Sunday, May 31, 2009

Wings vs Penguins Game 1

Ozzie outplayed Fleury. That's my summary of game 1.

I hope NBC and CBC keep focusing on Cindy Crosby. I liked that NBC had isolation cameras on Crosby and Malkin (and probably Malkin's parents, too). At some point, they might realize that there are two teams in the series and that there are more than two players on the ice.

The Wings played another solid, professional game. The Wings showed once again that they can win without goals from their stars. I don't think that the Penguins can win that way.

I loved Justin Abdelkader's goal!

The Penguins outshot the Wings 32-30. Ozzie played another solid game. Fleury let in two bad goals.

Game two is in a few hours. Let's see if the Penguins can play a better game. If they do not, the series will be short.

Friday, May 29, 2009

Red Wings in the Stanley Cup Finals 2009

I've been a hockey fan for as long as I can remember. I can remember Gordie Howe and Alex Delvecchio and Terry Sawchuck.

I haven't always been a Red Wings fan. I can remember the "Darkness of Harkness" and the "Dead Wings" in the seventies and eighties. I was a fan of the Flyers and the Canadiens and the Islanders during those years. In my lifetime, the Wings have been pitiful. I can remember when they had great regular seasons and failed in the playoffs. I can remember facing the Oilers in the conference finals and failng. I can remember Brad Park being the only Wing back on an Oiler two on one and looking like a fish out of water. I can remember losing a game seven at home to the Maple Leafs in overtime.

I can remember the Wings being the dominating team in the regular season and losing in early rounds of the playoffs.

I can remember being shocked when the Wings lost in the finals to New Jersey.

I can remember crying when the Wings won the first Stanley cup in my lifetime.

Now, the Wings have won multiple Stanley Cups. They are now in the Finals against the Penguins, again.

I love the Stanley Cup Playoffs. They always seem to be decided by someone that most hockey fans have not been heard of before the Finals.

This year, it could be Helm or Filppula (folks from the UP know how to pronounce his name properly), or anyone from the fourth line. The Wings have rolled four line pretty consistently through this year and the playoffs. The hero of the playoffs will probably be someone that most hockey fans have not heard of much this year.

I feel pretty good about the Wings in these playoffs. They are skilled and deep and have good goaltending. I doubted Chris Osgood during the regular season, but he has played out of his mind during the playoffs.

I watched most of the Penguins games during their playoff run, and while they are a good team, they have not played well enough to beat the Wings.

Wings in five.

Monday, May 25, 2009

More on Meaningful Use

I wrote earlier about what Meaningful Use is and why it is important. Recall that providers will be reimbursed for purchases of certified HIT products and that they will then recieve financial incentive for the "meaningful use" of that technololgy, but all that the legislation says is that meaningful use is:

1. ePrescribing
2. participation in an HIE
3. submission of quality measures

The importance of the definition is that it is the first step in a process that involves many others.

1. The HIT Standards committee will need to select the standards and implementation guides that support meaningful use
2. The certification body (which may be CCHIT, but HHS has not confirmed this) will need to align its certification criteria with these
3. Vendors may need to adjust their EHR Systems to ensure that it meets the criteria. This may require recertification.
4. HealthCare Organizations (HCOs) that already have technology in place may need to upgrade or adjust their systems so that they can meet the meaningful use criteria. Those organizations that do not have EHRs in place will likely wait until the vendors have caught up with the certification criteria before they begin implementing.

Until the definition is published, we can guess at what they mean, and try to be ready for it.

Money becomes available for the purchase of "certified" EHR systems in October, 2010. So, the timing is extremely tight.

These dates are from the website:

Standards Rulemaking: Recovery Act §3004 (B) (1) - No later than December 31, 2009, HHS shall adopt and publish an initial set of standards, implementation specifications, and certification criteria. The rulemaking for this initial set of standards, implementation specifications, and certification criteria may be issued on an interim, final basis. Fully competitive contract awards will be utilized to support the impact analysis.


Complete Draft Rule/ Regulatory Impact Analysis. Start: 05/01/2009 End: 08/26/2009

Submit for HHS Clearance. Start: 08/26/2009 end: 09/25/2009

Clear OMB (up to 90 day process) Start: 09/25/2009 End: 12/24/2009

Publish in Federal Register. Start: 12/24/2009 End: 12/31/2009

So, if the HIT Standards Committee is to meet the deadline of submitting the list of standards that are required to support “meaningful use” (August 26), the definition has to be published very, very soon.

Red Wings vs Hawks, Game 4

First, a word about the Kronwall hit. I thought that this was a clean hit and did not warrant a penalty, let alone an ejection. If you cannot hit someone who is standing over the puck, we might as well put skirts on them.

Now, for Game 4. The Wings played a very poised, professional game. I did not hear about the injury scratches of Lidstrom, Draper and Datsyuk until just before the game. I expected that veteran Wings and the kids would pick up their games and that is what happened. Hossa and Zetterberg scored two goals each.

The Hawks lost their composure and very well lost the series. They took too many penalties for cheap shots after the whistle. The Wings made them pay on the ensuing power plays. Coach Q can be upset, but it is hard not to call a cross check when your player snaps his stick across the back of a Wing.

The Wings are now up 3-1, going back to the Joe for game 5 on Wednesday. I expect the Wings to finish the series then.

Sunday, May 17, 2009

Red Wings vs Black Hawks, Game 1

Red Wings vs Hawks 5/17/2009

Final Score: Wings 5, Hawks 2

Both teams looked very good at times today. The Wings outshot the Hawks 43-32.

The Wings scored on a couple of nice high shots, which is what you have to do to beat a good butterfly goalie, and Khabibulin is a good butterfly goalie.

The first Wing goal by Dan Cleary was a great high shot, just under the bar on the glove side. The second Wing goal by Johan Franzen was a wrap around along the ice just inside the far post. The third Wing goal, by Mikael Samuelsson was another great wrist shot up that beat Khabibulin high on the short side. Samuelsson showed great patience and when the Hawk goalie went down to his knees, he was beaten by a high wrister. The fourth Wing goal was a tip by Cleary of a shot by Johan Franzen that went up and over the Hawk netminder. The fifth Wing goal was an empty netter by Henrik Zetterberg.

Chris Osgood, the Red Wing netminder, played a solid game. He faced 32 shots and stopped 30 of them.

Both sides looked out of sorts at times, but both teams played well for stretches of time. The game was physical at times with both teams laying on some good hits.

I expect both teams to play better in game 2 on Tuesday night.

Meaningful Use

I work in Health Information Technology (HIT) and am working on a Masters in Medical Informatics (MMI) degree at Northwestern University. One of the hot topics in HIT is the American Recovery and Reinvestment Act (ARRA) The act will reimburse hospitals and other providers for the “meaningful use” of HIT. But the act doesn’t fully define the term.

ARRA defines “meaningful use” as:

  1. ePrescribing
  2. participation in an HIE
  3. submission of quality measures

This is ok, but what does it really mean.

ePrescribing is well understood. When ePrescribing is implemented, your doctor no longer hand writes a paper prescription that you carry to your pharmacist. The prescription is entered into a computer system and it is electronically transmitted to a pharmacy that you select. Hopefully, the bottle of pills will be waiting for you to pick up when you get there. The advantages of this are that no one has to try to read the Doctor’s handwriting, unless, the doctor still writes out the order and has a nurse or a clerk enter the data for them. If the doctor is using Computerized Physician Order Entry (CPOE), they enter the order directly into the computer. Another advantage is that we can compare this prescription with your current medical conditions and other prescriptions that you are taking and a Decision Support System will flag any potential adverse drug event (ADE) that might occur. With CPOE, the physician is alerted when the order is entered. In the old paper based system, your pharmacist might catch the error and would have to phone the physician to get the prescription changed.

The second component of meaningful use is participation in a Health Information Exchange (HIE). What is a Health Information Exchange? An HIE is a network of Hospitals and other providers that will electronically exchange clinical information about patients. The idea is that if you go to see Dr. Smith, his office will be able to electronically retrieve information about your past treatments other doctors and hospitals in the region. The problem is that HIEs do not exist. Well, ok. There are some things out there that are called HIEs, but they are few and far between. CCHIT just published their certification criteria for HIEs last fall but many of the HIEs that are operational may not meet these criteria. The hope is that states and regions will build HIEs so that providers can participate in them.

The third component is the submission of quality measures. We still do not know what quality measures will be reported and to whom. When providers have EMRs in place, it should be fairly straightforward to collect these quality measures and to electronically transmit them to the appropriate agency. This is just the reporting of quality measures; there are no targets….yet. Expect to see quality defined as a measure of outcome, and not as a measure of effort. In other words, just giving the patient an aspirin should not be considered a measure of quality. Similarly, you shouldn’t get quality points for giving the patient the same “quit smoking” pamphlet that they have been getting for years. A better measure of quality might be “has the patient stopped smoking?” Many other industries have adopted quality measures that relate directly to the quality of the product and to customer satisfaction with a product or service.

So, when will we know what meaningful use means? National Coordinator for Health IT David Blumenthal said: “We hope to provide a direction and some specifications in the late spring, early summer.” He did not specify which year :-)

What’s the rush? Well we need to begin deploying these systems soon, because meaningful use must be achieved by 2012 in order for providers to get the full incentive money. Note that this refers to the federal fiscal year, so this really means October 1, 2011. These systems are complex and the timing is fairly tight.

Last month, the National Committee on Vital Health Statistics (NCVHS) met to discuss meaningful use. The meeting agenda and presentations can be found at the following link.

One thing we can expect is that meaningful use will be a target that will change every year. Expect the bar to be raised each year. For example, once everyone has ePrescribing implemented I would expect to see the addition of Decision Support to check for drug interactions and to look for cheaper alternatives.

The HIT Standards Committee met on Friday, 5/15. There is a nice summary of the meeting on John Halamka's blog:

That's enough of that. The Red Wings begin the conference finals this afternoon. Go Wings!

Saturday, May 2, 2009

First Post

First Post!

I don't know how often I'll post here, but this is a start.

I'm an HIT Interoperability Standards geek. I play hockey goalie in local "beer leagues" during the fall and winter in Ann Arbor. I'm working on a Masters in Medical Informatics at Northwestern University. I play the Chapman Stick....well actually, I don't play so much lately, as work, school and hockey don't give me as much time as I would like.

The Stanley Cup Playoffs are going on as I type this, which makes this my favorite time of the year!