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…

A very interesting post by Engin Erdogan on GOOD.is on presenting data: http://www.good.is/post/how-might-we-visualize-data-in-more-effective-and-inspiring-ways/.

I am organizing the 2009 Public Health & Technology Conference hosted by the Harvard School of Public Health on Monday, November 16, 2009. See more details and register at our website: www.hsph.harvard.edu/phat. The full announcement is below…

Hope to see you there!

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2009 Harvard Public Health & Technology Conference
Monday, November 16, 2009
Joseph B. Martin Conference Center at Harvard Medical School
www.hsph.harvard.edu/phat

Registration for the 2009 PHAT Conference is now open at www.hsph.harvard.edu/phat! This event will be held at the Joseph B. Martin Conference Center on Monday, Nov 16 and focuses on adoption of electronic health records, meaningful use, and patient empowerment. John Halamka, CIO of Boston CareGroup and Chair of the national HITSP Committee, and Adam Bosworth, Founder and CEO of Keas and former VP of Engineering at Google, will be speaking, along with David Cutler (Harvard Professor of Economics), Esther Dyson (23andme), Steve Lohr (NYTimes reporter on health and technology), John Moore (founder and president of Chilmark Research), Ashish Jha (HSPH associate professor of health policy & management), and others. Complete details are available on our website: www.hsph.harvard.edu/phat.

Standard registration is $75. Harvard faculty and staff is $20, and registration for full-time students is only $10. Tickets are limited, so register soon!

Please refer to our website or contact jpayne@hsph.harvard.edu for more information.

2 weeks ago I solicited help to put together a Health IT Ontology (see Components of HIT…a start). This post is the result of 6 rounds of edits. The new name, I think, better represents the goal of defining all the entities and relationships within the domain of health IT. Click on the image below to see it full size.

Following are the top-level categories:

• Health Information Technology
  • Clinical Information System
  • Hospital/Clinic Management
  • Consumer-Oriented Technologies
  • Public Health & Biosurveillance
  • Reference
  • Research
  • Regional & System-Level HIS

The initial motivation behind this was to determine where ART-focused EMRs sat in the scope of HIT, but what I expected to be a trivial exercise quickly became a difficult task. Health IT is an extremely complex and expansive domain and every item in this heirarchy could be broken down into even smaller pieces (similar to EMR/EHR). My goal for this diagram was to cover the breadth of health IT more than the depth. It is certainly possible that there are some oversights, in which case I would love to hear from you.

I welcome your thoughts, criticisms, and suggestions on the HIT Onthology. Using social media (esp. Twitter and Aardvark) was so successful this time around that I plan to pursue more online collaborative projects in the future.

Many thanks to everyone who contributed, and a special shout out to Jacob Sattelmair, Janette Heung, blog commenters, Richard Thall and Eddie from Aardvark, and the score of Twitterers who provided very valuable feedback!

Health information technology (HIT) is a broad and extremely complex field, and I want to visualize it. I’m going to need your help to do it. But first it needs defining…

HIT could simply be defined as any information technology utilized within the healthcare industry vertical, but that would be too inclusive, because that means a MySQL database is considered HIT because it is sometimes used in a hospital. Brailer & Thompson, former ONC Secretary and former HHS Secretary respectively, define it as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (Thompson & Braile, 2004). The line between HIT and health informatics is fuzzy and we’ll ignore it for now.

With this definition, I tried to create a hierarchical list of the types of health IT software. I want the list to be comprehensive in breadth and don’t care quite as much about depth (3 or 4 levels should be sufficient). There are dozens of ways to structure this list and probably hundreds of items I missed. This is a work in progress, so please leave a comment and let me know what you would change/add/remove. I’ll keep updating it until everyone feels good about it. After that comes the visualization…

A special thanks to the Twitterers that have already helped me on this: @chadosgood, @oneofthefreds, @ChristineKraft, @ePatientDave, @MedC2, and my good friend Jake. And a shout out to Sam Adam’s HIT Primer on his blog, IT (R)EVOLUTION, that helped get me started.

A few other helpful sources:

• Thompson & Braile, 2004
• Wikipedia: List of open source healthcare software
• Meaningful Use Matrix

I wanted to take this post to thank Cafe Luna and the many places like it that not only make my mobile work lifestyle possible, but also make it taste a lot better. Cafe Luna, just outside of Central Square in Cambridge, MA, is quickly becoming one of my favorites with free WI-FI, a great shot of espresso,  a suprisingly good lobster roll (right?), and even live music several times a week.

A few of my other favorites in Boston/Cambridge:

* Trident Bookseller – all types of teas, decent coffee with free refills, and a full menu with all-day breakfast (try the breakfast burrito); free WI-FI, like everything on Newbury

* Natural Bean Organic Coffee – also on Newbury; hands down the best cup of drip coffee I have had in Boston; just a few tables inside and out

* Flour – in the South End; no internet, but does it really matter when they make sticky buns as good as these? I think not. Plus, only 2 blocks from Orinoco, one of my favorite lunch or dinner restaurants around.

* Pete’s Coffee in Harvard Sq – the sticky buns aren’t quite as good as they are at Flour, but I haven’t found a better, more consistent cappuccino in the city; the park outside is also nice

Other suggestions? Leave it in the comments…

I never realized I was such a slacker next to President Bush. I was sent an article comparing the reading habits of Presidents Obama and Bush. Bush, it appears, had an ongoing competition with Karl Rove to see who could read the most and reportedly read nearly 2 per week (95 in 2006) during parts of his presidency. In April, Obama stated he is reading Joseph O’Neill’s novel “Netherland” and repeated it in a recent BBC interview, putting him at a pace of only 10 books per year.

While this isn’t a very accurate measurement of Obama’s commitment to reading–and I think we’d all rather him be leading our country!–I realized that I’m not doing much better. So, I committed to reading 1 book per week over the next year. I’m using my Book Log to help me track myprogress. Anyone else up for the challenge?

Here are the next few books on my lineup:

Follow me on Twitter @paynejd to receive links to SlideShare during the conference. I will post a summary when the conference is complete.

Here’s the agenda:

In addition, there will be several panels in the afternoon.

Over the past 2 weeks, David Blumenthal, the National Coordinator for Health IT and HHS announced members of the Health IT Policy and Standards Committees. Dr. John Halamka, author of Life as a Healthcare CIO and member of the policy committee, wrote about the committee’s first meeting on May 12, 2009.

The committee will focus on 6 priority areas:

• Meaningful Use
• Certification
• Infrastructure
• Privacy and Security
• Health Information Exchange
• Public Health

Of note, Blumenthal stated:

“This is the first time in history that Congress has acted to correct some of the market errors in the healthcare information technology industry.”

Blumenthal is referring to the fact that most people agree health IT can improve quality, but adoption remains low in part due to market failure. The major payers in healthcare, insurers, stand to save a lot of money but providers have to pay for the implementation of EHR, CPOE, etc.

The million dollar question is “What is meaningful use?” Under the ARRA, the federal government will increase Medicare/Medicaid reimbursement for providers with EHR implementations that meat meaningful use criteria. The National Committee on Vital and Health Statistics (NCVHS) convened a Hearing on Meaningful Use of HIT on April 28.  Entire agenda, transcript and slides are available online, including Dr. Blumenthal’s opening remarks. Blumenthal outlined 5 action points for the HIT Policy Committee to follow the NCVHS hearing:

1. Define meaningful use. This is an unprecedented task. The HIT Policy Committee will need to pick-up where NCVHS left off. ONC also has an internal group working on this.
2. Review certification, which is tied to meaningful use.
3. Infrastructure. Congress has allocated billions to accelerate industry adoption including extension centers, money to support information exchanges, training workers, training health professionals who will use these technologies and funding to states to help providers not eligible for Medicare/Medicaid payments.
4. Privacy and security. ONC will appoint a privacy officer
5. Public health and disease surveillance

The HIT Standards Committee also met on May 15. Whereas the Policy committee’s role is to define what standards are needed and how those standards will be implemented, the Standards Committee will actually cover certification criteria and specifications for information exchange and use of health information. The committee’s “8 guiding principles”:

• Technologies that protect the privacy of health information
• A nationwide health information technology infrastructure
• The utilization of a certified electronic record for each person in the US by 2014
• Technologies that support accounting of disclosures made by a covered entity
• The use of electronic records to improve quality
• Technologies that enable identifiable health information to be rendered unusable/unreadable
• Demographic data collection including race, ethnicity, primary language, and gender
• Technologies that address the needs of children and other vulnerable populations

Dr. John Halamka is the vice-chair of the HIT Standards Committee and posted an excellent summary of the meeting in his blog post: The First Meeting of the HIT Standards Committee.

Official HHS communication of committee posts is below.

——————————————————————————-

FOR IMMEDIATE RELEASE
Contact:  HHS Press Office
Friday, May 8, 2009
(202) 690-6343

HHS Announces Members of Committees That Will Advise on Implementation of Health IT Policy and Standards Committees Will Meet Next Week

The Department of Health and Human Services today announced the appointment of three members to the Health Information Technology (HIT) Policy Committee as well as members of the HIT Standards Committee. The two new federal advisory committees were established by the American Recovery & Reinvestment Act of 2009. The first meeting of the Health IT Policy Committee will be held on Monday, May 11 in Washington, D. C.

“The Policy and Standards committees bring together a wide diversity of key stakeholders to help guide the advancement of health IT as an integral part of health reform,” stated Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS and Chairman of the Policy Committee.  “It is an honor to lead one of these committees, and I am confident that these committees will provide valuable insight to help develop important health IT policy in the next few years.”

The HIT Policy Committee will make recommendations to the National Coordinator for Health Information Technology on a policy framework for the development and adoption of a nationwide interoperable health information infrastructure, including standards for the secure and private exchange of patient medical information.

The HHS appointees to the Policy Committee are:

David Blumenthal, MD, MPP,
National Coordinator for Health Information Technology, U.S. Department of Health and Human Services.

Michael J. Klag, MD, MPH
Dean, Johns Hopkins Bloomberg School of Public Health.

Deven C. McGraw, JD, MPH, Director
Health Privacy Project, Center for Democracy & Technology.

An additional 13 members were appointed by the Acting Comptroller General of the United States, and four members appointed by the Majority and Minority Leaders of the Senate and the Speaker and Minority Leader of the House of Representatives. A complete list of the Policy Committee members and information about the May 11th meeting can be found at http://healthit.hhs.gov/. The Presidential appointments from relevant federal agencies are expected to be announced prior to the HIT Policy Committee’s second meeting in June.

In addition, appointments were made to the HIT Standards Committee, also a federal advisory body, which is charged with making recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information.  The first meeting of this committee is scheduled for Friday, May 15, 2009.

Members appointed by HHS are:

Jonathan Perlin, MD, Chair
Healthcare Corporation of America

John Halamka, MD. Co-Chair
Harvard Medical School

Dixie Baker, PhD
Science Applications International Corporation

Anne Castro
BlueCross BlueShield of South Carolina

Christopher Chute, MD
Mayo Clinic College of Medicine

Janet Corrigan, PhD
National Quality Forum

John Derr, R.Ph.
Golden Living, LLC

Linda Dillman
Wal-Mart Stores, Inc.

James Ferguson
Kaiser Permanente

Steven Findlay, MPH
Consumers Union

Douglas Fridsma, MD, PhD
Arizona Biomedical Collaborataive 1

C. Martin Harris, MD, MBA
Cleveland Clinic Foundation

Stanley M. Huff, MD
Intermountain Healthcare

Kevin Hutchinson
Prematics, Inc.

Elizabeth O. Johnson, RN
Tenet Health

John Klimek, R.Ph.
National Council for Prescription Drug Programs

David McCallie, Jr., MD
Cerner Corporation

Judy Murphy, RN
Aurora Health Care

J. Marc Overhage, MD, PhD
Regenstrief Institute

Gina Perez, MPA
Delaware Health Information Network

Wes Rishel
Gartner, Inc.

Sharon Terry, MA
Genetic Alliance

James Walker, MD
Geisinger Health System

Representatives from relevant federal agencies will be named separately.
For more information about these committees, meeting dates and preliminary agendas please visit http://healthit.hhs.gov

Oh, the irony. The first PHAT Conference postponed due to the H1N1 virus.

At 10:58pm on Thursday, April 30, the Harvard School of Public Health sent the following notice:

Classes are cancelled Friday May 1 for HSPH and HMS students while public health authorities continue their investigation of student interactions on the Longwood Campus following the discovery of a possible case of H1N1 flu in a student at Harvard School of Dental Medicine where classes are also cancelled. Students are asked to minimize social contact on the campus until more is known.

The decision to postpone the conference did not come until 9am the morning of May 1. The delay was due to uncertainty as to whether events attended by non-HSPH people should also be cancelled. In the end, all events were also cancelled due to safety concerns.

We are grateful for the tremendous amount of interest in the conference and for the help of all our volunteers. We plan to reschedule the conference as soon as possible. I will post updates about the conference at www.hsph.harvard.edu/phat and on this blog.

Julio Frenk, former Mexican Minister of Health and HSPH Dean, submitted a NY Times op-ed on April 30 entitled Mexico’s Fast Diagnosis stating that approximately 10,000 Mexicans die each year due to the flu. There have now been 140 confirmed cases of swine flu in the US.

By the end of Friday, May 1, there were 2 confirmed cases among dental students and 7 probable cases. All are recovering well.

Ashish Jha, Assistant Professor of Health Policy & Management at the Harvard School of Public Health and practicing physician at the VA, discussed the digitization of health records on NPR’s OnPoint on Wednesday, April 22. You can hear the entire episode here at OnPoint Radio’s site: http://www.onpointradio.org/2009/04/tracking-electronic-medical-records. My favorite quote, in response to why automate a broken system rather than fix the fundamental problem:

“We can’t fix the healthcare system without IT, but IT alone can’t fix it.”

Dr. Ashish Jha also recently published an excellent article entitled Use of Electronic Health Records in U.S. Hospitals in the New England Journal of Medicine. Dr. Jha and colleagues found that only 1.5% of hospitals have comprehensive electronic medical record (EMR) systems and an additional 7.6% have basic EMR systems. Hospitals cited capital costs and high maintenance costs as primary obstacles to adoption. President Obama’s plan for every American to have an electronic health record by 2014 appears even more ambitious in light of these numbers.

Dr. Ashish Jha will be speaking at the Public Health & Technology Conference on Friday, May 1 at the Harvard School of Public Health. Details of the conference and free registration are available here: www.hsph.harvard.edu/phat.

The Public Health & Technology on May 1, 2009 schedule is below. It’s not too late to register: www.hsph.harvard.edu/phat. I will post all the video on this blog as soon as it is available.

The HSPH Public Health & Technology Forum is hosting the 1st annual Public Health & Technology Conference on Friday, May 1 featuring keynote John Halamka, CIO of Boston Beth Israel Deaconness Hospital and Harvard Medical, and panelists Karen Bell (ONC), Blackford Middleton (Clinical Informatics Research & Development, Partners HealthCare), John Loonsk (ONC), John Moore (Chilmark Research), Ashish Jha (HSPH), Isaac Kohane (Boston Children’s Medical Informatics Program), Jonathan Bush (AthenaHealth), Sharona Hoffman (Case Western Law School).

Despite health IT’s promise of better, faster, and cheaper health care, adoption of electronic health records in the US remains low. This conference brings together many of the leaders in the field to explore the potential to use health IT to improve health delivery, the challenges of health information exchange and the impact of the 2009 American Recovery and Reinvestment Act on health IT.

A great article in Business Week from April 7, 2009: How Kaiser Permanente Went Paperless. Describes Kaiser’s $2 billion electronic health record implementation and the resulting benefits. The major conclusions:

• Return on investment is a wash at best, although quality improves in some areas
• Implementation isn’t transferrable to small providers

“Preventive medicine” is a hot phrase in discussions of health reform. If we just get more people (why not everyone!) screened we can find disease early and save money by attacking these diseases before they become serious and expensive.

But this use of  ‘prevention’ is expensive. Or said another way: There’s a lot of money to be made in this kind of ‘prevention’.

True preventive medicine prevents disease: Reducing airborne particulate matter and pollution prevents incidence of asthma. Funding schools to provide healthy meals prevents childhood obesity. Eliminating the use of lead in paint prevents abnormal development in exposed children.

We must recognize that health screening technologies are not tools to prevent disease; rather, they are tools of early detection of disease. In a sense they define disease. Indeed as screening tools increase in specificity, the thresholds in defining disease status follow in their specificity. Certainly, early detection may give the upper hand to the patient and provider who can implement treatments that reduce the likelihood of that condition becoming life-threatening. But do all abnormalities warrant medical intervention?

Screening technologies such as MRIs are become increasingly sensitive to discovery. In his book How Doctors Think, Jerome Groopman, M.D., cites a physician: “The hateful part of MRIs – I mean they can be a wonderful technology – but they find abnormalities in everybody.” No doubt, part of the rise in the number of chronic conditions can be attributed to our increased ability to find abnormalities, even though not all abnormalities may warrant a medicinal response.

Screening tools do not and cannot prevent abnormalities. They can only find abnormalities.

The primary driver of health care costs is medical technology. Earlier detection coupled with expensive (yet often unproven) interventions have reduced mortality while increasing morbidity. Indeed, many diseases which even 15 years ago would have been a death sentence have now become manageable chronic conditions (HIV/AIDS is an obvious example). This is a testament to our ability to innovate and develop life saving technologies.

Simultaneously, technology has improved our ability to detect ‘disease’ while ensuring chronic care management through pharmaceuticals and/or invasive intervention through biopsies and more. Today, more than half of all Medicare beneficiaries have more than 5 chronic conditions. Soon it will not be uncommon for the bulk of Medicare beneficiaries to have eight or even ten chronic conditions.

One article published in the New England Journal of Medicine notes:

The demands of the public for definitive wellness are colliding with the public’s belief in a diagnostic system that can find only disease. A public in dogged pursuit of the unobtainable, combined with clinicians whose tools are powerful enough to find very small lesions, is a setup for diagnostic excess… Clinical medicine can only say, “With the methods we used, we found none of the diseases we looked for.” No one can measure the absence of all disease. (emphasis mine)

The unfortunate reality is that it is possible to over ‘prevent’ (to use the expensive version of the word). What is needed is not a halt on innovation nor a moratorium on technology. Rather what is needed is a conscious assessment as to when to screen and when treatment is necessary.

The decision as to when to do what should be made between physician and patient, but information is needed to build suggestive guidelines. Health IT, allowing for the aggregation of (anonymous) data, can help.