Today, the HIT Standards Committee Clinical Operations Workgroup met for the first time to discuss our charge, our deliverables, and our workplan.
As I discussed in Monday's blog, the broad charge of the workgroup is to make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification criteria related to EHRs and clinical operations. The specific charge is to make recommendations to the HIT Standards Committee on the role of EHRs and e-prescribing, clinical summaries, laboratory and radiology report functionality within two (2) months of the workgroup’s first meeting.
That means that by August 9, we must complete our initial work.
What will that work be?
On the call we discussed that the HIT Policy Committee will review a draft of meaningful use criteria at its June 16th meeting. Once this draft is delivered to the HIT Standards Committee, its workgroups can review the standards and certification criteria which map to meaningful use. Imagine a 4 column table
Column 1 - An aspect of meaningful use i.e. e-Prescribing
Column 2 - The standards and implementation guidance needed for meaningful use i.e. NCPDP Script 10.5 and RxNorm as implemented in the HITSP Capability document "Issue Ambulatory and Long-term Prescriptions"
Column 3 - The certification criteria i.e. Conformance testing using the CCHIT Laika tool for appropriate implementation of NCPDP Script 10.5
Column 4 - The meaningful use measure i.e. what percentage of prescriptions in a practice were e-prescribed?
The above examples are illustrative only - they are not work products of any committee.
Note that certification criteria and meaningful use measures are decoupled. Certification verifies the capability while the meaningful use measure documents the integration of the capability into daily workflow.
In addition to mapping all aspects of meaningful use to standards and certification criteria (leveraging all the work done by HITSP and CCHIT to date), the HIT Standards Committee and its workgroups will also consider the "ARRA 8" and how standards and certification support them.
1. Technologies that protect the privacy of health information i.e. common data transport, auditing, authentication, authorization
2. A nationwide health information technology infrastructure i.e. enveloping and delivery standards
3. The utilization of a certified electronic record for each person in the US by 2014 i.e. standards in support of meaningful use
4. Technologies that support accounting of disclosures made by a covered entity i.e. standards similar to audit trails that also include disclosures made to third party
5. The use of electronic records to improve quality i.e. aspects of meaningful use that enhance safety and standards which support quality measurement
6. Technologies that enable identifiable health information to be rendered unusable/unreadable i.e. encryption
7. Demographic data collection including race, ethnicity, primary language, and gender i.e. standards which support demographic exchange
8. Technologies that address the needs of children and other vulnerable populations i.e. standards supporting immunization registries
Thus, the Clinical Operations Workgroup will complete two documents over the next 60 days - one which provides the standards/certification guidance needed for implementation and measurement of meaningful use and one supporting the ARRA statutory requirements. The documents will be forwarded to the HIT Standards Committee for review/approval and then forwarded to ONC.
It's going to be a busy summer. The pace of the Clinical Operations Workgroup accelerates as soon as the HIT Policy Committee completes its meeting on June 16.
Wednesday, June 10, 2009
Tuesday, June 9, 2009
My Top 10 Tips for Staying Healthy
My blogs for the remainder of the week will cover the first meetings of the HIT Standards Committee Workgroups - Clinical Operations, Clinical Quality, and Privacy/Security. Thus, I'm doing my more personal blog of the week today.
Now that I'm 47, I'm learning to appreciate the challenges of staying healthy as I age. Based on my personal experience, here are my top 10 tips.
1. Maintain a normal Body Mass Index
A Body Mass Index between 18.5 and 24.9 is ideal. An ideal BMI is more about lifestyle than diet. It takes effort!
For me, the combination of daily exercise, a vegan diet, and green tea for the past 8 years has worked well to keep my BMI in the mid-normal range at 21.7
2. Exercise daily
I try to exercise every day through a combination of Kayaking on the Charles River, Cycling through the rural byways of Needham/Dover/Sherborn, Hiking in the White Mountains of New Hampshire, Nordic Skiing in Noanet Reservation, and very vigorous gardening (hauling, digging, mulching etc)
My goal is 3500 calories burned via exercise every week. This seems to keep my BMI stable.
3. Eat a vegan diet
It's easy to eat badly as a vegetarian. Ben and Jerry's Chunky Monkey is Vegetarian. Chili-cheese dip is vegetarian. Eggnog is vegetarian. Trying eating badly as a vegan (only foods that grow in the ground) . You could drink pure olive oil, but it's really hard to eat badly. If you further limit yourself to locally grown, organic foods (for the majority of your diet - tea and chocolate are not locally grown), you're going to eat a high fiber, low calorie, low fat diet. That's good for your heart and good for your BMI.
4. Drink green tea
I drink two pots of green tea every day, usually Gyokuro Asahi tea from Kyoto. It's very low in caffeine and high in polyphenols, reducing cholesterol and providing anti-oxidants. It has zero calories without the artificial sweeteners and chemicals found in diet drinks. Staying hydrated keeps your energy up and your mind clear.
5. Drink red wine in moderation
I drink 6 ounces of red wine with dinner each night. It do not consume wine as thirst quencher or as a stress reliever, I drink it as a complement to food. It's high in polyphenols and reduces heart attack/stroke risk.
6. Eat dark chocolate
Dark Chocolate is very high in anti-oxidants and has several health benefits including reduced cholesterol and blood pressure.
7. Use sunscreen
The time I spend outdoors can dry out my skin and increase my chance of skin cancer. I use SPF 45 on my face, neck and arms whenever I'm doing outdoor activities.
8. Take Vitamin D and a Multivitamin daily
Since I use sunscreen generously and do not drink milk, I do not get all the Vitamin D I need. Also, as a vegan, I get limited B12 (it does not exist in plants but small amounts are found in soil, which inevitably makes it way into our diet when we eat root vegetables). Taking Vitamin D and a Centrum Silver daily works for me.
9. Avoid caffeine and lifestyle medications
Rather than starting each day with a boost of caffeine and ending each day with a mixed drink, I just stay even all the time. I also avoid 'lifestyle medications' such as mood enhancing drugs, nicotine, energy drinks, sleeping aids, etc. Although they may have positive short term effects, the long term effects and side effects are ultimately deleterious.
10. Have a positive attitude
Each day is filled with success and failure, joy and sorrow, energy and fatigue. Having a positive attitude about the complexities of life and realizing that all will be well goes far to keep you healthy, active, and energized.
Maybe I should package these 10 items into a best selling book called "The CIO Diet - a prescription for a healthy lifestyle"!
Now that I'm 47, I'm learning to appreciate the challenges of staying healthy as I age. Based on my personal experience, here are my top 10 tips.
1. Maintain a normal Body Mass Index
A Body Mass Index between 18.5 and 24.9 is ideal. An ideal BMI is more about lifestyle than diet. It takes effort!
For me, the combination of daily exercise, a vegan diet, and green tea for the past 8 years has worked well to keep my BMI in the mid-normal range at 21.7
2. Exercise daily
I try to exercise every day through a combination of Kayaking on the Charles River, Cycling through the rural byways of Needham/Dover/Sherborn, Hiking in the White Mountains of New Hampshire, Nordic Skiing in Noanet Reservation, and very vigorous gardening (hauling, digging, mulching etc)
My goal is 3500 calories burned via exercise every week. This seems to keep my BMI stable.
3. Eat a vegan diet
It's easy to eat badly as a vegetarian. Ben and Jerry's Chunky Monkey is Vegetarian. Chili-cheese dip is vegetarian. Eggnog is vegetarian. Trying eating badly as a vegan (only foods that grow in the ground) . You could drink pure olive oil, but it's really hard to eat badly. If you further limit yourself to locally grown, organic foods (for the majority of your diet - tea and chocolate are not locally grown), you're going to eat a high fiber, low calorie, low fat diet. That's good for your heart and good for your BMI.
4. Drink green tea
I drink two pots of green tea every day, usually Gyokuro Asahi tea from Kyoto. It's very low in caffeine and high in polyphenols, reducing cholesterol and providing anti-oxidants. It has zero calories without the artificial sweeteners and chemicals found in diet drinks. Staying hydrated keeps your energy up and your mind clear.
5. Drink red wine in moderation
I drink 6 ounces of red wine with dinner each night. It do not consume wine as thirst quencher or as a stress reliever, I drink it as a complement to food. It's high in polyphenols and reduces heart attack/stroke risk.
6. Eat dark chocolate
Dark Chocolate is very high in anti-oxidants and has several health benefits including reduced cholesterol and blood pressure.
7. Use sunscreen
The time I spend outdoors can dry out my skin and increase my chance of skin cancer. I use SPF 45 on my face, neck and arms whenever I'm doing outdoor activities.
8. Take Vitamin D and a Multivitamin daily
Since I use sunscreen generously and do not drink milk, I do not get all the Vitamin D I need. Also, as a vegan, I get limited B12 (it does not exist in plants but small amounts are found in soil, which inevitably makes it way into our diet when we eat root vegetables). Taking Vitamin D and a Centrum Silver daily works for me.
9. Avoid caffeine and lifestyle medications
Rather than starting each day with a boost of caffeine and ending each day with a mixed drink, I just stay even all the time. I also avoid 'lifestyle medications' such as mood enhancing drugs, nicotine, energy drinks, sleeping aids, etc. Although they may have positive short term effects, the long term effects and side effects are ultimately deleterious.
10. Have a positive attitude
Each day is filled with success and failure, joy and sorrow, energy and fatigue. Having a positive attitude about the complexities of life and realizing that all will be well goes far to keep you healthy, active, and energized.
Maybe I should package these 10 items into a best selling book called "The CIO Diet - a prescription for a healthy lifestyle"!
Monday, June 8, 2009
The National HIT organizations - How it all works
Several blog readers have asked me to take a fresh look at all the organizations related to ARRA and explain how it all works. Here's my understanding:
Office of the National Coordinator
The Obama administration's ONC is different from the Bush administration's ONC in several ways. It's now funded with $2 billion to accelerate healthcare IT adoption. Its new leader, Dr. David Blumenthal has a policy focus, so we'll see broad policy guidance and specific healthcare outcome goals rather than technology for technology's sake. It has regulation - ARRA is law and there are several new privacy, standards, and implementation requirements that were only voluntary or market-driven previously. You can expect that ONC will have a major role in coordinating federal agencies' use of healthcare IT as well as adoption in the private sector. By controlling the definition of meaningful use of healthcare IT as the gatekeeping function for paying stimulus dollars to clinicians, ONC has real power.
HIT Standards Committee
The Health IT Standards Committee is charged with making recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Initially, the HIT Standards Committee will focus on the policies developed by the Health IT Policy Committee’s initial eight areas (listed below). The HIT Standards Committee will also provide for the testing of standards by the National Institute for Standards and Technology (NIST). In its first meeting, the HIT Standards Committee created three workgroups. Below are their Broad and Specific charges:
Clinical Operations Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification criteria related to EHRs and clinical operations.
Specific Charge –
Make recommendations to the HIT Standards Committee on the role of EHRs and e-prescribing, clinical summaries, laboratory and radiology report functionality within two (2) months of the workgroup’s first meeting. The workgroup will also take into consideration the eight (8) areas listed in Section 3002(b)(2)(B) when developing recommendations for the committee.
Clinical Quality Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on quality measures that should be included in the Meaningful Use definition and for future EHR requirements. Make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification related to EHRs and clinical quality.
Specific Charge –
Make recommendations to the HIT Standards Committee on specific quality measures that should be included in the definition of Meaningful Use for 2011 within two (2) months of the workgroup’s first meeting. The workgroup will also take into consideration the eight (8) areas listed in Section 3002(b)(2)(B) when developing recommendations for the committee.
Privacy and Security Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on privacy and security requirements for standards, implementation specifications, and certification criteria.
Specific Charge –
Make recommendations to the HIT Standards Committee on specific privacy and security safeguards that should be included in the definition of Meaningful Use, with a specific focus on the eight (8) areas listed in Section 3002(b)(2)(B), within two (2) months of the workgroup’s first meeting.
HIT Policy Committee
The Health IT Policy Committee will make recommendations to the National Coordinator on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information. The American Recovery and Reinvestment Act of 2009 (ARRA) provides that the HIT Policy Committee shall at least make recommendations on standards, implementation specifications, and certifications criteria in eight specific areas:
-Technologies that protect the privacy of health information
-A nationwide health information technology infrastructure
-The utilization of a certified electronic record for each person in the US by 2014
-Technologies that support accounting of disclosures made by a covered entity
-The use of electronic records to improve quality
-Technologies that enable identifiable health information to be rendered unusable/unreadable
-Demographic data collection including race, ethnicity, primary language, and gender
-Technologies that address the needs of children and other vulnerable populations
At it's first meeting, The HIT Policy Committee created three workgroups - Meaningful Use, Information Exchange, and Certification.
Here's the broad and specific charge for the Information Exchange workgroup. I'll add the details for the others as soon as I receive it.
Information Exchange Workgroup:
Broad Charge-
Make recommendations to the HIT Policy Committee on policies, guidance governance, sustainability, and architectural, and implementation approaches to enable the exchange of health information and increase capacity for health information exchange over time.
Specific Charge-
Make recommendations to the HIT Policy Committee within six (6) months regarding priority policy areas and other issues that are necessary in the short term to advance the exchange of health information through implementation of HITECH. Make recommendations to the HIT Policy Committee to inform and provide guidance on the implementation of the Nationwide Health Information Network (NHIN)
Health Information Technology Standards Panel
HITSP provides an important consultative role to the HIT Standards Committee. As the HIT Standards Committee and its workgroups prioritize the transactions needed to support meaningful use, they will consult standards harmonization organizations (HITSP), Standards Development Organizations, and Implementation Guide writers. HITSP volunteers and staff have been placed on each of the HIT Standards Committee workgroups to provide technical assistance.
National eHealth Collaborative
NeHC, based on their recent meeting, will focus on implementation topics such as regional healthcare IT extension centers and the reality of increasing EHR adoption in the country.
Certification Commission for Health Information Technology
I'm confident that CCHIT will continue to be the leading HIT certification organization in the US, but its certification criteria will evolve. The HIT Policy Committee's workgroup on certification is likely to provide valuable input about certification by the Fall.
I hope this helps clarify how all these organizations relate to one another as they all work together to support ARRA, improve healthcare quality, and enhance efficiency, all through the implementation of interoperable healthcare IT.
Office of the National Coordinator
The Obama administration's ONC is different from the Bush administration's ONC in several ways. It's now funded with $2 billion to accelerate healthcare IT adoption. Its new leader, Dr. David Blumenthal has a policy focus, so we'll see broad policy guidance and specific healthcare outcome goals rather than technology for technology's sake. It has regulation - ARRA is law and there are several new privacy, standards, and implementation requirements that were only voluntary or market-driven previously. You can expect that ONC will have a major role in coordinating federal agencies' use of healthcare IT as well as adoption in the private sector. By controlling the definition of meaningful use of healthcare IT as the gatekeeping function for paying stimulus dollars to clinicians, ONC has real power.
HIT Standards Committee
The Health IT Standards Committee is charged with making recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Initially, the HIT Standards Committee will focus on the policies developed by the Health IT Policy Committee’s initial eight areas (listed below). The HIT Standards Committee will also provide for the testing of standards by the National Institute for Standards and Technology (NIST). In its first meeting, the HIT Standards Committee created three workgroups. Below are their Broad and Specific charges:
Clinical Operations Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification criteria related to EHRs and clinical operations.
Specific Charge –
Make recommendations to the HIT Standards Committee on the role of EHRs and e-prescribing, clinical summaries, laboratory and radiology report functionality within two (2) months of the workgroup’s first meeting. The workgroup will also take into consideration the eight (8) areas listed in Section 3002(b)(2)(B) when developing recommendations for the committee.
Clinical Quality Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on quality measures that should be included in the Meaningful Use definition and for future EHR requirements. Make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification related to EHRs and clinical quality.
Specific Charge –
Make recommendations to the HIT Standards Committee on specific quality measures that should be included in the definition of Meaningful Use for 2011 within two (2) months of the workgroup’s first meeting. The workgroup will also take into consideration the eight (8) areas listed in Section 3002(b)(2)(B) when developing recommendations for the committee.
Privacy and Security Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on privacy and security requirements for standards, implementation specifications, and certification criteria.
Specific Charge –
Make recommendations to the HIT Standards Committee on specific privacy and security safeguards that should be included in the definition of Meaningful Use, with a specific focus on the eight (8) areas listed in Section 3002(b)(2)(B), within two (2) months of the workgroup’s first meeting.
HIT Policy Committee
The Health IT Policy Committee will make recommendations to the National Coordinator on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information. The American Recovery and Reinvestment Act of 2009 (ARRA) provides that the HIT Policy Committee shall at least make recommendations on standards, implementation specifications, and certifications criteria in eight specific areas:
-Technologies that protect the privacy of health information
-A nationwide health information technology infrastructure
-The utilization of a certified electronic record for each person in the US by 2014
-Technologies that support accounting of disclosures made by a covered entity
-The use of electronic records to improve quality
-Technologies that enable identifiable health information to be rendered unusable/unreadable
-Demographic data collection including race, ethnicity, primary language, and gender
-Technologies that address the needs of children and other vulnerable populations
At it's first meeting, The HIT Policy Committee created three workgroups - Meaningful Use, Information Exchange, and Certification.
Here's the broad and specific charge for the Information Exchange workgroup. I'll add the details for the others as soon as I receive it.
Information Exchange Workgroup:
Broad Charge-
Make recommendations to the HIT Policy Committee on policies, guidance governance, sustainability, and architectural, and implementation approaches to enable the exchange of health information and increase capacity for health information exchange over time.
Specific Charge-
Make recommendations to the HIT Policy Committee within six (6) months regarding priority policy areas and other issues that are necessary in the short term to advance the exchange of health information through implementation of HITECH. Make recommendations to the HIT Policy Committee to inform and provide guidance on the implementation of the Nationwide Health Information Network (NHIN)
Health Information Technology Standards Panel
HITSP provides an important consultative role to the HIT Standards Committee. As the HIT Standards Committee and its workgroups prioritize the transactions needed to support meaningful use, they will consult standards harmonization organizations (HITSP), Standards Development Organizations, and Implementation Guide writers. HITSP volunteers and staff have been placed on each of the HIT Standards Committee workgroups to provide technical assistance.
National eHealth Collaborative
NeHC, based on their recent meeting, will focus on implementation topics such as regional healthcare IT extension centers and the reality of increasing EHR adoption in the country.
Certification Commission for Health Information Technology
I'm confident that CCHIT will continue to be the leading HIT certification organization in the US, but its certification criteria will evolve. The HIT Policy Committee's workgroup on certification is likely to provide valuable input about certification by the Fall.
I hope this helps clarify how all these organizations relate to one another as they all work together to support ARRA, improve healthcare quality, and enhance efficiency, all through the implementation of interoperable healthcare IT.
Friday, June 5, 2009
Cool Technology of the Week
Today's Cool Technology blog entry is not about a product, but a concept.
I've had numerous companies (more than 5) approach me in the last 90 days with a product in development that I'll call "Image Exchange in the Cloud".
One of the great challenges we have in healthcare is that radiology/cardiology/GI/pulmonary/Ob-Gyn images are not easily sharable between organizations. Although DICOM is a generally accepted standard, there is not an easy to use health information exchange in most communities to send DICOM data from place to place.
Sure, we could engineer numerous point to point solutions i.e. one organization's imaging modalities push DICOM images to another organizations image archive. However, such an approach is complex. Who owns the medical record? How long should the image be retained? What security should be used to transmit the image between organizations? How should the patient be uniquely identified if we want to storage all images for a given patient from multiple institutions together?
Here's the solution that all the companies entering this marketplace are suggesting:
1. A cloud computing offering is made available on the web for image exchange. No IT department has to host data, manage images, or deal with security issues.
2. A DICOM image is sent to the cloud along with a list of email addresses of individuals who can access the image and the length of time they can access it i.e. 30 days
3. The named individuals receive an email along with a URL and password to access their images on the cloud. For example, such individuals could be a consulting radiologist or cardiologist who may be over-reading the study.
4. A universal web-based DICOM viewer enables the authorized individuals to view the image without installing additional software i.e. there is no need to run proprietary workstation software from GE, Siemens, Philips, Agfa, Kodak etc.
5. After the reading is done, the username/password used to access the cloud computing site expires after the duration specified.
This solution is appealing for image sharing because it is low impact on IT departments, requires no local storage, is secure, requires no special software, and is simple to implement.
I look forward to many product offerings for healthcare imaging sharing via the cloud over the next year. That's cool.
I've had numerous companies (more than 5) approach me in the last 90 days with a product in development that I'll call "Image Exchange in the Cloud".
One of the great challenges we have in healthcare is that radiology/cardiology/GI/pulmonary/Ob-Gyn images are not easily sharable between organizations. Although DICOM is a generally accepted standard, there is not an easy to use health information exchange in most communities to send DICOM data from place to place.
Sure, we could engineer numerous point to point solutions i.e. one organization's imaging modalities push DICOM images to another organizations image archive. However, such an approach is complex. Who owns the medical record? How long should the image be retained? What security should be used to transmit the image between organizations? How should the patient be uniquely identified if we want to storage all images for a given patient from multiple institutions together?
Here's the solution that all the companies entering this marketplace are suggesting:
1. A cloud computing offering is made available on the web for image exchange. No IT department has to host data, manage images, or deal with security issues.
2. A DICOM image is sent to the cloud along with a list of email addresses of individuals who can access the image and the length of time they can access it i.e. 30 days
3. The named individuals receive an email along with a URL and password to access their images on the cloud. For example, such individuals could be a consulting radiologist or cardiologist who may be over-reading the study.
4. A universal web-based DICOM viewer enables the authorized individuals to view the image without installing additional software i.e. there is no need to run proprietary workstation software from GE, Siemens, Philips, Agfa, Kodak etc.
5. After the reading is done, the username/password used to access the cloud computing site expires after the duration specified.
This solution is appealing for image sharing because it is low impact on IT departments, requires no local storage, is secure, requires no special software, and is simple to implement.
I look forward to many product offerings for healthcare imaging sharing via the cloud over the next year. That's cool.
Thursday, June 4, 2009
Our Garden
In New England, you never know what the weather will bring, so my family and I are always conservative about planting our garden. Every year for the past 13 years we've planted on Memorial day weekend.When we first moved to New England, the first thing we did was remove much of our lawn - it wastes water, uses chemical fertilizer, and various herbicides/insecticides to keep it green. Instead we planted a variety of perennials and native shrubs.
Our five mini-gardens are:
1. Japanese Garden - filled with Japanese ferns, bamboo, cedar, a Shinto Shrine, a meandering river of rock, and a Jizo statue.
2. Vegetable Garden - we grow many of our own vegetables including 5 varieties of heirloom tomatoes, eggplant, bok choi, cucumbers, lettuce, edamame, pumpkins, peas, and herbs.
3. Cottage Garden - A butterfly garden filled with white blooming perennials and a clematis trellis
4. Rhododendron Forest - a thicket of rhododendrons under the shade of old hemlock trees.
5. Iris Garden - bearded and beardless irises set among sedges, sedum, and maples.
My approach to gardening is phased and incremental, rather than big bang. I start in early April by cleaning up the yard from winter, removing branches, leaves, and accumulated debris. In mid April, I mulch heavily to eliminate any weed growth before the warm weather arrives. In late April, I place all the garden statuary, pots and bird houses that were stored away during the winter. In early May, I add fresh soil from my compost pile to the pots and raised beds. In mid May, I tune all the irrigation systems. Finally, at the end of May we plant - organic vegetables from Russell's, annuals from Volante Farms, and seeds from Seeds of Change .
The warm and temperate Spring has been great for 5 gardening areas. All of the photos above were taken today, so you have a real time view from June 3.
Wednesday, June 3, 2009
Service Level Agreements
I was recently asked about our approach to Service Level Agreements (SLAs) at BIDMC.
We develop customer facing SLA's for every new infrastructure and application as part of our standard project management methodology. We work collaboratively with the application owner and subject matter experts to develop a mutually acceptable process for support escalation, with defined availability and response times.
The end result is a series of documents which outline customer and IS responsibilities, as well as provide enough detail about the application to understand its scope and uses.
Customer Facing Documents:
1. Customer Project and Post Project Responsibilities - This document serves as a foundation for each project and sets customer expectations for support roles and responsibilities.
2. Service Level Agreement - I've attached an SLA for a live application to illustrate the types of service level documentation we provide.
Internal IT Documents:
1. Business Impact Analysis - a worksheet used by our managers to facilitate discussions with application owners and document service level of objectives based on business requirements.
2. Service Level Objectives - availability and disaster recovery service levels by class of application
A few general observations about our SLAs.
1. Much of our planned downtime is now done as a background task thanks to improvements in our configurations. For example, we have clustered servers, redundant network components and Internet connections, mirrored storage devices, shadowed or mirrored data bases, and other improvements that have remarkably decreased the need for disruptive, planned outages.
2. Escalation processes differ slightly for our mission critical clinical applications, such that downtime over two hours triggers implementation of paper-based downtime procedures.
3. In addition to our own hosted applications, we have a few Software as a Service applications. Our SLAs with hosting vendors include:
a. Expected uptime. In some cases this is backed by a well-defined formula that states the goal, e.g. 99.9%, and any other qualifiers such as excluding planned downtime that is done at a mutually agreed upon times. Whatever is set as an uptime goal usually drives the high availability and disaster recovery configurations.
b. Transaction performance. This has traditionally not been a problem for us, but for applications that may have not been engineered well, it's an important component of an SLA.
c. Escalation. Defining the event levels (priority one, priority two etc.), contacts, and what response time (phone vs on-site) and repair time can be expected is a key component. Time to repair is usually a tough negotiation in hosted application SLAs.
d. Remedies. This is not usually defined in internal agreements, but is for vendor agreements. The typical remedy is a credit on future maintenance payments, which is not always satisfying if you lose an application for a prolonged period.
Feel free to use my SLA documents as templates in support of your own service level documentation needs.
We develop customer facing SLA's for every new infrastructure and application as part of our standard project management methodology. We work collaboratively with the application owner and subject matter experts to develop a mutually acceptable process for support escalation, with defined availability and response times.
The end result is a series of documents which outline customer and IS responsibilities, as well as provide enough detail about the application to understand its scope and uses.
Customer Facing Documents:
1. Customer Project and Post Project Responsibilities - This document serves as a foundation for each project and sets customer expectations for support roles and responsibilities.
2. Service Level Agreement - I've attached an SLA for a live application to illustrate the types of service level documentation we provide.
Internal IT Documents:
1. Business Impact Analysis - a worksheet used by our managers to facilitate discussions with application owners and document service level of objectives based on business requirements.
2. Service Level Objectives - availability and disaster recovery service levels by class of application
A few general observations about our SLAs.
1. Much of our planned downtime is now done as a background task thanks to improvements in our configurations. For example, we have clustered servers, redundant network components and Internet connections, mirrored storage devices, shadowed or mirrored data bases, and other improvements that have remarkably decreased the need for disruptive, planned outages.
2. Escalation processes differ slightly for our mission critical clinical applications, such that downtime over two hours triggers implementation of paper-based downtime procedures.
3. In addition to our own hosted applications, we have a few Software as a Service applications. Our SLAs with hosting vendors include:
a. Expected uptime. In some cases this is backed by a well-defined formula that states the goal, e.g. 99.9%, and any other qualifiers such as excluding planned downtime that is done at a mutually agreed upon times. Whatever is set as an uptime goal usually drives the high availability and disaster recovery configurations.
b. Transaction performance. This has traditionally not been a problem for us, but for applications that may have not been engineered well, it's an important component of an SLA.
c. Escalation. Defining the event levels (priority one, priority two etc.), contacts, and what response time (phone vs on-site) and repair time can be expected is a key component. Time to repair is usually a tough negotiation in hosted application SLAs.
d. Remedies. This is not usually defined in internal agreements, but is for vendor agreements. The typical remedy is a credit on future maintenance payments, which is not always satisfying if you lose an application for a prolonged period.
Feel free to use my SLA documents as templates in support of your own service level documentation needs.
Tuesday, June 2, 2009
An Update to the National eHealth Collaborative
Today I'm in Washington presenting a HITSP update to the National eHealth Collaborative. My slides are available.
A few highlights:
1. HITSP has "turned on a dime" to focus on meaningful use and ARRA's 8 priorities:
-Technologies that protect the privacy of health information
-A nationwide health information technology infrastructure
-The utilization of a certified electronic record for each person in the US by 2014
-Technologies that support accounting of disclosures made by a covered entity
-The use of electronic records to improve quality
-Technologies that enable identifiable health information to be rendered unusable/unreadable
-Demographic data collection including race, ethnicity, primary language, and gender
-Technologies that address the needs of children and other vulnerable populations
2. HITSP has embraced a service oriented architecture which enables reuse of capabilities instead of requiring new value cases for each novel requirement. Our initial services include:
- Issue Ambulatory Prescriptions
- Query for Medication History
- Communication of Structured Documents
- Communication of Unstructured Documents
- Clinical Referral Request
- Retrieval of Medical Knowledge
- Return Laboratory Results Message
- Communication of Laboratory Reports
- Communication of Imaging Information
- Quality Measures for Hospital based Quality Information Collection and Reporting
- Quality Measures for Clinician Quality Information Collection and Reporting
- Immunization Registry Update
- Immunization Registry Query
- Communication of Immunization Documents
- Vaccine and Drug Inventory Reporting
- Public Health Case Reporting
- Emergency Common Alerting
- Send and Receive Relevant Bio-Surveillance Data
- Communicate Resource Utilization
- Exchange Administrative Benefits/Eligibility Transactions
- Exchange Administrative Referral/Authorization Transactions
- Provider Directory
3. HITSP is moving to an electronic publication approach for all its implementation guidance.
4. HITSP has embraced USHIK as a respository for its harmonized standards and codesets
5. The July 15 deliverables will directly support the needs of the HIT Standards Committee and its workgroups to identify standards, implementation guidance, and certification criteria in support of meaningful use.
Next week, the HIT Standards Committee Workgroups will meet for the first time. HITSP volunteers and staff will ensure all this ARRA specific work is communicated to those groups.
A few highlights:
1. HITSP has "turned on a dime" to focus on meaningful use and ARRA's 8 priorities:
-Technologies that protect the privacy of health information
-A nationwide health information technology infrastructure
-The utilization of a certified electronic record for each person in the US by 2014
-Technologies that support accounting of disclosures made by a covered entity
-The use of electronic records to improve quality
-Technologies that enable identifiable health information to be rendered unusable/unreadable
-Demographic data collection including race, ethnicity, primary language, and gender
-Technologies that address the needs of children and other vulnerable populations
2. HITSP has embraced a service oriented architecture which enables reuse of capabilities instead of requiring new value cases for each novel requirement. Our initial services include:
- Issue Ambulatory Prescriptions
- Query for Medication History
- Communication of Structured Documents
- Communication of Unstructured Documents
- Clinical Referral Request
- Retrieval of Medical Knowledge
- Return Laboratory Results Message
- Communication of Laboratory Reports
- Communication of Imaging Information
- Quality Measures for Hospital based Quality Information Collection and Reporting
- Quality Measures for Clinician Quality Information Collection and Reporting
- Immunization Registry Update
- Immunization Registry Query
- Communication of Immunization Documents
- Vaccine and Drug Inventory Reporting
- Public Health Case Reporting
- Emergency Common Alerting
- Send and Receive Relevant Bio-Surveillance Data
- Communicate Resource Utilization
- Exchange Administrative Benefits/Eligibility Transactions
- Exchange Administrative Referral/Authorization Transactions
- Provider Directory
3. HITSP is moving to an electronic publication approach for all its implementation guidance.
4. HITSP has embraced USHIK as a respository for its harmonized standards and codesets
5. The July 15 deliverables will directly support the needs of the HIT Standards Committee and its workgroups to identify standards, implementation guidance, and certification criteria in support of meaningful use.
Next week, the HIT Standards Committee Workgroups will meet for the first time. HITSP volunteers and staff will ensure all this ARRA specific work is communicated to those groups.
Subscribe to:
Posts (Atom)
