atom feed5 messages in org.oasis-open.lists.ihcRE: [ihc] RE: "state of the art" in m...
FromSent OnAttachments
David RR Webber (XML)Sep 6, 2006 10:12 am 
Elkin, Peter L. M.D.Sep 6, 2006 10:59 am 
Rex BrooksSep 6, 2006 11:35 am 
David RR Webber (XML)Sep 6, 2006 11:57 am 
David RR Webber (XML)Sep 7, 2006 6:05 am 
Subject:RE: [ihc] RE: "state of the art" in medical records sharing
From:David RR Webber (XML) (dav@drrw.info)
Date:Sep 6, 2006 10:12:52 am
List:org.oasis-open.lists.ihc

Peter,

Having worked long on HL7 in the past - I can understand how stakeholders cling to their existing systems, hewn from solid rock with bare hands and a chisel as they are.

It is also very intimidating to perview that mountain in itself.

And then there is the caBIG initiative which is throwing yet more high tech at the problem space.

What I see at this point in the game is that IT is not the answer nor Holy Grail that will make all the issues in healthcare go away.

I'm glad you mentioned results orientated accounting too. I see nurses paid by the hour resulting in fragmented patient care - where one nurse handles 8 cases per shift and another only 1, barely. And management is powerless to redress these inequities in the current environment - or deliberate exploiting of systems that do not reward good quality work as they should.

IMHO - if IHC is to have some measure of impact here - then we need to first decide exactly what solution set we are going to able - and the problem space it is designed to solve. I see the great work that IHE/XDS is doing by focusing on one area and attainable goals.

Of information interoperability is a speciality area for me - and the OASIS CAM work in a point in case. However - medical information - with mixed content and media - XML, handwritten notes, X-Rays and imaging - is something that resists traditional IT fixed bounded processing - as you so well described.

Perhaps - just defining those aspects that will be agreed to and bound - and those that will not - and the mechanisms to manage and exchange the "not" parts - is one possible integration path?

Although again - this is all so familiar terroritory - traversed by DICOM and more - before us.

???

DW

-------- Original Message -------- Subject: [ihc] RE: "state of the art" in medical records sharing From: "Elkin, Peter L. M.D." <Elki@mayo.edu> Date: Wed, September 06, 2006 11:56 am To: "'fult@coltsnecksolutions.com'" <fult@coltsnecksolutions.com>, 'Rex Brooks' <re@starbourne.com>, 'Brett Trusko' <bret@oasis-open.org>, "'David RR Webber (XML)'" <dav@drrw.info>, ih@lists.oasis-open.org, 'John Madden' <john@duke.edu> Cc: 'Patrick Gannon' <patr@oasis-open.org>, dda@himss.org

Dear Fulton,

I am intimately familiar with the debate. For me the issue rests with the ideas of coverage and meaning. From an Ontological perspective neither organization has an adequate set of upper level Ontologies. Level one Ontologies being things that are true about the whole world (domain independent) or Level two Ontologies which are the high level constructs / models in the domain of interest. In both cases a consistent set of domain models has been substituted for common messaging (although the VHA proposes to remedy this under the new redo of Vista).

Instead both organizations work on Interoperability using a combination of messaging and the use of controlled terminologies. Here is where the differences become more apparent. In the DOD systems they use Medcin which is a precoordinated terminology. In a recent study published in the Mayo Clinic Proceedings, we showed that only 51.4% of the problems commonly seen at Mayo could be covered by a pre-coordinated terminology. This is similar to the 58% coverage identified in the LSVT trial. However post-coordinated terminologies could cover 92.3% of the same problem list (p<0.001). The VHA understands the need for understanding not just what few options you give a clinician to pick from (e.g. on a drop down codified pick list), but also in the rich narrative associated with the descriptions of the patients' conditions. This will provide us with the opportunity to perform quality management, pay for performance, and will allow us to learn from our practices.

Both organizations have contributed greatly to health IT, and I believe that a truly interoperable specification for recording and transmitting clinical data will be of great benefit to patients. The OASIS IHC being unencumbered by legacy designs stands in a perfect position to deliver this result.

With warm regards,

Peter

Peter L. Elkin, MD Professor of Medicine Mayo Clinic College of Medicine (507) 284-1551 Fax: (507) 284-5370

-----Original Message----- From: Fulton Wilcox [mailto:fult@coltsnecksolutions.com] Sent: Wednesday, September 06, 2006 9:40 AM To: 'Rex Brooks'; 'Elkin, Peter L. M.D.'; 'Brett Trusko'; 'David RR Webber (XML)'; ih@lists.oasis-open.org Cc: 'Patrick Gannon'; dda@himss.org Subject: "state of the art" in medical records sharing

As a publicly accessible benchmark, the differences of opinion between the U.S. Veterans Affairs medical records proponents and the Department of Defense's vigorous defense of its AHLTA system are probably indicative of things to come as more large healthcare systems get "mated" for information exchange. Presumably this relationship will get sorted out, but it is interesting to contemplate the n-way debates that are likely to occur as many major and minor healthcare data originators and consumers start to integrate.

The VA side (and the VA has been riding has some public "halo effect") doesn't like AHLTA's architecture and skimpy coverage (mostly outpatient data, not inpatient), and the AHLTA proponents don't like the VA's less than standardized vocabularies and supposedly less than adaptable (to DOD's needs) architecture. The GAO seems to be mostly on the VA's side. See http://www.gao.gov/htext/d06794r.html .

See http://www.military.com/features/0,15240,111127,00.html for the full text and related discussion of the report - "Health Data Bottleneck Tom Philpott | August 25, 2006, DoD Medical Records Seen as Hurdle for VA Health Care (a portion shown below).

The barriers to attaining "seamless" health data exchanges still look pretty high.

Fulton Wilcox Colts Neck Solutions LLC

"William Winkenwerder Jr., assistant secretary of defense for health affairs, took time during an Aug. 23 teleconference with journalists to tout his department's ability to transfer electronically the medical records of separating service members to the Department of Veterans Affairs.

In doing so, Winkenwerder ignored a rising chorus of critics who say AHLTA, the Department of Defense's digitalized medical record system, is a problem for the VA and for veterans because, in fact, it doesn't allow electronic record transfers outside the military network.

The critics include the Government Accountability Office, senior VA officials and, most recently, the chairmen of the both the House and Senate veterans' affairs committees.

GAO reported last month that the biggest obstacle remaining for severely wounded troops to experience "seamless transition" from military care to VA trauma centers is the inability to transfer AHLTA records."

-----Original Message----- From: Rex Brooks [mailto:re@starbourne.com] Sent: Friday, August 11, 2006 8:28 PM To: Elkin, Peter L. M.D.; 'Brett Trusko'; 'David RR Webber (XML)'; ih@lists.oasis-open.org Cc: 'Patrick Gannon'; dda@himss.org Subject: RE: [ihc] RE: HIMSS / internet2 and OASIS IHC?

Hi Peter, David, et al,

This also sounds good to me, too.

Regards, Rex

-- Rex Brooks President, CEO Starbourne Communications Design GeoAddress: 1361-A Addison Berkeley, CA 94702 Tel: 510-849-2309