1. Today: Free Public Forum on HIT National Policy with David Blumenthal – Thursday, 8am-noon (www.hitpublicforum.com)
The Public Form on HIT National Policy is hosting a free conference this morning (it is starting right now!) with a great lineup of speakers, including David Blumenthal, the National Coordinator for Health IT, Marc Overhage, Director of Med Informatics at Regenstrief Institute, Aneesh Chopra, US Chief Technology Officer at the White House, and several others. Registration is free and the entire event will be webcasted. Blumenthal speaks from 9-9:30am. Content will be available online for 6 months…
2. Free OpenMRS Developer Training Week starting Feb 8
The Regenstrief Institute at Indiana University, the developers of OpenMRS, the popular open-source medical record system, are hosting a free week-long training session at IU beginning Monday, Feb 8. Most of the event will be webcasted. For more details: http://openmrs.org/wiki/OpenMRS_Developer_Training_Week_8-February-2010
3. Health Affairs February Issue on e-Health in the Developing World
This month’s Health Affairs issue is focused on e-health in the developing world, and includes articles on “An Agenda For Action On Global E-Health”, “e-Health Technologies Show Promise in Developing Countries”, and others on cell phones, EMR, informatics, and more.
http://content.healthaffairs.org/content/vol29/issue2/
Categories: Uncategorized
Tagged: aneesh chopra, david blumenthal, developing world, e-health, Health Affairs, openmrs, policy, regenstrief
Paul Farmer testified yesterday before the US Senate Committee on Foreign Relations regarding the work he and Partners in Health are doing to rebuild Haiti.
He opened: “Today, my hope is to do justice to Haiti not by chronicling the events of the past two weeks, which are well known to you, but by attesting to the possibility of hope for the country, and of the importance of meaningful investment and sustainable development in Haiti. That said, I will not pretend that hope is not at times difficult to muster.”
“In my role as the UN Deputy Special Envoy for Haiti, as well as from my long-standing homes at Partners In Health and at Harvard, I have witnessed the many varieties of privation endured by Haiti as well as the country’s extraordinary resilience. But in more than twenty-five years of working there, I have never seen devastation or suffering on this scale. The response from our community has been equally immense: acts of great courage within Haiti, and of great generosity beyond it.
“I know that Haiti can and will recover. I believe that there is an opportunity to build Haiti back better. I am convinced that it will require a massive and ongoing commitment on all of our parts, and that the road will be a long one. We are fortunate to have many partners in this effort, in addition to the five thousand employees of Zanmi Lasante: my colleagues now joining them in Haiti, many of whom have been sharing updates with us and with you; the extraordinary team in Boston; the legions of PIH supporters, old and new, as well as our organizational partners and our colleagues at the Clinton Foundation and the UN. Together, we are all working to serve the people of Haiti, especially those marginalized by chronic poverty as well as the acute insult (to use medical terms) of January 12.”
Read the full script of Paul Farmer’s testimony: http://standwithhaiti.org/haiti/news-entry/pih-co-founder-paul-farmer-testifies-at-senate-foreign-relations-committee/
Categories: Uncategorized
Tagged: build, haiti, paul farmer, un special envoy, zanmi lasante
President Obama delivered his first State of the Union Address last night. The Presidential blog at www.whitehouse.gov/blog has an excellent summary of all the initiatives Obama announced and the entire 90 minute video. The full script is also available at http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address.
I am going to highlight just a few initiatives that are particularly important to me:
- 3-year federal budget freeze – Beginning in 2011, Obama has called for a 3-year federal budget freeze that applies to everything but defense, Medicare/Medicaid, and Social Security. He claimed that without true health reform, it would be impossible to freeze spending on health.
- Financial reform package – use the Stimulus bank bailout money that banks are repaying to go towards funding small business loans; create a small business tax credit; eliminate all capital gains taxes on small businesses (the latter 2 received bipartisan clapping while imposing a fee on large banks to repay the stimulus bailout is not supported by republicans)
- College Financing Reform – this one is big! “To increase college access and completion, the Administration will make student loans more affordable by limiting a borrower’s payments to 10 percent of his/her income and forgives remaining debt after 20 years – 10 years for public service works. We will also make permanent the American Opportunity Tax Credit. The President urges the Senate to pass the American Graduation Initiative, which invests more than $10 billion over the next decade in reforming our nation’s community colleges, promoting college completion, and moving toward the President’s goal of having the highest proportion of college graduates in the world by 2020. The President is also asking colleges and universities to do their share to make college affordable for all Americans cutting their own costs.”
- Health IT – despite all the political action surrounding health IT right now (and a good amount of talk for and against it), this was not mentioned at all
- Nuclear Power Plants – FINALLY the government is going to pave the way to open up some more power plants, after a 30-yr hiatus
- Changing the way the government does business – The administration is going to continue with lobbying reform, increasing government transparency, and creating a public “earmarking” database so that the public can see what budget amounts have been earmarked for certain purposes. To see how serious this administration is about transparency, check out www.data.gov. For a very specific example, I have been able to call into every workgroup meeting and download the materials related to the Office of the national Coordinator’s work on meaningful use and the HITECH Act. Here’s the schedule: http://singularityblog.wordpress.com/2010/01/11/upcoming-hit-policy-standards-committees-workgroup-meetings/
Also, a few quotables:
- And what the American people hope -– what they deserve -– is for all of us, Democrats and Republicans, to work through our differences; to overcome the numbing weight of our politics. For while the people who sent us here have different backgrounds, different stories, different beliefs, the anxieties they face are the same.
- It’s because of this spirit -– this great decency and great strength -– that I have never been more hopeful about America’s future than I am tonight. Despite our hardships, our union is strong. We do not give up. We do not quit. We do not allow fear or division to break our spirit. In this new decade, it’s time the American people get a government that matches their decency; that embodies their strength.
- To recover the rest, I’ve proposed a fee on the biggest banks. Now, I know Wall Street isn’t keen on this idea. But if these firms can afford to hand out big bonuses again, they can afford a modest fee to pay back the taxpayers who rescued them in their time of need.
- Now, let’s clear a few things up. I didn’t choose to tackle this issue to get some legislative victory under my belt. And by now it should be fairly obvious that I didn’t take on health care because it was good politics. I took on health care because of the stories I’ve heard from Americans with preexisting conditions whose lives depend on getting coverage; patients who’ve been denied coverage; families –- even those with insurance -– who are just one illness away from financial ruin. After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans…Here’s what I ask Congress, though: Don’t walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let’s get it done.
- for the first time in history –- my administration posts on our White House visitors online. That’s why we’ve excluded lobbyists from policymaking jobs, or seats on federal boards and commissions.But we can’t stop there. It’s time to require lobbyists to disclose each contact they make on behalf of a client with my administration or with Congress. It’s time to put strict limits on the contributions that lobbyists give to candidates for federal office. With all due deference to separation of powers, last week the Supreme Court reversed a century of law that I believe will open the floodgates for special interests –- including foreign corporations –- to spend without limit in our elections. I don’t think American elections should be bankrolled by America’s most powerful interests, or worse, by foreign entities. They should be decided by the American people. And I’d urge Democrats and Republicans to pass a bill that helps to correct some of these problems.
- In the end, it’s our ideals, our values that built America — values that allowed us to forge a nation made up of immigrants from every corner of the globe; values that drive our citizens still. Every day, Americans meet their responsibilities to their families and their employers. Time and again, they lend a hand to their neighbors and give back to their country. They take pride in their labor, and are generous in spirit. These aren’t Republican values or Democratic values that they’re living by; business values or labor values. They’re American values.
Categories: Uncategorized
Tagged: barrack obama, education reform, financial reform, health IT, health reform, nuclear power, state of the union address, transparency
The Privacy and Security requirements of the recently released Meaningful Use NPRM and Certification IFR have received a lot of attention due to their lack of definition. I joined in on the Jan 22 ONC Privacy & Security Workgroup meeting to discuss which topics the workgroup will comment on and send to the HIT Policy Committee. The topics included risk assessments, the phrase “implement security updates as necessary”, HIPAA investigations, privacy and data transparency, and “consumer preference”.
- Risk assessments – There is still a lot of concern about the lack of clarity surrounding risk assessments. The ONC will need to ensure that education on risk assessments is available, especially targeted at small providers. Most organizations currently think they are HIPAA compliant, but few would feel comfortable if the government performed a HIPAA audit, because there is no guidance as to what the government would audit against. Guidance is needed on the “intended outcomes” of MU Security objective and greater transparency, such as Audit Program Compliance Guidelines, is needed on the audit process that will be used. It is unlikely that any guidance will be available by the time the final rulings are released. Large organizations commonly perform internal or 3rd party security/privacy audits, but this is rare (and not feasible) among smaller providers. Many of the comments related to this topic will not change the objective but how the ONC responds to the need for additional information.
- “Implement security updates as necessary” – The term “updates” is both a technology (i.e. software update) and business process (i.e. modify password policy) term, and its intended meaning (whether one or the other or both) should be clearly stated. Time requirements were discussed, such as software security patches must be updated within 90 days of release, but this was thrown out due to complications of implementing updates, especially in enterprise settings.
- HIPAA Investigations – ~5k HIPAA investigations are currently underway. Unclear if these are ~5k different hospitals, individual doctors, multiple investigations per entity, etc. Unclear if an open investigation will prevent an eligible professional or hospital from receiving incentive payments. The “expected” length and cost of investigations will be important to allow providers to make informed decisions. Unclear which HIPAA investigation types are relevant to MU.
- Privacy and Data Transparency – No objectives or measures for privacy and data transparency are present in Stage 1. The Committee wants to propose these for Stage 2. “Accounting of disclosures” is included in Stage 1 and is already required by HIPAA. The connection between the security/certification piece and the MU/privacy piece is weak. For example, the capability to prevent many breaches is a part of certified EHR, but there are no objectives or measures to guide providers in the use of these certification criteria.
- “Consumer-preference” – Also referred to as “patient-choice” requirements, consent management, or access control. There was some disagreement as to what the proper language was to discuss patient preference. Dixie Baker, who is also involved in the Security Standards Workgroup, posted a presentation (available on the ONC website), to address Access Control and its relation to privacy. There is no IFR criteria for access control to help entities manage the patient consent requirement with which they must comply. This discussion was cut short due to time and will probably be completed in private conversation.
Refer to my previous post to join in on future workgroup meetings: http://singularityblog.wordpress.com/2010/01/11/upcoming-hit-policy-standards-committees-workgroup-meetings/
Categories: Uncategorized
Tagged: Certification, HIPAA, meaningful use, NPRM, objective, ONC, policy committee, privacy, risk assessment, security, transparency
i’m a big fan of virtual assistants (VAs). a VA is a temporary worker that provides administrative assistance remotely. i originally learned about them from the 4-hour Work Week by Timothy Ferriss (which i highly recommend if you haven’t read it!). my goal was to maintain my same level of productivity while reducing my personal workload, but what ended up happening was an increase in productivity with an equal or greater workload. this wasn’t a bad outcome, but just not the one that i was going for, and that’s why I stopped using the service. it may be possible to achieve similar productivity levels and a reduced workload using a VA, but it would take more experimentation.
I used www.taskseveryday.com for 7 months total. my VA worked midnight to 4am EST 5 days per week at a cost of $6/hr. i assigned a variety of tasks, from voice transcriptions, conversion of scanned pages to word documents, conversion of photos of whiteboards to powerpoint presentations, research on contacts, screenshots of websites, and sending the occasional email. The skill of each VA varies and your ability to use them greatly depends on who you get. I recommend hiring more than one from different companies, assigning the same tasks for a variety of needs, and keeping the best one. you can only do this because it is inexpensive (i’ve seen as cheap as $4/hr).
The best thing I setup was taking pictures of my whiteboard from my phone using an application called Evernote, which immediately synced the photo to the internet to a website that my VA accessed every day first thing (using Evernote’s “publish to RSS” feature). He converted these to powerpoints and sent them back to me. In addition, I regularly asked my VA to send me 1-2 pages of summaries of a person I planned on contacting, including a photo, location, bio, publications, work history, etc. Kind of stalkerish, but cool. Converting scanned documents to word documents is also straightforward and was very helpful for me, since I keep almost all of my materials digital so that they are indexed and searchable. I also asked for someone that had an understanding of basic web programming, excel, databases, but my VA definitely did not. I recommend making VERY HIGH demands when you explain what you are looking for, and ensure that your VA has several years of real experience. If you don’t make big demands, they’ll give you on of the lesser trained guys. Make sure you talk to your VA on the phone before you commit. Your VAs english is going to have to be very good if he is going to help setup appointments, respond to emails, etc. I didn’t trust mine with this, but it could work if you got the right one.
I would recommend writing out a list of specific tasks that you want to have accomplished, enough to fill up about 75% of the VAs time for the first month. When you actually assign a task, each “assignment” should convey exactly what you are asking (usually in bullet points), desired format (e.g. Google Doc, Word Document), with specific instructions of the desired output, often with a template (what should each page of the word document look like, what info should it include, etc.).
i would love to hear about other peoples’ experience using VAs, especially if you have any specific tasks that worked extremely well (like the whiteboard -> powerpoint conversion for me).
Categories: Uncategorized
Tagged: virtual assistants
Thanks to Obama’s transparency policies, most of the ONC committee meetings are open to participation from the public. The links to the right of each workgroup provides audio (listening only) and video. Call 1-877-705-2976 for voice only and the opportunity to talk.
Categories: Uncategorized
Tagged: HIT, ONC
This morning, the Office of the National Coordinator for Health IT has released the Interim Final Rule on the Meaningful Use definition. How this document can be both “interim” and “final” is beyond me, but that’s the language being used right now. There will be a 60 day commenting period followed by revisions before the final report is published. The Meaningful Use criteria dictates how providers must modify their electronic medical record systems by 2011 in order to receive additional reimbursement through Medicare/Medicaid.
The full report is available at the federal register here: http://www.federalregister.gov/OFRUpload/OFRData/2009-31216_PI.pdf
Categories: Uncategorized
Tagged: hitech, meaningful use, ONC
The Gates Foundation funded a recently published study on Health Information Systems (HIS) in the Developing World. It includes overviews of HIS in 19 countries, including Uganda, Bangladesh, Haiti, India, Mexico, Kenya, and many more. Would love to hear everyone’s thoughts…
Categories: health information technology
Tagged: developing countries, gates foundation, health information systems
