We recently received an email from a laboratory system that sends us results. They currently send laboratory tests to us that are coded using "local vocabulary." They asked us if we could accept LOINC codes (http://loinc.org/) in the alternate codes.
What they are proposing is adding LOINC codes to the OBX-3 Observation Identifier field. The OBX-3 data type is Coded With Exceptions (CWE), The structure of this field is:
<Identifier (ST)> ^ <Text (ST)> ^ <Name of Coding System (ID)> ^ <Alternate Identifier (ST)> ^ <Alternate Text (ST)> ^ <Name of Alternate Coding System (ID)> ^ <Coding System Version ID (ST)> ^ <Alternate Coding System Version ID (ST)> ^ <Original Text (ST)>
So, they are proposing to send their local code in the first "triplet" of the CWE and the LOINC code in the second "triplet". This would change:
OBX|1|CWE|xxxxx^Local Test Value||result goes here.....
to
OBX|1|CWE|xxxxx^LocalTestValue^L^yyyyyy-y^Loinc Test Name^LN||result goes here.....
The first three subfields of obx-3 (aka the first triplet) are the local code (xxxxx), description (LocalTestValue), and the "L" indicates a local code. The second set of subfields (aka the second triplet) are the alternate identifiers and are the LOINC code for the test (yyyyyy-y), the description of the test from LOINC, and "LN" which specifies that the alternate code comes from LOINC.
This lab has been sending local codes for its tests for many years. The meaningful use requirements of ARRA/HITECH are nudging them to use LOINC.
Who says that we are not making progress :-)
Sunday, April 25, 2010
Sunday, April 18, 2010
NHL Playoffs 2010
This is my favorite time of the year. I love the Stanley Cup Playoffs. I love that teams play every other night, unlike the endless delays in the NBA playoffs. It does not take long for teams to develop a strong dislike for each other during a playoff round. Because the coaching and film study have advanced in recent years, each team knows the other's tendencies and can develop counters for them.
I love playoff overtime. The overtime games tend to end either very quickly or go on and on.... As long as I don't have to get up for work the next morning, I will stick it out to the bitter end.
Here are a few things that I will be watching for during the first round (I refuse to call them "the conference quarter finals"):
I love playoff overtime. The overtime games tend to end either very quickly or go on and on.... As long as I don't have to get up for work the next morning, I will stick it out to the bitter end.
Here are a few things that I will be watching for during the first round (I refuse to call them "the conference quarter finals"):
- Which of the goalies that are in the playoffs for the first time will shine? Jimmie Howard? Bryzgalov? Quick? Rask? Halak? Niemi? Wow. That's a lot of teams that are relying on untested goaltenders.
- Upsets. The first round always seems to give us an upset.
- San Jose. Can the Sharks make it out of the first round?
- Officiating. Which games will be decided by a crucial call or non-call?
- Who will step up and who will disappear? The playoffs usually give us an unlikely hero as well as some disappointing performances by "stars"?
Thursday, December 24, 2009
Healthcare, Quality and Deming
I reread Deming's book over the summer and scanned the fourteen points as adopted for healthcare as part of a discussion on leadership in my masters program this fall. As someone who came from manufacturing to healthcare, one thing that strikes me is that the "quality revolution" seems to have missed healthcare. I think that this will change, with the quality reporting requirements that are a part of ARRA's meaningful use definition. As Yogi Bera said, "It's like deja vu all over again." I'm hearing some of the same arguments that I heard twenty years ago.
So, here they are: Deming's fourteen points as adopted for health care.
From Out of the Crisis by W. Edwards Deming --
Adaptation of the 14 points to medical service. The 14 points of Chapter 2 apply to a service organization with little modification. For example, my friends Dr. Paul B. Batalden and Dr. Loren Vorlicky of the Health Services Research Center, Minneapolis, have written the 14 points for medical service:
1. Establish constancy of purpose toward service.
a. Define in operational terms what you mean by service to patients.
b. Specify standards of service for a year hence and for five years hence.
c. Define the patients whom you are seeking to serve - those here, those that you seek, those that have been here only once.
d. Constancy of purpose brings innovation.
e. Innovate for better service for a given cost; planning for the future will require the addition of new skills, training, and retraining of personnel, satisfaction of patients, new treatments, new methods.
f. Put resources into maintenance of equipment, furniture, and fixtures; new aids to production in the office.
g. Decide whom the administrator and the chairman of the board are responsible to and the means by which they will he held responsible for working for constancy of purpose.
h. Translate this constancy of purpose to service into patients and to the community.
i. The board of directors must hold on to the purpose.
2. Adopt the new philosophy. We are in a new economic age We can no longer live with commonly accepted levels of mistakes, materials not suited to the job, people on the job that do not know what the job is and are afraid to ask, failure of management to understand their job, antiquated methods of training on the job, inadequate and ineffective supervision. The board must put resources into this new philosophy, with commitment to in-service training.
3a. Require statistical evidence of quality of incoming materials, such as pharmaceuticals, serums, and equipment. Inspection is not the answer. Inspection is too late and is unreliable Inspection does not produce quality. The quality is already built in and paid for.
b. Require corrective action, where needed, for all tasks that are performed in the hospital or other facility, ranging all the way from bills that are produced to processes of registration. Institute a rigid program of feedback from patients in in regard to their satisfaction with services.
c. Look for evidence of rework or defects and the cost that may accrue as a result - an incorrect bill, an incorrect or incomplete registration.
4. Deal with vendors that can furnish statistical evidence of control. This will require us to examine generic lowest-price buying; it will cause us to ask more penetrating questions about prospective colleagues regarding their interactions and the track record of their interactions with patients and with colleagues.
We must take a clear stand that price of services has no meaning without adequate measure of quality. Without such a stand for rigorous measures of quality, business drifts to the lowest bidder, low quality and high cost being the inevitable result. We see this throughout the United States industry and government by rules that award business to the lowest bidder.
Requirement of suitable measures of quality will, in all likelihood, require us to reduce the number of vendors. The problem is to find one vendor that can furnish statistical evidence of quality. We must work with vendors so that we understand the procedures that they use to achieve reduced numbers of defects.
5. Improve constantly and forever the system of production and service.
6. Restructure training.
a, Develop the concept of tutors.
b. Develop increased in-service education.
c. Teach employees methods of statistical control on the job.
d. Provide operational definitions of all jobs.
e. Provide training until the learner's work reaches the state of statistical control, and focus the training to assist the learner to achieve the state of statistical control.
7. Improve supervision. Supervision belongs to the system and is the responsibility of the management.
a. Supervisors need time to help people on the job.
b. Supervisors need to find ways to translate the constancy of purpose to the individual employee.
c. Supervisors must he trained in simple statistical methods for aid to employees, with the aim to detect and eliminate special causes of mistakes and rework. Supervisors should find causes of trouble and not just chase anecdotes. They need information that shows when to take action, not just figures that describe the level of production and the level of mistakes in the past.
d. Focus supervisory time on people that are out of statistical control and not those that are low performers. If the members of a group are in fact in statistical control, there will be some that are low performers and some that are high performers.
e. Teach supervisors how to use the results of surveys of patients.
8. Drive out fear. We must break down the class distinctions between types of workers within the organization-physicians, nonphysicians, clinical providers versus nonclinical providers, physician to physician. Discontinue gossip. Cease to blame employees for problems of the system. Management should be held responsible for faults of the system. People need to feel secure to make suggestions. Management must follow through on suggestions. People on the job can not work effectively if they dare not inquire into the purpose of the work that they do, and dare not offer suggestions for simplification and improvement of the system.
9. Break down barriers between departments. Learn about the problems in the various departments. One way would be to encourage switches of personnel in related departments.
10. Eliminate numerical goals, slogans, and posters imploring people to do better. Instead, display accomplishments of the management in respect to assistance to employees to improve their performance. People need information about what the management is doing on these 14 points.
11. Eliminate work standards that set quotas, commonly called also measured day work. Work standards must produce quality, not mere quantity. It is better to take aim at rework, error, and defects, and to focus on help to people to do a better job. It is necessary for people to understand the purpose of the organization and how their jobs relate to the purpose of the organization.
12. Institute a massive training program in statistical techniques. Bring statistical techniques down to the level of the individual employee's job, and help him to gather information in a systematic way about the nature of his job. This kind of training must be married to the management function rather than to the personnel function within the organization.
13. Institute a vigorous program for retraining people in new skills. People must be secure about their jobs in the future, and must know that acquisition of new skills will facilitate security.
14. Create a structure in top management that will push every day on the above 13 points. Top management may organize a task force with the authority and obligation to act. This task force will require guidance from an experienced consultant, but the consultant can not take on obligations that only the management can carry out.
So, here they are: Deming's fourteen points as adopted for health care.
From Out of the Crisis by W. Edwards Deming --
Adaptation of the 14 points to medical service. The 14 points of Chapter 2 apply to a service organization with little modification. For example, my friends Dr. Paul B. Batalden and Dr. Loren Vorlicky of the Health Services Research Center, Minneapolis, have written the 14 points for medical service:
1. Establish constancy of purpose toward service.
a. Define in operational terms what you mean by service to patients.
b. Specify standards of service for a year hence and for five years hence.
c. Define the patients whom you are seeking to serve - those here, those that you seek, those that have been here only once.
d. Constancy of purpose brings innovation.
e. Innovate for better service for a given cost; planning for the future will require the addition of new skills, training, and retraining of personnel, satisfaction of patients, new treatments, new methods.
f. Put resources into maintenance of equipment, furniture, and fixtures; new aids to production in the office.
g. Decide whom the administrator and the chairman of the board are responsible to and the means by which they will he held responsible for working for constancy of purpose.
h. Translate this constancy of purpose to service into patients and to the community.
i. The board of directors must hold on to the purpose.
2. Adopt the new philosophy. We are in a new economic age We can no longer live with commonly accepted levels of mistakes, materials not suited to the job, people on the job that do not know what the job is and are afraid to ask, failure of management to understand their job, antiquated methods of training on the job, inadequate and ineffective supervision. The board must put resources into this new philosophy, with commitment to in-service training.
3a. Require statistical evidence of quality of incoming materials, such as pharmaceuticals, serums, and equipment. Inspection is not the answer. Inspection is too late and is unreliable Inspection does not produce quality. The quality is already built in and paid for.
b. Require corrective action, where needed, for all tasks that are performed in the hospital or other facility, ranging all the way from bills that are produced to processes of registration. Institute a rigid program of feedback from patients in in regard to their satisfaction with services.
c. Look for evidence of rework or defects and the cost that may accrue as a result - an incorrect bill, an incorrect or incomplete registration.
4. Deal with vendors that can furnish statistical evidence of control. This will require us to examine generic lowest-price buying; it will cause us to ask more penetrating questions about prospective colleagues regarding their interactions and the track record of their interactions with patients and with colleagues.
We must take a clear stand that price of services has no meaning without adequate measure of quality. Without such a stand for rigorous measures of quality, business drifts to the lowest bidder, low quality and high cost being the inevitable result. We see this throughout the United States industry and government by rules that award business to the lowest bidder.
Requirement of suitable measures of quality will, in all likelihood, require us to reduce the number of vendors. The problem is to find one vendor that can furnish statistical evidence of quality. We must work with vendors so that we understand the procedures that they use to achieve reduced numbers of defects.
5. Improve constantly and forever the system of production and service.
6. Restructure training.
a, Develop the concept of tutors.
b. Develop increased in-service education.
c. Teach employees methods of statistical control on the job.
d. Provide operational definitions of all jobs.
e. Provide training until the learner's work reaches the state of statistical control, and focus the training to assist the learner to achieve the state of statistical control.
7. Improve supervision. Supervision belongs to the system and is the responsibility of the management.
a. Supervisors need time to help people on the job.
b. Supervisors need to find ways to translate the constancy of purpose to the individual employee.
c. Supervisors must he trained in simple statistical methods for aid to employees, with the aim to detect and eliminate special causes of mistakes and rework. Supervisors should find causes of trouble and not just chase anecdotes. They need information that shows when to take action, not just figures that describe the level of production and the level of mistakes in the past.
d. Focus supervisory time on people that are out of statistical control and not those that are low performers. If the members of a group are in fact in statistical control, there will be some that are low performers and some that are high performers.
e. Teach supervisors how to use the results of surveys of patients.
8. Drive out fear. We must break down the class distinctions between types of workers within the organization-physicians, nonphysicians, clinical providers versus nonclinical providers, physician to physician. Discontinue gossip. Cease to blame employees for problems of the system. Management should be held responsible for faults of the system. People need to feel secure to make suggestions. Management must follow through on suggestions. People on the job can not work effectively if they dare not inquire into the purpose of the work that they do, and dare not offer suggestions for simplification and improvement of the system.
9. Break down barriers between departments. Learn about the problems in the various departments. One way would be to encourage switches of personnel in related departments.
10. Eliminate numerical goals, slogans, and posters imploring people to do better. Instead, display accomplishments of the management in respect to assistance to employees to improve their performance. People need information about what the management is doing on these 14 points.
11. Eliminate work standards that set quotas, commonly called also measured day work. Work standards must produce quality, not mere quantity. It is better to take aim at rework, error, and defects, and to focus on help to people to do a better job. It is necessary for people to understand the purpose of the organization and how their jobs relate to the purpose of the organization.
12. Institute a massive training program in statistical techniques. Bring statistical techniques down to the level of the individual employee's job, and help him to gather information in a systematic way about the nature of his job. This kind of training must be married to the management function rather than to the personnel function within the organization.
13. Institute a vigorous program for retraining people in new skills. People must be secure about their jobs in the future, and must know that acquisition of new skills will facilitate security.
14. Create a structure in top management that will push every day on the above 13 points. Top management may organize a task force with the authority and obligation to act. This task force will require guidance from an experienced consultant, but the consultant can not take on obligations that only the management can carry out.
Sunday, November 1, 2009
Formula One Abu Dhabi
This is a beautiful track. They will start the race as the sun sets and finish under the lights. The track looks to be wide enough to allow for passing, so it should be interesting.
This is the last race of the year. Jenson Button won the driver's championship last week, so that's already been decided.
Alguersuari missed his pit and ran out of fuel on the following lap...that's how tight they run things. The video replay of him trying to pull into another team's pit was funny.
The race settled down. Vettel wins. His fourth win of the season. Mark Webber holds off Jenson Button for third. Button had a few looks during the last few laps, but couldn't pull off the pass. Reubens finished fourth.
It was an entertaining season! I'm already looking forward to next season with all of the new teams and driver changes!
This is the last race of the year. Jenson Button won the driver's championship last week, so that's already been decided.
Alguersuari missed his pit and ran out of fuel on the following lap...that's how tight they run things. The video replay of him trying to pull into another team's pit was funny.
The race settled down. Vettel wins. His fourth win of the season. Mark Webber holds off Jenson Button for third. Button had a few looks during the last few laps, but couldn't pull off the pass. Reubens finished fourth.
It was an entertaining season! I'm already looking forward to next season with all of the new teams and driver changes!
Sunday, October 18, 2009
Formula One Race in Brasil
Reubens starts from the pole! The Brasilian fans are going wild! The first corner should be exciting.
There were a couple of nasty crashes on the first lap and the safety car was deployed. Sutil, Liuzzi and Alonso are out on the first lap.
The race settled down after that.
Brawn won the constructor's championship. That team wasn't very good until Ross took over the team this year. You kind of wonder how Ferrari feels now, since they booted Ross after Michael Schumacher retired. You also wonder how Honda feels - this team was Honda last year, and they couldn't play dead. This year, they win the constructor's championship.
Mark Webber wins the race. No drama. Unlike last year's race.
Jenson Button wins the drivers championship with a fifth place finish today.
This was a fairly entertaining F1 season. There is one more race in two weeks in Abu Dhabi.
There were a couple of nasty crashes on the first lap and the safety car was deployed. Sutil, Liuzzi and Alonso are out on the first lap.
The race settled down after that.
Brawn won the constructor's championship. That team wasn't very good until Ross took over the team this year. You kind of wonder how Ferrari feels now, since they booted Ross after Michael Schumacher retired. You also wonder how Honda feels - this team was Honda last year, and they couldn't play dead. This year, they win the constructor's championship.
Mark Webber wins the race. No drama. Unlike last year's race.
Jenson Button wins the drivers championship with a fifth place finish today.
This was a fairly entertaining F1 season. There is one more race in two weeks in Abu Dhabi.
Red Wings Early Season
I've watched most of the Wings games so far this season. They have not looked very good. They are clearly not as good as they were last year, and that wasn't good enough.
They have some potential, if some of the kids play well, however, they lost a lot of talent over the off season, and that is a large gap to fill. Also, the injury to Franzen will not help.
Many of the teams in the Western Conference are improved this year. Edmonton will be fun to watch. The Kings are much better than they have been for a while. Colorado is also better. The Blues should be tough to play.
It is especially sad to see empty seats in the Joe and to hear the commercials during the telecast for tickets. This team used to have a waiting list for season tickets. It is in large part due to the poor economy in Michigan that the Wings are having such a hard time selling tickets.
They lost on Saturday to the Avs in a shootout. The Wings blew a two goal lead in the third period.
I think it will be a tough year for the Wings. I wouldn't be surprised if they do not make the playoffs.
They have some potential, if some of the kids play well, however, they lost a lot of talent over the off season, and that is a large gap to fill. Also, the injury to Franzen will not help.
Many of the teams in the Western Conference are improved this year. Edmonton will be fun to watch. The Kings are much better than they have been for a while. Colorado is also better. The Blues should be tough to play.
It is especially sad to see empty seats in the Joe and to hear the commercials during the telecast for tickets. This team used to have a waiting list for season tickets. It is in large part due to the poor economy in Michigan that the Wings are having such a hard time selling tickets.
They lost on Saturday to the Avs in a shootout. The Wings blew a two goal lead in the third period.
I think it will be a tough year for the Wings. I wouldn't be surprised if they do not make the playoffs.
Saturday, October 17, 2009
Formula One Qualifying in Brasil
I've liked Formula One since they held a few races on the streets of Detroit back in the 80s. I was working in the Renaissance center at the time and it was in the middle of the track. I didn't watch the race, but I did walk around during Friday practice one year.
I am watching qualifying on Saturday as I type this. It is raining hard on the course. These are the best drivers in the world, so we expect them to be able to race in the rain. The on-board camera shots give some indication of just how poor the visibility is.
I always contrast that with the NASCAR attitude that says "We can't race in the rain."
I am an early riser, so I don't have an issue with getting up early on Sunday morning to watch an F1 race from Europe. I'm not dedicated enough to stay up and watch the races from Asia that start at 1am ET.
The completed the first qualifying session, but red flagged the second session following a nasty crash. It's raining very hard. The course has a number of elevation changes, which results in water running across the course.
They will finish qualifying this afternoon, but there is college football on, as well. I am going to watch that.
Reubens Baricello won the pole. I didn't see it.
I am watching qualifying on Saturday as I type this. It is raining hard on the course. These are the best drivers in the world, so we expect them to be able to race in the rain. The on-board camera shots give some indication of just how poor the visibility is.
I always contrast that with the NASCAR attitude that says "We can't race in the rain."
I am an early riser, so I don't have an issue with getting up early on Sunday morning to watch an F1 race from Europe. I'm not dedicated enough to stay up and watch the races from Asia that start at 1am ET.
The completed the first qualifying session, but red flagged the second session following a nasty crash. It's raining very hard. The course has a number of elevation changes, which results in water running across the course.
They will finish qualifying this afternoon, but there is college football on, as well. I am going to watch that.
Reubens Baricello won the pole. I didn't see it.
Subscribe to:
Posts (Atom)