Vegan Dining in Chicago

While at HIMSS, you can munch on the usual gourmet convention center cuisine - Hamburgers, Cappuccino, Pretzels, or Jumbo dogs. Or you could a walk a mile or two and enjoy Vegan Chicago. Most folks think of Chicago as deep dish pizza, ribs or steaks. However, there are a remarkable array of Vegan friendly restaurants and delis.

I walked from the Convention Center to Opera at 1301 S. Wabash to sample their vegan specialties. On Friday night I had a starter of a Vegan Corn fritter, followed by Spicy Shitake Wontons surrounding an asparagus salad, and then an entree not on the menu but made by the chef for me as a experimental future addition to the vegan menu - Pressed Tofu Kung Pao style. However, a side of Bok Choy provided a cool counterpoint.

On Monday night, I dropped by for a reprise and had a starter of fresh vegetable Moo Shu in two spicy sauces followed by an entree of Mapo Tofu. Another remarkable meal.

Here are a few resources for Chicago Vegan dining:

The Chicago Diner

Vegan Living overview of dining in Chicago

EcoBusinessLinks overview of dining in Chicago

The Happy Cow overview of dining in Chicago

Next time you're at HIMSS, go for something vegan. It gives you the endurance to run through the HIMSS exhibits in record time!

Myocardial Infarction

This is a cool short video that shows how a heart attack happens.

The Data Elements of an EHR

I've recently been asked to provide a list of the data elements of an EHR which might be used as part of the ARRA mandate to exchange data as part of meaningful use. There are a nearly infinite number of actors, actions and events for data exchange, but in the interest of getting "data liquidity" in healthcare, here are the elements that are most commonly used and represent a great starting point for healthcare information exchange. I always strive for parsimony of standards - the fewest that we need for the purpose. Below you'll see that I've included the standards that support the systems we have in place today as well as the XML/Web-based standards that support newer web-centric systems and healthcare information exchanges.

Demographics
Content: HL7 2.x for messaging, CCD for document summaries
Vocabulary: HITSP Harmonized codesets for gender, marital status

Problem List
Content: HL7 2.x for messaging, CCD for document summaries
Vocabulary: SNOMED-CT

Medications
Content: NCPDP script for messaging, CCD for document summaries
Vocabulary: RxNorm and Structured SIG

Allergies
Content: HL7 2.x for messaging, CCD for document summaries
Vocabulary: UNII for foods and substances, NDF-RT for medication class, RxNorm for Medications

Progress Notes and Other Narrative Documents (History and Physical, Operative Notes, Discharge Summary)
Content: HL7 2.x for messaging, CCD for document summaries
Vocabulary: CDA Templates

Departmental Reports (Pathology/Cytology, GI, Pulmonary, Cardiology etc.)
Content: HL7 2.x for messaging, CCD for document summaries
Vocabulary: SNOMED-CT

Laboratory Results
Content: HL7 2.x for messaging, CCD for document summaries
Vocabulary: LOINC for lab name, UCUM for units of measure, SNOMED-CT for test ordering reason

Microbiology
Content: HL7 2.x for messaging, CCD for document summaries
Vocabulary: LOINC for lab name/observation

Images
Content: DICOM

Administrative Transactions (Benefits/Eligibility, Referral/Authorization, Claims/Remittance)
Content: X12
Vocabulary: X12, CAQH CORE

Quality Measures
Content: Derived from all the data elements above
Vocabulary: Derived from all the data elements above

Privacy and Security
Transport: HTTPS, SOAP/REST
Transport Orchestration: WS*
Authorization/Access Control: XACML

Given that meaningful use needs to be achieved by 2011-2012, it's clear that we cannot rip and replace existing hospital information systems and EHRs. We need to leverage them, upgrade them over time, and install new systems in an incremental fashion. This is really true of any change in healthcare. If we had a greenfield, we would design healthcare delivery, payment, and infrastructure entirely differently. Unfortunately, we do not have a greenfield, we have limited resources, and limited time to achieve healthcare reform, so we need to leverage what we have and evolve it in phases.

HITSP will be reformatting and streamlining its previous work over the next 90 days to support ARRA, the HIT Standards and Policies Committees, and ONC. I hope you agree that the list of EHR data elements above is practical, achievable now, and reasonable.

Dispatch from HIMSS

Every year, I walk the floor of HIMSS and summarize the broad trends I see in the industry. Here are my 2009 observations

1. The Stimulus - There's energy and optimism at HIMSS this year caused by the prospect of $34 billion dollars of stimulus funding for Healthcare IT. Since the current healthcare IT annual spend is somewhere between $15-25 billion, this could double the entire industry.

2. The Economy - the euphoria of the stimulus is tempered by the challenging economy - downsizing, wage cuts, and the collapse of 401k's are a stark contrast to the hope of new EHR rollouts.

3. Software as a Service - It's clear that all these new EHRs are not going to be hosted in the offices of rural solo practitioners. Web-based software as a service hosting centers for EHRs are being discussed by many companies - software producers, infrastructure providers and consulting companies. Many server, storage and virtualization suppliers are offering new products to support the Cloud Computing infrastructure needed to support Software as a Service hosting.

4. Security - with the prospect of every patient in the country having an interoperable EHR by 2014, there are increasing concerns about protecting confidentiality. Companies are creating new security tools, new consent management systems, and new audit reporting systems.

5. Open Source - Just as Linux has become mainstream in corporate data centers, open source EHR and HIE products are becoming more mainstream. A group of open source vendors met with CCHIT to discuss their role in the EHR ecosystem.

6. PHRs - with more EHRs comes the prospect of more PHRs to share electronic data with patients. Google announced its Medicare data sharing pilot. A really interesting question to be answered is the role of PHRs in the meaningful use of EHRs. Will EHR to PHR data sharing qualify for the interoperability requirements of meaningful use? To be determined.

7. Appliances for HIE - In previous years, folks exchanging data among stakeholders focused on content - shall we use HL7 2.x or 3.x, shall we use LOINC or SNOMED-CT? This year, the focus has been on infrastructure - how do we transport data securely from one stakeholder to another? A few companies are offering integration engines and health information exchange appliances to address this secure transport requirement. HHS released its CONNECT open source Nationwide Health Information Network gateway, built by 20 members of the Federal Health Architecture team.

8. Home Healthcare Care/Telemedicine - Continua Alliance, GE and Intel have all embraced remote monitoring and home care as one strategy to reduce healthcare costs while improving quality.

9. Performance Measurement and Outcomes - Tools for quality warehousing, business intelligence/reporting, and risk adjustment are being offered by many vendors.

10. Decision Support - As more EHRs are rolled out, we'll need decision support rules and services. Several companies offer order sets, knowledgebases, and decision support web services.

A good show with many innovative interoperability products, especially in the interoperability showcase. It was good to catchup with colleagues and vendors - 24,000 of my closest friends!

Saving the Boston Globe

I've joined a dozen other bloggers in posting this message simultaneously:

"We have all read recently about the threat of possible closure faced by the Boston Globe. A number of Boston-based bloggers who care about the continued existence of the Globe have banded together in conducting a blog rally. We are simultaneously posting this paragraph to solicit your ideas of steps the Globe could take to improve its financial picture.

"We view the Globe as an important community resource, and we think that lots of people in the region agree and might have creative ideas that might help in this situation. So, here's your chance. Please don't write with nasty comments and sarcasm: Use this forum for thoughtful and interesting steps you would recommend to the management that would improve readership, enhance the Globe's community presence, and make money. Who knows, someone here might come up with an idea that will work, or at least help. Thank you."

Testosterone Levels After Menopause

One of the little mentioned effects of menopause in women is low libido. As Estrogen levels decline, sexual desire seems to fade too. Since this isn't openly discussed, women and their partners wonder what the heck has happened.In the past it was blamed on "empty nest" or mid-life crisis but we know now that the culprit is the hormone testosterone. Yup! That male hormone, testosterone, is present

My Telepresence Experience

I returned to Boston from HIMSS to spend the day with my daughter on her 16th birthday. We had a great day cooking, hiking, and enjoying a fabulous Japanese meal as a family. However, I was also in Chicago for 2 hours, speaking with the press about the Stimulus Bill, Interoperability, and Decision Support.

The press gathered at the Cisco booth on the floor of HIMSS and I welcomed them to my basement via Telepresence. We chatted for an hour with full life-sized 1080p real time video. Truly, there was no difference from sitting in a room together, other than the fact that my basement had a bubbling fish tank and 2 rabbits running around.

My Telepresence experience was different from traditional video conferencing in that it did not feel like a video conference. All the other units I've used in the past have had a small grainy picture with tinny sound, often displaying picture within a picture. Telepresence is just high definition video and audio with the feeling that you are in room with the other participants, not on a video conference.

All the eye contact, gestures, and common courtesy you'd use in an in person meeting are natural in Telepresence. I changed my body position, my eye focus and my voice direction as I spoke to various participants.

The technology worked perfectly over my home Verizon FIOS 20 megabit connection.

I really enjoyed using the technology to connect with HIMSS while being in Boston with my daughter. At 4am I'm heading back to HIMSS for a day of meetings with many stakeholders. I'm working on becoming 100% virtual, but our culture is not quite ready for that!