Tuesday, April 22, 2008
Decision Support for Inpatient Systems
I've written about the 10 projects that keep me up at night and published my clinical systems mid year strategic update. In addition, as a physician CIO, I tend to have a few projects that receive more attention and guidance from me than others.
The three areas that are my passion and focus in 2008-2010 are Clinical Documentation, Decision Support, and an Integrated Electronic Record throughout the community. I wrote about Clinical Documentation last week. The Integrated Electronic Record is next week. I've covered Outpatient Decision Support earlier, so this week is an overview of all our Inpatient Decision Support efforts at Beth Israel Deaconess. You'll see that we have thousands of decision support rules, updated regularly, which are fully integrated into our inpatient systems.
Drug interactions and alerts
a) Drug duplicate warnings - Identifies duplicates using chemical component information that is included with First Data Bank (FDB), the commercial drug database underlying our pharmacy and provider order entry systems. Component information is updated via monthly FDB updates.
b) Drug-drug interactions - Identifies interactions using chemical components and rules included with the FDB database. Displays only the classes of alerts identified as clinically significant by Pharmacy, to ensure clinicians are not overwhelmed with minor interactions. Rules are updated via monthly FDB updates. Clinical significance filters are maintained in a dictionary by Pharmacy.
c) Drug-allergy interactions - Identifies interactions using chemical components included with the FDB database. Components are updated via monthly FDB updates.
d) Drug Substitutions – Alerts the ordering provider with suggested substitutions for therapeutic equivalents on the inpatient formulary, which is maintained by Pharmacy.
Default dosing
There are currently 1,545 entries in the Pharmacy Provider Order Entry dictionary with default dosing schemas defined. These are maintained by Pharmacy.
Renal Dosing
Targeted drugs, rules and default dosing are maintained in a dictionary by Pharmacy. There are currently 48 renally dosed drugs.
Diagnosis or Indication based dosing
Target drugs, rules and default dosing are maintained in a dictionary by Pharmacy, such as ciprofloxacin and chemotherapy agents used for non-oncological reasons such as cytoxan.
Geriatric alerts
Beers criteria are used to alert physicians to age-specific medication issues. Information is updated via monthly FDB updates.
Heparin, insulin and enoxaparin
Ordering of these high risk medications is done via automated protocols and guidelines to promote best practice dosing. These are updated as best practices change.
Information Displayed on Medication Ordering Screens
a) Screens display the patient’s most recent relevant labs specific to the drug being ordered. The relationship between drug and lab(s) to display is maintained in a dictionary by the Pharmacy
b) Informational text about ordering parameters for the drug is displayed. These are maintained in a dictionary by the Pharmacy. A link to Micromedex is also available on the ordering screen.
Nurse instructions for drug handling
Custom instructions are displayed on Medication Administration Record labels. These are maintained by the Pharmacy.
Information Displayed on Lab Ordering Screen
a) Messages appear during ordering that inform clinicians about best practices such as guidance for ordering heparin dependent antibodies. These are maintained in a dictionary by the Lab.
b) Links appear to the online lab manual for each test ordered. Thousands of lab tests are documented including all the details on how the specimen is collected and processed. The Lab updates this manual regularly.
Blood bank
Specialized screens appear to provide pertinent clinical information when blood products are ordered.
Total Parenteral Nutrition
Guidelines, relevant labs and prior day’s TPN order appear automatically.
Consequent Orders
a) IV access flush ordering -POE automatically generates the correct flush order when documenting IV status
b) Blood products – POE gives current information about active specimens in the blood bank and can generate a type and screen if necessary
c) Mechanical ventilation- POE automatically suggests mouth care orders after ventilation is ordered
Quick access to reference/informational screens
Specific links to guidelines/web sites appear on many POE screens. For example, a link to the current weaning protocol is available directly on the mechanical ventilation order screen.
Quick access to patient specific data in other clinical systems
Specific links to data in other information systems appear on many Provider Order Entry screens. For example, a link to display transfusion restrictions available in the Blood Bank system appears on the blood product ordering screen.
Alerts and reminders for items such as pneumovax and influenza
Providers are prompted at appropriate points over the course of a hospital admission to order and document outcomes.
Order sets
"Packages" of orders that can be rapidly entered as a group are available to all clinicians. These are updated as clinical practice changes. There are currently 95 inpatient admission, postoperative, transfer and procedure order sets (5 megabyte download) and 195 outpatient chemotherapy regimens.
Hydration protocol to minimize risk of iodinated contrast nephropathy
Provider Order Entry recommends specific IV fluid orders when ordering pre-procedure prep orders.
You can see that the task of providing comprehensive decision support for our inpatient systems involves thousands of rules, kept updated by pharmacy, lab, and IS staff, as guided by our various steering committees. Only through the use of this much decision support can we ensure that data is transformed into information, knowledge and wisdom
Showing posts with label Dr John Halamka. Show all posts
Showing posts with label Dr John Halamka. Show all posts
Tuesday, January 18, 2011
Monday, January 3, 2011
John Halamka blog for meaningful use and payment.
MONDAY, JANUARY 3, 2011
BIDMC's Meaningful Use Email
As hospitals and eligible professionals prepare for their meaningful use reporting period (registration begins today), they will want to communicate the details of the program to stakeholders. Here's the email we're sending out today. Feel free to use any part of it for your organization.
"As part of the Stimulus Package, the federal government has allocated $19 billion to encourage the health care industry to adopt Electronic Health Records. Demonstrating "meaningful use" of our electronic systems will mean several million dollars in additional reimbursement from CMS for the medical center, and additional funds for physicians. To be eligible for these additional payments, we must do 3 things:
1. Be an eligible professional or hospital
2. Implement a certified Electronic Health Record (EHR)
3. Use the certified EHR in a meaningful way
Who qualifies as an eligible professional?
Eligible professionals include doctors of medicine, osteopathy, dental surgery, dental medicine, podiatry, optometry, and chiropractors. Professionals who perform 90% or more of their services in the inpatient or emergency setting are considered “hospital-based” and are not eligible.
Are we using a certified Electronic Health Record?
Collectively, all of the clinical systems we use here at BIDMC make up our Electronic Health Record. The hospital is in the process of having our collective systems certified by the Certification Commission for Health Information Technology (CCHIT) via their EACH program for hospitals. We expect to be one of the first hospitals in the country to do so.
What does it mean to use our systems in a Meaningful Way?
Simply put, 'meaningful use' means hospitals and professionals need to show they are using a certified EHR in ways that can be measured significantly in quality and quantity.
Hospitals have 14 required ('core') criteria and eligible professionals (clinicians) have 15 required criteria. There is 100% overlap, with the only difference that the hospital is not measured on e-prescribing because that is seen as an ambulatory clinician activity.
There are 10 optional ('menu') criteria of which hospitals and eligible professionals must choose 5. There is 100% overlap except that reporting lab results to public health and advanced directive management is hospital only.
A grid of the criteria is available here. We have completed an assessment of the criteria and how well BIDMC is doing in meeting the required metrics. Good news! As of January 1, 2011 BIDMC has the necessary system functions to meet meaningful use criteria and with few exceptions we, collectively (hospital and eligible professionals), are doing well in meeting the required metrics.
When does this program begin?
The earliest possible 'reporting period' for demonstration of meaningful use is January 3-March 31, 2011. Measurement of performance on the 15 required and the chosen 5 optional criteria is done during this time. CMS will make a website available to register hospitals and eligible professionals for participation in the meaningful use program. The process for registering is being launched by CMS today, and BIDMC/BIDPO will act swiftly to ensure all eligible providers are enrolled. In April, the hospital and eligible clinicians 'attest' that they have achieved meaningful use, with additional reimbursements starting in May.
What do I need to do on January 3, 2011?
For Core Requirements:
As mentioned above, we are collectively doing well in meeting most criteria as the information collected is required for a patient to receive care here at BIDMC or part of our standard workflow. Here is where we need your help in collecting and documenting additional information within webOMR/other points of entry systems:
Problem Lists: Requirement: 80% of all unique patients must have at least one entry or an indication that the patient has no known problems documented as part of the problem list in webOMR.
Medication Allergy List: 80% of all unique patients must have at least one entry or an indication that the patient has no known allergies/ADRs documented in the Allergy module in webOMR
Smoking Status: 50% of patients age 13 or older must have smoking status recorded in webOMR (within Sheets).
Clinical Summaries: Clinical summaries must be provided to patients for 50% of all outpatient office visits within 3 business days. This is not currently standard practice throughout our outpatient practices. With the help of the webOMR User Group, a standard clinical summary will be available for printing from webOMR and other CCC applications. Your administrative staff will be briefed on this within the next few days and are ready to help implement this within the outpatient practices.
Within the next few days you will receive additional information from OMR Support describing how you can use the system to meet the criteria. In the meantime if you have questions or concerns about webOMR functions, please contact: omrsupport@bidmc.harvard.edu.
Ideally, we believe that the documentation requirements needed to meet meaningful use are in the best interest of providing safe patient care and allowing clinicians to communicate with each other and patients effectively and efficiently. Therefore, we support the continued use of webOMR and other BIDMC systems for Problems, Medications, Allergies, Smoking Status, etc. So although the reporting period ends in March/April of 2011, we request your ongoing use of our systems for this documentation.
How do funds flow?
Assuming we begin our measurement period on January 3rd and we complete attestation in April: Beginning in May, increased Medicare payments to the hospital and to the clinicians begin to flow. For the hospital, the value of these increased payments will be approximately $2 million per year. For clinicians, the value is:
2011 $18,000
2012 $12,000
2013 $8000
2014 $4000
2015 $2000
Thus, the flow of funds will follow whatever path Medicare payments to the hospital and clinicians have in place today.
Note that Meaningful Use Stage 1 is 2011-2012, Stage 2 is 2013-2014 and Stage 3 is 2015. This means that the criteria for meaningful use will get more challenging to meet over time and that the hospital and eligible professionals will need to repeat the "reporting period" and attestation in 2013 and 2015."
POSTED BY JOHN HALAMKA AT 3:00 AM 0 COMMENTS
BIDMC's Meaningful Use Email
As hospitals and eligible professionals prepare for their meaningful use reporting period (registration begins today), they will want to communicate the details of the program to stakeholders. Here's the email we're sending out today. Feel free to use any part of it for your organization.
"As part of the Stimulus Package, the federal government has allocated $19 billion to encourage the health care industry to adopt Electronic Health Records. Demonstrating "meaningful use" of our electronic systems will mean several million dollars in additional reimbursement from CMS for the medical center, and additional funds for physicians. To be eligible for these additional payments, we must do 3 things:
1. Be an eligible professional or hospital
2. Implement a certified Electronic Health Record (EHR)
3. Use the certified EHR in a meaningful way
Who qualifies as an eligible professional?
Eligible professionals include doctors of medicine, osteopathy, dental surgery, dental medicine, podiatry, optometry, and chiropractors. Professionals who perform 90% or more of their services in the inpatient or emergency setting are considered “hospital-based” and are not eligible.
Are we using a certified Electronic Health Record?
Collectively, all of the clinical systems we use here at BIDMC make up our Electronic Health Record. The hospital is in the process of having our collective systems certified by the Certification Commission for Health Information Technology (CCHIT) via their EACH program for hospitals. We expect to be one of the first hospitals in the country to do so.
What does it mean to use our systems in a Meaningful Way?
Simply put, 'meaningful use' means hospitals and professionals need to show they are using a certified EHR in ways that can be measured significantly in quality and quantity.
Hospitals have 14 required ('core') criteria and eligible professionals (clinicians) have 15 required criteria. There is 100% overlap, with the only difference that the hospital is not measured on e-prescribing because that is seen as an ambulatory clinician activity.
There are 10 optional ('menu') criteria of which hospitals and eligible professionals must choose 5. There is 100% overlap except that reporting lab results to public health and advanced directive management is hospital only.
A grid of the criteria is available here. We have completed an assessment of the criteria and how well BIDMC is doing in meeting the required metrics. Good news! As of January 1, 2011 BIDMC has the necessary system functions to meet meaningful use criteria and with few exceptions we, collectively (hospital and eligible professionals), are doing well in meeting the required metrics.
When does this program begin?
The earliest possible 'reporting period' for demonstration of meaningful use is January 3-March 31, 2011. Measurement of performance on the 15 required and the chosen 5 optional criteria is done during this time. CMS will make a website available to register hospitals and eligible professionals for participation in the meaningful use program. The process for registering is being launched by CMS today, and BIDMC/BIDPO will act swiftly to ensure all eligible providers are enrolled. In April, the hospital and eligible clinicians 'attest' that they have achieved meaningful use, with additional reimbursements starting in May.
What do I need to do on January 3, 2011?
For Core Requirements:
As mentioned above, we are collectively doing well in meeting most criteria as the information collected is required for a patient to receive care here at BIDMC or part of our standard workflow. Here is where we need your help in collecting and documenting additional information within webOMR/other points of entry systems:
Problem Lists: Requirement: 80% of all unique patients must have at least one entry or an indication that the patient has no known problems documented as part of the problem list in webOMR.
Medication Allergy List: 80% of all unique patients must have at least one entry or an indication that the patient has no known allergies/ADRs documented in the Allergy module in webOMR
Smoking Status: 50% of patients age 13 or older must have smoking status recorded in webOMR (within Sheets).
Clinical Summaries: Clinical summaries must be provided to patients for 50% of all outpatient office visits within 3 business days. This is not currently standard practice throughout our outpatient practices. With the help of the webOMR User Group, a standard clinical summary will be available for printing from webOMR and other CCC applications. Your administrative staff will be briefed on this within the next few days and are ready to help implement this within the outpatient practices.
Within the next few days you will receive additional information from OMR Support describing how you can use the system to meet the criteria. In the meantime if you have questions or concerns about webOMR functions, please contact: omrsupport@bidmc.harvard.edu.
Ideally, we believe that the documentation requirements needed to meet meaningful use are in the best interest of providing safe patient care and allowing clinicians to communicate with each other and patients effectively and efficiently. Therefore, we support the continued use of webOMR and other BIDMC systems for Problems, Medications, Allergies, Smoking Status, etc. So although the reporting period ends in March/April of 2011, we request your ongoing use of our systems for this documentation.
How do funds flow?
Assuming we begin our measurement period on January 3rd and we complete attestation in April: Beginning in May, increased Medicare payments to the hospital and to the clinicians begin to flow. For the hospital, the value of these increased payments will be approximately $2 million per year. For clinicians, the value is:
2011 $18,000
2012 $12,000
2013 $8000
2014 $4000
2015 $2000
Thus, the flow of funds will follow whatever path Medicare payments to the hospital and clinicians have in place today.
Note that Meaningful Use Stage 1 is 2011-2012, Stage 2 is 2013-2014 and Stage 3 is 2015. This means that the criteria for meaningful use will get more challenging to meet over time and that the hospital and eligible professionals will need to repeat the "reporting period" and attestation in 2013 and 2015."
POSTED BY JOHN HALAMKA AT 3:00 AM 0 COMMENTS
Friday, December 10, 2010
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.
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
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