The Joy of a Local Hardware Store

Let me describe two experiences:

I walk into a big box home improvement store and ask for advice about screens for storm windows that were popular in Wellesley, Massachusetts in the 1960's. No one has any idea what I'm talking about. Not just about my storm windows, but any storm windows. The store is 40 aisles of 20 foot high racks without an easy to navigate map. Oddly, screens are not in the Windows section, they're in the Building Materials area. No one knows what tools I need or how much screen I should purchase, so I make several trips back and forth from home to store. I spend hours in the process and throw away an entire roll of screen I've wasted.

I walk into my neighborhood hardware store. A cheerful, experienced salesperson greets me at the door and asks to help with my project. The person instantly knows the type of windows I have, the tools needed, the best materials, and a few tips to get the job done right. The person wanders around the 5000 square foot store, picks up all the materials I need and rings me up. I spend minutes in the process, do the job perfectly the first time, and have no waste.

Just as I have extolled the virtues of embracing locavore food culture and community supported agriculture, I suggest supporting your local hardware store - let's take back the neighborhood from the big box stores.

Life is short and I really care about the quality of my day to day experiences. I want to shop locally from farmers, craftsmen, vendors, and salespeople that I know. I realize that in our complex world that is not always possible. If you have a choice of buying a bolt for fifty cents from a helpful, knowledgeable shopkeeper OR buying a bolt of lesser quality for forty cents that takes an hour to find a big box store, I suggest that you and your wallet shop locally.

I'm so impressed with Green's Hardware in Wellesley, that I actually seek out home projects to do on weekends, just so that I can enjoy the experience of getting sound advice and quality products from people who teach me how to maintain my home. My house was built in the 1930's but every part of it - from electrical to plumbing to carpentry - is perfectly maintained thanks to the partnership I've developed with Green's, my local hardware store.

The HIT Symposium at MIT

This morning I joined a panel discussion about Standards at the HIT Symposium at MIT.

We had a great panel discussion, moderated by Janet Marchibroda (Chief Healthcare Officer at IBM) that included Christine Bechtel (Vice President, National Partnership for Women and Families Patrick Gallagher (Deputy Director at NIST) and me.

Patrick provided an overview of NIST and the work the government is doing to ensure selected healthcare standards perform as advertised, are implementable, and usable.

Christine described the role of the HIT Policy Committee and its workgroups.

I described the current HITSP Tiger Team work, the standards committee/workgroups including their charge, purpose, milestones.

Here's my presentation that describes all the latest standards work for the country.

On the last slide, you'll see our deadlines:

HITSP ARRA Deliverables will be approved and delivered to ONC on July 8

The HIT Standards Committee Workgroups finish their initial naming of standards and certification criteria by July 15

All this work is presented publicly at the HIT Standards Committee on July 21.

The Notice of Proposed Rulemaking process then begins and we'll see a finished Interim Final Rule by December 31.

A whirlwind of activity!

Standards Deployability

I've described the taxonomy that we're using in the HIT Standards Committee to characterize "deployability":

Category I- Known/Certain for 2011
Standards are well-accepted and generally seen as deployable

Category II- Known/Certain for 2013
Standards exist, are determined, but are not in the market yet

Category III- Work In Process for 2013 or 2015
Need to converge/refine standards for 2013 or develop for 2015

Category IV- Standards to be determined
“Gleam in the eye,” some concepts exist but no clear path

Providing a measure of vendor, clinician, lab, pharmacy, hospital, and HIE ability to implement standards is just as important as naming the standards to be used in support of meaningful use.

During our recent HIT Standards Committee meeting we discussed other interpretations of deployability including implementation experience to date, known costs of implementation, and trading partner willingness to implement.

Dr. Jim Walker MD, Chief Healthcare Information Officer of Geisinger Health System, summarized the discussion as:

I. Mature – Implemented in 20% (inspired by Gartner's metric that 20% represents a tipping point of acceptance) of relevant healthcare organizations. Implementation methods and costs well specified. Success is dependent on factors external to the implementing organization at most minimally.

II. Ready for Introduction – Widely agreed on and thoroughly tested in detail. Implementation methods and costs are variable and difficult to predict. Ready for widespread implementation in production health IT. Success is largely dependent on internal factors.

III. Well Developed – Widely agreed in concept. Needs detailed specification and testing. Implementation methods and costs are largely unknown. Success is largely dependent on factors external to the implementing organization.

IV. In Development


Over the next month, the HIT Standards Committee will ensure that the concept of deployability accompanies each standard in the meaningful use matrix. This consensus assessment will enable the HIT Policy Committee, ONC, and HHS to make the final decision on meaningful use implementation phasing after weighing the impact of deployability Although it is likely that 2011 meaningful use criteria will be Category I's, there may be a few Category II's if the value/impact of early implementation justifies the effort.

As David Blumenthal said at last HIT Standards Committee meeting, stimulus dollars and the urgency to change may accelerate the ability of all stakeholders to deploy health information exchange and we should not set the bar too low.

Implementing a Modern Hospital Website

Over the past two years, I've witnessed a transition in modern website design from plain text and static information to multimedia centric and interactive. I've written about the new BIDMC website we implemented to meet patient expectations for a modern website.

Many healthcare organizations I work with are considering content managed, new media, highly interactive web 2.0 sites. I thought it would be useful to describe how we approached the BIDMC website so you can leverage our experience.

Content Management - BIDMC has a great deal of .NET expertise, so we wanted a content management system that worked well in our .NET/SQL Server 2008 environment. SiteCore has been ideal for us, providing content templates, distributed content management, and publishing workflow in a load balanced, secure, virtualized environment. At HMS we use Drupal and Wordpress for content management. They also work well for hosting institutional web sites.

Interactive features - The Corporate Communications folks at BIDMC really wanted to highly interactivity. We built and bought the components they needed as follows

Blogs - Uses a SiteCore provided blogging module

Chat - a commercial application called Cute Chat from CuteSoft.

BIDMC TV (news and information videos produced by BIDMC)- Hosted by BrightCove.

Medical Edge (videos about innovation produced by BIDMC)- Hosted by BrightCove.

Podcast Gallery - Hosted on BIDMC servers.

Health Quizzes - created using a commercial application called SelectSurvey.NET from ClassApps.

Social Networking - entirely hosted by outside service providers (Facebook/Twitter/You Tube).

Secure patient web pages for communication with their families - a commercial application provided by CarePages.

Conditions A-Z - a web-based encyclopedia branded for BIDMC using commercial reference provided by Ebsco.

Search Engine - We're using a Google Appliance

Thus, the combination of SiteCore plus purchased interactive applications and externally hosted streaming video has worked very well to provide our patients with an information rich, interactive experience.

I hope this is useful to you as you implement your own hospital websites.

Cool Technology of the Week

I work in the Longwood Medical Area - a former cowpath that is now the only access to the center of biomedical research, healthcare, and informatics. It's a very challenging place to commute, especially on Red Sox games days. I carry a red sox schedule in my wallet to help me plan commutes - leaving an hour earlier in the morning or an hour later at night.

There must be a better way than trying to drive through a nightmare of red sox traffic, commuters, and road construction.

In July I'm going to try a bold experiment with a cool technology. I'm going to park my car away from the madness and use a foldable bicycle that weighs under 20 pounds for all my Boston city commuting.

I've investigating many folding bicycle technologies - Bike Friday, Brompton, and Dahon, but none is light enough, small enough, or quick to fold enough to just toss in and our of car/office/train in a few seconds. The Strida is.

The Strida was invented by Mark Sanders in the UK in the 1980's as part of his graduate work. It's use case is not long distance travel or hill climbing. It's a greaseless, chainless, gearless bike that folds in 10 seconds and is perfect for Park and Bike or Train and Bike travel.

My goal in July is to leave the car 2 miles from the Longwood Medical area in a place that's easy to commute to/from, then bike to all my remaining destinations. Admittedly our unusually wet Summer this year in Boston will make this a bit challenging, but my rayon and linen clothes drive fast. I have a messenger bag for my Macbook Air and meeting materials.

So if you're in Boston, look for me on a Strida, dressed in black and carrying a computer on my back. My only reservation is that rock climbing, ice climbing, and kayaking are completely safe compared to bicycling in Boston. My Mort level may go up a bit during this experiment. Those disc brakes on the Strida are likely to come in handy.

A lightweight, folding, greaseless bike to solve your commuting nightmares. That's cool!

The Future of Personal Genomics

I recently participated in an panel discussion at Bio-IT World on the future of personal genomics.

As one of the PGP-10, I'm a passionate supporter of full genome sequencing as a means to empower patients to work with their clinicians in formulating a plan for lifelong wellness.

You'll find my personal comments in this webcast.

Within the next year, the $1000 per person genome will be a reality. Our next challenge will not be the science but the need for robust patient decision support tools which translate base pair variation into probabilities for pathology. Further, we'll need to provide the educational materials which will enable patients to turn these probabilities into informed decisions about proactive lifestyle changes and therapies.

I hope you enjoy the hour long discussion from Bio-IT world from folks who are actively working on Personal Genomics science, policy, and education.

The Second Meeting of the HIT Standards Committee

Today, Jonathan Perlin and I ran the second meeting of the HIT Standards Committee.

Here's a report on presentations and the work ahead.

Jamie Ferguson presented the work of the Clinical Operations Working Group. There are three major threads of effort
- Clearly define the standards work to be completed by the Clinical Operations Workgroup and the Clinical Quality Workgroup, since quality measures depend upon clinical operations data
- Select the specific standards and certification criteria supporting Meaningful Use Objectives and Measures
- Create a taxonomy for standards maturity and industry readiness to deploy standards. The draft taxonomy we discussed is:

Category I- Known/Certain for 2011
Standards are well-accepted and generally seen as deployable

Category II- Known/Certain for 2013
Standards exist, are determined, but are not in the market yet

Category III- Work In Process for 2013 or 2015
Need to converge/refine standards for 2013 or develop for 2015

Category IV- Standards to be determined
“Gleam in the eye,” some concepts exist but no clear path

David Blumenthal noted that the stimulus may motivate stakeholders to adopt data exchange more quickly than the past, making stretch goals possible. As a group we discussed the challenge of the healthcare ecosystem - motivating just one segment of the industry may not be sufficient to achieve data exchange i.e. standardizing EHRs to accept specific lab data standards is not sufficient unless the labs also agree to send data in a single standard format.

Janet Corrigan presented the work of the Clinical Quality Working Group. Her group is building on the work of the National Quality Forum's Health Information Technology Expert Panel to identify the Quality Data Set needed to support measurement and reporting. They are not choosing new standards or vocabularies, instead they are developing a framework of datatypes that enable the measures to be expressed in terms of EHR capabilities. For example

% of Hypertensive Patients with BP under Control [OP] requires EHR datatypes for

Age
Hypertension diagnosis
Ambulatory encounter
Systolic blood pressure result
Systolic blood pressure result

The Clinical Quality Workgroup will spend the next month specifying the precise measures in terms of datatypes that will meet the quality measurement requirements of meaningful use. They will work closely with the Clinical Operations Workgroup to ensure the needed data exchanges supporting collection of these datatypes are included in the standards chosen.

Dixie Baker presented the work of the Privacy and Security Working Group. Her group identified three categories of standards and best practices supporting security:

1) Products that can be purchased (certified by CCHIT outside the real-life setting)
2) IT infrastructure necessary to enable the product to be meaningfully used
3) Operational environment in which the product will be used meaningfully

She also described recommended wording improvements to the meaningful use matrix items that will be forwarded to the HIT Policy Committee.

Their work over the next month will be to name the security standards and best practices for each meaningful use item and the ARRA 8 items.

The entire Committee discussed some of the existing gaps in standards. These included
-Standards for ordering including lab orders
-Standards for supporting electronic reporting of some of the meaningful use measures i.e. what percentage of prescriptions were written electronically - how do you calculate the number of prescriptions written manually?
-Standards supporting some of the patient/family engagement provisions of meaningful use

Our plan is to complete the efforts of our 3 Workgroups by the next meeting of the HIT Standards Committee on July 21. The end result will be a matrix of standards, an estimate of the readiness for deployment of each standard, quality measures, and privacy/security best practices for each meaningful use objective.

This work will give ONC and HHS the lead time they need for legal review, budget impact, and rule writing by the appropriate federal agencies.

The next month will be a whirlwind of activity. My thanks and appreciation to everyone involved!