e-HealthExpert.org - Primum non nocere

Scottish health secretary Nicola Sturgeon has launched the country's Chronic Medication Service, which aims to set up shared care records between GPs and pharmacists by the end of the year.

By Bianca Grogan Matthew Holt and Indu Subaiya of Health 2.0 and Denise Silber of Basil Strategies give the introduction to the Health 2.0 Europe Conference, April 6-7, 2010, in Paris, France. In their presentation they give a complete overview...

By DAVID C. KIBBE & BRIAN KLEPPER Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs. The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still...

Leaders often think about succession plans for their direct reports, but what about themselves?
What if I had a serious health problem or accident that impaired my ability to lead my IT organizations? Here's my brief analysis.
BIDMC
My role at BIDMC is to document the strategies prioritized by our governance groups, ensure our organizational chart structure is optimized for executing the strategies, and to find/retain the best people. I also work on the processes that support our strategy including governance, budgeting, and communication.
In the 1990's, I wrote the code that powered our clinical web-based applications and intranet. At this point, we've retired all the code I've written or transitioned its development/support to full time programmers. I am no longer a single point of failure for any application or infrastructure. At BIDMC, about 30% of applications are built and 70% are purchased. Occasionally some stakeholders wonder if building a few applications is a risk. It's actually a risk mitigator. We create the "glue" that links together vendor applications via portals and web-based service-oriented architecture approaches. Since we control the front end that clinicians see for electronic health records and provider order entry we can rapidly add features needed for meaningful use, healthcare reform and Joint Commission requirements. We've implemented novel solutions for medication reconciliation, decision support, and health information exchange. Building what is not available in the marketplace and buying products that are mature is the best way to reduce risk.
Some projects depend upon my strength of will - implementing EHRs for the community, embracing interoperability/standards, and keeping us focused on the large projects that move us forward. If I were to disappear, it is true that efforts to achieve meaningful use would slow significantly. As I've discussed in my blog several times, it takes all the energy and reputation I have to ensure all our clinicians - those in academic health centers and those in small community practices - have all the tools they need and training/education they require to achieve meaningful use.
In any large complex organization, satisfaction with IT goes up and down. As resources are pulled into large projects, smaller projects suffer and stakeholders may feel underserved. As compliance requirements, new regulations, Joint Commission mandates, and senior management signature initiatives appear, existing initiatives may be slowed or cancelled. My role is to foster communication, ensure that governance includes all stakeholders, and to provide a buffer for my staff from the ups and downs of opinion and changing priorities. If I disappeared, the "tyranny of the urgent" may triumph, preventing IT from staying focused on the functionality needed to achieve meaningful use.
HMS
At Harvard Medical School, my role in governance, strategy, structure, staffing and process is similar to BIDMC. I work with research, education, and administrative stakeholders to define their priorities and allocate resources. My major projects include building one of the top 100 supercomputers in the world, providing a petabyte of storage to support translational research, and supporting all the interactive media for over 1000 courses. My role is a balance of managing day to day issues while also engaging all stakeholders in long term planning activities. If I were to disappear, the communication/education of stakeholders and the delicate balance of services among the research/education/administrative communities would suffer.
Overall in my roles as CIO of two institutions, my greatest utility is to provide a common link between the academic/education/research activities of the medical school and the clinical/financial/research activities of the hospital while also leveraging my state and federal activities to ensure BIDMC and HMS are early adopters of federal requirements and participants in pilots. My multi-organizational role provides economies of scale, knowledge sharing, and community-wide visibility for IT activities. My absence would diminish these cross-organizational collaborations, slowing down our work.
My role has evolved substantially over the past decade and I've moved from programmer to convener, from a focus on operations to a focus on innovation, and from technologist to policymaker. Senior leaders owe it to their organizations to periodically reflect on their role and how their organization would carry on without them.

Royal Bolton Hospital NHS Foundation Trust has announced that it has signed a multi-million pound managed equipment service agreement with Siemens Healthcare.

Pharmacy system supplier Cegedim Rx has become the first supplier to receive roll-out approval for Release 2 of the Electronic Prescription Service.

By PAUL LEVY The talk around the country among health insurance companies is that their insurance business is dying. What is happening? First, the consolidations in other industries, resulting in large, multistate corporations, already mean that many companies self insure...

By Matthew Holt Next week there’s post-Labor day health care fun in San Diego. The 2nd mHealth Networking Conference is Sept 8-9 and Healthcamp San Diego is the day before (Sept 6). Both are run by good health care friends—Peter...

Gary Cohen has resigned as the chief executive of iSoft as the company has announced major losses in its full-year results.

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This month's industry round up covers the launch of a new patient wristband from JL Group, a new clinical correspondence system from SRC, and improvements to Imprivata's OneSign single sign-on and context management system. There is also news of contract renewals and wins, and the award of an international information security management standard to NHS City and Hackney.

The agenda began with comments from Jon Perlin and me reflecting on the busy Summer, reacting to the final rules, and planning for the future of policies and technologies to support interoperability. I summarized my experience with questions and feedback on the Standards Final Rule. Thus far, questions about consistency of content, vocabulary, and standards named in quality measures have been clarified without requiring changes in the rule.
Sam Karp and Aneesh Chopra summarized the Enrollment Workgroup deliverables that satisfy the requirements of Section 1561 of Affordable Care Act. The recommend use of the NIEM framework to support standards and processes going forward. They recommend the creation of web services on top of existing legacy systems as well as create a reference implementation of running software that could be used by states and other stakeholders (note, this does not imply creating a single Federal hub for all transactions). They recommended use of the HIPAA Content standards (834, 270, 271) and codification of human readable business rules using tools such as OMG’s SBVR. Finally, they made a number of privacy/security recommendations that highlight consumer access to data and disclosure logging.
Deven McGraw and Paul Egerman summarized the Privacy & Security Tiger Team Recommendations. Most important are the consent recommendations that require the patient be provided with an opportunity to give meaningful consent before the provider releases control over exchange decisions. The trigger is when the decision to disclose or exchange the patient’s identifiable health information from the provider’s record is not in the control of the provider or that provider’s organized health care arrangement (“OHCA”), patients should be able to exercise meaningful consent to their participation.
Doug Fridsma provided an overview of Standards and Interoperability Framework and its associated RFPs.
The awardees thus far are:Harmonization of Core Concepts (NIEM Framework) - DeloitteImplementation Specifications - DeloittePilot Demonstration Projects - LockheedReference Implementation - LockheedTesting - StanleyTools and Services - Stanley
The role of the HIT Standards Committee will be to provide oversight, coordination and prioritization advice on the Standards and Interoperability Framework to ONC.
Jamie Ferguson presented the Vocabulary Task Force Update. Judy Murphy and Liz Johnson presented the Implementation Workgroup Update. The work ahead in September is defining the Standards requirements for Meaningful use Stage 2 and 3. It will be a busy Fall!

By DAVID DRANOVE Over the next few years, the U.S. healthcare system will be in the hands of academics from Cambridge, Massachusetts. New CMS Czar Donald Berwick was a member of the Harvard Medical School faculty. Joe Newhouse, who has...

By ROB LAMBERTS I walk into the exam room and the patient looks up at me with a surprised expression. ”Wow! I didn’t expect to see you so quickly!” I smile and turn around to walk out of the door,...