Today the Washington state chapters of HIMSS, AHIMA, and CHITA streamed the content from our conference on 5010 & ICD-10. Many thanks to the incredible Television Services team at Bellevue College for making this possible.
Below are the ICD-10 talks:
10:00 am to Noon
Richard Saulsgiver – COMSYS
Joe Nichols – Health Data Consulting
12:45 pm to 3:15
Katheleen Peterson – Sr. Lecturer UW
Cheron Vail – VP/CIO Regence Blue Shield
Kellie Henderson – 3M HIS
Speaker Q & A
The Health IT branch of the National Institute for Standards & Technology (NIST) has been hard at work publishing draft certification procedures for hospitals, doctors, and vendors looking to achieve each of the Meaningful Use requirements. You can see what they’ve published so far here: http://healthcare.nist.gov/use_testing.
We recently found these wonderful documents, and after reading through the ones that pertain to Nimbus eRelease, we realized a couple of them require the use of explicit data formats where none are warranted. Namely, they require health information that must be presented to patients in an electronic, human-readable format, be done so via a CCD or CCR.
We wrote up our thoughts and posted them to email@example.com today. For anyone interested, our comments are below. We’ll let you know what they say.
To whom it may concern:
We have a question regarding the test procedures for the “Electronic copy of health information” criteria. According to the Meaningful Use Interm Final Rule, the objective of these criteria is to “Provide patients with an electronic copy of their health information.” While the IFR mentions the use of CDs, USB drives, and providing online access to the information, it neither mentions nor requires the use of a particular health record format when storing, transmitting, or displaying the information to patients.
Knowing that, we were surprised by what appears to be, an explicit requirement in the test procedures (§170.304 (f) & §170.306 (d)) to structure the underlying health information in the HL7 CCD or ASTM CCR formats.
Question: Assuming all of the required information (e.g. diagnostic test results, problem list, medication lists, allergies, discharge summary, and procedures) is shared with the patient electronically in a human readable format, does it matter what the underlying format of the data is?
Note: the testing procedure for “Electronic copy of discharge information” (§170.306 (e)) has the same electronic delivery and human readable requirements, but appropriately, in our opinion, does not explicitly require the use of a particular standard for the underlying data.
Why We’re Asking
We have a module that enables sharing health information with patients from any EHR, even if the EHR doesn’t know how to produce CCD or CCR-formatted data. We’re able to do this by offering an online service that redirects printed output from EHRs to our secure portal, where is it turned into a PDF that is accessible by the patient. With this service, providers can securely share health information with patients electronically online, and in the same human-readable format as if it was printed directly from the EHR.
Due to the “plug-and-play” nature of the service, and to ensure it works for all EHRs (even ones that will see little investment going forward), we cannot customize the service to build a CCD or CCR out of the data, en-route to creating a PDF. Not only would it be prohibitively expensive, it would ultimately be of little value since the final objectives are only that the health information be complete, electronic, and human readable. Clearly, all of these objectives can be met without requiring a specific format for the underlying data.
Please let us know if we’re misinterpreting the draft procedures or if there’s an opportunity to adjust them before they are finalized.
Thank you for your time, and for the great work you’re doing preparing providers and vendors for certification.
Over the past 6 months we’ve talked with dozens of healthcare providers, members of Regional Extension Centers, service providers, and EHR vendors to get there take on a new service we were thinking about building. We are now proud to share the details of that service with everyone with the announcement of Nimbus eRelelase.
As mentioned in the video, we have two goals with Nimbus eRelease:
While the ground beneath the healthcare industry is still moving quite a bit, we’ve tried to embrace the principles of Customer Development, as evangelized by terrific Steve Blank, as much as possible. So far, we’re hearing a lot of positive responses to eRelease’s value prop, let’s hope they keep coming as Meaningful Use solidifies.
A friend of mine recently asked how she could easily share files with her teammates while they worked on a project. Here are some great tools to securely do just that.
A free service for people to store documents online and share them with other people. Simple, easy to use, and you can set it up yourself without any help.
Note, Google docs is not just for sharing files, it also has online editors for them (e.g. you can edit Excel, Word, files, etc. via their website), although it doesn’t have all of same functionality as Microsoft Office.
Awesome Microsoft Office plug-in that lets you share documents with anyone you like, work on them simultaneously, and merge them all within your favorite office app (e.g. Excel, Word, PowerPoint). Uses Google Docs as your back end and it’s free!
The same functionality as Google Docs, but also enables you to provide email, calendar & other services for your teammates. Feels a bit more official since people would log in with their business email addresses, but if you don’t want/need that, stick with Google Docs to start.
Free but you need to own a domain (e.g. http://www.NimbusHealth.com).
This isn’t so much a web site, as it is an application that sits on your computer and automatically keeps copies of your business files backed up and synchronized with your associates.
You install it, tell it which directories you want it to watch, and not only will it back up those folders for you online, you can share those folders with other people and whenever you make a change to a file within it, it will automatically be updated on your teammates’ computer. You can still access the files on their website, but you don’t have to re-upload them every time you make a change – it does it automatically. Very cool.
Free for up to 2 gb of storage per-person. I recommend only having it backup the directories with the files you want to share at first, you can extra directories later (because it takes a while to back up all of your My Documents, for example).
An online project management and file sharing/collaboration tool. Very simple to use and includes the ability to schedule and track time as well as share files.
I haven’t used this, but I think it’s a light weight version of Sharepoint. Probably enough to a small team going.
If you need the full functionality of a Sharepoint site, I suggest searching for hosted Sharepoint services online. It shouldn’t take too long to setup and should be fairly inexpensive.
I know that’s quite a few options, but each one has their advantages for any given situation. For reference, we use Google Apps for business purposes, Google Docs for personal, and Syncplicity for both.
[Update - 6/2/2010]
The gracious members of the HIMSS Small & Independent Consultants Special Interest Group (SIC SIG) offered some great suggestions as well:
Joomla or DotNetNuke
Content management systems you and also use as a company web site. If you use either system as your company web site, then creating workspaces for clients or colleagues is straightforward and you have easy access to all the functionality required to run your business.
- Jerome Carter (NTM Informatics)
Feels like what Sharepoint would be if you built it in 2010. Highly integrated and collaborative file sharing, editing, project management and calendar functionality.
- Bob Brown (Mosaica Partners)
The folks at Amazon Web Services invited me to speak at an event last week focused on helping enterprise customers understand how they could leverage cloud services.
Considering we store sensitive information like electronic medical records in the cloud, they asked me to speak on how AWS can be HIPAA compliant, as well as how we scale our services. Here’s the presentation I put together:
- Who is Nimbus Health & what we’re building
- Why we chose AWS over traditional hosting
- Why we prefer virtual servers over physical servers
- Why we think cloud hosting is more secure from a HIPAA perspective than traditional hosting
- How we use EC2, S3, Elastic Load Balancing, Auto-Scaling and Cloud Watch to automatically resize our infrastructure based on load
Some of the above won’t come through without my commentary, but perhaps when I get a moment I’ll record some.
Questions, comments, concerns? Let’s hear ‘um.
I had the privlege of speaking at AHIMA’s Washington State’s annual chapter meeting, on the topic of Professional Social Networking last week. I had a really great time. The group was eager to learn, had some great energy, and as a bonus, I got to know quite a few of the attendees over the rest of the conference.
I decided to record the talk after the fact for anyone who wasn’t able to make it. Questions and comments are welcome as always, and I want to send one more huge thanks again to the WSHIMA conference organizers and attendees; I had a blast.
Have you ever connected with someone on LinkedIn only to find sometime down the road you see their name on an update email and have no clue when/where you met them? I have, and every time it happens I wish LinkedIn had the ability to write private notes about a contact so I could write myself a little reminder.
Guess what, LinkedIn can do that! Not sure how long it’s been able to, but I just found it and figured I’d share.
Amazon, our bff when it comes to hosting, published on a case study of our use of AWS yesterday. In particular, they discuss why we chose AWS over their competitors and how we use Auto-Scaling. More info in the study: http://bit.ly/97yOfN.
I did want to expand a bit on the lessons we learned during our Auto-Scaling experience. If you’re thinking about going that route, which I highly recommend for the right kind of problems, be able to answer these questions about your architecture before diving in too deep:
How will your machines “start their work” when they come up?
You need to have a way for the machines to know what to do and when, once they come to life. We use TopShelf to run services that periodically ping some web services asking for records to process.
How will your auto-scaled machine get your latest bits?
You don’t want to have to rebundle your AMIs every time you make a change that’s to be deployed on an auto-scaled server. Instead, build a way for auto-scaled machines to auto-update themselves when they come to life.
For example, our AS machines have a simple batch script that downloads a zip file with the latest processing bits, deploys them, and restarts the appropriate services.
Can you save money by leveraging different size machines?
We have one Auto-Scaling group that’s a single small machine with a min and max count of one machine. That means no matter what, we always have one small instance running. Let’s call this the “small auto-scaling group.”
We also have another Auto-Scaling group that consists of medium instances with a min of 0 and a relatively large max. Let’s call this the “medium auto-scaling group.”
The number of machines Auto-Scaling spins up within the “medium” auto-scaling group is actually determined by the performance of the “small” AS group. That enables us to keep the cost of our idling servers low with a single small instance, but provide extra power in the form of 0-N medium instances when records are available for processing.
Note: since small & medium instances are both 32-bit servers, we can use the same AMIs for both groups. We do have custom code in our processing service however that changes the number of processes we run based on the number of processors the machine has. You should consider doing the same.
What happens when your machine is terminated?
Make sure whatever processing you’re doing on your auto-scaled machines isn’t affected by having a particular machine terminate at any point. Since Auto-Scaling is determined by machine performance metrics, once you’re below your load threshold, machines will start terminating automatically. Make sure your infrastructure is prepared to cope with processing services that terminate mid-job.
If you’re like me, you’ll come back from a conference like HIMSS with a stack of business cards, all of which have barely legible notes on the back serving as a reminder to follow-up with newly found contacts.
Wouldn’t it be great if there was a way to track who you’ve followed-up and who you haven’t, assign yourself follow-up reminders, track your on-going discussions with contacts, and be able to use it for both conference connections and new customers? Lucky for us, there are apps that do just that.
Customer Relationship Management systems (CRMs) do precisely what they sound like they should – they help you manage your customer relationships. We’ve started using one, Highrise, and we’ve had such a good experience with it, I wanted to share a little about it.
Quick Demo Video – full screen version here: http://bit.ly/bfLFaG
It’s well hidden, just beneath the “Basic” plan, but you can sign up for a free Highrise account which will support two users here: http://highrisehq.com/signup
Other inexpensive CRMs are:
We’d love to hear other techniques/tools you use to track your customer and contact interactions, so fire away!
There’s one metric, above all others, that represents the state of the healthcare information technology industry – the number of two-story vendor booths at HIMSS. While there are always vendors that take up an acre or two of floor space, the number of exhibitors with double-decker exhibitions fluctuates based on the industry’s outlook.
At HIMSS 2008, just before the recession hit hard, I counted a dozen two-story booths in the literally mile-long corridor of vendors. Last year, when the economy was tanking and the HITECH stimulus $ was a big unknown, I only saw two double-decker booths. This year, we’re probably in the 6-8 range, despite the economically tumultuous times. The reason for the rebounding is undoubtedly, the ARRA/HITECH Stimulus funds.
Thanks to the adept implementation of the legislation by the Office of the National Coordinator, the support of organizations like HIMSS & HITSP, and the enthusiasm of an industry primed for a federal booster shot, vendors and providers alike are spending $ and hiring people as if we weren’t recovering from the great recession. People on the exhibit floor, on the shuttles, and in the bars are abuzz with talk of “meaningful use” and the tone is overwhelmingly optimistic.
If the goal of the HITECH stimulus was to get this sector of the economy moving again while advancing the use of electronic medical records, the rebounding number of two-story booths means we can safely check-off one of those goals off the list. Based on the progress I’ve seen and the discussions I’ve heard so far, the second is not far behind.
We make heavy use of Amazon Web Services (AWS) for our hosting, large scale data storage, and load balancing needs. In fact, the latest release of Breeze leverages AWS’s Auto-Scaling functionality to automatically bring additional servers to life during times of heavy load.
For anyone interested, here’s how:
As records come in for processing, Amazon’s CloudWatch monitors the performance of our processing servers and, once a certain CPU threshold is exceeded, more servers are added to the job. These new machines are configured to automatically jump in and start lending a hand in the processing. When all of the charts have been processed, the additional machines are terminated and the system goes back to its normal state.
Obviously, the best part of this system is that we don’t do anything. The system automatically resizes itself based on load which means we can processes large batches of records at any moment, without having to pay for idling high-end servers 24/7. Ah, the power of the cloud.
After hanging out with other Seattle upstarts for a while now, here are my favorite Seattle startup networking resources:
- Seattle Tech Startups – The Seattle tech startup mailing list
- Seattle 2.0 – Great resource for news and startup events through-out Seattle
- Seattle Tech Calendar – Exactly what it sounds like
- Poker 2.0 – (Reserved for Tech Startup Execs & VCs/Angels) Terrific, relaxed low-stakes poker, food & beer. One of my favorite events. Contact me for an intro.
- ideakickSEATTLE – Got an idea for a company and want some feedback? Got some skills and want to find someone with an idea? Just want to meet some great? Awesome event for building meaningful relationships. (started by a real stand-up guy)
- Tech Cafe – Monthly lunches sponsored by a local startup
- Hops and Chops – Good people, casual conversation at Spitfire every Thursday from 6:30 – 9:00
- NWEN – Northwest Entrepreneurial Network. More structure & a bit more establishy than other events/organizations.
- Open Coffee – Tuesday mornings from 8:30 – 10:00 at Louisa’s in Eastlake.
- Startup Drinks – Monthly drinks at a bar somewhere in Seattle
- Encrypted File System (EFS): This option lets you encrypt some folders in your hard drive, without having to encrypt the entire drive. That means you don’t have the (relatively) small performance hit of encrypting the entire drive, but if someone steals your hard drive, they’ll be able to see the names of all of your files/folders (although they won’t be able to see the contents of them). This assumes you have a very strong password protecting your login – if you don’t, there’s no point in EFS because someone could simply brute force your password and get your files.
- BitLocker: If you have the Ultimate or Enterprise versions of Vista or Windows 7, you can turn on BitLocker and encrypt an entire hard drive. Note, BitLocker only encrypts the drive your OS is installed on (most likely C:) and requires some special hardware, which your computer may or not have. Pros: encrypts entire drive & doesn’t rely on your login password for security. Cons: slight performance hit, requires Ultimate or Enterprise versions of Vista or Win7, and requires special (although fairly common) hardware.
- TrueCrypt: An Open Source version of BitLokcer which works on any Windows OS version (e.g. Windows XP, Vista Home, etc.). Cons: not quite as fast as BitLocker.
Now, if your laptop gets stolen, at least you won’t have to worry about notifying hundreds of patients that their data has been compromised.
We’ve finished our first webisode in our “Business Power Tools” series, highlighting useful tools for booking HIMSS travel and planning out your education sessions while you’re there.
Problems playing the video? Try here: http://blip.tv/file/3146159.
Here’s what we covered:
- New Tools for Buying Airline Tickets Online
- Great hotels for < $100/night (no roommate required)
- Build an Outlook calendar of your HIMSS keynotes, SIG meetings, education sessions, etc. ahead of time
- Tools: myHIMSS10
Too fast, too slow, too boring? Feedback welcome!
Based on interest from within, and outside, our HIMSS Small & Independent Consulting Special Interest Group (SIC SIG), the Nimbus Health team has decided to do a trial run of some free recurring webinars to highlight online tools & resources that we’re hoping HIMSS members, and healthcare oriented organizations at-large, can benefit from.
To test the waters, we’re going to do a webinar on “Tools for a Great HIMSS.” In it, we’ll cover:
- New Tools for Buying Airline Tickets Online
- Great hotels for < $100/night (no roommate required)
- Build an Outlook calendar of your HIMSS keynotes, SIG meetings, education sessions, etc. ahead of time
- Tools: myHIMSS10
The webinar will be at:
Please “register” by accepting this Outlook meeting request so we can keep you posted if there are any last minute changes:
Subscribe to this blog using the links on the right hand side to get updates when new webinars are scheduled.
Asked thousands of times, is it “Electronic Medical Record” or “Electronic Health Record.” A colleague of mine was tired of Outlook, Word, and PowerPoint converting EHR into HER, every time he typed it up, so he went with EMR. Seemed as good a logic as any I’d heard.
For anyone else stuck in an epic battle with Microsoft Office’s auto-correct functionality, here’s how to turn it off for specific words:
Full screen version: here.
We are pleased to announce that we have completed another update to the Breeze system this evening January 19, 2010. The enhancements included in this release are geared toward increased integration, improved system efficiency, faster chart processing and the ability to view charts while they’re being indexed. Please take a few minutes to review the complete list of system changes included in this release, which is shown at the bottom of this post.
We appreciate the feedback we’re receiving from our users and are pleased when we are able to improve your experience using Breeze.
Please let us know if you have any questions or comments regarding the changes in this release. As always, we would encourage you to report any problems you find in the software and any enhancements you would like to see in the future using our support contact information – firstname.lastname@example.org.
Thanks for all your assistance.
Breeze Release Notes
This document identifies all enhancements and system changes that have been made to the Breeze Medical System with the January 20, 2010 release.
Support for All Electronic Medical Record Systems
- Breeze now supports all EMRs including Cerner, McKesson, Epic, Allscripts, etc.
- To share an electronic medical record through Breeze, simply select the medical record in the EMR and print it using the automatically installed Breeze Medical System Virtual Printer
- Patient demographic data will be automatically populated within Breeze
Support for Hybrid Records
- Breeze makes it easy to combine paper and electronic sections of medical records
- When any two charts are uploaded with the same demographic data, users will have the option to:
- Add the new pages to the beginning or the end of the existing pages
- Manually arrange the new pages as necessary
- Or overwrite the existing pages with the new pages
Support for Uploading PDF Files
- Breeze can now support uploading full, multi-page PDF files in addition to scanned and “virtually printed” records
- Drag and drop any PDF into a chart and its pages will automatically be added to the chart
Faster Loading Charts
- Unindexed/temporary charts are now created after initial upload, decreasing wait time during full chart processing
- Faster processing of large charts
Additional Chart Status Values
- Chart processing Status values in order of occurrence:
- Awaiting Processing
- Building Temporary Chart
- Temporary Chart Available
- Indexing Permanent Chart
I figure, there’s no worse way to break a month-long silence than with a purely self-glorifying post…so here goes:
We got named Microsoft’s Startup of the Day today!
Big thanks to Microsoft, and to the BizSpark team for taking the time to get to know us and what we’re all about. Anyone else out there with a startup, I highly recommend the BizSpark program.
Newsletters sent via email are great because they let you reach out to specific people, provide unsolicited value, and remind them that you’re out there. The downside is that when you email newsletters, the information inside them isn’t easily discoverable by new people.
Blogs on the other hand are automatically indexed by search engines and will virtually guarantee new people find your information. Of course, those new people may or may not people the people you really want to reach out to. So…
Why not do both? The purpose of both your newsletter and your blog should be largely the same: demonstrate expertise by providing value to your readers. In fact, the content should be largely the same as well. Neither blogs nor newsletters will be successful if you’re just shilling your services. If on the other hand you’re always providing value, readers won’t care what format it comes in.
Here’s what I recommend:
- Write blog posts once or twice a week
- Figure out which blog posts are most useful/generate the most traffic
- Once/quarter send out a newsletter with summaries and links to your five most popular articles
This technique will ensure you are not only sending out the most valuable information to your newsletter recipients, it will also remind them you have a blog and should lead to more subscribers.
When you get ready to send out your newsletter, check out the following services:
- Constant Contact – The “big name” in managing email campaigns
- MailChimp – Free if you’re sending to 100 people or fewer. Also offer pay/email pricing plan.
- iContact – Strong alternative
I got the privilege of speaking at the annual Oregon chapter meeting of the American Health Information Management Association (OrHIMA) on leveraging the web for professional networking. I figured I’d record the dry run so anyone else interested in the talk could take a look.
- What is professional networking online (aka professional social networking)?
- Why is it worth it?
- What are some of the key tools?
- Generic communities (FaceBook groups, LinkedIn groups, Yahoo! Groups)
- Specific communities (Codapedia.com, AskLeslie.net, etc.)
- Your community (blogging & twitter)
- How to get started
There’s a lot more information on this subject that I’d love an excuse to share, so if you have any questions, please don’t hesitate to ask.