HIMSS 2010 – Tuesday

I started out the day attending a keynote by Dr. John D. Halamka (Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), Chair of the US Healthcare Information Technology Standards Panel (HITSP)/Co-Chair of the HIT Standards Committee, and a practicing Emergency Physician).

Okay, now that that’s out of the way…

It was an outstanding talk, far more interesting than the title (“Using Harmonized Standards in the Era of Meaningful Use”) would suggest. Basically, Dr. Halamka talked about some suggestions that HITSP made to improve the Meaningful Use requirements.

Instead of trying to summarize Dr. Halamka’s talk, I’ll just direct you to his blog, particularly his HIMSS Top 10 list.

HIMSS 2010 – Monday

We may be in the middle of a major recession, but they forgot to tell the organizers and attendees of the 2010 HIMSS Conference in Atlanta. The Georgia World Conference Center is bursting at the seams, and teeming with activity. If you didn’t know any better, you’d think the government was about to pump a few billion dollars into the healthcare industry.

So far, most of the energy seems to be around Meaningful Use (and, by extension, EHRs and interoperability in general), ICD-10, and 5010, in that order.

Meaningful Use is, of course, a very broad topic, since it covers requirements ranging from clinician workflow to interoperability to patient communication, and beyond.

Patient Portals

I attended a very interesting presentation by Dr. Eric Liederman and Jan Oldenburg of Kaiser Permanente this morning, explaining why and how they built a “transactional patient portal” and deployed it to all of their members (the last hospital to implement the system will go live this week).

Kaiser Permanente has the largest civilian EHR deployment in the world.

Some no-brainer points of interest:

• According to a 2009 Deloitte survey of healthcare consumers, 57% of patients want a secure website to “access their medical records, schedule office visits, refill prescriptions and pay medical bills.”
• Among Kaiser Permanente members, the retention rate is 2.6-4.6 percentage points higher among patient portal users than the rest of the population.

Some surprises (at least to me):

• The most popular feature on KP’s patient portal is lab results.
• Initially, only “normal” results were available to patients via the portal. Eventually, though, most KP regions started posting all results (that can be provided legally) on the portal, because they got more from people wondering why some of their results were missing than they would from people worried about abnormal results.

Patient portals (or something very close) will be required in 2013, so it’s inevitable that most doctors will need to find and implement a solution pretty soon.

5010/ICD-10

I also attended a great round table session on 5010 and ICD-10 migration. As we’ve known for a while, there is a lot of anxiety out there around these requirements and—surprise!—healthcare providers expect software and clearinghouse vendors to solve their problems for them.

In fact, there is a lot that technology can do (and providers will absolutely have to leverage technology to address the issues), but clinicians, coders, billers, office managers, front desk staff, etc., will all be heavily impacted by 5010 and ICD-10, regardless of what their software and clearinghouses do for them.

Much of the angst right now is centered around providing training and education to staff. Providers are looking to HIMSS, AHIMA, WEDI, and CMS for guidance.

Incidentally, a Product Manager from RealMed was sitting at my table and said that around 40% of their customers are still sending claims as print image files (PIFs) of HCFA 1500 forms and NSF files, and RealMed is translating them to 4010s. He anticipates that he’ll have to continue to convert those archaic file formats to 5010. Yikes!

Ten Years with MCSD

A few months ago, I downloaded my Microsoft Certified Professional Transcript. The significant portion is shown here:

Ten years ago today, I passed the SQL Server 7.0 exam—the final requirement for MCSD certification.

Remember SQL 7? That was back when none of us really knew whether Microsoft would be a serious player in the RDBMS space. I think we know the answer now.

We started building AdvancedMD using SQL 7, but migrated to SQL 2000 by the time we released. Today, we’re enjoying the T-SQL and data type benefits (think XML) of SQL 2005, and our DCO team is in the process of migrating our primary client database servers to SQL 2008. Combined with Windows Server 2008, it’s giving us some significant performance perks.

Back when I passed Exam 176, we were still basking in the glow of Windows NT 4.0, and the “Option Pack” (including MSMQ and MTS) that came out in 1998. (I started building on MSMQ when it was in beta testing in 1997.)

So…ten years since I passed any sort of Microsoft certification exam, and now I’m waxing nostalgic over a queueing system. I must be getting old…maybe it’s a good thing I’m not writing code any more!

Do you think doctors use iPhones?

AdvancedMD dipped our toes in the mobile device world clear back in 2002, when we released our Handheld Charge Slips application, which runs on Windows Mobile PDA devices. It’s actually a pretty slick little app, but it hasn’t seen much adoption—perhaps because not many doctors use Windows Mobile PDAs.

So, what are doctors using? Well, I can’t find any stats on the subject, but it’s probably safe to say that doctors are as likely to gravitate towards whatever is “coolest” as anyone else, so I’ve been looking at general smartphone market share.

Worldwide, Symbian continues to dominate the landscape…but, according to Gartner, Apple iPhone market share grew from 2.8% in Q2 2008 to 13.3% a year later!

During that same year, BlackBerry’s market share grew from 17.3% to 18.7%

Perhaps more significant is a report from AdMob that indicates that the iPhone accounts for 52% of all mobile web site traffic in North America. So…people who browse the mobile web via smartphones (and, perhaps, those most likely to utilize a smartphone to perform clinical tasks) use the iPhone more to do that than all other phones combined. Geesh.

Oh, and that new upstart OS, Android? It already accounts for 13% of all mobile web traffic. That’s over twice the traffic generated by Windows Mobile OS. And AT&T doesn’t even have an Android phone yet.

To be fair, Microsoft knows they’re way behind the curve in this area, and that Windows Mobile 6.5 is only a (weak) temporary stopgap measure until they can get WM 7.0 ready to release. But they have a lot of ground to make up.

It’s also interesting to note that Epic and Apple are working together to get doctors at Stanford Hospital and Clinics, in Palo Alto, California, to start using their iPhones to access patients’ charts. That’s going to take some arm twisting!

Check out this article in the Washington Post for more examples of how doctors are using smartphones (especially iPhones and BlackBerrys).

For the foreseeable future, it looks like the iPhone is the smartphone to watch, with BlackBerry and Android fighting for second place.

Happy Anniversary to Me: 10 Years as Microsoft Certified Partner

On October 1, 1999, I took (and passed) Exam 176: Designing and Implementing Desktop Applications with Microsoft® Visual Basic 6.0, thereby officially becoming an MCP (Microsoft Certified Partner).

Years earlier, I had made a conscious decision to ride Microsoft’s coattails, having developed a fondness for Visual Basic as a quick and dirty development tool. Fortunately, I never had to build a Windows application using MFC or ATL, since my career has focused on middle tier and database code, with a few opportunities to play with .NET (C#) WinForm apps and VB6 ActiveX controls.

This certainly wasn’t the only road to follow, and I wouldn’t even say it was definitively “the best” choice. Many developers have built successful careers around Java, the “LAMP stack”, etc. But it’s worked out well for me.

In a few months (January 25, to be exact), I’ll celebrate my 10th anniversary of passing the last of four exams required to achieve Microsoft Certified Solution Developer certification.

A lot of water has gone under the bridge in those 10 years, and a lot of code (good, bad, and ugly) has fallen out of my head. Not a bad way to spend ten years.

MS-HUG Exchange 2009: Clinical Informatics Track Session 7

Building Clinical Solutions Using Microsoft Office, Microsoft SharePoint and the Connected Health Platform
Andrew Kirby, Director, Healthcare Solutions, Microsoft

In this session, Andrew Kirby was able to really demonstrate in an easy-to-consume, visual way exactly how heavily Microsoft is investing in the healthcare market.

Andrew spent a fair amount of time defining and describing Microsoft’s work on the Microsoft Health Common User Interface (CUI). Per the MSCUI website:

The Microsoft Health Common User Interface (CUI) provides User Interface Design Guidance and Toolkit controls that address a wide range of patient safety concerns for healthcare organizations worldwide, enabling a new generation of safer, more usable and compelling health applications to be quickly and easily created.

This initiative is a few years old, and I’m very impressed with the progress that they’ve made. The last time I visited the website, the collection of controls was limited to some very basic components like date pickers. They’ve made huge progress in the past year or two, adding very robust, feature-rich controls like a Medications List View and Patient Banner.

It’s easy to “geek out” over the control toolkit, but I think most of the real value comes from the Design Guidance. It is always a few steps ahead of the control toolkit (because the design gets fleshed out and validated before controls are built), but, more importantly, it provides a deeper view into the rationale behind the design of the controls.

The Patient Journey Demonstrator is used to showcase the controls and design guidance principles and could really be used to design a full-featured EMR, at least the UI.

MS-HUG Exchange 2009: Day One Closing Keynote

Life on the Front Line – Perspectives on the Role of the CIO and the Evolution of IT
Tony Scott, Corporate Vice President and CIO, Microsoft

At Microsoft for about 10 months, 3 years at Disney.

Microsoft CIO Scorecard columns:

• Q2 Value
  • June Value
  • July Value
  • August Value
• Q3 Value
• Baseline
• Target
• Stretch (goal)
• Owner
• Level
• Definition

Four roles commonly served by CIOs:

• Embedded CIO
  Works with non-IT colleagues: Focused on strategy, business process execution and innovation, new product development and compliance.
• Enterprise Process CIO
  Manages enterprise business processes such as sourcing, facilities, operations, shared services (often non-IT tasks).
• Customer CIO
  Works with external customers/partners to sell and provide IT/products.
• Services CIO
  Provides IT services firm-wide to support internal staff.

Fix processes, then enable with IT.