What is VLER?

In honor of Veterans day being celebrated here in the US, I thought I'd describe an important US healthcare project that affects Veterans and members of the Military.

The Virtual Lifetime Electronic Record (VLER) is a project that intends to ensure that health information used by the US Department of Defense and the Veteran's Administration is seamlessly available across agencies.  A recent report indicates that this project will available nationwide by 2012 based on information in the current VA Strategic plan (pdf).

The key point of VLER is seamless sharing of health information between the DOD and VA.  The goal is to create an integrated, personal, lifelong electronic health record.  The record is supposed to contain information from enlistment (including prior data) through discharge and beyond until the last benefit is realized.

VLER will work through the Nationwide Health Information Network (NWHIN).  The first part of this program will be executed through the VLER Health Communities projects.

Phase 1a of the project tested exchange via NWHIN between Kaiser and the VA. Phase 1b tests exchange between three Virginia based healthcare providers, the DOD and VA in Hampton Rhodes. Other regions include Indianapolis, Indiana, and the Pudget Sound region of Washington.

In addition to exchange between DOD, VA and Private healthcare providers, VLER will also facilitate exchange between other federal agencies.   I believe that includes the Social Security Admihnistration for disability determination, but haven't been able to track that down.

So, what kinds of information will be exchanged?  If you have been following the Exchange program, you can guess that the first projects included some support for the HITSP C32.  I know they also very much want to exchange lab results, and they want other documents as well.  You can certainly expect these projects to recieve some priority in the ONC S&I Framework.

Apparently there were some vocabulary based challenges using C32, but because I'm not on the project, and those projects tend to be black holes for information, I don't know the details.  I can certainly guess that it is related to some of the topics I mentioned in in this post.  That's not really a C32 limitation, but in fact, was introduced because C32 Version 2.5 RELAXED contraints in order to be consistent with Meaningful Use Regulations.  I have to laugh when I see complaints like that because otherwise I'd be crying.  If the Feds wanted to eliminate optionality, they had the opportunity to do it by following the recommendations of the HIT Standards Committee. 

I expect you'll be hearing more about #VLER on this blog in the future, and on the tweet-stream

A best practice for data element descriptions

Once again someone has given me a spreadsheet with two and three word phrases to explain a set of data elements (more than 400 this time).  Yet there is no explanation of each of these items in lay terms.  I can understand them in a general way.  But the challenge for me is when the terms have specific meanings according to the way care is practiced at the institution.  It requires a great deal of back and forth to refine these definitions in ways that implementers will understand.

The C154 HITSP Data Dictionary document executes what I consider to be best practice in this arena.  Each row in the data dictionary includes four items, which are described below¹:

1. DATA ELEMENT IDENTIFIER
   Each data element has an identifier that uniquely identifies it. The first part of the identifier is assigned based upon the module where it is found. The second part of the identifier uniquely identifies the element within the module. As new data elements are created, they are added to the end of the data module. The data element identifiers are persistent and will not be changed or reused between versions of HITSP specifications.
2. DATA ELEMENT NAME
   Each data element has a name that briefly describes the content and purpose of the data element. Data element names may be changed between versions of HITSP specifications to better describe the content and purpose.
3. DATA ELEMENT DEFINITION
   Each HITSP data element has a definition that is intended to precisely describe the purpose and structure of the data element independent from the standards that it may be mapped to. This independence allows HITSP data elements to be mapped to data elements using a variety of standards. The concise definition and mapping to the standards data element also supports harmonization of data across exchanges using different standards. The definition should describe the data element with sufficient enough detail to clearly indicate the purpose and content of the data element.
4. DATA ELEMENT CONSTRAINTS
   In some cases, the data element will have additional restrictions limiting the values that can be communicated within it. HITSP may apply restrictions to a data element when it is communicated. These restrictions could be with regard to its precision, the units, and the range of legal values that may be transmitted or other restrictions as necessary. These will be described in or referred to by this column.
   
   This column defines universal constraints that apply to data elements regardless of the Base Standard (i.e. HL7 CDA, HL7 V2 messages, NCPDP, etc.) allowing for harmonized constraints across the various Base Standards. Additional data element constraints may also be defined in the CDA-specific sections of this document (2.2.x), or in HITSP Components, Transactions, Transaction Packages or Interoperability Specifications.

I'm sending the spreadsheet back to ask for column 3 and where necessary column 4 to be completed.  I hope that eventually this becomes a recognized practice in the industry.

  -- Keith

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¹ © 2010 ANSI. This material may be copied without permission from ANSI only if and to the extent that the text is not altered in any fashion and ANSI's copyright is clearly noted.

A do-it-yourself presentation on Health and Information Technology

A nice do-it-yourself presentation on Health and Information Technology from AHIMA developed for HI&T Week.

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Health Information and Technology Week

The professionals who work in the ever-evolving fields of health information management (HIM) and information technology (IT) will be recognized throughout the United States and Canada during Health Information and Technology Week, November 7 through 13. The theme for the 21st annual event is “Ensuring Health Information Integrity.”

Fast-paced changes in technology have accelerated demand for HIM professionals whose responsibility is to ensure that the health information used in care, research, and health management is valid, accurate, complete, trustworthy, and timely. While technology can improve data quality and efficiency in consumer healthcare, management of that information is one of the most complex challenges facing healthcare organizations today.

Health Information and Technology (HI&T) Week is a great opportunity to raise awareness and celebrate the progress and benefits of HIM and IT professionals working in tandem to deliver quality healthcare through quality information.

The AHIMA Web site (ahima.org) provides an HI&T Week planning kit. Materials in this kit include:

• Articles and quizzes
• Suggested activities
• PowerPoint presentation
• HI&T Week merchandise
• Other resources

Health Information and Technology Week is sponsored by the American Health Information Management Association (AHIMA) and the Canadian Health Information Management Association (CHIMA) with the support of Perceptive Software.

About AHIMA

Representing more than 60,000 specially educated HIM professionals in the United States and around the world, AHIMA is committed to promoting and advocating for high quality research, best practices, and effective standards in health information and to actively contributing to the development and advancement of health information professionals worldwide. AHIMA’s enduring goal is quality healthcare through quality information. http://www.ahima.org/

About CHIMA

CHIMA was founded in 1942 to provide a national forum for HIM professionals to share their expertise. Its federal charter was obtained in 1949. CHIMA represents more than 3,700 certified HIM professionals from across Canada, in addition to 1,300 affiliate, student, and retired members. CHIMA is the certifying body for HIM programs in Canadian colleges and universities, and certifies HIM professionals through the Canadian College of Health Information Management. http://www.echima.ca/

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HI&T Week logo courtesy of Bells International, Inc.
2010 AHIMA and Bells International, Inc.

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For my own part, there are the several HIT professionals that have been recognized over this past year in this blog.  Please consider nominating someone by selecting the contact me link.  If an adequate candidate is nominated this week, I'll post the announcement on Friday.  The selection criteria may be arbitrary, but the honor is not.

Land Speed Records

Wes Rishel said that if the Direct Project finished its work in a year, it would set a new land speed record.  He may be right, but I have thoughts about what record we are talking about.

From 0 to completed specification?  Nah, the Direct project missed that boat on that one.  IHE PCC took down that record in 2005 in the newly created Patient Care Coordination Domain.  That domain went from 0 to trial implementation specification (with a 30 day public comment period in the middle) from the beginning of July 2005 to October 2005, with testing by 14 implementors at the January 2006 connectathon. That's 4 months to an implementable specification, or 7 months to tested implementations, depending on how you want to count it.  Those implementations went into production in the following year.

HL7 has done pretty well also.  Several specifications have been created and published inside 6-8 months (mostly DSTUs, which require two implementors).  Some of those also went into production fairly quickly.

But not as fast as the Direct project seems to be going, and that is a real change.  The real record for the Direct Project is from project inception to announcement of commercial support (PDF).  But I don't think the Direct project can take all the credit for that speed.  In order for their to be commercial support for standards or interoperability specification, there must be a market for it.  Meaningful use created a market need for provider to provider communication with more than $20B in incentives, and the Direct project met that need.

It is no surprise to me that the Direct project is viewed as a big success.  It should be viewed that way, but it should also be viewed in the larger context as well. If the next project that is taken on in a "Direct-like" fashion doesn't have the same kind of incentives behind it, it may not succeed nearly as well.  We need to remember that in these projects and "keep our eyes on the prize" as it were. 

If we can do that, I believe we will succeed.

Event: Using Standards to Enable Communication Between Health Care Systems

Not quite in my inbox, but someone asked if I could make people aware of this event being put on by the Chicago Chapter of the Association for Computing Machinery.

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Next Chicago Chapter ACM Meeting - Wednesday November 10, 2010

A joint ACM/Loyola University Computer Science Department meeting

Avoiding the Fall of Babel: Using Standards to Enable Communication Between Health Care Systems

Speaker: Michael Donnelly of Epic

Wednesday, November 10, 2010 

5:30 pm -6:30 pm (Social Hour)
6:30 pm Presentation

Loyola University Water Tower Campus (Chicago/Michigan Area)
820 N Michigan, Chicago IL 60611

Beane Ballroom (13th Floor, Lewis Towers) Campus map

Admission: Free (General Admission, No Reserved Seats)

RSVP on the Chicago ACM website (chicagoacm.org)

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Click here for Chicago Chapter ACM's Facebook page

When you go to the emergency room, will the doctors have the information they need to take care of you? Those doctors can save critical time and money if they know your allergies, medications and ongoing medical problems. Access to that data can also prevent them from going down the wrong path thus reducing the risk of harming you.

Hospitals and clinics are replacing their paper charts with electronic medical record systems.  That change gives doctors and nurses quick and easy access to your medical information over the Internet.  Data exchanged by doctors and nurses require standards. And those standards help save lives at a significant financial benefit to the medical organizations.

This talk will discuss the standards that enable this communication, the process by which those standards are formed, and their workflow and security implications.  This will include discussion of standards and implementation profiles from www.hl7.org and www.ihe.net

Michael Donnelly is a software engineer at Epic, a Madison, WI based company that creates software systems for medical groups, hospitals, and integrated healthcare organizations.  Customers include community and multi-hospital systems, academic facilities, children's organizations and safety net providers.

Michael currently works on Care Everywhere, Epic's framework for cross-system interoperability. Previously at Epic he developed graphical tools to make it easier to administer interfaces and before that developed software to optimize machinery and processes in paper factories.  He started programming at age eight on an Apple IIe and was immediately hooked.  Outside work, he is an avid blogger, amateur journalist, and bicyclist.

Reservations:
To make a reservation, use this form:
Click here to Reserve for November 10, 2010 nowor send an e-mail to greg@neumarke.net

 Although there will be no food served at this event, feel free to "brown bag" it and bring in food from the outside to eat during the social hour. 

It's your data, ask for it.

This is a script for a very short commercial.  Each scene in it can also stand on its own, fading to a website URL.  I'd love to see commercials like these be more ubiquitous than ads for drugs on TV (at least here in the US):

Setting:  A bedroom.  There is a suitcase on the bed, and a woman is clearly packing it. A man (her husband) walks in to start taking things out of his closet to pack:

Wife:  Honey, when you get your flu shot today, can you ask Dr. ____ to give you an updated copy of your records?
Husband:  Sure, I'll just get him to print ...
Wife (interupting):  No, here... she hands him a thumb drive.
Husband:  What is he supposed to do with this?
Wife:  He should be able to give us an electronic copy...
Husband:  Are you sure?
Wife:  Sure am, I got mine (dangling a thumb drive) yesterday from Dr. ____, if she can do it, he should.  They use the same system you know.
Husband:  Great.
Wife:  But if he can't, just get him to print it out or e-mail it to you?
Husband: They can do that?...
Wife:  Well, not everyone can, but our doctor is getting money from Medicare to help pay for systems that support that, so he can.
Husband:  Wow, how did you find this out?
--- fade to next scene ---
Setting:  A doctor's office.  The Dr. is just finishing up giving the husband his flu shot.
Dr:  All done...
Husband:  Just one more thing doc... my wife want's me to get an updated copy of my records before we leave for our trip.
Dr:  Sure, just let me finishing updating (he turns to computer and presses a button), and I'll print it ...
Husband (Interupting):  No.. here, she said you could put it on this...
Dr:  Sure can, not many patients know we can do that.  How did you find that out?
--- fade to next scene ---
Somebody famous:  Hi, I'm _____.  Not many patients know it, but the Federal govenment is making it easier for you to get your healthcare data.  They've sponsored a program called Meaningful Use that makes it possible for your doctors to give you your healthcare information.  In order to qualify for benefits under that program, Doctors have to make your data available to most patients within a few days, and some will be able to give it to you immediately.

"It's your data, ask for it."

If you want to find out more, see our website at ____