Wednesday, December 15, 2010
healthcare info
http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_0_5317_1432_17051_43/http%3B/wci-pubcontent/publish/onc/public_communities/f_j/funding_opportunities/competency_exam_facts_portlet/files/hitech_fs_workforce_training_v7.pdf
Health Care info associate degree at bristol community college
Health Sciences
Degree offered
Associate in Science in Healthcare Information
Credits required 70
Dean ext. 2141
Patricia Dent
Program Contact ext. 2329
Joy Rose, Interim Program Director
Program Goals Statement
The goal of the Health Information Technology Program is
to prepare competent entry-level Health Information Technicians
eligible to take the national certification exam to become
credentialed as Registered Health Information Technicians
(RHIT). Graduates are prepared for employment in a variety
of healthcare facilities such as physician offices, hospitals, long
term care or rehabilitation facilities, clinics and vendors.
After BCC
Graduates are actively recruited for such positions as health
information department supervisor, medical coding specialist,
health information technician, medical record coordinator,
and medical coder.
Student Learning Outcomes (see page 159)
Program Information
The Healthcare Information program prepares students to
become registered health information technicians. Employment
prospects for graduates are excellent.
Some courses in this program are only offered during the day.
During the second year of the program, students do Professional
Practices Experiences (PPEs) at healthcare provider
organizations throughout southeastern Massachusetts and
Rhode Island. Students are responsible for providing their
own transportation.
Medical Coding students should take HCI 237 and BIO
115 as a prerequisite to HCI 239 and HCI 242.
Healthcare Information students should take HCI 237 and
BIO 234 as a prerequisite to HCI 239 and HCI 242.
Program Accreditation
The Healthcare Information program is accredited by the
Commission on Accreditation for Health Informatics and
Information Management Education. Program graduates
are eligible to apply to sit for the National Qualifying Examination
for Certification as a Registered Health Information
Technician.
Infused General Education Competencies
Degree offered
Associate in Science in Healthcare Information
Credits required 70
Dean ext. 2141
Patricia Dent
Program Contact ext. 2329
Joy Rose, Interim Program Director
Program Goals Statement
The goal of the Health Information Technology Program is
to prepare competent entry-level Health Information Technicians
eligible to take the national certification exam to become
credentialed as Registered Health Information Technicians
(RHIT). Graduates are prepared for employment in a variety
of healthcare facilities such as physician offices, hospitals, long
term care or rehabilitation facilities, clinics and vendors.
After BCC
Graduates are actively recruited for such positions as health
information department supervisor, medical coding specialist,
health information technician, medical record coordinator,
and medical coder.
Student Learning Outcomes (see page 159)
Program Information
The Healthcare Information program prepares students to
become registered health information technicians. Employment
prospects for graduates are excellent.
Some courses in this program are only offered during the day.
During the second year of the program, students do Professional
Practices Experiences (PPEs) at healthcare provider
organizations throughout southeastern Massachusetts and
Rhode Island. Students are responsible for providing their
own transportation.
Medical Coding students should take HCI 237 and BIO
115 as a prerequisite to HCI 239 and HCI 242.
Healthcare Information students should take HCI 237 and
BIO 234 as a prerequisite to HCI 239 and HCI 242.
Program Accreditation
The Healthcare Information program is accredited by the
Commission on Accreditation for Health Informatics and
Information Management Education. Program graduates
are eligible to apply to sit for the National Qualifying Examination
for Certification as a Registered Health Information
Technician.
Infused General Education Competencies
How to implement the patient mandate equitably
Final rule 170,302(m)wants the mandate to create patient education resources,problem lists,medication lists,and to make the test results available to patients.
I add in a medium most accesible to patient(Cell phone app,written in varoius languages,or interactive Web content).This is how many of the people in the field are interpretting it.
One of the goals of the EMR is to remove the inequities in delivery of the medical services because of other inequities.
Uninsured ,underinsured and medically underserved amd minority communities need to be benefitted by it. We have seen that in massachussetts where only 2.6 % are uninsured in general population in the hispanics the rate is 7.2 %.
Race based health inequities exist across .Blacks live five years less than whites and their is an anomaly that Hispanics outlive whites by two years even when they have lower level of health coverage than populations in general.
We will have to work extra hard so that our underrepresented population opt in the health exchanges to get the benefits to be derived from the new EMR mandate.
Better management of critical diseases will help us effect better health outcome for our people.Five or so are critical fields where we can make a major difference.
Hypertension
Diabeties
obesity
Mal nutrition in mothers and children
respiratory problems
smoking
We think by focusing on nutrition,smoking cessation,and physical activity we can improve health outcomes of many people.We will have to identify at risk populations and then educate them and provide resources.An ounce of prevention is always better than a pound of cure.
When we look at the risk groups we may find that it is a moving target.Now they include large number of:
Hispanics
blakcs
hmongs
Glbstg
unemployed
children
foreign born populaion
and now home less and even vetrans
We will have to make sure that they remain healthy mentally and physically for society to do well.
I add in a medium most accesible to patient(Cell phone app,written in varoius languages,or interactive Web content).This is how many of the people in the field are interpretting it.
One of the goals of the EMR is to remove the inequities in delivery of the medical services because of other inequities.
Uninsured ,underinsured and medically underserved amd minority communities need to be benefitted by it. We have seen that in massachussetts where only 2.6 % are uninsured in general population in the hispanics the rate is 7.2 %.
Race based health inequities exist across .Blacks live five years less than whites and their is an anomaly that Hispanics outlive whites by two years even when they have lower level of health coverage than populations in general.
We will have to work extra hard so that our underrepresented population opt in the health exchanges to get the benefits to be derived from the new EMR mandate.
Better management of critical diseases will help us effect better health outcome for our people.Five or so are critical fields where we can make a major difference.
Hypertension
Diabeties
obesity
Mal nutrition in mothers and children
respiratory problems
smoking
We think by focusing on nutrition,smoking cessation,and physical activity we can improve health outcomes of many people.We will have to identify at risk populations and then educate them and provide resources.An ounce of prevention is always better than a pound of cure.
When we look at the risk groups we may find that it is a moving target.Now they include large number of:
Hispanics
blakcs
hmongs
Glbstg
unemployed
children
foreign born populaion
and now home less and even vetrans
We will have to make sure that they remain healthy mentally and physically for society to do well.
Tuesday, December 14, 2010
NY times article onEHR 12/13/2010
Panel Set to Study Safety of Electronic Patient DataBy MILT FREUDENHEIM
Published: December 13, 2010
Almost two years ago, President Obama pledged $19 billion in stimulus incentives to help convert the nation’s doctors and hospitals to using a paperless system of electronic health records intended to improve the quality of care and reduce costs. But the conversion is still a slow work in progress.
A family clinic in Walsenburg, Colo., is part of the Spanish Peaks Regional Health Center, which planned to adopt an electronic health records system. Administrators predicted the cost would be recovered through federal funds.
Only about one in four doctors, mostly in large group practices, is using the electronic record system. A vast majority of physicians in small offices, the doctors who serve most Americans, still track patients’ illnesses and other problems with pen and paper.
The thousands of sometimes deadly medical errors tallied by an Institute of Medicine study in 1999 are still all too common, according to a recent report on North Carolina hospitals in the New England Journal of Medicine. And the electronic record systems are themselves increasingly attracting concerns that computer errors, design flaws and breakdowns in communication sometimes endanger patients.
For example, parts of a patient’s electronic medical records have disappeared or been saved in the wrong patient’s file, according to the Food and Drug Administration. Incorrect entries have sometimes been posted for drug allergies and blood pressure readings, the agency said.
Taking a fresh look at such concerns, the Institute of Medicine created the Committee on Patient Safety and Health Information Technology to run a yearlong study and issue recommendations. The 16-member panel is meeting for the first time on Tuesday in Washington.
In February, the F.D.A. said it had received 260 reports of malfunctions related to health information technology “with the potential for patient harm,” including 44 reported injuries and six reported deaths in 2008 and 2009. The malfunctions were reported voluntarily to the agency, mainly by hospitals.
“Because these reports are purely voluntary, they may represent only the tip of the iceberg,” said Dr. Jeffrey Shuren, a senior F.D.A. policy and enforcement official.
In an indication of interest from Congress, Senator Charles E. Grassley of Iowa, the ranking Republican on the Senate Finance Committee, wrote to the health information industry and to Kathleen Sebelius, the secretary of Health and Human Services, to ask what was being done to make sure the systems were being reviewed and monitored for patient safety concerns and what role the F.D.A. played in regulating health information technology.
Dr. Shuren suggested that F.D.A. regulators could consider a range of new safety requirements under the agency’s authority to assure the safety, effectiveness and quality of medical devices, including software devices.
“All options for assuring safety are on the table,” said Dr. David Blumenthal, the Obama administration’s national coordinator for health information technology. His office gave the Institute of Medicine $989,000 for the patient safety panel, which is led by Gail L. Warden, the former president and chief executive of the Henry Ford Health System in Detroit.
Dr. Blumenthal said health information experts like Dr. Donald M. Berwick, the Medicare and Medicaid administrator, and Dr. Brent James, of Intermountain Healthcare, based in Salt Lake City, “agree that electronic health records will improve the safety of care.”
“At the same time, any time you change the world you create risks,” Dr. Blumenthal said in a telephone interview last weekend. “We want to make sure that implementation is as safe as it can be and all safety benefits are realized.”
He said that if the Institute of Medicine “concludes that regulation is an important part of this fabric of assuring safety, we will want to balance regulation and innovation as we do in every marketplace.”
Manufacturers of the systems have long opposed government regulation of their products.
“The policing of design by a third party or agency, however well intended, will likely stifle innovation and inhibit the growth and development of electronic health records in the future,” said Carl Dvorak, executive vice president of Epic Systems, which has built electronic records systems for Kaiser Permanente and other large health care and hospital groups.
The industry has recently avoided speaking out on a role for the F.D.A. In a statement for this article, the Healthcare Information and Management Systems Society, a Washington-based industry group, said only that it “supports the administration’s decision to ask the Institute of Medicine to study this complex issue and report back over the next 12 months.”
Last month, in protest of one common industry practice, the American Medical Informatics Association said “hold harmless” clauses in many purchasing contracts were unethical. The clauses typically absolve manufacturers of responsibility for any errors or misuse.
“We said we value innovation, but we don’t value it more than safety,” said Kenneth W. Goodman, a University of Miami bioethicist who headed an association advisory group on patient safety.
“We just do not have good data on medical errors, whatever the cause,” said Arthur A. Levin, a member of the new Institute of Medicine commission. Mr. Levin, director of Center for Medical Consumers in New York, also was a member of the institute group that warned in a 1999 report, “To Err Is Human,” that there could be 98,000 preventable deaths each year in hospitals.
An article in the New England Journal of Medicine last month pointed to a potential for malpractice liability risks because more information might be available on electronic records that might have gone unnoticed on a paper chart. Health care providers must weigh the substantial upfront costs and possible risks against the potentially sizable, but uncertain long-run benefits, Dr. Sandeep S. Mangalmurti, an internist at New York University’s Langone Medical Center, and his colleagues wrote.
“We probably catch about 2 percent of the errors,” said Ross Koppel, a University of Pennsylvania sociologist and investigator for RAND Corporation, the research organization based in Santa Monica, Calif. “The errors are the 98 percent that got through
Published: December 13, 2010
Almost two years ago, President Obama pledged $19 billion in stimulus incentives to help convert the nation’s doctors and hospitals to using a paperless system of electronic health records intended to improve the quality of care and reduce costs. But the conversion is still a slow work in progress.
A family clinic in Walsenburg, Colo., is part of the Spanish Peaks Regional Health Center, which planned to adopt an electronic health records system. Administrators predicted the cost would be recovered through federal funds.
Only about one in four doctors, mostly in large group practices, is using the electronic record system. A vast majority of physicians in small offices, the doctors who serve most Americans, still track patients’ illnesses and other problems with pen and paper.
The thousands of sometimes deadly medical errors tallied by an Institute of Medicine study in 1999 are still all too common, according to a recent report on North Carolina hospitals in the New England Journal of Medicine. And the electronic record systems are themselves increasingly attracting concerns that computer errors, design flaws and breakdowns in communication sometimes endanger patients.
For example, parts of a patient’s electronic medical records have disappeared or been saved in the wrong patient’s file, according to the Food and Drug Administration. Incorrect entries have sometimes been posted for drug allergies and blood pressure readings, the agency said.
Taking a fresh look at such concerns, the Institute of Medicine created the Committee on Patient Safety and Health Information Technology to run a yearlong study and issue recommendations. The 16-member panel is meeting for the first time on Tuesday in Washington.
In February, the F.D.A. said it had received 260 reports of malfunctions related to health information technology “with the potential for patient harm,” including 44 reported injuries and six reported deaths in 2008 and 2009. The malfunctions were reported voluntarily to the agency, mainly by hospitals.
“Because these reports are purely voluntary, they may represent only the tip of the iceberg,” said Dr. Jeffrey Shuren, a senior F.D.A. policy and enforcement official.
In an indication of interest from Congress, Senator Charles E. Grassley of Iowa, the ranking Republican on the Senate Finance Committee, wrote to the health information industry and to Kathleen Sebelius, the secretary of Health and Human Services, to ask what was being done to make sure the systems were being reviewed and monitored for patient safety concerns and what role the F.D.A. played in regulating health information technology.
Dr. Shuren suggested that F.D.A. regulators could consider a range of new safety requirements under the agency’s authority to assure the safety, effectiveness and quality of medical devices, including software devices.
“All options for assuring safety are on the table,” said Dr. David Blumenthal, the Obama administration’s national coordinator for health information technology. His office gave the Institute of Medicine $989,000 for the patient safety panel, which is led by Gail L. Warden, the former president and chief executive of the Henry Ford Health System in Detroit.
Dr. Blumenthal said health information experts like Dr. Donald M. Berwick, the Medicare and Medicaid administrator, and Dr. Brent James, of Intermountain Healthcare, based in Salt Lake City, “agree that electronic health records will improve the safety of care.”
“At the same time, any time you change the world you create risks,” Dr. Blumenthal said in a telephone interview last weekend. “We want to make sure that implementation is as safe as it can be and all safety benefits are realized.”
He said that if the Institute of Medicine “concludes that regulation is an important part of this fabric of assuring safety, we will want to balance regulation and innovation as we do in every marketplace.”
Manufacturers of the systems have long opposed government regulation of their products.
“The policing of design by a third party or agency, however well intended, will likely stifle innovation and inhibit the growth and development of electronic health records in the future,” said Carl Dvorak, executive vice president of Epic Systems, which has built electronic records systems for Kaiser Permanente and other large health care and hospital groups.
The industry has recently avoided speaking out on a role for the F.D.A. In a statement for this article, the Healthcare Information and Management Systems Society, a Washington-based industry group, said only that it “supports the administration’s decision to ask the Institute of Medicine to study this complex issue and report back over the next 12 months.”
Last month, in protest of one common industry practice, the American Medical Informatics Association said “hold harmless” clauses in many purchasing contracts were unethical. The clauses typically absolve manufacturers of responsibility for any errors or misuse.
“We said we value innovation, but we don’t value it more than safety,” said Kenneth W. Goodman, a University of Miami bioethicist who headed an association advisory group on patient safety.
“We just do not have good data on medical errors, whatever the cause,” said Arthur A. Levin, a member of the new Institute of Medicine commission. Mr. Levin, director of Center for Medical Consumers in New York, also was a member of the institute group that warned in a 1999 report, “To Err Is Human,” that there could be 98,000 preventable deaths each year in hospitals.
An article in the New England Journal of Medicine last month pointed to a potential for malpractice liability risks because more information might be available on electronic records that might have gone unnoticed on a paper chart. Health care providers must weigh the substantial upfront costs and possible risks against the potentially sizable, but uncertain long-run benefits, Dr. Sandeep S. Mangalmurti, an internist at New York University’s Langone Medical Center, and his colleagues wrote.
“We probably catch about 2 percent of the errors,” said Ross Koppel, a University of Pennsylvania sociologist and investigator for RAND Corporation, the research organization based in Santa Monica, Calif. “The errors are the 98 percent that got through
Friday, December 10, 2010
FUll 91 pages report of The PCAST
http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf
Dr Halamka's Blog on Presidents council of Advisers on Science and Technology(PCAST) today
Friday, December 10, 2010
The Spirit of PCAST
On December 8, the President's Council of Advisors on Science and Technology (PCAST) released the report "Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward"
In its 91 pages are several "gold star" ideas for empowering patients, providers and payers to improve quality, safety, and efficiency.
The major ideas are
1. "Universal Exchange Language" - As I have discussed many times, interoperability requires content, vocabulary and transport standards. Although the PCAST report does not provide specifics, it does list characteristics of this language
*Should be XML-based
*Should be optimized for representing structured data, not just unstructured text
*Should include controlled vocabularies/code sets where possible for each data element
*Should be infinitely extensible
*Should be architecturally neutral, decoupling content and transport standards
2. Data elements should be separable and not confined to a specific collection of elements forming a document. There are thousands of forms and document types in an average hospital. Rather than trying to create one ideal format for each of these (which would be a never-ending task) providing a modular approach that enables collections of data elements to be repurposed for different needs would enhance flexibility and reduce the burden on implementation guide writers/developers/users.
3. Each data element should include metadata attributes that enable the datum to be reused outside of any collection of elements or context. The report does not specify how this would work, but let's presume that each data element would contain attributes such as the data element name, the patient name, and the patient date of birth so that information about a specific patient could be searched and aggregated.
4. Privacy controls specified by the patient used in conjunction with the metadata would enable multiple data uses that adhere to patient consent declarations and support multiple types of consent models (opt in, opt out, HIV/genetics/mental health restrictions etc). Although this is a noble goal, the reality of implementing this is quite difficult. Deciding if a data element does or does not imply a condition is a major informatics challenge.
5. Search engine technology should be able to index data elements based on metadata. Search results would reflect patient consent preferences and the access rights of the authenticated user.
6. De-identified data should be available for population health, clinical research, syndromic surveillance, and other novel uses to advance healthcare science and operations.
How does this compare to the work to date by ONC, the Federal Advisory Committees, and vendors to implement meaningful use data exchanges?
I believe that the PCAST report is consistent with the work done to date and that the foundation created by Meaningful Use Stage 1 puts us on the right trajectory to embrace the spirit of PCAST.
Let's look at each of the PCAST ideas as compared to our current trajectory
1. There are 2 kinds of content standards specified in the Standards and Certification Final rule - transactions and summaries. Transactions include such things as e-prescribing a medicine or ordering a diagnostic test through a CPOE system. Summaries include sharing a lifetime health history or episode of care between providers or with patients. Transactions, such as specific actionable orders, work very well today using the HL7 2.x messages specified in the rule. Transactions are not a problem. It's the summaries that should be the focus of the PCAST ideas.
The current summary formats specified by the Standards and Certification Final Rule are CCR and CCD. Both are XML. CCR is extensible but I do not believe there has been much demand in the industry to expand it. CCD is based on CDA which is extensible. In fact, CCD is just the CCR expressed as a CDA template. It’s a demonstration of the extensibility of CDA.
CCR and CCD incorporate vocabularies for each data element where appropriate - ICD9/SNOMED-CT for problems, LOINC for labs, and RXNORM for medications.
I would hope that the country does not start from scratch to build a new Universal Exchange Language. Wise people can take the best of CCR, CDA Templates, Green CDA, and other existing XML constructs to create implementation guides which fulfill the PCAST recommendations.
2. If data elements are going to stand alone, do we need an information model or dictionary so that we know how to name data elements in a consistent way? If the goal is to represent every possible data element in healthcare in a manner that allows consistent searching, then the metadata will need to include consistent data element names and the relationship of data elements to each other i.e. a problem list consists of a problem name, problem code, problem date, active/inactive flag.
3. CCR and CCD/CDA both include metadata. What does it mean to represent metadata at the data element level? CCR and CCD have specific sections that incorporate patient identity information. Should that be replicated in every data element so that each data element can stand alone? While that could be done, it will result in substantially larger payloads to exchange because of the redundant metadata added to each datum.
4. The ONC Privacy and Security Tiger Team has already been working on a framework for meaningful consent. Their work is truly a pre-requisite to the privacy protections suggested by PCAST. The Tiger Team has acknowledged the value of highly granular consent, but has been realistic about the challenges of implementing it. A phased approach to get us to the goals outlined in the PCAST report would work well.
5. Search engine technology has not been a part of the work on healthcare information exchange to date. It will be interesting to think about the security issues of cached indexes in such search engines. Just knowing that a data element exists (HIV test or visit to a substance abuse facility), regardless of the actual data contents, can be disclosing. Another issue is that search engines would have to do a probabilistic match of name, date of birth and other patient demographics from metadata to assemble data elements into a complete record for clinical care. Although such approaches might work for research, quality measurement, or public health reporting, they are problematic for clinical care where false positives (matching the wrong patient) could have significant consequences.
6. De-identified data for public health has already been part of the ONC effort. Novel data mining in support of research has been a part of the NIH CTSA projects, such as Shrine/I2B2. These CTSA applications already adhere to many of the PCAST principles.
What are the next steps?
I presume ONC/CMS will convene teams from the HIT Policy Committee, the HIT Standards Committee and existing Workgroups to discuss the PCAST report and its implication for the work ahead.
In the spirit of my recent blog about The Glass Half Full, I believe the PCAST report is a positive set of recommendations that builds on the Meaningful Use Stage 1 effort to date. ONC should be congratulated for creating a foundation that is so consistent with the PCAST vision for the future.
The Spirit of PCAST
On December 8, the President's Council of Advisors on Science and Technology (PCAST) released the report "Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward"
In its 91 pages are several "gold star" ideas for empowering patients, providers and payers to improve quality, safety, and efficiency.
The major ideas are
1. "Universal Exchange Language" - As I have discussed many times, interoperability requires content, vocabulary and transport standards. Although the PCAST report does not provide specifics, it does list characteristics of this language
*Should be XML-based
*Should be optimized for representing structured data, not just unstructured text
*Should include controlled vocabularies/code sets where possible for each data element
*Should be infinitely extensible
*Should be architecturally neutral, decoupling content and transport standards
2. Data elements should be separable and not confined to a specific collection of elements forming a document. There are thousands of forms and document types in an average hospital. Rather than trying to create one ideal format for each of these (which would be a never-ending task) providing a modular approach that enables collections of data elements to be repurposed for different needs would enhance flexibility and reduce the burden on implementation guide writers/developers/users.
3. Each data element should include metadata attributes that enable the datum to be reused outside of any collection of elements or context. The report does not specify how this would work, but let's presume that each data element would contain attributes such as the data element name, the patient name, and the patient date of birth so that information about a specific patient could be searched and aggregated.
4. Privacy controls specified by the patient used in conjunction with the metadata would enable multiple data uses that adhere to patient consent declarations and support multiple types of consent models (opt in, opt out, HIV/genetics/mental health restrictions etc). Although this is a noble goal, the reality of implementing this is quite difficult. Deciding if a data element does or does not imply a condition is a major informatics challenge.
5. Search engine technology should be able to index data elements based on metadata. Search results would reflect patient consent preferences and the access rights of the authenticated user.
6. De-identified data should be available for population health, clinical research, syndromic surveillance, and other novel uses to advance healthcare science and operations.
How does this compare to the work to date by ONC, the Federal Advisory Committees, and vendors to implement meaningful use data exchanges?
I believe that the PCAST report is consistent with the work done to date and that the foundation created by Meaningful Use Stage 1 puts us on the right trajectory to embrace the spirit of PCAST.
Let's look at each of the PCAST ideas as compared to our current trajectory
1. There are 2 kinds of content standards specified in the Standards and Certification Final rule - transactions and summaries. Transactions include such things as e-prescribing a medicine or ordering a diagnostic test through a CPOE system. Summaries include sharing a lifetime health history or episode of care between providers or with patients. Transactions, such as specific actionable orders, work very well today using the HL7 2.x messages specified in the rule. Transactions are not a problem. It's the summaries that should be the focus of the PCAST ideas.
The current summary formats specified by the Standards and Certification Final Rule are CCR and CCD. Both are XML. CCR is extensible but I do not believe there has been much demand in the industry to expand it. CCD is based on CDA which is extensible. In fact, CCD is just the CCR expressed as a CDA template. It’s a demonstration of the extensibility of CDA.
CCR and CCD incorporate vocabularies for each data element where appropriate - ICD9/SNOMED-CT for problems, LOINC for labs, and RXNORM for medications.
I would hope that the country does not start from scratch to build a new Universal Exchange Language. Wise people can take the best of CCR, CDA Templates, Green CDA, and other existing XML constructs to create implementation guides which fulfill the PCAST recommendations.
2. If data elements are going to stand alone, do we need an information model or dictionary so that we know how to name data elements in a consistent way? If the goal is to represent every possible data element in healthcare in a manner that allows consistent searching, then the metadata will need to include consistent data element names and the relationship of data elements to each other i.e. a problem list consists of a problem name, problem code, problem date, active/inactive flag.
3. CCR and CCD/CDA both include metadata. What does it mean to represent metadata at the data element level? CCR and CCD have specific sections that incorporate patient identity information. Should that be replicated in every data element so that each data element can stand alone? While that could be done, it will result in substantially larger payloads to exchange because of the redundant metadata added to each datum.
4. The ONC Privacy and Security Tiger Team has already been working on a framework for meaningful consent. Their work is truly a pre-requisite to the privacy protections suggested by PCAST. The Tiger Team has acknowledged the value of highly granular consent, but has been realistic about the challenges of implementing it. A phased approach to get us to the goals outlined in the PCAST report would work well.
5. Search engine technology has not been a part of the work on healthcare information exchange to date. It will be interesting to think about the security issues of cached indexes in such search engines. Just knowing that a data element exists (HIV test or visit to a substance abuse facility), regardless of the actual data contents, can be disclosing. Another issue is that search engines would have to do a probabilistic match of name, date of birth and other patient demographics from metadata to assemble data elements into a complete record for clinical care. Although such approaches might work for research, quality measurement, or public health reporting, they are problematic for clinical care where false positives (matching the wrong patient) could have significant consequences.
6. De-identified data for public health has already been part of the ONC effort. Novel data mining in support of research has been a part of the NIH CTSA projects, such as Shrine/I2B2. These CTSA applications already adhere to many of the PCAST principles.
What are the next steps?
I presume ONC/CMS will convene teams from the HIT Policy Committee, the HIT Standards Committee and existing Workgroups to discuss the PCAST report and its implication for the work ahead.
In the spirit of my recent blog about The Glass Half Full, I believe the PCAST report is a positive set of recommendations that builds on the Meaningful Use Stage 1 effort to date. ONC should be congratulated for creating a foundation that is so consistent with the PCAST vision for the future.
Friday, December 3, 2010
Eating disorders
An article in NY times explains how Eating disorder can be exorbitantly expensive and may be like a catastrophic illness. Very expensive and difficult to treat .
The article states that many of the specialists do not accept most insurance plans and if they do they do not cover entirety of charges.That may be the problem in many of the specialties.Obama care for lack of better word should take care of many of the issues involved in the health coverage.
We as a society has a need to find reasonable cost care for many of our problems. Most expensive solutions for the problems of different magnitude is not the solution.At somepoint we will have to make available a certain ammount of care available to all and once we reach that goal and are able to contain costs we can add other benefits.
It is important that as a nation we figure out what will be comensation for the professionals in the field.We may have to have doctors who want treat patients as the priority that the one's whose goal is to bill the insurance companies for the maximum.I know many doctors who focus on the patient care.BRAVO.
The article states that many of the specialists do not accept most insurance plans and if they do they do not cover entirety of charges.That may be the problem in many of the specialties.Obama care for lack of better word should take care of many of the issues involved in the health coverage.
We as a society has a need to find reasonable cost care for many of our problems. Most expensive solutions for the problems of different magnitude is not the solution.At somepoint we will have to make available a certain ammount of care available to all and once we reach that goal and are able to contain costs we can add other benefits.
It is important that as a nation we figure out what will be comensation for the professionals in the field.We may have to have doctors who want treat patients as the priority that the one's whose goal is to bill the insurance companies for the maximum.I know many doctors who focus on the patient care.BRAVO.
Monday, November 29, 2010
Dancing or moving to music can make one steady on feet.
Now we have a research showing that the people who Dance are more steady on their feet ,they have to be,that is what dancing is all about.More the practice the better one gets.
So go and dance .It does not matter if one dances alone to music or with partner or in a group.
I still remember that Portuguese tipsy old man dancing by himself in the plaza with a great grace.He had grace of stars.This man was fats and nimble on feet must have been in seventies .He really had good time telling us that he was offered dancing roles in Hollywood and it was very believable.
MOVE TO MUSIC OR JUST DANCE.IT IS GOOD FOR YOU AND THE COUNTRY .STEADY ON FEET MEANS LESSER INJURY ,BETTER HEALTH AND SAVINGS ON THE HEALTH CARE.
So go and dance .It does not matter if one dances alone to music or with partner or in a group.
I still remember that Portuguese tipsy old man dancing by himself in the plaza with a great grace.He had grace of stars.This man was fats and nimble on feet must have been in seventies .He really had good time telling us that he was offered dancing roles in Hollywood and it was very believable.
MOVE TO MUSIC OR JUST DANCE.IT IS GOOD FOR YOU AND THE COUNTRY .STEADY ON FEET MEANS LESSER INJURY ,BETTER HEALTH AND SAVINGS ON THE HEALTH CARE.
Inefficiency Hurts U.S. In Ranking of Health
Whereas in the U.S. we have a highly inefficient health system that’s taking away financial resources from other lifesaving programs.”
New study has found that our health care cost has increased three fold in last 30 or so years and we have not improved the ranking on the health in the world.This is based on study of many advanced countries of the world.We have most expensive health care system which fails to deliver us the services.
We have reduced smoking in our population .Our ranking remains terrible 49 th in the world.
We will have to improve the health care delivery and efficiency in our system so we may control cost and deliver better care for our patients(that is us).I see it happening with EMR mandate and meaningful use part of it which will benefit us tremendously
New study has found that our health care cost has increased three fold in last 30 or so years and we have not improved the ranking on the health in the world.This is based on study of many advanced countries of the world.We have most expensive health care system which fails to deliver us the services.
We have reduced smoking in our population .Our ranking remains terrible 49 th in the world.
We will have to improve the health care delivery and efficiency in our system so we may control cost and deliver better care for our patients(that is us).I see it happening with EMR mandate and meaningful use part of it which will benefit us tremendously
RI Quality institute
Todays a press release from Direct project formerly known as NHIN direct.
http://mycourses.med.harvard.edu/ec_res/nt/82BD96DE-2D02-4512-AE70-B2BCF37C6A31/TheDirectProject.pd
The Direct Project is organizing real-world pilots to demonstrate health information exchange
using The Direct Project standards and services. Six pilots are ramping up including:
Rhode Island Quality Institute.
It is a great honor that my little Rhody is participating in this pilot project .I am not sure how it is interacting with NEHEN . What are the Future implications .
from superficial look at the RIQI it seems like a private public partnership.Board constitutes of retired officials and current health practioners and providers.
http://mycourses.med.harvard.edu/ec_res/nt/82BD96DE-2D02-4512-AE70-B2BCF37C6A31/TheDirectProject.pd
The Direct Project is organizing real-world pilots to demonstrate health information exchange
using The Direct Project standards and services. Six pilots are ramping up including:
Rhode Island Quality Institute.
It is a great honor that my little Rhody is participating in this pilot project .I am not sure how it is interacting with NEHEN . What are the Future implications .
from superficial look at the RIQI it seems like a private public partnership.Board constitutes of retired officials and current health practioners and providers.
Sunday, November 28, 2010
An experiment In mother and child care delivers results
In India failing to provide public health services in the state of Gujrat they contracted OBs GNY practitioners in private practice.They compensated them at on average cost of rupees 1795 per delivery which is about 40 dollars .In US average cost of a child birth may be in excess of 12000 dollars.
In the process many practitioners were able to improve their earnings to 20000 dollars per year which is a handsome ammount.
This is not a silver bullet to the problem .With a shortage of services and many times money to pay for it A complicated pregnancy can ruin the finances of a family and put them in a downward spiral of financial ruin.The government has made a leap in service and is providing solutions out of the box .Mixing the public and private for the public good.
It would be good if in America we could get some benefits of the systems they are creating for the universal problems we all share.
May be their are solutions Like unique Identification they are creating in India .Security of personal data is very critical in our society.Hope we can help each other from the experiences we have and develop. It is always important to use just enough medicine to treat the ailment.
In the process many practitioners were able to improve their earnings to 20000 dollars per year which is a handsome ammount.
This is not a silver bullet to the problem .With a shortage of services and many times money to pay for it A complicated pregnancy can ruin the finances of a family and put them in a downward spiral of financial ruin.The government has made a leap in service and is providing solutions out of the box .Mixing the public and private for the public good.
It would be good if in America we could get some benefits of the systems they are creating for the universal problems we all share.
May be their are solutions Like unique Identification they are creating in India .Security of personal data is very critical in our society.Hope we can help each other from the experiences we have and develop. It is always important to use just enough medicine to treat the ailment.
Friday, November 26, 2010
List of approved softwares by Certification Commision
cchit.org/media/news/2010/10/commission-announces-first-onc-atcb-20112012-certifications
Monday, November 22, 2010
Medication histories and current medication lists.
Dr Halamka in his blog geekdoctor.blogspot.com.
Discusses how he found both of his parents in hospital on his visit with them and had difficulty in clearly defining medication histories for them.He as a trained physician was able to do with great effort and found that in their cupboard their were medications they were not using any more and he had to separate medications for each of them.
It raised an important issue that EMR and our medical care system should help us facilitate to track the medications we are taking even when we are getting older.A better system can solve this problem.
Any body making such a system or improved system could make money and help medication errors.
P.s. These Problems will be resolved in coming years by implementing EMR and meaningful use.It is important that system may remain simple and important information sensitive.These long pamphlets given with all medicines are useless for patients simple label warnings should be the norm and Doctors and Pharmacists should be required to check for the conflicts.
Discusses how he found both of his parents in hospital on his visit with them and had difficulty in clearly defining medication histories for them.He as a trained physician was able to do with great effort and found that in their cupboard their were medications they were not using any more and he had to separate medications for each of them.
It raised an important issue that EMR and our medical care system should help us facilitate to track the medications we are taking even when we are getting older.A better system can solve this problem.
Any body making such a system or improved system could make money and help medication errors.
P.s. These Problems will be resolved in coming years by implementing EMR and meaningful use.It is important that system may remain simple and important information sensitive.These long pamphlets given with all medicines are useless for patients simple label warnings should be the norm and Doctors and Pharmacists should be required to check for the conflicts.
Friday, November 19, 2010
Why Ipads could become Device of choice for EMR practices.
Here is a detailed article in CIO insider Magazine.
Why One Company is Ditching Sales Laptops for iPads
Take a look at the decision process behind one company's move to replace laptops with iPads and embrace the consumerization of enterprise IT - plus the training and security issues that have popped up.
http://www.cio.com/article/637864/Why_One_Company_is_Ditching_Sales_Laptops_for_iPads?page=2&taxonomyId=3004
This article analyses how Ipad is a better tool than laptop. I am a strong believer that any technology which mimics the current process and improves on it without complicating it will be the final successfully accepted technology.
I can envision all the Medical practices will have a device like Ipad/or other tablet in every examination room.Once a patient is checked in. The person checking in would create and open the records of the patient for the doctor review.Check for all the things they do now and hand it over to attending doctor like they do with paper files now.Doctor reviews and examins the patient, makes recomendations including prescrptions.Patients goes back to the front desk and the attendent reviews required follow up and sends the instructions to required providers and bill for it while updating the records.
While filling prescription software checks and double checks for any allergies and conflicts in prescriptions.In future it may also check for the best cost effective choices for filling the prescrptions.
I KNOW IT MAY PLAY HAVOC IF IT WOULD ALSO CALCULATE COSTS OF THE PROCEDURES TO BE PERFORMED INSTANTLY AND INFORM THE BEST CHOICES ON THE BASIS OF COST AND OUTCOME BASIS.
The company has figured costs for Ipad in the range of 1500 dollars per unit against a laptop 2200 dollars.They think their are issues with support which need attention.
Conceptus is looking at a few apps on the App Store as a temporary fix, but the long-term goal is to implement a Citrix virtual desktop solution sometime next year, whereby documents reside on the server and are accessed via a native iPad app.
"Until we get some level of virtualization on the device for those tasks, we don't have a firm answer," Letasse says. "There's a gap between now and when we can go without a laptop."
In the case of EMR this problem does not exist as IPad will WI Fi connected with the web and a server with in few feets.
Why One Company is Ditching Sales Laptops for iPads
Take a look at the decision process behind one company's move to replace laptops with iPads and embrace the consumerization of enterprise IT - plus the training and security issues that have popped up.
http://www.cio.com/article/637864/Why_One_Company_is_Ditching_Sales_Laptops_for_iPads?page=2&taxonomyId=3004
This article analyses how Ipad is a better tool than laptop. I am a strong believer that any technology which mimics the current process and improves on it without complicating it will be the final successfully accepted technology.
I can envision all the Medical practices will have a device like Ipad/or other tablet in every examination room.Once a patient is checked in. The person checking in would create and open the records of the patient for the doctor review.Check for all the things they do now and hand it over to attending doctor like they do with paper files now.Doctor reviews and examins the patient, makes recomendations including prescrptions.Patients goes back to the front desk and the attendent reviews required follow up and sends the instructions to required providers and bill for it while updating the records.
While filling prescription software checks and double checks for any allergies and conflicts in prescriptions.In future it may also check for the best cost effective choices for filling the prescrptions.
I KNOW IT MAY PLAY HAVOC IF IT WOULD ALSO CALCULATE COSTS OF THE PROCEDURES TO BE PERFORMED INSTANTLY AND INFORM THE BEST CHOICES ON THE BASIS OF COST AND OUTCOME BASIS.
The company has figured costs for Ipad in the range of 1500 dollars per unit against a laptop 2200 dollars.They think their are issues with support which need attention.
Conceptus is looking at a few apps on the App Store as a temporary fix, but the long-term goal is to implement a Citrix virtual desktop solution sometime next year, whereby documents reside on the server and are accessed via a native iPad app.
"Until we get some level of virtualization on the device for those tasks, we don't have a firm answer," Letasse says. "There's a gap between now and when we can go without a laptop."
In the case of EMR this problem does not exist as IPad will WI Fi connected with the web and a server with in few feets.
Thursday, November 18, 2010
Eclinical works 2010 conferrence
The 2010 eClinicalWorks National Users' Conference with nearly 3,000 attendees was an unprecedented success.
Dr John Halamka was the keynote speaker.I still do not know enough about EMR.Dr John Halamka's presence gives me confidence in EClinical Works.Time is coming when we will have to study the EMR's like EClinical Works and others .Are they one of the leaders.Number of practitioners using it gives one impression that they are.
newsletter@Eclinicalworks.com
Dr John Halamka was the keynote speaker.I still do not know enough about EMR.Dr John Halamka's presence gives me confidence in EClinical Works.Time is coming when we will have to study the EMR's like EClinical Works and others .Are they one of the leaders.Number of practitioners using it gives one impression that they are.
newsletter@Eclinicalworks.com
Wednesday, November 17, 2010
Lifespan Part of NEHEN (Founding Memebr)
Just a short study is letting me understand that in RI Lifespan is ahead of the game as it was one of the founding members of the exchange.
CONGRATULATIONS LIFESPAN.
No wonder you are the leaders.
I am assured that it would be able to meet meaningful use criteria set by the mandates.
CONGRATULATIONS LIFESPAN.
No wonder you are the leaders.
I am assured that it would be able to meet meaningful use criteria set by the mandates.
Where is RI health exchange network.
I am new at understanding Health exchanges .My understanding is they provide as (Central)reservoir for information to all participating providers.They should be neutral and not for profit if possible. Massachusetts has an early start as it created NEHEN for that purpose.It has been operating since 1998.
I think it would be better that we join it and for interstate partnership with it .That will keep our costs down and will help public which uses services in neighboring state and many time work or live in both states.
Expertise developed by NEHEN would be a great asset to Rhode Island and we will benefit from their experience at little cost.
From NEHEN website what others are saying about NEHEN
Forrester's Top 10 Healthcare Predictions
“Successful regional solutions ... like New England's NEHEN will force national players ... to trim prices and find new sources of revenue
MANAGED CARE
“An alternative to turning everything over to a national clearinghouse is to create a regional clearinghouse. We've seen a lot of regional efforts to do this. One mature example is something called NEHEN…. The economics are compelling.”
Modern Healthcare, EYE on INFO
“…. Boston providers are finding that the case for electronic claims transaction standards is open and shut. Who can argue with a double or triple return on investment within two to three years? …”
LA Times
“NEHEN is so efficient that several members are considering reductions in their administrative staff.”
Baseline Magazine
“…a near-""plug and play"" infrastructure that can accept any New England health care provider or payer in days rather than months……”
HealthData Management
“NEHEN …is an innovative example of how organizations can work together on administrative simplification…”
HIPAAdvisory.com
“One of the members initially developed the software used to route transactions … donated that software to NEHEN, enabling the other members to quickly ramp up their transaction volumes with minimal cost.”
healthleaders.com
“…successfully active …Statewide healthcare information network…”"
I HAVE NOT VISITED NEHEN this just what their website is telling.By the way DR John Halamka is NEHEN chairman.
I think it would be better that we join it and for interstate partnership with it .That will keep our costs down and will help public which uses services in neighboring state and many time work or live in both states.
Expertise developed by NEHEN would be a great asset to Rhode Island and we will benefit from their experience at little cost.
From NEHEN website what others are saying about NEHEN
Forrester's Top 10 Healthcare Predictions
“Successful regional solutions ... like New England's NEHEN will force national players ... to trim prices and find new sources of revenue
MANAGED CARE
“An alternative to turning everything over to a national clearinghouse is to create a regional clearinghouse. We've seen a lot of regional efforts to do this. One mature example is something called NEHEN…. The economics are compelling.”
Modern Healthcare, EYE on INFO
“…. Boston providers are finding that the case for electronic claims transaction standards is open and shut. Who can argue with a double or triple return on investment within two to three years? …”
LA Times
“NEHEN is so efficient that several members are considering reductions in their administrative staff.”
Baseline Magazine
“…a near-""plug and play"" infrastructure that can accept any New England health care provider or payer in days rather than months……”
HealthData Management
“NEHEN …is an innovative example of how organizations can work together on administrative simplification…”
HIPAAdvisory.com
“One of the members initially developed the software used to route transactions … donated that software to NEHEN, enabling the other members to quickly ramp up their transaction volumes with minimal cost.”
healthleaders.com
“…successfully active …Statewide healthcare information network…”"
I HAVE NOT VISITED NEHEN this just what their website is telling.By the way DR John Halamka is NEHEN chairman.
Some ideas on EMR
As a national agenda to control costs and serve our population better Obama administaration has under taken and funded a mandate for EMR. A greate ammount of investment is being made in the IT of the medical delivery services to meat this goal.
With EMR and meaningful mandates the medical care will become more responsive to patients needs and deliver better care . I will be working with you ,to get the maximum benefits out of the process so that minorities and others who are extensive useres of hospital services may benefit from this investment of 100s of billion dollars.Education of patients ( through the effected communities) is integral part of that.representation of minority providers make it urgent for us to educate and train the youth in this field to provide the services .When we want to raise the standard of living in our communities it is important that we provide jobs to the one who do not have and upgrade the skills for all so that upward mobility is the norm not the exception.We need to be reminded that who are given a lotshould lift the one's who are left behind.
One way to uplift our community is to develop our talents locally by using our institutions to their fullest potential. Let us use all the advantages we have including proximity to learning institution of Mass and take advantage of using the experiences of state mandated health
Low cost care and developments in EMRS in that state .
things to study
What are the softwares used by hospital for EMRs
What are the softwares used by insurance companies that is blue cross,aetna,medicaid and medicare
What are the softwares used by providers (doctors,pharmacists,other providers )
Study the massachusset NEHEN software operablity.
Study what dept of health had plans for data and what sytem they were using.
Develop relationship with suppliers of software as agents and sell it to the service providers with ayearly billing to be aupported by federal funding for the project.
With EMR and meaningful mandates the medical care will become more responsive to patients needs and deliver better care . I will be working with you ,to get the maximum benefits out of the process so that minorities and others who are extensive useres of hospital services may benefit from this investment of 100s of billion dollars.Education of patients ( through the effected communities) is integral part of that.representation of minority providers make it urgent for us to educate and train the youth in this field to provide the services .When we want to raise the standard of living in our communities it is important that we provide jobs to the one who do not have and upgrade the skills for all so that upward mobility is the norm not the exception.We need to be reminded that who are given a lotshould lift the one's who are left behind.
One way to uplift our community is to develop our talents locally by using our institutions to their fullest potential. Let us use all the advantages we have including proximity to learning institution of Mass and take advantage of using the experiences of state mandated health
Low cost care and developments in EMRS in that state .
things to study
What are the softwares used by hospital for EMRs
What are the softwares used by insurance companies that is blue cross,aetna,medicaid and medicare
What are the softwares used by providers (doctors,pharmacists,other providers )
Study the massachusset NEHEN software operablity.
Study what dept of health had plans for data and what sytem they were using.
Develop relationship with suppliers of software as agents and sell it to the service providers with ayearly billing to be aupported by federal funding for the project.
This is the first post on Halamaka's bad day
I will be posting articles concerning EMR and my research on the subject.
Here is a nice article,chronicling the events when all systems went down for the hospital in 2002.This showes the travails of best among us.In the end Dr Halamka shares his experience for the benefit of everybody.
Halamka on Beth Israel's Health-Care IT Disaster
By Scott Berinato
Sat, February 15, 2003
http://www.cio.com/article/31701/Halamka_on_Beth_Israel_s_Health_Care_IT_Disaster?page=3&taxonomyId=3071
Here is a nice article,chronicling the events when all systems went down for the hospital in 2002.This showes the travails of best among us.In the end Dr Halamka shares his experience for the benefit of everybody.
Halamka on Beth Israel's Health-Care IT Disaster
By Scott Berinato
Sat, February 15, 2003
http://www.cio.com/article/31701/Halamka_on_Beth_Israel_s_Health_Care_IT_Disaster?page=3&taxonomyId=3071
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