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.

Use of Mobile Devices Increasing in Health Care

A recent article on Bloomberg.com highlights the increasing use of wireless devices such as smartphones and tablet PCs in the delivery and receipt of health care. The article emphasizes not only the popularity of such devices, but the real and potential health benefits they afford or promise, such as increased collaboration between patients and physicians.

The Information Technology group within CCHS is actively exploring ways to leverage this technology for our patients and providers. As usual, things are moving at "County speed", but we hope to include better affordance for mobile devices as part of the iSITE (intranet) redesign project. Beyond that, we want to develop a strategic approach to supporting mobile computing for CCHS. If you have ideas that you would like us to consider, I encourage you to publish them as comments to this post, so that we can begin a conversation about needs, expectations, and visions.

Is there any interest in forming an informal advisory board to offer suggestions and guidance to IT on this topic? Contact me if you'd like to participate.

CMS/HHS Release Meaningful-Use Regs

The CMS and HHS' Office of the National Coordinator issued their much-anticipated final meaningful-use information technology regulations. These are the rules that hospitals and physicians must follow to be eligible for a portion of the $27.3 billion in financial incentives authorized by the stimulus act.

Responding to concerns from providers, hospitals and physicians will not be required to satisfy all of the objectives in the new standard in order to qualify. The new standard establishes a "core set of objectives" and a "menu set of objectives". "Meaningful" EHR users must meet the measure for each objective in the core set and meet all but five of the objectives in the menu set. The standard also adopts an incremental approach to requiring adoption of CPOE (computerized physician order entry).

UW Safely Reduces Resident Hours with Computerized Rounding and Sign-Out

The University of Washington has developed a computer system for the handover of patient responsibilities that promises to reduce the amount of time that residents spend signing out and recopying data prerounds.

The system, called "UW Cores", was evaluated in a 14-week, randomized crossover study involving 14 inpatient resident teams (6 general surgery, 8 internal medicine) at two hospitals. The study suggests that resident time can be reduced while simultaneously improving continuity and enhanced resident efficiency without weakening systemic defenses against error or jeopardizing patient safety.

The study, by Erik Van Eaton, MD, Karen McDonough, MD, William Lober, MD, Eric Johnson, MS, Carlos Pellegrini, MD, and Karen Horvath, MD, is available at the Academic Medicine website. Subscription is required to access the full text.

"IS" Becomes "IT"

In an all-hands staff meeting this afternoon, CIO David Runt announced that, effective immediately, the "Information Systems" business unit will be officially known as "Information Technology".

This change is part of a broader reorganization that will be occurring in the IT department over the coming months, but the rebranding also reflects Mr. Runt's desire to emphasize the full range of professional services provided by our department.

I'd say, "New name, same great service," but the reorg, combined with our ongoing commitment to continuous improvement, is intended to enhance both IT performance and customer satisfaction.

Contra Costa Health Services Information Technology, at your service!

Microsoft and Google Unveil "Community Health Mapping" Applications

Coinciding with Wednesday's launch of the Community Health Data Initiative (aimed at leveraging community health information to spur the development of new applications that could improve health care), both Google and Microsoft announced new health mapping applications.

Microsoft is releasing Bing Health Maps, using community health data from the Health & Human Services (HHS) department to help consumers compare Medicare costs by region. It provides access to national or county-specific information on topics like births, deaths, and health risk factors.

Google is rolling out Google Fusion Tables, which is a database service intended to help patients compare and share data on communities, hospitals, and nursing homes. Consumers can use the application to create custom maps highlighting data of interest.

The Future of the User Interface?

Did you see Minority Report, the Steven Spielberg movie starring Tom Cruise (based on a short story by Philip K. Dick)?

The film features a futuristic computer user interface (UI) that intrigued viewers and suggested an entirely new way of interacting with computing devices. The story was set in 2054, but it turns out that the future is almost here.... See the film's science advisor, inventor John Underkoffler, present the current state of the art in a TED Talk posted on the I.S. homepage in iSITE.

Roger Case, R.I.P.

from the Contra Costa Times:

Roger D. Case
Oct. 12, 1943 ~ April 12, 2010

Sadly we announce the passing of Roger Case on April 12, 2010 after a long and courageous battle with cancer. He now rests with the Lord, from whom he sought guidance, strength and wisdom.

Roger leaves behind his beloved Patty Taylor, parents Bob and June Case, brother and sister-in-law Ron and Nita Case, nieces, nephews and grandchildren who affectionately called him "Grumpy."

Born in Oakland, CA. Roger attended Claremont Jr. High and Oakland Technical High and later received a Bachelor's Degree in Business. After duty in the National Guard Roger's work lead to a career in computer technology, one of Roger's many passions. Roger worked for Contra Costa County Health Services through 2009 as an IT engineer. He was a devoted and grateful member of Alcoholics Anonymous; he gave tirelessly to newcomers seeking sobriety and others simply seeking his wisdom. When he spoke people listened knowing his sharing would be either profound and life changing or funny to the point of tears. He was an avid runner with the Diablo Road Runners. He loved music, cars, Harleys, literature, photography and poetry. Roger had a passion for life and the people in it, but his greatest love was for God.

Celebrate Roger's life May 1, 2010 at 1:00pm at Calvary Temple, 4725 Evora Road, Concord, CA 94520.

Donations can be made to The Wellness Community 3276 Mcnutt Ave, Walnut Creek, CA 94597.

Goodby, Roger. We'll miss you!

Wireless Monitoring of Physiological Data?

Computerworld reports:

As part of its first national broadband plan unveiled earlier this month, the Federal Communications Commission proposed allocating spectrum for new medical body area networks (MBAN).

If approved:

many patients may no longer need to travel to a health care facility to be tethered to large machines that monitor their health.

The plan was first proposed by GE's healthcare division. The FCC is now seeking public comment.

WARNING: File-sharing Risk for Sensitive Data

Physicians who use file-sharing software (like BitTorrent , Kazaa, or LimeWire) on their computers could inadvertently put their patients' health and financial information at risk, according to a recent study published in the Journal of the American Medical Informatics Association.

A year-long study analyzed 23 million to 24 million files in the U.S. and Canada, finding that personal health & financial information could be accessed through a simple search in 5% of U.S. files -- hundreds of thousands of files, including Social Security numbers, patient insurance information, personal banking information, and more.

TED Talks on iSITE

Microsoft's Gary Flake demonstrates an exciting new paradigm for navigating data and content. Watch his TED Talk on the Information Systems homepage in iSITE!

iSITE Update - Have You Been Heard?

For those who read the IS Newsletter, Insight Out, or are members of the iSITE Users' Group, this will be old news, but the iSITE Redesign Project is moving ahead on schedule.

"iSITE", for the uninitiated, is the CCHS intranet -- an internal website designed to promote information-sharing and collaboration among CCHS employees. The redesign project is intended to produce the "next generation" of the site, improving both the user-friendliness and usefulness of this tool.

The initial user research segment of the project, which included one-on-one interviews, an online survey, usability testing, and a card-sorting exercise, is drawing to a close, and our design consultants, Blue River Interactive Agency, are beginning to rework the site's information architecture, based on what we have learned from this research. More than 20 individuals, representing most CCHS divisions, were personally interviewed, and over 200 people participated in the online survey.

But if your were not contacted by the iSITE or were unable to participate in our research for any reason, and you would still like to contribute your ideas & opinions, don't worry: we still want to hear from you! If you're in a hurry, simply add your thoughts in a comment to this blog post. Please include your name and email address if you'd like a personal response (for additional comments or questions), but feel free to respond anonymously if you wish. If you'd like to provide more detailed feedback, send it in an email or contact me to set up a personal interview.

Closing IT Gaps in the Hospital

What issues do some of the major hospital networks see?

Executives from Catholic Healthcare West, Intermountain Healthcare, and Kaiser Permanente discussed the challenges they face at the Regional Healthcare Stimulus Exchange Conference in San Francisco.

Take the iSITE Survey!

We recently kicked off our much-anticipated iSITE Redesign Project, and we're eager to get your opinions and suggestions for improving the CCHS intranet (a.k.a., iSITE).

CCHS employees can take a quick survey online to help us better understand your perceptions of and expectations for the intranet. The survey consists of 21 simple questions, including opportunities to provide free-form input about problems you'd like to see corrected or improvements you'd like to see made.

If you are interested in more active engagement in the redesign project, please contact me to talk about participating in usability tests, field studies, or other exercises.

Fulfiller of the Year

Jeffrey Cameron of the IS Network Group fulfilled 2,119 system access requests for CCHS staff during 2009. His average turnaround time for all those requests was 8 hours and 46 minutes.

Congratulations, Jeff!

Thanks for your dedication and diligent service!