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Saturday, May 19, 2012

Two Years on...

I launched this blog two years ago today. I'm glad I did so, notwithstanding the disconcerting internal heat I took for it right at the outset. I've enjoyed doing every post to date, every assiduously off-the-clock minute and hour spent on each of them.


TEDMED 2012: Atul Butte

From The Health Care Blog:
Supporters of the Big Data movement argue that data will change everything, but only once we break down the institutional and technological barriers that prevent us from getting at it. In his talk at TEDMED 2012 at the Kennedy Center, Stanford’s Atul Butte argues that the we already have more than enough to do real science, if only we know where to look.

About this Talk

Who needs the scientific method? Vast stores of available data and outsourced research are simply waiting for the right questions, says Atul Butte, Chief of Systems Medicine at Stanford University.


Chief of the Division of Systems Medicine and Associate Professor of Pediatrics, Medicine, and Computer Science, at Stanford University

Atul Butte, M.D., Ph.D. is Chief of the Division of Systems Medicine and Associate Professor of Pediatrics, Medicine, and by courtesy, Computer Science, at Stanford University and Lucile Packard Childrens Hospital. Dr. Butte trained in Computer Science at Brown University, worked as a software engineer at Apple and Microsoft, received his M.D. at Brown University, trained in Pediatrics and Pediatric Endocrinology at Children's Hospital Boston, and received his Ph.D. in Health Sciences and Technology from Harvard Medical School and MIT. The Butte Laboratory builds and applies tools that convert more than 300 billion points of molecular, clinical, and epidemiological data -- measured by researchers and clinicians over the past decade -- into diagnostics, therapeutics, and new insights into disease.

Who needs the scientific method? Interesting question. But, "the scientific method" is as much or more a habit of mind, a way of approaching problems in need of solution. I am wary of any proposition that it can reduced to simply mining the zettabytes. Such may work well in commercial disciplines wherein you can be empirically "wrong" the majority of the time as long as your minority "true positives" can carry the ROI/profitability freight.

Having said that, I could not be more in favor of having more timely access to more complete and accurate health process and outcomes data. See "Medicine in Denial." It's why I continue to work in Health IT.

"Data IS..."

I've pretty much lost this fight. And, I've got a $500 UHC deductible for these injuries.


Well, this was unfortunate.
Expanding Our Team
posted on March 14th, 2012 by Laura Landry 
Cal eConnect is getting ready for our next HIE Cooperative Agreement scope of work, and we are looking for people to join our team. Over the next few weeks, we will be posting job opportunities for analysts, system engineers, and others to join our team.

If you’re the kind of person who likes making sure things get done right – there’s an opportunity for a Compliance Director posted right now.

Please keep an eye on our Careers page for exciting opportunities to accelerate health information exchange in California!
Four days later, on the 18th:
Calif. switches contractors for info exchange
By Joseph Conn, May 18th, 2012
In California, a land renowned for upheaval, the ground has shifted once again under federal and state efforts to promote health information exchange.

The California Health and Human Services Agency is switching contractors for implementation of the exchange programs, according to a CHHS news release (PDF). The agency is the recipient of nearly $38.8 million in federal funds under the American Recovery and Reinvestment Act of 2009 to promote statewide health information exchanges.

Taking over is the Institute for Population Health Improvement at the University of California-Davis...
Ouch. Would love to learn more about this. Nevada has a HIE Cooperative Agreement with ONC as well, but our HIE, HealtHIE Nevada, doesn't get any of that state money. I Don't think Nevada DHHS has even as yet named a non-profit state HIE governance contractor -- analogous to the now apparently scuttled Cal eConnect. Wonder what the California HIE contractor has done with all their funding to date.

Meanwhile, north of the CA border
CareAccord, Oregon’s Health Information Exchange, is administered by the Oregon Health Authority. CareAccord facilitates the secure exchange of health information between Oregon’s health care organizations and providers, enabling the coordination of care for better health, better care and lower cost.

Oregon has received federal funding to plan and begin implementation of statewide health information exchange services through the Office of the National Coordinator for Health Information Technology’s (ONC) State Health Information Exchange Cooperative Agreement Program.

The Oregon Health Authority has contracted with Harris Healthcare Solutions to implement a statewide Health Information Exchange (HIE). The first HIE service to be offered is Direct Secure Messaging, a secure email system using national standards that allows participants to send (push) encrypted health information directly to known, trusted recipients over the Internet...
...CareAccord, Oregon’s Health Information Exchange, is providing no-cost Direct Secure Messaging services...
"No-cost"? Interesting. What's the business model here?


Nothing to report. REC Stage 1 milestones money effectively runs out in a year. Not much time left to mount a start-up REC lobby, particularly that we're now in a major transition national election year.

 "Positioning ONC for Continued Success"

I left a comment under this post by Dr. Mostashari. It stayed "in moderation" the remainder of the week and then just disappeared. So, I re-posted my comment.

I would expect that it will disappear as well.

We are already taking provider questions and concerns regarding Stage 2 of the Meaningful Use program. I rather doubt that RECs will be around en masse to actually help them comply with the measures.

I may have to gripe about this with Reid's office.


In the wake my latest client workflow meeting, I've been boning up on the elements of "HPI" (History of Present Illness), which the client's business manager sees as a key locus of financially successful EHR utilization (they're now transitioning from paper).

This is pretty much a "Subjective" section of the SOAP, an active listening / subjective impressions interchange with a patient.

Good link to all of this clinical workup stuff here.

BTW, this manager stated that his goal was to have the docs offload all or most of the HPI to their M.A.s. I'm not sure that that's legal. Anybody?

After reading and reflecting upon "God's Hotel," I cannot but have a concern that the "Subjective" is increasing taking a back seat to the "Objective" (vitals, labs, imaging, quantitative PE & ROS findings, etc) in pursuit of a hurried heuristic Assessment and Plan, at least in non- STAT circumstances.

I don't know how they manage it all.

More to come...

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