The Direct Project - Where We Are Today

This article originally appeared in The Health Care Blog and O'Reilly Radar. by Brian Ahier, Rich Elmore and David C. Kibbe The Direct Project announced today the completion of its open-source connectivity-enabling software and the start of a series of... read the rest.

I have copied highlights below, but please note that CareSpark will be piloting the standards used by the Direct project to demonstrate our ability to be a Health Information Service Provider (HISP) communicating to the Veterans Administration.  Carespark (Tennesee) will be linking the VA with private clinics providing health services to veterans.  This is of particular interest to me as my father and mother-in-law locally receive health care benefits from the VA. In addition, I have multiple family members across TN and the state of Tennessee has over 500,000 veterans with over 1 million dependents who will eventually benefit when the pilots move into production in the future.  

The Direct Project announced today the completion of its open-source connectivity-enabling software and the start of a series of pilots that will be demonstrating directed secure messaging for healthcare stakeholders over the internet. The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

Also announced:

• A new name - The Direct Project was previously known as NHIN Direct 
• An NHIN University course(The Direct Project - Where We Are Today), to be presented  by Arien Malec, November 29 at 1PM ET, sponsored by the National eHealth Collaborative
• An extensive list of HIt vendors (20+) that have announced plans to leverage the Direct Project for message transport in connection with their solutions and services.  
• Presentations at the HIT Standards Committee on Tuesday, November 30 where three or more vendors will be announcing their support for the Direct Project. 
• A thorough documentation library including a Direct Project Overview 
• Best practice guidance for directed messaging based on the policy work of the Privacy and Security Tiger team
• A new website at DirectProject.org
• A new hashtag #directproject for following the Direct Project on twitter.

What is The Direct Project?

Today, communication of health information among providers and patients is most often achieved by sending paper through the mail or via fax. The Direct Project seeks to benefit patients and providers by improving the transport of health information, making it faster, more secure, and less expensive. The Direct Project will facilitate “direct” communication patterns with an eye toward approaching more advanced levels of interoperability than simple paper can provide.

The Direct Project provides for universal boundaryless addressing to other Direct Project participants using a health internet “email-like” address.

The Direct Project focuses on the technical standards and services necessary to securely transport content from point A to point B and does not specify the actual content exchanged.  When The Direct Project is used by providers to transport and share qualifying clinical content, the combination of content and The Direct Project-specified transport standards may satisfy some Stage 1 Meaningful Use requirements. For example, a primary care physician who is referring a patient to a specialist can use The Direct Project to send a clinical summary of that patient to the specialist and to receive a summary of the consultation.

How might the Direct Project be Used?
2009-10 Congress and agencies of the federal government have created regulations that require physicians and hospitals participating in the ARRA/HITECH incentives awarded for meaningful use of EHR technology to:

• send messages and data to each other for referral and care coordination purposes;
• send alerts and reminders for preventive care to their patients;
• send patients clinical summaries of their visit and of their health information
• receive lab results from labs
• send immunization and syndromic surveillance data to public health agencies
• integrate with HIT vendor systems

There are already organizations that have announced the establishment of national clinical exchange networks, including integration with the Direct Project. States and HIO’s will need to decide how best to provide Direct Project services to their constituents, whether by partnering with existing exchange networks or incorporating direct messaging into the services they provide.
 

The Direct Project Implementation
The Direct Project is organizing real-world pilots to demonstrate health information exchange using The Direct Project standards and services. Six pilots are ramping up including:

Rhode Island Quality Institute, Redwood MedNet and MedAllies will be sending Continuity of Care
Documents to other providers for referrals and transitions of care. Visionshare will be linking to
immunization registries. Carespark (Tennesee) will be linking the VA with private clinics providing health services to veterans. And Connecticut’s Medical Professional Services, an IPA, will be
linking Middlesex Hospital with primary care providers.

The HISP
Connectivity among providers is facilitated by Health Information Service Providers (HISP). HISP describes both a function (the management of security and transport for directed exchange) and an organizational model (an organization that performs HISP functions on behalf of the sending or receiving organization or individual).
 

Best Practices
The Direct Project is bound by a set of policies that have been recommended to the HIT Policy Committee (HITPC) or are being examined by the HITPC’s Privacy and Security Tiger Team for directed messaging. Within this context, the Direct Project has developed best practice guidance for secure communication of health data among health care participants who already know and trust each other. The Direct Project assumes that the Sender is responsible for several minimum requirements before sending data, including the collection of patient consent. These requirements may or may not be handled in an electronic health record, but they are handled nonetheless, even when sharing information today via paper or fax. For example, a sender may call to ask whether a fax was sent to the correct fax number and was received by the intended provider. The following best practices provide context for the Direct Project standards and services:

• The Sender has obtained the patient’s consent to send the information to the Receiver.
• The Sender and Receiver ensure that the patient’s privacy preferences are being honored.
• The Sender of a Direct Project transmission has determined that it is clinically and legally appropriate to send the information to the Receiver.
• The Sender has determined that the Receiver’s address is correct.
• The Sender has communicated to the receiver, perhaps out-of-band, the purpose for  exchanging the information.
• The Sender and Receiver do not require common or pre-negotiated patient identifiers. Similar to the exchange of fax or paper documents, there is no expectation that a received message will be automatically matched to a patient or automatically filed in an EHR.
• The communication will be performed in a secure, encrypted, and reliable way, as described in the detailed The Direct Project technical specifications.
• When the HISP is a separate entity from the sending or receiving organization, best practice guidance for the HISP has been developed for privacy, security and transparency.

The demonstrations will likely take place early next year at the HIMSS Annual Conference in Orlando. 

What is a Unicorn?

When I was much younger and extending into my early 20’s, I loved the concept of and collected Unicorns. While I still love the concept of Unicorns, I no longer collect them, so you can imagine my surprise to hear from one of the CareSpark stakeholders that I was leading and helping to build the region’s Unicorn. 

During the last CareSpark Board meeting, a CIO from one of the hospital systems in the region mentioned that he could share his vision of a Unicorn to support the needs of his providers for Health information exchange (HIE). He went onto mention that an HIE is like a Unicorn…we all know what we think one should look like, but who’s to say my unicorn looks like your unicorn. What does your Unicorn look like?  

 

I would like to think my Unicorn would be golden and sparkly…something like this…  

“Now I will believe that there are unicorns…” William Shakespeare – The Tempest

As the common fare of little girls' fantasies, the origin in histories becomes quite ironic. In thinking about this blog topic, I thought it was interesting to correlate that the Unicorn is known for the healing power in it’s horn.  A fabulous beast born of man’s imagination, the unicorn form and function are as variable as the minds and religions of mankind;  but whatever its shape – and it has been described as an ox, ram, goat, bull, antelope, wild ass, horse,  rhinoceros, serpent or fish, - a one-horned beast was always a symbol of supreme power.

In the west, the unicorn was first mentioned in 398 BC by Ctesias, a Greek physician and historian of Persia and India.  He traveled to the Persian court and remained there working as a physician for 17 years under two rulers.  

Why did they go away, do you think? "Who knows? Times change –especially in health care today. Would you call this age a good one for unicorns?"  

For those of you who may not be aware yet, I stepped in as Interim CEO for CareSpark on September 30, 2010. One of my deliverables during my tenure will be to develop a sustainable business plan and I have spent the past several weeks helping to shepherd and lead CareSpark toward the evolution necessary to sustain them into the future and reduce the dependency on federal funding. 

Out of the 234 HIEs surveyed by the eHealth Initiative for 2010 only 18 are operational, not dependent on federal funding, and have broken even through operational revenue only. To date, CareSpark has been dependent on federal funding business plan will begin to wean them from the dependencies over the next several years with the support of the community and state.

In addition to the Carespark business plan, I have the pleasure of working with the State of TN and the state designated entity (HIP TN) to develop their sustainability plan and roll out the backbone connecting the various HIEs across the state beginning in 2011. 
 

At the beginning of this week, after the Thanksgiving holidays, I have much to give thanks for reflecting back over the past two years of business after starting Serendipity Health. I am doing what I set out to do and am working full time to help improve the quality of health care in my region and across the state. CareSpark has always had a place in my heart having followed the standards based approach for building the HIE which now has 33 signed data sharing agreements from providers in the region. Over the coming years, I look forward to working with health care provides to deploy connected health care, thus providing actionable information at the point of care.As the cartoon below depicts, I am pleading for all providers to give generously! 

Call for Participation - 2010 Summit of the Southeast

 

As a TN HIMSS Board Member and HIE Liaison, I feel it is my duty to fulfill the mission and vision of the TN HIMSS Chapter and ask all those that follow me to consider attending the next conference event. Join the AL, AR, KY, SC and TN Chapters in the largest HIMSS Combined Chapter Conference.There is still time to register for the early bird rates for the 2010 HIMSS Summit of the Southeast.  The Summit offers attendees the chance to join one of the most unique Chapter conferences in the country.  

This meeting is designed to offer attendees access to and hear from the leading healthcare providers and healthcare technology companies in the Southeast.  By attending this conference, you will get a chance to hear national and local leaders on these key agenda items:

• Clinical Informatics (A Credit Session)
• Hospital CEO Discussion
• Keynote – Meaningful Use and Meaningful Change
• State of HIMSS
• Keynote – State of our Nation: A National Road Map
• HIT/HIE Short-term Benefits and Long-term Investment – Panel Discussion
• Evolving Role of the CIO/CMIO/CMO – Panel Discussion
• Keynote – Safety and Quality
• Hospital Point of Care Impact:  Clinicians Sound Off
• Ambulatory Point of Care Impact:  Clinicians Sound Off

This year, the Summit is two days, October 11th and 12th. As such, we have two different options for registration. If you would like to attend the Special Session on October 11th ONLY, please choose that option. If you wish to attend the ENTIRE Summit on October 11th and 12th, please choose the Entire Summit option. I will be attending both days and look forward to seeing many of you there. Make sure to register now to get your early bird rates while they still apply! Safe travels!

Tennessee's Department of Economic & Community Development...Invest in Tennessee

The 57th Annual/2010 Governor's Conference will be held September 16 - 17, 2010 in Nashville, TN.   I won't be able to attend as I will be on vacation, but a variety of informative sessions will be delivered. As a proud Tennessean, I can say, Tennessee is good for business, offering a beneficial labor environment, productive and educated work force, wonderful quality of life and wealth of technology resources. These factors combine to create a business climate that gives companies a winning edge in their long-term growth and profitability.

Since my blog is centered on Healthcare IT, I wanted to tie together this conference with the Nashville Medical Trade Center.  I blogged about this new center back in April.  I understand that since the initial announcement in April, there has been significant activities.  I wanted to share this video that highlighted some of these activities.



I am so happy to see the continued success of the interactive interoperability showcase that I helped create in 2004 and launch internationally in Europe and Asia. I was blessed to meet and introduce our Governor to the showcase for the first time in 2005. It is wonderful to see this key feature for HIMSS now have a permanent and flexible home at the Nashville Medical Trade Center.  I look forward to seeing the vision and passion continue to grow while creating many wonderful opportunities for the citizens in our great state.  I hope that I as founder and President of Serendipity Health can continue collaborating with stakeholders across the state of Tennessee to find ways to deploy connected healthcare to help improve the quality of care for us all.   

Temporary Certification Announced and Tennessee excels toward HIE

In my first blog post dated January 5, 2010, I mentioned that our nation is at the forefront of aligning the stars with monetary incentives to stimulate the adoption and meaningful use of the Electronic Health Record (EHR). Some have dubbed this as the perfect storm of Healthcare reform. Earlier this month, the Office of the National Coordinator for Health IT (ONC) issued a final rule to establish a temporary certification program for EHR technology. This program will establish processes that organizations will need to follow in order to be authorized by ONC to test and certify EHR technology. Use of "certified EHR technology" is a core requirement for providers who seek to qualify to receive incentive payments under the Medicare and Medicaid EHR Incentive Program. 

Certification will be used to provide "assurance and confidence" that a product or service will work as expected. By purchasing certified EHR technology, hospitals and eligible providers will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of EHRs to qualify for the payment incentives and begin to use EHRs in a way that will improve quality and efficiency in our health care system. Systems will include the capabilities a hospital or provider envisioned when they purchased the EHR. The certification will also ensure the capabilities are available to achieve meaningful use incentives.

Exchanging health information among disparate systems quickly and in usable formats, might be the vision for improving healthcare, but getting information beyond point-to-point transactions is a challenge for even the most engaged, forward thinking organizations. As the drive for information exchange standards continues, some healthcare systems as well as Tennessee are gearing up to purchase tools to harness, index, route, and harmonize patient data to make it available at the right place and at the right time to enable the clinical caregiver to improve the patient care process.

Tennessee has been making incremental strides towards improving the patient care process and was recently recognized as one of the top five most improved states in routing prescriptions electronically. Surescripts, a health information network that operates the country's largest electronic prescribing network, announced that Tennessee ranked second behind Vermont and just ahead of Kansas, Illinois and Missouri on the top five list. Tennessee Gov. Phil Bredesen co-hosted the fourth annual Safe-Rx Awards event as part of the recent State Alliance for e-Health meeting. Bredesen has long supported improving the process and co-chairs the alliance with Vermont Gov. Jim Douglas. Surescripts created the Safe-Rx Awards to raise awareness of e-prescribing as a way to improve patient safety by providing a secure, accurate and informed prescribing process. This is the first of many steps our state will have to make to truly improve the quality of patient care.

Tennessee's department of eHealth, in conjunction with nine other states, is conducting market research regarding enterprise medication management technologies and services. An RFI was published June 17, 2010 and is due July 12, 2010. The responses to this RFI will assist the nine states in understanding the current state of the marketplace, including commercial/government best practices, industry capabilities, innovative delivery approaches, commercial market service levels, and performance strategies and measures. Information gained through this RFI will greatly assist TN in determining how best to advance innovative medication management services.

In addition to the above RFI, the Health Information Partnership for Tennessee (HIP TN) also released an RFP on June 25, 2010. Responses are due July 13, 2010. HIP TN is the state designated entity charged with coordinating activities for the Regional Extension Center (tnREC) as well as the Health Information Exchange (HIE) strategy for Tennessee. HIP TN, a non-profit organization, works to improve access to health information through a statewide collaborative process by providing services and infrastructure for the secure electronic exchange and use of health information between state-wide agencies and local or Regional Health Information Organizations (RHIO). This RFP is soliciting proposals to provide a statewide HIE infrastructure platform for Core Services and other functions to be accessed by physicians, hospitals, other health care organizations, and consumers.

HIP TN has defined Core Services to include:

• Service Access Layer
• Patient Matching Service
• Master Clinician Index
• Master Facilities Index
• Trust Broker
• NHIN Gateway

In addition, the RFP will describe hosting services and operational expertise in support of the Core Services that will be administered on behalf of HIP TN by the Solution Provider. I currently volunteer on the Technology work group who has been leading the RFP process. While the remainder of the year ahead is full of deadlines and deliverables, I look forward to assisting with one of the biggest challenges, to keep various stakeholders in HIP TN, across my state, and various other states abreast of all the technology and standards that are out there.

Tennessee’s State of the Union for Health Information Exchange (HIE) Collaboration

Tennessee’s State of the Union for Health Information Exchange (HIE)

With each passing decade, health care has consumed a larger share of gross domestic product (GDP) and Federal budgets. The Centers for Medicare and Medicaid Services (CMS) is estimating that the healthcare sector’s share of GDP made its biggest one-year jump ever, going to 17.3 % in 2009 from 16.2 in 2008. The financial burden of the ever increasing ratio of total out-of-pocket spending for health care services and premiums to total family income—continues to increase nationally. As a result of this trend, more people have been exposed to high costs and lack essential services.

In pilot programs across the US, it has been demonstrated that the use of electronic health records (EHRs) can significantly reduce the cost of health care while improving the quality. The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes CMS to provide reimbursement incentives for eligible professionals and hospitals who are successful in adopting and becoming “meaningful users” of certified EHR technology. CMS’ goal is for the definition of meaningful use to be consistent with applicable provisions of Medicare and Medicaid law while continually advancing the stages for contributions certified EHR technology can make to improving health care quality, efficiency, and patient safety. For stage 1, which begins in 2011, CMS proposes objectives for physicians and hospitals to meet to be deemed meaningful EHR users. Stages 2 and 3 will expand the list in 2013 and 2015. Hospitals and physicians failing to adopt EHRs and meet the objectives by 2015 will face penalties.

One future requirement to achieve meaning use is to participate in an HIE. The Knoxville region has operated an HIE infrastructure since June 2004 among the area hospitals known as Innovation Valley Health Information Network (IVHIN). In June 2009 the board of IVHIN approved a collaborative initiative with CareSpark, another HIE based in the Tri-cities for health improvement for East Tennessee. Progress to date for the collaborative community known as CareSpark – Knoxville region includes the following:

• Achieved the goal of full commitment of area hospitals and certain large physician practices to improve internal infrastructures and adopt systems to collectively connect to a secure utility for health information exchange.
• CareSpark hired Leigh Sterling as the Knoxville region coordinator for its 17 counties.
• Outreach has begun regarding the available CareSpark offering for HIE between hospitals, physician practices, health plans and public health departments. CareSpark currently serves almost 400,000 patients and 250 clinicians in the Tri-Cities region. IVHin and CareSpark are now aligning efforts and collaborating to share infrastructure for technical services, governance and policy, and business operations to enable HIE.

In addition, the state of Tennessee formed the Health Information Partnership for Tennessee (HIP TN) as a non-profit organization in the summer of 2009 with the purpose of “improving the health of people served in Tennessee using a public-private framework to coordinate and empower the sharing of appropriate health information through local and regional HIEs, as well as in areas not yet covered by exchange thereby improving quality, coordination of care, cost efficiency and public health. HIP TN is responsible for selecting and managing the infrastructure and services to support statewide HIE." The HIP-TN organization in partnership with the state of TN’s office of eHealth are working together to determine incentive program deployment strategies. HIP TN brings together Tennessee’s local, regional and state electronic health information initiatives and resources to form a collaborative partnership and framework.

With dozens of different vendors to choose from and the fast paced requirements beginning in 2011 for meaningful use, providers will need assistance with getting connected to an HIE, acquiring and implementing EHRs and other associated information systems. These systems often can't easily talk to each other; therefore, the use of qualified intermediaries will be required to support providers through the deployment of EHR technology in a meaningful way to qualify for incentives. These intermediaries will coordinate with the Regional Extension Center (REC) activities underway within TN and will increase successful adoption of EHRs by providing community-wide technical assistance and facilitating group purchasing. This coupled with the coordinated HIE efforts of HIP TN will ensure the requirements and capabilities for meaningful use can be consistently met as funding will be coordinated between programs to ensure consistency in application of rules and to maximize impact.

Serendipity Health, LLC will act as one of the intermediaries working with CareSpark, IVHIN, HIP-TN and others at the TN state office of eHealth to help area providers and hospitals understand and qualify for federal EHR incentive money while improving the health care in East TN. If your organization is interested in finding out more about deploying connected health care, please contact us at info@serendipityhealth.net to learn more about how your organization can qualify for incentives and help optimize health care for all.

Kudos to my home state of Tennessee on the newly announced Nashville Medical Trade Center

The Nashville Medical Trade Center has signed its first major tenant: the Healthcare Information and Management Systems Society (HIMSS). The partnership with HIMSS was announced at a news conference today in Nashville attended by Gov. Phil Bredesen, Nashville Mayor Karl Dean, state Economic and Community Development Commissioner Matt Kisber, HIMSS President and CEO Stephen Lieber and Bill Winsor, president and CEO of Market Center Management Co., the developer of the medical mart.

Project officials said today that HIMSS an “anchor tenant,” is one that is essential to the initial success of the project and will attract other tenants. The medical mart must lease 60 to 70 percent of its 1.5 million square feet in permanent showroom space to secure financing for its plans to remodel and expand the existing Nashville Convention Center downtown.

Market Center Management Co., the developer for the Nashville Medical Trade Center, hopes to transform the Nashville Convention Center into a global headquarters for health care events and the exchange of medical equipment and other related products. The highly anticipated project would employ 2,760 people, generate $390 million in economic activity a year and produce $21 million a year in state and local taxes by 2019, according to a study conducted by the University of Tennessee.

The proposed $250 million medical mart will lease 25,000 square feet permanently to HIMSS to use for a an “interoperability showcase.” The last US showcase, which was part of HIMSS’ annual conference in March in Atlanta, included 84 vendors and 71 educational sessions and attracted about 5,000 people over the course of three days. At 25,000 square feet, HIMSS would occupy 1.7 percent of the medical mart.

“A permanent, year-round destination for (health information technology) activity and innovation would only be possible inside this groundbreaking marketplace,” Lieber said. “By joining the trade center we are able to reach more participants, demonstrate meaningful use more completely, and offer more flexibility than ever before.”

I am proud to have been the first co-chair helping launch of the first US HIMSS Interoperability Showcase in 2004 and then launching the first HIMSS World of Health IT and HIMSS AsiaPac Showcases in 2006 and 2007 while working for HIMSS. I am so very proud of my home state, Tennessee, for providing a new  home for the showcase.   The showcases have always been used to “demonstrate standards-based health IT applications in a venue that stimulates health information exchange in health care settings.” HIMSS is a nonprofit organization that promotes “a better understanding of health care information and management systems. I would never have believed that I would serendipitously host Governor Phil Bredesen at the 2007 HIMSS Interoperability Showcase, host former Senator Bill Frist at the 2008 Showcase and now live and work in Tennessee who will be hosting the Interoperability Showcase permanently in the future.



I feel very blessed to have worked with HIMSS to bring vendors and users together to demonstrate meaningful use and improved quality that interoperable health care applications and devices can bring; I look forward to seeing Nashville, TN move forward in it's plans to be an epicenter for the medical industry with the new medical mart. This is a new concept that does not exist any other place in the world, but the Market Center hopes to transform the Nashville Convention Center into a global headquarters for health care events and the exchange of medical equipment and other related products.

Make sure to check out the video gallery to get further information and see the live press conference from earlier today.  Go Tennessee!.

Thoughts from 2010 HIMSS Annual Conference in Atlanta, GA

The federal government is using the American Recovery and Reinvestment Act (ARRA), in part, as an impetus for the nation’s health care organizations to acquire the health IT necessary to manage costs and improve patient care. The HIMSS Annual conference held March 1 - 4, 2010 provided an opportunity for more than 900 vendors to showcase their potential configurations of meaningful use of their products.  Health care leaders and HIMSS members helped to educate the more than 27,500 attendees what is possible when a health information exchange is put in place to foster community collaboration in association with commercial vendors. When interoperable electronic health record systems are coupled with the required infrastructure vendors the possibilities to improve the delivery of quality patient care harnesses the power of Health IT and can make the difference in health care delivery.  

More than 300 educational sessions were delivered on hot topics such as meaningful use standards, certification criteria, meaningful use standards, certification criteria, ARRA and government contributions to advancing health IT and nationwide electronic health records, and health IT privacy and security practices that will be necessary. I had the pleasure of moderating two of the Health Information Exchange (HIE) sessions. I see the state initiatives as the key to adopting the standards, implementation specifications and certification criteria that will incrementally enhance the interoperability, functionality, utility, and security of HIT. States will be the ones empowered to engage public-private sector discussions, develop policies and support demonstration projects, where appropriate, to explore incentives, penalties, and other mechanisms to help increase business demand and public support for exchange and encourage a plurality of exchange architectures that are cost effective and sustainable.

It was rewarding to again fulfill my HIMSS volunteer duties within the HIMSS10 Interoperability Showcase which was more than double the size of the largest in show history at over 25,000 square feet.  New this year was the collaboration between the HIMSS Interoperability Showcase and the Federal Health Architecture, featuring “A Path to Improved Care: Communities CONNECTing to the NHIN,” demonstrating advanced technology that allows the exchange of information between government entities and the private sector. The combination of both the IHE/HITSP standards-based demonstration along with the additional federal partners provided eighty-four participants demonstrating 96 unique systems, and more than 50 clinical scenarios while highlighting a proposed metric for achieving meaningful use. This is a significant increase from the 2009 showcase I was responsible for before transitioning my 5 year leadership period and leaving HIMSS in 2009 when 72 participants demonstrated interoperability of 60 unique systems. I can say that I feel like the proud mother of a successful child who has finally grown beyond the toddler years and has endless years of life to blossom. I had the opportunity to help educate attendees as a speaker for two presentations within the showcase theaters and I volunteered as a docent tour leader to share several of the wonderful scenarios demonstrated during my shift of 3 hours. The showcase and all the other conference activities provided an opportunity to learn from many of my fellow peers, visit with old friends, while networking and attending sessions.

It is great to see the continued evolution towards adoption of technology used within health care in a meaningful way. I hope to continue evangelizing and promoting the use of HIT. The Office of the National Coordinator continues to evolve and grow with staff leading focused areas.  (ONC) announced a new initiative called NHIN Direct. As one of the members currently involved with the current NHIN work accomplished to date, I do have to agree with John Halamka who recently blogged "NHIN Direct is a powerful idea...a reference implementation for simple transport of data packages (X12, NCPDP, HL7 v2, CDA, CCR) among payers, providers and patients. NHIN Direct will assemble energetic, well intentioned people to create open source software that solves real world transport problems." I see NHIN Direct as another component to help fill the gaps of HIE, but am wary of the quick timelines proposed.  I am interested and look forward to participating to learn more. Living in the real world running Serendipity Health to deploy connected health care, I see that my state has gaps of infrastructure in rural areas to achieve the connectivity necessary.

I look forward to seeing the new Notice on Proposed Rule Making (NPRM) for Meaningful Use document after all comments are reviewed and resolved to allow us to begin deploying a Learning Health System and the HITECH Act Framework for Meaningful Use of EHRs." I don't envy those at ONC that will have to review all comments received for the NPRM and IFR. Having been involved with the comment compilation from various organizations and having reviewed many of the submissions myself from stakeholders, there are many diverse points of view that will have to be onsidered. It seems like a lifetime getting to this point, but I have hope after the HIMSS conference and am excited to have the opportunity to be a champion and leader while helping evangelize and deploy these initiatives in Tennessee and across the nation. Each state has different priorities and are in the process of developing plans for how best to distribute funding and as of March 15 all states have received funding to incrementally advance their initiatives.

My home state of TN has designated the Health information Partnership of Tennessee (HIP-TN) to collaborate with stakeholders from across the state to determine priorities and distribute the $24 million in recovery act grants funding for adoption, education and training. I look forward to continuing my participation on the technical work group for HIP-TN. I am also working in partnership with staff and committees of CareSpark in East TN which is one of Tennessee's  functional HIE's. I will be helping CareSpark with the technical deployment deliverables as required by some of the recent funding they have received from ONC and the Social Security Administration (SSA). I will also work with CareSpark to connect various providers, hospitals and public health in East TN and Southwest VA. I look forward to working with others in our state to determine the process and communicate the messaging to enable organizations to leverage buying power to be offered and reduce the total cost of ownership of goods and services to foster smarter buying practices that I will call strategic sourcing.  Much of what I have been responsible for demonstrating at HIMSS Interoperability Showcases since 2004 is finally starting to become reality and I am anxious to have the opportunity to use my previous experiences and knowledge to help our various stakeholders within TN and in other states as opportunities arise.  I truly want to help improve the health care outcomes for my family, friends and others in my community while learning along the way.  More to come as we traverse this year ahead...

IHE 2010 North America Connectathon

I wanted to share a bit about the IHE 2010 North America Connectathon that was held last week in Chicago, IL. I have been part of the IHE world since 2001 and during this tenure I have worn many hats. I was...

1. One of first Founding Planning Committee Co-Chair duties for the IT Infrastructure Domain
2. Founding Co-Chair for Interoperability Showcase Planning Committee
3. Sr. Director responsible for the North American Connectathon event along with RSNA who share the IHE USA secretariat duties. In addition, while at HIMSS, I was responsible for the IHE deployment activities for HIMSS Interoperability Showcases in North America, Europe, and Asia as well as the IHE International Secretariat duties for the four HIMSS sponsored domains:

• IT Infrastructure (ITI)
  
• Patient Care Coordination (PCC)
• Patient Care Devices (PCD)
• Quality, Research and Public Health (QRPH)

And now, I wear yet another hat of the User Stakeholder community in need of interoperable systems. As a Connectathon monitor this year, I am happy to report that I saw "meaningful use requirements" tested among systems using IHE profiles and HITSP Interoperability Specifications.

IHE Connectathons have been used by vendors to help develop interoperable HIT systems and by healthcare institutions and government-organized electronic health record programs around the world to design, test, acquire and implement such systems.  I look forward to seeing the scenarios demonstrating the support of  "meaningful use" at the 2010 HIMSS Interoperability Showcase to be held in Atlanta during the annual conference.

IHE national deployment organizations have been established in Australia, Canada, China, France, Germany, Italy, Japan, the Netherlands, Spain, the United Kingdom and the USA.  Regional deployment organizations are active in Europe and North America. 

I volunteered to help with monitor duties this year for the North American Connectathon and was assigned to be part of a team of monitors responsible for reviewing vendor compliance to the Patient Care Coordinaton (PCC) profiles. I was one of some 50 monitors led by 4 managers for the event. You will see me in my green jacket along with all the others wearing orange. Of note, my friend and partner, founding co-chair for both the showcases as well as the ITI Domain, Glen Marshall, is also in this picture (6th from the right/second row).

I do like to be unique, but this day I was not only being unique but also rebelling in support of our TN Football team who had just lost a coach the day before that made national news and the talk in Chicago.

While helping with monitor duties this past week, I had the opportunity to learn more about how Europe and Australia will be holding their own testing Connectathons and Projectathon (the newly coined term for Regional project based activities. One such example is what IHE Europe is helping epSOS with later this year). 

It was wonderful to learn how  these two countries along with many others continue to leverage the technical frameworks made freely available by IHE. Not many know that the IHE testing tools are actually a collection of open source offerings made freely available to all. 

This picture was taken of Charles Parisot, IHE Europe member representing GE Healthcare and Dr Vincent McCauley MB BS, Ph.D who is chair of IHE Australia. We discussed the various plans underway for live deployments and I provided Charles updated information for CareSpark who I am working with in my region.  CareSpark is a not-for-profit organization that has implemented an IHE/HITSP standards-based Health Information Exchanges (HIEs) that began in 2005 and is listed in the "Where in the World is XDS" google map along with deployments nationally and internationally across the globe. 

It  has been estimated that some 125 test per hour were reviewed by monitors during the week long event. I really enjoyed seeing many old friends this past week and meeting many new ones.  The Connectathon attendance was a record high this year and I continue to be inspired by all the hard work and support from all the organizations to ensure their systems are interoperable. I will be giving an update on the Connectathon events this week at the TN HIMSS Chapter meeting on January 21, 2010. I look forward to educating the stakeholders in my region as well as across the nation about what is available today and how one can leverage IHE profiles and testing tools to help test for deployment of "meaningful use" of connected healthcare. IHE members and volunteers continue to make a difference in health care today !  I look forward to seeing many of you at the HIMSS 2010 Interoperability Showcase in Atlanta in March.

The Uncanny Valley

As the new calendar year begins, Serendipity Health and I wish you and your family a happy, healthy 2010. At the same time, we thank you for being a part of our growing community of professionals interested in learning more about how health information technology can be leveraged. 2010 promises to be another important year in advancing technology to improve our overall healthcare system, and we look forward to continuing this journey with you and providing all the vital information you need to know.


I had the opportunity to see what is dubbed the most expensive movie ever made; Avatar which takes you to a spectacular world beyond imagination. James Cameron first wrote the script over a decade ago and tried to make the movie in 1995. He found that the technology did not exist to do what he wanted. Therefore, he patiently waited a decade until 2005 when it appeared more promising. In 2005, he started to try again and even invented a new performance capture technology to cross what is called the uncanny valley. James Cameron needed to make sure that his new technology could cross the chasm, known in robotics and animation as the uncanny valley. James Cameron worked with the best animators in the world and the movie has now reached over a billion dollars in sales.


Over the past 19 years of my career, I have experienced similarities with our healthcare reform. As we begin a new year, and as we contemplate our resolutions for 2010, let’s take a look at a few predictions from the past that led to innovation.


• In 1876, American president Rutherford B. Hayes told Alexander Graham Bell: “The telephone is an amazing invention, but who would ever want to use one?”


• In 1873, Sir John Eric Erickson, the Surgeon-Extraordinary to Queen Victoria, said: “The abdomen, the chest, and the brain will forever be shut from the intrusion of the wise and humane surgeon.”


• In 1949, mathematician John von Neumann said: “It would appear that we have reached the limits of what is possible to achieve with computer technology.”


Many inventions have taken several centuries to develop into their modern forms and are rarely the product of a single inventor's efforts. Every breakthrough is a collective effort that combines and tweaks already existing ideas and technology in novel ways. As James Burke said; “The easier it is to communicate, the faster change happens.” In 1985, Burke produced a 10-part series The Day The Universe Changed. Burke worried that computing and communications would increasingly be in the hands of expert elite, in the closing scenes of The Day the Universe Changed he instead suggested that a forthcoming revolution in communication and computer technology would allow people all over the world to exchange ideas and opinions instantaneously. With the launch of Microsoft’s first version of Windows 1.0, on November 20, 1985 and other subsequent events, such as the rise of popular access to the Internet, suggest he had been correct.


Inventions only become successful when they are not only needed, but when mankind is so far advanced in intelligence as to appreciate and to express the necessity for them, and to at once make use of them. Each invention may be just one small step on the road to the ultimate goal. I feel we must take baby steps, always moving toward our goal of interoperable health care. I agree with James Burke that the easier it is to communicate, the faster change happens.


Our nation is at the forefront of aligning the stars with monetary incentives to stimulate the adoption and meaningful use of the Electronic Health Record (EHR). The Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the Recovery Act of 2009 create a historic opportunity to improve the health of Americans and the performance of the nation’s health system through an unprecedented investment in health information technology (HIT). This initiative will be an important part of health reform as health professionals and health care institutions, both public and private, will be enabled to harness the full potential of digital technology to prevent and treat illnesses and to improve our nation’s health. The HITECH grants are specifically designed to work together to provide the necessary assistance and technical support to providers, enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of EHRs.


Meaningful Use has been a long time in the making, as those who have been in this industry as long as I can recall. I remember being required to read the Institute of Medicine’s (IOM) report entitled Crossing the Quality Chasm: A New Health System for the 21st Century while working for a major EHR vendor in 2001. The report stated that Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge. The formation of the Committee on the Quality of Health Care in America in June 1998 set our nation on the decade-long journey. They were charged with developing a strategy that would result in a substantial improvement in the quality of healthcare.


I know there are still gaps and obstacles ahead as not all stakeholders are incentivized to make the necessary changes to allow ubiquitous communication. A well respected friend and colleague of mine, Wes Rishel explained some of the pitfalls in his blog recently. I am hopeful that he is right in his statement that

“We expect that the incentive-bump will create a ripple of adoption of interoperable HIT. We hope the ripple will be a good-sized wave.”

Being an eternal optimist, I expect that this “good-sized wave” will carry us across the uncanny valley we are facing right now.


I continue to be inspired by ongoing work with members of Integrating the Healthcare Enterprise (IHE), who I have worked with for the past decade to profile many of the infrastructure standards to carry us along this wave. With the Healthcare Information Technology Standards Panel (HITSP) adoption of many of these standards, our nation now has a framework that will enable vendors and other stakeholders to start collaborating in new and innovative ways. I am further encouraged by those who are well on their way and will be showing meaningful use sooner rather than later as reference by another friend of mine John Halamka, in his blog this week. I am excited to see what innovations will come in the next decade of my career as I help stakeholders navigate the waters while riding the wave to help deploy connected healthcare with my friends and family close by.