American Medical Informatics Association (AMIA) 2009 Annual Symposium

Estenda will be exhibiting at the AMIA 2009 conference in San Francisco November 14th – 18th.  From their website, “The AMIA Annual Symposium is the world’s most comprehensive annual meeting on biomedical and health informatics.”

Hope to see you there!

DMAA Publishes 4th Volume Outcomes Guidelines Report

The  DMAA: The Care Continuum Alliance has just published the 4th volume of their Outcomes Guidelines Report.  This report is a wealth of information on measuring outcomes. The best part is that it is now freely available from their website. (Link here.)

CCHIT Certification and meaningful use

The CCHIT commission responsible for certifying EMRs held two town hall conference calls to unveil their proposed modifications to the certification process to better handle open source solutions as well as modular and in-house built solutions.  The proposal was well-received

“In real-time polling conducted during both sessions, 70 percent of respondents expressed a very favorable or favorable reaction to the plan.”, from a CCHIT email dated 6/18/2009.

and I agree that the proposed modifications will make the certification process much more friendly to the open source community and open the door to a host of solutions being certified. There was also discussion of the meaningful use guidelines that were released the same day.

The original vendor certification will continue and be updated to include the meaningful use criteria that was pushed forward last week (here).  There are two new certifications and they are EHR-M and EHR-S.  EHR-M or Module allows components of a complete solution to be certified. This allows medication management vendors or lab system to certify their solution without it being a full EMR.  I am most interested in this type of certification as eHIP is not a full EMR but incorporates many components.  I can see individually certifying components within the overall platform.  EHR-S or site certification allows a hospital or physician’s office to self-certify an open source product they have implemented or software that was developed in house.  This is also intriguing because I can easily imagine one of our client’s applying for this certification using eHIP.

Two factors that differentiate the original certification and the new ones are cost and emphasis.  Costs for EHR-M and EHR-S are planned to be significantly lower than the existing certification which is a barrier to many open source solutions.  The EHR-S cost might be as low as a few hundred dollars per provider.  While this is important, the emphasis will also be different.  The traditional EMR certification has concentrated on and while continue to concentrate on functionality.  Can the EMR do X, Y, and Z as well as 1,2, and 3?  With EMR-M and S, the emphasis will be on interoperability, a much more important factor.

I think the original EMR certification has had the potential to stifle innovation. With the rules constantly changing, vendors have had to keep up with the new requirements, limiting their ability to add new, more innovative features. I think the new proposed guidelines open the door to new possibilities and I look forward to seeing what eventually is implemented.

Robert Wood Johnson Project HealthDesign

The Robert Wood Johnson Project HealthDesign has finally posted the materials created by the grant recipients online. One of the novel concepts behind this grant was that everything produced would be released as open source.  As an advocate and contributor of open source software, this was an intriguing concept.  Estenda participated in one of the projects and the material is now available on-line at their site.

GOSCON – Government Open Source Conference

Yesterday, I came across a new conference, at least new to me.  It is called GOSCON or Government Open Source Conference. (here) It will be held in D.C. this year.  I will be attending as the Comprehensive Diabetes Management Program (CDMP) that we are part of is a prime example of government using open source and making the results of projects open source.  The development of CDMP was originally for the creation of a diabetes management application for military healthcare.  It has expanded beyond that today, but still has its root in government.  Because of it being funded by the government it is available license free to government institutions and it has always been given freely to interested researchers and third parties. We are currently working with our partners on officially declaring it open source, but working through the legal issues is taking some time.

Update 6/22/09 – The conference was rescheduled for Fall 2009.  The decision to do this was based on conversations with the Obama administration and other IT leaders.  No date has been announced.  I find this to be fairly vague and while a lot will change and be formalized in the next few months regarding IT particularly in health care, one has to wonder if there was an attendance issue?

Continuous Glucose Monitoring Research and CADS

The Diabetes Technology & Therapeutics Journal just released a special free supplement covering continuous glucose monitoring. (here) While I haven’t had a chance to read the articles thoroughly, I have perused the titles and abstracts. It looks like I have a lot of reading to do over the next few weeks.  One of the articles, “Interpretation of Continuous Glucose Monitoring Data: Glycemic Variability and Quality of Glycemic Control” is by a doctor David Rodbard.  We are working with him and another endocrinologist on a project called CADS, short for Computer Assisted Decision Support. A fairly generic name, but the goal is to be able to make medication regime adjustments/suggestions to primary care providers for patients with diabetes based on an automated blood glucose profile.  We expect to have the project in beta within the next six months and then it will undergo extensive clinical testing at several military institutions.

Dollars for Healthcare

It seems healthcare, particularly rural and personal health care, has reached a tipping point of sorts.  For starters, we have the Obama healthcare dollars, but recently China (here) and GE (here) have both committed to spending billions of dollars in healthcare.  China has plans to invest $124B over 3 years to provide healthcare to its rural populations.  I have also heard Australia is going to invest billions to outfit the interior with broadband technology in an effort to bring healthcare to the aboriginal populations.  As for personal health GE is going to invest $6B over the next few years in healthcare related ventures. 

I have always thought working in healthcare was one of the best industries because of the huge challenges involved and the personal satisfaction that what you are doing can help others, but now it is really going to get interesting.  Healthcare and personal healthcare are going to move out of the shadows into the mainstream. Its going to be a brave new world.

Seminars, Conferences, and Education Sessions

Over the past few weeks I have been at several different events.  First up was a one day AMIA education covering HIT in general. Dr. Halamaka of Beth Israel fame was there and did address the PHR claims data mess from a few weeks back. Nothing too shocking, just back to the drawing board to figure out what next.  He has been on the cutting edge of HIT over the past few years and discussed the chip he has embedded with his personal health data and how he had his genome scanned a few years back.  Just a really interesting guy all around.  Interestingly there was a report that he has given up on embedded chips as a means to access PHR data. At least for now.  I think the concept is viable, just a little before its time.

The big event of the last few weeks was the American Telemedicine Association Annual Conference in Vegas.  This is an event Estenda has attended for the last five years.  It is a great networking event with lots of technology vendors.  This was their largest conference ever.  In the past vendors have been very focused on remote video technology and only somewhat devices. This year there was an explosion in personal health devices and the associated software to manage the data.  Telemedicine is coming into its own. One keynote speaker noted the fact that there are now over 10,000 articles on PubMed that reference telemedicine. Telemedicine is no longer the up and coming technology. It is here and here to stay.

Finally, I attended a one day seminar sponsored by PAeHI. PAeHI is the Pennyslvania eHealth Initiative.  Several topics were discussed including the Obama Healthcare dollars and how to best use them, an overview of the Medical Home concept, and telemedicine in general.  The closing panel was lead by Mark Frisse.  I am familiar with Mark from working on the RWJF Project HealthDesign Grant. His is a dynamic individual that always brings something interesting to the table.  In part he discussed the initiative he lead in Tennessee to create a state-wide medical record repository.  From the sounds of it, they largely ignored all standards and said let’s just get something done! We will figure it out later.  In the end it worked, they have the data, and have been able to generate some interesting reports.

As for the next session, I will be attending a training session on the NHIN Connect program in June.  It will be interesting to get an indepth look at what it is all about and how it works. From monitoring the messageboards it appears to be having a bunch of issues, but nothing that can’t be worked through.

Beth Israel stops sending claims data to Google and Microsoft PHRs

If you haven’t seen the recent news article in the Bostom Globe about the inaccuracy of data being stored in Google Health and Microsoft HealthVault and how it can be confusing, it is definitely worth reading.  Beth Israel was sending the claims data to Google Health and Microsoft HealthVault PHRs.  Sounds good in theory, but in practice it doesn’t work out so nicely.  Because of the resulting confusing, they have decided to stop sending the claims data into any PHR.  The title of the article detailing what happened mentions Google, but it also stopped sending claims data elsewhere.

The important thing to note is that this is not a problem limited to Beth Israel or any particular PHR. It is systemic and related to the coding of medical data for billing purposes. Read the article for the reasoning behind this.

I am attending the 2nd Annual Healthcare Informatics Symposium sponsored by The Children’s Hospital of Philadelphia on Friday.  Dr. Halamka, Beth Israel’s chief information officer and part of the Google Health’s advisory council last year, will be speaking at lunch.  I wonder if he will address this?

PAeHI Health Information Technology (HIT) Summit

May 4th I will be in Harrisburg attending the PAeHI Health Information Technology Summit. 

The Pennsylvania eHealth Initiative (PAeHI) was created to encourage the development and use of electronic medical records (EMR) in Pennsylvania along with health information exchanges (HIE), which will ultimately tie into a national system allowing patients and health care providers to securely access medical records regionally and throughout the country.

The Summit is a one day session covering a broad range of topics including the impact of President Obama’s Recovery Act and information on what is going on in Pennsylvania with respect to HIT.