NYeC 2013 Digital Health Conference Day One

Up at 5:50 a.m., head down to grab some illy lattes. Headlines above the fold on the comp papers out by the elevator. More HealthCare.gov woes. The topic came up late in the afternoon during the Q&A at the Interoperability session. I think it's safe to say that most of these attendees are PPACA supporters to a great degree, and they are all sadly aghast at the absurdly incompetent rollout.

Below, the ballroom calm before the Keynote storm.

First up, Kaiser Permanente head George Halvorson.

 

I thought the stage lighting would come up appropriately for the talent, but it did not. The ballroom looked like the the Starlite Lounge during Happy Hour. I started tweeting #DHC13 and @NYeHealth:

 I looked up. A rack of Fresnells overhead, and banks of top/backlighting parcans in the stage ceiling. None of them activated.

They eventually got the front lighting pumped up OK, but it was a disappointment. Not ready for Prime Time. And, to think I'm 3 blocks away from the Theater District.

Maybe this was a non-union gig. ;)

So were these. ;) So was this one. ;)

Let There Be Light.

Jus' sayin'...
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Mr. Halvorson speed-clicked his way through his detailed and by now memorized KP-kicks-HIT-and-process-improvement-ass deck. The KP Mantra: "Make the right thing easy to do."

And then ranged far afield to this:

Answer? Vocabulary, and its correlated physical neural connections developmental capacity. It was all rather stunning, and the import has bothered me all day. Goes way beyond nominal "health care." Goes to social morality.

BTW: George has written a new book. I immediately bought the Kindle edition.

Disparities kill. People die every day in this country from health care disparities.

The life expectancy of an African American runs more than four years shorter than the life expectancy of a white American. Four years is a lot of years to lose. 

Multiple studies have shown higher rates of several key diseases for both African Americans and Hispanic Americans. There are higher death rates as well for both African Americans and Hispanic Americans when those particular diseases occur.

The risk levels and the death rates for those key diseases are even higher for our Native American people. 

It is absolutely clear from the data that differences among the various racial and ethnic groups who make up the American population are very real and highly significant. Many people die every year who would not die if every ethnic and racial group in this country had the same health care outcomes and the same disease levels as our most healthy groups for those same diseases. 

A major study of health care disparities that was done by the Institute of Medicine (IOM) in 2003 pointed out both patterns of care and care outcomes that differed significantly from group to group. Some studies included in that report had data about care gaps among the groups that were so significant that they were hard to believe. 

In a country that spends 2.8 trillion dollars on care each year -- more money than the total economies of all but five entire nations -- we should not have those kinds of care gaps and we should not experience those kinds of outcome differences among groups of people for our care...

A lot to ponder.

Below, the real photographer is here.

Looking forward to seeing her work. She's shooting for the conference. She's local, didn't have a card. Gave her mine, asked her to look up this blog.

UPDATE: Her name is Beatrice. She is fabulous. And totally sweet.

Above, Mana Health CEO Chris Bradley. I hope they bring their product to California. It looks like a great PHR. Below, Chris's panel, "Building the Health IT Ecosystem."

Had to ramp the ISO up to 6400 to get these shots. It was still pretty dim. Lots of great questions from the audience. Humbling to be around so many extremely smart people.

During the afternoon I went to the Interoperability panel session. I was a little surprised at the relatively sparse attendance. Good panel.

Below, ONC's Lee Stevens. Extremely nice young man. We chatted at length after the session.

I have some lingering Interop questions. One goes to the humorous phrase proffered by one of the presenters:

"Smiling Almighty Jesus."

The point was miscommunication resulting from information garble over time between people. The above refers to a dx of "Spinal meningitis," which the elderly fictional patient in the slide got wrong. As it goes to HIE, this aligns with my chronic rant about a data dictionary standard. As I have observed by way of analogy:

True interoperability requires a comprehensive data dictionary standard. Without it, information can become “garbled.” That is, altered during sequential transmissions. For example, what if you took these sentences and ran them through Google Translate from one language to another — say, [1] from English to Spanish, [2] then from Spanish to French, [3] then from French to German, [4] then from German to Greek, [5] then from Greek to Swedish, [6] then from Swedish to Portuguese, and [7] then back to English?

1. Verdadero interoperabilidad requiere un amplio diccionario de datos estándar. Sin ella, la información puede llegar a ser "confusa". Esto es, alterado durante las transmisiones secuenciales. Por ejemplo, ¿qué pasa si usted tomó estas frases y las pasó por Google traducir de un idioma a otro - por ejemplo, del Inglés al Español, a continuación, del español al francés, después del francés al alemán, después del alemán al griego, luego del griego al sueco, luego del sueco al portugués, y luego de nuevo a Inglés?
2. Véritable interopérabilité requiert une vaste série de dictionnaire de données. Sans elle, l'information peut devenir "confus". C'est, séquentielle modifié pendant la transmission. Par exemple, si vous avez pris ces mots et a traversé Google traduire d'une langue à l'autre - par exemple, de l'anglais à l'espagnol, puis l'espagnol vers le français, puis du français en allemand, puis de l'allemand vers grec , puis du grec au Suédois Suédois Portugais après, puis revenir à l’anglais?
3. Echte Interoperabilität erfordert eine breite Palette von Data-Dictionary. Ohne sie können die Informationen zu "verwirrt". Dies wird sequenziell während der Übertragung verändert. Zum Beispiel, wenn Sie mir das Wort und ging durch Google übersetzen von einer Sprache in die andere - zum Beispiel aus dem Englischen ins Spanische und Spanisch in Französisch und von Französisch ins Deutsche und Deutsch auf Griechisch, dann aus dem Griechischen ins Schwedisch Portugiesisch nach dann wieder auf Englisch?
4. True διαλειτουργικότητα απαιτεί ένα ευρύ φάσμα του λεξικού δεδομένων. Χωρίς αυτά τα στοιχεία για να "σύγχυση". Αυτό είναι διαδοχικά αλλαχτούν κατά τη μεταφορά. Για παράδειγμα, αν η λέξη και μου περπάτησε μέσα από το Google μετάφραση από τη μία γλώσσα στην άλλη - για παράδειγμα, από τα αγγλικά στα ισπανικά και ισπανικά στα γαλλικά και από Γαλλικά σε Γερμανικά και Γερμανικά σε Ελληνικά, στη συνέχεια, από τα ελληνικά στα Σουηδικά Πορτογαλικά σε συνέχεια πίσω στα Αγγλικά;
5. Verklig driftskompatibilitet kräver ett brett spektrum av data dictionary. Utan denna information till "förvirring." Detta successivt förändras under transporten. Till exempel, om ordet och promenerade mig genom Google översättning från ett språk till ett annat - till exempel från engelska till spanska och spanska till franska och från franska till tyska och tyska till grekiska, sedan från grekiska till Svenska Portugisiska in sedan tillbaka till engelska?
6. Plena interoperabilidade exige uma ampla gama de dicionário de dados. Sem esta informação a "confusão". Isso mudou gradualmente em trânsito. Por exemplo, se a palavra e me atravessou tradução do Google a partir de uma língua para outra - por exemplo, de Inglês para Espanhol e Espanhol para Francês e de Francês para Alemão e Alemão para o grego, depois do grego para o Português Sueco em seguida, de volta para Inglês?
7. Full interoperability requires a broad range of data dictionary. Without this information to "confusion." This gradually changed in transit. For example, if the word and I went through Google translation from one language to another - for example, from English to Spanish and Spanish to French and from French to German and German to Greek, then from Greek to Portuguese Swedish in then back to English?

Ouch.

Pull up Google Translate, try it yourself. Pick additional languages. The results can often be quite amusing. Broadly, Google "Sapir–Whorf hypothesis."

As it goes to HIE/"Interoperability," what I don't yet know is whether a CDA compliant CCD/CCR ePHI transmission arrives as "read-only," or whether it can go from the incoming HL7 message and be parsed into the destination EHR database fields where the data can subsequently be edited ("read-write" -- I would require appending a new record in order to preserve the original data).

There are HIPAA considerations here, specifically 45 CFR 164.312 (Technical Safeguards -- data authentication), and requisite audit log capture. Moreover, given the lack of a single HIT RDBMS Data Dictionary standard, might ePHI undergo modifications strictly resulting from point A to point "n" sequential transmission? Now, if a HIE CDA transmission is read-only, garble concerns would be allayed, but...

I will defer to others further down in the weeds on this issue. Stay tuned.
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More to come...