Forget Tax Cuts -- Get into Taxonomy!

Taxonomy is the practice and science of classification (Wikipedia).

Why should you care? Because, as Humpty Dumpty said to Alice in Through the Looking Glass, "When I use a word, it means just what I choose it to mean, neither more nor less." No matter how much we might wish to challenge Mr. Dumpty's assertion, that attitude is standard operating procedure for most of us in most aspects of our lives. The problem is: words matter, and we need to agree on some basic definitions to ensure the smooth flow of information -- not to mention appropriate delivery of care -- in our workplace.

For example, there may be many different understandings of what constitutes a "visit", but only one definition counts when it comes to billing for services.

"The most advanced companies are now leveraging taxonomies to map heterogeneous data sources to a common conceptual model," says Seth Earley, a prominent taxonomy consultant.

This topic has special relevance to CCHS as we redesign our corporate intranet, iSITE, because the categories used to organize our knowledge base -- and the very labels used to describe those categories -- are crucial to effective management of our information.

One way to achieve common understanding and develop a shared institutional taxonomy is to use a "controlled vocabulary", wherein a set of "preferred terms" are fully defined and mapped to sets of "equivalent terms" or synonyms.

I propose that we at CCHS adopt the "Unified Medical Language System", a controlled vocabulary of health terminology produced and maintained by the National Library of Medicine in conjunction with the U.S. Department of Health & Human Services and the National Institutes of Health.

Microsoft SharePoint, the chosen development platform for the next generation of iSITE, provides taxonomy support, and the UMLS could be integrated into our system to help populate selection lists, provide guidance for labeling and document-naming conventions, and serve as a general reference for a common language. As a governmental standard, it should offer miminum conflict with other standards and conventions.

I would be very interested in getting your feedback on this concept. If you have an interest in this topic, I would also encourage you to get involved with the iSITE Users' Group to discuss these issues in depth.

UPDATE:
Dr. Kaji suggests that I emphasize that the UMLS is a public domain standard and is available for free. We have a licensed copy (licensed, because it is updated regularly) installed on a local server for evaluation. When I am confident that I understand the system well enough to teach others, I will release it to the community for detailed review and evaluation.

Three Healthcare Orgs Win Baldrige Awards

The Malcolm Baldrige National Quality Awards are among the most prestigious recognitions of quality improvement efforts in the world. Receiving the award for 2010 were an Illinois hospital and two other healthcare sector businesses.

• Advocate Good Samaritan Hospital, Downers Grove IL
  
• Medrad, Warrendale PA (medical device manufacturer)
  
• Studer Group, Gulf Breeze FL (healthcare coaching and consulting)

The Baldrige Performance Excellence Program is overseen by the U.S. Commerce Department's National Institute of Standards and Technology. Commerce Secretary Gary Locke observed, "This award is unique in that it honors the collective effort of an entire organization that has systematically strived to achieve excellence in all aspects of its work."

Reevaluating Paradigms

From Joseph Conn's IT Everything blog at ModernHealthcare.com:

The IT history of the Veterans Affairs Department has been one of intermittent battling between two groups: One is the programmers and clinicians who, starting in the late 1970s, built their public-domain IT system from scratch. The other side is composed of political and bureaucratic supporters of a centralized command-and-control IT bureaucracy who have sought to thwart the home-grown effort, typically in favor of purchasing or programming software from the commercial market. [emphasis added]

Sound familiar? The "build vs. buy" question has been kicking around CCHS IT for some time now. But at an even deeper level, it reflects the growing pains of an information technology organization that was itself "built from scratch".

"Information Systems" evolved somewhat organically in response to both Health Services' information needs and the burgeoning technology revolution of the late 20th century. However, with both changing leadership and a dramatically different environment (in terms of regulation, technology, and opportunity), we are pausing to purposefully plan a strategic approach for the future.

Information Systems has become Information Technology. This is intended to be more than a simple re-branding. It reflects a maturing of our organization, embracing our role as service providers for all our CCHS customers, not as robed guardians of sacred, secret systems.

Look for more news soon about how IT is reorganizing to meet the challenges of the future and improve the quality of service to all.

Army Software Helps Scientists Identify Cause of Honeybee Colony Collapse

A fascinating collaboration between Army scientists in Maryland and bee experts in Montana has led to an explanation for the "colony collapse" phenomenon that has devastated 20-40 percent of the bee colonies in the United States.

A new Army software system, designed to test and identify biological agents in circumstances where commanders might have no idea what sort of threat they face, has been used to study affected bees, and it suggests that the phenomenon is caused by an interaction between a fungus and a virus.

Not only is this good news for those of us who have been concerned with the fate of the bees (not to mention its implications for agriculture and human life), but it is a wonderful example of the benefits of cross-disciplinary collaboration -- where very diverse disciplines can learn from each other and mutually benefit in unexpected ways.

For more information about this exciting collaboration, see the New York Times.

How Would You Use Mobile Health Technology?

A recent survey of physicians (conducted by PriceWaterhouseCoopers)found 86% wanted to access EHRs via wireless mobile devices. 83% were interested in using mobile devices to prescribe medication, and 74% were interested in monitoring the health of patients in the hospital.

Does this correspond with the needs, wishes, and expectations of CCHS doctors? How would you like to use mobile technology in health care?

California Telehealth Network

The State of California launched the nation's largest telemedicine network yesterday.

The network connects patients and physicians using broadband technology. Telemedicine is intended to link small hospitals and health clinics with a system of physicians, surgeons, and specialists who may be hundreds of miles away. Currently, the California Telehealth Network (CTN) is set up across 50 sites, with the UC-Davis Medical Center serving as the network's control center. CTN is expected to link almost 900 health care facilities across the state by 2011.

Is there a place for CCHS in this system? Do we have a vision for our role or any plans brewing? What do we in IT need to do to help prepare?

Mobile Health Strategy -- More Than Devices

Smartphones and other mobile devices offer a lot of promise for improving health outcomes, but in order to deliver on that promise, healthcare providers must understand how patients bond with their phones!

A recent article in PC World illustrates some of the potential uses for mobile computing technology, ranging from doctors using tablet devices in consultations to patients sending data on sleep patterns over a wireless LAN.

But effective use of these new technologies is not just "plug and play". Lack of standards is one constraining factor, but just as important is an understanding of the personal relationship between people and their phones.

Another recent article in Computerworld emphasizes personalization as a key to customer satisfaction, but also notes the potential conflict between privacy and personalization. One organization quoted in the article recommends learning from the experience with your Website -- but not attempting to duplicate it. "Applications must be useful. You want them to do more than mimic the Web portal," says Bud Flagstad of UnitedHealth Group.

As an information architect and user experience designer, I can only echo the concept that the key to success in technology deployments is to understand the "mental models" of the target audience, the end users.