The Information Week 500

Today, Beth Israel Deaconess issued this press release, noting that BIDMC Information Systems has been named the No. 1 technology innovator in the United States for 2012.    The incredible people of BIDMC IT earned this recognition.   They are an amazing, hard working, and dedicated group.


BOSTON – Beth Israel Deaconess Medical Center has been named the No. 1 technology innovator in the United States in this year’s InformationWeek 500 – a list of the top technology innovators in the US.

The annual list was released Tuesday at an awards ceremony at the exclusive InformationWeek 500 Conference at the St. Regis Monarch Beach Resort, Dana Point, CA.

“Beth Israel Deaconess has gotten into the habit of being No. 1,” says Rob Preston, VP and editor in chief of InformationWeek. “It was the first medical center to go live with iPads for clinical use, the first with a Web-based medical record system, the first to attest to ‘Meaningful Use’ via the national HIT stimulus program.

“Now it’s leading the way with Clinical Query, its clinical research business intelligence system. All of that innovative thinking and doing – and the outcomes those efforts are producing – has earned the hospital one more top slot: No. 1 on our annual InformationWeek 500 ranking of business technology innovators.”

Clinical Query enables investigators to ask questions, preliminary to research, that will help them understand the potential statistical power of a clinical trial or the availability of data for clinical research.
It was built by loading 2.2 million patients (1997 to the present) and 200 million data elements into a repository, then creating a web-based query tool capable of navigating 20,000 medical concepts to ask questions such as “how many people have a certain disease and what treatments did they receive?”
“The remarkable IT professionals, caregivers and administrators of BIDMC have worked together for more than 30 years to create a culture of technology innovation,” says John Halamka, MD, BIDMC’s chief information officer. “Boston is a kind of medical mecca and I can think of no better place than BIDMC to serve as a healthcare IT learning lab for the country. All of us are honored to be named No. 1 for 2012 on the Information Week 500.”

Now in its 24th year, the InformationWeek 500 recognizes business technology teams that have made a notable improvement to how their companies operate. To be considered, companies complete a rigorous application on their business technology strategies. The ranking process is quantitative and qualitative, with applicants earning points based a questionnaire and based on the achievements they outline in an essay submission. Applications are evaluated by a panel of InformationWeek editors. The survey data is aggregated across all InformationWeek 500 companies and by industry; individual responses are kept confidential and individual company data is never disclosed without permission.
Past overall winners include PACCAR Inc., The Vanguard Group, CME Group, National Semiconductor, Con-Way, and Principal Financial Group. The InformationWeek 500 rankings are unique among corporate rankings as it spotlights the power of innovation in information technology, rather than simply identifying the biggest IT spenders.

Additional details on the InformationWeek 500 can be found at www.informationweek.com/iw500/ 

About InformationWeek Business Technology Network (http://www.informationweek.com)
The InformationWeek Business Technology Network provides IT executives with unique analysis and tools that parallel their work flow—from defining and framing objectives through to the evaluation and recommendation of solutions. Anchored by InformationWeek, the multimedia powerhouse that looks across the enterprise, the network scales across the most critical technology categories with online properties such as DarkReading.com (security), NetworkComputing.com (networking and communications) and BYTE (consumer technology). The network also provides focused content for key IT targets, such as CIOs, developers and SMBs, via InformationWeek Global CIO, Dr. Dobb's and InformationWeek SMB, as well as vital vertical industries with InformationWeek Financial Services, Government and Healthcare sites. Content is at the nucleus of our information distribution strategy – IT professionals turn to our experts and communities to stay informed, get advice and research technologies to make strategic business decisions.

About Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.

The ITDotHealth Conference

Today, I participated in the ITDotHealth Conference in Boston, discussing one simple question with a selection of the nation's EHR and PHR experts :

How we can best innovate/change our EHRs while also operating them to transact daily patient care?

Here's what I suggested:

1.  Federal

Meaningful Use Stage 3 is likely to include bidirectional exchange between patients and providers to ensure patient generated data is incorporated into EHRs.  It's also likely to include federated query capability (see Query Health for details) supporting quality measures, population management, and public health.    Meaningful Use Stage 2 requires many core interoperability features including 1) specific implementation guides for content, vocabulary, and transmission standards supporting transition of care exchanges among different vendor products 2) patient view/access/download/transmit and 3) ability to export summary records to aid in migration from one EHR to another.    Combine,  these requirements will create a new level of data liquidity which will inspire new modular "apps" that supplement core EHR functionality and will even be used in the certification process to fill gaps in EHR capabilities.

2.  State

Next month, Massachusetts goes live with a Statewide HIE that includes a comprehensive provider directory, Public Key Infrastructure trust fabric, and gateways supporting the Direct protocol.   Payers, Providers, and innovative third parties companies (including those which connect to patients) can all participate in data exchange as long they are trusted members of the community which sign the participation agreement and follow HIE security/privacy policies.   This ecosystem will result in many new innovative applications that leverage the frictionless data exchange to create value added services for all stakeholders.

3.  Local

BIDMC and its affiliated practices are preparing for the globally capitated future of medicine by embracing healthcare information exchange, analytics, and patient/family engagement.  We serve as the pilot site for many Federal, State, and Accountable Care Organization initiatives .   To us, innovation is a requirement for success.  Without a foundation of data liquidity, we cannot survive in a healthcare reform world.

My colleagues on the panel offered their own insights into the future of iPhone-like application platforms that extend the capabilities of EHRs by offering bidirectional interfaces and APIs to the thousands of agile start ups eager to change healthcare.   A great conference.

Building Unity Farm - the Alpacas and Llamas

Many folks have asked about the reality of running a farm.

As the owner of a winery on the Marin/Sonoma border from 1986-1993, I can tell you that there is little romance in agriculture - it's hard work.

In my ongoing Thursday personal posts about Building Unity Farm, I'll tackle a variety of lessons learned as I've transitioned from suburban gardener to rural farmer.

Today's post is about preparing for alpacas and llamas - camelids

First the basics.  Alpacas and llamas are native to the Andes of southern Peru, northern Bolivia, Ecuador, and northern Chile.  They enjoy cold, dry weather and do not do well in New England Summer heat.

A barn or loafing shed with cooling fans, fresh water, and access to hay is essential.

We improved our barn to create male and female indoor living areas (Camelids ovulate on demand, so you do not want them living together unless you want an every increasing herd).   We cut (with Japanese hand saws) thick rubber floors to provide a clean, durable surface in the barn.

We installed heated buckets (to keep water from freezing in the winter) hung on wall brackets  32 inches off the floor.

We hung indoor hay saving feeders.

We added mineral feeders since alpacas and llamas need access to selenium salts to stay healthy.

We mounted circulating barn fans to keep the living areas cool.

Finally, as part of our overall fly management program we hung flytapes.


We clean the indoor areas every morning at dawn using rakes and manure scoops.   I built a 16x16 foot manure management area (picture shows the compost, manure and woodlot management areas) to compost the 5 tons of "llama beans" we'll move every year.

Outdoors, we fenced (5 foot woven wire with electric top wire) 1/2 acre for each gender and created gates that enable us easy access to the paddocks for feeding, cleaning, and herd health (monthly medications, toenail trimming and weighing).

We added covered 6 foot feeders and hanging water buckets.

We planted a mixture of orchard grass, timothy hay and alfalfa in our paddocks and in an adjacent pasture where the alpacas (one gender at a time) can graze during the day.

We have coyotes roaming our property and the adjacent 50 acre apple orchard, so we needed to plan for livestock guardians.   We placed two Great Pyrenees Mountain dogs in the male paddock and a large llama in the female side.

Camelids eat 2% of their body weight per day, which means that we need about 10,000 pounds of hay per year.   We built a hay loft capable of storing 7 tons, adding seven foot loft doors for easy loading from delivery trucks and ventilation to keep the hay cool and dry.

We did all over this before the camelids arrived.

Our daily routine includes cleaning the inside and outside living areas, refreshing water/food/minerals, and spending time with each animal to ensure they are healthy.   There's nothing like hot llama breath or a nose to nose alpaca nuzzle to start your day.

At night we repeat our morning chores, feed the guardian dogs, and turn on the electric fence.

When we're woken by alert barking (or llama yodeling) in the middle of the night, we chase away predators.  Although we do not own a firearm, we have taken classes in firearm safety should we ever need to provide another layer of defense.

On weekends, you'll find me sitting in the paddocks with my laptop, a dog at my side, and alpacas eating fresh second cut hay (the September harvest is higher in protein and sweeter than the July first cut hay) and guinea fowl running around the barnyard eating insects.   It's hard work, but the sights and sounds of a camelid filled barnyard are priceless.

A Meaningful Use Stage 2 FAQ

Today I had the privilege of speaking with CMS colleagues about Meaningful Use Stage 2.

As I've written in previous posts, MU 2 is truly a work of art and the stakeholder response to it has been very positive.

There are a few persistent questions about the MU program that are worth sharing with the community

1. What is the timing of each stage for early adopters - those who wish to attest as early as possible?

2012 - use stage 1 criteria
Eligible Professional (EP) reporting period is  January 1, 2012-December 31, 2012  with attestation in Jan/Feb 2013
Hospital reporting period is October 1,2011-Sept 30, 2012 with attestation in Oct/Nov 2012

2013 - use stage 1 criteria with optional refinements
EP reporting period is January 1, 2013-December 31, 2013  with attestation in Jan/Feb 2014
Hospital reporting period is October 1,2012-Sept 30, 2013 with attestation in Oct/Nov 2013

2014 - use stage 2 criteria (NOTE the 90 day reporting period to enable adoption of new MU Stage 2 certified products)
EP reporting period is January 1, 2014-March 31, 2014 with attestation in April/May 2014
Hospital reporting period is October 1, 2013-December 31, 2013 with attestation in Jan/Feb 2014

I'm guessing that stage 3 will return to the year long reporting period pattern
2015 - use stage 3 criteria
EP reporting period is January 1, 2015-December 31, 2015  with attestation in Jan/Feb 2016
Hospital reporting period October 1,2014-Sept 30, 2015 with attestation in Oct/Nov 2015

The program ends in 2016 and then penalties for non-attestation begin.

I've also been asked by pathologists, , anesthesiologists and especially radiologists about penalties for non-attestation.   These hospital-based specialists may file for the hardship exemption.  See the MU Stage 2 final rule page 446 for more detail

Finally, the stage 2 tip sheets provide valuable educational material for EPs and hospitals.  In the past, I've created educational materials on my blog, but these are so good, you can use materials directly from CMS!

A Milestone for Interoperability

Today, HL7 announced its decision to make much of its intellectual property, including standards, freely available under licensing terms. . The new policy is expected to take effect in the first quarter of 2013.

Why is this so important?

Over the past few years the HIT Standards Panel  (HITSP) and the HIT Standards Committee (HITSC) have developed standards readiness/standards maturity and adaptability evaluation metrics.    Each has included implementation guide accessibility, licensing permissiveness, and affordability.

When federal advisory committees have chosen HL7 standards as the most appropriate for the clinical need, some have commented that the intellectual property is only available with HL7 membership and thus it is not easily accessible.

Today's announcement eliminates that concern.

HL7 intellectual property will become free, but not open source i.e. HL7 will still retain copyright and the usual consensus processes will still be used to maintain and improve standards.  However, anyone will be able to license the intellectual property without charge.

HL7 and the teams that worked on this radical transformation of HL7's policies should be congratulated.

Meaningful Use Stage 2 depends upon many HL7 standards -HL77 2.51 for transactions and Consolidated CDA for summaries.   Today's announcement is very timely and we can expect that the Meaningful Use Stage 2 HL7 intellectual property will be available without charge to all stakeholders in the first quarter 2013, months before the first reporting period for October 1, 2014 attestation begins.

For more details, here's the press release about HL7's achievement.

Today is a milestone for interoperability and the entire HIT industry should offer their thanks.