The KHIT Blog: The latest Interoperababble news

Thursday, October 16, 2014

The latest Interoperababble news

We interrupt our regularly scheduled 24/7 Ebola panic for a bit of other news...

'Actionable' steps to interoperability
JASON task force offers its final report to ONC
Tom Sullivan, Healthcare IT News, October 16, 2014

JASON, a group of independent scientists who advise the federal government, issued a November 2013 report to the Department of Health and Human Services, the Office of the National Coordinator for Health IT and the Agency for Health Research and Quality on the matter of interoperability...

Here are the half-dozen recommendations the JASON task force made to ONC, as co-chairs David McCallie, vice president of medical informatics at Cerner, and Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, explained them:

Focus on interoperability. ONC and CMS should re-align the meaningful use program to shift focus to expanding interoperability, and initiating adoption of Public APIs.

Establish an industry-based ecosystem. A Coordinated Architecture based on market-based arrangements should be defined to create an ecosystem to support API-based interoperability.

Set up Data Sharing Networks. The architecture should be based on a Coordinated Architecture that loosely couples market-based Data Sharing Networks.

Enable the Public API as basic conduit of interoperability. The Public API should allow data- and document-level access to clinical and financial systems according to contemporary Internet principles

Create Priority API Services. Core Data Services and Profiles should define the minimal data and document types supported by Public APIs

Institute the government as market motivator. ONC should assertively monitor the progress of exchange and implement non-regulatory steps to catalyze the adoption of Public APIs.

"Market motivator? Hmmm... No more federal money. "Non-regulatory" incentive steps? "Loosely couples market-based Data Sharing Networks?" "Loosely?" Oh, yeah, that's swell.

What's not to love?

Expect several more years of wheel-spinning and cludge-fix outside-in band-aids. After which we'll issue ONC Ten Year Interoperability Plan 2.0 (assuming their budget hasn't been zeroed out by then).

Clinic Monkey

Thus endeth today's edition of The Interoperababble News.

WE NOW RETURN YOU TO YOUR REGULARLY SCHEDULED NIGHTMARE

America doesn’t have an Ebola epidemic, but it’s been infected with a whole lot of fear-mongering, finger-pointing and downright nonsense lately. Politicians, in particular, have unleashed a whirlwind of irresponsible speculation and policy prescriptions with no basis in reality.

Senator Rand Paul is telling reporters that you can catch Ebola at a cocktail party — an unlikely prospect, unless if, for some reason, you manage to make contact with the bodily fluids of someone who’s actively sick with the disease. Todd Kincannon, the former general counsel and executive director of the South Carolina Republican Party, declared that the “immediate humane execution” of U.S. Ebola patients would somehow save lives. Lawmakers on both sides of the aisle continue to push for travel bans, despite experts’ warnings that they could make the crisis worse. And a vocal contingent of conservatives is convinced that the threat of an infectious disease from West Africa warrants sealing the U.S.-Mexico border — an enormously expensive and probably impossible to execute solution...

Sanity.

Ever-predictable insanity:

Infographic from Sermo: The problem withe Ebola preparedness.

SATURDAY MORNING UPDATE:
ALL EBOLA ALL THE TIME

From my email inbox.

Also:

The Ebola Voter
Thirteen ways Democrats and Republicans are exploiting the virus for political gain.

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More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Thursday, October 16, 2014

The latest Interoperababble news

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