Goodbye to 2011 - A Recap of the Year's Events - Part 1

As 2011 washes into history making way for 2012, I want to send my warmest and most sincere wishes for a Healthy, Happy and Most Blessed New Year in 2012 for all. 

I entered 2011 finishing up my duties as Interim CEO for CareSpark.  I have had the pleasure of working with CareSpark since 2005 first as a volunteer and then starting in 2009, I contracted to provide strategic and technical services in support of their implementation of the Nationwide Health Information Network (NwHIN), the SSA Sponsored Project as well as a limited CMS pilot with three HIE's. 

Unfortunately, CareSpark made the decision to close and announced it in July 2011.  I had really hoped that the community would be able to come together to move the services forward under the CareSpark umbrella.  I am still busy running my business, Serendipity Health, LLC, that has provided full time employment for me this year for which I am grateful.  It has been quite some time since I have posted, so I will start this first post of the year giving you a recap of some of the highlights that I experienced in 2011.  

In January 2011, I had the opportunity to volunteer my time as one of the IHE North American Connectathon monitors helping grade/evaluate vendor tests for various Integrating the Healthcare Enterprise (IHE) profiles. Over 4000 tests were completed by over 450 health IT system engineers.  These engineers represent over 100 HIT organizations who had the goal of testing interoperability and working to fine tune their implementations in over 150 products to meet the requirements of the various IHE International profiles. These same profiles make up components of the many NwHIN and Meaningful Use standards. This group picture is of all the monitors that worked together to pull off the grand task of grading the over 4000 tests over the one week event.

January in Chicago is not my favorite place to be, but I feel honored that I was asked to help and gladly volunteered my time to help the healthcare industry with this worthwhile effort. The event this year will be held January 9-14, 2012.  

In February 2011, I attended the Healthcare Information Management and Systems Society (HIMSS) Annual Conference along with some 30,000+ other attendees. The week started with me being one of the presenters at the Interoperability Workshop held early in the week.  My contribution to the agenda was to wrap up the workshop with the overview of US relevant standards including NwHIN and The Direct Project that are required for providers to implement Meaningful Use. The workshop sold out attendance and was very interactive for all attendees. I shared the presenter duties with Lee Jones, Keith Boone, and Bob Yencha.   

The week was full of activities and networking. Steve Leiber and David Blumenthal presented to a standing room only audience at the HIMSS Interoperability Showcase.  The next several topics were all included in the Showcase which was the largest ever at nearly one acre in size.  It had all the typical areas represented as well as the area hosted by Office of the National Coordinator (ONC) showing approximately 40 demonstrations highlighting how health practitioners are securely exchanging health data between doctor's offices, hospitals, benefit providers, government agencies and with other health organizations, all across America.  I am happy to report that two stations within the ONC area, showcased some of my contracted endeavors from 2010 through 2011.  

The AmeriHealth Mercy and Independence Blue Cross station showcased the initiative created by both organizations that gives health care providers better access to health plan information and improves the quality of member care.  I am proud to have been involved in a small way with this innovative way of leveraging the standards by various stakeholders focusing on two use cases - sharing medication information and hospital admission through secure patient portals, provider portals, and HIEs.

The second station that I was involved with was one of eight pilots demonstrating the use of Direct Project specifications.  I have been involved with the Direct Project since it's launch in March 2010. This demonstration illustrated the feasibility of utilizing the Direct Project constructs to enable secure messaging between a federal agency (Veterans Affairs), and a regional health information exchange network (CareSpark). This demonstration showed the secure, standards-based transmission of a referral for mammography from a VA medical center to a private sector provider clinic, and the reply from the private sector provider clinic with a text based report. 

This CareSpark pilot demonstration  transitioned to the Health Information Partnership for Tennessee (HIP-TN) after the HIMSS conference and resulted in the delivery of live patient information in September 2011.  I feel very lucky to be managing the Direct Project strategy as well as the NwHIN Exchange onboarding and acting as the CTO contracted to HIP-TN both last year and now going into 2012.  I count my blessing each day and give thanks for the priviledge to help my own state and Keith Cox, CEO of HIP-TN with our go forward strategies to improve the healthcare quality while reducing the costs associated.  

Michael J. Fox was one of the keynote speakers and the DeLorean time machine used in the Back to the Future trilogy was on display on the showroom floor.  I had a good friend offer to take the picture of me in front of it. Yes, it is a bit silly, but I just had to when the offer was made.  Thanks Cliff...

One of the days there was a Tweetup of of us "technogeeks" in the HIT industry who showed to support the cause of outreach and education.  I finally got to meet up with some of the wonderful folks I have had the opportunity to work with over my 22 year career in HIT. 

I attended several events over the course of the week in Orlando at HIMSS, including the H.I.T. Men and Women Reception which toasts the art and inspired vision of today's most powerful healthcare IT leaders. I am honored to serve on the TN HIMSS Board with Michael Hollis who is the brainchild for this event. At HIMSS 2011, I was lucky enough to walk the red carpet with Michael and Antoine Aggasi both of which are working to advance interoperable healthcare. I am going to end this post update today since I have written quite a bit for your to digest and tomorrow morning will be here before i know it.  

I will give the update on the remainder of the year tomorrow so stay tuned for another post soon.  I have been asked by so many of my friends lately what I have been up to, so I share this with those who care. If you don't care, then you would not have read this far.  I promise to post more often this coming year and reconnect with many of you who I look forward to seeing and working with again in 2012.  Until next time.....

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!

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.

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!.

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.