be more diligent in taking his medications. Is it assumed that only medical staff can be an actor? Is only the physician case allowed?
(2) Heterogeneity: the HL7 moods are extremely heterogenous. (Many clearly could never be matched by something like a grammatical mood.) Take, for instance, OPT and ActMoodPredicate. These are not moods; they are organizational labels for relating moods.
(3) Name/Description Mismatch: ActMoodPromise is characterized thoroughly as a "commitment". Why not call it ActMoodCommitment?
(4) Temporal and Locational Intermixed: The specification of some moods (e.g., EVN, SLOT and APT) have temporal or locational constraints.
(5) Contextual Dependence: Some moods (e.g., ActMoodActRequest) depend on other moods.
(6) Definitional: The mood DEF is a definition (probably some kind of communally accepted and mandated description) that holds independent of time, place or event. This seems to something that stands apart from act-oriented moods.
(7) Act as Uniform Basis for Moods: It seems very odd to base moods uniformaly on an "act". For EXPEC, for instance, how is the prognosis of a condition interpretable as an "act"?
I could write much more about the HL7 moods.
Suggestion:
(1) Operational Rules: With respect to distinguishing one type of mood from another, I would suggest that you use "operational" questions for making these distinctions. These are questions that can be answered "yes" or "no" about how a narrative event is being viewed, to place it in one mood or another (sometimes in more than one). For instance, to determine that you're dealing with hortative mood, you could ask: "Is the physician or medical staff [speaker] speaking to the patient [listener] and strongly asking or requesting the patient to do something?" (Here "speaking" stands for communication in general; and there are a wide range of medical "exhortations" -- stopping smoking, taking medicines regularly, and so forth.) Similar formulas with examples could be constructed for each type of mood.
(g) And to help you think more about how we communicate, I'd suggest that you also think about two further subjects:
(1) "speech acts"
To quote from the Wikipedia article on "Speech acts":
"Speech acts can be analysed on three levels: A locutionary act
This work arose from a short book by J.L. Austin, "How to Do Things With Words".
Thinking about "speech acts" shows how complex the underlying act of communication really is; and that there are a lot of unstated inferences we can draw and implications we can make from even apparently very simple statements.
(2) Grice's Conversational Maxims
Grice is interested in the link between our utterances and what we're talking about. Here's a short description from the Wikipedia article:
"The Maxims are based on his cooperative principle
These maxims give a different way to analyze how the medical information for an encounter is constructed.
Win
Win Carus is the President and Founder of Information Extraction Systems. InfoExtract has developed a suite of high-performance, multilingual, adaptive, platform-independent natural language and semantic processing tools which they license and use to develop applications that combine structured, semi-structured and unstructured information. Their medical informatics application suite includes applications for physician referrals, patient selection, medical terminology servers, and patient problem list processing.
Thursday, September 2, 2010
Book Review: The Ten Commandments for Effective Standards by @karenbartleson
Subtitled "Practical Insights for Creating Technical Standards", Karen Barlteson's new (May 2010) book is a must read for anyone wanting to get involved in Standardization Efforts, here in the US or Internationally. It's a quick read and it contains exactly what the subtitle claims. I polished it off after dinner (it arrived today) in about 45 minutes.
Earlier this year I was asked to put together a class on Standards along with some of my colleagues for engineering master's degree students (not just in healthcare). It was to last four hours, have about two days worth of homework and we were asked to recommend a text book. We had no recommendations for texts, just a few good articles on the web here and there. I just went back into the curriculumn and added this book as the text.
The book is very short, checking in at just under 100 pages of content (with about 25 pages or so of footnotes, references, and an index). It can easily be read in one sitting (even if you aren't a speed reader). It's also a picture book, as all of Ms. Bartleson's commandments are very well illustrated by Rick Jamison as demonstrated here. I want the clip art!
Since you can get the 10 Commandments from the Table of Contents at Amazon, I don't have a problem listing them here.
- Cooperate on Standards, Compete on Products
- Use Caution when Mixing Patents and Standards
- Know When to Stop
- Be Truly Open
- Realize there is No Neutral Party
- Leverage Existing Organizations and Proven Processes
- Think Relevance
- Recognize that there is More than One Way to Create a Standard
- Start with Contributions, Not from Scratch
- Know that Standards Have Technical and Business Aspects
Karen also happens to write a blog on guess what ... standards. It's called the Standards Game and is also worth reading. But I have to go back and read this book again, just a little bit more slowly this time. There has to be something in there that I can disagree with...
Keith
Wednesday, September 1, 2010
Random Musings on Identity
“|You have as many identities as you have friends. -- Unknown
This particular post is one in which something I learn via one persona crosses over to the other, and of course, because this is a different persona, gets warped and rewritten.
My online identities are quite convoluted. I reported in a post titled Tweet a little bit more than a year ago that I have at least 16 different ways that I communicate electronically. Associated with each one is a slightly different identity. Some identities (e.g., @motorcycle_guy on Twitter and this blog ) cross over to the point of being virtually indistinguishable.
Others are very closely held, not quite secrets (you can find me on the interweb), that I try to keep separate. These are not identities I share with many, some only to close friends and colleagues, and others only to people that have known me in college (or through that tribe). One thing that I have learned through all my friends and close colleagues is that no matter what issues I have with identity, they have even more. I know of one person who is male in one place, female in another, and in yet a third, both.
I have a Facebook account, mostly so that I can peruse pictures from my family members, but I rarely ever post there.
I have a LinkedIn account that I started when I was first hunting (for this job), and now use it to stay connected with former colleagues and to connect to others in this industry. That is pretty well hooked into my twitter identity.
I have a Blog internal to GE that I haven't posted to in quite a while because I do so much more writing here.
I'm on at least 50 different mailing lists, some using my personal e-mail and others with my work e-mail address. The rule is, if I'm officially representing my employer it get's my work e-mail, but otherwise, it goes to the personal one. I don't post my e-mail address because frankly, it's too easy to scrape and I've burned at least three personal e-mail addresses due to junk mail. My e-mail address is on the web, and if you know what I do and for who, you can find it easily enough (big hint, I cochair committees for HL7 and IHE). And if not, you can always hit the Contact Me link on this blog (and if you know how that works, you can e-mail me directly).
One useful rule I've figured out is that if it's coming with me should I leave my current employer, the identity is tied to my personal e-mail address.
I have a personal journal, and if you are among the about 10 people I share it with, you are pretty lucky, and also pretty cool. Most of my friends have already agreed that what I post there to "friends only" will not make it back into the wider twitterverse. I need a place to moan and gripe where I don't have to worry about what [redacted] thinks. I once recieved a job offer from someone who found me there and though it would be neat to let me know he discovered my "alternate self". That wasn't a complete and total turn-off, but it definately had a negative impact.
I have a Skype account, you can find me there using "Keith W. Boone".
So, with all of these different musings on identity, what are you to do? Don't worry, I'll figure it out for you. If you contact me through one identity and I think another is more appropriate, I'll let you know. If you want to tweet, share, or otherwise link to this content feel free to do so, in whatever venue you like (In fact, I just made it easier to do that). That of course doesn't give you free reign to exceed your rights or mine under copyright (see the Policies Page),
With all of these identities, my mind next wonders (or is it wanders) to how that relates to the online relationships I want to have with my healthcare providers. I don't think I want healthcare information in my "gmail" inbox. For one, its not something I can reliably secure. I want an e-mail inbox that requires encryption on the way in via TLS. No, that's not the NHIN Direct way (they have specified an S/MIME solution). But I worry that someone will try to e-mail me healthcare data without knowing what they are doing, and I want to make sure that A) it is secure and B) I can tell my mother how to do it.
I think I'll be happy to have one or two direct electronic relationships with my providers. When that becomes three our four, then I'll start looking for better solutions. But I can take this identity thing one step at a time.
My last musing on Identity? It seems that while the American populace (or at least it's Congress) is not ready for a National Patient Identity, the VA and DOD are ready for a national solidier healthcare identifier. Maybe that's another step at a time approach. Of course the VA and DOD have a pretty well documented reason to want it that the rest of the citizenry may just be waiting to have. Frankly, I could skip that step if you don't mind.
Keith W. Boone
"That Motorcycle Guy"
Standards Geek
@motorcycle_guy
Co-chair HL7 Structured Documents Workgroup
Co-chair IHE Patient Care Coordination Planning Committee
Co-chair EHRA Quality and Clinical Decision Support Special Interest Group
A few unmentionables and some private ones
P.S. If you know the source or original for the quote above, please let me know.
HL7 Offers Free Webinar on CDA Release 2 and the CCD: Standards for the Meaningful Exchange of Health Information and Clinical Summaries
For Immediate Release
HL7 Offers Free Ambassador Webinar—CDA Release 2 and the CCD:
Standards for the Meaningful Exchange of Health Information and Clinical Summaries
Ann Arbor, Michigan, USA – September 1, 2010 – Health Level Seven® International (HL7®), the global authority for interoperability and standards in healthcare information technology with members in 55 countries, will present a complimentary Ambassador webinar on the HL7 Clinical Document Architecture Release 2.0 (CDA) and the Continuity of Care Document (CCD) on Tuesday, September 14 from 11:00 am – 12:00 noon EDT.
The CDA is designed to support the exchange of health information in clinical documentation and the CCD for creating clinical summaries. These specifications were recently named under the federal regulation in the United States to support meaningful use requirements and have also been selected for use in national and regional programs throughout the world. This webinar will explain how the CDA and CCD benefit patients and healthcare providers. It will also assist managers and decision makers involved in the acquisition or development of healthcare IT solutions to understand the business needs met by these HL7 standards.
Keith W. Boone, standards architect with GE Healthcare, co-chair of the HL7 Structured Documents Work Group, and HL7 ambassador will be presenting the webinar. Mr. Boone was involved in the development of CDA Release 2.0, and has been an editor of many CDA-based implementation guides developed by organizations including HL7, Integrating the Healthcare Enterprise and ANSI/HITSP, including the HL7 CCD and the ANSI/HITSP C32.
To register for this free webinar, please visit http://www.hl7.org/events/ambassador092010/. HL7 will also be offering a face-to-face Ambassador session on HL7 and standards for meaningful use at its Annual Plenary and Working Group Meeting being held in Cambridge, MA on October 4, 2010. For more details, please see http://www.hl7.org/documentcenter/public/pressreleases/HL7_PRESS_20100826.pdf
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 Health Level Seven International (HL7)
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; 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; 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, Colombia, Croatia, Czech Republic, Finland, Germany, Greece, Hong Kong, India, Italy, Japan, Korea, The Netherlands, New Zealand, Norway, 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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Top O' the Month
Although it's midweek, August is now over and school has finally started (yesterday for my kids). July was a banner month for this blog, breaking just about all records previously establed, and given that Meaningful Use Standards Summary was clearly the reason for it, I did not expect to beat any of July's numbers in August. But I just managed to surpass the number of page hits in August over July according to Google and came pretty close according to Blogger's more accurate records. The three topics most important to readers in August were (based on data in Blogger Stats):
My second post ever, and one I think that finally had the impact (pun intended) that it deserved.
20. Clinical Decision Support (2)
Another really good post, and the foundation of a lot of my thinking on the topic of CDS.
- Meaningful Use Standards Summary
Still going strong after 6 weeks, and I imagine it will continue going strong for another month or so. - Can you imagine this nurse on a Harley?
I'm quite pleased this post has received the attention that it has. It's long overdue. - The definition of Transparency is apparently Invisibility
This post had tremendous impact. There has been a lot of subsequent activity making the ONC Standards and Interoperability Framework more transparent, including the Monday presentation of this framework by Doug Fridsma given to the HIT Standards FACA. I reported on that presentation here.
- Meaningful Use Standards Summary (1)
I don't expect this post to be beaten by anything I write until 2013. Frankly, I hope that predicion is wrong. - Template Identifiers, Business Rules and Degrees of Interoperability (3)
This post talks about how templates work. I'm thrilled to see it in the top 10, because it's really important for people to understand how to convey and reuse of business rules in an exchange. - Laboratory Orders (5)
The industry has been struggling with how to come up with a set of laboratory order codes for decades. The work reported on here led to the publication of the LOINC Common Laboratory Order value set. - Where in the World is XDS (6)
The most popular web page I've put together of all time started wth this post I did for Wes Rishel, and that map still beats this blog by about 40,000 views. - Demystifying SAEAF...maybe (7)
Getting lots of hits in the first quarter of this year, but dropped off after HL7 changed the name to SAIF. I've updated the title of this post to reflect the new name to ensure that it shows up in searches. - Recognition (8)
This was my first Ad Hoc Harley award, and on the day it posted, it blew away all previous records. Still worth reading. - Open Source Standards Implementations (9)
I added this page as a permanent page and have a few pending updates to make to it, but its apparently been a good resource for people. - Meaningful Use IFR Comments (10)
Temporally useful but at this point no longer worth reading since the rules have now been finalized. - Meaningful Use Posters (11)
Robin's Eggs are pretty, what more can I say? - A Quick Overview of the ebXML RIM objects in XDS Metadata (12)
Still a topic of discussion for many, and a prettuy useful table to boot.
My second post ever, and one I think that finally had the impact (pun intended) that it deserved.
20. Clinical Decision Support (2)
Another really good post, and the foundation of a lot of my thinking on the topic of CDS.
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