This week I'm in Shanghai and surrounding cities working on EHR implementation and health information exchange issues.
There will be a few days without blog posts this week due to my travels, but I will detail all the lessons learned when I return.
Aligning quality, safety, and efficiency with technology and politics pose the same challenges all over the world but the scale of China makes implementation particularly interesting.
And now off to spread the gospel of Meaningful Use.
Cool Technology of the Week
Not exactly a cool technology, but a cool product of nature. I was walking in the apple orchard at dawn this morning and found a Giant Puffball mushroom - Calvatia Gigantea
As a mycologist, I generally get calls about humans eating mushrooms. With this one, I'm more concerned about mushrooms eating humans!
Fungi that's bigger than a car tire. That's cool!
As a mycologist, I generally get calls about humans eating mushrooms. With this one, I'm more concerned about mushrooms eating humans!
Fungi that's bigger than a car tire. That's cool!
Building Unity Farm - the Barn
To me, the barn is the centerpiece of any farm. The tools, the hay/food, animal stalls, season specific items, and heavy equipment are all protected from the elements in the barn.
In New England, barns are a classic barn red or white, having sliding access doors, and ventilation such as a cupola. Ours is red with black accents.
At Unity Farm, our barn is about 40x40 feet in size, has two post and beam stories, and three access doors. The front of the barn holds our grains and seeds in water proof metal cans held closed by spring loaded metal chains and hooks of my own design - call them unchewable bungie cords. Our tools are racked in a Rubbermaid tool caddy. The chainsaw and brush cutter are stacked against the east wall. Our red dragon flamethrower (for weeding), and our commercial sprayer are hung on hooks. A Craftsman workbench and pegboard provides storage for hammers, screw drivers and saws.
We store our portable animal pens (great for veterinary visits, isolating animals during their introduction to the herd, and for containing animals when they need to be haltered) and llama/alpaca scale against the west wall.
Our freeze proof water source - a yard hydrant - is also on the first floor inside a five foot deep french drain.
Fly management is via hanging fly tapes strategically placed in areas that flies gather.
Ventilation fans on the first floor keep the air moving.
The animal stalls have heavy sliding wood doors that keep the animals separated from the tool and storage area. Sliding weatherproof doors give them easy access to the paddocks. Lighting inside the barn is all LED, consuming less than 100 watts for the entire structure. Lighting outside the barn includes 4 classic gooseneck barn lights with halogen bulbs on a photo sensor circuit that turns them on during night time hours.
The stalls are outfitted with wall mounted buckets and hay feeders. Floors are lined with one inch thick rubber mats that are easy to clean.
The second floor hayloft can store up to 10 tons of hay. Hay doors give us easy loading access using a hay elevator. A heat activated ventilator fan keeps the hay cool and dry.
Kathy designed the Unity Farm signage that is mounted on rails attached to the clapboard.
The barn is so functional that all our animal chores are simple. We can move animals in and out of stalls, retrieve hay, and fill water buckets seamlessly.
We clean the stalls twice a day - once in the early morning and once in the early evening, managing manure in our compost area.
Our Great Pyrenees Mountain dogs sleep with the alpacas and llamas, which is especially comforting for us when we hear a pack of coyotes calling from the apple orchard late at night. Thus far, the security of the barn with its nighttime lighting and livestock guardian animals has kept the citizens of Unity Farm healthy and happy.
The scent of hay, sounds of humming camelids, and crunch of straw underfoot is so appealing, that I often sit in the barn with the animals at night before bed.
If I'm ever asked about my manners, I can always claim that I feel at home in a barn!
The October HIT Standards Committee meeting
The October HIT Standards Committee reviewed the FDA Universal Device Identifer NPRM, the transition of the NwHIN to a public/private partnership, and an update from ONC on S&I Framework/related programs.
Jamie Ferguson presented a very thoughtful list of recommendations to the FDA, including the notion that all healthcare devices, including consumer devices, should have a universal device identifier that can be used as metadata when exchanging information. A UDI will help us understand the nature of the data, the accuracy of the data, and the range of possible data from each healthcare device.
Mariann Yeager, Interim Executive Director of Healtheway, presented an overview of the public/private partnership successor to the NwHIN program. As ARRA/HITECH funds diminish, it is important to move ongoing ONC operational components such as NwHIN to self- sustaining partnerships. Healtheway will ensure continuity of the NwHIN Exchange efforts, regardless of the outcome of the election or fluctuations in Federal budgets.
Continuing the theme of public/private partnership, Doug Frisdma presented an overview of ONC project transitions to a combination of public, public/private, and private efforts.
I look forward to the next meeting in which we'll likely begin discussion of the testing and certification scripts as we move forward to the implementation of Stage 2 programs.
The Golden Spike Part 2
Today we made history in the Commonwealth of Massachusetts. At 11:35am Governor Deval and his physician sent the Governor's healthcare record from Massachusetts General Hospital to Baystate Medical Center. It arrived and was integrated into Baystate's Cerner medical record.
The Massachusetts HIE is now open for business.
Immediately following the Governor's record, institutions throughout the Commonwealth sent their own transactions.
The record I exchanged had special significance to my family.
When Kathy was diagnosed with breast cancer (a highly suspicious mammogram) at Newton Wellesley (a Partners hospital), she was told that Massachusetts had no healthcare information highway and she would have to drive her records and images to Beth Israel Deaconess where she chose to seek the care of oncologists,surgeons, and radiation oncologists.
Two months after she began treatment, her health plan called and told her "we think you have cancer because you have incurred $25,000 in chemotherapy costs since December";.
Her out of network caregivers had no visibility into her cancer care.
Her care at multiple institutions was not aggregated for quality measurement.
All of that ended today. In front of the press and leaders of Massachusetts, I accessed her BIDMC records, with her consent, and sent them electronically to Partners Healthcare, a payer (Network Health), a private primary care provider (Dr. Ayobami Ojutalayo, MD at Ruhke Medical Center), and the Massachusetts eHealth Collaborative (a quality measurement and analytics service provider). Within seconds, we broke down silos, demonstrating that care coordination, population health, and quality analytics based on healthcare information exchange is now possible in Massachusetts. EHRs included Partners' LMR, eClincialWorks, a custom payer system, and self built analytic applications.
Other transactions followed.
Tufts New England Medical Center sent summaries to and received summaries from Vanguard Health Systems New England illustrating primary care physician to specialist closed loop workflow. EHRs included Siemens Soarian and Meditech.
Boston Children's sent pediatric patient summaries to Atrius Healthcare, a multi-specialty group, illustrating tertiary hospital to primary care giver coordination.
All were successful and were documented in real time on the Twitter stream.
The Governor distributed golden spikes (photo above) made from actual railroad spikes salvaged from rail near Promontory Point.
Just as the original golden spike in 1869 issued in a new era of connectness, so does today's HIT golden spike change business as usual in Massachusetts. Over the next year, we'll be building new "bridges", ensuring that every payer, provider, and payer can join the ecosystem.
Here's to innovation!
The Massachusetts HIE is now open for business.
Immediately following the Governor's record, institutions throughout the Commonwealth sent their own transactions.
The record I exchanged had special significance to my family.
When Kathy was diagnosed with breast cancer (a highly suspicious mammogram) at Newton Wellesley (a Partners hospital), she was told that Massachusetts had no healthcare information highway and she would have to drive her records and images to Beth Israel Deaconess where she chose to seek the care of oncologists,surgeons, and radiation oncologists.
Two months after she began treatment, her health plan called and told her "we think you have cancer because you have incurred $25,000 in chemotherapy costs since December";.
Her out of network caregivers had no visibility into her cancer care.
Her care at multiple institutions was not aggregated for quality measurement.
All of that ended today. In front of the press and leaders of Massachusetts, I accessed her BIDMC records, with her consent, and sent them electronically to Partners Healthcare, a payer (Network Health), a private primary care provider (Dr. Ayobami Ojutalayo, MD at Ruhke Medical Center), and the Massachusetts eHealth Collaborative (a quality measurement and analytics service provider). Within seconds, we broke down silos, demonstrating that care coordination, population health, and quality analytics based on healthcare information exchange is now possible in Massachusetts. EHRs included Partners' LMR, eClincialWorks, a custom payer system, and self built analytic applications.
Other transactions followed.
Tufts New England Medical Center sent summaries to and received summaries from Vanguard Health Systems New England illustrating primary care physician to specialist closed loop workflow. EHRs included Siemens Soarian and Meditech.
Boston Children's sent pediatric patient summaries to Atrius Healthcare, a multi-specialty group, illustrating tertiary hospital to primary care giver coordination.
All were successful and were documented in real time on the Twitter stream.
The Governor distributed golden spikes (photo above) made from actual railroad spikes salvaged from rail near Promontory Point.
Just as the original golden spike in 1869 issued in a new era of connectness, so does today's HIT golden spike change business as usual in Massachusetts. Over the next year, we'll be building new "bridges", ensuring that every payer, provider, and payer can join the ecosystem.
Here's to innovation!
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