Using an HIE to Stalk a Patient

One of my state-wide HIE clients asked me the following question:

A battered woman moves from CityA to CityB and she doesn’t want her husband to find her so she opts out of the exchange. The woman seeks medical attention from a doctor in CityB. The doctor sends the woman’s new address to the exchange. Can a doctor who treated the woman in CityA see her new address or will the doctor only see the CityA address they have on file for the woman?

This one initially threw me for a loop. The purpose of an exchange is to allow doctors to see updated information on their patients. This state has a strong “opt out” policy that does not allow information to be exchanged if the patient has “opted out.” In the above use case, the patient has “opted out”, so we would not share clinical information. This state does not allow a provider to “break the glass” to override the patient’s decision to not share their information.

I think that we can configure the relationship between the Master Patient Index (MPI) and Clinical front end to prohibit the updated demographics from flowing from the MPI to the clinical system when the patient has “opted out” of data sharing.

The curious case here is that the patient would have to be stalked by either a doctor that had treated her previously, or a friend of a doctor that had treated her previously that was willing to violate HIPAA and share that information with the stalker. The real world is such a complex place that I am fairly certain that this will happen.

The bottom line is that technology is not foolproof and relies on policy and the law. Technology implements policy. If a user is willing to abuse the system and/or violate the law, they can do some unpleasant things.

This is certainly a use case that I had not considered.

2011 Stanley Cup Finals

The Boston Bruins play the Vancouver Canucks for the Stanley Cup!

I did not expect the Canucks to make the finals, but Roberto Luongo finally started to play some good games in goal, and here they are. In my Stanley Cup preview, I thought that either the Bruins or the Lightning would be the Eastern Conference's representatives, so I got that right.

The schedule starts off kind of odd this year. Game 1 is on Wednesday, June 1 and Game two is not until Saturday. Those games are in Vancouver. I don't understand the extra day off, but it is probably to keep NBC happy. The teams then fly to Boston for Games 3 and 4. The series will settle down to the normal "every other day" schedule that makes the NHL playoffs much more watchable than the NBA playoffs. All games start at 8pm eastern, even those in Vancouver.

If the series goes to six or seven games, I will be on the road and will acutally be on a flight back to Detroit during Game 7. If it comes to that, I will have to figure out some way to watch the game from the plane.

I expect a close series. There is really not too much that separates the two teams. Vancouver has more offensive weapons. The defenses are pretty even. I give the Bruins the edge on goal, simply because I trust Tim Thomas more than I trust Roberto Luongo in goal.

I am looking forward to another fine series!

CDA IG Consolidation Ballot Reconciliation

The ballot for the ONC S&I Framework Consolidated CDA IGs closed earlier this month. The response was overwhelming.

There were a total of 554 comments submitted. Of these, 277 were negative.

The HL7 ballot process requires that all negative comments be addressed, resolved and withdrawn by the submitters. So, there is a lot of work to be done before the consolidated guides are approved. This is important, because the ONC would like the consolidated guides to be used for Meaningful Use Stage 2.

The HL7 Structured Documents Working Group (SDWG) resolved 56 negatives during the Orlando Working Group meeting.

A number of the negative votes are publishing related, and we will begin looking at these during today's CDA Documentation call.

Reconciliation will continue to take place on the two ONC calls on Tuesday and Wednesday and during the regular HL7 SDWG call on Thursdays.

I hope to map out a strategy for getting the final Consolidated Guides published using MDHT. We will start that work and not wait for reconciliation to be completed.

It should be a busy summer.

The ONC S&I Framework teams will meet next month in Washington, DC for two days and we hope to get more work done then.

First Week

I have had an exciting first week at my new job. It is a hectic environment, so I may be dragged into a meeting without any notice. Either someone will drop by my cube and ask me to join them, or I will receive an electronic meeting invitation ten minutes after the meeting started. It is not unusual to find that I have been "double booked." I've worked in similar environments before, and so far, I have managed to keep up.

I don't have my work email and calendar sync'd up to my Blackberry, yet, so I occasionally miss a meeting. I've submitted a request to have that done, so that should be taken care of in a few days.

I'm reviewing project proposals prior to our submitting a response. These are all for technologies that I have worked with, so I know what to look for. I've read proposals for three state-wide HIEs, and at least one for a regional HIE. It looks like I should be a part of the project teams for most of those.

I am being asked to consult existing project teams to explain technical options to them.

I've written use case narratives that will be handed off to developers.

I am getting better at finding my car in the parking structure after work. The first couple of days, I wandered around for five minutes or so before locating my car. I think that I have that figured out, now.

It has been a good week. I am looking forward to my second week.

My New Job: Healthcare Solution Architect

I will start a new job on May 9. I will be working for Covisint as a Healthcare Solution Architect. I am really looking forward to this.

When I started the Masters program at Northwestern, this is the sort of job that I was hoping that the degree would prepare me for.

I did get a curious question when I was interviewing for the position. The question was, "Will you be comfortable not doing any of the development?" My roll will be to design or "architect" the systems and to outline the deployment plan, but then I will get to hand the real work off to others. Hmmm.... I hadn't thought of that. I have been building IT systems for over twenty years. I think that I will be able to live vicariously through the work of the teams that will be implementing the solutions that I design. I think that my years as a developer will give me a better understanding of what I need to provide the developers so that we can succeed.

Winston Churchill said that "However beautiful the strategy, we must occasionally look at results." I intend to make sure that we have success metrics in place before we begin implementing so that we can see whether we successfully implemented.

It should be an interesting transition, and I am looking forward to a new role and challenges.

PCAST, UEL, Molecules and green CDA

I listened to a discussion on Thursday's Structured Documents Work Group call about PCAST, UEL and the relationship to the templated CDA that HL7 uses. We had an earlier discussion about "green CDA".

As often happens, later in the day, it occurred to me that perhaps the UEL that PCAST is seeking could be met by "greening of templated CDA entries." Let me explain.

The President's Council on Science and Technology has called for the development of a Universal Exchange Language to exchange "atomic" health data. They feel that the current exchange standards are not granular enough.

HL7 feels that templated CDA should be sufficient and there is concern that an attempt to get too granular will result in data that lacks context and therefore meaning.

Green CDA is an attempt to create a simpler version of the xml than that which CDA currently is, and to provide transforms that will take a "full CDA" document and transform it into a "green CDA" document, and vice versa. The transforms will allow developers that are comfortable with "full CDA" to use that and to exchange documents with developers (and their systems) that are more comfortable with the simpler "green CDA."

Now, it occurs to me that we can use the concept of the "full to green" translation to take the full, templated CDA and extract the UEL molecule and transform the data into "green UEL." The process of moving from full to "green UEL" should maintain sufficient meta data in the molecule to maintain context.

The translation from the "green UEL" to "full CDA" is trickier and may require fetching data from elsewhere to reassemble a proper "full CDA" instance.

I'm not sure that this is a solution, but it just might work.

2011 Stanley Cup Preview

I have been a hockey fan for as long as I can remember. The Stanley Cup Playoffs are my favorite time of the year.

Each year, I look at the playoff teams and see which are cup contenders, and which have little or no chance to sip from the cup. The bottom line is that goaltending and depth win cups. One line teams that have suspect goaltending make early playoff exits.

Let’s look at the conferences starting with the East.

The Capitals are the #1 seed from the East. They have played better defensively this year, but I do not expect their goaltending to hold up. I don’t see them winning the cup.

The Flyers will go as far as their goaltending and Chris Pronger will take them. They are stumbling in to the playoffs. I don’t see them winning the cup.

The Bruins are as complete a team as there is in the East. Tim Thomas has had a remarkable regular season, and I expect him to keep it up in the playoffs. The Bruins could make a long playoff run.

The Penguins have played better than anyone expected them to. I know that Gary Bettman would love to see the Penguins make a long playoff run, but this team is not deep enough and does not have the goaltending to play for the cup.

The Lightning have played better than any of us expected. Roloson has proven playoff experience. The Lightning could make a long playoff run.

The Canadians are not a deep team. They will go as far as Cary Price carries them, but I don’t expect that to be very far.

The Sabres will not last long. Ryan Miller could stand on his head, but I don’t expect him to carry them very far.

The Rangers could win one round, if Lundquist stands on his head, but I also do not expect him to be able to take this team to the cup finals.

So, I think that either the Bruins or the Lightning will come out of the East. At this point, I think that the Bruins are more likely to do so.

Let’s look at the Western Conference.

The Canucks still have not proven that they can win in the playoffs. They have had a wonderful regular season, but, that is no guarantee of playoff success. I do not expect the Canucks to play for the cup.

The San Jose Sharks are in the same boat as the Canucks. They have better goaltending than they have had in previous years, but I do not see it being good enough to carry them to the cup.

The Red Wings have not played well enough defensively to play for the cup. They are stumbling their way into the playoffs. There is some feeling that they will magically “turn it on” for the playoffs, but I don’t see how they can end all of the bad habits that they have shown over the last month. I don’t see them making it out of the first round. That will depend on the matchup. I do not expect them to play for the cup.

The Ducks will go as far as Hiller can carry them. They might go a round or two, but I do not expect them to play for the cup.

The Predators are a team that could make a long playoff run. They have great goaltending and are a balanced team.

The Coyotes may make it out of the first round. They took the Red Wings to a seventh game in their series last year, and this Red Wings team is not as good as last year. I don’t see the Coyotes being deep enough and having the goaltending to play for the cup.

The Kings might win the first round, but I don’t expect them to play for the cup.

The Blackhawks could upset the Canucks in their first round matchup, but I don’t see the Hawks going much farther.

I’m not sold on any team from the west this year. The Predators could be the sleeper team from the west to play for the cup. The Canucks and the Sharks have yet to prove that they can win in the playoffs.