ICD-10 by 2013

HHS today approved a final rule specifying that ICD-10 is to adopted in the USA by October 1, 2013.

ICD-9 in use currently was published by WHO in 1977. The work on ICD-10 was completed in 1992 and it was quickly adopted by many countries around the world. By the time ICD-10 is adopted in the States (no surprises if it will be delayed, I am sure), the new version will be out (draft of ICD-11 is expected in 2010).

Transition to ICD-10 will be a major challenge for entire healthcare establishment in this country.

Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions

National Research Council, part of our National Academies of Science, released the report of a committee chaired by Bill Stead of Vanderbilt University. The report addresses healthcare IT from the policy perspective. Below is the author's summary of the report:

Two key statements:

• page S-2: “current efforts aimed at the nationwide deployment of HCIT will not be sufficient to achieve the vision of 21^st century health care, and may even set back the cause…”
• page S-8:  “… government institutions—especially the federal government—should explicitly embrace measurable health care quality improvement as the driving rationale for its health care IT adoption efforts, and should shun programs that focus on promoting adoption of specific clinical applications.” 

 

Observations & reasoning behind the statements:

• page 1-5:   “Many health care institutions, especially large ones, do spend considerable money on IT, but the IT is implemented in ways that make even small improvements hard to introduce.  Even across the systems within an institution, interoperability is often awkward and slow.  Information exchange with the information systems of other institutions is rare.” 
• page S-3:  “IT applications appear designed largely to automate tasks or business processes.  They are often designed in ways that simply mimic existing paper-based forms and provide little support for the cognitive tasks of clinicians or the workflow of the people who must actually use the system.  Moreover, these applications do not take advantage of human-computer interaction principles, leading to poor designs that can increase the chance of error, add to rather than reduce work, and compound the frustrations of doing required tasks. …”
• page S-4:  “Health care IT was rarely used to provide clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research.  Health care IT rarely provided an integrative view of patient data.”
• page 3-2:  “Care providers spent a great deal of time in electronically documenting what they did for patients, but these providers often said they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care.”
• page S-2:  “Success … will require greater emphasis on providing cognitive support for health care providers and for patients/family caregivers … which refers to computer-based tools and systems that offer clinicians and patients assistance for thinking about and solving problems related to specific instances of health care.”
• page 3-3:  “The majority of today’s health care IT is designed to support automation, with some investment in supporting connectivity, and little in support of decision support or data mining.   Yet the IOM’s vision for 21^st century health care expects health care IT capable of supporting cognitive activities and a learning health care system.  These activities are much more about connectivity, decision support and data mining than they are about automation.  The health care IT investment portfolio must be re-balanced to address this mismatch.”
• page S-8:  “In focusing on the goal to be achieved, namely better and/or less expensive health care, clinicians and other providers will appropriately be drawn to IT only if, where, and when it can be shown to enable them to do their jobs more effectively. Blanket promotion of IT adoption where benefits are not clear or are over-sold—especially in a non-infrastructure context—will only waste resources and sour clinicians on the true potential of health care IT.”

 

What health care needs from IT that today’s systems rarely provide (pages S-3 to S-4):

• “Comprehensive data on patients’ conditions, treatments and outcomes;
• Cognitive support for health care professionals and patients to help integrate patient-specific data where possible and account for any uncertainties that remain;
• Cognitive support for health care professionals to help integrate evidence-based practice guidelines and research results into daily practice;
• Instruments and tools that allow clinicians to manage a portfolio of patients and to highlight problems as they arise both for an individual patient and within populations;
• Rapid integration of new instrumentation, biological knowledge, treatment modalities, and so on into a “learning” health care system that encourages early adoption of promising methods but also analyzes all patient experience as experimental data;
• Accommodation of growing heterogeneity of locales for provision of care, including home instrumentation for monitoring and treatment, lifestyle integration, and remote assistance; and
• Empowerment of patients and their families in effective management of health care decisions and their implementation, including personal health records, education about the individual’s conditions and options, and support of timely and focused communication with professional health care providers.”

 

Making progress in the near term:

Page S-5: “Principles for evolutionary change:

• Focus on improvements in care - technology is secondary.
• Seek incremental gain from incremental effort.
• Record available data so that today’s biomedical knowledge can be used to interpret the data to drive care, process improvement, and research. 
• Design for human and organizational factors so that social and institutional processes will not pose barriers to appropriately taking advantage of technology.
• Support the cognitive functions of all caregivers, including health professionals, patients, and their families.”

 

While preparing for the long term:

Page S5:  “Principles for radical change:

• Architect information and workflow systems to accommodate disruptive change.
• Archive data for subsequent re-interpretation, that is, in anticipation of future advances in biomedical knowledge that may change today’s interpretation of data and advances in computer science that may provide new ways extracting meaningful and useful knowledge from existing data stores.
• Seek and develop technologies that identify and eliminate ineffective work processes.
• Seek and develop technologies that clarify the context of data.”

 

And (page S-9) “Encourage interdisciplinary research in three critical areas: (a) organizational systems-level research into the design of health care systems processes and workflow; (b) computable knowledge structures and models for medicine needed to make sense of available patient data including preferences, health behaviors, and so on;  and (c) human-computer interaction in a clinical context.”  

 

 

YouTube - Where the Hell is Matt? (2008)

This is absolutely amazing!!!

YouTube - Where the Hell is Matt? (2008)

Personal Health Information - Privacy and Security principles

Outgoing HHS Secretary Mike Leavitt articulated his own "doctrine" on privacy and security of patient medical data. He is attempting to tackle two conflicting forces - accessibility vs. protection against unintended use. I like the strong emphasis on personal control - patient is in charge of who can access their data and how. I would like to see made explicit the notion that clinical content should really be authored by medical professionals and this authorship be clearly separated from content provided by the patient or other stakeholders. While privacy and security are clearly distinct from the realm of interoperability, I am concerned that principles below seem to regard patient data as being meant solely for human consumption - it's worthwhile keeping in mind that making this data machine-processable and truly interoperable holds enormous promise of higher quality, more cost efficient and - most importantly - correct, timely and safer care. Here are Mike Leavitt's eight principles:

Individual Access – Consumers should be provided with a simple and timely means to access and obtain their personal health information in a readable form and format.

Correction – Consumers should be provided with a timely means to dispute the accuracy or integrity of their personal identifiable health information, and to have erroneous information corrected or to have a dispute documented if their requests are denied. Consumers also should be able to add to and amend personal health information in products controlled by them such as personal health records (PHRs).

Openness and Transparency -- Consumers should have information about the policies and practices related to the collection, use and disclosure of their personal information. This can be accomplished through an easy-to-read, standard notice about how their personal health information is protected. This notice should indicate with whom their information can or cannot be shared, under what conditions and how they can exercise choice over such collections, uses and disclosures. In addition, consumers should have reasonable opportunities to review who has accessed their personal identifiable health information and to whom it has been disclosed.

Individual Choice -- Consumers should be empowered to make decisions about with whom, when, and how their personal health information is shared (or not shared).

Collection, Use, and Disclosure Limitation – It is important to limit the collection, use and disclosure of personal health information to the extent necessary to accomplish a specified purpose. The ability to collect and analyze health care data as part of a public good serves the American people and it should be encouraged. But every precaution must be taken to ensure that this personal health information is secured, deidentified when appropriate, limited in scope and protected wherever possible.

Data Integrity – Those who hold records must take reasonable steps to ensure that information is accurate and up-to-date and has not been altered or destroyed in an unauthorized manner. This principle is tightly linked to the correction principle. A process must exist in which, if consumers perceive a part of their record is inaccurate, they can notify their provider. Of course the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides consumers that right, but this principle should be applied even where the information is not covered by the Rule.

Safeguards – Personal identifiable health information should be protected with reasonable administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use, or disclosure.

Accountability – Compliance with these principles is strongly encouraged so that Americans can realize the benefit of electronic health information exchange. Those who break rules and put consumers’ personal health information at risk must not be tolerated. Consumers need to be confident that violators will be held accountable.

tap tap tap ~ 10 useful iPhone tips & tricks

tap tap tap ~ 10 useful iPhone tips & tricks - useful and beautifully illustrated iPhone tips

Google Native Client - a step to browser as operating system

Google announced Native Client - a browser plugin technology that allows applications written in native code (as opposed to code requiring a virtual machine like Java or scripting languages that are interpreted at runtime like JavaScript) to run on your computer. This means much more powerful applications taking full advantage of the processing power modern computers provide. Security is a huge concern here but Google skirts the issue by claiming that potential benefits will outweigh the risks.

Seeing Google talk about browser plugins brings to mind its own Chrome browser. Chrome plus Native Client sounds to me like a giant step toward the idea of Web browser essentially replacing the local operating system. So we have Google already basically controlling the Web and now gaining a foothold on local devices! Cloud computing, here we come.

Blue Screen of Death

Found at an airport - departures and arrivals brought to you by Microsoft...