In my previous writing, I’ve suggested that the federal government co-opted our Clinical IT agenda over the past three years with Meaningful Use Stage 2, ICD-10, the HIPAA Omnibus Rule, and the Affordable Care Act (ACA).
Now that Stage 2 attestation is done, ICD-10 is on a trajectory for October go live, OCR/OIG/internal security audit activities are done for the moment, and the care management medical record we need to support the Affordable Care Act is live, we can once again ask our customers to help set priorities.
Here’s the process we’re following:
In June, we’re convening a group of senior VPs, clinicians, and IT professionals to jointly review the current HIMSS Electronic Medical Record Adoption Model (EMRAM) Stage 7 criteria and benchmark ourselves. It’s likely that we’ll amend the HIMSS criteria in a few areas where BIDMC considers itself a market leader - patient family engagement, mobile technologies, big data analytics, and cloud adoption. We’ll then identify gaps in functionality/workflow to focus our strategic goals for FY16.
Once we have identified the goals, we’ll ensure we have the right organizational structure and staffing to accomplish those goals. We’ll verify the operating and capital budgets required. We’ll create Gantt charts and resource leveling artifacts to illustrate the relationship among the scope of projects, timing, and resources.
These artifacts will be used in FY16 by all our clinical governance bodies. As new projects are mandated by government, mergers/acquisitions, or changes in local requirements, additions will be weighed against the scope, timelines, and resources already allocated.
I expect FY16 to be focused on the clinical documentation needed to support ICD-10, quality measurement, and care coordination.
It will be interesting to see what projects bubble up to the top and to identify the gaps between the ideal state of an academic medical center and our current state.
I’m hopeful that the process will have such transparency and inclusiveness that it will be an effective means to align supply and demand in FY16, increasing customer satisfaction by documenting the prioritized goals and communicating the progress we’re making.
Wednesday, June 17, 2015
Thursday, June 11, 2015
Unity Farm Journal - Second Week of June 2015
It’s mid-June so the farm is filled with Summer greenery, rapidly growing fruits, new animal babies, a flurry of harvesting/planting activity, and beekeeping.
Here’s a view of chives near the hoop house, ready for harvest. The orchard grass is growing so fast, we mow it weekly.
Our baby geese continue to feather out and in a few weeks we’ll add them to the barnyard. We’re also raising baby pheasants per the picture below. They are the size of ping pong balls and constantly bouncing around the brooder. Our intent is to release them into the wild of our forests once they are mature enough to defend themselves.
We check on Daisy, our pregnant alpaca, multiple times per day. She’s nearly at term and spends her time lying comfortably in the hay. The baby is so large that I’m sure she’s anticipating the birth.
On Tuesday, all of the alpaca began alarming and Peter, who helps us when I’m out of town, explored the cause of their concern. On the lawn outside the paddock, a newborn fawn lay resting, temporarily abandoned by its mother. Peter examined the fawn to ensure it was not sick/injured and then carefully placed it in the nearby forest. Within the hour, mom returned and the unsteady fawn rambled along behind its mother. Mother and baby are doing well, feeding on grass at the edge of the paddock.
All our 22 hives in 4 locations are doing well. Kathy believes we’ll have significant honey production this year. What to do with all that honey?
Our mead recipe calls for 22 pounds of honey in each 6 gallon batch. Last Sunday’s batch is fermenting vigorously.
Our honey lager recipe calls for 10 pounds of honey in each 15 gallon batch. This could become our Unity Farm signature beer. I’ll keg it in 3 weeks and know for sure.
This weekend we’ll harvest snap peas, shitake mushrooms, lettuce, and chard. The tomatoes are doing well and a few cucumbers are nearly ready. Kathy is attending a queen bee rearing class and I’ll do the usual weekend farm chores. Maybe for the first time this year, I’ll sit down on Saturday afternoon and enjoy a glass of cider while overlooking the fruits of our labor. Then again, there will always be something to do at Unity Farm.
Here’s a view of chives near the hoop house, ready for harvest. The orchard grass is growing so fast, we mow it weekly.
Our baby geese continue to feather out and in a few weeks we’ll add them to the barnyard. We’re also raising baby pheasants per the picture below. They are the size of ping pong balls and constantly bouncing around the brooder. Our intent is to release them into the wild of our forests once they are mature enough to defend themselves.
We check on Daisy, our pregnant alpaca, multiple times per day. She’s nearly at term and spends her time lying comfortably in the hay. The baby is so large that I’m sure she’s anticipating the birth.
On Tuesday, all of the alpaca began alarming and Peter, who helps us when I’m out of town, explored the cause of their concern. On the lawn outside the paddock, a newborn fawn lay resting, temporarily abandoned by its mother. Peter examined the fawn to ensure it was not sick/injured and then carefully placed it in the nearby forest. Within the hour, mom returned and the unsteady fawn rambled along behind its mother. Mother and baby are doing well, feeding on grass at the edge of the paddock.
All our 22 hives in 4 locations are doing well. Kathy believes we’ll have significant honey production this year. What to do with all that honey?
Our mead recipe calls for 22 pounds of honey in each 6 gallon batch. Last Sunday’s batch is fermenting vigorously.
Our honey lager recipe calls for 10 pounds of honey in each 15 gallon batch. This could become our Unity Farm signature beer. I’ll keg it in 3 weeks and know for sure.
This weekend we’ll harvest snap peas, shitake mushrooms, lettuce, and chard. The tomatoes are doing well and a few cucumbers are nearly ready. Kathy is attending a queen bee rearing class and I’ll do the usual weekend farm chores. Maybe for the first time this year, I’ll sit down on Saturday afternoon and enjoy a glass of cider while overlooking the fruits of our labor. Then again, there will always be something to do at Unity Farm.
Wednesday, June 10, 2015
Standards Alone are not the Answer for Interoperability
Today I have the honor of presenting a guest blog by David McCallie MD, SVP Medical Informatics, Cerner. He summarizes the collective feeling of the industry about the trajectory of interoperability.
"I have been honored to have served on the HIT Standards Committee from its beginning in 2009. As I reach my term limits, I have reflected on what we have all learned over the past six years of helping to define the standards for the certified EHR technology that lies behind the Meaningful Use program.
But before diving into those reflections, we should acknowledge what we have accomplished. It's fashionable to complain that we haven't 'solved interoperability.' This is certainly true, but we have come a long way, and have achieved significant and lasting advances.
In particular, we have mostly settled the vocabulary questions for encoding the record. We have widely deployed a good ePrescribing standard. We have established a standard for secure email that will eventually replace the fax machine, and we have widely (but not yet universally) deployed a good standard for document-centric query exchange. We are close to broad support for a stable standard for encoding complex clinical data into summary documents. And perhaps most interestingly, we have opened the door to the promising world of API-based interoperability.
Nonetheless, the refrain we hear from Capitol Hill is that we have failed to achieve the seamless interoperability that many had expected. This has lead to numerous legislative attempts to 'fix' the problem by re-thinking government approaches to the standard setting processes authorized by HITECH.
We should be careful not to overreact in light of any disappointments and perceived failures around interoperability. There are many things we must improve, but we should not inadvertently take steps backwards.
I think the biggest mistake Congress appears to be legislating is to assume that standards alone are what creates interoperability.
Standards are necessary, but are not sufficient, for interoperability to occur.
Standards organizations (SDOs) can create standards, but they do not create the additional entities that are necessary for standards to deliver useful interoperability.
I believe that the sufficient conditions for interoperability include the following:
*A business process must exist for which standardization is needed. As Arien Malec put it recently, 'SDOs don't create standards de novo. They standardize working practices.'
*A proven standard then needs to be developed, via an iterative process that involves repeated real-world testing and validation.
*A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose. The business purpose may include satisfying regulatory requirements, or meeting market pressures, or both.
*A 'network architecture' must be defined that provides for the identity, trust, and security frameworks necessary for data sharing in the complex world of healthcare.
*A 'business architecture' must exist that manages the contractual and legal arrangements necessary for healthcare data sharing to occur.
*A governance mechanism with sufficient authority over the participants must ensure that the network and business frameworks are followed.
*And almost no healthcare standard can be deployed in isolation, so all of the ancillary infrastructure (such as directory services, certificate authorities, and certification tests) must be organized and deployed in support of the standard.
The Jason Task Force (which I was privileged to co-chair with Micky Tripathi) summed up these requirements into what they called a 'Data Sharing Arrangement (DSA).' DSAs do not emerge from SDOs. DSAs cannot be simply created by legislative fiat. They require the active engagement and collaboration of the many entities who are willing to do the hard work to create the necessary infrastructure for an interoperability standard to find real-world, widespread use.
We've learned that forcing providers to simply deploy standards and then to expect interoperability to happen is ineffective policy. The most rapid progress has happened when DSAs have emerged because provider organizations, Health IT developers and SDOs agree to work together to achieve a clear mission, focused on meaningful outcomes. Congress should accordingly define the 'what' and let the U.S. health care stakeholders define and achieve the 'how.'"
"I have been honored to have served on the HIT Standards Committee from its beginning in 2009. As I reach my term limits, I have reflected on what we have all learned over the past six years of helping to define the standards for the certified EHR technology that lies behind the Meaningful Use program.
But before diving into those reflections, we should acknowledge what we have accomplished. It's fashionable to complain that we haven't 'solved interoperability.' This is certainly true, but we have come a long way, and have achieved significant and lasting advances.
In particular, we have mostly settled the vocabulary questions for encoding the record. We have widely deployed a good ePrescribing standard. We have established a standard for secure email that will eventually replace the fax machine, and we have widely (but not yet universally) deployed a good standard for document-centric query exchange. We are close to broad support for a stable standard for encoding complex clinical data into summary documents. And perhaps most interestingly, we have opened the door to the promising world of API-based interoperability.
Nonetheless, the refrain we hear from Capitol Hill is that we have failed to achieve the seamless interoperability that many had expected. This has lead to numerous legislative attempts to 'fix' the problem by re-thinking government approaches to the standard setting processes authorized by HITECH.
We should be careful not to overreact in light of any disappointments and perceived failures around interoperability. There are many things we must improve, but we should not inadvertently take steps backwards.
I think the biggest mistake Congress appears to be legislating is to assume that standards alone are what creates interoperability.
Standards are necessary, but are not sufficient, for interoperability to occur.
Standards organizations (SDOs) can create standards, but they do not create the additional entities that are necessary for standards to deliver useful interoperability.
I believe that the sufficient conditions for interoperability include the following:
*A business process must exist for which standardization is needed. As Arien Malec put it recently, 'SDOs don't create standards de novo. They standardize working practices.'
*A proven standard then needs to be developed, via an iterative process that involves repeated real-world testing and validation.
*A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose. The business purpose may include satisfying regulatory requirements, or meeting market pressures, or both.
*A 'network architecture' must be defined that provides for the identity, trust, and security frameworks necessary for data sharing in the complex world of healthcare.
*A 'business architecture' must exist that manages the contractual and legal arrangements necessary for healthcare data sharing to occur.
*A governance mechanism with sufficient authority over the participants must ensure that the network and business frameworks are followed.
*And almost no healthcare standard can be deployed in isolation, so all of the ancillary infrastructure (such as directory services, certificate authorities, and certification tests) must be organized and deployed in support of the standard.
The Jason Task Force (which I was privileged to co-chair with Micky Tripathi) summed up these requirements into what they called a 'Data Sharing Arrangement (DSA).' DSAs do not emerge from SDOs. DSAs cannot be simply created by legislative fiat. They require the active engagement and collaboration of the many entities who are willing to do the hard work to create the necessary infrastructure for an interoperability standard to find real-world, widespread use.
We've learned that forcing providers to simply deploy standards and then to expect interoperability to happen is ineffective policy. The most rapid progress has happened when DSAs have emerged because provider organizations, Health IT developers and SDOs agree to work together to achieve a clear mission, focused on meaningful outcomes. Congress should accordingly define the 'what' and let the U.S. health care stakeholders define and achieve the 'how.'"
Thursday, June 4, 2015
Unity Farm Journal - First Week of June 2015
As I’ve written previously, running a farm is about life and death. When you’re supporting over 100 creatures, every day is filled with unpredictable events. This week, one of our chickens, Terra, developed “sour crop”.
We treated her by inducing vomiting, feeding her olive oil, offering apple cider vinegar in water, and isolating her from the other chickens. Despite 2 days of treatment, she passed away. She’s buried in our forest garden, near the Shinto shrine.
With the death of our rooster, Lucky, by coyote and Terra by infection, we’re down two Ameraucana chickens.
Kathy and I discussed our last three years of chicken raising and decided that we should supplement our flock. This week we added 6 Barred Rock hens (1 week old) and 3 Buff Orpingtons (2 weeks old). Although our Guinea Fowl have multiplied on their own (they lay 40 fertile eggs per day), we’ve not hatched our chicken eggs. With 9 adult chickens and 9 new chicks, the population should be stable despite occasional losses.
We also had another thought. Our guineas, Great Pyrenees and llamas sound an alarm when predators threaten. However, one of the best watch dogs for the barnyard is a goose. Here’s a photo of the 3 geese babies that recently joined the farm ecosystem. In another 6-8 weeks, they’ll be added to our existing poultry flocks and begin defending them all.
Last week, the IEEE Spectrum published Kathy’s cancer story in the context of big data. Here’s the article. IEEE took a family portrait to illustrate Kathy and I in our natural state.
Daisy Mae, one of our alpaca, is nearing the 11th month of her pregnancy. As alpaca approach delivery, they develop a condition that some call “alien butt” - the features of the soon to be born young alpaca appear on the rear of the mom. I consider this a clinical photograph, educating the public about the appearance of a gravid alpaca.
Shiro, our 150 pound male Great Pyrenees, is always looking for toys. He figured out a way to bury his bowl in a hay bale. Very artistic
This weekend will include mead making with 21 pounds of honey and harvesting mushrooms after the 3 inches of rain this week. I’ve also signed up with a local brewer to create a honey lager next week - my honey, his hops. Now that we’re a bonded winery from a federal and state perspective, the test batches of interesting beverages are beginning to multiply.
We treated her by inducing vomiting, feeding her olive oil, offering apple cider vinegar in water, and isolating her from the other chickens. Despite 2 days of treatment, she passed away. She’s buried in our forest garden, near the Shinto shrine.
With the death of our rooster, Lucky, by coyote and Terra by infection, we’re down two Ameraucana chickens.
Kathy and I discussed our last three years of chicken raising and decided that we should supplement our flock. This week we added 6 Barred Rock hens (1 week old) and 3 Buff Orpingtons (2 weeks old). Although our Guinea Fowl have multiplied on their own (they lay 40 fertile eggs per day), we’ve not hatched our chicken eggs. With 9 adult chickens and 9 new chicks, the population should be stable despite occasional losses.
We also had another thought. Our guineas, Great Pyrenees and llamas sound an alarm when predators threaten. However, one of the best watch dogs for the barnyard is a goose. Here’s a photo of the 3 geese babies that recently joined the farm ecosystem. In another 6-8 weeks, they’ll be added to our existing poultry flocks and begin defending them all.
Last week, the IEEE Spectrum published Kathy’s cancer story in the context of big data. Here’s the article. IEEE took a family portrait to illustrate Kathy and I in our natural state.
Daisy Mae, one of our alpaca, is nearing the 11th month of her pregnancy. As alpaca approach delivery, they develop a condition that some call “alien butt” - the features of the soon to be born young alpaca appear on the rear of the mom. I consider this a clinical photograph, educating the public about the appearance of a gravid alpaca.
Shiro, our 150 pound male Great Pyrenees, is always looking for toys. He figured out a way to bury his bowl in a hay bale. Very artistic
This weekend will include mead making with 21 pounds of honey and harvesting mushrooms after the 3 inches of rain this week. I’ve also signed up with a local brewer to create a honey lager next week - my honey, his hops. Now that we’re a bonded winery from a federal and state perspective, the test batches of interesting beverages are beginning to multiply.
Wednesday, June 3, 2015
So What is Interoperability Anyway?
One of my most memorable experiences as an IT leader was working with with a dissatisfied customer. I asked what requirements were unmet, what features were priorities, and what future state was desired. The answer was “I’m not sure, but I know I’m not getting what I need”.
The use of the term interoperability is being tossed around in ways that makes it seem like the test for obscenity used by Supreme Court Justice Potter Stewart in 1964 when he wrote “I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description ["hard-core pornography"], and perhaps I could never succeed in intelligibly doing so. But I know it when I see it…”
Congress is angry about the lack of interoperability. What does that mean?
House and Senate stakeholders believe that vendors enjoyed a government funded windfall yet are building proprietary networks. They have heard that vendors are blocking information sharing by charging significant interface fees and that HITECH distributed $30 billion with minimal requirements for information sharing. Many in the House feel after all this investment, the country is not prepared for new payment models.
Some in the House have stated that Americans can communicate because "we speak English" so interoperability is about picking a common language.
Senate HELP Committee Chairman Lamar Alexander plans to take up this issue, working closely with Ranking Member Senator Patty Murray through a bipartisan effort over the coming months.
So what is the real issue causing providers anxiety and resulting in Congress wanting to take action?
Providers are fed up with interface fees and at how hard it is to accomplish the workflow required by Accountable Care business models including care management and population health. They are unsatisfied with the kind of summaries we’re exchanging today which are often lengthy, missing clinical narrative and hard to incorporate/reconcile with existing records.
All these things are true.
So what is our next step to help providers do their job and improve satisfaction to the point that Congress no longer wants to legislate the solution to the problem?
I think we all have to step back, carefully define the requirements for care coordination and care management in an ACO world and admit that the Meaningful Use regulations did not address those requirements. We should allow the private sector initiatives already in progress (Argonaut, Commonwell, eHealthExchange) to address these market needs in collaboration with vendors, entrepreneurs, and innovators. The economic incentives of the Affordable Care Act and the Sustainable Growth Rate fix will result in hospitals and professionals demanding different kinds of technology than was prescribed in regulation.
The role for Congress should be to hold us accountable for the outcomes we want to achieve.
At a recent AMIA presentation in Boston, Zak Kohane, Ken Mandl and I were asked to be provocative - to go rogue.
I suggested that the Meaningful Use program should be eliminated. Yes, there should be Merit-based incentives for achieving stretch goals, but those can be created in another CMS program. Meaningful Use is no longer necessary.
ONC should focus on the 5 enablers I’ve written about
1. Facilitating the creation of a national provider directory for message routing
2. Encouraging the adoption of a voluntary national identifier for healthcare
3. Providing guidance to streamline the heterogeneous patchwork of state privacy laws that are impeding information exchange
4. Serve as the coordinating body for aligning federal government health IT priorities.
5. Supporting private sector initiatives such as Argonaut that are simplifying the tools for health information exchange.
It's not a problem of "language". We have the terminologies we need, already included in certified EHRs. We have standards for content and transport, again written into certification requirements. So what's the gap? We need to make the standards better, and build interoperability into EHR workflow. That doesn't require top down regulation, it takes the kind of goal-oriented interaction between providers, developers, and standards bodies that characterizes efforts like the Argonaut Project.
No more regulation, no more legislation. Those will only crush innovation.
Instead of saying we need interoperability, the conversation needs to include a crisp set of requirements for care management and care coordination with defined metrics of success, supported by government enablers, and accelerated with the economic incentives provided by new reimbursement models.
To paraphrase Justice Potter, if patients and providers are happier, I’ll know it when I see it.
The use of the term interoperability is being tossed around in ways that makes it seem like the test for obscenity used by Supreme Court Justice Potter Stewart in 1964 when he wrote “I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description ["hard-core pornography"], and perhaps I could never succeed in intelligibly doing so. But I know it when I see it…”
Congress is angry about the lack of interoperability. What does that mean?
House and Senate stakeholders believe that vendors enjoyed a government funded windfall yet are building proprietary networks. They have heard that vendors are blocking information sharing by charging significant interface fees and that HITECH distributed $30 billion with minimal requirements for information sharing. Many in the House feel after all this investment, the country is not prepared for new payment models.
Some in the House have stated that Americans can communicate because "we speak English" so interoperability is about picking a common language.
Senate HELP Committee Chairman Lamar Alexander plans to take up this issue, working closely with Ranking Member Senator Patty Murray through a bipartisan effort over the coming months.
So what is the real issue causing providers anxiety and resulting in Congress wanting to take action?
Providers are fed up with interface fees and at how hard it is to accomplish the workflow required by Accountable Care business models including care management and population health. They are unsatisfied with the kind of summaries we’re exchanging today which are often lengthy, missing clinical narrative and hard to incorporate/reconcile with existing records.
All these things are true.
So what is our next step to help providers do their job and improve satisfaction to the point that Congress no longer wants to legislate the solution to the problem?
I think we all have to step back, carefully define the requirements for care coordination and care management in an ACO world and admit that the Meaningful Use regulations did not address those requirements. We should allow the private sector initiatives already in progress (Argonaut, Commonwell, eHealthExchange) to address these market needs in collaboration with vendors, entrepreneurs, and innovators. The economic incentives of the Affordable Care Act and the Sustainable Growth Rate fix will result in hospitals and professionals demanding different kinds of technology than was prescribed in regulation.
The role for Congress should be to hold us accountable for the outcomes we want to achieve.
At a recent AMIA presentation in Boston, Zak Kohane, Ken Mandl and I were asked to be provocative - to go rogue.
I suggested that the Meaningful Use program should be eliminated. Yes, there should be Merit-based incentives for achieving stretch goals, but those can be created in another CMS program. Meaningful Use is no longer necessary.
ONC should focus on the 5 enablers I’ve written about
1. Facilitating the creation of a national provider directory for message routing
2. Encouraging the adoption of a voluntary national identifier for healthcare
3. Providing guidance to streamline the heterogeneous patchwork of state privacy laws that are impeding information exchange
4. Serve as the coordinating body for aligning federal government health IT priorities.
5. Supporting private sector initiatives such as Argonaut that are simplifying the tools for health information exchange.
It's not a problem of "language". We have the terminologies we need, already included in certified EHRs. We have standards for content and transport, again written into certification requirements. So what's the gap? We need to make the standards better, and build interoperability into EHR workflow. That doesn't require top down regulation, it takes the kind of goal-oriented interaction between providers, developers, and standards bodies that characterizes efforts like the Argonaut Project.
No more regulation, no more legislation. Those will only crush innovation.
Instead of saying we need interoperability, the conversation needs to include a crisp set of requirements for care management and care coordination with defined metrics of success, supported by government enablers, and accelerated with the economic incentives provided by new reimbursement models.
To paraphrase Justice Potter, if patients and providers are happier, I’ll know it when I see it.
Thursday, May 28, 2015
Unity Farm Journal- Fifth week of May 2015
Spring and Fall are very busy days on the farm. With each passing day in May, you never know what new task will appear.
On Saturday, Kathy and I drove to Western Massachusetts near the border of Vermont and New York to pick up our Russian “nucs”, the mini-hives used to start a new hive. Russian bees are challenging (I’m not making this up) since they tend to swarm and take over territory. They are unpredictable and hard to control. Thus, we created a site for them to take over, called a swarm trap. We mounted a 10 frame deep hive with wax and lemon grass extract (a bee attractant) on one of our 8 foot fence posts. If the bees swarm, they are likely to find this new home, making it easy to put the bees in a new hive. Here's what a Russian nuc looks like.
The bees are busy gathering nectar from our 15 acres of wildflowers. Here's a glimpse of the bees on wild honeysuckle.
This week one of our roosters, Lucky, disappeared. He was a fierce defender of our hens. I found a collection of his feathers in the deep forest, near coyote droppings. He gave his life to protect his women. Thanks Lucky.
Just as the West Coast has had water issues, the Spring in New England has been dry, windy, and problematic for growing crops. We’ve had to use our stored water - the snow melt from this winter now in our local aquifer, to keep our orchard healthy.
The hoop house continues to burst with vegetables. I harvest 25 pounds a day for humans and animals on the farm.
Our state Farmer-Winery license arrived this week, so now we’re a Federal bonded winery and licensed by the state to produce wines of all kinds including hard cider and mead. Next weekend we’ll be making Spiced Orange Mead. I sterilized all the equipment in the cider house in preparation for the fermentation to come. You’ll see our beverages available for sale soon!
The dogs have been groomed and the alpaca sheared, so everyone looks picture perfect. Here’s a random family portrait of the creatures gathered in the barn.
We're very close to all our creatures. There's nothing like a roll in the hay with a Great Pyrenees. I'm 6 foot 2. Shiro is 6 foot 5 end to end. Our weights are identical.
The weekend ahead includes mushroom inoculation, mead making, planting, harvesting, and mowing meadows. It's joyful work!
On Saturday, Kathy and I drove to Western Massachusetts near the border of Vermont and New York to pick up our Russian “nucs”, the mini-hives used to start a new hive. Russian bees are challenging (I’m not making this up) since they tend to swarm and take over territory. They are unpredictable and hard to control. Thus, we created a site for them to take over, called a swarm trap. We mounted a 10 frame deep hive with wax and lemon grass extract (a bee attractant) on one of our 8 foot fence posts. If the bees swarm, they are likely to find this new home, making it easy to put the bees in a new hive. Here's what a Russian nuc looks like.
The bees are busy gathering nectar from our 15 acres of wildflowers. Here's a glimpse of the bees on wild honeysuckle.
This week one of our roosters, Lucky, disappeared. He was a fierce defender of our hens. I found a collection of his feathers in the deep forest, near coyote droppings. He gave his life to protect his women. Thanks Lucky.
Just as the West Coast has had water issues, the Spring in New England has been dry, windy, and problematic for growing crops. We’ve had to use our stored water - the snow melt from this winter now in our local aquifer, to keep our orchard healthy.
The hoop house continues to burst with vegetables. I harvest 25 pounds a day for humans and animals on the farm.
Our state Farmer-Winery license arrived this week, so now we’re a Federal bonded winery and licensed by the state to produce wines of all kinds including hard cider and mead. Next weekend we’ll be making Spiced Orange Mead. I sterilized all the equipment in the cider house in preparation for the fermentation to come. You’ll see our beverages available for sale soon!
The dogs have been groomed and the alpaca sheared, so everyone looks picture perfect. Here’s a random family portrait of the creatures gathered in the barn.
We're very close to all our creatures. There's nothing like a roll in the hay with a Great Pyrenees. I'm 6 foot 2. Shiro is 6 foot 5 end to end. Our weights are identical.
The weekend ahead includes mushroom inoculation, mead making, planting, harvesting, and mowing meadows. It's joyful work!
Wednesday, May 27, 2015
Interoperability and the Trough of Disillusionment
Every technology has an adoption journey. The classic Gartner hype curve travels from a Technology Trigger to the Peak of Inflated Expectations followed by the Trough of Disillusionment. It often takes years before organizations reach the Slope of Enlightenment and finally achieve a Plateau of Productivity.
Have you noticed that Congress and the popular press have entered the Trough of Disillusionment for EHRs and interoperability over the past month?
Congressional staffers writing the 21st Century Cures bill (which is not yet law) seem to have concluded
1) we don¹t have interoperability (although no one is sure what exactly we have and do not have)
2) therefore we need more standards and that will solve all the business, political, and policy barriers to health information exchange
3) The Health IT Standards Committee must not be doing a good job because there are not enough standards
4) Therefore we should disband it and create a new politically appointed body
5) That new body will invent all the standards we need and then force vendors to stop their information blocking behavior (whatever that is), enabling precision medicine
USA Today, in one of the most one sided articles I’ve read, confuses ACA and HITECH, ignores the data about EHR adoption/health information exchange and concludes that EHRs “don’t talk to each other”, whatever that means.
It’s time to take a step back, define our requirements, examine our current state, and then focus on closing any gaps we find.
I oversee 5,000 patient data exchanges at BIDMC every day. 50,000 patients view/download/transmit their data every month. We’re in beta testing with apps using Apple HealthKit, connecting home devices, iPhones and our EHR. We have numerous affiliates with bidirectional data exchange. There are few technology limitations. The real challenges are political and policy barriers.
The Direct protocol, although more complex than the RESTful methods used by Facebook, Amazon and Google that we should embrace, has provided a foundation for health information exchange across the country. Below is a snapshot of the current Massachusetts State HIE (the Mass HiWay) connections to Health Information Services Providers (HISPs), creating thousands of connections among hospitals and eligible professionals nationwide. Every week, some new practice or hospital comes knocking at the BIDMC door and within hours we can create a connection.
Interoperability is real. Interoperability has a very positive trajectory. Saying otherwise is oversimplifying the reality of ongoing good work in progress.
When confronted by naysayers, we have only three choices
1. Give up and declare defeat
2. Get angry, frustrated, and flustered by the negativity
3. Move forward with gusto, identifying gap after gap, then solving them. We eat the elephant of interoperability one bite at a time.
Over the past week, I’ve found myself setting aside my emotions. I’ve redoubled my commitment to doing the right thing, hiring great people and broadly communicating the change processes needed to ensure more data is exchanged with more people for more reasons, while still respecting patient privacy preferences.
I’ve thought long and hard about the day to day criticism we hear from government, special interests, and various press resources. We have to avoid being distracted by the politics of any given moment. In a year and half the federal government will change completely . Every major political leader in healthcare IT has changed since 2013.
If we stay above the fray, work on interoperability one practice and one institution at a time, and toil diligently to enable new infrastructure such as record locator services/provider directories/quality registries, we will create a learning healthcare system that is better with each passing year.
So next time you encounter the Trough of Disillusionment about interoperability, do your best to educate stakeholders about the trajectory we’re on and the challenges we can overcome by focusing and working together.
Maybe we can all stand on a hilltop and sing "I'd Like to Teach the World to Interoperate (In Perfect Harmony)" celebrating our progress to date and highlighting the work yet to be done?
Have you noticed that Congress and the popular press have entered the Trough of Disillusionment for EHRs and interoperability over the past month?
Congressional staffers writing the 21st Century Cures bill (which is not yet law) seem to have concluded
1) we don¹t have interoperability (although no one is sure what exactly we have and do not have)
2) therefore we need more standards and that will solve all the business, political, and policy barriers to health information exchange
3) The Health IT Standards Committee must not be doing a good job because there are not enough standards
4) Therefore we should disband it and create a new politically appointed body
5) That new body will invent all the standards we need and then force vendors to stop their information blocking behavior (whatever that is), enabling precision medicine
USA Today, in one of the most one sided articles I’ve read, confuses ACA and HITECH, ignores the data about EHR adoption/health information exchange and concludes that EHRs “don’t talk to each other”, whatever that means.
It’s time to take a step back, define our requirements, examine our current state, and then focus on closing any gaps we find.
I oversee 5,000 patient data exchanges at BIDMC every day. 50,000 patients view/download/transmit their data every month. We’re in beta testing with apps using Apple HealthKit, connecting home devices, iPhones and our EHR. We have numerous affiliates with bidirectional data exchange. There are few technology limitations. The real challenges are political and policy barriers.
The Direct protocol, although more complex than the RESTful methods used by Facebook, Amazon and Google that we should embrace, has provided a foundation for health information exchange across the country. Below is a snapshot of the current Massachusetts State HIE (the Mass HiWay) connections to Health Information Services Providers (HISPs), creating thousands of connections among hospitals and eligible professionals nationwide. Every week, some new practice or hospital comes knocking at the BIDMC door and within hours we can create a connection.
Interoperability is real. Interoperability has a very positive trajectory. Saying otherwise is oversimplifying the reality of ongoing good work in progress.
When confronted by naysayers, we have only three choices
1. Give up and declare defeat
2. Get angry, frustrated, and flustered by the negativity
3. Move forward with gusto, identifying gap after gap, then solving them. We eat the elephant of interoperability one bite at a time.
Over the past week, I’ve found myself setting aside my emotions. I’ve redoubled my commitment to doing the right thing, hiring great people and broadly communicating the change processes needed to ensure more data is exchanged with more people for more reasons, while still respecting patient privacy preferences.
I’ve thought long and hard about the day to day criticism we hear from government, special interests, and various press resources. We have to avoid being distracted by the politics of any given moment. In a year and half the federal government will change completely . Every major political leader in healthcare IT has changed since 2013.
If we stay above the fray, work on interoperability one practice and one institution at a time, and toil diligently to enable new infrastructure such as record locator services/provider directories/quality registries, we will create a learning healthcare system that is better with each passing year.
So next time you encounter the Trough of Disillusionment about interoperability, do your best to educate stakeholders about the trajectory we’re on and the challenges we can overcome by focusing and working together.
Maybe we can all stand on a hilltop and sing "I'd Like to Teach the World to Interoperate (In Perfect Harmony)" celebrating our progress to date and highlighting the work yet to be done?
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