ONC, CMS, HL7, IHE in brief

 Healthcare Standards  No Responses »
Dec 222012
 

There are a num­ber of organ­iz­a­tions in the US try­ing to encour­age the use of vari­ous stand­ards in health­care, but­tressed by US Fed­er­al funds. Here’s a brief sum­mary of some of them, which glosses over many details. All of this is sub­ject to change at any time depend­ing on both fed­er­al and state polit­ics (in the US, some parts of the health­care sys­tem are fun­ded and man­aged fed­er­ally, oth­ers at a state level). I wrote this for a friend in Ger­many, and then thought oth­ers might also find it useful. 

Office of the Nation­al Coordin­at­or for Health Inform­a­tion Tech­no­logy (ONC; http://healthit.hhs.gov/): part of the US Depart­ment of Health and Human Ser­vices, the Nation­al Coordin­at­or has the job of encour­aging the adop­tion of health­care IT and appro­pri­ate stand­ards. It’s a rel­at­ively new depart­ment, foun­ded in 2004. It cer­ti­fies health IT products accord­ing to the stand­ards it adopts, and provides fund­ing for vari­ous aspects of health­care IT, for example as part of Mean­ing­ful Use.

Cen­ters for Medi­care and Medi­caid Ser­vices (CMS; https://www.cms.gov/): runs Medi­care (health insur­ance for the eld­erly as well as young­er people with dis­ab­il­it­ies), Medi­caid (means-tested health insur­ance for those on low incomes), and the Chil­dren’s Health Insur­ance Pro­gram. CMS does­n’t set the stand­ards for the clin­ic­al care itself, but they do set stand­ards for report­ing the qual­ity met­rics for clin­ic­al care, as well as deal­ing with pay­ment for their programs.

Mean­ing­ful Use (http://www.healthit.gov/policy-researchers-implementers/meaningful-use): the US ver­sion of Mean­ing­ful Use is a health IT pro­gram that’s meant to pro­mote the spread of elec­tron­ic health records to improve health care in the United States. There are a num­ber of aspects to this pro­gram. CMS provides fin­an­cial incent­ives to phys­i­cians and oth­er eli­gible pro­fes­sion­als, as well as hos­pit­als, to use cer­ti­fied elec­tron­ic health record (EHR) sys­tems, for example. The oth­er part of the pro­gram is decid­ing which stand­ards are the appro­pri­ate ones for the EHR sys­tems to use. This is where ONC plays a role. The pro­ject is being rolled out in stages across a num­ber of years. Stage 1 is also called the 2011 edi­tion. Stage 2 was just released; the Stage 2 Mean­ing­ful Use set of stand­ards is also known as the 2014 Edi­tion S&CC final rule and com­ple­ments the CMS Stage 2 of the Medi­care and Medi­caid Elec­tron­ic Health Record (EHR) Incent­ive Pro­grams. There are con­crete plans up to Stage 3; any fur­ther stages depend on polit­ics and per­ceived needs.

Health Level 7 Inter­na­tion­al (HL7; http://www.hl7.org): an ANSI-accred­ited stand­ards devel­op­ing organ­iz­a­tion that has mem­bers and affil­i­ates in many coun­tries. HL7 cre­ates health­care IT stand­ards based on an over­all archi­tec­ture. Stand­ards can be norm­at­ive or inform­a­tion, and go through a peri­od of tri­al use (Draft Stand­ard for Tri­al Use; DSTU) before becom­ing full stand­ards. The list of stand­ards in the DSTU phase is at http://www.hl7.org/dstucomments/. The list of ANSI-approved HL7 stand­ards is at http://www.hl7.org/implement/standards/ansiapproved.cfm, and the list of ISO-approved HL7 stand­ards is at http://www.iso.org/iso/search.htm?qt=HL7&sort=rel&type=simple&published=on. People who are not mem­bers of HL7 do have to pay for the stand­ards, but HL7 has com­mit­ted to mak­ing them free of charge in early 2013. Sev­er­al HL7 stand­ards are quoted in the mean­ing­ful use reg­u­la­tions that have been pub­lished so far, both Stage 1 and Stage 2.

Integ­rat­ing the Health­care Enter­prise (IHE; http://www.ihe.net/) is an ini­ti­at­ive to cre­ate pro­files of vari­ous stand­ards to improve the way health­care IT sys­tems share inform­a­tion. They are an inter­na­tion­al organ­iz­a­tion with many mem­bers and run con­necta­thons to test inter­op­er­ab­il­ity of health­care IT sys­tems both in the US and in Europe. Many IHE pro­files and tech­nic­al frame­works are cited for Mean­ing­ful Use. There is sig­ni­fic­ant cross-mem­ber­ship between HL7 and IHE.

Thanks to Bob Yen­cha for review and sug­ges­tions for improve­ments. Any errors, of course, are mine. After writ­ing this, I do find myself won­der­ing wheth­er there is some rule about three-let­ter acronyms in health­care IT. And no, there is no mean­ing to the order­ing of the descriptions.

Delete Evernote Note Location

 Identity and Privacy, Technology  1 Response »
Nov 202012
 

I’m sure there are people who like hav­ing Ever­note track where they recor­ded some note, but there are also some of us who don’t. Yes, I tend to be slightly pri­vacy-ori­ented, or even more than slightly at times. If you’re in that cat­egory, here’s one way to delete the locations.

First off, they often come in when you have the Ever­note app on your phone. On Android, to turn off the auto-loc­a­tion, you need to go to the Ever­note app on your phone, go into set­tings, and click on “Oth­er Options”. You should see some­thing that says “Loc­a­tion for new notes” with two pos­sible options under­neath, one for GPS, and one for wire­less net­works. Make sure they’re both turned off. You might like to turn off Auto-title while you’re there, espe­cially if you don’t like Ever­note read­ing your cal­en­dar to find an appoint­ment or date to write in that title. Yes, I know, I’m sure there are people who find this use­ful. I don’t.

Hav­ing done your best to ensure loc­a­tions aren’t added to future posts, let’s get rid of the already-exist­ing ones. These instruc­tions are for Ever­note 5.0 on the Mac. Find the note, and double-click on it to open it in the edit­ing win­dow. Click on the ital­ic ‘i’ in the top right corner. Then click on the arrow head next to the loc­a­tion field. That gets rid of the loc­a­tion. You may be asked to update the loc­a­tion to your cur­rent loc­a­tion; I only needed to say ‘no’ once. Close the edit­ing win­dow and you’re done! Yes, this does reset the updated date, so if that mat­ters, copy it before mak­ing your changes so you can change it back again.

There may be a pro­gram­mat­ic way to do this, but I only had 5 notes with loc­a­tion inform­a­tion on them, so I did­n’t need it.

Pidgin and XMPP

 Technology  No Responses »
Oct 222012
 

I’m fil­ing this away in the ‘finally tracked down why’ buck­et. In case any­one else spends time on Pidgin won­der­ing why some of their con­tacts have lots of “Status” lines, here’s the reas­on. In par­tic­u­lar, I’ve noticed that when I chat to Tim using Pidgin and Google Talk (which is based on Jabber/XMPP), he has approx­im­ately 10 “Status” lines when I mouse-over the name (the num­ber var­ies, but not by much). It turns out it’s a simple explan­a­tion — Google Talk allows you to log in from mul­tiple cli­ents on mul­tiple devices (this is part of the XMPP pro­tocol), and Pidgin sup­ports that. 

Hence the mul­tiple Status lines, one for each device that’s logged in to the XMPP serv­er. The whole thing seems to be clev­er about send­ing the mes­sages to the appro­pri­ate device, it all some­how just works. The oth­er sys­tems I use to chat with people via Pidgin (AIM or Yahoo!) don’t sup­port log­ging in from mul­tiple com­puters (although it looks like the AIM pro­tocol itself does, but they don’t sup­port it with most cli­ents).

I guess this is gen­er­ally a fea­ture, but it does mean people need to be fairly care­ful about fig­ur­ing out which chat cli­ent they want to use when they have mul­tiple cli­ents on mul­tiple devices (and since ‘cli­ents’ includes GMail, one for each Google account, they can eas­ily add up). Still, Pidgin/XMPP seems good at fig­ur­ing out when someone really is ‘Avail­able’ rather than ‘Away’ and rout­ing the mes­sage to the right place so it’s prob­ably not as much of an issue as it could be.

The deadline dilemma

 General  No Responses »
Sep 122012
 

It hap­pens every year — the slides are due for the XML Sum­mer School, and some people have them done early, and oth­ers don’t. Some­times it’s because Life Hap­pens — fam­ily mem­bers fall ill, bosses demand more hours, oth­er people on whom you’re depend­ing are late. Some­times it’s because you hit the log­jam or just can­’t get star­ted. (By which I mean me, not just you). The same dead­line dilemma applies to oth­er pro­jects, of course; any task that takes more than 10 minutes, and some­times even those, just Don’t Get Done.

Get­ting oth­er stuff done first can be use­ful to clear the decks, as it were. Struc­tured pro­cras­tin­a­tion can be a good way to get oth­er neces­sary tasks com­pleted in an effort to hold off the really import­ant, urgent, fright­en­ingly loom­ing task. But even­tu­ally you (by which I mean me) actu­ally do have to start work­ing on the pro­ject, have to find the motiv­a­tion from somewhere.

A couple of years ago I dis­covered the Pomodoro tech­nique. When I remem­ber to use it, it solves the prob­lem in a num­ber of ways.

The prin­ciple of work for 20 minutes, then take a 5 minute break, repeat until done is simple. It means I can give myself a reward at the end of the 20 minutes (stand up, stretch, tidy up the desk, get a glass of water). I take notes on inter­est­ing ideas or items that might side-track me, that I can get back to after the 20 minutes are up (or even later), rather than fol­low­ing them dur­ing the work time. And after 20 minutes of doing some­thing on the pro­ject, the momentum has built up and I want to keep going, want to fin­ish what I’m work­ing on. 

Nice side-effects — my office is tidi­er (I often do that dur­ing the 5‑minute break), and I think my work is bet­ter because I haven’t got side-tracked. Often which end of the ele­phant you start with is less import­ant than get­ting star­ted — you can always start at anoth­er end in the next work chunk. Mak­ing myself take a break for 5 minutes every 20 helps me pace myself. I stretch, stand up, breathe more deeply than when hunched over the com­puter screen, and feel less tired at the end of the day. I often also have ideas dur­ing the 5‑minute break that help solve whatever issue I’m work­ing on, or make it better.

Unfuck Your Hab­it­at uses the same prin­ciple — either 20 minutes on, 10 off (the 20/10), or 45 minutes on and 15 off (45/15), for clean­ing, study, or whatever needs to be done. The tagline that speaks to me the most? IT’S 20 MINUTES, NOT A LIFETIME COMMITMENT. (Their caps).

Notes: I don’t use the full pomodoro sys­tem with review and I don’t track inter­rupts. Maybe I’d get more bene­fit if I did, but I don’t feel the need.

Tools: you can get by with a kit­chen timer, but you need one that does both times (20/5, 20/10, or whatever com­bin­a­tion). I use Xor­Time on Win­dows, Pomodoro Desktop on the Mac (which appears to have been dis­con­tin­ued), and Pomo­droido (minus all the lead­er­board stuff) on Android. I turn off the tick­ing sound on all of them as I find it annoy­ing and distracting.

Now I just have to remem­ber to use this tech­nique more often. I wish I could use it in hours-long phone calls and meetings!

Coding Fun

 Conference, Technology  No Responses »
Aug 222012
 

A large part of my decision to move back to tech­nic­al work, and less pro­ject man­age­ment, was due to how much fun it was last year work­ing on the web applic­a­tions course for the XML Sum­mer School. And now it’s that time of year again to brush up on my cod­ing for this year’s ver­sion. For­tu­nately, although I’m run­ning a bit late in my pre­par­a­tions, Matt has done ster­ling work get­ting the code base work­ing, and Norm and Paul are doing their bits too.

This is all very dif­fer­ent to the health­care doc­u­ment ana­lys­is I’ve been doing recently, so I need to refresh my memory on Ruby, Sinatra, OAu­th, and co, as well as catch up on recent changes (in par­tic­u­lar to OAuth2, which finally made it to RFC not so long ago). Last year I worked through Singing with Sinatra; this year I get to see what Matt did for our XML web pub­lish­ing applic­a­tion (tak­ing XML files, con­vert­ing to HTML for browser view­ing, adding vari­ous webby bells and whistles) before the del­eg­ates do.

I’m mostly talk­ing about the secur­ity and iden­tity aspects of web sites (as well as help­ing out on the oth­er sec­tions), with the stated aim of mak­ing every­one para­noid enough to be care­ful. The hack­ers are get­ting more soph­ist­ic­ated these days, which means web­site coders have to be more careful.

Northern Voice 2012

 Conference, Vancouver  No Responses »
Jun 262012
 

This year’s North­ern Voice was held down­town, and was smal­ler than the last couple of years. I like the small con­fer­ence per­son­ally, it’s easi­er to chat with lots of dif­fer­ent people, the lines at regis­tra­tion aren’t as long, and the con­fer­ence as a whole feels more per­son­al. This is the strength of North­ern Voice for me, it’s a pleas­ant con­trast to large con­fer­ences where key­notes are sold to the spon­sors and there are advert­ising ban­ners every­where. Yes, North­ern Voice has spon­sors who show up and have a pres­ence and maybe even a table, but they are all respect­ful of the spir­it of the con­fer­ence. For which I, at least, am grateful.

I spent the first bit of the con­fer­ence help­ing out on the regis­tra­tion table. A cer­tain amount of hec­tic, but not too bad. I then mod­er­ated Martha Rans’ talk on Copy­right for Cana­dians did a good job, I thought, of giv­ing inform­a­tion without over­whelm­ing every­one. The Artists Leg­al Out­reach site has more in-depth inform­a­tion, in what they call toolkits.

Lunch at the W2 cafe was great and the big wooden circles in the middle of the atri­um space were full of people chat­ting while bal­an­cing plates and glasses. After lunch I sat in on Moose­Camp for a while, knit­ting and listen­ing and relax­ing. And singing with Nancy and the ukuleles. I really must get back to singing, it’s been a long time since I sang regularly.

Anoth­er import­ant talk was Daniel Cowen’s talk on pri­vacy. A lot of the sub­ject mat­ter was famil­i­ar to me from my work at Sun, where I was part of a pri­vacy and iden­tity group, but Daniel took it a step fur­ther by see­ing how much someone without spe­cial­ised tools or know­ledge could find out about someone online. In four hours they had a wor­ry­ing amount of inform­a­tion about a woman they code-named “Tara”, enough to run any num­ber of social engin­eer­ing attacks or com­prom­ise any “secret ques­tion” sys­tems. People in the ses­sion were genu­inely shocked at just how much inform­a­tion is avail­able online, and how many details, innoc­u­ous in them­selves, can be added together.

Fri­day ended with the wine tast­ing and party in the atrium.

Sat­urday dawned bright and early with Blaine Cook’s won­der­ful key­note, cel­eb­rat­ing diversity in cul­ture, life, and tech­no­logy plat­forms in the face of glob­al­isa­tion and mar­ket forces. He tied togeth­er archi­tec­ture, rain­forest, and people fight­ing to save their cul­ture with the dom­in­a­tion by large plat­forms such as Face­book and Twit­ter to encour­age diversity and independence. 

Shane Birley’s key­note was of a dif­fer­ent style but had some of the same under­ly­ing themes, cel­eb­rat­ing indi­vidu­al voice, chart­ing his per­son­al jour­ney online, and encour­aging all of us to try out new ways of com­mu­nic­at­ing and shar­ing who we are. All delivered in inim­it­able Shane style, of course!

All in all, it was a lot of work and I was exhausted by the end of the two days, but it was all worth­while. The energy and enthu­si­asm was obvi­ous with all the dis­cus­sions and inter­ac­tions and it’s also been great to see all the tweets and blog posts continue.

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