Beyond Medical Informatics

I found a great online resource: IT Execs Release Guidebook on E-Health Records Implementation – CIO.com.

The College of Healthcare Information Management Executives released a guidebook for CIOs and other IT managers with tips and first-hand experiences in implementing electronic health records in order to meet government “meaningful use” standards.

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The publication, The CIO’s Guide to Implementing EHRs in the HITECH Era, includes best practices and steps health-care organizations should take to successfully implement EMRs, from the initial planning through the final documentation of results.

The guidebook is free for the public and can be downloaded here.

Recent email discussions got me thinking about the challenges of implementing Healthcare IT for developing countries (HIT4Dev). The basic assumptions of HIT4Dev include the following:

• The US (and other western countries) are more advanced in HIT concepts and implementations.
• Because of this, they are models for HIT implementations.
• Compared to these models, the developing countries lag behind.
• There is a palpable gap.
• HIT for developing countries (HIT4Dev) try to bridge this gap.

Here are 5 tips to help meet the challenges of bridging the gap and implementing HIT for developing countries:

1) Know what can work for developing countries.

With so much HIT updates today, it’s challenging to identify the ones applicable for Philippine settings. Not every technological advancement is relevant. Many implementations and applications brought about by US regulations may not hold true for the Philippines.

A good example would be the US HIPAA regulations. The concepts behind HIPAA are legitimate, yes, but direct compliance does not provide immediate or relevant impact to local implementations as of yet. It would be a foolish waste of resources to work on that given other areas for improvement.

2) Know why it worked.

Don’t stop knowing the “What”. The biggest lessons from successful HIT implementations in other countries are in the “Why”. Understanding and insight are the best tools in bridging the gap.

Being a copycat is a sure recipe for failure. Know what factors and concepts made it work. Know the conditions wherein it will NOT work. Get a clear handle of the ‘because’ of HIT implementations and activities, e.g. “Let’s do this BECAUSE…”, “Let’s not do that BECAUSE…”

3) Identify relevant target results.

After a thorough study, ask yourself these questions:

• What tangible results can I get out of the implementation?
• What specific deliverables provide the most relevant impact?
• What measures of success matters to the local users and stakeholders?

Get the successful US model and break it down into workable and relevant targets. As the saying goes, “You eat a whole elephant one bite at a time.” Just make sure the bite is something you can chew and use.

4) Understand ALL the components of the gap.

Understand that the gap is not specific to Healthcare IT because clinical applications do not exist in a vacuum. There are technological advancements, organizational dynamics, societal changes and governance structures that contribute towards the gap. These other things matter.

Focusing on clinical applications without understanding the non-clinical environment in which it thrives is a big mistake. Many HIT4Dev teams make that mistake.

5) Go beyond funding as the solution.

“If we only had funding, this problem would be solved.” How many times have we heard that?

People who think that way when trying to bridge the gap are simpletons.

The simplest problems are those where funding is the solution. They are easy to solve. But many problems are not that simple. Pouring money into a problem does not solve itself.

Take money out of the picture when solving problems. And you’ll find the real solutions worth funding.

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Comments and violent reactions? Do you have other tips for HIT4Dev teams? Post them below! Thanks!

Singapore moves forward with their National EHR Project.

Singapore Awards US$144M EHR Contract

A consortium made up by Accenture, Oracle, and Orion Health has won Singapore’s National Electronic Health Record project, a credible source has told FutureGov.

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The National EHR project aims to connect all the EMRs in Singapore and achieve the “one patient, one record” vision.

Healthcare IT professionals all over the Asia-Pacific region should watch the progress of this project closely. I know I will. I can only hope we can start something similar in the Philippines.

3rd SEMINAR ON HEALTH INFORMATICS — UPM-NThC

College of Dentistry Auditorium, University of the Philippines Manila Pedro Gil St. Cor. Taft Avenue, Manila June 26 2010 8:00 AM – 5:00 PM.

Coming from the widely successful first (April and second (May 21) Seminars on Health Informatics, the UP Manila National Telehealth Center is inviting more health and IT professionals and students to participate in the third offering at the UP College of Dentistry Auditorium on June 26th, 2010.

This third seminar aims to offer the same content as the first but with additional talks by professionals working in health IT. It also promises to provide participants with concrete action items that they can pursue to further sharpen their knowledge and skills in health informatics.

The growing popularity of iPad is a boon for other touchscreen or tablet devices. These devices hold great potential for better mobility and portability in clinical settings.

Competing models from China and Taiwan should drive prices down in the Asian marketplace. Hopefully, this translates to penetration and adoption of these technologies.

Other articles about iPad alternatives:

• iPad Alternatives: The Main Contenders
• iPad alternatives
• Top 10 iPad Alternatives
• Seven alternatives to the Apple iPad
• Seven more iPad alternatives

Mobile healthcare has been waiting for this kind of technology to proliferate. I can’t wait to get my hands on any of them to test them out.

From: PubMed Advanced Search Page Modified. NLM Technical Bulletin. 2010 May–Jun.

The PubMed Search Builder section of the Advanced Search page will soon be modified to provide users with a more cohesive method to build searches.

This should help make searching easier. I should start upgrading my PubMed searching skills.

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Found a new e-Journal: Applied Clinical Informatics

ACI (Applied Clinical Informatics)

As the Official eJournal of IMIA and AMDIS, the online journal ACI will publish approximately 100 peer reviewed articles per year. It aims to establish a platform that allows sharing knowledge between clinical medicine and health IT specialists worldwide as well as bridging gaps between visionary design and successful and pragmatic deployment.

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The core editorial subject matters of ACI are: Clinical information systems (including electronic medical records and systems, personal health records, physician/provider order entry, electronic prescribing, clinical decision support, nursing information systems, patient scheduling and tracking tools, lab information systems, radiology information systems, PACS, GP information systems), administrative and management systems, eHealth systems, information technology development,  deployment, and evaluation, socio-technical aspects of information technology and health IT training.

The target group of ACI is an international and potentially very influential readership, e.g.: Chief Information Officers, Chief Executive Officers, Chief Financial Officers, Medical Informatics Researchers, Nurse Informaticians, Consultants, Public Health Officials, Vendors, IT Safety Healthcare providers, Informatics trainees as well as organizations such as IMIA , AMDIS, AMIA, HIMSS or the equivalent.

I hope I get to read some of the articles. Access is not free so I will have to borrow from some friends.

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This bit of news caught my eye: California hospital says it’s first to self-implement VistA

I found a great resource for NLM Updates:

NLM In Focus

This electronic newsletter gives readers a behind-the-scenes look at the National Library of Medicine and how its vast resources are being used to improve public health and safety, and advance science and medicine.

The US NLM is important to me because I spent over 2 years there for my Postdoc Fellowship in Medical Informatics. I am still looking forward to future collaborations with them once I get the right projects.

A personal emphasis on the article, Going Mobile: Information When and Where You Need It. It tackles research topics in Mobile technology and access–projects I worked with back in NLM with my mentor, Dr. Paul Fontelo (who was also mentioned in the article).

WHAT: 2nd SEMINAR ON HEALTH INFORMATICS
WHERE: College of Dentistry Auditorium, UP Manila, Pedro Gil St. Cor. Taft Avenue, Manila
WHEN: 21 May 2010 8:00 AM – 5:00 PM

Coming from the widely successful first Seminar on Health Informatics last April 8, the UP Manila National Telehealth Center is inviting more health and IT professionals and students to participate in the second offering at the UP College of Dentistry Auditorium on May 21st, 2010.

This second seminar aims to offer the same content as the first but with additional talks by professionals working in health IT. It also promises to provide participants with concrete action items that they can pursue to further sharpen their knowledge and skills in health informatics.

More information here.

I’ve been working with HL7 for the past 3 years. And although I am not an expert (yet), I know enough to have successfully integrated several systems, including legacy ones, using HL7 version 2.x.

Project sponsors and stakeholders often have many misconceptions about HL7—what it is, what it does, and what it can do. Below are some of the common misconceptions I’ve encountered.

Misconception 1: HL7 is a software.

“How do we install HL7? Is the software free? Where can we download it?”

HL7 is NOT a software. It is a messaging standard. Something like a common language among systems so they can understand each other.

For the non-IT side of the healthcare business, IT is about software and hardware. If HL7 is not hardware, then it must be software. Otherwise, why all the fuss about it?

Correcting this misconception involves impromptu lectures about system communication and messaging protocols. About integration and interfaces. About stand-alone systems sharing information.

Still, HL7 integration commonly involves software. Some of these software can be interface engines, messaging platforms and file managers. We use Mirth Connect as our HL7 interface engine.

Misconception 2: Integration is easy with HL7.

“I thought you were using HL7. Why are you still having integration problems?”

Healthcare IT integration projects will always be challenging. HL7 makes it easier but NOT easy.

Choosing HL7 is like going to a grueling negotiations meeting with an agreement to talk in English. It’s a good starting point, but it doesn’t guarantee a win.

Decisions, processes and activities in HIT integration projects can include database preparations, staging tables, data dictionaries, field-to-field mapping and data migration. The integration may use HL7, but critical errors in these other areas can kill a project.

Misconception 3: HL7 compliance is a sign of quality software.

“If it’s HL7-compliant, it must be good!”

Project clients, vendors and even Healthcare IT professionals can have this misconception. HL7 addresses the need for a common protocol between systems. It does NOT address the features, functions and usability of the software itself.

HL7 compliance doesn’t even mean seamless integration. It just means the software has methods of handling HL7 messages—hopefully both incoming and outgoing. Sometimes, those HL7-compliant systems can be the most challenging to work with because their compliance is based on strict usage and formatting standards of specific segments and fields. They become too compliant to their own HL7 implementation, they become inflexible when working with other systems.

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I had to deal with plenty of misconceptions—and even misgivings—about HL7 in my projects. I’ll share some more in future posts. And maybe include some lessons learned.

On another note, a lot of successful local HIT integration projects use customized protocols. Why? Because HL7 is not that well understood. So there are lots of opportunities for HIT standards education and advocacy. And that’s a challenge I’m ready to take head on.

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What misconceptions (and misgivings) about HL7 have you encountered? How did you deal with it? What are the challenges in educating people about HIT standards?

Here’s the first bit of news:

Electronic medical orders may save lives

Doctors at a California children’s hospital have found the first evidence that using an electronic system to communicate their orders may save lives.

After the system was introduced in 2007, the hospital witnessed a 20-percent drop in mortality rate, the equivalent of 36 fewer deaths over a year and a half.

CPOE implementations are challenging projects–and are prone to failure. But this shows the risk is worth taking.

About Telehealth:

Telehealth takes off as evidence grows that it can improve care, save money – FierceHealthIT

Telehealth is helping to expand the reach of dermatologists, neurologists, radiologists, critical care physicians and mental health professionals, among other specialties, and to reduce the need to transport the sickest of patients.

This news bit refers to an InformationWeek Article, which expounds on the points made about the activities and benefits of Telemedicine.

In the Philippines, the gap between what is and what should be when it comes to the delivery of basic health services is still wide. Undoubtedly, telemedicine plays an important role in bridging that gap. News like these can help in the cause.