Sunday, August 31, 2008
New Orleans Evacuates - 3 years after Katrina
Exactly three years ago today we were glued to our TV sets watching the horror unfold in that unique American city, New Orleans. The unthinkable was happening...an entire city was under water and tens of thousands of people were stuck on rooftops, abandoned on freeways and inside the superdome in stifling heat with no provisions. It was such a shock. Within 24 hours I heeded an email call for
Friday, August 29, 2008
Barack Roll
No political statement here. Just go dance this weekend!!!Hat Tip to Cary at List of the day
Cool Technology of the Week
In my role as Chair of the Healthcare Information Technology Standards Panel (HITSP), I've worked with 500 stakeholder organizations to harmonize the standards for clinical summaries, labs, e-prescribing, public health reporting, quality measurement, and personal health records.
These standards are now beginning to be implemented widely in the private and public sector since being mandated for Federal procurement in January of 2008.
Massachusetts and its hospitals have embraced these new standards and today we're sending thousands of transactions with them. One of our more exciting implementations went live earlier this month - lifetime medical record exchange with the Social Security Administration (SSA) for disability processing.
Using HITSP standards for data content (CCD) and transmission (SOAP), BIDMC has built a web service to provide real time exchange of data with the Social Security Administration. The client and the web service communicate using XML messages that follow the SOAP standard. The client sends a SOAP message containing patient demographics and a copy of the digitized consent and the web service responds with a SOAP message containing the Continuity of Care Document of the patient. Transport layer security is enforced via SSL. Message layer security is enforced using X.509 certificates and digital signature. All SOAP messages are digitally signed by sender’s certificate. Both the digital signature and the sender’s certificate are validated for data origin authentication.
A deidentified sample of an actual SSA transmission is available online.
It contains:
Patient Demographics:
SSN
Name
Gender
Birth time
Address
Phone number
Next of Kin information
Condition/Problems: (fully coded)
Current Problem list from webOMR
All inpatient visit diagnosis in the date range requested
All ED visit diagnosis in the date range requested
All Outpatient visit diagnosis in the date range requested
Results (human readable) limited to date range requested
All Lab results (chem, hem, urinalysis, blood gases, blood bank, etc.)
All reports from:
CT Scan Reports
Pathology/Biopsy Reports
X-ray Reports
MRI Reports
Cardiac Catheterization Reports
EEG (electroencephalogram)
ECG/EKG Reports
PET Scan Reports
Pulmonary Function Test Reports and Tracings
Graded Exercise Test/Exercise Tolerance Test Reports (cardiac tests)
Procedures (fully coded) limited to date range requested
Inpatient procedures
ED procedures
Outpatient procedures
Encounter (human readable) limited to date range requested
All discharge summaries from Inpatient stays – (identical to MA Share document)
All Operative notes
All ED visit summaries
All Notes on patient from webOMR
Letters
Phone calls
Encounter summaries
Thus, we've leveraged the internet (not private networks or VPNs), existing web standards (SOAP, SSL), and a structured, vocabulary controlled XML exchange (CCD) to rapidly implement interoperability with patient consent.
I've read some articles and heard some rumors that HITSP efforts are not XML based, are not vocabulary controlled, and are not embracing existing web standards. The SSA project illustrates the reality of how HITSP interoperability specifications empower connectivity at low cost with little effort using XML, vocabularies, and existing web standards.
These standards are now beginning to be implemented widely in the private and public sector since being mandated for Federal procurement in January of 2008.
Massachusetts and its hospitals have embraced these new standards and today we're sending thousands of transactions with them. One of our more exciting implementations went live earlier this month - lifetime medical record exchange with the Social Security Administration (SSA) for disability processing.
Using HITSP standards for data content (CCD) and transmission (SOAP), BIDMC has built a web service to provide real time exchange of data with the Social Security Administration. The client and the web service communicate using XML messages that follow the SOAP standard. The client sends a SOAP message containing patient demographics and a copy of the digitized consent and the web service responds with a SOAP message containing the Continuity of Care Document of the patient. Transport layer security is enforced via SSL. Message layer security is enforced using X.509 certificates and digital signature. All SOAP messages are digitally signed by sender’s certificate. Both the digital signature and the sender’s certificate are validated for data origin authentication.
A deidentified sample of an actual SSA transmission is available online.
It contains:
Patient Demographics:
SSN
Name
Gender
Birth time
Address
Phone number
Next of Kin information
Condition/Problems: (fully coded)
Current Problem list from webOMR
All inpatient visit diagnosis in the date range requested
All ED visit diagnosis in the date range requested
All Outpatient visit diagnosis in the date range requested
Results (human readable) limited to date range requested
All Lab results (chem, hem, urinalysis, blood gases, blood bank, etc.)
All reports from:
CT Scan Reports
Pathology/Biopsy Reports
X-ray Reports
MRI Reports
Cardiac Catheterization Reports
EEG (electroencephalogram)
ECG/EKG Reports
PET Scan Reports
Pulmonary Function Test Reports and Tracings
Graded Exercise Test/Exercise Tolerance Test Reports (cardiac tests)
Procedures (fully coded) limited to date range requested
Inpatient procedures
ED procedures
Outpatient procedures
Encounter (human readable) limited to date range requested
All discharge summaries from Inpatient stays – (identical to MA Share document)
All Operative notes
All ED visit summaries
All Notes on patient from webOMR
Letters
Phone calls
Encounter summaries
Thus, we've leveraged the internet (not private networks or VPNs), existing web standards (SOAP, SSL), and a structured, vocabulary controlled XML exchange (CCD) to rapidly implement interoperability with patient consent.
I've read some articles and heard some rumors that HITSP efforts are not XML based, are not vocabulary controlled, and are not embracing existing web standards. The SSA project illustrates the reality of how HITSP interoperability specifications empower connectivity at low cost with little effort using XML, vocabularies, and existing web standards.
Thursday, August 28, 2008
Hospital Infections - Take Charge
Hospital acquired infections are a serious problem that the quality improvement movement is shining a light on. Each year 2 million Americans acquire an infection while hospitalized. We used to accept these rates as just unfortunate events. From methacillin resistant staph (MRSA) to Clostridium difficile (C. diff), we now know that these infections can be prevented through rigorous precautions
100 Things to Do Before You Die
Today I heard about a sobering accidental death.Dave Freeman, co-author of “100 Things to Do Before You Die,” a travel guide and ode to odd adventures that inspired readers and imitators, died on Aug. 17 after a fall at his home in the Venice section of Los Angeles. He was 47.
Dave and I were only 6 months different in age. Over the past 10 years while I've been climbing, hiking, and traveling the world, I've tried to live each day to the fullest, creating my own 100 Things list. Here are a few completed entries on my list from my recent vacation and previous travels:
1. Explore the excavations of old Jerusalem with an archeologist. I did consulting for the government of Israel on coordinating electronic health records for mass causality incidents. I asked for a day with an archeologist as my compensation.
2. Walk Hadrian's Wall (separates England and Scotland in the UK) coast to coast and have a pint of ale in a rural Scottish Pub with farmers who've never met an American.
3. Kayak across the Baltic Sea (it took 3 days)
4. Gather crawfish by moonlight in Sweden (before I was a vegan)
5. Explore the fiords of Norway on foot
6. Bicycle throughout East Anglia in England, exploring the backroads and hedgerows.
7. Walk the 7 hills of Rome and climb the stairs to the top of St. Peters
8. Climb the Untersberg in Salzburg, Austria
9. Play the Turkish Ney in a Mosque in Istanbul
10. Walk the John Muir Trail
11. Climb every mountain in New England in every season of the year
12. Spend a weekend meditating and praying with Buddhist Monks at a temple on Mt. Koya
13. Spend the night on top of Half Dome
14. Play the Digeridoo in Australia
15. Scuba dive with Grey Whales
16. Watch the sunrise from the top of Mt. Fuji
17. Walk the old city of Prague where my ancestors made Pilsner
18. Play a flute concert on the top of the Eichorn Pinnacle in Yosemite (photo above)
19. Have dinner in the Smithsonian at night after it's closed
20. Walk 5 miles on the Great Wall of China
21. Climb the Grand Tetons at dawn
22. Camp under the stars at 11,000 feet in Yosemite during a meteor shower
23. Get licked on the face by a giraffe
24. Watch a sunrise from Machu Picchu
25. Ride a sleeper train with my family from Tokyo to Sapporo Japan.
Wherever I wander, I always look for the road less traveled. I never sit in a hotel room or seek the comforts of home - there will be time for that later. By filling each moment with lasting experiences instead of buying 'stuff' , I have very memorable encounters with people and places that provide me with long term satisfaction when I return home.
Dave - I wish you well and I hope you experienced your 100. I've already made a list for 2009 that includes sunsets on Santorini, playing the Hungarian Furulya with shepherds near Budapest, and climbing the East Face of Mt. Whitney. Whenever my time comes, I'll know that I balanced each day with work, family, and personal pursuits that include the best things I can find in this world.
Wednesday, August 27, 2008
Answer to Medical Quiz
The answer is #5. Squamous-cell carcinoma (above is another image that shows squamous cell and basal cell. A biopsy is needed to confirm diagnosis).The squamous cell lesion is exophytic and hyperkeratotic with central ulceration, features that are most typical of a squamous-cell carcinoma. Basal-cell carcinomas typically present as a papule with a pearly border. Granuloma fissuratum refers to a
High Performance Computing for Research
In the past, I've written about the Harvard infrastructure I oversee in support of the research community
High Performance Computing clusters are a collaboration of the research community and IT to create a shared infrastructure for the benefit of all. We've learned a great detail about how to balance central/local IT offerings and how to build highly reliable low cost research IT infrastructure. Last year we organized a summit to share lessons learned. Over 100 leaders in high performance computing (HPC) gathered at Harvard Medical School to share ideas and hear presentations from their colleagues.
The Summit was a great success with over 90% of attendees rating it as extremely valuable and that they learned something that would be of immediate use to them. And this was the point of the Summit -- to bring together the leaders to share ideas and approaches. Sharing stories and best practices (and worst practices!) allows the field to grow more rapidly and efficiently.
Biomedical Informatics is at an exciting cross roads: the computational challenges facing researchers, clinicians and public health professionals now exceed the computational power typically available in an academic biomedical setting. This is exciting because it means that the advances in high performance computing from other disciplines (e.g. physics) can be brought to bear on the great challenges of life sciences, health and medical research. The opportunities to develop new therapies, monitor trends in ambulatory hospital data and catch and avert drug related mishaps (e.g. Vioxx) are truly astounding. With the advent of the $1,000 “ome” (genotype, phenotype, labs) – the capacity to analyze and predict longitudinally and in real time as well as the ability to hypothesis test retrospectively will challenge the computational boundaries of all biomedical research organizations. Computational power is now at the very core or our ability to rapidly advance the state of clinical care and healthcare. In fact some new labs at Harvard Medical School do not even have a wet lab component, but do all of their work through "in silico" simulations and modeling. All of this leads to an exciting time for people who need to build and provide HPC infrastructure to the research community!
One unique part of the summit is the use of audience participation devices which allow the organizers and participants to poll all the attendees. Here are a few of the results of last year's audience participation surveys:
* While 43% of biomed HPC facilities are building new data centers -- but 35% are leasing commercial data center space instead!
* Around 50% of biomed HPC clusters now use some sort of parallel or distributed filesystem -- with 95% of leaders planning in production or implemented in the next two years
* Most facilities (63%) still rely on gigabit Ethernet as their primary interconnect followed by 10G ethernet (17%) and Infiniband (12%)
* Around hald of biomed HPC shops use virtualization in their production environment and when they do they use VMWare (66%) and Xen (23%)
* Platform LSF is the primary job scheduler, used in nearly half of all Biomed HPC shops -- the remainder of shops are divided amongst Sun Grid Engine, Open PBS and Univa
The Summit has four focus areas this year:
* Managing biomedical storage growth -- with many institutions seeing storage growth measured in petabytes the challenges with managing, archiving and retrieving accelerate
* Bringing HPC to the users -- many scientists need access to HPC resources but don't have the technical skills to adapt to command lines and shell scripts. New frameworks allow researchers to do common tasks through a web GUI or via automated web services.
* Connecting to the grid -- many small and medium biomedical HPC shops would like to participate in the national grid efforts, but knowing where to start and how to participate is an ongoing challenge
* Trends in Biomedical HPC -- hear from the experts about the latest trends in Biomedical HPC including the new Centers for Translational Science and the growing demand for large scale HPC services in Biomedical Research
I'd like to invite anyone interested in High Performance Computing in the Biomedical fields to join their colleagues and other leaders in this rapidly evolving field to join us at Harvard Medical School in October. Registration is open at https://biomedhpc.med.harvard.edu
I hope to see you there!
High Performance Computing clusters are a collaboration of the research community and IT to create a shared infrastructure for the benefit of all. We've learned a great detail about how to balance central/local IT offerings and how to build highly reliable low cost research IT infrastructure. Last year we organized a summit to share lessons learned. Over 100 leaders in high performance computing (HPC) gathered at Harvard Medical School to share ideas and hear presentations from their colleagues.
The Summit was a great success with over 90% of attendees rating it as extremely valuable and that they learned something that would be of immediate use to them. And this was the point of the Summit -- to bring together the leaders to share ideas and approaches. Sharing stories and best practices (and worst practices!) allows the field to grow more rapidly and efficiently.
Biomedical Informatics is at an exciting cross roads: the computational challenges facing researchers, clinicians and public health professionals now exceed the computational power typically available in an academic biomedical setting. This is exciting because it means that the advances in high performance computing from other disciplines (e.g. physics) can be brought to bear on the great challenges of life sciences, health and medical research. The opportunities to develop new therapies, monitor trends in ambulatory hospital data and catch and avert drug related mishaps (e.g. Vioxx) are truly astounding. With the advent of the $1,000 “ome” (genotype, phenotype, labs) – the capacity to analyze and predict longitudinally and in real time as well as the ability to hypothesis test retrospectively will challenge the computational boundaries of all biomedical research organizations. Computational power is now at the very core or our ability to rapidly advance the state of clinical care and healthcare. In fact some new labs at Harvard Medical School do not even have a wet lab component, but do all of their work through "in silico" simulations and modeling. All of this leads to an exciting time for people who need to build and provide HPC infrastructure to the research community!
One unique part of the summit is the use of audience participation devices which allow the organizers and participants to poll all the attendees. Here are a few of the results of last year's audience participation surveys:
* While 43% of biomed HPC facilities are building new data centers -- but 35% are leasing commercial data center space instead!
* Around 50% of biomed HPC clusters now use some sort of parallel or distributed filesystem -- with 95% of leaders planning in production or implemented in the next two years
* Most facilities (63%) still rely on gigabit Ethernet as their primary interconnect followed by 10G ethernet (17%) and Infiniband (12%)
* Around hald of biomed HPC shops use virtualization in their production environment and when they do they use VMWare (66%) and Xen (23%)
* Platform LSF is the primary job scheduler, used in nearly half of all Biomed HPC shops -- the remainder of shops are divided amongst Sun Grid Engine, Open PBS and Univa
The Summit has four focus areas this year:
* Managing biomedical storage growth -- with many institutions seeing storage growth measured in petabytes the challenges with managing, archiving and retrieving accelerate
* Bringing HPC to the users -- many scientists need access to HPC resources but don't have the technical skills to adapt to command lines and shell scripts. New frameworks allow researchers to do common tasks through a web GUI or via automated web services.
* Connecting to the grid -- many small and medium biomedical HPC shops would like to participate in the national grid efforts, but knowing where to start and how to participate is an ongoing challenge
* Trends in Biomedical HPC -- hear from the experts about the latest trends in Biomedical HPC including the new Centers for Translational Science and the growing demand for large scale HPC services in Biomedical Research
I'd like to invite anyone interested in High Performance Computing in the Biomedical fields to join their colleagues and other leaders in this rapidly evolving field to join us at Harvard Medical School in October. Registration is open at https://biomedhpc.med.harvard.edu
I hope to see you there!
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