NextGen System Configuration Training

We are replacing the Practice Management at work with the NextGen Enterprise Practice Management (EPM) system. WSUPG installed the NextGen EMR several years ago. The normal practice is to install EPM and then EMR, so we are going about it backwards.

Next week, I will be in System Configuration Training for three days. In preparation for this, I took web based training that walked me through most of the functionality. Earlier this week I actually got access to a test environment for EPM and have been poking around that.

The online training was ok, and I learned a lot. I feel prepared for the coursework next week.

At several points in the training, I found myself thinking "Oh, that's how we'll do that."

I did have one issue with the web based training: it would only run in Internet Explorer. I gave up on using IE several years ago and use Firefox as my primary browser after a brief experiment with Chrome earlier this year. It is appalling that ANY web based application requires a particular browser to run in 2010! I sent feedback to NextGen on this when I started the online training.

We're upgrading the EMR next month and once that is done I'll get cracking on building interfaces to EPM. I'll be busy this fall building interfaces to EPM. We'll have several ADT feeds, several charge interfaces, a few lab results interfaces and a Master File interface to load updated provider information. I also have several "flat files" that I will have to parse and use the content to build HL7 messages that will be fed into EPM. I have started coding those, and we should be in good shape.

This should keep me busy most of the fall and winter.

Camping Trip in August 2010

I just returned from a camping trip to Michigan's Upper Peninsula (aka "the UP:) with my dog Sonny. We spent time in rustic campgrounds at Tahquamenon Falls (the River-mouth Unit) and on Brevort Lake.

Sonny and I have enjoyed our summer camping trips for ten years, now. Every year, I think that he might be too old for hiking in the woods. And, every year, I have to remind him to slow down once we hit the hiking trails.

We traveled to the Tahquamenon River-mouth Unit campground on Saturday. It was an easy drive, and we arrived at the campground shortly after 1pm. I set up camp and we walked a bit around the campground. The campground is on the south bank of the Tahquamenon River located very close to where the river empties into Lake Superior. The campground has two loops, and we stayed in the "Semi Modern" loop, which had been called the "rustic loop" when I first camped here over twenty years ago. The sites are nicely wooded. There is no electricity. There are pit toilets. There are modern facilities, including a shower in the Modern loop, and we could utilize those, if we chose to.

On Sunday morning, it rained heavily while I was making breakfast. We waited out the deluge in the car. This is the first time that we have done that in all the years that we have been camping. A curious thing about the campground is that the soil is quite porous and following the heavy rain, the standing puddles of water disappeared in fifteen minutes or so.

I foolishly tried to continue to make breakfast, but bacon that has been waterlogged is not very tasty. Sonny enjoyed it, however. After breakfast, we drove to Whitefish point and walked a bit up there.

The main event for Sunday was a hike through the back-country at the Upper Tahquamenan Falls. We hiked the 8.5 mile Wilderness Loop during the afternoon. It was much warmer than it had been that morning. The trail was quite overgrown, and we had to crawl over and under and around many fallen trees. At one point, the trail which had been next to the Beaver Pond was a part of the pond, and I walked through water that was up to my knees. We returned to the car late in the afternoon and Sonny was asleep before we left the parking lot.

We moved camp to Brevort on Monday morning. We have been to this campground for eight of the last ten years and have been to this campsite three times. I like this campground because it is over a mile from US-2, but is close enough that we can drive to the beach on Lake Michigan and walk there. We walked that beach every day that we were there. There is a portion of the North Country trail that passes nearby. We have hiked this trail in our previous trips, but did not do so this year.

The routine for Tuesday and Wednesday began with breakfast, and then a walk along the beach on Lake Michigan. We returned to the campsite for the afternoon. We took it easy and I spent the afternoon reading Churchill's "The World Crisis" and practicing my Chapman Stick.

We packed up on Thursday morning and were back home at 2pm.

It does my soul good to leave the technology home for a week. I did take my cellphone with me, but I had it turned off for most of the trip.

Sonny is getting older. Here are some signs:

1. If nature calls during the middle of the night, Sonny will stay curled up and sleeping in the tent. Years ago he would always go outside with me.

2. At the Brevort campsite, he laid there and watched ducks swim up to the shore. Years ago, he would have charged after them.

3. He was so tired after our Sunday hike, that when I went to put him in the car, he would stop and look as if to say "that looks awfully high." I would ask him if he wanted a ramp. Normally, he leaps right in to the car whenever I open the door.

All in all, it was a wonderful trip. I'll be back to work on Monday.

HL7 SDWG Completes Review of CDA R3 Formal Proposals

The final formal proposal for changes to the HL7 Clinical Document Architecture standard was reviewed today. The HL7 Structured Documents Work Group (SDWG) has been reviewing formal proposals for the next release of CDA for over a year. CDA R2 is the standard that is used for most of the exchange of clinical information in the Meaningful Use requirements that were published in the Federal Register this week.

I am the publishing facilitator for the SDWG, so this means that I get to work on creating the new version of the standard. I worked on CDA R2 back when I was working for HL7, converting the word document into "publishing XML." The new version of the standard will be developed using the HL7 Publishing database. I have not used the publishing db in several years, so it will be interesting to see how the tool has changed over the years.

The enhancements in CDA R3 are based on the experience of implementers. CDA will also use HL7 Version 3 Datatypes Release 2, which will give us new functionality.

Here is a link to the list of suggested enhancements for CDA R3:

http://wiki.hl7.org/index.php?title=CDA_Suggested_Enhancements

I'll post updates as we work through the process. I expect that we will ballot the new document early next year, and, hopefully, CDA R3 will become an approved standard sometime in 2011.

Meaningful Use Final Rule

The Final Rule for Meaningful Use was published today.

I haven't finished reading the 1000 pages, yet, so here are my preliminary impressions.

The document is available here..

http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

They relaxed a couple of requirements, with thresholds being reduced from 80% to 50%. I don't see this as significant, because if your organization is really committed to meeting the requirements, you will be well over 80%. If you are committed to CPOE, you will be at well over 80%. If reducing the limit means that a few more organizations qualify for MU funds, that's fine with me.

They also removed the requirement for either SOAP or REST to be used as a transport protocol, which means that those organizations that use MLLP through encrypted tunnels will not have to re-do those interfaces.

I am still a little troubled by the requirement to use CCR and CCD, but since that means that my organization can produce CCD and the other CDA based documents, we should be fine. We will have to be able to consume CCR, but that is not as onerous as it might be. HL7 and ASTM are beginning a project to translate from CCR to CCD, so that should help organizations that do not want to have to support both.

It could have been better. It could have been worse.

Northwestern Commencement 2010

On Thursday, I drove to Evanston for Northwestern's Commencement. There were ceremonies on Friday and Saturday. I took my parents with me, because I felt that they should be part of the celebration.

Before the main ceremony, the School of Continuing Studies (SCS) held a reception that we attended. As a distance learning student, I had not actually met many of my classmates. It was nice to finally meet some of them. I would recognize a voice in the crowd and walk over and introduce myself. I told the associate dean that I still thought that they might come to their senses and pull my diploma. He thought that was funny.

The main ceremony was on Friday at 6pm. At approximately 4:30pm, a thunderstorm hit the city, and we were drenched while we were on our way to the stadium. The weather cleared, and they were able to hold the ceremony outside, as scheduled. It was quite a sight. I was glad that I went. Mike Wilbon from ESPN and ABC (and a Northwestern Alum) gave the commencement address.

We went and had a wonderful dinner at Morton's following the ceremony. Another thunderstorm hit while we were having dinner, and we drove back to the hotel through downed power lines and traffic signals that were not functioning.

The ceremony for SCS was on Saturday afternoon at the Millar Chapel. It was hot. I was hooded and received my diploma. The drive back to Ann Arbor took longer than I expected, and I did not make it home until after 9pm. My brother Rob and Leslie were dog sitting for me, and we had steaks after I got home.

All in all, it was a wonderful weekend.

Restarting Interfaces

We recently changed five existing interfaces to "pass through" the Rhapsody interface engine that I am working with. These interfaces are made via a vpn tunnel between the two organizations.

That first day, one of the interfaces stopped working several times. I stopped and started the communication point on my end, and the connection was re-established and messages began to flow, again.

The next morning, one of the interfaces had not seen messages cross for seven hours. I again stopped and started the communication point, and messages began to flow.

I was told that "they do that all the time."

The next morning, three of the five new interfaces had stopped overnight. I restarted them, they connected and messages began to flow.

I have seen this sort of behavior with interfaces that cross through VPNs. When the interface is inactive, the vpn shuts down, but the receiving end still thinks that it has a connection. The sending end will try to re-establish a connection, but since the receiving side still thinks that it has a connection, the new connection is refused.

Being the cautious person that I am, I changed one of the three communications points to restart every hour. The interface would stop, reconnect, and messages would begin to flow, again. I wanted to see one of them work before I changed anything else.

Once I saw that this worked, I made similar changes to the other two interfaces that had exhibited similar issues. Two of the five original interfaces had not shown any issues. One was an ADT feed that constantly had traffic. The other received a "batch" of messages every morning. It would reconnect, deliver the messages, and then disconnect.

So far, the hourly re-start seems to be working. For years, these interfaces had failed. A trouble ticket would be opened, and an operator would manually stop and start the interface to get things working, again. Based on previous experience, I was able to diagnose the problem and implement a simple fix. This will save our business partner opening trouble tickets and our operators from manually restarting these interfaces.

One small step...

Masters in Medical Informatics

I just completed the Capstone project for my Masters in Medical Informatics (MMI) program at Northwestern University. I have been working on this degree for two and a half years. This is a distance learning program, so I did all of the course work online. I found it difficult to say that I was "going back to school" while I sat in front of my computer.

I learned a lot in the program, and discovered that I knew a lot, too.

Here is my "portfolio" website that I created as part of the Capstone Project.

http://sites.google.com/site/peterngilbert/home