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Ben Mehling
0

"To quit or retain MUMPS, all or in part, that is the question" is lead on FCM.com's article discussing the industry's take on the VA's recent Modernization input, then subsequent Open Source RFI.

The topic is generating strong opinions among industry members.

 

Stakeholders include executives with a financial investment in existing open source VistA applications retaining MUMPS. For example, Medsphere Systems Corp.’s OpenVista is currently used in a modified form by the Indian Health Service and a number of public and private hospitals. MUMPS also is used in several other commercial electronic health record systems and in the banking industry.

 

“For modernization of VistA, we are recommending MUMPS for heavy-duty transaction processing,” said Rick Jung, chief operating officer of Medsphere. “MUMPS’ power to rapidly process transactions is unparalleled.”

 

MUMPS ought to remain the core of VistA, while other computer languages could be used for developing applications for related processes such as pushing data out to physicians, Jung said.

 

The point is not to replace MUMPS, but rather to build upon the stable and high performance platform that is VistA. New applications and technologies can and should be built using M and other languages -- the technology to extend the platform exists and is already being used in this manner.

 

 

 

The chair of the IAC Modernization committee initially backed away from the idea of replacing M, but went on to state he believes it should be considered for a few reasons:

He said the working group members anticipated controversy if they addressed the MUMPS question, and sought to avoid it.

 

“Why should we pick that fight? Let the experts decide,” Meagher said in a recent interview with FCW.

 

However, Meagher added that in his personal opinion, MUMPS should not be retained as part of a VistA modernization because it is outdated and because he claimed few MUMPS programmers are being trained. “Is MUMPS the right entity? I think the obvious answer is ‘no,’”

 

You can read the entire article at FCW.com.

99 Views 0 Comments 0 References Permalink Tags: medsphere_press, ed_meagher, iac, rick_jung, vista, va, open_source
Ben Mehling
0

DVIDS (defense industry news) picked up a story suggesting several Iraqi ministries have agreed to work collaboratively on a WorldVistA-based EHR in Iraq:

Representatives from the Iraqi Ministries of Defense and Health and the Kurdistan Ministry of Health signed a memorandum of agreement earlier this month that will facilitate the implementation of an integrated, comprehensive health information system.

 

The program, WorldVistA, is based on the U.S. Department of Veterans Affairs health care management system and is expected to be in place in October.

 

 

The US military medical advisor in Iraq also supports the collaboration:

“WorldVistA will greatly enhance the Iraqis’ capability to communicate with each other, which in turn will provide quality health care to the people of Iraq,” said U.S. Army Col. Andrew Kosmowski, the senior medical advisor to the MoD Surgeon General’s Office.

 

Read the entire article at DVIDS.com.

209 Views 0 Comments 0 References Permalink Tags: worldvista, vista_press, iraq, kurdistan
Ben Mehling
0

Nextgov.com published an article on the recent open source RFI from the VA:

The Veterans Affairs Department asked industry, government agencies and academic researchers last week for insights on using open source software as a key component of a modernized electronic heath record system, a move that could have serious implications for the Obama administration's initiative for adoption of digital medical files nationwide.

 

The focus of the RFI is for public comment on a series of questions around the implications of open source and VistA:

VistA software can be obtained under the Freedom of Information Act, and developers such as Medsphere Systems Corp. in San Diego have used the code to configure open source electronic health records systems. VA wants to take advantage of third-party developers such as Medsphere to improve and develop a modern VistA system. The project could lead to "broader proliferation of common electronic health record software and solutions," VA officials said.

While collaboration in the open source community brings with it "tremendous options," officials added, it also requires sensitivity to intellectual property rights and the development of a governance system to ensure stability.

VA asked for comments and insights on how to use open source software in its modernization efforts, including the role it should play in an "open source ecosystem and the role that non-VA developers should play in that ecosystem." The department also wants input on how other federal agencies could participate or benefit from an open source approach to develop a modernized electronic health record.

 

The article makes mention of the IAC "modernization committee" report, which published a series of recommendations, including the use of open source within the VA and more directly as a part of VistA.  Of note, the VA put the comment period on a fast track, requesting responses by August 25th.

 

You can read the entire article at nextgov.com.

139 Views 0 Comments 0 References Permalink Tags: open_source, vista_press, medsphere_press, iac, roger_baker, ed_meagher, joseph_dal_molin
Ben Mehling
0

Government Health IT is reporting that ONC has begun forming a workgroup to study the issue of governance.

With creation of the “governance” panel, ONC wants to host discussions  from the health IT community on what to include in a formal  rulemaking on the issue planned for early next year.

 

The 2009 HITECH Act called for a mechanism for official NHIN governance, which has been lacking.

 

Read the entire article on Government Health IT.

126 Views 0 Comments Permalink Tags: nhin, governance, transparency, hitech
Ben Mehling
0

Healthcare IT News is reporting that the VA is now posting security breach data online.  Baker continues to deliver on his pledge of transparency.

VA must notify Congress monthly about both routine and major data  breaches, a requirement imposed in the aftermath of several security  breakdowns during the past year.

 

The public can now see those reports for itself, as the VA began to post them on the VA's Web site on Aug. 11.

 

"We gain a lot with transparency," Baker said. "When you see what  normally happens and how they are handled, it lends a bit of confidence  to what we're going to do when more serious ones occur," he said.

 

Amusingly, the document still bears the warning that the data should only be released under the direction of the CIO and states "No portion of this report should be furnished to the media, either in written or verbal form." (unless they read it on the web, I guess?)

 

Why would the open source VistA community care?  In some cases, potential adopters of open source VistA have legitimate concerns around VistA codebase security. Being able to review monthly reports showing mundane equipment or employee security breaches, but no VistA-based security risks, should provide a new level of comfort that VistA (properly protected within an enterprise) is indeed secure and ready for their facility.

 

Read the entire article on Healthcare IT.com

101 Views 0 Comments 0 References Permalink Tags: security, va, transparency, roger_baker
Ben Mehling
0

Last month I attended the annual Open Source Conference hosted by O'Reilly Media.  2010 was the first year that open source healthcare projects had a dedicated track. Tim O'Reilly felt so strongly about healthcare and open source, that he took his entire keynote to talk about the importance of HIT and EHRs. Tim even mentions VistA and Meaningful Use.

 

The majority of the talks are available on YouTube:

 

It turned out to be quite a showing for VistA, with talks by Phillip Longman, David Uhlman, DSS and a few others. K.S. Bhaskar (of FIS), David Whiles (of Midland Memorial Hospital), and I presented an Introduction to FOSS VistA:

 

 

 

Beyond VistA related presentations, there were quite a few good open source HIT projects unrelated to VistA.  The most interesting talks I listened in on follow:

 

258 Views 0 Comments Permalink Tags: genomics, ben_mehling, ovid, meaningful_use, google, whiles, nhin, oscon, vista_press, ks_bhaskar
Ben Mehling
0

In Federal Computer Week, VA CIO Roger Baker announced progress on the VLER program, referencing the adoption of the DOD's patient identifier to help track service personnel between the two systems:

To move along the VLER project, a month and a half ago, the VA began using DOD's Electronic Data Interchange Personal Identifier (EDIPI) for all its health and benefits records for veterans, Baker said.

“We will have a single, individual identifier for beneficiaries,” Baker said. “This is fundamental for the VLER.”

The EDIPI is a personal identifier code used internally by the DOD. The department assigns a nine-digit unique identifier to each new service member. The DOD identity cards display a 10-digit identity code, which consists of the EDIPI and an additional digit.

Previously, after service members retired from the military, the VA assigned additional number codes to identify them as they received benefits.

 

 

More interestingly, Baker specifically referenced the efforts around establishing a VistA modernization strategy by year's end:

Meanwhile, the VA expects to make a decision by year’s end about modernizing its Veterans Health Information Systems and Technology Architecture (VistA) record system and will issue several requests for information from industry before that decision, Baker said in a conference call with reporters.

 

Baker goes on to reference the IAC report, suggesting that the report was "good advice" and being incorporated into their strategy.  He suggested the transparency of that report was important to "stimulate the discussion" about VistA's future.

 

Read the entire article at FCW.com.

136 Views 0 Comments 0 References Permalink Tags: dod, vler, vista_press, va, roger_baker
Carol Somer
1

InformationWeek Healthcare's Marianne McGee reports today on the introduction in the U.S. Senate of  "a bill proposing to extend Health Information Technology for Economic  and Clinical Health Act (HITECH) financial incentives for e-health  record use by mental health professionals . . . complementing similar  legislation introduced in the U.S. House of Representatives in April."

 

"The Health  Information Technology Extension for Behavioral Health Services Act of  2010, introduced last week in the U.S. Senate by Senators Sheldon  Whitehouse (D-RI) and Jack Reed (D-RI) aims to expand use of e-health  record system by mental health, behavioral health and substance abuse  professionals and facilities, including licensed psychologists, clinical  social workers and psychiatric hospitals."

 

She interviewed  open-source-for-mental-health advocate Sigurd  Ackerman, MD, president and medical director of Silver  Hill Hospital (and a professor of clinical psychiatry at Columbia  University).

 

The  nationally recognized psychiatric hospital in New Canaan, Conn.  actively participated in the Ecosystem even before they went live with  OpenVista this winter:

 

"'The appeal of OpenVista is that it's an open platform that could be modified for diverse healthcare settings like a psychiatric hospital.'" Ackerman told  McGee.

 

"The  Medsphere product includes a 'group notes' feature important for the  collaborative nature of mental healthcare, Ackerman said. Plus,  'commercial packages [not based on VistA] cost six to seven times more,'  he said."

 

Click  on HITECH Mental Health  Extension/Silver Hill to see the full story (scroll to the  underlined section at the end for section on Silver Hill and open  source) and be directed to pertinent links.

147 Views 1 Comments Permalink Tags: :, behavioral_health_it_solution, ehr_for_psychiatry, sigurd_ackerman, silver_hill_hospital, psychiatric_hospitals, act, extension, hitech, mental_health_parity, open_vista, medsphere, open_source, medsphere_press, electronic_health_record, ehr, collaboration_in_medicine, ecosystem, stimulus, vista_press, healthcare_reform, healthcare, emr, health_it, electronic
Carol Somer
0
As part of their settlement for the accidental Heparin drug overdose of his infant twins, one of the nation's best hospitals, Los Angeles' Cedars-Sinai, "spent millions*—on electronic record keeping, bedside bar coding, computerized physician-order entry systems—to improve patient safety," says Dennis Quaid in the September/October 2010 AARP The Magazine. "I have to commend them for that."

 

Writer Meg Grant tells the story of this now-famous medication error and how it is prompted Quaid to become a public advocate of patient safety. Prior to the near tragic event with his babies, Quaid was an actor better known for his wild-man-about-town days (after his marriage to the other Meg ended) and his portrayal of Jerry Lee Lewis in Great Balls of Fire** than for being a man on a mission. In early 2008, Dennis and Kimberly Quaid established the Quaid Foundation, which called for hospitals to adopt bedside bar coding, requiring scans on patient's wristbands to match scans on medications. Says Quaid: "It's based on the same technology that you have at every gas station and grocery store in America. If it's the wrong medicine or the wrong patient, an alarm goes off."

 

Then Quaid met patient-safety leader Charles Denham, MD, founder and chair of the nonprofit Texas Medical Institute of Technology (TMIT), which tests systems to improve healthcare safety. The son of a NASA rocket scientist and a jet pilot himself, Denham bonded with Quaid over their mutual enthusiasm for aviation. The Quaids folded their foundation into TMIT this year.

 

Says Quaid: "There are thousands of people who have been victims, whose voices have never been heard. We're now coming together and demanding that something happen."

 

To that end, Quaid is narrating a series of TMIT documentaries on medical harm that are being distributed free to every US hospital in the country. The first, "Chasing Zero: Winning the War on Healthcare Harm," is available for free download from TMIT's website, safetyleaders.org, and tells the stories of medical-error victims and providers who have made mistakes. The video sounds a bit like the award-winning Beyond Blame documentary we produced and distributed free years ago at Bridge Medical.***

 

Quaid and Denham are now calling on hospitals to invest in a set of 34 practices  (called the National Quality Forum Safe Practices for Better  Healthcare)—everything from simple checklists to computerized infection  control. ["Safe Practice 16: Implement a computerized prescriber order entry (CPOE) system built upon the requisite foundation of re-engineered evidence-based Computerized Prescriber care, an assurance of healthcare organization staff and independent Order Entry practitioner readiness, and an integrated information technology infrastructure."]

 

"Our community-hospital boardrooms decide where the money is spent and  whether it goes to patient safety," says Denham, who together with Quaid believes the country needs an oversight agency similar to the National Transportation Safety Board (NTSB) to monitor and investigate medical accidents, and that  reimbursements for care be tied to providers' safety records.

 

It's wonderful that Quaid, Denham and TMIT are still fighting the good fight but sad that not much progress has been made since the 1999 IOM report on the prevalence of medical errors in a country that spends billions on healthcare and fancy healthcare devices.

 

Click on Dennis Quaid's Quest to read the full article.

 

*According to Cedars-Sinai spokesperson Simi Singer, the hospital began  implementing such safety measures before  the twins' accident.  "Immediately following this incident, we began additional focused  education on medication safety and  have implemented additional  procedures and protocols for our pharmacy and nursing staff."


**Living in North County San Diego, I have the opportunity to join 1000 or more of my closest female friends to see Quaid up close and personal at his annual JLL show at Solana Beach's Belly Up.


***We donated Beyond Blame to the Institute for Safe Medication Practices to use to help support their organization. Purchase it for $45 from ISMP's Online Store.

257 Views 0 Comments Permalink Tags: jerry_lee_lewis, patient_safety, medical_errors, dennis_quaid, medication_errors, charles_denham, cedars-sinai, texas_medical_institute_of_technology, tmit, institute_for_safe_medication_practices, beyond_blame, ismp
Carol Somer
0

I guess I'm a bit prejudiced with regard to the ability of electronic health records to help prevent medical errors. However, all prejudice aside, use of EHRs in early detection of public health issues has been well-documented at the VA (i.e, VistA).

 

So, these truths seem self-evident, that a helping of EHR with a little dash of appropriate clinical decision support, and an operational NHIN, might have helped clinicians and technicians more quickly identify what The New York Times'  Walt Bogdanich reports as fairly widespread weird (my word) hair loss induced by stroke-scan radiation overdoses at hospitals as well-known as Cedars-Sinai Medical Center (LA) and not so well-known as Huntsville Hospital (AL).

 

Click on NY Times:Mark of an Overdose to read the full article, which begins with this chilling paragraph, complete with photos:

 

"When Alain Reyes’s hair suddenly fell out in a freakish band circling his  head, he was not the only one worried about his health. His co-workers at a shipping company avoided him, and his boss sent him home, fearing he had a  contagious disease."

 

The Times' investigation found "that radiation overdoses were  larger and more widespread than previously known, that patients have reported  symptoms considerably more serious than losing their hair, and that experts say  they may face long-term risks of cancer and brain damage. . . . So far, the number of patients nationwide who got higher-than-expected  radiation doses exceeds 400 at eight hospitals,  six in California alone, according to figures supplied by hospitals, regulators  and lawyers representing overdosed patients. A health official in California who played a leading role in uncovering the cases predicts that many more will be  found as states intensify their search.

 

“I cannot believe that this is not occurring in the rest of the country,”  said Kathleen Kaufman, head of radiation management for the Los Angeles County Department of Public Health. “That’s why we are so keen on the rest of the  states to go look at this.”

 

Whether you use a GE Healthcare, Toshiba or other brand scanner, I'm sure your hospital is already checking the settings and contacting the manufacturer.

 

To hear from patients who received  radiation overdoses from a CT brain perfusion scan--in their own voices, click on Stroke  Scan Victims Voices
And listen to your mother and hairdresser. One patient was alerted to the cause of her hair loss, when her hairdresser read about a similar incident in the newspaper.
187 Views 0 Comments Permalink Tags: stroke_scan_radiation_overdoses, patient_safety, cedars-sinai_medical_center, medical_errors, radiation, ge_healthcare, electronic, health_it, electronic_health_record_system, walt_bogdanich, toshiba, nhin
Carol Somer
0

In "After IT, there's more that needs fixing," (July 28, 2010) Healthcare IT News editor Bernie Monegain reports on comments by health IT advocate Barry Chaiken, MD, at this week's iHT2 Summer Health IT Summit in Denver.

 

"We need clinical transformation, and we need it now," said Chaiken, chief medical officer of DocsNetwork Ltd. and outgoing HIMSS chairman.

 

That transformation, of course, includes IT. But, he said, "we need  to be smart at implementing technology."

 

Chaiken also laid out other areas requiring immediate attention  to improve healthcare quality and patient safety. One of these was comparative  effectiveness research.

 

"It's a 'dirty word' in some quarters," he  acknowledged. "But, there's nothing to fear. It's just medical research."

 

"It's trying to find out what works better. It's not death  panels; it's science. An example, he said, is using a diuretic to  control high blood pressure. It's been shown to be effective and  inexpensive.

 

"If it works, let's use it."

 

Click on Monegain on Chaikin to access the full article.

 

145 Views 0 Comments Permalink Tags: death_panels, medical_research, healthcare, healthcare_reform, health_it, health, clinical_transformation, barry_chaiken, bernie_monegain, iht2, summer, it, summit, in, denver
Carol Somer
0

"The Grateful Dead broke almost every rule in the music industry book," according to an email I just received from ManageCamp Inc.

 

"They  encouraged fans to record shows and trade tapes (sound a little like downloading open-source software?); they built a mailing list and sold concert tickets directly to fans; and they built their business model  on live concerts, not album sales."

 

"By cultivating a dedicated, active community, collaborating with their audience, and giving away "freemium" content, the Dead pioneered many social  media and inbound marketing concepts successfully used by trailblazing  organizations today."

 

ManageCamp's email markets a new book by "marketing guru" and lifelong Deadhead David Meerman Scott.

 

If you're interested in Scott's book, click on Deadhead.

 

If you'd prefer to learn how Medsphere is breaking every rule in the health IT rulebook, by being transparent and open and collaborative, click here to start.

 

Disclaimer: I am not now nor have I ever been a Deadhead, but I do love Ben & Jerry's Cherry Garcia.

134 Views 0 Comments Permalink Tags: grateful_dead, deadheads, collaboration_in_medicine, ecosystem, ehr, electronic, healthcare, health_it, medsphere, social_media, community
Carol Somer
1

"Saint Augustine wrote: 'Miracles are not contrary to nature, but only  contrary to what we know about nature.'"

 

"A phenomena within health care, often applied when no rational scientific  explanation can be given, preexists medicine itself. Be it via the Internet,  urban legends or contemporary television and cinema, we have all marveled at the  thought of the teen who lived 118 days without a heart, or the paraplegic man  who was once again able to walk after being bitten by a brown recluse spider, or  the window washer who fell 47 stories and awoke from his coma on Christmas Day.  Sometimes, medical degree or no, the only way to explain the reasoning behind  such patient outcomes is to use that often overburdened word--miracle."

 

What follows is a fascinating blog on the intersection of medicine and religion by Craig B. Garner. Now CEO and chairman of the board at Coast  Plaza  Hospital (Norwalk, Calif.), Garner practiced law as an attorney and partner specializing in health care  issues.

 

Read the rest by clicking on Huffington Post/Garner blog.

147 Views 1 Comments Permalink Tags: huffington_post, craig_garner, medicine, religion, miracles, coast_plaza_hospital
Carol Somer
0

"Most of us have heard that sitting is unhealthy," writes Gretchen Reynolds in last Sunday's New York Times Magazine. "But many of us also have discounted the warnings, since we spend our lunch hours conscientiously visiting the gym. We consider ourselves sufficiently active. But then we drive back to the office, settle at our desks and sit for the rest of the day. We are, in a  phrase adopted by physiologists, 'active couch potatoes.'’’

 

In an article entitled "The Men Who Stare at Screens," Reynolds reports that "the physiological consequences (of sitting at a desk or computer all day) are only slowly being untangled.

 

"In a number  of recent animal studies, when rats or mice were not allowed to amble normally  around in their cages, they rapidly developed unhealthy cellular changes in  their muscles. The animals showed signs of insulin resistance and had higher levels of fatty acids in their blood. Scientists believe the changes are caused by a lack of muscular contractions. If you sit for long hours, you experience no 'isometric contraction of the antigravity (postural) muscles,' according to an overview of the consequences of inactivity  published this month in Exercise and Sports Sciences Reviews. Your muscles, unused for hours at a time, change in subtle fashion, and as a result, your risk for heart disease, diabetes and other diseases can rise."

 

In an unfortunate news for laptop potatoes everywhere, regular workouts do not seem to fully undo the hazardous effects of prolonged  sitting.

 

‘‘There seem to be different pathways' involved in the beneficial  physiological effects of exercising and the deleterious impacts of sitting," according to the University of  South Carolina researcher who led the study. Says Tatiana Warren: ‘‘One  does not undo the other."

 

Warren's suggestions for ameliorating the dangers of inactivity?

 

‘‘Look for ways to decrease physical inactivity,’’ beyond 30-minute bouts of jogging or structured exercise. Suggestions include:

 

  1. Stand up.
  2. Pace around your office.
  3. Get off the couch and grab a mop or change a light bulb  the next time you watch ‘‘Dancing With the Stars.’’

 

Other suggestions, from me, include (i) manage your team, hospital, home, by walking around; and (ii) plan a San Diego beach vacation this summer and stop in at Medsphere in Carlsbad, for a beach-walk-and-talk with whomever you are here to collaborate with.

 

Click on Reynolds/Men Who Stare at Screens for the full article.

188 Views 0 Comments Permalink Tags: health, healthcare, laptops, exercise, fitness, couch_potato
Carol Somer
0

In an article entitled "Taking the Mystery Out of Web Anonymity," New York Times reporter John Markoff describes what the Obama Administration is doing to try and "fix the Internet’s dog problem."

 

"The problem, as depicted in Peter Steiner’s legendary 1993 New Yorker cartoon, is that on the Internet nobody knows you’re a dog. And thus the enduring conundrum over who can be trusted in cyberspace.

 

"The Internet affords anonymity to its users — a boon to privacy and freedom of speech. But that very anonymity is also behind the explosion of cybercrime that has swept across the Web.

 

"Can privacy be preserved while bringing a semblance of safety and security to a world that seems increasingly lawless?

 

"Last month, Howard Schmidt, the nation’s cyberczar, offered the Obama administration’s proposal to make the Web a safer place — a 'voluntary trusted identity' system that would be the high-tech equivalent of a physical key, a fingerprint and a photo ID card, all rolled into one. The system might use a smart identity card, or a digital credential linked to a specific computer, and would authenticate users at a range of online services.

 

"The idea is to create a federation of private online identity systems. Users could select which system to join, and only registered users whose identities have been authenticated could navigate those systems. The approach contrasts with one that would require a government-issued Internet driver’s license. (Civil liberties groups oppose a government system, fearful that it could lead  to national identity cards.)

 

"Google and Microsoft are among companies that already have these “single sign-on” systems that make it possible for users to log in just once but use many different services.

 

"In effect, the approach would create a 'walled garden' in cyberspace, with  (virtually) safe neighborhoods and bright (cyber) streetlights to establish a sense of a trusted community.

 

"Mr. Schmidt described it as a 'voluntary ecosystem' in which 'individuals and  organizations can complete online transactions with confidence, trusting the  identities of each other and the identities of the infrastructure that the  transaction runs on.'"

 

Read more at Markoff: Ecosystem or comment below on how this might impact civil liberties or your healthcare organization.

155 Views 0 Comments Permalink Tags: howard_schmidt, federal_cyberczar, internet, ecosystem, electronic, privacy, online_identity, smart_identity_card
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