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Thursday, September 19, 2013

Back online in California

Our move from Las Vegas to the Bay Area has consumed my life for the past eight days.We arrived at 11:20 pm Sunday to find an inch of water all over the kitchen floor, extending out to all corners of the ground floor. The freezer ice cube maker line had ruptured during the ten days we were over in Vegas wrapping up the sale of our house and our exodus to CA. ServiceMaster has ripped up the floors and baseboards and has installed blowers to run for five days before assessing the extent of needed repairs.

Unreal. A nightmare. We are now relegated to the upper floor until repairs are complete.

Whatever. No one died or went to jail.Comcast installed my new cable and internet service yesterday afternoon. I'm back up.

Ganguly: Strong patient data standards cure EHR interoperability flu
"...the lack of a strong standard has caused tremendous problems from a technical standpoint as we try to ensure the accurate flow of information..."
I've been harping on this for a long time. Nice to see others touting the case. However, I still have yet to see anyone argue for a comprehensive Data Dictionary standard, as I have repatedly done.

I repeat that which I posted on April 25th.

One. Then stand back and watch the Market Work Its Magic in terms of features, functionality, and usability. Let a Thousand RDBMS Schema and Workflow Logic Paths Bloom. Let a Thousand Certified Health IT Systems compete to survive. You need not specify by federal regulation any additional substantive "regulation" of the "means" for achieving the ends that we all agree are desirable and necessary. There are, after all, only three fundamental data types at issue: text (structured, e.g., ICD9, and unstructured, e,g., open-ended SOAP note narrative), numbers (integer and floating-point decimal), and images. All things above that are mere "representations" of the basic data (e.g., text lengths, datetime formats, logical, .tiffs, .jpegs etc). You can't tell me that a world that can live with, e.g., 10,000 ICD-9 codes (going up soon by a factor of 5 or so with the migration to ICD-10) would melt into a puddle on the floor at the prospect of a standard data dictionary comprised of perhaps a similar number of metadata-standardized data elements spanning the gamut of administrative and clinical data definitions cutting across ambulatory and inpatient settings and the numerous medical specialties. We're probably already a good bit of the way there given the certain overlap across systems, just not in any organized fashion.

Think about it.

Why don't we do this? Well, no one wants to have to "re-map" their myriad proprietary RDBMS schema to link back to a single data hub dictionary standard. And, apparently the IT industry doesn't come equipped with any lessons-learned rear view mirrors.

That's pretty understandable, I have to admit. In the parlance, it goes to opaque data silos, “vendor lock,” etc. But, such is fundamentally anathema to efficient and accurate data interchange (the "interoperability" misnomer).

Yet, the alternative to a data dictionary standard is our old-news, frustratingly entrenched, Clunkitude-on-Steroids Nibble-Endlessly-Around-the-Edges Outside-In workaround -- albeit one that keeps armies of Health IT geeks employed starting and putting out fires.

Money better spent on actual clinical care.
I'm still awaiting substantive pushback. There are conceptually really only two alternatives: [1] n-dimensional point-to-point data mapping, from EHR 1 to EHRs 2-n, or [2] a central data mapping/routing "hub," into which EHRs 1-n send their data for translation for the receiving EHR.

The complications arising from these two alternative scenarios ought to be obvious.


Nice job. No mention of health IT. Interesting.


Ten more days of The Stupid in DC. Three more days to the HIPAA Omnibus compliance deadline for Covered Entities and their Business Associates.


By Karen Tumulty and Paul Kane, Washington Post

With little more than a week to go before a potential government shutdown, Washington feels like a car without a driver on a road without a guardrail.

As it hurtles toward the edge, no one — conservatives, GOP leadership, congressional Democrats, the White House — seems to have a way to stop it.

Lurching from near-calamity to near-catastrophe has become a way of life in the capital, which has stood at the edge of a financial precipice at least four times since the end of 2010...
Ten days to a potential federal shutdown. Ten more days of DC Freak Show antics, current edition. Health IT is nowhere on the radar that I can see, though a quiet backroom eleventh hour cutoff of the remaining Meaningful Use funding could indeed happen (but, it's chump change relative to the big money controversies, so maybe it'll survive). Continuation of MU is basically a "sunk costs" argument at this point, albeit one that is not totally a rhetorical fallacy.

Below, this is rather significant.
Rand Paul: We Probably Can't Get Rid Of Obamacare

MACKINAC ISLAND, Mich. -- Republican Sen. Rand Paul says President Barack Obama's health care law probably can't be defeated or gotten rid of. And he's suggesting there are few ways and little time for him and other congressional Republicans to stop it.

Speaking to reporters Saturday at a gathering of Michigan Republicans, the presidential prospect said Republicans in Congress could use votes on measures in the House and in the Senate to come up with compromise legislation that could make the law more palatable. Some provisions, Paul said, include removing caps on health savings account contributions or deductibles for health policies.

But the Kentucky Republican said time for that is running out before Oct. 1, the start of the 2014 fiscal year and the date that state insurance exchanges begin.

Paul said Republicans still expect members to fight the law, which national polls show only about a third of Americans support.

"I'm acknowledging we can't probably defeat or get rid of Obamacare," he said. "But by starting with our position of not funding it, maybe we get to a position where we make it less bad." ...
Well, can we just move on, then, to some actual rational legislative business?



More to come...

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