When I lecture about the new generation of personal health records such as Google Health and Microsoft Healthvault, I emphasize that these applications are not covered by HIPAA. Google and Microsoft are not healthcare provider organizations and thus their privacy is only as strong as the policies they post on the website. Since Google and Microsoft monetize these sites by attracting search traffic, they are highly motivated to build secure and trustworthy systems. As a member of the Google Advisory Council, I know that the Google privacy policies are stronger than HIPAA. Microsoft has very similar policies.
These policies are good, but they are self developed by the companies. Ideally we would have a single national privacy policy framework for all personal health record products.
On Monday at the Nationwide Health Information Network meeting, Secretary Leavitt released the nation's first national privacy framework for personal health records.
This framework builds upon national and international efforts such as the Markle Connecting for Health Framework , HIPAA, and privacy legislation from the EU/Japan/Australia/Canada.
The framework is based on 8 principles:
Individual Access - HIPAA mandates that every patient have access to their records, but it does not specify the means of access. The default in most institutions requires patients to visit medical records and request a paper copy. This privacy principle highlights the need for secure electronic delivery of medical records to patients.
Correction - Existing regulations and best practices mandate the non-repudiability of the medical record. Doctors cannot simple delete data or change previously signed notes. However, medical records often contain incomplete or inaccurate information. This privacy principle requires that a process exists for amendment/correction of inaccurate information. In the case of Beth Israel Deaconess, we do not delete or edit previously entered information, we amend it with a time/date stamp to reflect an audit trail of correction to previously documented records.
Openness and Transparency - HIPAA mandates that health care providers provide a notice of privacy practices to patients. The Openness and Transparency privacy principle extends that to include a notice of how information is collected, used, and disclosed including policies, procedures, and technology. Also it importantly highlights the need to explain to patients their control over the use and disclosure of their information. In Massachusetts, all our community data sharing efforts require opt in consent.
Individual Choice -- Consumers should be empowered to make decisions about with whom, when, and how their personal health information is shared (or not shared).
Collection, Use, and Disclosure Limitation – It is important to limit the collection, use and disclosure of personal health information to the extent necessary to accomplish a specified purpose. The ability to collect and analyze health care data as part of a public good serves the American people and it should be encouraged. But every precaution must be taken to ensure that this personal health information is secured, deidentified when appropriate, limited in scope and protected wherever possible.
Data Integrity – Those who hold records must take reasonable steps to ensure that information is accurate and up-to-date and has not been altered or destroyed in an unauthorized manner. This principle is tightly linked to the correction principle. A process must exist in which, if consumers perceive a part of their record is inaccurate, they can notify their provider. Of course the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides consumers that right, but this principle should be applied even where the information is not covered by the Rule.
Safeguards – Personal identifiable health information should be protected with reasonable administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use, or disclosure.
Accountability – Compliance with these principles is strongly encouraged so that Americans can realize the benefit of electronic health information exchange. Those who break rules and put consumers’ personal health information at risk must not be tolerated. Consumers need to be confident that violators will be held accountable.
Having a framework for privacy that can be applied to all PHR products - those tethered to an EHR, those offered by a payer, those sponsored by an employer or those created by third party vendor ensures that consumers have a rubric to evaluate these products. Hopefully a certification group like CCHIT will also certify PHR products to these framework, making it easy for consumers to look for the "Good Housekeeping Seal" and be confident that their privacy is being protected.
As I have said many times, with good policy, appropriate technology, and funding, we can do anything. With the the release of this framework, the policy is now available.
Wednesday, December 17, 2008
Tuesday, December 16, 2008
The Lexicon of the Interactive Web
As a champion for social networking and next generation web functionality, I'm often in meetings with folks who are not sure what I mean by Twittering, Facebooking, or Texting. Here's a lexicon of the interactive web, assembled by my colleague, Dr. Michael Parker. Feel free to share it with anyone who has not yet joined the overly connected set!
Web 2.0 – A somewhat loosely defined idea, rather than a reference to any specific technology. It generally refers to use of the web in participatory, collaborative ways where users shape the content. The ability for users to contribute and/or interact is one of the features distinguishing Web 2.0 from the model of viewing static web pages. Web services that fall under this umbrella include social networking sites, video sharing sites, wikis, blogs, and folksonomies (each of which is described briefly below).
Social networking sites – These web sites allow users to form online communities, which can be further organized around specific topics (work or recreational). In general, these sites allow users to maintain profiles with information about themselves and to make connections to other users. Examples include MySpace and Facebook, among many others. More focused examples include LinkedIn and Epernicus.
Video sharing sites – These are sites that allow uploading of video clips for others to view. Probably the most popular example is YouTube.
Wikis – Web pages or web sites that allow people to contribute to and/or edit existing material. Whereas blogs are cumulative, with little if anything being subtracted or modified over time, wikis are iterative in that users continually modify and build upon existing content. Wikipedia is probably the most well-known example of a wiki.
Collaborative document creation – Software that allows multiple users to co-author a document. Web-based versions can maintain multiple backup versions of documents, allow simultaneous editing by multiple users, enable email notification of document changes, among other features. Examples of such software include Buzzword by Adobe and Google documents.
You can also subscribe via RSS (see link at bottom of page when you visit the document) to receive notifications of document changes via programs like Google Reader (see RSS below).
Blogs – A blog is a web site, usually of an individual (although sometimes representing an organization), that has chronological entries of text and sometimes multimedia. Entries are usually shown in reverse chronological order, with most recent entries shown first. Blogs form cumulative records with “posts” (blog owner’s entries) and viewer comments accumulated over time.
RSS – Sites that offer RSS (Really Simple Syndication) feeds allow users to be notified of new or changed content by receiving e-mails or by subscribing via “Reader” technology (like Google Reader). Blog readers are one example, although RSS technology is not limited to blogs.
Folksonomies – A folksonomy may be thought of as a collective of user-defined tags (simple, often single word, descriptions) on web objects (pictures, web pages, documents, etc.). This is different than an expert-defined taxonomy (e.g. MESH terms) in that users are free to come up with their own terms. A folksonomy may facilitate interesting methods of search and exploration, particularly if association is maintained between a user, his or her tags, and the objects being tagged. For example, user #1 could observe that user #2 has tagged a web page with terms that make sense to user #1; user #1 could then look at the rest of the items user #2 has tagged with those terms. The site Delicious is a good example of such tagging and association.
Tags – Simple, often single word, descriptions that users assign to web objects (eg photographs or web pages). These are often free-form, in other words, users can come up with their own terms rather than being constrained to choose from pre-existing terms. Although tagging is often performed for one’s own personal retrieval of information, there may be power in making use of the collective set of tags assigned by many users (see Folksonomy).
Instant messaging – Refers to synchronous or near-synchronous interaction via short text-based messages over the internet. It is basically a text-based conversation in real time. AOL (with AOL Instant Messenger or ‘AIM’), Yahoo!, and Microsoft (MSN Messenger) are some of the more popular technologies in this category.
Chat – This tends to refer to multi-user instant messaging applications, and is also called synchronous conferencing.
Text messaging (aka “texting” or SMSing) – Refers to sending short text messages, usually from cell phones. SMS stands for ‘Short Message Service.’ This is a phone-based version of instant messaging, although it has a broad range of applications other than conversational (for example, polling or surveys can be conducted this way).
Voice over IP (VoIP) – Software that allows users to make telephone calls (real time audio communication) over the internet. In many such calls, there are no phones involved, and users are talking/listening via microphones/speakers connected to their computers. Skype is a good example of such a service. These services often also include text-based features like chat.
Web conferencing – Software that allows users to conduct meetings over the web. Common features include screen sharing, text chat, voice over IP, and virtual whiteboard. Examples of software in this category include Adobe Acrobat ConnectNow, GoToMeeting, WebEx, and Elluminate.
Project management software – Applications for managing multi-person projects; may have a variety of features, such as to-do lists, timelines, document version control, multi-person document editing, email notifications of document updates, etc. BaseCamp is one web-based example of such software.
Recommendation engines – Algorithms, like on Amazon or NetFlix, that analyze your shopping/browsing/renting habits and those of others like you and make recommendations as to what you might like.
As a member of the overly connected, you'll find me at:
Facebook
Twitter
Plaxo
LinkedIn
Web 2.0 – A somewhat loosely defined idea, rather than a reference to any specific technology. It generally refers to use of the web in participatory, collaborative ways where users shape the content. The ability for users to contribute and/or interact is one of the features distinguishing Web 2.0 from the model of viewing static web pages. Web services that fall under this umbrella include social networking sites, video sharing sites, wikis, blogs, and folksonomies (each of which is described briefly below).
Social networking sites – These web sites allow users to form online communities, which can be further organized around specific topics (work or recreational). In general, these sites allow users to maintain profiles with information about themselves and to make connections to other users. Examples include MySpace and Facebook, among many others. More focused examples include LinkedIn and Epernicus.
Video sharing sites – These are sites that allow uploading of video clips for others to view. Probably the most popular example is YouTube.
Wikis – Web pages or web sites that allow people to contribute to and/or edit existing material. Whereas blogs are cumulative, with little if anything being subtracted or modified over time, wikis are iterative in that users continually modify and build upon existing content. Wikipedia is probably the most well-known example of a wiki.
Collaborative document creation – Software that allows multiple users to co-author a document. Web-based versions can maintain multiple backup versions of documents, allow simultaneous editing by multiple users, enable email notification of document changes, among other features. Examples of such software include Buzzword by Adobe and Google documents.
You can also subscribe via RSS (see link at bottom of page when you visit the document) to receive notifications of document changes via programs like Google Reader (see RSS below).
Blogs – A blog is a web site, usually of an individual (although sometimes representing an organization), that has chronological entries of text and sometimes multimedia. Entries are usually shown in reverse chronological order, with most recent entries shown first. Blogs form cumulative records with “posts” (blog owner’s entries) and viewer comments accumulated over time.
RSS – Sites that offer RSS (Really Simple Syndication) feeds allow users to be notified of new or changed content by receiving e-mails or by subscribing via “Reader” technology (like Google Reader). Blog readers are one example, although RSS technology is not limited to blogs.
Folksonomies – A folksonomy may be thought of as a collective of user-defined tags (simple, often single word, descriptions) on web objects (pictures, web pages, documents, etc.). This is different than an expert-defined taxonomy (e.g. MESH terms) in that users are free to come up with their own terms. A folksonomy may facilitate interesting methods of search and exploration, particularly if association is maintained between a user, his or her tags, and the objects being tagged. For example, user #1 could observe that user #2 has tagged a web page with terms that make sense to user #1; user #1 could then look at the rest of the items user #2 has tagged with those terms. The site Delicious is a good example of such tagging and association.
Tags – Simple, often single word, descriptions that users assign to web objects (eg photographs or web pages). These are often free-form, in other words, users can come up with their own terms rather than being constrained to choose from pre-existing terms. Although tagging is often performed for one’s own personal retrieval of information, there may be power in making use of the collective set of tags assigned by many users (see Folksonomy).
Instant messaging – Refers to synchronous or near-synchronous interaction via short text-based messages over the internet. It is basically a text-based conversation in real time. AOL (with AOL Instant Messenger or ‘AIM’), Yahoo!, and Microsoft (MSN Messenger) are some of the more popular technologies in this category.
Chat – This tends to refer to multi-user instant messaging applications, and is also called synchronous conferencing.
Text messaging (aka “texting” or SMSing) – Refers to sending short text messages, usually from cell phones. SMS stands for ‘Short Message Service.’ This is a phone-based version of instant messaging, although it has a broad range of applications other than conversational (for example, polling or surveys can be conducted this way).
Voice over IP (VoIP) – Software that allows users to make telephone calls (real time audio communication) over the internet. In many such calls, there are no phones involved, and users are talking/listening via microphones/speakers connected to their computers. Skype is a good example of such a service. These services often also include text-based features like chat.
Web conferencing – Software that allows users to conduct meetings over the web. Common features include screen sharing, text chat, voice over IP, and virtual whiteboard. Examples of software in this category include Adobe Acrobat ConnectNow, GoToMeeting, WebEx, and Elluminate.
Project management software – Applications for managing multi-person projects; may have a variety of features, such as to-do lists, timelines, document version control, multi-person document editing, email notifications of document updates, etc. BaseCamp is one web-based example of such software.
Recommendation engines – Algorithms, like on Amazon or NetFlix, that analyze your shopping/browsing/renting habits and those of others like you and make recommendations as to what you might like.
As a member of the overly connected, you'll find me at:
Plaxo
Monday, December 15, 2008
Policy Enablers for Healthcare Information Technology
I've often written that technology needs to be complemented by policy in order to be successful. Local policies help protect privacy by documenting "community standards" and ensure local IT assets are used wisely. Federal and State policies define best practices, align incentives, and establish priorities.
I try to divide my time on various local, state and federal initiatives between technology and policy work to ensure I meet all stakeholder expectations for data use.
Last week I read a great summary of the policy work being done throughout the country. The National Conference of State Legislatures published "Health Information Technology: 2007 and 2008 State Legislation"
Over the past 18 months, 132 bills related to health information technology were enacted in 44 states (everywhere except Arkansas, Kentucky, Mississippi, Nebraska, South Dakota, and Wyoming). Legislation included EHR adoption, e-prescribing incentives, financing, healthcare information exchange, and privacy. This burst of legislative activity demonstrates that eHealth is on the radar screen of just about every state and the pace of change is truly enabling interoperability.
In Massachusetts, there were 3 major legislative efforts in 2007 and 2008
Massachusetts HB 4141, 2007 (Enacted 7/12/2007)
* Creates an eHealth Task Force that will develop a healthcare information exchange plan to link multiple settings of care, both public and private 2) evaluate the economic model and the anticipated benefits of electronic health record implementation and 3) provide quarterly updates to the governor and the chairs of the House and Senate committees on Ways and Means and the chairs of the Joint Committee on Health Care Financing regarding the status of national standards efforts
Massachusetts HB 4900, 2008 (Enacted 7/13/2008)
* Establishes and appropriates $25 million to the e-Health Institute Fund. Provides the Department of Public Health with $425,710 for a federally funded grant entitled Enabling Electronic Prescribing and Enhancement.
Massachusetts SB 2863, 2008 (Enacted 08/10/2008)
* Establishes the Healthcare Quality and Cost Council, which just launched its transparency site documenting procedure costs, quality and patient satisfaction measures for all hospitals in the state.
*Establishes the Massachusetts e-Health Institute and the e-Health Institute Fund to accelerate EHR implementation.
*Defines consent as Opt-In (no data is shared until patients give permission)
*Establishes rules for reporting unauthorized access or disclosure of healthcare data.
*Requires Computerized Physician Order Entry as a requirement for hospital licensure by October 1, 2012. Requires interoperable CCHIT certified EHRs by October 1, 2015 as a condition of hospital licensure.
*Requires IT competency as a condition for licensing healthcare providers.
*Calls for a medical home demonstration project based on IT interoperability.
The combination of technology, policies, and funding is all we need to accelerate health information technology. The legislative accomplishments of 2007-2008 are a great enabler.
I try to divide my time on various local, state and federal initiatives between technology and policy work to ensure I meet all stakeholder expectations for data use.
Last week I read a great summary of the policy work being done throughout the country. The National Conference of State Legislatures published "Health Information Technology: 2007 and 2008 State Legislation"
Over the past 18 months, 132 bills related to health information technology were enacted in 44 states (everywhere except Arkansas, Kentucky, Mississippi, Nebraska, South Dakota, and Wyoming). Legislation included EHR adoption, e-prescribing incentives, financing, healthcare information exchange, and privacy. This burst of legislative activity demonstrates that eHealth is on the radar screen of just about every state and the pace of change is truly enabling interoperability.
In Massachusetts, there were 3 major legislative efforts in 2007 and 2008
Massachusetts HB 4141, 2007 (Enacted 7/12/2007)
* Creates an eHealth Task Force that will develop a healthcare information exchange plan to link multiple settings of care, both public and private 2) evaluate the economic model and the anticipated benefits of electronic health record implementation and 3) provide quarterly updates to the governor and the chairs of the House and Senate committees on Ways and Means and the chairs of the Joint Committee on Health Care Financing regarding the status of national standards efforts
Massachusetts HB 4900, 2008 (Enacted 7/13/2008)
* Establishes and appropriates $25 million to the e-Health Institute Fund. Provides the Department of Public Health with $425,710 for a federally funded grant entitled Enabling Electronic Prescribing and Enhancement.
Massachusetts SB 2863, 2008 (Enacted 08/10/2008)
* Establishes the Healthcare Quality and Cost Council, which just launched its transparency site documenting procedure costs, quality and patient satisfaction measures for all hospitals in the state.
*Establishes the Massachusetts e-Health Institute and the e-Health Institute Fund to accelerate EHR implementation.
*Defines consent as Opt-In (no data is shared until patients give permission)
*Establishes rules for reporting unauthorized access or disclosure of healthcare data.
*Requires Computerized Physician Order Entry as a requirement for hospital licensure by October 1, 2012. Requires interoperable CCHIT certified EHRs by October 1, 2015 as a condition of hospital licensure.
*Requires IT competency as a condition for licensing healthcare providers.
*Calls for a medical home demonstration project based on IT interoperability.
The combination of technology, policies, and funding is all we need to accelerate health information technology. The legislative accomplishments of 2007-2008 are a great enabler.
Sunday, December 14, 2008
Luminary Night
Tonight in Wellesley, we had a very spiritual experience.1000 families donated to help the local food bank and as a sign of solidarity for the season we placed candles (safely in pools of water in paper bag luminaries) in our yards.
The photo above shows the view down my street.
It was a wonderful opportunity for families of all ages, religions, and backgrounds to come together, enjoy the light, and donate to a worthy cause.
My wife, daughter, and I wandered the neighborhood, reconnecting with folks who had retreated into their homes when the weather turned cold a month ago.
One house built a fire ring and offered smores, folks brewed hot chocolate and cider, and a horse drawn carriage filled with children circulated the neighborhoods.
Definitely a magical time. My daughter told me that these are the memories she'll remember as an adult. Not a Wii, not an iPod, but families coming together to share the spirit of the season.
Friday, December 12, 2008
Cool Technology of the Week
Given our new 2009 Massachusetts Data Protection regulations, I've been focusing on cool technologies related to information security such as Lo-Jack for Laptops/Blackberries and Third Brigade's Host-based intrusion protection.
Completing the triad of security postings, my cool technology of the week is the Bio-key fingerprint biometrics authentication system, an authentication solution that is my favorite candidate for two factor authentication, such as will likely be required by the Drug Enforcement Agency for e-prescribing of controlled substances.
We're testing their Web-Key product which provides a browser plug in for the most popular browsers and interfaces with any fingerprint reader. Our implementation of the software development kit eliminates the need to use passwords and connects our Emergency Department Dashboard web application, our authentication/authorization web service and a fingerprint reader.
Here's the challenge we've had with authentication in the Emergency Department.
Per my recent post about application timeouts, clinicians in the Emergency Room are moving fast from workstation to workstation. The time to sign in can impact their productivity. However, we need to protect patient confidentiality, so we cannot leave workstations logged on.
Ideally, a clinician should be able to walk up to computer, open a browser, wave their finger over a reader, and get instant access to applications. The Web-Key client is easy to deploy. Once you download their applet it autodetects the fingerprint reader and the client pops up in the browser, offering seamless integration with the web application. It works just as well in Firefox as it does Internet Explorer.
Simple to implement, standards-based, and easy to use biometric authentication - that's cool!
Completing the triad of security postings, my cool technology of the week is the Bio-key fingerprint biometrics authentication system, an authentication solution that is my favorite candidate for two factor authentication, such as will likely be required by the Drug Enforcement Agency for e-prescribing of controlled substances.
We're testing their Web-Key product which provides a browser plug in for the most popular browsers and interfaces with any fingerprint reader. Our implementation of the software development kit eliminates the need to use passwords and connects our Emergency Department Dashboard web application, our authentication/authorization web service and a fingerprint reader.
Here's the challenge we've had with authentication in the Emergency Department.
Per my recent post about application timeouts, clinicians in the Emergency Room are moving fast from workstation to workstation. The time to sign in can impact their productivity. However, we need to protect patient confidentiality, so we cannot leave workstations logged on.
Ideally, a clinician should be able to walk up to computer, open a browser, wave their finger over a reader, and get instant access to applications. The Web-Key client is easy to deploy. Once you download their applet it autodetects the fingerprint reader and the client pops up in the browser, offering seamless integration with the web application. It works just as well in Firefox as it does Internet Explorer.
Simple to implement, standards-based, and easy to use biometric authentication - that's cool!
Thursday, December 11, 2008
Chestnuts roasting on an open fire
I recently visited the Old CiderPress Farm in New Hampshire and had a great conversation with owners Angie & Marius Hauri.
In addition to 60 varieties of apples, they have a magnificent row of Chestnut trees which produce up to 250 pounds per mature tree per season. We bought several pounds of fresh chestnuts, which led us to ask just how do you create "chestnuts roasting on an open fire?" (We already figured out the jack frost nipping at your nose)
First - what is a chestnut? It's not a Water Chestnut. Those are the edible corm of the Chinese Water Sedge (Eleocharis Duclis). It's not a Horse-chestnut (Aesculus hippocastanum), which has bitter/poisonous nuts. (The Horse-chestnut is the spreading chestnut tree mentioned in Longfellow's The Village Blacksmith)
The chestnut we roast over open fires is the edible, starchy seed of Castanea species, native to Europe, Asia and North American. It has a long history of being a staple food in all these these cultures. When I researched the chestnut, I found its nutritional characteristics to be fascinating. One cup of peeled fresh chestnuts contains:
Calories 285
Protein 6.3g
Fat 1.7g
Carbohydrates 74g
Water 66
Fiber 2.6g
Unlike many other nuts, the chestnut is a low fat nut. It's closer to a grain than a nut. For thousands of years it's been ground into flour and used as a vegetable, thickener, and flavor enhancer for pastas.
Roasting chestnuts is a great tradition and I've had bags of hot chestnuts in Tokyo/Kyoto, Taipei, Bejing, London, Paris, and New York. Here's how to do it from The Chestnut Cookbook by Annie Bhagwandin:
To roast a chestnut, you must first pierce the shell to allow hot air to escape while cooking. Use a sharp paring knife to cut a slash through shell but not into the nut. The larger the cut, the easier the nut will be to peel. Heat the nuts by shaking them in a dry skillet over medium heat for 20 minutes. Alternatively, microwave them on a paper plate for 4 minutes. In an over place them on a cookie sheet, sprinkle with water and bake at 400F for 15-20 minutes.
In my experience, baking is best.
Once the nuts are roasted, slice the shells and peel them while they are hot. Hot roasted chestnuts are remarkable. If making a meal of chestnuts, plan on 1/3 pound per person.
For Thanksgiving, we made fresh bread stuffing with pecans and roasted chestnuts. An all vegan dish that was remarkable! You can buy your own online.
In addition to 60 varieties of apples, they have a magnificent row of Chestnut trees which produce up to 250 pounds per mature tree per season. We bought several pounds of fresh chestnuts, which led us to ask just how do you create "chestnuts roasting on an open fire?" (We already figured out the jack frost nipping at your nose)
First - what is a chestnut? It's not a Water Chestnut. Those are the edible corm of the Chinese Water Sedge (Eleocharis Duclis). It's not a Horse-chestnut (Aesculus hippocastanum), which has bitter/poisonous nuts. (The Horse-chestnut is the spreading chestnut tree mentioned in Longfellow's The Village Blacksmith)
The chestnut we roast over open fires is the edible, starchy seed of Castanea species, native to Europe, Asia and North American. It has a long history of being a staple food in all these these cultures. When I researched the chestnut, I found its nutritional characteristics to be fascinating. One cup of peeled fresh chestnuts contains:
Calories 285
Protein 6.3g
Fat 1.7g
Carbohydrates 74g
Water 66
Fiber 2.6g
Unlike many other nuts, the chestnut is a low fat nut. It's closer to a grain than a nut. For thousands of years it's been ground into flour and used as a vegetable, thickener, and flavor enhancer for pastas.
Roasting chestnuts is a great tradition and I've had bags of hot chestnuts in Tokyo/Kyoto, Taipei, Bejing, London, Paris, and New York. Here's how to do it from The Chestnut Cookbook by Annie Bhagwandin:
To roast a chestnut, you must first pierce the shell to allow hot air to escape while cooking. Use a sharp paring knife to cut a slash through shell but not into the nut. The larger the cut, the easier the nut will be to peel. Heat the nuts by shaking them in a dry skillet over medium heat for 20 minutes. Alternatively, microwave them on a paper plate for 4 minutes. In an over place them on a cookie sheet, sprinkle with water and bake at 400F for 15-20 minutes.
In my experience, baking is best.
Once the nuts are roasted, slice the shells and peel them while they are hot. Hot roasted chestnuts are remarkable. If making a meal of chestnuts, plan on 1/3 pound per person.
For Thanksgiving, we made fresh bread stuffing with pecans and roasted chestnuts. An all vegan dish that was remarkable! You can buy your own online.
Wednesday, December 10, 2008
A Dispatch from IHI
Today, I'm at the Institute for Healthcare Improvement Conference in Nashville, Tennessee. For the past 5 years, I've had the privilege of presenting the Information Technology workshops at IHI, focusing on the quality impact of EHRs and PHRs.The highlight of IHI is always the keynote address by Don Berwick, CEO of IHI. Past presentations have included Escape Fire and Eating Soup with a Fork
I'm blogging this year's keynote in real time to capture the high points. The title of the presentation was "Tense". Don began with a poem by David Whyte called Loaves and Fishes
He noted that hospitals have to report 1500 different quality and performance measures to hundreds of organizations demanding compliance. This takes incredible energy and feels chaotic.
In the past, IHI has tried to organize this chaos into 5 "portfolio areas"
Hospitals
Continuum of Care
Population Health, Experience of Care, Per Capita Cost
Developing Nations
Professional Development
Don hypothesized that 80% of healthcare can be reduced to approximately 100 processes. If we focus on perfecting these 100 processes, we're likely to make a major impact. IHI will soon implement an Improvement Map as a next step to the 5 million lives campaign. He highlighted three new focuses for IHI
Quality and Financial Management - increased value
Prevent Catheter associated urinary tract infections
WHO Surgical Safety checklist
Atul Gawande took the stage and spoke about the WHO Surgical Safety checklist - SignIn, TimeOut, SignOut. Early pilots suggest it may be the most powerful way for hospitals to reduce harm.
Don announced a challenge to all the hospitals in American - a sprint to implement the WHO Surgical Safety Checklist in 90 days.
Don then described the future by reading two letters that he's written for his daughter Jessica to open in 20 years, describing two healthcare futures.
The first was an apology that we failed to reform and improve healthcare, we tried and failed because change was too hard. The second described the success of change embraced and resistance overcome.
The summary of Don's remarks is that we must cut through the chaos and the overwhelming amounts of data, instead focusing our efforts on just a few high value projects that will create definitive results.
As I wrote in my blog entry Data, Information, Knowledge, Wisdom , simplifying our care processes and ensuring every patient gets the right care at the right time is not only a good idea, it's a necessity.
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