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Subject: RE: [ihc] RE: "state of the art" in medical records sharing
Dear Colleagues, I am passing this along separately to the NCOR Committee on Ontology for Health Informatics as another point of discussion for our next meeting. in addition to the most recent addition: IHE Patient Care Coordination Technical Framework http://www.ihe.net/Technical_Framework/index.cfm#pcc Since our charter is to consider recommendations or guidance on some of these issues, it is good to have a wider range of thought such as this thread provides. Thanks, Rex At 12:59 PM -0500 9/6/06, Elkin, Peter L. M.D. wrote: >David, > >My summation of your comments is: It is one thing to walk a >mountain, it is another entirely to conquer the same mountain. > >I agree and believe that a more formal method for knowledge >representation and a set of standards built on a common data >infrastructure to address organizational and workflow issues is >where we need to head. These have more to do with the success of an >implementation than the technical details of the systems design. > >I have a meeting Friday with Brett and John and I hope that the >output of that discussion points a direction toward these goals. > >It is great to have your expertise included in the thinking which >drives this work. > >With warm regards, > >Peter > > >Peter L. Elkin, MD >Professor of Medicine >Mayo Clinic College of Medicine >(507) 284-1551 >Fax: (507) 284-5370 > > > >From: David RR Webber (XML) [mailto:david@drrw.info] >Sent: Wednesday, September 06, 2006 12:13 PM >To: Elkin,Peter L. M.D. >Cc: 'Patrick Gannon'; ddavis@himss.org; >'fulton.wilcox@coltsnecksolutions.com'; 'Rex Brooks'; 'Brett >Trusko'; ihc@lists.oasis-open.org; 'John Madden' >Subject: RE: [ihc] RE: "state of the art" in medical records sharing > >Peter, > > >Having worked long on HL7 in the past - I can understand how >stakeholders cling to their existing systems, hewn from solid rock >with bare hands and a chisel as they are. > >It is also very intimidating to perview that mountain in itself. > >And then there is the caBIG initiative which is throwing yet more >high tech at the problem space. > >What I see at this point in the game is that IT is not the answer >nor Holy Grail that will make all the issues in healthcare go away. > >I'm glad you mentioned results orientated accounting too. I see >nurses paid by the hour resulting in fragmented patient care - where >one nurse handles 8 cases per shift and another only 1, barely. And >management is powerless to redress these inequities in the current >environment - or deliberate exploiting of systems that do not reward >good quality work as they should. > >IMHO - if IHC is to have some measure of impact here - then we need >to first decide exactly what solution set we are going to able - and >the problem space it is designed to solve. I see the great work >that IHE/XDS is doing by focusing on one area and attainable goals. > >Of information interoperability is a speciality area for me - and >the OASIS CAM work in a point in case. However - medical >information - with mixed content and media - XML, handwritten notes, >X-Rays and imaging - is something that resists traditional IT fixed >bounded processing - as you so well described. > >Perhaps - just defining those aspects that will be agreed to and >bound - and those that will not - and the mechanisms to manage and >exchange the "not" parts - is one possible integration path? > >Although again - this is all so familiar terroritory - traversed by >DICOM and more - before us. > >??? > >DW > > >-------- Original Message -------- >Subject: [ihc] RE: "state of the art" in medical records sharing >From: "Elkin, Peter L. M.D." <Elkin.Peter@mayo.edu> >Date: Wed, September 06, 2006 11:56 am >To: "'fulton.wilcox@coltsnecksolutions.com'" ><fulton.wilcox@coltsnecksolutions.com>, 'Rex Brooks' ><rexb@starbourne.com>, 'Brett Trusko' <brett.trusko@oasis-open.org>, >"'David RR Webber (XML)'" <david@drrw.info>, ihc@lists.oasis-open.org, >'John Madden' <john.madden@duke.edu> >Cc: 'Patrick Gannon' <patrick.gannon@oasis-open.org>, ddavis@himss.org > >Dear Fulton, > >I am intimately familiar with the debate. For me the issue rests >with the ideas of coverage and meaning. From an Ontological >perspective neither organization has an adequate set of upper level >Ontologies. Level one Ontologies being things that are true about >the whole world (domain independent) or Level two Ontologies which >are the high level constructs / models in the domain of interest. > In both cases a consistent set of domain models has been >substituted for common messaging (although the VHA proposes to >remedy this under the new redo of Vista). > >Instead both organizations work on Interoperability using a >combination of messaging and the use of controlled terminologies. > Here is where the differences become more apparent. In the DOD >systems they use Medcin which is a precoordinated terminology. In a >recent study published in the Mayo Clinic Proceedings, we showed >that only 51.4% of the problems commonly seen at Mayo could be >covered by a pre-coordinated terminology. This is similar to the >58% coverage identified in the LSVT trial. However post-coordinated >terminologies could cover 92.3% of the same problem list (p<0.001). > The VHA understands the need for understanding not just what few >options you give a clinician to pick from (e.g. on a drop down >codified pick list), but also in the rich narrative associated with >the descriptions of the patients' conditions. This will provide us >with the opportunity to perform quality management, pay for >performance, and will allow us to learn from our practices. > >Both organizations have contributed greatly to health IT, and I >believe that a truly interoperable specification for recording and >transmitting clinical data will be of great benefit to patients. > The OASIS IHC being unencumbered by legacy designs stands in a >perfect position to deliver this result. > >With warm regards, > >Peter > >Peter L. Elkin, MD >Professor of Medicine >Mayo Clinic College of Medicine >(507) 284-1551 >Fax: (507) 284-5370 > > > >-----Original Message----- >From: Fulton Wilcox [mailto:fulton.wilcox@coltsnecksolutions.com] >Sent: Wednesday, September 06, 2006 9:40 AM >To: 'Rex Brooks'; 'Elkin, Peter L. M.D.'; 'Brett Trusko'; 'David RR >Webber (XML)'; ihc@lists.oasis-open.org >Cc: 'Patrick Gannon'; ddavis@himss.org >Subject: "state of the art" in medical records sharing > > >As a publicly accessible benchmark, the differences of opinion between the >U.S. Veterans Affairs medical records proponents and the Department of >Defense's vigorous defense of its AHLTA system are probably indicative of >things to come as more large healthcare systems get "mated" for information >exchange. Presumably this relationship will get sorted out, but it is >interesting to contemplate the n-way debates that are likely to occur as >many major and minor healthcare data originators and consumers start to >integrate. > >The VA side (and the VA has been riding has some public "halo effect") >doesn't like AHLTA's architecture and skimpy coverage (mostly outpatient >data, not inpatient), and the AHLTA proponents don't like the VA's less than >standardized vocabularies and supposedly less than adaptable (to DOD's >needs) architecture. The GAO seems to be mostly on the VA's side. See >http://www.gao.gov/htext/d06794r.html . > >See http://www.military.com/features/0,15240,111127,00.html for the full >text and related discussion of the report - "Health Data Bottleneck >Tom Philpott | August 25, 2006, DoD Medical Records Seen as Hurdle for VA >Health Care (a portion shown below). > >The barriers to attaining "seamless" health data exchanges still look pretty >high. > >Fulton Wilcox >Colts Neck Solutions LLC > >"William Winkenwerder Jr., assistant secretary of defense for health >affairs, took time during an Aug. 23 teleconference with journalists to tout >his department's ability to transfer electronically the medical records of >separating service members to the Department of Veterans Affairs. > >In doing so, Winkenwerder ignored a rising chorus of critics who say AHLTA, >the Department of Defense's digitalized medical record system, is a problem >for the VA and for veterans because, in fact, it doesn't allow electronic >record transfers outside the military network. > >The critics include the Government Accountability Office, senior VA >officials and, most recently, the chairmen of the both the House and Senate >veterans' affairs committees. > >GAO reported last month that the biggest obstacle remaining for severely >wounded troops to experience "seamless transition" from military care to VA >trauma centers is the inability to transfer AHLTA records." > > >-----Original Message----- >From: Rex Brooks [mailto:rexb@starbourne.com] >Sent: Friday, August 11, 2006 8:28 PM >To: Elkin, Peter L. M.D.; 'Brett Trusko'; 'David RR Webber (XML)'; >ihc@lists.oasis-open.org >Cc: 'Patrick Gannon'; ddavis@himss.org >Subject: RE: [ihc] RE: HIMSS / internet2 and OASIS IHC? > >Hi Peter, David, et al, > >This also sounds good to me, too. > >Regards, >Rex > >At 5:21 PM -0500 8/11/06, Elkin, Peter L. M.D. wrote: >>David, >> >>It makes sense to me. I think we need to pull together a face to >>face meeting to broach these issues in a serious way. We might >>start with the HITSP use cases and see where we feel OASIS does a >>better job than other available standards, or where there is a >>crying need for new standards development. >> >>Warm regards, >> >>Peter >> >>Peter L. Elkin, MD >>Professor of Medicine >>Mayo Clinic College of Medicine >>(507) 284-1551 >>Fax: (507) 284-5370 >> >> >>From: ihc-return-3-elkin.peter=mayo.edu@lists.oasis-open.org >>[mailto:ihc-return-3-elkin.peter=mayo.edu@lists.oasis-open.org] On >>Behalf Of Brett Trusko >>Sent: Friday, August 11, 2006 4:52 PM >>To: 'David RR Webber (XML)'; ihc@lists.oasis-open.org >>Cc: 'Patrick Gannon'; ddavis@himss.org >>Subject: [ihc] RE: HIMSS / internet2 and OASIS IHC? >> >>Hi David, >> >>I will be chatting with everyone next week. I am on the road this >>week but should be able to coordinate something starting next Wed. >> >>Best, >> >>Brett >> >> >>From: David RR Webber (XML) [mailto:david@drrw.info] >>Sent: Tuesday, August 08, 2006 2:28 PM >>To: ihc@lists.oasis-open.org >>Cc: Patrick Gannon; Brett Trusko; ddavis@himss.org >>Subject: HIMSS / internet2 and OASIS IHC? >> >>Folks, >> >>I circulated the announcement below this week and asked the question >>- where does OASIS fit in the puzzle here? >> >>At first brush - the notion is that HIMSS is the owner of the >>business domain needs, I2 folks understand the network and bit and >>byte layer, while OASIS sits in between providing the facilitation >>mechanisms that reach up to the business users ultimately. >> >>Well in talking with Didi (Blanca) Davis today who is Director, >>Integrating the Healthcare Enterprise at HIMSS seems like this could >>be fitting together quiet nicely. >> >>HIMSS next steps is to form working groups with I2 folks to start >>defining the USE CASES. >> >>At that point they will then solicit input and feedback and we can >>start figuring out how our OASIS works fits into the equation - and >>what we can do today and what new enhancements we need to >>accommodate HIMSS / I2<http://era.nih.gov/> next generation >>capabilities? >> >>My suggest is that IHC is the ready-made TC on the OASIS side that >>can take ownership of that process and be the conduit between the >>other OASIS TCs and HIMSS / I2. >> >>Does everyone concur? >> >>If so - then of course - those interested can involve themselves >>more deeply in the HIMSS / I2 use case development - but otherwise I >>think this is a good plan for now. >> >>I've CC:d Didi here so she has our PoC information. >> >>Thanks, DW >> >> >>FYI >> >>Focused on Creating an Advanced and Interoperable Medical Network, >>HIMSS and Internet2 Announce Collaboration >> >>The two organizations will leverage each other's expertise to >>explore the viability of an independent and logically interconnected >>medical network in the United States >> >> >> >>CHICAGO, Ill. and ANN ARBOR, Mich. - August 1, 2006 - The > ><http://www.himss.org/>Healthcare Information and Management Systems >>Society (HIMSS) and <http://www.internet2.edu/>Internet2 announced >>today that the two organizations have created a partnership to >>explore the development of a secure, reliable and advanced >>networking solution for the transmission of medical information, >>messages and images throughout the broad healthcare industry. >> >> >> >>The two organizations are exploring a new network designed to offer >>the health sciences and healthcare sectors a private and secure >>medium for exchanging health information. A next-generation >>architecture built to meet federal regulatory requirements, this new >>network may also have value to offer in the work of the Nationwide >>Health Information Network (NHIN). >> >> >> >>This ground-breaking collaboration is a natural extension for both >>not-for-profit organizations. Through a membership of 20,000 >>individuals, 45 chapters, and more than 300 corporations >>representing millions of employees, the HIMSS mission focuses on the >>betterment of healthcare through the most effective use of >>information technology and management systems. Internet2, the U.S.'s >>advanced networking consortium led by 208 U.S. university members in >>partnership with over 100 industry and government members, works to >>develop and deploy advanced networks, applications and resources. >> >> >> >>"HIMSS and our members look forward to this collaboration with >>Internet2," said H. Stephen Lieber, HIMSS president/CEO. "The >>synergies between HIMSS and Internet2 brought our organizations >>together to consider and evaluate the feasibility of establishing a >>network that would meet the evolving needs of the biomedical and >>healthcare delivery community." >> >> >> >>Since 1999, Internet2 has operated an advanced nationwide network >>that supports leading-edge Internet technology development for the >>research and academic community. Internet2 recently announced a >>major upgrade to this network to provide members 10 times the >>capacity and speed of its current infrastructure. In addition, the >>Internet2 community has successfully developed important middleware >>technologies to address critical issues in authentication and >>authorization in order to enable active privacy management. Through >>this partnership, HIMSS and the Internet2 community will work >>closely together to leverage these leading-edge technologies to >>explore development of brand new capabilities that meet the specific >>security and privacy needs of the healthcare industry. >> >> >> >>"The research and education community has long understood the >>potential for leveraging advanced Internet technology to enhance the >>healthcare industry's ability to serve the public's needs, to >>improve the flow of information for research, to streamline care >>processes and to enable cost savings," said Douglas Van Houweling, >>Internet2 president and CEO. "Our partnership with the HIMSS >>community is a major step forward in realizing this vision. Together >>we will work to create a new state-of-the-art platform for >>biomedical research, education and clinical practice on a national >>scale." >> >> >> >>Through the partnership, four working groups have been established >>to explore the requirements and capabilities needed to create an >>advanced medical network during the next year. HIMSS and Internet2 >>will join each other's organizations. Members of both organizations >>will also join each of the four working groups, which include: >> >>o Identity Management that will allow the identification and >>authentication of individuals regardless of their physical location. >> >>o Privacy & Security that will focus on the tools and >>techniques that will assure the privacy and security of the >>information that travels on the network. >> >>o Biomedical (Health Sciences and Healthcare) Education that >>will focus on meeting the unique needs and accessing the resources >>required for biomedical education. >> >>o Telehealth that will focus on the implications for clinical >>practice when a reliable advanced network is available. >> >> >> >>In addition, members of both organizations will work for the > >development and implementation of the network with other >>partnerships and collaborations, including Integrating the >>Healthcare Enterprise (IHE). >> >> >> >>About HIMSS >>The Healthcare Information and Management Systems Society (HIMSS) is >>the healthcare industry's membership organization exclusively >>focused on providing leadership for the optimal use of healthcare >>information technology (IT) and management systems for the >>betterment of healthcare. >> >> >> >>Founded in 1961 with offices in Chicago, Washington D.C., and other >>locations across the country, HIMSS represents more than 20,000 >>individual members and over 300 corporate members that collectively >>represent organizations employing millions of people. HIMSS frames >>and leads healthcare public policy and industry practices through >>its advocacy, educational and professional development initiatives >>designed to promote information and management systems' >>contributions to ensuring quality patient care. >> >> >> >>About Internet2 >>Led by more than 200 U.S. universities, working with industry and >>government, Internet2 develops and deploys advanced network >>applications and technologies for research and higher education, >>accelerating the creation of tomorrow's Internet. Internet2 >>facilitates the kinds of dynamic partnerships among academia, >>industry, and government that helped foster today's Internet in its >>infancy. For more information about Internet2 network capabilities, >>visit <http://networks.internet2.edu/>http://networks.internet2.edu. >> >> >> >>For more information, contact: >>HIMSS >>Joyce Lofstrom, MS, APR >>Manager, Corporate Communications >>312-915-9237 - <mailto:jlofstrom@himss.org>jlofstrom@himss.org >> >> >> >>Internet2 >>Lauren Rotman >>Manager, Public Relations >>202-331-5345 - <mailto:lauren@internet2.edu>lauren@internet2.edu >> >> >> >> >>--------------------------------------------------------------------------- >---- >>This message and any included attachments are from Siemens Medical >Solutions >>USA, Inc. and are intended only for the addressee(s). >>The information contained herein may include trade secrets or privileged or >>otherwise confidential information. Unauthorized review, forwarding, >printing, >>copying, distributing, or using such information is strictly >>prohibited and may >>be unlawful. If you received this message in error, or have reason to >believe >>you are not authorized to receive it, please promptly delete this message >and >>notify the sender by e-mail with a copy to >>Central.SecurityOffice@shs.siemens.com >> >>Thank you >> > > >-- >Rex Brooks >President, CEO >Starbourne Communications Design >GeoAddress: 1361-A Addison >Berkeley, CA 94702 >Tel: 510-849-2309 -- Rex Brooks President, CEO Starbourne Communications Design GeoAddress: 1361-A Addison Berkeley, CA 94702 Tel: 510-849-2309
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