phenomenalplace

Today’s headline was, “Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion.”The Kaiser Family Foundation estimates that 3.4 million people in the individual market will receive $426 million in consumer rebates because of the Affordable Care Act's new MLR rules. In the small group market 4.9 million enrollees will see $377 million in rebates, and 7.5 million people will get $540

The April HIT Standards Committee included a comprehensive review of the Standards & Certification Criteria Notice of Proposed Rulemaking (NPRM) by each workgroup/task force/power team during a 5 hour marathon session.   The capstone of the meeting with a thematic review of the entire NPRM by the Patient Engagement Power Team. The meeting began with a " chapter and verse" review of each NPRM standard . Here are the section by section highlights of our discussion: § 170.314(b)(3) E-prescribing The NPRM requires NCPDP Script 10.6 for content and RxNorm as the vocabulary.  We also recommended that HL7 2.x be allowed for the highly constrained use case of pharmacies located within a hospital as part of an organized healthcare arrangement, since such interfaces are widely implemented today. § 170.314(b)(3) Demographics The NPRM requires OMB standards for race and ethnicity, ISO 639-1 subset of 639-2 for language and ICD10 (not ICD10-CM) for Cause of Death, which has been used ...

Meg Aranow, the former CIO of Boston Medical Center and now a principal at Aranow Consulting recently assembled several of the IT leaders in Boston to discuss opportunities for reducing costs and enhancing infrastructure by pooling our collective resources.   Here's her guest post describing the exploration: "I recently met with IT leadership from Partners Healthcare, Childrens Hospital Boston and Beth Israel Deaconess, all teaching affiliates of Harvard.  The topic around which we convened was to discuss the idea of a collaborative datacenter. With the potential upside of staffing and procurement efficiencies stipulated as a launching point for the discussion the conversation turned to what it would take to make it happen. There were issues of (very) long term lease obligations, the cost of re-routing communication lines and the daunting spectra of demanding SLAs. Clearly all of these challenges could be met by the combined IT talent…given a solid business case, time and res...

Kathy and I move from our current house to our farm on April 27, so we have just one weekend of packing to go.    Nancy P from Dallas posted a spectacular comment that is so accurate and timely I had to share it broadly: "K. and J. - You may enjoy my 30 day packing calendar, written from my experience. DAYS 1-5: We are lovingly admiring and discussing each of our material possessions while discarding what we no longer use. We’ll have a garage sale and make trips to Goodwill to donate unused items. I’ll wash, dry and organize objects to be sold or donated. We have plenty of boxes, bubble wrap, Sharpie pens and packing tape. Boxes are organized in categories based on their contents. We write a detailed list of the items in the right-hand corner of the top of the box and carefully seal it with packing tape. DAYS 6-10: It is not realistic to cull through all of our belongings in 30 days. We’ll cull and reflect when we unpack. We’ll also have a lot more time when we unpack to plan ...

I've written several posts about BIDMC's use of "private cloud" approaches to host electronic records and gather community-wide quality data.   Healthcare organizations have avoided the use of "public cloud"  because of HIPAA/HITECH privacy concerns, lack of breach indemnification/data integrity guarantees, and the unwillingness of many cloud providers to sign business associate agreements. Although it has not been widely discussed in the industry, the Centers for Disease Control and Prevention's (CDC) Biosense 2.0 initiative has done ground breaking work to solve these issues, using Amazon's AWS GovCloud to create a national repository of syndromic surveillance data that includes all the protections needed to protect privacy including independent security testing  at the FISMA-Moderate Level . CDC is the first government agency to complete all the rigorous certification needed to host sensitive data in the public cloud. CDC has also built gateway...

Although Kathy's body is sore and her hands/feet are numb, her mood is good as we finalize our house sale, pick out the chickens we'll raise on the new farm, and prepare for the life ahead instead of looking back on our old life and the events of the past 5 months. She lost her last eyebrow hairs this week and the toenails on her big toes will likely fall off soon.   She cannot open jars or water bottles because of diminished grip strength and today she visits the orthopedist for followup of her probable right knee medial collateral ligament tear.  But she's happy. The chickens we've decided to raise are Buff Orpingtons , Jersey Giants , and Brahmas  - all docile large breeds.    We'll likely raise a small number to start with, ensuring we learn chicken care incrementally.   We have local farms and grain mills as well as web-based chicken farming resources to help us.   This Summer, we'll build a portable chicken tractor , then design a permanent coo...

Today I'm presenting an overview of our new clinical trials/clinical research business intelligence system, called Clinical Query to the BIDMC Chiefs and Vice Presidents. Here are the slides I'll use . The principle behind Clinical Query is that investigators will want to ask questions, preliminary to research, that will help them understand the potential statistical power of a clinical trial or the availability of data for clinical research. What did we do? We loaded 2.2 million patients (1997 to the present) and 200 million data elements into a repository,  ensuring that every data element was mapped to a controlled vocabulary.  When then built a web-based query tool capable of navigating 20,000 medical concepts via boolean (AND.OR) expressions of arbitrary complexity. Labs were mapped to LOINC codes. Problems/Encounter Diagnoses were mapped to SNOMED-CT codes. Medications and Allergies were mapped to RxNorm codes Demographics were mapped to the same code sets required for M...

I've written several posts about the issues that keep me up at night.  Here's what I wrote in 2011 . Today, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC.   Here's my list of top risks for 2012: 1.  Old Internet browsers - many vended clinical applications require specific versions of older browsers such as Internet Explorer 6, which are known to have security flaws.  We've worked diligently to eliminate, upgrade or replace applications with browser specificity.   At this point we are 96% Internet Explorer 8/Firefox 7/Safari 5 minimizing our risks to the extent possible. 2.  Local Administrative rights - Of our 18,000 devices on the network, a few thousand are devices that require the user to have local administrative rights to run their niche applications (often the research community doing cutting edge research with open source or self developed software).   We have done everything possible to eliminate Local ...

I was recently asked by BIDMC clinical leaders to describe the difference between the Medicare Electronic Prescribing Incentive Program  and the Meaningful Use Stage 1 core requirement to e-Prescribe. Some clinicians are receiving Medicare penalties/fee reductions even though they have achieved the much more rigorous Meaningful Use requirements. The Medicare Electronic Prescribing Incentive Program and Meaningful Use are two separate initiatives with two separate requirements, although both promote the use of electronic prescribing through the use of incentives and payment adjustments. The Medicare Electronic Prescribing Incentive Program promotes electronic prescribing by requiring that an eligible professional report the electronic prescribing activities using G-codes in billing claims for 10 encounters per year. The Meaningful Use Stage 1 requirements promote electronic prescribing by requiring that clinicians meet an electronic prescribing objective by electronically prescribin...

Although I normally write a cool technology update on Friday, today I want to share an important survey - the   2012 Deloitte-AMIA Health Informatics Industry Maturity Survey targeting US-focused provider, health plan and life sciences organizations. This project will help us all understand the alignment of healthcare informatics efforts, organizational strategy, and business alignment.  If this first iteration goes well, Deloitte and AMIA hope to make it an annual survey, opening it to a wider audience that includes public health, government, and perhaps making it global in scope.   I completed it on behalf of BIDMC and look forward to the results.   As you can imagine, I said that informatics is critically important and needs more institutional funding!

Kathy returns to chemotherapy tomorrow although the numbness in her hands and feet has not changed and she now has a probable tear of a ligament in her right knee, which gives new meaning to limping through her treatments. Many people responded to my March 29 post with concern that Kathy and I might lose our optimism, given all the events happening in our lives simultaneously. We have two responses to the events that life throws at us 1.  First, we have the support of each other.  We have not been apart more than a few days for past 32 years and have the same passion, infatuation, and mutual respect for each other we had on day 1. 2.  Second, we believe that everything happens for a reason. We do not follow any formal religion, although I was baptized a Catholic and Kathy was raised in a Methodist household.    We have great respect for the world's religions and feel a special affinity to the Japanese Shinto believe that there is spirituality in every rock, tree...

I've previously written about multitasking and work induced attention deficit disorder . I've also written about the burden of having two workdays every 24 hours - one for meetings and one for email  Yesterday, I was sent a post from the Harvard Business Review that summarizes these issues very well. It highlights the problem and a series of solutions. Nearly half of employees report the overwhelming stress and burden of their current jobs, not based on the hours they work, but the volume of multitasking - too many simultaneous inputs in too little time.  They've lost the sense of a beginning, middle, and an end to their day, their tasks and their projects.  There is no work/life boundary. As a case in point, I'm writing now while doing email and listening to a Harvard School of Public Health eHealth symposium.   Am I being more productive or just doing a greater quantity of work with less quality? The author of the post points to evidence that multi-tasking increa...

Hospitals and eligible professionals are attesting to Meaningful Use at an accelerating rate.    To me, the Stage 1 Menu Set options NOT CHOSEN are the most valuable predictor of the challenging areas in Stage 2, since all the Stage 1 Menu Set items become Core in Stage 2. At the January HIT Policy Committee, CMS presented an overview of Menu Set items deferred.  Interestingly, the items deferred in Stage 1 are those most likely  required for successful Accountable Care Organizations and interoperability. The top items hospitals deferred are:  Summary of care at transitions (93% deferred), medication reconciliation (75%), and provide educational resources to patients (62%). The top items Eligible Professionals deferred are:  Summary of care at transitions (85% deferred), patient reminders sent via patient preference (77%), medication reconciliation (56%), provide timely electronic access to data via PHR (62%), and provide educational resources (49%). Submit...

In the March HIT Standards Committee we highlighted 3 gaps in the standards needed to calculate quality metrics automatically from EHRs 1.  A longitudinal (not encounter level) patient summary format to transmit appropriate data elements from an EHR to a quality measurement entity 2.  A batch reporting format to transmit data elements for multiple patients to a quality measurement entity 3.  Although PQRI XML and QRDA have been suggested for reporting data between quality measurement entities and organizations that use this data for payment/compliance, there is not a widely adopted standard for quality reporting in production today. As I wrote in a wrote in a previous post, ONC/MITRE/BIDMC/Massachusetts eHealth collaborative  worked together to evaluate the PopHealth tool with 2 million Continuity of Care Documents. The full results of that analysis are now available and here's the document for public circulation . Key lessons learned include 1.  The CCD is a...