|Subject:||RE: [ihc] RE: "state of the art" in medical records sharing|
|From:||Elkin, Peter L. M.D. (Elki...@mayo.edu)|
|Date:||Sep 6, 2006 10:59:44 am|
My summation of your comments is: It is one thing to walk a mountain, it is another entirely to conquer the same mountain.
I agree and believe that a more formal method for knowledge representation and a set of standards built on a common data infrastructure to address organizational and workflow issues is where we need to head. These have more to do with the success of an implementation than the technical details of the systems design.
I have a meeting Friday with Brett and John and I hope that the output of that discussion points a direction toward these goals.
It is great to have your expertise included in the thinking which drives this work.
With warm regards,
Peter L. Elkin, MD Professor of Medicine Mayo Clinic College of Medicine (507) 284-1551 Fax: (507) 284-5370
From: David RR Webber (XML) [mailto:dav...@drrw.info] Sent: Wednesday, September 06, 2006 12:13 PM To: Elkin,Peter L. M.D. Cc: 'Patrick Gannon'; dda...@himss.org; 'fult...@coltsnecksolutions.com'; 'Rex Brooks'; 'Brett Trusko'; ih...@lists.oasis-open.org; 'John Madden' Subject: RE: [ihc] RE: "state of the art" in medical records sharing 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.
-------- 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
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 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.
At 5:21 PM -0500 8/11/06, Elkin, Peter L. M.D. wrote: >David, > >It makes sense to me. I think we need to pull together a face to >face meeting to broach these issues in a serious way. We might >start with the HITSP use cases and see where we feel OASIS does a >better job than other available standards, or where there is a >crying need for new standards development. > >Warm regards, > >Peter > >Peter L. Elkin, MD >Professor of Medicine >Mayo Clinic College of Medicine >(507) 284-1551 >Fax: (507) 284-5370 > > From: ihc-return-3-elkin.peter=mayo...@lists.oasis-open.org >[mailto:ihc-return-3-elkin.peter=mayo...@lists.oasis-open.org] On >Behalf Of Brett Trusko >Sent: Friday, August 11, 2006 4:52 PM >To: 'David RR Webber (XML)'; ih...@lists.oasis-open.org >Cc: 'Patrick Gannon'; dda...@himss.org >Subject: [ihc] RE: HIMSS / internet2 and OASIS IHC? > >Hi David, > >I will be chatting with everyone next week. I am on the road this >week but should be able to coordinate something starting next Wed. > >Best, > >Brett > > From: David RR Webber (XML) [mailto:dav...@drrw.info] >Sent: Tuesday, August 08, 2006 2:28 PM >To: ih...@lists.oasis-open.org >Cc: Patrick Gannon; Brett Trusko; dda...@himss.org >Subject: HIMSS / internet2 and OASIS IHC? > >Folks, > >I circulated the announcement below this week and asked the question >- where does OASIS fit in the puzzle here? > >At first brush - the notion is that HIMSS is the owner of the >business domain needs, I2 folks understand the network and bit and >byte layer, while OASIS sits in between providing the facilitation >mechanisms that reach up to the business users ultimately. > >Well in talking with Didi (Blanca) Davis today who is Director, >Integrating the Healthcare Enterprise at HIMSS seems like this could >be fitting together quiet nicely. > >HIMSS next steps is to form working groups with I2 folks to start >defining the USE CASES. > >At that point they will then solicit input and feedback and we can >start figuring out how our OASIS works fits into the equation - and >what we can do today and what new enhancements we need to >accommodate HIMSS / I2<http://era.nih.gov/> next generation >capabilities? > >My suggest is that IHC is the ready-made TC on the OASIS side that >can take ownership of that process and be the conduit between the >other OASIS TCs and HIMSS / I2. > >Does everyone concur? > >If so - then of course - those interested can involve themselves >more deeply in the HIMSS / I2 use case development - but otherwise I >think this is a good plan for now. > >I've CC:d Didi here so she has our PoC information. > >Thanks, DW > > >FYI > >Focused on Creating an Advanced and Interoperable Medical Network, >HIMSS and Internet2 Announce Collaboration > >The two organizations will leverage each other's expertise to >explore the viability of an independent and logically interconnected >medical network in the United States > > > >CHICAGO, Ill. and ANN ARBOR, Mich. - August 1, 2006 - The ><http://www.himss.org/>Healthcare Information and Management Systems >Society (HIMSS) and <http://www.internet2.edu/>Internet2 announced >today that the two organizations have created a partnership to >explore the development of a secure, reliable and advanced >networking solution for the transmission of medical information, >messages and images throughout the broad healthcare industry. > > > >The two organizations are exploring a new network designed to offer >the health sciences and healthcare sectors a private and secure >medium for exchanging health information. A next-generation >architecture built to meet federal regulatory requirements, this new >network may also have value to offer in the work of the Nationwide >Health Information Network (NHIN). > > > >This ground-breaking collaboration is a natural extension for both >not-for-profit organizations. Through a membership of 20,000 >individuals, 45 chapters, and more than 300 corporations >representing millions of employees, the HIMSS mission focuses on the >betterment of healthcare through the most effective use of >information technology and management systems. Internet2, the U.S.'s >advanced networking consortium led by 208 U.S. university members in >partnership with over 100 industry and government members, works to >develop and deploy advanced networks, applications and resources. > > > >"HIMSS and our members look forward to this collaboration with >Internet2," said H. Stephen Lieber, HIMSS president/CEO. "The >synergies between HIMSS and Internet2 brought our organizations >together to consider and evaluate the feasibility of establishing a >network that would meet the evolving needs of the biomedical and >healthcare delivery community." > > > >Since 1999, Internet2 has operated an advanced nationwide network >that supports leading-edge Internet technology development for the >research and academic community. Internet2 recently announced a >major upgrade to this network to provide members 10 times the >capacity and speed of its current infrastructure. In addition, the >Internet2 community has successfully developed important middleware >technologies to address critical issues in authentication and >authorization in order to enable active privacy management. Through >this partnership, HIMSS and the Internet2 community will work >closely together to leverage these leading-edge technologies to >explore development of brand new capabilities that meet the specific >security and privacy needs of the healthcare industry. > > > >"The research and education community has long understood the >potential for leveraging advanced Internet technology to enhance the >healthcare industry's ability to serve the public's needs, to >improve the flow of information for research, to streamline care >processes and to enable cost savings," said Douglas Van Houweling, >Internet2 president and CEO. "Our partnership with the HIMSS >community is a major step forward in realizing this vision. Together >we will work to create a new state-of-the-art platform for >biomedical research, education and clinical practice on a national >scale." > > > >Through the partnership, four working groups have been established >to explore the requirements and capabilities needed to create an >advanced medical network during the next year. HIMSS and Internet2 >will join each other's organizations. Members of both organizations >will also join each of the four working groups, which include: > >o Identity Management that will allow the identification and >authentication of individuals regardless of their physical location. > >o Privacy & Security that will focus on the tools and >techniques that will assure the privacy and security of the >information that travels on the network. > >o Biomedical (Health Sciences and Healthcare) Education that >will focus on meeting the unique needs and accessing the resources >required for biomedical education. > >o Telehealth that will focus on the implications for clinical >practice when a reliable advanced network is available. > > > >In addition, members of both organizations will work for the >development and implementation of the network with other >partnerships and collaborations, including Integrating the >Healthcare Enterprise (IHE). > > > >About HIMSS >The Healthcare Information and Management Systems Society (HIMSS) is >the healthcare industry's membership organization exclusively >focused on providing leadership for the optimal use of healthcare >information technology (IT) and management systems for the >betterment of healthcare. > > > >Founded in 1961 with offices in Chicago, Washington D.C., and other >locations across the country, HIMSS represents more than 20,000 >individual members and over 300 corporate members that collectively >represent organizations employing millions of people. HIMSS frames >and leads healthcare public policy and industry practices through >its advocacy, educational and professional development initiatives >designed to promote information and management systems' >contributions to ensuring quality patient care. > > > >About Internet2 >Led by more than 200 U.S. universities, working with industry and >government, Internet2 develops and deploys advanced network >applications and technologies for research and higher education, >accelerating the creation of tomorrow's Internet. Internet2 >facilitates the kinds of dynamic partnerships among academia, >industry, and government that helped foster today's Internet in its >infancy. For more information about Internet2 network capabilities, >visit <http://networks.internet2.edu/>http://networks.internet2.edu. > > > >For more information, contact: >HIMSS >Joyce Lofstrom, MS, APR >Manager, Corporate Communications >312-915-9237 - <mailto:jlof...@himss.org>jlof...@himss.org > > > >Internet2 >Lauren Rotman >Manager, Public Relations >202-331-5345 - <mailto:lau...@internet2.edu>lau...@internet2.edu > > > > >--------------------------------------------------------------------------- ---- >This message and any included attachments are from Siemens Medical Solutions >USA, Inc. and are intended only for the addressee(s). >The information contained herein may include trade secrets or privileged or >otherwise confidential information. Unauthorized review, forwarding, printing, >copying, distributing, or using such information is strictly >prohibited and may >be unlawful. 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