<Conmergence/>

Brailer: I.T. a Question of Economics

June 28, 2005 Health Data Management

“Adopting health care information technology is not a technical feat; it’s a feat of economics.” That was the heart of David J. Brailer, M.D.’s message in his presentation at the Healthcare Financial Management Association’s Annual National Institute on June 28 in Las Vegas.

Brailer, national coordinator for health information technology in the Department of Health and Human Services, acknowledged that a better case needs to be made for the financial benefits of I.T., particularly electronic medical records. Today, electronic records use is in the “early adopter phase” where “the costs are quite high and the risks are great,” he said.

Creating a uniform definition of what constitutes a valid electronic health record will remove some of the risk involved in buying the technology, he contended. Brailer also touted certification of I.T. software to enable providers to more easily compare products. He further called for the industry to “harmonize” the ongoing multiple standards-setting initiatives, which could lead to more affordable records systems.

Cooperative Open-source Medical Banking Architecture & Technology

MBProject announced a new initiative, C.O.M.B.A.T., at the 2005 Medical Banking Institute to implement a testing and certification "medical banking platform" that will use existing open source/open standards. Where there are gaps in standards, MBProject is sponsoring the creation of a new type of open source standards/components called "mbXML".

This platform was envisioned in 2001 when MBProject initially launched its "portfolio of ideas" for the industry. That is why over four years later, we are excited to finally announce this initiative!

C.O.M.B.A.T. will focus MBProject workgroups and general industry efforts towards the necessary development of cross-industry business models. The initial series of use cases are targeted towards linking the "community safety net" with the traditional healthcare setting (proving out a component of the Charitable Communities Network model).

The C.O.M.B.A.T. Initiative has been reviewed by some of the nation's largest employers and we expect multiple announcements from these groups to join the initiative over the next 6 months. A group of members have chosen to answer the ONCHIT RFP related to this effort; although, MBProject intends to fund the effort with or without government funding.

World Customs Organization Adopts International Trade Standards

Jun 28, 2005 Frontline Solutions

U.S. pledges supply chain security support for developing nations

The World Customs Organization (WCO) last week unanimously adopted the group's new Framework of Standards to Secure and Facilitate Global Trade. U.S. Customs and Border Protection Commissioner Robert Bonner had previously praised the proposed standards, which incorporate several elements of U.S. trade security policy.

The WCO's 166 members voted on the standards last Friday at a meeting in Paris. The Framework of Standards is designed to protect trade from international terrorism, organized crime and "Customs offenses," while facilitating the movement of legitimate goods.

The Framework requires implementation of a series of 17 standards that regulate the security and facilitation of world trade.

ATIS Launches IPTV Standards Forum

itvt.com

Hopes to Create Overall Reference Architecture for IPTV

ATIS, an organization that develops standards for the communications industry, says that it is forming an IPTV Interoperability Forum (IIF) to develop standards and related technical and operations activities that enable the interoperability, interconnection and implementation of IPTV systems and services, including VOD and interactive TV services.

Deborah Elizabeth Finn - Cyber-Yenta: Request For Links

<ed.note>Mentally I live in a world 5 years from now -- and make assumptions about the IP based, broadband infrastructure which will likely exist. This, my wife tells me, drives people nuts. I'm constantly firing off emails with two or three technologies mentioned with the "obvious" connection to be inferred. Every now and then, colleagues, instead of deleting these emails or blog comments, help me with communicating "the vision-thing" by sending a request for info. Deborah Elizabeth Finn, Cyber-Yenta, has helpfully done just that re: my comments re: her blog article ...Moreover, I Am Not An Economist. My only regret is that I didn't figure out an angle to bring in xbrl. Here follows the linked version of my stream of consciousness prose:</ed.note>

Micropayments, yes! The problem with this adoption lag is we simply don't have the infrastructure in the US today. However, as the Nationwide Health Information Network (NHIN) is built out and open source medical banking infrastructure is developed, for instance, initiatives like the Charitable Communities Network will be able to transfer micro as well as macropayments. As m-commerce finally hits US phones (like in Scandanavia where you can charge snack food to your cell), and digital chips, and smartcards, and rfid passports, etc. allowing the cellphone companies to become the new mortgage brokers (hello, ernie: geolocate this property -- I want to make an offer -- am I preapproved -- great! Press seven for downpayment). Do you think Nokia announced that tablet the other day for a whim? And then add that Apple open source browser project and Osirix for medical record storage on iPods (and why don't they just relaunch the Newton now -- we're ready for it this time!?!) Remember Motorola's set top box with the eCommerce slot and USB port -- think truly interactive TV when you're taking a course via TV (teachers have you studied the balanced scorecard movement? -- finally you'll be paid what you're worth -- is that a blessing or a curse?) and your connecting your medical device for monitoring and you have to buy new prescriptions. Press Remote Control button 7 and removes $ from Health Savings Account.

Feeling shut out on the Hill

June 27, 2005 By Michael Cass, Tennessean.com

Karlen Evins, co-host of Teddy Bart's Roundtable, a public-affairs radio program based in Nashville, said she tried to open up the workings of state government last year. Evins wanted to create a statewide cable TV network to broadcast meetings of the House and Senate — in effect, a Tennessee version of C-SPAN.

But Evins said she was unable to move the idea beyond the Senate State and Local Government Committee, which is chaired by Sen. Steve Cohen, D-Memphis. She said Cohen, who had led the effort to start a state lottery, was getting revenge on Evins because Teddy Bart's Roundtable had featured a number of anti-lottery guests before a statewide referendum on the issue in 2002.

"You can do everything right and play by the rules, and if somebody has a personal vendetta, it doesn't matter," Evins said. "I was so disillusioned. If you can't get past certain people holding the cards, why bother?"

The power behind the SOA repository

By Ash Parikh, Robert Smik, and Premal Parikh, JavaWorld

The nature of SOA data requires a native XML data management server

This article is written for readers looking at and considering efficient, flexible, and standards-based approaches to implementing real-world service-oriented architectures, or SOAs. With the proliferation of Web services and, hence, SOAs as viable approaches to developing and enhancing software architectures, it is imperative to acknowledge that the amount of SOA data will also continue to grow. Furthermore, as the Web services standards stack broadens in functionality, the number of SOA artifacts required to support these new standards grows by the day. We must recognize the obvious need to store, manage, query, manipulate, and transform SOA data. Also, requesting applications frequently access SOA data. A case can thus be made for a mid-tier cache that exposes technology-independent, reusable, and functionality-rich services, hence, improving SOA scalability and performance. Additionally, as enterprises engage in collaborations with trading partners, interaction with complex schemas becomes a challenge. Thus, more than just a simple XML persistence mechanism is needed. A native XML data management server lends itself seamlessly to such complex demands for SOA data management. (3,000 words; June 27, 2005)

GEFEG US Offers Training for ANSI ASC X12 CICA Standard

June 22, 2005 PRWEB

GEFEG US is pleased to announce the first in a series of one-day workshops on creating CICA Constructs using the GEFEG EDIFIX® CICA Editor.

The first workshop will be held on August 5, 2005 at the Adam's Mark Denver Hotel. Future workshops will be held in major cities, and on-site by request. Registration details are available at http://www.gefeg.com/en/training/train_cica.htm or by sending email to info-us@gefeg.com.

This introductory workshop focuses on the most frequently used features and functionalities of the EDIFIX CICA Editor. The target audience for this workshop includes programmers, systems analysts, business analysts, and other technically oriented business professionals who need to understand how to create ASC X12 CICA standards.

The EDIFIX® CICA Editor is the world's first and only software in the world to implement the complete ASC X12 CICA standard. This means you can use the CICA Editor to create CICA based constructs and data models.

The CICA Editor belongs to the scaleable EDIFIX® product line. EDIFIX® supports companies in modeling, creating, testing and documenting guidelines based on international EDI business standards, like ASC X12 and UN/EDIFACT, XML business schemas, like CICA, or custom defined. The numerous benefits include high data quality, business standard to trading partner compatibility and earlier productivity to avoid costly error-search with the archival of error-free transactions at early product stages

About GEFEG
GEFEG is an internationally renowned software development, professional services, and training company with a strong focus on national and international eBusiness Standards. Founded in 1990, the company has a long history and extensive experience in IT standards and the use of business documents in electronic business. GEFEG’s goal is to support companies to accomplish consistent and high-quality business data standards and specifications, and thus achieve substantial timesavings in the design, implementation, and subsequent maintenance phases of business communication projects.

Press Contact: Sylvia Webb
Company Name: GEFEG US
Email: swebb@gefeg.com
Phone: 310-370-3410
Website: www.gefeg.com/en

Vordel debuts latest version of hardened XML security appliance - with on-board acceleration developed in association with Dajeil

June 21, 2005 – webitpr.com

Best-of-breed combination of XML processing and security acceleration addresses the enterprise requirements for XML security appliance 

Vordel, the XML Web Services security company today announced the release of VS3000, the latest version of its hardened XML security gateway appliance. Developed in conjunction with hardware security acceleration experts Dajeil, the Vordel VS3000 XML Security Gateway is a wire-speed in-line device which filters XML traffic on the network.

Through a combination of standards-based access control and comprehensive XML attack prevention, the VS3000 allows an organization to control who accesses its XML applications, as well as controlling what data they send to it. The device functions as an XML-level router, augmenting existing network infrastructure.

The VS3000 is unique in its capability to provide protection for all classes of XML applications: SOAP-based Web Services, “plain XML” applications and “REST style” applications invoked using only HTTP. The device supports all XML dialects, including ACORD, FIXML, and ebXML.

ebXML Registry News from SUN [Update]

This week saw the announcement of a new ebXML Registry product by Sun. Related stories appeared in|on cbr, i-newswire, internetnews, techworld, and yahoo. One more at javaworld.

Hearing impaired see promise in high speed Internet video

June 17, 2005 by Chloe Albanesius

Congress should expand a provision of the 1996 Telecommunications Act on telecom access for the disabled to include high-speed Internet access -- so that the hearing-impaired can communicate via broadband video, advocates of the deaf community said Thursday.

Access to such service is a "civil rights issue," Andrew Imparato, president of the American Association of People with Disabilities, said during a Capitol Hill demonstration of real-time communication for the deaf.

The 1996 law, which some lawmakers are seeking to overhaul, currently "applies to old technology," he said, because it gives the disabled telecom access only via telephone and not broadband. "We need to make sure our policy brings us into the modern era," Imparato declared.

Other issues include the economic availability of equipment, Kelby Brick, director of law and advocacy for the National Association of the Deaf, said through a sign-language interpreter. With so many products on the market, some are bound to be incompatible -- making the devices useless if two deaf people who want to communicate have equipment with different standards, he added.

Brick called on Congress to require the FCC to recognize that video phone service is necessary and needs to be incorporated into updated telecom laws.

"Our goal is for it to work," Imparato said when asked if he supports mandated standards. That could mean industry-led standards reached through negotiation or action by Congress. "However it happens," it would be a good move, he said.

Brick, meanwhile, praised the FCC for requiring Internet phone providers to offer 911 service but urged the commission to also include video services. "We're talking about life-saving issues," he said.

Rep. Fred Upton, R-Mich., chairman of the House Energy and Commerce Telecommunications and the Internet Subcommittee, said he would do "all that I can" to push legislation that makes new communication systems available to all. "It's imperative that the disabled have access to what other people have," he said.

Rep. Eliot Engel, D-N.Y., a member of the subcommittee, also pledged to be "very vocal" in support of making broadband technologies available to the deaf. "Telecommunications is the great equalizer," he said. Engel called tax cuts during the Bush administration "one of the major impediments in technology spending." He said his office encounters a number of groups pushing "good technology," but because Congress is "not doing a very good job of being fiscally responsible," many promising projects fall by the wayside.

Frank Bowe, a professor at New York's Hofstra University, was on hand for the demonstration of broadband communication technology. After dialing his office number, Bowe's secretary and sign-language interpreter appeared on the screen. Bowe was able to get real-time messages from his secretary and later converse with a student in sign language.

"I've never once spoken to my secretary on the phone," he said.

Can a National Healthcare Information Network Work?

strategy+business and Knowledge@Wharton

A central medical records database could yield economic and social benefits. However, the network will only succeed if it is designed for all healthcare system stakeholders

It’s been five years since scientists mapped the human genome — and nearly 40 years since doctors completed the first successful heart transplant — but in the realm of information technology, healthcare’s miracles are limited. Even as so many other industries have shown that handling information electronically is cheaper, faster, and more accurate than using written records, hospitals and doctors have stuck with their paper trails. A recent study by the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention found that only 31 percent of hospital emergency departments, 29 percent of outpatient departments, and 17 percent of doctors’ offices use electronic medical records.

Bill Would Offer I.T. Grants, Loans

Health Data Management

The federal government would provide $250 million in grants--and another $250 million in loans--in each fiscal year from 2006 through 2011 to support development of a national health information network under legislation introduced in the Senate. Grant recipients would be required to provide matching funds of at least 20%.

Full text is available at http://thomas.loc.gov.

HHS sees incorporating health care standards into Federal Information Processing Standards

Jun. 7, 2005 BY Bob Brewin

The National Institute for Standards and Technology will work to add electronic health standards to a new series of Federal Information Processing Standards (FIPS). NIST officials will also incorporate certified electronic health record (EHR) systems developed under contract proposals released today by the Department of Health and Human Services.

According to the statements of work in the requests for proposals, NIST will consider whether a contractor’s list of standards is ready for governmentwide use. The RFP for certification of EHR systems and software contained similar language. It added that the next version of FIPS will be based on public and private recommendations from the American Health Information Community, a public/private organization announced yesterday by HHS Secretary Mike Leavitt. The community will lead the development of a nationwide electronic health care system.

Dr. David Brailer, the national coordinator for health information technology, said the agency will use the results from the two standards and certification contracts to help develop a model of what a standards-based “commercially available electronic health record should look like.”

US government encourages development of e-health records network

7th June 2005 By CBR Staff Writer

The US government has formed a new collaboration in the hope of advancing efforts to establish a network of electronic medical records across the US.

According to Health and Human Services (HHS) Secretary Michael Leavitt, the advisory panel will help the US in its transition to electronic health records (EHR) by providing input and recommendations to the HHS on how to make health records digital and interoperable while maintaining privacy and security.

The move is an attempt to meet President Bush's call for the nationwide adoption of EHRs within ten years. It is hoped this will enable patients, doctors and other health care providers to securely access health information over the internet at any given place or time.

Secretary Leavitt TAKES NEW STEPS TO ADVANCE Health IT

National Collaboration and RFPs will pave the way for interoperability

Health and Human Services Secretary Mike Leavitt today announced the formation of a national collaboration and four requests for proposals that will advance efforts to reach President Bush's call for most Americans to have electronic health records within ten years.  The President's vision would create a personal health record that patients, doctors and other health care providers could securely access through the Internet no matter where a patient is seeking medical care.  Today's announcement provides a way for patients, doctors, hospitals, insurance companies, and employers to agree on standards for electronic health records and ways to achieve interoperability - the ability to access this vital medical information immediately and efficiently. 

"The national strategy for achieving interoperability of digital health information is for federal agencies - who pay for more than one-third of all health care in the country - to  work with private-sector health care providers and employers  in developing and adopting an architecture, standards and certification process," said Secretary Leavitt.   

An electronic health record is a digital collection of a patient's medical history and could include items like diagnosed medical conditions, prescribed medications, vital signs, immunizations, lab results, and personal characteristics like age and weight. 

"The use of electronic health records and other information technology will transform our health care system by reducing medical errors, minimizing paperwork hassles, lowering costs and improving quality of care," Secretary Leavitt said.  "We will bring together the public and private health care sectors to transform health care as we know it."

The cornerstone of this effort, a private-public collaboration called the American Health Information Community (AHIC), will help nationwide transition to electronic health records - including common standards and interoperability - in a smooth, market-led  way.  The AHIC, which will be formed under the auspices of the Federal Advisory Committee Act, will provide input and recommendations to the Department of Health and Human Services (HHS) on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected. 

HHS will solicit nominations for people to serve on the AHIC and Secretary Leavitt will appoint up to 17 commission members, as well as serve as chairperson.  The AHIC will be chartered for two years, with the option to renew and duration of no more than five years.  The Department intends for the AHIC to be succeeded within five years by a private-sector health information community initiative that, among other things, would set additional needed standards, certify new health information technology, and provide long-term governance for health care transformation. 

HHS will also issue four requests for proposals (RFPs) to pave the way for interoperability.  These RFPs will create processes for setting data standards, certification, and architecture for an Internet-based nationwide health information exchange, as well as assess patient privacy and security policies.  In total, HHS will spend $86.5 million on health IT in FY05, and President Bush has requested $125 million for health IT in FY06. 

"Once the market has structure, patients, providers, medical professionals and vendors will innovate, create efficiencies and improve care," Secretary Leavitt said. 

The Institute of Medicine estimates that medical errors kill 45,000 to 98,000 Americans each year in hospitals.  Technology can help reduce these medical mistakes by making health information more accessible to patients and providers.  As important, the information needed to treat patients effectively will be a computer click away, no matter where the patient is receiving care, which will improve patient care and satisfaction.  Moreover, health technology can reduce costs by saving time, reducing duplication and waste, and improving efficiency with the potential to reduce costs by as much as 10%.  Consumers not only benefit by saving money and improved patient care, but also by saving time because they will not have to supply basic information over and over again, or be subjected to duplicative and unnecessary tests. 

Secretary Leavitt noted that HHS will do its part by adopting standards and data-sharing processes for Internet-based applications that will help Federal programs like Medicaid and Medicare support the use of digital and interoperable health records that are privacy-protected and secure. 

AHIC will advise the Department on how to accelerate the nationwide adoption of interoperable digital records, while striking the right balance between the public and private sectors.   The AHIC will have five specific tasks:

1. Make recommendations on how to protect privacy and security.

2. Identify and make recommendations for prioritizing health information technology achievements that will provide immediate benefits to consumers of health care (e.g., drug safety, lab results, bio-terrorism surveillance, etc.).

3. Make recommendations regarding the creation of a private-sector, consensus-based, standard-setting and harmonization process, and a separate product certification process.

4. Make recommendations for a nationwide architecture that uses the Internet to share health information in a secure and timely manner. 

5. Make recommendations on how the AHIC can be succeeded by a private-sector health information community initiative within five years.  The sunset of the AHIC, after no more than five years, will be written into the charter.

"We've outlined a powerful vision for heath IT and the steps to achieve the President's goal," said Dr. David J. Brailer, National Coordinator for Health Information Technology. "The actions announced today build on the evaluation and strategies that we have developed in collaboration with the broad community of healthcare leaders."

More information is available at www.hhs.gov/healthit

HHS Press Office
202/690-6343
June 6, 2005

CNBC Announces Two Credit Card Companies To Be Acquired In The Last Week

I wonder why? Could it be related to this:

A telling sign that things are heating up for the medical banking industry is a call by the CIO Executive Council™, comprised of 200 leading companies, to the US Department of Health &Human Services to implement an ATM-styled approach for a national healthcare information network (NHIN).

“Public/private partnership is necessary to achieve the successful development of NHIN standards and operating guidelines,” commented Jeff Balagna in a recent press release by the organization. Mr. Balagna is an advisory board member to the Council and is CIO of Medtronic.

John Hummel, who is CIO of Sutter Healthcare and chairs the CIO Healthcare IT Taskforce explained that an “industry and government collaboration will ultimately expedite program implementation, maximize available technologies and leverage industry experiences.”

Read more of the March|April 2005 Medical Banking Report

John Casillas talks Medical Banking today

HHS' Leavitt continues to push health IT standards

May 23, 2005 By Bob Brewin, FCW.com

The federal government can play a major role in developing nationwide health information technology standards by using the power of its purse, Department of Health and Human Services Secretary Mike Leavitt said in a speech today at the Stanford University School of Medicine.

Leavitt has been campaigning for the development of a nationwide health IT system.

Because the federal government picks up 46 percent of the nation's health care bill through Medicare and other programs, “if we adopt standards, it will move the market,’’ Leavitt said.

The federal government can influence the health care market by becoming an early adopter of standards-based health IT systems, which will create a sense of certainty in the marketplace, he said.

HHS views standards as the essential building block of a nationwide health IT system, which will give providers and consumers quick and easy access to electronic health records, with the federal government playing a key role in standards development.

"Unifying health IT with standards [is] a major [effort] on the part the national government," Leavitt told the Stanford audience, but it needs to be done through what he called “organic collaboration’’ between the government and the health care sector. The federal government should not mandate standards, he said.

IBM To Launch Electronic Medical-Record-Sharing Project [ or ebIBM ]

April 27, 2005 by Charles Babcock, InformationWeek

Use of transferable electronic medical records could cut health-care spending by 10%, experts say.

IBM wants to help pave the way for the free exchange of electronic health-care records that today are trapped in hundreds of disparate hospital, physician, and health insurance systems.

<ed.note>I conjecture that what this article leaves out is that Boaz Carmeli at Haifa and Iris Eiron at Almaden are both investigating ebxml registry (specifically the freebxml.org distro, OMAR) as a foundational component of "the Interoperable Health Information Infrastructure" since in Eiron's words "[t]he IHE XDS specification contain numerous references to ebXML RIM and RS version 2.0."</ed.note>

By the end of the year, IBM will launch a pilot system, the Interoperable Health Information Infrastructure, that will link IBM sites in San Jose, Calif.; Rochester, Minn. (home of the Mayo Clinic); and Haifa, Israel, to demonstrate how electronic medical records based on open standards could move from one health-care provider to another and follow a patient around the world.

"Our test bed will model the world of the future. We'll have both real and simulated data for 200 million individuals, with the resulting message flow," said James Kaufman, research manager for health-care information at IBM's Almaden Research Center in San Jose. Kaufman was interviewed during a forum called Transforming Healthcare with Information this week at the San Jose facility.

The Turkish Online Journal of Distance Education Call for Papers: eLearning, eMed, GRID

Call for Papers to the 4th Special Issue of The Turkish Online Journal of Distance Education (TOJDE) (Volume: 7, Number: 2) To be delivered in April 2006

Guest Editor
Takeshi UTSUMI, Ph.D., P. E.
Guest Co-Editor
Associate Professor Piet KOMMERS

This special issue is to indicate foresight, innovation, and strategy for the future direction of e-learning, more than web-oriented teaching and multipoint videoconferencing, for collaborative, distributed, experiential learning and creation of new knowledge, with youngsters around the world, which hence promote mutual understanding for global peace.  Emphasis will be on knowledgeable and inspiring papers (but not limited) on the use of GRID networking technology with distributed computer simulation for experiential (hands-on) learning through broadband Internet, across national, continental and oceanic boundaries.  Subjects are in any fields of e-learning and e-healthcare/telemedicine, in research, case studies, project descriptions, implementation, reports from the field or book review.

All papers will be evaluated for originality, significance, clarity, and soundness. Approximately between 7 to 11 papers will be selected for this 4th Special Issue.

Paper Specifications
Please visit to http://tojde.anadolu.edu.tr and then click Call for Papers button

Important Dates
Paper submission deadline:  December 31, 2005
Acknowledgement for acceptance: January 30, 2006
Submission of final papers:  February 28, 2006

Guest Editor
Takeshi UTSUMI, Ph.D., P. E.
Chairman, GLObal Systems Analysis and Simulation Association in the U.S.A., (GLOSAS/USA)
Founder and V. P. for Technology and Coordination of Global University System (GUS)
43-23 Colden Street, Flushing, NY 11355-3998, U.S.A.
Tel: +1-718-939-0928
utsumi@columbia.edu
http://www.friends-partners.org/GLOSAS

Guest Co-Editor
Associate Professor  Piet KOMMERS
Faculty of Educational Science and Technology
Division of Educational Instrumentation
University of Twente, P.O. Box 217, 7500 AE Enschede
The Netherlands
Tel. +31 53 4893576 or 3611
Fax +31 53 4894580
kommers@edte.utwente.nl
http://users.edte.utwente.nl/kommers/index.html

HL7 Italia IHE XDS

HL7 Italia and XDS FAQ

A Medical Banking Road Map for America Now Available

Franklin, TN (May 16, 2005) Medical banking, or "the latent integration of banking technology, infrastructure and credit with healthcare administrative operations" is occurring at a much quicker pace today relative to even six months ago. Acquisitions between banks, their supporting vendors and healthcare firms is a key area to watch today. These acquisitions are at the tip of a sea of change in industry patterns that is finding unlikely alliances between banks and healthcare organizations.

The Medical Banking Project, which facilitates the medical banking industry (and coined the term "medical banking™" to denote this area), recently completed a 69 page volume entitled "A Medical Banking Road Map for America". The document is available on their website at http://www.mbproject.org/services-pubs-roadmap.php for a fee of $195.00 (non-member price).

The concept for the document originated after ONCHIT Director, Dr. David Brailer, convened a national conference in Washington, DC, in July 2004. Speaking to a broad spectrum of healthcare stakeholders he challenged the industry to adopt a "National Healthcare Information Network". MBProject subsequently drafted an open letter to the banking and healthcare industry, encouraging participation in workgroups that finally presented at the 3rd National Medical Banking Institute in Nashville, TN, in February 2005. The recommendations of these workgroups are part of the information in the new volume.

"We are pleased to present this work to the industry. It comes after many years of wrestling with issues and trying to find clarity. Yet there is more work to do and this is definitely 'Version 1.0'. The volume will continue to be refined at our next Institute and we'll include our work on seamless HSA processing at that time," said MBProject founder John Casillas.

"Banks need to understand their role in the national effort to ramp healthcare onto digital networks. America benefits by leveraging banking systems to move healthcare from a paper and error-intense environment to a digital paradigm that we all want and need. Many banks are pressing forward yet the 'road map' isn't easy to follow and frankly, trail blazing never is. We will continue to meet a critical need for subject matter expertise, educational programming and facilitating pilot development as recommended by Institute attendees. This includes reaching out to non-bank stakeholders," says Casillas.

A Medical Banking Road Map for America is central to MBProject's educational goals. The document itself has been weaved into the Project's efforts to organize educational programming, from workgroups to the Medical Banking Institute itself. "As we continue this process, the road map will become so clear that the smallest community bank will help our national healthcare technology process", predicts Casillas.

etwAbout the Medical Banking Project...

MBProject is an independent policy research and strategic advisory firm established to promote the development of "Charitable Communities Network", an industry model that leverages HIPAA's security, privacy and electronic mandates to deliver substantive cost benefits to care givers. The firm does not provide legal advice and urges medical banking stakeholders to consult with private counsel. For more information, please go to http://www.mbproject.org.

Contact: Evelyn Marquez Sanchez
615-794-2009
info@mbproject.org

2005 Public Health Information Network Conference Presentations Posted

The 3rd annual Public Health Information Network (PHIN) Conference was held at the Hyatt Regency Atlanta in Atlanta, Georgia from May 10-12, 2005. This year's theme, "Improving the Public's Health: Convergence & Partnerships in Health Information", was aimed at connecting public health and clinical care in order to better protect the public. ... ensuring the implementation of standards-based integrated systems that address the needs of public health at all levels.

Traditional IVR to Become Extinct with the Emergence of Open-Standards Platforms

May 13, 2005 CRM2Day
 
'Traditional' touchtone interactive voice response (IVR) - utilized by businesses over the past two decades for the purposes of phone-based routing and self-service functionality, is firmly in its twilight years."

In a new report, "The Definitive Guide to the IVR Marketplace: North America and EMEA," independent market analyst Datamonitor expects revenues from proprietary touchtone IVR in North America, Europe, the Middle East and Africa (EMEA) to decrease by more than 35% through 2009 as a growing number of businesses are opting to invest in emerging open-standard IVR platforms such as Voice-XML and SALT, to better leverage web infrastructure, improve functionality and potentially graduate to speech technology to further improve routing, transactions and self-service capabilities.

According to Datamonitor, spend on traditional IVR licenses will dip from $277 million to $179 million in North America and EMEA by 2009.

Spend on open-standards IVR licenses will grow from $166 million to $332 million in North America and EMEA by 2009

Health IT report calls for fed leadership

May 11, 2005 By Bob Brewin FCW.com

Mike Leavitt, secretary of the Department of Health and Human Services, said investment in health care information technology is essential and a high priority for the U.S. health care system. He also released a report calling for the federal government to lead the promotion of widespread adoption of health care IT.

IT “is a pivotal part of transforming our health care system,” Leavitt said today. "We are at a critical juncture. Working in close collaboration, the federal government and private sector can drive changes that will lead to fewer medical errors, lower costs, less hassle and better care."

He spoke at the CEO Health Care Summit in Washington, D.C., organized by the Business Roundtable, an association of executives of major U.S. corporations.

Leavitt released a report prepared by HHS and the Business Roundtable's Health Information Technology Leadership Panel. The document states that widespread adoption of interoperable health IT should be a top priority for U.S. health care officials. As the biggest health payer and provider in the United States, the federal government should lead the widespread adoption of health technology, the report states.

Members of the Leadership Panel include the following chief executive officers: Frederick Smith of FedEx, Rick Wagoner of General Motors, John Faraci of International Paper, John Barth of Johnson Controls, Robert Ulrich of Target, Steve Reinemund of PepsiCo, Alan Lafley of Procter & Gamble, Richard Kovacevich of Wells Fargo and David Glass, formerly of Wal-Mart.

Health Information Technology Leadership Panel: Final Report

On May 11, 2005 Secretary Leavitt released the "Health Information Technology Leadership Panel: Final Report," in conjunction with the Business Roundtable.  The Report, prepared by The Lewin Group, a health care policy consulting firm, through a contract with HHS, contains the findings of nine CEOs from leading U.S. companies who purchase a substantial amount of health care for their employees.

The press release announcing the release of the report can be found at:
http://www.hhs.gov/news/press/2005pres/20050511.html

"The Health Information Technology Leadership Panel: Final Report" can be
found at: http://www.hhs.gov/healthit/HITFinalReport.pdf

OASIS Symposium Proceedings Posted

Ash Parikh, Director of Development and Technology - Enterprise, RainingData was the only one to ask me to highlight their talk so I will:

Multi-Layer XML Data Model for EPC/RFID (ppt)

The EPC/RFID physical stack consists of many layers, starting from the event layers at the reader hardware level, all the way through business process layers, and finally to the consuming application layer. The data that flows between each of the layers can be represented in a platform-independent form as XML. This data also needs to be self-aware, location-aware and business process-aware. This means that for the EPC/RFID Industry Domain, there needs to be an XML Schema and Vocabulary that describes the domain-specific capabilities, location and business processes details pertaining to the EPC/RFID Industry Domain. This also means that interaction with existing OASIS Standards, such as WS-BPEL, ebXML CPPA/CPA, and other technologies such as WS-Policy, is required.

Presenters: Ash Parikh, Director of Development and Technology - Enterprise Applications Group, Raining Data Corporation and Robert Smik, Lead Architect/Team Lead - Enterprise Applications Group, Raining Data Corporation

The rest are here.

Of XDS, IHE, NIST and ebXML Registry

NIST are working with IHE on developing a cross-enterprise secure document exchange system (XDS). Read about this and related developments at the new ebxmlforum blog.

Leavitt Calls for Development of Health IT Standards

May 03, 2005 iHealthBeat

HHS Secretary Mike Leavitt on Monday said the federal government and the health care industry must make a "forced march commitment" to develop national standards for health care IT systems, CQ HealthBeat reports. At an annual American Hospital Association meeting, Leavitt said that "if we do not act and do not act soon," the health care system will lose hundreds of millions of dollars because of incompatible health care IT systems.

Leavitt said that the development of health care IT standards is "difficult, it's time-consuming, it's expensive," but he added that "it's absolutely essential" that the process begin over the next several months. He did not provide a timeline for the completion of the development of health care IT standards or comment on whether Congress should establish a deadline.

However, Leavitt said that the federal government could encourage the health care industry to reach agreement on health care IT standards and serve in a "soil testing" role to help ensure that investments in health care IT systems are not wasted. In addition, the federal government could serve as an "early and certain adopter" of health care IT standards, he said.

Three Standards, Three Convergence Waves

April 2005 By Bob Emmerson, VON Magazine

IP, SIP and XML are more than standards, they're technology milestones. They've given us VoIP, presence and dynamic Web pages, developments that are enabling different convergence scenarios. But at the end of the day everything is coming together.

IP was the first standard. No surprises there. The lingua franca of data communications moved on in the 1990s: it enabled voice-data convergence and became the foundation for communications in the 21st century. VoIP has driven tariffs down to the level at which we can start talking about free telephony on public networks and network operators accept that it is not a sustainable business model.

SIP is the second standard. This is a 'rendezvous' protocol that establishes end-toend sessions over IP networks. You need a SIP proxy server to set up calls, but after that, all the network does is transport the traffic. SIP's ability to traverse different IP domains means that any IP network mix appears as a single converged network to users: that is their perception and it's the only one that matters. SIP's other major claim to fame comes via its deployment in presence-aware, real-time communications software.

The third standard is XML (eXtensible Markup Language). XML allows the content of web pages to be defined and there will be myriad uses for this technology. In the business environment XML is being used in business process integration. XML pages are de facto database records and they can be passed from one application to another, e.g. from CRM to ERP. The technology therefore enables the automated flow of information from the start of the process to the end; this is the basis of the real-time enterprise.

JCP Watch: WSCI on J2ME, Mobile Messaging from J2SE/EE and ebXML Support

By Apu Shah

Mobile mania has hit the JCP this week with three new specification requests relating to mobile technologies. The first proposes an API for mobile messaging (such as SMS and MMS) from J2SE and J2EE applications as opposed to J2ME applications. The other two proposals deal with adding Web Services Choreography and support for an ebXML specification to J2ME. In addition, Java Servlet, JSP and J2EE proposed final specifications have also been posted.

E-Business Meets and Greets ebXML

By Tom Clements, Oracle Magazine

Bringing business standards and processes to XML.

By themselves, business documents present a flat, one-dimensional landscape to most companies engaged in internet trade. What's missing is a way to define business processes—order entry, inventory control, payments—that can process data in a standardized and consistent manner both within and across industries. Also missing is a way to define a set of unambiguous and standardized core components for business transactions so that there is no misunderstanding over what a particular piece of business data means.

By cataloging common business processes and workflows, ebXML establishes common message sequences that can be deployed across industry boundaries to foster global trade.

ebXML Initiative

The ebXML initiative is broadly based on two earlier initiatives, OpenEDI and XML/EDI, and now operates under the auspices of the Organization for the Advancement of Structured Information Standards (OASIS) and the United Nations Centre for Trade Facilitation and Electronic Business (UN/CEFACT). The ebXML initiative is an attempt, in the words of the specification, to "create a single electronic global market."

OASIS Forms Committee to Develop SOA Reference Model

May 3, 2005

Adobe Systems, AmSoft, Boeing, Booz Allen Hamilton, Fujitsu, General Motors, Infravio, NEC, Reactivity, SOA Software, VISA, and Others Collaborate on a Foundation for Service Oriented Architectures

International standards consortium, OASIS, announced the formation of a new committee to develop a core reference model that will guide and foster the creation of specific, service-oriented architectures (SOA). The new OASIS SOA Reference Model (SOA-RM) Technical Committee will promote the continued development of multiple SOAs and related standards by acting as a guide for those writing SOAs and an analysis of their functional components.

"The term SOA is used in an increasing number of contexts with differing -- and even conflicting -- meanings," said Duane Nickull of Adobe Systems, chair of the OASIS SOA-RM Technical Committee. "If SOA is architecture, as the name implies, then we should define it as architecture. The reference model we create will be useful for the entire industry, offering a way to preserve a common layer of understanding across multiple service oriented environments and architectures."

Specifically, the SOA reference model will offer an understanding of the core elements within a service oriented environment and the associations and relationships among those elements. The reference model itself will not be directly tied to any standards, technologies or other concrete implementation details. Rather, it will be an abstract, designed to be used as a tool by software and enterprise architects developing specific SOAs.

"In addition to vendors, there is a significant contingent of SOA end users from across the globe rallying around this work to define the basic, common elements of any service-oriented system," noted James Bryce Clark, Director of Standards Development at OASIS. He cited participation from government agencies such as Japan's Electronic Commerce Promotion Council, Canada's Public Works and Government Services, and USA's Department of Homeland Security, as well as users that include Boeing, General Motors, Lockheed Martin, Mitre, and VISA.

The OASIS SOA-RM Technical Committee already has more than 45 members, and participation remains open to all organizations and individuals, especially those directly involved in the design, documentation, or implementation of SOAs. As with all OASIS projects, archives of the Committee's work are accessible to both members and non-members, and OASIS hosts an open mail list for public comment.

Industry Support for SOA-RM

Booz Allen Hamilton

"Booz Allen Hamilton is proud to participate in the development of a standardized SOA reference model" said Rebekah Metz, Associate at Booz Allen Hamilton. "A cornerstone of the service-oriented approach is encouraging the growth of diverse yet interoperable implementations. The planned SOA reference model will provide a unified foundation from which the architecture for such implementations can evolve. We look forward to sharing the benefits of this important concept with our clients."

Infravio

"This week, Infravio increased sponsorship of OASIS to participate in the OASIS SOA-RM TC and future SOA work," said Miko Matsumura, vice president of marketing at Infravio. "As OASIS moves 'up the stack' it becomes increasingly important to Infravio and our focus on SOA customer's business requirements."

Reactivity

"SOA success requires a reliable and flexible reference model enterprises can use as the basis for implementing their own infrastructures to support SOA," said Andrew Nash, CTO at Reactivity. "Reactivity has been a leader in the development of the SOA infrastructure and believes this OASIS Technical Committee presents a great opportunity to for all vendors to align their efforts to simplify SOA for the enterprise."

SOA Software

"As a leader in Service Oriented Architecture Infrastructure, we are focused on rapid implementation and adoption of emerging standards and are deeply committed to the standards process," said Roberto Medrano, Executive Vice President at SOA Software. "The SOA reference model will promote a deeper understanding of the value employing a correctly designed service-oriented architecture can bring to large enterprise and government organizations."

About OASIS

OASIS (Organization for the Advancement of Structured Information Standards) is a not-for-profit, international consortium that drives the development, convergence, and adoption of e-business standards. Members themselves set the OASIS technical agenda, using a lightweight, open process expressly designed to promote industry consensus and unite disparate efforts. The consortium produces open standards for Web services, security, e-business, and standardization efforts in the public sector and for application-specific markets. Founded in 1993, OASIS has more than 4,000 participants representing over 600 organizations and individual members in 100 countries. Approved OASIS Standards include AVDL, CAP, DocBook, DSML, ebXML, SAML, SPML, UBL, UDDI, WSDM, WS-Reliability, WSRP, WS-Security, XACML, and XCBF. http://www.oasis-open.org

Additional information:

OASIS SOA-RM Technical Committee: http://www.oasis-open.org/committees/soa-rm

Cover Pages Technology Report: Service Oriented Architecture (SOA): http://xml.coverpages.org/soa.html
Contact: OASIS Carol Geyer,
978-667-5115 x209
carol.geyer@oasis-open.org

Register for the May 5th National Healthcare Technology Summit, Nashville, TN

The National Healthcare Information Technology Summit is May 5th! The Summit brings together the brightest minds in healthcare technology and industry policy for a 1-day conference in Nashville.

If you’re involved in healthcare or healthcare technology, this is the one event in 2005 you should not miss!

The inaugural keynote speaker is Dr. David Brailer, the first National Coordinator for Health Information Technology and a senior advisor for the Bush Administration. Dr. Brailer will discuss the President's vision and will also moderate a panel discussion about Regional Health Information Organizations (RHIOs). This is the first panel discussion of its kind on RHIOs, which are designed to facilitate the development, implementation and application of a secure health-information exchange across care settings and ultimately improve patient care.

Dr. Brailer will be joined at the conference by a distinguished group of speakers and panelists, including:

• Dr. John Blair, chair of the New York Taconic Independent Physicians Association
• John Casillas, founder of the Medical Banking Project
• John Evans, chair of the Vermont Information Technology Leaders
• Dr. Mark Frisse, Executive Director of Vanderbilt’s Volunteer eHealth Initiative
• Newt Gingrich, former Speaker of the House and founder of the Center for Health Transformation (via live, interactive satellite telecast)
• Dr. John Halamka, CIO Harvard Medical School, CIO CareGroup Health System, Chair of the New England Healthcare EDI Network (NEHEN)
• Lisa Rawlins, Bureau Chief of the Florida Governor's Health Information Initiative
• Dr. David Reagan, Executive Director, Central Appalachian Health Improvement Project

Register today – space will fill up quickly!

WHO:	Attendees include hospital administrators, physicians, nurses, HIM professionals, government officials, payers, vendors, scholars and consultants
WHEN:	Thursday, May 5 Continental breakfast begins at 7:30 a.m. Lunch will also be served
WHERE:	Delta Ballroom Gaylord Opryland Resort and Convention Center Nashville, Tennessee
COST:	$99 for member organization registration before April 22 $199 for non-member registration before April 22 $249 for registration after April 22

To see the Summit’s full agenda, click here.

Hotel reservations: Gaylord Opryland Resort and Convention Center

Ralph Szygenda believes that the high-tech industry can learn from the auto industry

GM May Shop for IT Needs in Red Herring’s TechSpin

... and standardize the way it does much of its business, particularly the routine parts of its business. They can still maintain unique differentiators, but for most of what they do, he believes, they should standardize. And that would help companies like GM that have far-flung enterprises but still put a premium on consistency. Today, IBM Global Services takes computer inventory differently than EDS. It also orders new equipment in different ways. They troubleshoot systems and network problems differently; and they handle human resources in different ways. “In the auto industry, when you buy parts and materials from suppliers, it’s done pretty much the same way with all suppliers,” Mr. Szygenda said to the Dallas Morning News {Steering Changes at EDS - GM's Clout May Prompt Tech Firm and Peers to Standardize Functions By Crayton Harrison}. “Where’s the model to just manage IT in corporations?”

<ed.note>While many high-tech industry execs are not smart enough to develop tech skills they are smart enough to know that a services and support industry (which Szygenda's "standards" implies) no longer requires an overpaid, iddatarate management strata since it can easily be replaced by a webbed database. Since many execs lack requisite burger flipping skills (and are loathe to admit it) they have to champion creative, alternative, if not truthful, strategies.</ed.note>

Americans want personal health records

May 3 2005 E-HEALTH-MEDIA LTD.

The majority of Americans want to be able to access an online personal health record (PHR), providing them with details of their medical record.

According to a survey conducted by the US health IT research body Connecting for Health, 61% of Amercans questioned agreed with the statement: "It's my health information. I should have access to it anywhere, anytime."

The telephone survey also found strong support for people wanting to be able to check their medical record for mistakes. Some 54% of those surveyed agreed with the statement: "Anybody can make a mistake I'd like to double-check what's in my medical records".

In addition, a majority of respondents also said they'd like to get an automatic copy of their doctor's notes and records after each visit. Details of the 2004 survey are carried in a report on PHRs in the current issue of American Medical News.

Massachusetts takes a spoonful of SOA

May 02, 2005 By Galen Gruman, InfoWorld

When doctors, hospitals, and insurers needed to exchange data across the state of Massachusetts, an SOA turned out to be the most practical, cost effective solution

Many organizations are looking to SOA to tie together systems within the enterprise or among partners. But few face the diversity and complexity that the state of Massachusetts did when it tried to connect independent insurer, hospital, and physician systems with one another -- and with the state’s own systems for care, reimbursement, and billing.

“How do you craft enterpriselike functionality across hundreds of moving parts that don’t interoperate with each other?” was the question the state faced in 1997, recalls Harvard Medical School CIO Dr. John Halamka, who spearheaded the effort. Because the Health Insurance Portability and Accountability Act of 1998 required that every doctor, hospital, and insurer be able to exchange data for transactions, doing nothing was not an option.

The Enterprise: Business Process Management Languages Part 3: BPSS [Business Process Specification Schema (BPSS) for ebXML]

May 2005 By Clive Finkelstein, DM Review Magazine

In February and April, I introduced two BPM Languages: BPEL (Business Process Execution Language) and BPML (Business Process Modeling Language). This month I will cover a third BPM language: Business Process Specification Schema (BPSS) for ebXML.

XML Vocabularies Key to Cross-Business Interop

April 28, 2005 by Vance McCarthy, idevnews.com

This month, F100 IT execs and top providers of enterprise software and web services tools are meeting at an OASIS event to discuss how to make it easier for corporate IT to develop web services across vertical sectors.

The OASIS "Future of XML Vocabularies" symposium is bringing together commercial and government end users, software and integration vendors and representatives from various Open Source and standards groups. One of OASIS' long-term goals is to help construct a common liobrary of cross-industry web services, akin to J2EE's common library of objects, OASIS president and CEO Patrick Gannon told IDN.

Sarvega to Undergo Common Criteria EAL 4+ Evaluation and Extends Its Leadership for Secure Web Services

April 27, 2005 Business Wire

Sarvega(TM), Inc, the leader in XML Networking solutions, announced today that its XML Guardian(TM) Gateway has been registered as In Evaluation at EAL 4+ under the Common Criteria scheme administered by the Communications Security Establishment (CSE). The company entered into the evaluation as part of its commitment to deliver the industry's most secure XML Networking products for governments and enterprises world-wide.

The Common Criteria for IT Security Evaluation, also known as ISO standard 15408, were initially developed by the national security organizations of the United States, Canada, the United Kingdom, France, Germany, and the Netherlands and is recognized by twenty-one countries today. The Common Criteria are a comprehensive set of guidelines which provide consistent criteria for evaluating security products. They provide a structured framework for the rigorous analysis and testing of IT security products across a defined set of requirements and functionality.

... The Sarvega Command Center provides a simple visual drag-and-drop mechanism for security policy configuration, testing, and deployment on one or many XML Guardian Gateway appliances. The Sarvega Command Center provides an open, extensible and interoperable platform that can be easily extended and integrated into applications security management environments. Its palette of pre-built security policy actions includes support for raw-XML and ebXML security, local and delegated Authentication, Authorization and Access Control (AAA), logging and auditing, and XML threat mitigation.

A Survey of Proposals for the Further Federal Regulation of Nonprofits

by the editors of The Nonprofit Quarterly

The U.S. Senate Finance Committee held hearings on June 22 and July 22 of 2004 to consider what might be wrong with the regulatory system for foundations and the nonprofit sector, meeting under the title “Charity Oversight and Reform: Keeping Bad Things from Happening to Good Charities.” Ranking Democratic Finance Committee member Max Baucus (D-Montana) set the tone when at the first hearing he stated: “It’s obvious from the abuses we see that there’s been no check on charities. Big money, tax free, and no oversight have created a cesspool in too many cases.”

The June 22nd hearing featured mystery witnesses testifying under the pseudonyms “Mr. House” and “Mr. Car” (as if these were protected mafia witnesses) with their voices and appearances obscured. “Mr. Car” testified about vehicle donation scams, and soon after the Finance Committee drafted legislation to reduce vehicle donation deductions to the sale amount realized by the charity (not the “Blue Book” value). The very quick action changing deductions for vehicles, starting January 1, 2005 is projected to save $3.5 billion for the treasury. It shows the Senate Finance Committee is ready to get Congress to act on charitable reform - at least when it increases revenue.

Get familiar with ebXML Registry

By Ash Parikh, JavaWorld.com

Learn the basics about the ebXML Registry standard

Summary
This article is the first of a series of short articles that will introduce readers to the industry's various Web services standards. These articles will provide a quick introduction to a standard, its background, underlying architecture, benefits, status, and industry adoption. As some of the content might be a depiction of the author's viewpoint, readers are encouraged to refer to the links provided in Resources to gain a deeper understanding of a particular standard. This article focuses on ebXML Registry from OASIS. (1,000 words; April 25, 2005)

Much like Electronic Data Interchange (EDI), electronic business XML (ebXML) was developed to enable business to be conducted electronically over the Internet. Custom protocols and proprietary messaging formats between trading partners created a deterrent to the widespread adoption of EDI. ebXML, on the other hand, provides an open and flexible alternative, allowing enterprises anywhere, anyplace, and anytime to engage in meaningful collaborations.

OASIS Members to Vote on Four XML Measures

April 21, 2005 By XMLJ Newsdesk

The ebXML Registry Information Model (RIM) v3.0 and ebXML Registry Services and Protocols (RS) v3.0 offer a method for defining and managing interoperable registries and repositories. OpenDocument provides an XML-based file format specification for office applications. The Darwin Information Typing Architecture (DITA) provides an end-to-end architecture for authoring, producing, and delivering readable information as discrete, typed topics.

The Book of Five Healthcare IT Rings

or the Art of Peace

According to Neil Versel, contributing editor, Health-IT World, Dr. David Brailer taught the AMIA the Way of Standards harmonization; Clear, unambiguous policies about data control and ownership; Common security practices; Security of vendor products; and Interoperability as a business model.

ebXML at the CDC has been a success story

Integration languages make B2B communication more effective

April 7, 2005 By Johanna Ambrosio, SearchCIO.com

... Granted, it's early going, according to experts, and adopting these kinds of communications protocols is anything but a quick-and-dirty kind of project. It can take years for systems to be built and for customers and partners to be brought fully into the loop.

But that's not stopping the Centers for Disease Control and Prevention (CDC) in Atlanta. The federal watchdog organization over flu, hepatitis and other health threats has based the messaging portion of its new Public Health Information Network (PHIN) on ebXML. The protocol will act as the standard means for exchanging messages among all 50 states and the CDC. Other users -- including clinical facilities and medical laboratories around the country -- will be brought in as well, said Barry Rhodes, associate director for public health systems development.

At this point, PHIN has been implemented in about 15 state health departments, with the rest to be rolled out over the next three years, Rhodes said. PHIN, based on a bevy of computing and other standards, is about the secure and reliable exchange of information. It's envisioned to be a unifying framework built on top of existing standards whenever possible; for instance, Secure Sockets Layer and some Java technologies are included in the system as well.

For its part, ebXML is "the envelope into which we put messages," Rhodes explained. "Some are XML messages and some are not."

The CDC chose ebXML as the underlying message transport because it liked its approach. "The developers of ebXML looked at the business need of interactions between business partners, of how that could happen." Rhodes said. "We needed that business process modeling perspective that ebXML provides. [In comparison,] Web services tools take a bottoms-up approach -- that approach is more of a solution to a technical issue, of how to distribute functionality across servers and the Internet."

So far, ebXML at the CDC has been a "success story," because it has allowed much greater interoperability than what previously occurred among the states, Rhodes said. "Our ROI is about communication and getting more information to and from the CDC."

Rhodes was not able to share specific data, but he talked about one application -- in operation for years -- that gathers information about notifiable public health threats, including E. coli bacteria and the chickenpox.

"We look at the data and analyze it for things like latency and the amount of data received -- and we have compared those to what was happening pre-PHIN," Rhodes explained. "We've seen a demonstrable increase in the amount of data and a decrease in information latency."

The biggest threat to ebXML adoption, he said, is that it's early enough in the technology's lifecycle that it's not yet a sure bet that all the major computing vendors will support it. "It's one thing to put forth a standard," he said, "but if Microsoft and IBM choose not to implement it, that makes it very difficult. Predicting the future is a hard thing." ...

OASIS Approves First International Dictionary for UBL

April 21, 2005 By John K. Waters, adtmag.com

The Universal Business Language (UBL) is on its way to becoming truer to its name. The English-only standard for XML business documents in B2B applications, approved last November by the OASIS standards consortium, has been translated into four new languages.

OASIS last week approved the first edition of the UBL 1.0 International Data Dictionary (IDD), which comprises over 600 business data definitions from the UBL 1.0 schema, combined with translations of the definitions into Chinese, Japanese, Korean and Spanish.

The purpose of UBL is to unify the various business "dialects" of XML used in electronic commerce. UBL standardizes the XML format of basic business documents, making purchase orders, invoices and other business forms--the docs used in the "order-to-invoice process"--readable by compliant XML applications for e-business transactions.

The new dictionaries contain both "normative" and "non-normative" definitions, explains Jon Bosak, editor and chair of the UBL technical committee. The 600 business data definitions from the UBL 1.0 schema are standards (normative), but the helpful translations of English terms--say "line item"--into the various languages are not yet standards (non-normative).

XBRL-US Launches Online Resource Center

AccountingWeb.com

The Securities and Exchange Commission's (SEC) voluntary filing program encouraging companies to submit XBRL-enabled documents to the EDGAR database, received a little help Monday. The American members of XBRL International announced the availability of resources supporting the effort on the U.S. jurisdiction's website at www.xbrl.org/us/secvfp. Among the resources being made available are FAQs, tutorials, an email discussion group and guidelines. The site also includes links to US GAAP taxonomies, sample XBRL instance documents, and technical background information.

OpenClinical, standards that aim to support system interoperability

The OpenClinical Web site is aimed in particular at healthcare professionals and managers, medical informaticians and computer scientists and industry. It is designed to be a "one-stop shop" for anyone interested in learning about and tracking developments on advanced knowledge management technologies for healthcare such as point-of-care decision support systems, "intelligent" guidelines and clinical workflow.

• Promote decision support, clinical workflow and other knowledge management technologies in patient care and clinical research;
• Disseminate methods and tools for building healthcare knowledge applications that comply with the highest quality, safety and ethical standards;
• Build a community of individuals, organisations and commercial companies who believe in the value of knowledge management, and who wish to contribute to the definition and adoption of open technical standards for medical applications.

Call the Ontologist -- Stat!

Project Mission: To round up a joint Ontolog community effort, to author a response and submit that to the (US) National Health Information Network, Request for Information of 2004.11.15. Using that as the beginning of a collaborative effort where the Ontolog community can contribute professionally to the NHIN initiative.

Information Superhighways are Paths to Better Health Care

Jan. 2, 1994 By John M. Eger, San Diego Union-Tribune [Vintage Article]

Forty to eighty billion dollars a year could be saved in existing health care costs using advanced communications technology. And even more if information technology were aggressively embraced by the health care industry.

It is not at all clear that the administration has given much thought to the inescapable connection between health care, and the role of advanced communications technology. But they should, for it would be good for consumers, telecommunications providers and the entire health care industry.

Health care is essentially a knowledge or information-intensive business, and the health care industry is heavily dependent on and comfortable with information technologies. But transforming health care delivery to increase efficiency affects not just the cost side of the equation. Health care, not unlike other uniquely American information products and services, represents one of America's greatest strengths in the new global information economy. Indeed, health care broadly defined could be one of our nation's greatest exports. That's the good news.

WorldVistA makes plans to support open-source application

Fred Bazzoli, Senior editor, Healthcare IT News

BOSTON — WorldVistA is gearing up for growing demand for the open-source healthcare application it champions.

The not-for-profit organization sees mounting interest in OpenVistA, the version of clinical software that’s in the public domain. OpenVistA is a derivative of VistA, the clinical software developed by the Veterans Administration for its healthcare system.

While domestic non-government interest in OpenVistA is limited now, there’s surging interest overseas, said Rick Marshall, president of WorldVistA, a not-for-profit organization. Marshall says all of Mexico’s facilities will run OpenVistA in the near future.

As open-source software, OpenVistA can be acquired for virtually no charge. However, many organizations are reluctant to adopt it because it requires knowledge for MUMPS, the original programming knowledge used to develop it.

Architecting XML for Finance

April 11, 2005 Integration Developer News

The country's largest brokerage firms took XML standards into their own hands, and over the last two years have expanded them to define a new open and standard markup language for financial services.

FpML (Financial Products Markup Language) provides developers in the financial sectors important new guidelines for building B2B web services.

FpML also provides an overall template for execs in other vertical industries how they might map XML (schema and transmission) concerns to their needs for dataflow, business rules and access control.

The FpML standard, which is freely licensed (under the FpML public license), is intended to automate the flow of information across the entire derivatives partner and client network, independent of the underlying software or hardware infrastructure supporting the activities related to these transactions.

Bush Targets State Medicaid Accounting Practice

April 11, 2005 AccountingWEB.com

If the Bush administration has its way, Congress will take steps this year to end an accounting practice in states that some say is tantamount to money laundering.

The accounting trick, used by California for instance, will yield the state $2 billion more in federal Medicaid money than it would otherwise receive, the Washington Post reported.

The trick goes something like this: cash-strapped California counties, public universities and government hospitals find $1.9 billion to send to the state capitol, under the guise of a local contribution to Medicaid. The money then comes back to the localities, but the state continues to show the funds on the balance sheet. Then the state asks for federal matching funds, not only to match the state's Medicaid costs, but to match those local donations as well, the Post reported.

HKSAR Government Collects Infectious Disease Information with XML and Hermes

Hong Kong SAR, Peoples Republic of China - April 14, 2005 - Center for E-Commerce Infrastructure Development (CECID), University of Hong Kong (HKU) is pleased to announce the completion of the Notifiable Infectious Disease Information Messaging System (NIDIMS) project for Department of Health (DH), which is the health advisor of the Government of the Hong Kong Special Administrative Region and an executive arm in health legislation and policy.

Rapid transmission of infectious diseases like SARS and meningitis as well as emerging diseases of Avian Flu pose a tremendous threat to our community. Special attention must be paid to the surveillance mechanism within HKSAR and between HKSAR and neighboring regions. As a result, DH invited CECID to set up a centralized and standardized disease surveillance system based on XML and ebXML technologies. The project involves designing a set of XML Schemas according to the W3C XML Schema Recommendation and the XML Schema Design and Management Guide (under the HKSARG Interoperability Framework). These resulting Schemas are the underlying architecture for information exchange on 28 regulatory infectious diseases. Another objective of the project is to develop a software application, the Notifiable Infectious Disease Information Messaging System (NIDIMS) that supports reliable and secure disease surveillance information collection. The messaging framework is based on ebXML Messaging Service version 2.0 (ebMS v2.0) specification developed under OASIS. The flagship products of CECID, ebMail and Hermes (free downloads at http://www.freebxml.org) are deployed in the software for secure and reliable information exchange. This system not only brings enormous economic benefit to the Government and Hong Kong in terms of reducing communication lead time and data entry errors, but also improves the efficiency and effectiveness in communication between DH and other healthcare service providers.

Deliverables of the NIDIMS Project are deployed in Hong Kong Centre for Health Protection (http://www.chp.gov.hk/) (CHP)'s central notification office (CNO) online reporting system to help CHP strengthen Hong Kong's surveillance system and network for infectious diseases. The CHP's vision is to become a centre of excellence in disease prevention and control with the focus on epidemiology training, surveillance, risk communication, research, coordination and preparedness, and contingency planning.

About CECID (http://www.cecid.hku.hk)
Established in January 2002, Center for E-Commerce Infrastructure Development (CECID) at the University of Hong Kong conducts e-commerce research and development with the vision of helping organizations increase their competitiveness in the global economy. CECID develops e-commerce enabling technologies, participates in important international e-commerce initiatives, supports e-commerce standardization for Hong Kong and the Asia Pacific Region, and transfers e-commerce technology and skills to the community. With projects primarily funded by the Hong Kong Government's Innovation and Technology Commission, CECID is an active member of OASIS and the ebXML Asia Committee. The Center also collaborates with a number of lead technology users in the Asia-Pacific Region on turning R&D results into real-life business applications. CECID's contributions to the community include its code donation of Hermes and ebMail to freebXML
(http://www.freebxml.org) and the production of an in-depth design and management guide on XML Schemas for the Hong Kong Government. CECID is currently developing a plug-and-play Internet appliance for secure and reliable transmission of electronic documents based on ebXML / Web Services.

PR Contacts for Press and Analysts:
Dorris Tai (cwtai@cecid.hku.hk)
Business Manager
Center for E-Commerce Infrastructure Development (CECID) Dept. of Computer Science The University of Hong Kong
Tel: +852 2859 2818
Fax: +852 2547 4611
URL: http://www.cecid.hku.hk

GOVERNOR BREDESEN WILL SPEAK AT 2005 NHIT SUMMIT

BREAKING NEWS:

Gov. Phil Bredesen has accepted an invitation to speak at the 2005 NHIT Summit on May 5 in Nashville, it was announced today. Gov. Bredesen is at the forefront of the national public policy debate on healthcare, and his views on the importance of information technology in that debate will make his remarks extremely relevant and timely. Gov. Bredesen joins an all-star lineup of healthcare technology professionals who will speak at the conference.

Influencing the IRS

April 12, 2005

Nathan Kommers of the Center for Public Integrity writes that nearly 500 companies and organizations have reported lobbying the IRS between 1998 and 2004, putting the nation's revenue collector among the top 30 most frequently lobbied federal agencies, according to a study of federal lobbying records by the Center for Public Integrity. In fact, more companies and organizations reported lobbying the IRS than the Navy, the Joint Chiefs of Staff and the President of the United States combined. Indeed, among the top 250 companies and organizations that have spent the most money lobbying the federal government, one in three has lobbied the IRS.

IRS Probes Nonprofit Sector

April 6, 2005 - AccountingWEB.com

Internal Revenue Service Commissioner Mark Everson has notified the Senate Finance Committee of his concerns about possible wide-scale evasion and abuse within the rapidly expanding nonprofit sector, the Washington Post reported.

"We can see that tax abuse is increasingly present in the sector," and unless the government takes effective steps to curb it, such organizations risk "the loss of the faith and support that the public has always given to this sector," Everson said in his letter, which laid out the abuses his agency has uncovered.

Everson said the problems found by the IRS extend across the sector, which has grown to include about 3 million entities that control $8 trillion in assets. Nonprofits extend beyond charities to include colleges and universities, many hospitals, pension plans, trade associations and think tanks, the Post reported.

Nonprofit Innovation Alliance calls for a "business-method patent-free zone"

Information exchange  @ philanthropyjournal.org

04.06.2005 -  Nonprofits ban together to fight for access to technology.

Several well-known nonprofits have joined the call for freer access to innovative technology for charities.

United Way of America, the American Diabetes Association, Network for Good and the Electronic Frontier Foundation announced their support for the Nonprofit Innovation Alliance and have called for a "business-method patent-free zone" for the nonprofit sector.

The alliance, a coalition of technology and consulting companies that provide products and services to the nonprofit sector, have agreed to cross-license their business-method patents so their nonprofit clients can benefit from them royalty-free.

VA Recommends Medical Banking Strategy

"We have made implementing EFT a corporate strategy," Barbara Mayerick told the audience at the 3rd National Medical Banking Institute. Mayerick heads business development for the Veterans Healthcare Administration, a division of the US Department of Veterans Affairs. She adds, "we want to open the dialogue to the industry to try to get more health plans to implement electronic funds."

This industry call by the likes of the Veterans Healthcare Administration is significant according to John Casillas, Executive Director of the Medical Banking Project. "The tide is turning," says Casillas, "from claims automation to operationalizing payments and remittances."

Today’s medical remittances are largely paper-based exchanges that result in a trail of paper following each patient visit. The VHA’s emphasis on digitizing and operationalizing remittances shows that it understands how it is possible to reap a significant return on investment for HIPAA implementation, according to Casillas.

In fact, the VA claims that it has saved $2 million already by "wiring" 100 (of some 1,600 payers it does business with) to send an Electronic Funds Transfer (EFT) for payment, as opposed to paper checks. Mayerick expects the savings to grow as more payers come online and as the VA finds other ways to use the data for enterprise management.

The MEDICAL BANKING REPORT Vol. 2, No.2 March/April 2005

http://www.technorati.com/tag/medical+banking

http://www.technorati.com/tag/NHIN

Smart solutions for Germany’s next-generation e-health card

Germany is poised to introduce its next generation e-health card in 2006. The new version, set to replace the existing insurance card - holding only the patient’s name, address and insurance number - will be the latest example of smart card technology to hit the market in Europe. It will be able to store prescription information and might even be used as the standard card for a digital signature - the key to modern eGovernment applications.

Germany’s Fraunhofer-Gesellschaft unveiled the technology solutions behind the country’s much-discussed project to introduce next-generation electronic medical passes. Coinciding with the recent international CeBIT technology fair, scientists close to the project stressed the special data security features in the new smart cards.

Germans already carry slightly ‘dumb’ smart cards that hold key health insurance information, such as their name, address and insurance number. Now the government plans to introduce a new e-health card which, in addition to holding personal data, could also store emergency data, including the holder’s blood group, known allergies to drugs and so on.

To cut red tape and streamline the health system, the Germans decided to include prescriptions on the card, which can store several A4 pages of typed text. No final decision has been taken whether the e-health card, which will have all the security features of today’s smart card technology, could also carry a digital signature – a fundament of modern eGovernment applications, including filing tax declarations electronically.

Smart cards are not new to Germany, or Europe for that matter. Mobile telephony introduced the use of ‘smart security’ systems – personal identification numbers (PIN) that safeguard the owner’s account details – to the masses. Credit card companies are also putting smart technology in their cards to cut out the huge problem of fraud.

Electronic Frontier Foundation Action Alert: Stop the REAL ID Act!

Earlier this year, the US House of Representatives passed the REAL ID Act, bringing us a giant step closer to a "national ID." The REAL ID Act would establish a vast national database of ID holders, where even a small percentage of errors would cause major social disruption. The ID would essentially be an internal passport that would be shown before accessing planes, trains, national parks, and court houses - an irresistible target for forgers and identity thieves. It would also divert resources from security measures that could actually work. And in calling for the use of "common machine-readable technology," the REAL ID Act paves the way for the federal government to force every state to put radio-frequency identification (RFID) chips into their ID cards. The Senate needs to be reminded that such proposals have always been rejected for good reason: our privacy and civil liberties are at the core of what it means to be an American citzen, and they shouldn't be traded for what amounts to security theater. Tell your senators to reject the REAL ID Act. Make your voice heard with the EFF Action Center: http://action.eff.org/site/Advocacy?id=119

IT may finally get its chance to sell Web services

By Eric Knorr, CIO-ASIA

<ed.note>In this article Knorr writes "And the ebXML registry spec, once championed by IBM and Sun, never really got off the ground" which is strange since Infravio's X-registry product is built on a version of ebReg.</ed.note>

Nearly four years ago, I sat at the back of a packed conference on something new and exciting called Web services. 

Web services was going to be bigger than the Web itself. Any machine would be able to talk to any machine, and eventually most apps would be built from components strung together across the Internet.

But IT had other priorities, like slashing costs. And Web services mainly became a cheap integration method. But recently those giddy early days came rushing back when I spoke with Infravio CEO Jeff Tonkel about his X-registry product, an enterprise registry and repository for publishing and even selling Web services.

Medical Banking: Leveraging Bank Technology To Reduce Operating Costs Audio Webcast

April 12, 2005

Healthcare Financial Management Association Event.  HFMA is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors.

<ed.note>John Casillas has been asked to present medical banking subject matter before the Commission on Systemic Interoperability. The Commission was authorized by the Medicare Modernization Act and comprises appointees made by President Bush, Senator Majority Leader Bill Frist and other members of the Congress. In addition to this testimony, he will also communicate the findings of the Third Medical Banking Institute to the May 5 National Healthcare Information Summit sponsored by TN HIMSS.</ed.note>

You’ll Learn:

• New banking solutions for health care.
• To understand the medical banking ROI model.
• Compliance issues related to new medical banking services.

Audio Webcast Summary

Medical banking has emerged as a potential industry strategy to reduce healthcare administrative costs and increase A/R capture. In fact, the CIO Executive Council, comprised of chief information officers and other IT executives from more than 200 top U.S. companies, recently asked Dr. David Brailer, the HHS’s National Coordinator for Health Information Technology, to use an ATM-style approach for implementing a national healthcare information network.

A key driver setting the stage for medical banking models is HIPAA. As natural aggregators of payments, banks are well positioned to offer HIPAA-enabled solutions that streamline the payment cycle. Banks are re-engineering cash management services in a manner that reduces operating costs of health plans and healthcare providers as well as increases AR capture. This is the first step of what is being viewed as a paradigm shift in healthcare operations and financing.

This Audio Webcast will explore ways that medical banking may have an impact on health care, as well as investigate the models being proposed. One area of considerable focus by the country’s largest banks is specialization of the lockbox platform to enhance the revenue cycle (i.e., “all-payer” secondary billing, denials management, etc.). Additionally, card-based programs that not only manage the Health Savings Accounts (HSAs) but efficiently process other real-time financial functions are emerging. More here

Nashville Launches New Healthcare Technology Summit

The Medical Banking Project will provide a headline speaker for Nashville's new National Healthcare Information Technology Summit, organized by the Tennessee Chapter of the Healthcare Information Management Systems Society (HIMSS).  The annual event is scheduled for May 5, 2005 from 7:30 am to 6:30 pm at the Gaylord Opryland Resort and Convention Center in Nashville, Tennessee.  Dr. David Brailer (ONCHIT) will provide the Inaugural Keynote and moderate a panel of RHIO directors from around the country.  Newt Gingrich, former Speaker of the House, will provide a telecast headline speech.

"Nashville is home to many of the largest for-profit healthcare organizations," said Jeanine Martin, Director of Business Development of Oasis Software and a chief organizer of the event.  "Our community is very involved in the national dialogue on healthcare IT and this summit will provide unique updates of those ongoing discussions as well as surface best practices for regional healthcare information organization or RHIO initiatives," she adds.

John Casillas, founder of MBProject, will provide the morning headline speech: Braving A New World Takes Vision. "We will begin the process of disseminating final recommendations made by national executives at the 3rd National Medical Banking Institute held in February," Casillas said.  MBProject is planning other events in 2005 to carry the message that banks can leverage significant investments in transaction architecture, infrastructure and other resources to ramp providers onto vibrant digital platforms, and this will both reduce costs and help clinicians to better interact with their patients.  Casillas noted that "banks can provide extraordinary and easily demonstrated value to the national process, especially in combination with other healthcare stakeholders like HIMSS and others."

Registration:  http://www.tnhimss.org/nhits/index.html

Early Bird registration ends April 15, 2005.

About HIMSS...

The Tennessee Chapter of the Healthcare Information and Management Systems Society provides statewide leadership for the advancement and management of healthcare information and technology. Our affiliation with national HIMSS allows us to participate in directing and shaping the healthcare industry, encouraging emerging technology and promoting public policies that will improve healthcare delivery. At the local and regional level we are committed to providing educational and networking opportunities for our members. For more information, please go to http://www.tnhimss.org.

About the Medical Banking Project...

MBProject is an independent policy research and strategic advisory firm established to promote the development of "Charitable Communities Network", an industry model that leverages HIPAA's security, privacy and electronic mandates to deliver substantive cost benefits to care givers. The firm does not provide legal advice and urges medical banking stakeholders to consult with private counsel. For more information, please go to http://www.mbproject.org.

Contact: Evelyn Marquez Sanchez
615-794-2009
info@mbproject.org

ONCHIT List of NHIN RFI Responses Available On The Internet (March 29, 2005)

The following RFI responses have been made available to the public on the Internet by their authors.

This list is provided as a convenience to readers and the ONCHIT does not have any responsibility for the web sites cited.  The authors may choose to move or remove their responses at any time.

Academy of Managed Care Pharmacy
http://www.amcp.org/data/legislative/analysis/ONCHIT%20%2D%20RFI%20Comment%20Letter%20%2D%20AMCP%20letterhead%2Epdf

American College of Emergency Physicians
http://www.imedi.org/docs/Azyxxi/6.%20Misc/American%20College%20of%20Emergency%20Physicians%20letter%20to%20David%20Brailer.htm

American College of Physicians
http://www.acponline.org/hpp/nhin.pdf

American Geriatrics Society
http://www.americangeriatrics.org/news/AGSNHITComments3.pdf

American Hospital Association
http://www.hospitalconnect.com/aha/advocacy-grassroots/advocacy/agencyletters/content/050118RFI.pdf

Apelon
http://www.apelon.com/news/misc/Apelon%20NHIN%20Response%20Extract.pdf

Association of American Physicians & Surgeons
http://www.aapsonline.org/confiden/nhincomments.htm

CapTech Ventures
http://www.captechventures.com/news/current/CapTech_Ventures_Response_to_Electronic_Health_Record_Interchange_RFI.pdf

Center for Health Transformation
http://www.healthtransformation.net/content/getfile.cfm?FamilyID=778&filename=CHTResponseRFIFINAL1-18-05.doc

Cerner Corporation
http://www.cerner.com/public/filedownload.asp?LibraryID=10899

Citizens' Council on Health Care
http://www.cchconline.org/pdf/NHIN_public_comments.pdf

Confidentiality Coalition
http://www.hlc.org/FINAL.pdf

Connecting for Health-Collaborative Response
http://www.connectingforhealth.org/resources/collaborative_response/collaborative_response.pdf

Electronic Frontier Foundation/World Privacy Forum
http://www.worldprivacyforum.org/pdf/NHIN_final_EFFWPF.pdf

FasterCures
http://www.fastercures.org/sec/nhincomments

Federation of American Hospitals
http://www.fahs.com/issues/comment_letters/2005/CL%201.18.05%20BrailerRFI.pdf

Hawaii HIPAA Readiness Collaborative Steering Committee
http://www.hhic.org/hipaa/documents/NHIN_RequestForInformation_Final-HAWAIIFINALRESPONSES..pdf

Health Level Seven
http://www.hl7.org/Library/General/HL7Q14-18_final.pdf

Health Privacy Project
http://www.healthprivacy.org/usr_doc/NHIN_RFI_Response.pdf

HIMSS Electronic Health Record Vendor Association
http://www.himssehrva.org/docs/EHRVA_Response_to_ONCHIT_RFI-FINAL1.pdf

HLN Consulting
http://www.hln.com/noam/ONCHIT-RFI-HLNConsulting.pdf

Internet2
http://health.internet2.edu/files/NHINResponseInternet2.pdf

Joint Response SureScripts and RxHub
http://www.rxhub.net/pdf/Final%20RxHub%20Surescripts%20NHIN%20RFI%20Response%20jan18%2005%20joint.pdf

Liberty Alliance Project
https://www.projectliberty.org/resources/LAP_ONCHIT_RFI_Response_1172005165359.pdf

Massachusetts Health Data Consortium
http://www.mahealthdata.org/ma-share/20050118_ONCHIT-RFI%20Response.pdf

McKesson
http://www.mckesson.com/pdf/NHIN_RFI_Response_01_18_05.pdf

Minnesota e-Health Initiative Steering Committee
http://www.health.state.mn.us/e-health/rfiresponse.pdf

National Association of Health Data Organizations
http://www.nahdo.org/news/NAHDO%20Response%20to%20NHIN%20RFI.pdf

National Consumers League
http://www.nclnet.org/advocacy/health/letter_national_health_network_01182005.htm

NetMesh, Inc
http://netmesh.org/papers/nhin-rfi/NetMesh-NHIN-RFI-Response.pdf

NCHICA
http://www.nchica.org/FinalNHINResponse.doc

Ontolog Community
http://ontolog.cim3.net/file/work/health-ont/NHIN-RFI/NHIN_final-ontolog-rfi-response_20050118.doc

Open Health Records Exchange Project
http://www.openhre.org/local/NHIN_RFI_OpenHRE.pdf

PrivacyActivism
http://www.privacyactivism.org/docs/EHR-PAandPRC-050118.htm

UNYPHIED Project
http://www.unyphied.org/content_files/documents/unyphied%20rfi%20response.doc

See NHIN at Technorati

David Megginson Asks: "Business requirements: the weakest link?"

We’ve gotten a lot better at building systems to spec, so if we’re going to see similar improvements in the future, we’ll have to start looking at the specs themselves, learning to iterate all the way back up to the top, instead of just inside our little technology sandbox – in other words, it’s not just the technical requirements but the business requirements that have to be agile. If that means that the CEO occasionally has to be troubled with nuts-and-bolts details like web protocols or database scalability, so be it – it beats losing the whole company to a bad technology decision.

Figure 1 – classic ebXML deployment components

Using this classic ebXML model implementers create two-player business exchanges. An archetypal exchange is that of purchase orders, shipping notices and invoices between a buyer and a seller. In figure 2 below we see the activity model for such a Requester / Responder configuration that is supported using the classic ebXML components.

The individual main steps are ‘Create Order’ and ‘Order Fulfillment’, along with the business transactions that enable those. There is an initiating request from the requester partner, and then the responder replies with a selection of transactions depending on the business state of the interaction, either rejecting or confirming the order accordingly.

The ‘join’ indicates that the process will only proceed when both an order confirmation and a ship delivery notice have been received. The ‘fork’ allows more than one action depending on a condition. In this case either a payment notice has to be created or not, based on the requirement of the particular supplier’s application system (if it can reconcile electronic payments, or requires information to be able to reconcile them).

Figure 2 – classic ebXML Requester / Responder business activity model [click for image]

Figure 2 here shows various steps and business transaction exchanges involved in completing the sample purchase, delivery and payment for goods.

Advocates of web services have borrowed from this classic ebXML model with some important and critical differences. Web services are not based around formal business transaction exchanges but just fragments of information within an XML instance and instead of the formal CPA business agreements; they use WSDL (Web Service Description Language) scripts that are a programming device for describing the connections and software services, but not the business function. The failure and success guard conditions are not formally defined for a WSDL based exchange. Also web services are intended to perform in real-time as instant interaction points, whereas ebXML messaging can also exploit a batch operating mode with persistent and guaranteed authenticated message delivery. Instant interaction is also a tougher environment to manage, often exposing implementers to higher risks of exploitation through unscrupulous users of the Internet itself.

Figure 3 – enhanced ebXML for SOA solutions [click for image]

To support enhanced ebXML the new BPSS V2 provides key functionality that is once again groundbreaking for e-Business via the Internet. The first change allows roles and steps to be defined for multiple participants along with process forks and joins and thus extends the original ‘two-player’ ebXML exchanges to include extended interactions between many partners. But instead of this being more confusing spaghetti of complex flows, the BPSS approach forces constrained deterministic business process steps to be defined between participants with single entry and exit points. The activity diagram in Figure 4 below shows how this works. This is crucial for defining real usable and enforceable business agreements. Now industry groups have the means to define exchanges for their members that can be re-usable and stable.

However building such exchange models in the past has been difficult because of the need to support local customization and variables. Again BPSS V2 provides the answer through managing context across the whole business process by participant (item #4 in figure 3 above). This allows local conditions to be resolved and special requirements to be integrated seamlessly. Local players in a marketplace can individually configure their own special context requirements and tie those to their role and exchanges.

The third piece that BPSS V2 adds is the ability to integrate into the application layer provided by existing business application systems. By providing context in a formal XML-based way – the BPSS can pass that context to the underlying integration systems. In addition logical business transaction handling can be mapping to physical integration services directly using the document definitions that BPSS provides. OASIS has also developed an open source solution to even further expedite this called the OASIS Content Assembly Mechanism (CAM) that uses simple XML-based scripts to document the business rules needed (item #5 in figure 3 above). Simply put these give participants the ability to pre-packaged information integration scripts in XML and then share those. This greatly enhances the consistent information flow between partners systems.

Put together this allows business users to now use the Registry services to fully document their end-to-end exchanges using XML structures as a coherent package. A typical such package can contain CPA, BPSS and CAM definitions along with traditional ubiquitous XML tools such as transaction schemas defined in either XSD or DTD syntax. By sharing such a package across an industry this allows partners to quickly configure their own ebXML systems and begin doing business, rather than having to endure a long and costly setup.

To accommodate web service based interactions, BPSS V2 also provides an ability to include WSDL-based steps into a BPSS model (item #9 in figure 3 above). These use a limited interaction model that provides the means to control and manage those steps using the ebXML approach. This does not include all web services, but only this discreet set of formally structured web service interactions. The key is to provide a deterministic and known business implementation where all end-conditions are known in advance.

Put together this enhanced ebXML provides the most complete e-Business services environment available today. BPSS sits at heart of the components and conducts the orchestra of components. Providing business context, transaction integration, process management, partner role details and deterministic transport messaging delivery flows.

Using this model figure 4 shows a complex multiparty interaction and how the components and participants interact together.

Figure 4 – Multi-party business collaboration using ebXML [click for image]

Figure 4 includes a multi-step interaction sample exchange between participants in an automotive industry supply-chain marketplace. Included in the diagram is the car dealership that is requesting a part supply, the manufacturer (General Motors) then querying their partners (Eaton, MetalDyne) and the automotive marketplace (Covisint). After consolidating the replies on parts available and price, they then notify the dealer who then confirms the order. The ship notices from the delivery carrier are then forwarded to the dealership. Being able to manage such as complex interaction, and allow each participant to configure their own profiles and business context parameters, along with message details (EDI or XML) is what the new enhanced ebXML systems are capable of directing. For more details on how to model all the aspects of the multi-party interaction, that enhance and compliment the activity diagram shown in figure 4, see the BPSS tutorial available online from the BPSS resource sites noted below.

Senate Finance Committee to Hold Hearing on "Charities and Charitable Giving: Proposals for Reform"

I am writing to make sure you know that the Senate Finance Committee has scheduled a hearing this Tuesday on “Charities and Charitable Giving: Proposals for Reform.”

The committee has asked me, as president and CEO of INDEPENDENT SECTOR, to testify. A key part of my remarks will be about the Panel on the Nonprofit Sector's Interim Report, which was released March 1. I will highlight the Panel’s call to the nation’s 1.3 million charities and foundations to implement a series of measures that will improve their governance and financial disclosure, and I will share the report’s recommendations on how Congress and the Internal Revenue Service can enhance government oversight. I will also describe some of the issues the Panel is now examining in preparation for its final report, to be released in late spring. To help show our community’s commitment to maintaining the public trust that is vital to our work, I will emphasize to the Committee the broad range of organizations that are supporting the Interim Report.

The hearing will be held on Tuesday, April 5, at 10 a.m., in 628 Dirksen Senate Office Building, and is open to the public.

Also testifying will be Leon Panetta, a member of the Panel's Citizens Advisory Group and director of the Panetta Institute for Public Policy, and Panel member Brian Gallagher, president of United Way of America.

For a list of witnesses announced by the Senate Finance Committee and for other information on the hearing, visit the Panel's website.

The Panel will continue to keep you informed, both through messages like this one or through our website.

Diana Aviv
Executive Director, Panel on the Nonprofit Sector
President and CEO, INDEPENDENT SECTOR

==========================================

Three Massachusetts Communities Chosen To Be Test Cases For Digital Health Records

March 29, 2005 By Marianne Kolbasuk McGee, InformationWeek

Backed by $50 million from a health insurer, the multiyear project will test whether digital health records can cut errors and costs in the real world.

Three Massachusetts communities have been chosen as pilot sites for an electronic-health-record project that could serve as the model for statewide adoption of digitized medical-record systems.

... Within each community, health-care providers--including acute-care hospitals or group hospitals, physician practices, long-term care facilities, nursing and home health-care agencies, and community health centers--will implement interoperable E-health records systems.

3rd Annual Public Health Information Network (ebMS based) Conference Call for Abstracts

Background

The Public Health Information Network (PHIN) is a critical component to improving public health capacity in the 21st Century. With this in mind, we are pleased to invite abstracts for our 3rd Annual Conference at the Hyatt Regency Hotel in Atlanta, Ga. We expect this to be a competitive process and encourage the submission of cross-sector and cross-jurisdictional abstracts. This includes abstracts that show linkage to the clinical and/or emergency response sectors. While presentations showcasing a particular project may be of some interest, the presentations of greatest value will be those that guide us towards standards-based integrated systems.

XBRL: A Technology Whose Time Is Now

By Glenn Cheney

The question isn't whether XBRL is going to happen, but how quickly, where first and with how much collaboration. Even with big U.S. players behind it, fewer than 5 percent of U.S. public companies are now using XBRL - but this could soon change.

   XBRL is today what HTML was 10 years ago: full of potential, yet all but unknown. And those who know what XBRL, or eXtensible Business Reporting Language, is all about and all it can be are concerned about a most disturbing fact: The XRBL information engine of the world's most powerful economy - the U.S. - is lagging behind that of every other developed economy in the world.

   XBRL allows business information to carry digital tags that let it pass seamlessly between enabled applications. It has been likened to bar codes that stick to data wherever it goes. Once business information is tagged, everyone along the information supply chain - investors, creditors, analysts, stock exchanges, auditors, regulators, policymakers and others - can quickly, accurately, easily and inexpensively access, validate, compare, analyze, slice, dice, mix, match and manipulate information from any number of companies. It also allows the same body of data to automatically - instantly - find its proper place in spreadsheets, tax returns, business reports, annual reports, pie charts, government forms, Web sites and financial statements. No manual transcription. No mistakes along the way.

Second Hospital to 'Read' Humans

March 14, 2005 - Mobilehealthdata.com

Hackensack (N.J.) University Medical Center will become the second provider organization that can read radio frequency identification chips embedded in patients. The 683-bed, not-for-profit provider plans to test the VeriChip system--from Delray Beach, Fla.-based Applied Digital--in its emergency department. The technology can read the vendor's RFID chips that have been implanted underneath a patient's skin, between the elbow and shoulder. Each VeriChip contains a 16-digit identification number assigned by Applied Digital. Hackensack will map patients' VeriChip numbers to their medical records number. The provider then will be able to access patient data from their electronic medical records system, which is in development, by scanning them with the vendor's reader to find their chip number. The chip numbers will be mapped to patients' electronic records ID numbers.

Making Medical Imaging Collaborative: OsiriX Combines Open Source with Key Apple Technologies

OsiriX Brings Collaboration to Medical Imaging

Medical imaging research is complex, time-consuming and often very expensive, with a wide range of standards, equipment and software available. Worse, medical researchers can find themselves unable to share data easily with colleagues—something that they need to do constantly in order to improve understanding for diagnosis and treatment.

Two enterprising medical doctors addressed this problem and came up with a Macintosh-only solution called OsiriX that is changing how many in the field examine and share scanned images, medical image data and visualizations. It’s powerful, fully integrated with many Apple applications and hardware, and it’s open source, so others can contribute to the expansion and refinement of the tool. And, it’s freely available for download and use.

Voice-Technology Startup Aims To Get Doctors Using E-Records

March 8, 2005 By Marianne Kolbasuk McGee, InformationWeek

Voice-recognition tools built specifically for medical uses could help doctors reluctant to type their patient interactions.

For some doctors, the prospect of trading in their paper-based patient files for electronic-medical-record systems means big changes in their work, and they and their staffs can't afford the initial slowdown as they learn to enter and deal with digitized patient information.

But what if speech-recognition technology was good enough to actually understand and digitize not just a doctor's words to include in medical records, but the medical lingo held in them? A startup tech vendor led by George Newstrom, the former secretary of technology for Virginia under Gov. Mark Warner, is making plans for such technology to be one of the many tools for getting more doctors using electronic records.

Health demands open standards

March 9, 2005 by Karen Dearne, AustralianIT

THERE is no future for proprietary systems in health IT, vendors have been warned at Health-e-Nation 2005 conference in Sydney.

"Medical providers will not be locked into proprietary software that prevents the online sharing of health information and makes it difficult to migrate to new systems," chief executive of the National E-Health Transition Authority (NEHTA) Ian Reinecke said.

"We intend to level the playing field for vendors, to facilitate more competition and a greater choice of software."

To date, health IT suppliers have been reluctant to invest in open standards, as proprietary standards provided an opportunity to "lock in" users.

The Content-Rich Workplace

March 15, 2005 by Bruce Sharpe, Line56

How XML marks the end of slow, labor-intensive and error-prone content creation and publishing

Today's business environment has borne a new breed of corporate executive: the content owner. Across almost every line of business more and more managers, directors and team leaders are now tasked with publishing the key information critical to doing business. Thanks to heightened customer expectations set by the Internet, globalization and unrelenting competitive pressure, a complex and ever-growing mandate rests on the shoulders of this diverse group.

It's not an enviable position. With limited resources and outdated methods, content executives struggle to keep up with the sheer volume of information. But instead of surviving in their mandate, they'd rather thrive in it -- which means turning the process of content creation, traditionally a cost center for their organization, into an efficiency center.

For many, an XML-powered workflow has marked the end of slow, labor-intensive and error-prone content creation and publishing. Even non-technical executives and managers in content-rich organizations are making the shift to XML- (eXtensible Markup Language-) based content creation, releasing higher-quality information with less effort, more confidence and greater speed.

Day Software Releases Beta Version of Java Content Repository Extreme - CRX

March 15, 2005 – Internetadsales.com

Day Software today announced the release of the Beta version of it’s Java Content Repository Extreme - CRX to the industry. CRX is the first commercially available product line that fully implements the ground breaking new standard for Enterprise Content, JSR 170. Based on extensive feedback and input from Global 1000 clients, CRX is a true innovation: The product is the first content repository in the industry that has been developed completely on an enterprise-class, 100% Java, J2EE architecture.

CRX makes high value enterprise content easily accessible for any application. CRX allows for the storage, retrieval and management of content across large-scale enterprises. As the first fully standard compliant content repository, CRX protects technology investment in content and applications and enables companies to create a content infrastructure that is future-proof and sustainable.

Business Document to Leverage IXIASOFT XML Server

By Brice Dunwoodie, CMSWire

IXIASOFT, an embeddable XML database and search engine vendor, announces an OEM partnership with Business Document, a provider of Business Process Management (BPM) software solutions.

Business Document will integrate TEXTML Server to Bdoc-Suite, a document management and automation solution aimed primarily at the financial, insurance, telecommunications and services markets.

Pinnacle Delivers Pinnacle Liquid Version 6.1 for Broadcast

March 16, 2005 DMNNewswire

Powerful, open design - Liquid’s open design facilitates integration into new and existing infrastructures and workflows. Liquid supports industry standards, including MXF and XML metadata exchange, shared network projects with built-in instant messaging and a variety of network storage configurations.

Pinnacle Systems, Inc., a leader in digital video solutions, announced the availability of version 6.1 of its Pinnacle Liquid real-time standard definition (SD) and high definition (HD) video editing systems for broadcast environments. Liquid version 6.1 marks the first release of the significantly improved Liquid version 6 software in broadcast editing configurations. New capabilities include true multi-stream native high definition editing, format-independent real-time effects, integrated DVD authoring , advanced audio tools, multi-cam support and a redesigned user interface.

Quark commits to open standards by opening QuarkXPress file format as XML

January 12, 2005

New QXML DOM schema makes developing XTensions software for QuarkXPress easier than ever

Quark, Inc. today introduced QuarkXPress Markup Language (QXML), an XML schema of the World Wide Web Consortium (W3C) Document Object Model (DOM) that will make it even easier for developers to create custom XTensions software for Quark’s industry-leading page-layout software, QuarkXPress. The QXML schema fully describes the QuarkXPress file format in XML and enables QuarkXPress 6.5 XTensions software to be developed using industry standards and a wide variety of development platforms and languages, including Java, .Net, and many scripting languages.

Working with standards
"For many years, valuable content has been locked in proprietary file formats, while the move towards multi-channel publishing has dictated that it can no longer be used just for print," said Juergen Kurz, Quark’s vice president of product development. "With an industry-standard methodology for describing the QuarkXPress file format, our customers have greater security because their QuarkXPress content can be easily integrated into today’s complex multi-channel publishing environments."

Easier programming
One of the strengths of QuarkXPress is its strong developer community with hundreds of third-party XTensions modules available to augment the functionality of QuarkXPress to meet the diverse requirements of its customers. XTensions software developers have always programmed in C or C++, but with QXML, developers can write XTensions modules for multiple platforms in C++, Java, any language supported on the .Net platform (including C# and VB.Net), and scripting languages (including AppleScript, Perl, JScript, and VBScript).

To make development even easier, QXML presents a QuarkXPress project as an XML tree, and any modifications to the XML files change the project - in real time.

The Document Object Model
The Document Object Model (DOM) is a W3C standard that provides a language-neutral interface for applications and scripts to dynamically access and update content, structure, and styling of documents.

With QXML, the new DOM schema for QuarkXPress, developers can dynamically access and update the content, structure, and style of a QuarkXPress project using a DOM interface. XTensions modules can be more versatile because they can use a project’s complete content, including all formatting, style sheets, hyphenation, and justification specifications. Additionally, developers can run powerful query expressions with just a few lines of code using XPath queries. The same query using C/C++ code would require pages of code.

"While C and C++ are powerful development languages, developers now use a wide variety of development languages. Porting software from other applications and platforms to and from C and C++ can be a lengthy and cost-prohibitive task," explained QuarkXPress Product Manager Tim Banister. "The creation of QXML radically changes the landscape for XTensions development and lets a brand-new group of developers create custom XTensions software for QuarkXPress - and with it, an even wider variety of solutions for our customers. Quark is absolutely committed to open standards, and this demonstrates the strength of that commitment."

Example of simplified porting
How can QXML simplify development? For example, a publisher has a Java application that uses a Web services protocol to pull TV listings information onto a Web site. The publisher also wants to pull this content into a weekly magazine. Manually importing and styling this data in QuarkXPress takes time, so an automated solution is required. Formerly, developers faced fairly complex issues porting the application from Java to C/C++, and they essentially would be required to rewrite the program. With the QuarkXPress DOM interface, QXML, the complexity of these issues is reduced, and the task is easier and much more manageable.

Future enhancements
The initial version of QXML allows developers to read data from a QuarkXPress project. In the next version, developers will be able to both read from and write to QuarkXPress projects.

Availability
The QXML developer kit is available immediately to certified QuarkXPress XTensions developers. Developers can choose to develop XTensions modules using the QuarkXPress XTensions Developer Kit (XDK), QXML, or both. For more information about becoming a QuarkAlliance XTensions developer, visit the Quark Web site at http://www.quark.com/partners/xtdevelopers/desktop/requirements.html.

About XTensions software
XTensions software enhances the functionality of Quark products. Easy-to-install XTensions modules can add new features (such as palettes, commands, tools, and menus) to augment just about every activity users can accomplish with QuarkXPress. Hundreds of QuarkXPress XTensions modules are available commercially from third-party developers, and Quark periodically releases QuarkXTensions software for its desktop and enterprise products based on customer needs and requests.

About Quark
Quark Inc. (www.quark.com) is a leading developer of tools and technologies for collaborative content workflows from the desktop to the enterprise. Quark has been providing award-winning software for professional publishers since its flagship product QuarkXPress changed the course of traditional publishing. Today, as Quark software is used by millions of customers around the world, the company is guiding the creation of vital open standards to promote productivity and interoperability throughout the industry. With a new generation of products and solutions, Quark is helping its customers create, manage, personalize, and distribute content to a variety of media formats and devices at low cost. Founded in 1981, Denver-based Quark Inc. is privately held.

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For background information, please visit the Quark press center at www.quark.com/about/presscenter or send an e-mail message to pr@quark.com.

[Tennessee] The Drive to Save Lives

<ed.note>It should be noted that while Tennesseans for Fair Taxation constantly call for an income tax they refuse to acknowledge the lack of a Tennessee State Budget in a number crunchable format {xml | xbrl} (which the citizenry can actually review and audit to determine what amount is currently spent on any given program). In the interest of fairness, I have heard no call from the self-professed fiscal conservatives {a la phil valentine}, nor the self-professed public forums {thepublicforum.org | the league of women voters}. Apparently no one is interested in doing a cost|benefit analysis based on the actual data -- must be easier to just use "fakestistics"*.</ed.note>

“The Drive to Save Lives” is being organized by key TFT allies and coalition members to oppose Gov. Bredesen's proposal to cut of over 320,000 Tennesseans from the state's health care program, and drastically reduce coverage for 900,000 other Tennesseans.

With three ambulances carrying heath care advocates and TennCare enrollees across the state, the caravan will be stopping for media and public education events from Memphis to Tri-Cities over the next 9 days. Just today in Nashville, over 100 health care advocates gathered to send the caravan of ambulances off on their voyage. Click the links at right for more information on the activities in your area.

While TFT does not work directly on the health care issue, we recognize the proposed cuts are a symptom of Tennessee's outdated and unfair tax system that fails to invest in Tennessee and its future.

This announcement is being forwarded to our supporters as a courtesy to our member groups and allies who are spearheading the effort to save the lives of thousands across the state. For more information about the health care debate, visit the web site of the Tennessee Health Care Campaign, a long-time TFT member group.

* fakestistics - a doddsism referring to made up data helpful to one's cause.

Kent uses telehealth for chronic disease support

March 15, 2005 E-HEALTH-MEDIA

Kent County Council has launched a series of telehealth and telecare initiatives, in what it claims makes it one of the leading local authority users of new technology.

The countywide Kent Telehealth scheme is a partnership between Viterion in the USA and Kent County Council, with KCC providing £1m funding for a pilot project to support 275 people with chronic diseases in their own homes.

Clients have been drawn from Ashford, Maidstone Weald, South West Kent and Dartford, Gravesham and Swanley PCTs.

Each will be provided with a touch screen, video link-up and digital cameras. They will be able to self-assess and monitor chronic conditions and then communicate with health and social care professionals via a telephone line to a secure web-based facility.

The scheme proposed to cover conditions such as chronic obstructive pulmonary disease, diabetes and asthma, congestive heart failure and depression.

According to Viterion such systems in the US have cut hospital admissions by half and meant reduced travelling time and costs for patients.

The council is also pioneering use of telecare at HomeBridge, a joint health, housing and social services project in Ashford that provides recuperative care for older people who have been discharged from hospital but are not ready to return home.

The project's seven bungalows have been upgraded to the latest Tunstall telecare overlay which allows staff to use remote detectors to monitor clients for falls or changes in daily routines.

Housing manager Richard Robinson said: "It's aimed at preventing readmission to hospital and gives an opportunity for clients to use equipment and realise that with the right support they can use it and can live independently."

Kent's announcement comes as the Department of Health tries once again to kick start the use of telecare and telehealth in preventing hospital admissions of older people.

Health minister Stephen Ladyman last week announced a £60m fund for councils to develop innovative ways to help older people avoid emergency admissions and live independently longer.

Despite being endorsed by the House of Commons Health Select Committee in 2002 and the Audit Commission last year, telecare has yet to make a real impact in reducing hospital admissions.

Mike McCurry, board member of the UK eHealth Association, said: "There have been a number of attempts on a pilot basis and there are some good pilot projects around. But we are not seeing these translated into mainstream initiatives with long term funding."

Using telecare and telehealth systems required more than installing equipment and software, he said. "It requires a new way of working and a lot of change management."

The UK lacked a strong business case that could be used to persuade PCTs and local authorities to fund telecare and telehealth properly, he added.

James Barlow, professor of Technology and Innovation Management at Imperial College's Tanaka Business School, agreed that uptake had been slow, with very little mainstream development despite a multitude of pilot projects.

But he added: "The speed is picking up and seems to be building up to a critical mass."

He agreed that the evidence base was poor and that development was hindered by budgeting constraints. He is now chairing a group set up by the DH to develop a business case for telecare, weighing up the costs and benefits.

He said: "Without wishing to prejudge that work, the results are encouraging and the benefits are clear. It comes down the right side of the cost of equipment and the benefit it provides. "

Professor Barlow's work is designed to inform the £80m preventive technology grant announced in last year’s spending review. This will be available from 2006-2008 and will enable 160,000 older people to live at home.

It is part of the DH's Telecare Policy Collaborative, set up last September and expected to report this summer.

He said: "The big issue is who pays for what. Social services invest in the equipment but the benefit is accrued by people on the acute side. Getting acute trusts to cough up will be difficult."

Building A National Infrastructure

Blackford Middleton, M.D. , Corporate Director of Clinical Informatics Research & Development and Chairman of the Center for IT Leadership, Partners HealthCare System Inc., Boston

Last year, the Bush administration created the National Health Information Infrastructure, a voluntary, government-backed effort to motivate healthcare providers to swap information electronically. Healthcare informatics expert Blackford Middleton, M.D., who has been involved with the planning for NHII, says that industry efforts failed in the past due to policy and technology problems. Moving forward, he says, standards will be the primary challenge. HealthLeaders spoke with Middleton about NHII's prospects.

DF Young Implements e-Logistics on BEA WebLogic Server

March 15, 2005 PRNewswire-FirstCall

BEA Systems, Inc. , a world leader in enterprise infrastructure software, today announced that DF Young, Inc., an international logistics leader since 1903, has built its e-Logistics application on BEA WebLogic Server(R) 8.1, helping to provide customers with an interactive, Web-based solution that is designed to process and display real-time supply-chain information.

DF Young, a preferred logistics provider for Fortune 500 companies, is among the first to offer customized real-time global processing and visibility of supply chain information via DFY e-Logistics, a marked improvement over the current trend of commoditizing logistics services where single supply chain solutions are offered for all customers, ignoring specific customer and industry requirements. DFY e-Logistics has helped to enable DF Young to differentiate itself, helping to enable customers to view inventory details (e.g., SKU level and detail attributes of goods), see the precise physical location of inventory, understand how varying conditions or events may impact delivery schedules, and view shipment documentation. The BEA-powered solution is more advanced than generic supply chain applications offered by other providers. Additionally, DF Young is developing integrations for data exchange with its customers using ebXML, leveraging WebLogic Integration 8.1.

UK Telecare reporting at E-HEALTH-MEDIA

Faced with an ageing population and sharp rise in chronic conditions, like diabetes and asthma, health and social care organisations need to find new ways to deliver care. Part of the solution looks certain to involve embracing telecare services to remotely monitor, support and treat patients in their homes, improving self-care and cutting avoidable admissions to hospital and residential care.

Until now telecare has remained strictly a niche technology – there have been many pilots but its use has never become widespread or mainstream. But there are now some encouraging signs this may be about to change. As we report this week Kent County Council is to begin a large scale project to use technology to support people with chronic diseases in their own home.

Even more encouraging is the news that PCTs and Social Services Departments will soon be able to apply for a special grant to develop telecare, with the Government investing £80 million through a 'Preventative Technology Grant' from next year.

Microsoft, Intel Team to Target Healthcare Market

By Joris Evers, IDG News Service

Microsoft Corp. and Intel Corp. have partnered to create products and services targeted at European healthcare providers, who the vendors say have antiquated IT infrastructures.

The partnership to create an E-Health Integration Platform currently covers Germany, Austria and Switzerland, but the companies are looking to expand across Europe and possibly beyond, representatives for Microsoft and Intel said Thursday. The partnership agreement wasl to be formally signed yesterday at the Cebit trade show in Hanover, Germany.

The companies plan to create several product and service bundles for healthcare providers. They currently have 20 projects running with several healthcare providers, including the biggest telemedicine project in Germany, according to Jens Dommel, manager for the healthcare sector at Microsoft in Germany.

While the partnership is limited to three countries today, Microsoft and Intel are keen to replicate it elsewhere, said Garbis Bedoian, business development manager at Intel in Germany.

"This is a local initiative created by Microsoft and Intel in Germany, but we are taking it to our European headquarters to broaden it," he said.

Healthcare is a key area for both vendors as it has the biggest growth in IT spending in Europe, Bedoian said. The spending is driven by upgrades and government-backed initiatives to streamline healthcare services, he said. "In German hospitals, the IT infrastructure is 10 to 15 years behind what we see in other sectors," he said

The telemedicine project is with hospital group Asklepios Kliniken GmbH. The objective is to electronically connect about 1,000 doctors and specialists to the group's hospitals. The system will support capabilities such as remote diagnoses, as well as more basic features such as online billing, Microsoft's Dommel said.

Another project is for a "medical dashboard" that will make all of a hospital's applications accessible through one user interface. With help from partners, Microsoft and Intel are delivering the first dashboard to Lahn Dill Kliniken GmbH, a Wetzlar, Germany-based operator of three hospitals, Dommel said. This project was begun off in the third quarter of 2004.

The medical dashboard uses Microsoft software including Windows Server 2003, SQL Server, SharePoint Portal Server, Windows XP and Office 2003. The software runs on servers equipped with Intel processors and other hardware including Tablet PCs, according to Microsoft and Intel.

Once developed, Microsoft and Intel plan to use the system as a reference case to help it sell to other customers. The information will be shared with systems integrators who may be able to provide related services, Dommel and Bedoian said.

Inefficiencies Cost Healthcare $100 Billion Yearly, Says HSS

By Neil Versel, Health-IT World

Improved coding and streamlined claims submission could save the healthcare industry upwards of $100 billion a year in unnecessary costs, a reimbursement management firm claims in a new report,  America's Hidden Healthcare Crisis. However, the convoluted and ever-changing nature of payment rules, combined with the high cost and glacial pace of implementation of information technology make for a daunting challenge says the report's author, consultant firm HSS.

The claims are based on extrapolation of data from a recent Centers for Medicare and Medicaid Services (CMS) report (FY 2004 Improper Medicare Fee For Service Payment Report) saying that a 9 percent error rate in Medicare fee-for-service coding resulted in $19.9 billion in wasteful federal spending during fiscal year 2004.

HSS  extrapolated  the CMS data across the entire healthcare system, into Medicare managed care, Medicaid and privately paid healthcare. HSS analyzed errors resulting from insufficient documentation, lack of medical necessity and improper coding, as well as "non-response errors," for which the provider either did not respond to a request for documentation or did not submit a medical record to support a claim.

Registries vs. Repositories and Standards vs. Products ZapFlash

By Ronald Schmelzer Document ID: ZAPFLASH-2005315 | Document Type: ZapFlash

Question:
what’s the difference between a bagpipe and an onion? Answer: no one cries when you chop up a bagpipe. If only the difference between registries and repositories were as clear! In the world of SOA, significant confusion surrounds the storage and management of Service metadata that developers need during design time, as well as the metadata that the SOA infrastructure requires to manage Service operation during runtime. In particular, people are confusing the capabilities of registries with those of repositories. Adding to the confusion, people are attributing product features to the UDDI standard. This ZapFlash aims to clarify not only the differences between these various different aspects of metadata management, but also provides a framework for evaluating the roles registries vs. repositories play, and what they can expect from specifications vs. the products they buy.

Registries vs. Repositories
The dictionary definition of “registry” is a place where official records are kept. In the technical sense, a registry is an authoritative store of information that relates to a particular task at hand. For those that are married, engaged, or have friends who are, when you hear the term “registry”, you might instantly think of the kiosk in stores like Crate & Barrel that point you to the goodies that you want to be given, or the gifts that your friends encourage you to purchase. Like a gift registry that provides listings of the items you wish your friends to purchase, or the Windows registry that stores pointers and configuration information for how the operating system should handle the various resources on your machine, registries store metadata that relate to the particular asset you have interest in, without actually containing those assets. The store that actually contains those assets is the repository. A repository, like the gold repository in Fort Knox, stores actual assets and typically controls access to those assets. So, while a registry simply records official information that relates to an asset, the repository stores the assets themselves.

SAML v2.0 Approved as OASIS Standard

March 14, 2005 ebizQ

OASIS, the international e-business standards consortium, today announced that its members have approved the Security Assertion Markup Language (SAML) version 2.0 as an OASIS Standard, a status that signifies the highest level of ratification. SAML v2.0 enables the secure exchange of authentication, attribute, and authorization information between disparate security domains, making vendor-independent Web single sign-on and secure e-business transactions possible. Version 2.0 adds key functions to create and manage federated networks that combine and appropriately share pre-existing repositories of identity information.

“Prior to SAML, there was no XML-based standard that enabled the exchange of security information between a security system and an application,” said John Pescatore, analyst at Gartner, Inc. “SAML provides a standard XML schema for specifying authentication, attribute, and authorization decision statements, and it also specifies a Web services-based request/reply protocol for exchanging these statements.”

The Top Seven Risks of SOA Without a Business Service Registry

Feb. 27, 2005 By Luc Clément, Senior Program Manager, Systinet - ebizQ

In recent years, there has been a steady migration away from non-standard legacy interfaces, toward Web services. By offering a standards-based interoperability platform, Web services allow enterprises to more efficiently integrate applications and improve the accessibility of business processes for customers, partners, and internal users. Essential for both business-to-business commerce and internal business applications, Web services are increasingly used by organizations that want to improve responsiveness and efficiency.

Yet the exciting new capabilities offered by Web services arrive with some risk. An unplanned, broad adoption of Web services opens companies to uncertainty and even potential anarchy. How can enterprise architects make sure that the people who need the services will find them? Is there a way to ensure that developers are not wasting time developing services that already exist? How can management ensure that services comply with technology, business policies, and application standards? Finally, how can IT and business leaders control how the services interoperate?

Kentucky e-Health Network

Mar 8, 2005 By Scott Render, Government Technology

Snap Shot of Proposed Technology-Related Legislation in Kentucky

As Kentucky's General Assembly winds down for the 2005 session, Techlines has been keeping an eye on some bills that feature technology. Whether they win passage or get passed over is still to be determined, but here is a snap shot as of March 7, 2005:

XBRL for Financial Statements

Technology News Daily

XML publishing standard currently used in financial reporting.

XBRL is a royalty-free computer language specifically designed for communicating and publishing financial information. It is based on the XML publishing standard currently used in financial reporting, and uses specific data tags to identify and describe individual elements in financial statements. XBRL increases the speed at which data is processed, reduces the chance of error caused by data re-entry, and allows users to automatically verify information.

In an effort to support the growth and development of this emerging financial reporting tool, CGA-Canada will publish the Association's financial statements in both XBRL and PDF formats, starting with fiscal year 2004-05 and continuing forward from that point.

John Yu, Vice-President, Information Technology at CGA-Canada, represents the Association at the XBRL Canada consortium and says early adoption of XBRL at CGA-Canada is important. "XBRL is becoming the new global business reporting standard, and CGA-Canada, as an association representing financial professionals, has a pesponsibility to position ourselves at the leading edge of this trend," commented Yu.

He went on to note, "Adopting XBRL for our financial statements demonstrates our commitment to the technology, which has tangible benefits for both organizations delivering financial statements and end-users such as analysts, financial institutions, and regulators. It also increases transparency in financial reporting, which CGA-Canada believes is a vital part of promoting improved corporate governance and accountability."

CGA-Canada's decision to use XBRL has been facilitated by XBRL Canada's December 2004 release of a Canadian business taxonomy. The Canadian taxonomy covers Primary Financial Statements issued in accordance with Canadian GAAP (Generally Accepted Accounting Principles).

Major software companies including Oracle, Microsoft, Hyperion, SAP, PeopleSoft, ACCPAC, JD Edwards, and Cartesis all offer XBRL, or XBRL-compatible, products.

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Standards Groups to Collaborate (HL7 and OMG)

March 10, 2005 HealthDataManagement.com

Two standards development organizations will work together to build interface standards to promote interoperability of health care information systems.

The initial focus of the collaboration between the Object Management Group and Health Level Seven is to address standards to enhance the information exchange capabilities of electronic medical records.

The organizations will jointly identify and prioritize standardization needs. HL7 then will elaborate the business functional needs, allocate functions to services, and provide information modeling and content. OMG will develop these business requirements into specifications for software architecture and components using its Unified Modeling Language and Model Driven Architecture technologies. The organizations expect to have candidate standards ready for testing and validation by the end of this year.

Danish Commerce and Companies Agency have launched digital filing through XBRL

Michael Rugaard, Programme Manager, DCCA
<rugaardmichael at yahoo.com>

As of Wednesday the 9th of March 2005, 130.000 Danish companies have the possibilty to file their annual reports with the DCCA using XBRL.

The companies can file by mailing an XBRL instance document containing some of the annul report along with a PDF file containing the complete report. The mail must be signed with the company's government approved digital signature - which can be obtained at low or no cost.

The DCCA has developed 4 overlapping XBRL-taxonomies targeting specific needs of the individual companies. The taxonomies cover balance and profit and loss statement as well as a number of supplementary questions intended to automate the use of instance documents. They vary according to the ways in which a Danish company can vary the contents of balance and profit and loss statement. The DCCA will continue to produce targeted, overlapping taxonomies in an attempt to make the concept of XBRL as user friendly as possible.

If you have any questions, please feel free to contact me. Response time is quicker if you use my work e-mail, which is "rug" followed by "@eogs.dk" (without quotation marks).

The four taxonomies, that are made according to XBRL spec. 2.0a, can be found as zip-files or by reference at the DCCA website. Please find the links below.

Taxonomy 1 Zip-file

Reference

Sample instance

Taxonomy 2 Zip-file

Reference

Sample Instance

Taxonomy 3 Zip-file

Reference

Sample Instance

Taxonomy 4 Zip-file

Reference

Sample Instance

DOJ and DHS Explore Development of XML Core Data Exchange Model

Mar. 8, 2005 By News Staff, Government Technology

Last week, officials from the Department of Justice (DOJ) and the Department of Homeland Security (DHS) announced a partnership to explore future development of a Global Extensible Markup Language (XML) Core Data Model. Extensible Markup Language, or ''XML,'' is an open standard that allows agencies to exchange data, regardless of computer system or platform. The core model would be an enhanced version of the DOJ-sponsored Global Justice XML Data Model (Global JXDM), which was first released in April 2003 as an XML-based framework to enable the entire justice and public safety community to effectively share information at all levels -- laying the foundation for local, state, tribal, and national interoperability.

The Global JXDM has greatly improved the ability of justice and public safety agencies to share information. Today, more than 50 justice information sharing projects are utilizing the Global JXDM to revolutionize the justice system. The Global JXDM has already proven its value in expediting crime solving. For example, last April, police in Delaware County, Pennsylvania, were able to capture a bank robbery suspect in less than two hours by matching his bank surveillance photo with an image on Justice Network, or JNET, Pennsylvania's XML-enabled justice information sharing network.

The Global JXDM also aided police in Allegheny County, Pennsylvania in quickly apprehending a homicide suspect. Within hours of learning of four homicides in one neighborhood, officers used a JNET photo image to confirm the suspect's identity. Through a stakeout, police apprehended the homicide suspect and recovered an assault weapon.

These are only a few examples of the successful use of the Global JXDM to solve crimes. In addition to solving cases, state and local jurisdictions that have implemented the Global Justice XML Data Model are reporting substantial cost savings.

Why Attention.xml Could Change PR Forever

Steve Rubel, Micro Persuasion

Attention.xml is a new technology standard that's being proselytized by influencers like Steve Gillmor, David Sifry, Robert Scoble and Jeremy Zawodny. Basically it is metadata that records and shares information on the "attention" users give to their RSS feeds and blogs. Scoble said that by the end of 2005 we'll all know what attention.xml is and why it's important for the services we choose to support it. Listening to this podcast with Steve Gillmor and Chris Pirillo today, I could not help but agree.

March 10 Louisiana eHealth Conference Seminars to Feature Louisiana Projects

Eleven Louisiana eHealth projects will be featured in presentations during seminars at the Louisiana eHealth Conference, March 10 in the Lafayette Cajundome Convention Center.

The featured projects cover a broad range of public and private sectors, urban and rural settings, and large and small institution initiatives involving the use of information technology and community networks to improve the quality of healthcare patients receive.

Conference organizers released the list of projects and presenters today, with details of the presentations to be released in the days leading up to the statewide conference.

The projects and presenters are:

• Christus Health Information Management Strategy — Ronnie Ryan.

• Louisiana Rural Health Information Partnership — Paul Salles, Rebecca Bradley, Wayne Arboneaux, and Tony Sun, MD.

• The Clinical Inquiry System (CLIQ): Enabling Collaborative Networks of Care for the Uninsured — Clayton Williams, MPH; Wayne Wilbright, MD, MS; Elmore Rigamer, MD, MPA; Robert Post, MD.

• 21st Century Interoperable Communications: Distant Multi-point Clinical Decision-making Support — William Steinmann, M.D. M.Sc., and Bruce Bowdish, Ph.D.

• Doctor's Office Quality — Information Technology Program — Jack Olden, RN, MA.

• Health Information Technology Certification — Susan Melsheimer, Michelle Meaux, and Annelle Tanner, EdD. RN.

• VistA: The Veterans' Administration's Electronic Health Record — Steve Test.

• The CERT Institute for Biomedical Informatics — Paul Sissons, Ph.D., Nathan Hutchings, Ph.D., Susan Pierce, Ph.D., and Dennis Lower.

• Health Informatics Center of Acadiana Projects — L. Philip Caillouet, Ph.D.

• ePrescribing — Tony Sun, MD.

• The ByNet Story — Michelle Lemming.

Starting times and room assignments for the two blocks of breakout sessions at the Louisiana eHealth Conference will be announced on March 1.

For additional information on the conference, visit the Louisiana eHealth Conference website at www.louisianaEhealth.org

Open-source tool for XBRL taxonomies generation

http://www.mcoletti.net/dev/myXBRL/index.html

This project is a generator for XBRL taxonomies. The aim of this tool is to help the taxonomy designer in two ways:

• an user-friendly data entry tool, allowing to paste elements from existing Office documents;

• a controlled generator, that helps the novice to fill the knowledge gap required to produce an FRTA-compliant taxonomy.

Currently the tool is used in my bank for an internal-use taxonomy, and helped us to generate a DTS for more than 7,000 concepts. The tool (currently only in italian language -- I am working on an english translation) is available at http://taxogen.sourceforge.net. Comments and suggestions are welcome.

Postie piloting medical e-card

MARCH 08, 2005  Karen Dearne

AUSTRALIA Post has emerged as the surprise leader of a consortium testing Medicare smartcards in Tasmania.

If the pilot is successful, the consortium will be in the box seat for a national roll-out of Medicare smartcards.

The 12-month project is based on the smartcard technology developed by French payment and security card developer Oberthur.

Neotech Australia will supply touchscreen kiosks for installation in Medicare offices, and plastic card maker Placard will produce the cards.

Australia Post is the systems integrator for the pilot, which is the first phase of the Health Insurance Commission's plan to adopt smart Medicare cards that store large amounts of data.

To date, 800 Tasmanians have registered for the trial and received smartcards.

What not-for-profit organizations need to know about free software

Last updated December 2004 Collaboratively authored by Dmytri Kleiner and Phillip Smith

Like many curious onlookers, you're probably wondering, Are free and open-source applications really able to meet our needs? or, Are open-source systems compatible with the software that our clients, partners and colleagues are using? The honest answer is yes. In the past two years, the pace of open-source desktop development has increased dramatically, the usability of Linux has been improved(http://www.relevantive.de/Linux-Usabilitystudy_e.html), the installed base of users has increased to an estimated 18 million (http://counter.li.org/estimates.php) and many large software companiesfrom IBM to Novell to Sun—have made significant commitments to develop on, integrate with and support open-source operating systems and software. Additionally, several "e-Riders" (organizations and individuals that support not-for-profit groups with technology) have started the process of moving their clients in the direction of free software (http://www.lincproject.org), and many brands you experience every day, like the Government of Canada, CNN, Google and Yahoo, use open-source software to power their Web sites.

News Standard Summit 2005 - request for a presenter on RSS

Laurent Le Meur, IPTC News Architecture WP, Head of Médialab, Agence France Presse

IDEAlliance, IPTC, IFRA and G-Sam are to co-organize a News Standards Summit on May 24th (Tuesday) in Amsterdam, in conjunction with XTech 2005 (24-27 May). The idea is for the news community to exchange information on current developments on news-related XML standards, and check if convergence is possible.

The focus will be on the representation of news content (the upcoming IPTC NewsML2 and EventsML), news metadata (publication metadata with PRISM, photo metadata with IPTC/XMP and DISC, and the introduction of RDF/OWL in this industry) and news syndication (RSS, Atom, ICE). Case studies will help get information about real-life needs in the media industry. More information can be found on the IDEAlliance web site: http://www.idealliance.org/news-summit/

The planning committee is looking for presenters deeply involved in the development of Atom and RSS. In 2003, during the first News Standards Summit in Philadelphia, Sam Ruby introduced Atom and Ben Hammersley gave an interesting presentation of RSS. Now, RSS1.0 is under review and a new flavor - RSS1.1 – is proposed. Would an RSS expert be interested in presenting in Amsterdam the latest developments on RSS (especially if you already plan attending XTech 2005)?

Note: this event is not financially sponsored, so there are no funds available for presenters.

Health Level Seven, Object Management Group Begin Joint Healthcare Software Services Standardization Work

March 7, 2005

Combined Effort Leverages Strengths of Each Organization

Health Level Seven (HL7) Inc., one of the world’s most prolific healthcare standards developers, and the IT specifications consortium Object Management Group (OMG) are collaborating to build a set of healthcare-domain software components and services interface standards to promote interoperability across health provider organizations and healthrelated software products. Conceived to support healthcare IT as part of national initiatives such as the U.S. Department of Health and Human Services’ National Health Information Infrastructure and similar initiatives throughout the world, the cooperative effort builds on the complementary strengths of the two organizations. The initial focus of the effort is to address the need for standards directly supportive of electronic health record interoperability and information exchange.

As set out in the project charter, the two organizations will jointly identify and prioritize candidate services for standardization. HL7 will elaborate the business functional needs, allocate functions to services, and provide information modeling and content. OMG will then develop these business domain requirements into specifications for software architecture and components using its foundation technologies - the Unified Modeling Language - (UML®) and Model Driven Architecture® (MDA®). Strengthened by the support of numerous companies holding membership in both organizations, the cooperative effort is on track to produce its initial deliverables by the end of 2005.

Spearheaded by the MedicAlert® Foundation, Kaiser-Permanente, and the Veterans Health Administration, a growing list of companies and organizations have formally committed their support and resources in support of this initiative, which includes global interest and engagement. These organizations are: Blue Cross and Blue Shield Association Eclipse Foundation Electronic Data Systems Incorporated (EDS) US Government Division HL7 International Affiliate Organizations from Australia, Finland and New Zealand IBM Kaiser-Permanente Mayo Laboratory for Biomedical Informatics MedicAlert® Foundation Ocean Informatics PatientKeeper, Inc. Universata VHA Office of Information, Health Information Architecture Office

“The initial focus of the effort is to identify services that have well-defined boundaries, are reasonably scoped, and have broad utility and applicability to support the Electronic Health Record,” said Ken Rubin, an enterprise architect with EDS who is co-chairing this initiative on behalf of the Veterans Health Administration. “We want to produce standards that are of business value and result in implementations and not shelfware. This is one of the benefits of the HL7-OMG collaboration.”

“MedicAlert hopes that this effort will prompt the large healthcare IT vendors to commit to using UML-based standards, open-source code and Web services in their applications,” said David Harrington, CTO of MedicAlert®. “These standards will also allow existing Healthcare IT applications to be adapted for greater interoperability.” “Health Level Seven is committed to establishing standards that assist its members and the health industry at large to overcome technical barriers to health information system interoperability,” said HL7 Board Chair Mark Shafarman. “This project is another example of that commitment. We will continue to explore new areas of focus and engage in collaborations with organizations such as OMG that provide solutions and capabilities complementary to ours and that extend the application of our standards beyond ’just-messaging’ to technical paradigms such as service architectures.”

“OMG is committed to rapidly providing standards, reflected in products available in commercial and open-source form, that provide interoperability, portability and software reuse in the healthcare IT market,” said Dr. Richard Soley, OMG CEO.“ We are gratified that this strong partnership with HL7 is bearing fruit so rapidly. The needs of healthcare providers and ISV's and government organizations to build interoperable solutions are stronger than ever, and this joint freight train is roaring down the tracks faster than we could have imagined.

The project effort is already underway, and a joint project meeting between the two organizations is planned for April 5-6, 2005 in Salt Lake City, Utah. For more information, contact Nicole Glazen Rikkinen, OMG, VP of Business Development at nicole@omg.org or 781-444-0404.

About HL7

Founded in 1987, Health Level Seven, Inc. (http://www.HL7.org/) is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. HL7’s more than 2,000 members represent approximately 500 corporate members, including 90 percent of the largest information systems vendors serving healthcare. Recently, HL7 joined 12 other healthcare stakeholders in a collaborative response to the Request for Information (RFI) issued by the Office of the National Coordinator for Health Information Technology (ONCHIT) to learn how widespread interoperability of health information technologies and health information exchange could be achieved through a National Health Information Network (NHIN). The Collaborative response can be viewed in its entirety at: http://www.hl7.org/Library/General/Collaborative_RFI_Responsefinal.pdf. The HL7 additional response specific to Standards and Policies to Achieve Interoperability can be found at http://www.hl7.org/Library/General/HL7Q14-18_final.pdf. HL7's endeavors are sponsored, in part, by the support of its benefactors: Booz Allen Hamilton, Inc.; Capgemini; Centers for Disease Control and Prevention (CDC); Documentum; Eclipsys Corporation; Eli Lilly & Company; the Food and Drug Administration; GE Medical Systems; Guidant Corporation; HIMS Solutions, Inc.; IBM; IDX Systems Corporation; InterSystems Corporation; Kaiser Permanente; McKesson Provider Technologies; Microsoft Corporation; Misys Healthcare Systems; NHS National Programme for IT; NICTIZ National ICT Institute for Healthcare in The Netherlands; Oracle Corporation; Partners HealthCare System, Inc.; Pfizer, Inc.; Philips Medical Systems; Quest Diagnostics Inc.; Science Applications International Corporation; Siemens Medical Solutions Health Services; the U.S. Department of Defense; Military Health System; the U.S. Department of Veterans Affairs; and Wyeth Pharmaceuticals. HL7 International affiliates have also been established in 27 countries throughout the globe including Argentina, Australia, Brazil, Canada, China, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, India, Ireland, Italy, Japan, Korea, Lithuania, Mexico, The Netherlands, New Zealand, Poland, Spain, Switzerland, Taiwan, Turkey and the United Kingdom.

About The OMG

With well-established standards covering software from design and development, through deployment and maintenance, and extending to evolution to future platforms, the Object Management Group (OMG) supports a full-lifecycle approach to enterprise integration which maximizes ROI, the key to successful IT. OMG's standards cover multiple operating systems, programming languages, middleware and networking infrastructures, and software development environments. OMG's Modeling standards, the basis for the MDA, include the Unified Modeling Language (UML) and Common Warehouse Metamodel (CWM). CORBA, the Common Object Request Broker Architecture, is OMG's standard open platform with hundreds of millions of deployments running today. Headquartered in Needham, MA, USA, with a U.S. government representative in Washington, DC, and international marketing representatives in Japan, the UK, and Germany, the Object Management Group is an international, open membership, not-for-profit computer industry specifications consortium. OMG member companies write, adopt, and maintain the organization’s standards following a mature, open process. All current OMG specifications may be downloaded without charge from the organization’s website, www.omg.org; the site also provides additional information about OMG and its activities. For information on joining the OMG, or questions not addressed on the website, please contact OMG headquarters by email at info@omg.org, by phone at +1-781-444 0404, or by fax at +1-781-444 0320. Note to editors: The OMG Object Management Group Logo®, MDA®, Model Driven Architecture®, UML®, CORBA®, CORBA Academy®, The Information Brokerage®, XMI® and IIOP® are registered trademarks of the Object Management Group. OMG™, Object Management Group™, CORBA logos™, Model Driven Development™, MDD™, OMG Interface Definition Language (IDL)™, The Architecture of Choice for a Changing World™, CORBAservices™, CORBAfacilities™, CORBAmed™, CORBAnet™, Integrate 2004™, Middleware That's Everywhere™, Unified Modeling Language™, The UML Cube logo™, MOF™, CWM™, The CWM Logo™, Model Driven Architecture Logos™ and the XMI Logo™ are trademarks of the Object Management Group. All other products or company names mentioned are used for identification purposes only, and may be trademarks of their respective owners.

Contacts: Health Level Seven, Inc. Jonathan Himlin 734-677-7777 jhimlin@HL7.org Object Management Group Dana Morris +1-781-444 0404 ext. 142 pr@omg.org

The Television Bureau of Advertising (TVB) XML Available Now for All TV Buyers and Sellers

Mar 5, 2005 New Age Media Concepts

Strata Saluted for Contributions to Historic EDI Milestone

The historic announcement was made on the opening day of the American Association of Advertising Agencies’ (AAAA) trade show in New Orleans. Jim Shanney, EVP and CIO, Horizon Media, said “Our buyers are thrilled at the prospect of eliminating tedious tasks like sending orders and re-keying data as well as reducing errors and discrepancies. I am extremely happy that agencies, stations and rep firms have finally agreed to, and implemented, a single set of standards that can be shared by all.” John Shelton, President and COO, Strata Marketing, Inc., said, “The TVB XML standards do not require commitment or dependency on any one system to be a successful electronic trading partner. Any system on the agency side or the selling side can be enabled to accept these standard XML files. Strata is thrilled to be a part of this pilot, and we hope to be one of many systems sending and receiving electronic orders in the future.”

Brixlogic: Next generation XML services

March 7, 2005 By Dan Farber, Tech Update on ZDNet News

COMMENTARY -- The promise of Web services and services-oriented architecture (SOA) is interoperability among disparate software components, regardless of platform. It's the next software development nirvana, which is at the beginning of its ascendancy--meaning that there is lot of room for new companies to pave the way to the future.

I met with one of those companies, San Mateo, CA-based startup Brixlogic, which has developed a development tool for creating Web services based on XML schemas. XML schemas provide a way to define the structure, content and semantics of XML documents for a particular industry or set of tasks. For example, the Interactive Financial eXchange (IFX) schema was developed in collaboration with the financial industry as a way to express, in XML, standards for electronic bill presentment and payment, business-to-business payments, , business-to-business banking and ATM communications, as well as consumer-to-business and banking payments. It sets up relationships for performing processes among the various entities involved in financial transactions, such as debiting an account prior to an ATM withdrawal. Similarly, the ACORD Life Data Model defines a structured way of sharing complex insurance information to all parties involved in the industry.

Team Computing and XML Yes Make Electronic Trading Easy

March 7, 2005 ComputerWorld

Team Computing has joined with leader in its field, XML Yes. Together they provide companies with the opportunity to get into eBusiness - and gain the benefits - at a fraction of the cost and effort of what has been available up until now.

According to Rob Thompson, Director of XML Yes, “In the past small to medium companies have suffered from a number of barriers to entry when trying to trade electronically. For example, EDI has been prohibitive due to cost and complexity; using trading partners’ websites is too manual and requires double data entry; and with hubs/portals/exchanges the more you use them the more you pay. Now all companies can derive exactly the same benefits as the larger corporates. All the complex technical tasks required for business-to-business electronic trading are done 'under the cover', making XML Yes easy to implement and use and very affordable.”

Open source web services project hits milestone

Mar 7, 2005 CBROnline.com

An open source project designed to simplify construction of web services written in Java has notched up its first developer release.

The Eclipse Foundation's Web Tools Platform (WTP) Project has added support for web services standards from the World Wide Web consortium (W3C) and Web Services Interoperability (WS-I) organization.

WTP features authoring tools for Web Services Description Language (WSDL), XML, and XML schema standards and wizards designed to simplify creation of web services.

CSC's Electronic Service-of-Process Now Integrated With DirectInvoice(TM)

March 7, 2005 /PRNewswire/

Integrated Systems Utilizing XML Technology Deliver Breakthrough Functionality

Corporation Service Company(SM) (CSC), the leading domestically owned registered agent and provider of litigation management, entity management, IP, corporate governance and compliance services for business and attorneys, and Tripoint Systems Development Corporation, a leading provider of Strategic Cost Management, Matter Management and law department software applications, today announced the XML integration of CSC's Electronic Service of Process (e-SOP) offering with Tripoint's DirectInvoice(TM), a market-leading strategic cost management and electronic invoicing service.

CSC and Tripoint have not only overcome the significant challenges associated with connecting technologies of these types but have also perfected the integration capabilities between the two systems, setting a standard that will be very difficult to match. The system has undergone intensive live testing at a Fortune 50 client site for the past ten months and has yielded remarkable savings, delivering an entirely new level of Registered Agent and electronic litigation management services to the client's corporate law department.

With this new integration, CSC can automatically pre-populate DirectInvoice litigation matter records for any corporate law department using XML technology without costly re-keying, scanning or redundant data entry. The law department will automatically receive the information and imaged documents to an online queue, where department members can receive, accept and share service of process data securely with both internal and external members of their legal defense team, providing tremendous cost-savings and increased efficiency.

US Governors Call for a National Health Care Innovations Fund

This paper calls for the establishment of a National Health Care Innovations Fund to support large-scale demonstrations emphasizing cost-effectiveness and quality improvements in the health care system. The Fund will help support state-led partnerships between government and the private sector to test major innovations. As they were with welfare reform a decade ago, states are anxious to help drive improvements in the nation’s health care system to help lower cost and improve quality. Without such an effort, we will face ever growing health care costs, a higher uninsured population and increased public spending that will threaten our ability to invest in education and other priorities.

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A National Health Care Innovations Program

A proposal to increase the cost-effectiveness and quality of the U.S. health care system

Summary

The U.S. health care system is reaching a breaking point. The amount we spend on health care and the rate of spending growth outpaces all other industrialized countries. Neither the public nor private sector can sustain this trend. If it continues unchecked, fewer and fewer employers will be able to afford health care for their employees and public health care spending will skyrocket as qualified, low-income individuals sign on to and Medicaid and the State Children’s Health Insurance Program (SCHIP). Caught in the middle will be a growing population of Americans who do not qualify for public benefits and cannot afford to insure themselves.

The crisis is not just one of cost, however. It is a broader crisis of quality and access to quality care. As much as we spend on health care, we achieve only mediocre results as gauged by our population’s health and, at times, clinical outcomes. Many other countries spend less and achieve better returns on their health care investments.

We must increase the efficiency, productivity, and quality of our entire health care system. By making the system more efficient and effective for those now covered by health insurance, we also increase the opportunities for coverage expansions.

Just as they did with welfare reform a decade ago, states can once again play a lead role in driving change. Through demonstration projects in partnership with the private sector, states can illustrate the benefits of large-scale system reforms. Accordingly, the nation’s governors call on Congress to establish a National Health Care Innovations Program to support the implementation of 10 to 15 state-led demonstrations in health care reform over a three- to five-year period. We propose states serve as the lead entity for these large-scale demonstrations that will focus on:

• deploying information and communications technology to improve services;

• improving quality of care, including disease prevention and management;

• allowing innovative financing strategies and rules changes to expand health care coverage for the working uninsured;

• empowering consumer choice through price transparency, quality reporting, and financial incentives; and

• reducing malpractice incidents and improving adjudication of malpractice claims.

Each demonstration project would be selected through competition and encouraged to demonstrate multiple innovations. All projects would need to emphasize the goal of increasing cost-effectiveness and, to the extent possible, improving health care quality. In addition, a few projects that expand coverage should be supported but these, too, must show improved cost-effectiveness and quality of care.

The Problem

The United States spends about $1.7 trillion or almost 15 percent of its Gross Domestic Product (GDP) on health care. This is more than any other industrialized country and 41 percent higher than the median of all 30 member countries in the Organization for Economic Co-operation and Development, or OECD (2002 data). On a per capita basis, the United States also outspends its peers. In 2002, Americans spent $5,267 per person on health care, more than twice the OECD median of $2,294 per person. In addition, from 2000 to 2005, the rise in health care costs alone is estimated to absorb an astounding 25 percent of the nation’s projected economic growth.1

Given the high expenditures devoted to health in this country, one should expect equally high healthy outcomes. But that is simply not the case:

• In 2001, the U.S. average life expectancy for males was just 74.4 years, a value exceeded by 21 other countries, including Iceland (78.3 years), Japan (78.1 years) and Sweden (77.6 years). Moreover, 21 other countries also exceeded the U.S.
life expectancy for females of 79.8 years, including Japan (84.9), Switzerland (83), and Spain (82.9).

• In 2001, infant mortality in the United States was the fifth highest in the industrialized world at 6.8 deaths per thousand live births. The lowest recorded rate was Iceland at 2.7 deaths per thousand live births.

• In 2000, the United States reported 322 cancers per 100,000 people, a level higher than roughly half of all reporting OECD countries. The United Kingdom, which devotes only 7.7 percent of its GDP to health care (half the U.S. level), had the lowest reported rate at 254 cases per 100.000 population.

• In 2002, the United States had the highest obesity rate (22 percent of the total population) of any other industrialized country except the Slovak Republic, which reported an obesity rate of 22.4 percent. In contrast, Japan reported that only 3.6 percent of its population was obese.

• In 2003, the National Academy of Sciences reported that annual U.S deaths from medical errors likely range between 44,000 and 98,000, exceeding the annual deaths recorded for motor vehicle accidents, breast cancer, or AIDS.2

Why does the United States spend so much of its money on health care and yet still produce such mediocre rankings? The reasons are many, but in general they can be attributed to four broad factors:

First, by failing to effectively use information technology, the U.S. health care industry has created a system that encourages inefficiency. The state of medical informatics is dismal. The U.S. health care industry remains a bastion of paper-based recordkeeping, billing and information exchange. As a result, administrative costs account for 31 percent of total health care spending in the United States, a level almost double Canada’s rate3. Part of this inefficiency can be blamed on our fragmented system, in which multiple insurance and health care providers, regulatory systems, and health care networks all use different forms and standards. But a more important reason is the fact that the U.S health care system is dramatically behind in deploying computer technology to standardize information, store data, and share records.

The result of this inefficiency is not just an increased administrative burden, but a loss of efficiency in patient care. Without electronic record-keeping, doctors in different locations or organizations cannot easily examine a patient’s medical records or coordinate treatment with other providers. Their knowledge often is limited to their own examination and the information supplied by the patient. Likewise, patients cannot easily monitor their own health status or treatment progress. As a result, the efficacy of care is reduced, errors are more likely, and over- or under-use of services are frequent.

America’s health care system will not be transformed until it fully implements information technology at the hospital, provider, and community level. Every aspect of care that creates or uses information must move that information to a paperless, integrated, and interoperable environment. Patient billing must become standardized and electronic. Providers and patients must be given remote access to up-to-date health records. And all prescriptions should be ordered, reviewed, and completed without paper transactions. Development of a real-time, virtual health information system is the first step toward improving productivity.

Second, the U.S. health care system does not emphasize quality and effectiveness of care. The current system fails to reward doctors for quality of care, encourage the reporting and elimination of errors, or promote cooperation among providers to enhance services. For example, most doctors today are compensated based on the complexity and volume of the clinical services they provide, not the quality of care. Therefore, to improve quality, provider payments should reward the achievement of better outcomes and use of best practices, including disease management and prevention protocols. Clinicians should be compensated for taking good care of all types of patients, neither gaining nor losing financially for caring for sicker ones or those with more complicated conditions.

The current system also discourages the reporting of errors and the identification, remediation, and elimination of sub-quality providers. Some of the problem lies with our current medical liability system, which can impose severe costs on doctors and hospitals that report errors, even when they have no adverse clinical impact. Some of the problem also lies with our licensing and accreditation processes, which do not focus on safety and performance except in the most egregious cases. And some of the problem lies in the way we pay for medical services, since most health insurers provide little incentive for health care organizations to improve safety and reduce errors.

Finally, our failure to use information technology to store patients’ medical records and exchange information hinders a quality approach to patient care. Multiple providers serving the same patient rarely have access to the patient’s complete and current medical information. As a result, each provider will treat what they see, often addressing a single set of symptoms. Patients rarely obtain a coordinated diagnosis or treatment regimen under such a system. For this reason, prescription overuse is common and duplicative tests and procedures frequently are requested.

Quality of care must be a focal point of all efforts to transform America’s health industry. This may mean developing “pay for performance” models that reward doctors for the quality of care they provide (including disease prevention). It means developing treatment guidelines for providers to follow based on accepted standards of care. It means changing the way we oversee provider performance to focus on improving quality, re-examining skills, and eliminating incompetence. It also means developing systems to encourage doctors to report mistakes without threat of liability and developing more equitable adjudication processes for medical errors.

Third, the health care system in this country does not permit the consumer to make informed decisions on the cost and quality of the services they receive. Little incentive or opportunity exists in today’s system for the consumer to compare the prices or quality of the clinical services they receive or to implement lifestyle changes to reduce future service demands. The financial motivation for most consumers is to find the least costly insurance plan, not to find the most cost-effective treatment. Because most treatment costs are born by insurers, the consumer is not motivated to minimize costs.

Even if cost control was a motivation of consumers, the absence of data on prices for medical services and quality of care thwarts anyone from making an informed choice. This lack of transparency further fragments a system in which health care services are delivered to one party (the patient) but purchased by another (the insurer).

In a transformed market, consumers would have access to information on prices and quality and would be encouraged to select services based on these measures. To improve the cost-effectiveness of health care, consumers must be empowered to make cost-effective choices. This requires building an information technology backbone so people have the knowledge and the tools to help themselves better manage their health status. It also requires giving consumers the financial incentive to manage the cost and quality of their care.

Fourth, government rules help stifle innovative approaches for extending coverage to the uninsured. Myriad federal and state regulations make it difficult to create insurance options to cover a large number of low-income workers. Problems include government regulations that prevent public dollars from subsidizing private insurance, and rules that make it difficult for employees to receive a tax benefit for health insurance not purchased through an employer-sponsored plan. This helps create a fragmented system that cannot optimize dollars to meet demand. Failing to cover all workers means many will seek care when it is most costly – in emergency rooms and when prevention options have passed – driving health care costs upward throughout the system.

One problem is the difficulty small businesses face in sponsoring their own health insurance plans. Of the approximately 45 million non-elderly Americans who are uninsured, almost half are self-employed or work in firms of less than 25 workers.4 These firms do not sponsor insurance plans because:

• administrative costs per worker can be high;

• small firms lack the bargaining power of larger firms;

• the small size of the insured pool drives up costs; and

• insurance for small groups may not be available in their area.

One available solution is to encourage the formation of alliances among small firms to provide coverage for a large pool of workers. States can help sponsor such alliances by bringing the right parties to the table and changing state rules to ensure “alliance employees” receive the same tax-free benefits as workers covered by office health plans. State rules establishing minimum benefit requirements for business-sponsored plans also may need changing.

Another problem is federal rules make it difficult to blend public and private funds to create hybrid plans, which extend coverage to the working uninsured. For example, low-income workers typically cannot use Medicaid money to purchase a private health insurance plan or “buy in” to an alliance as described above. This can even limit insurance coverage options for low-income workers, depending on how many providers in the area participate in Medicaid. A better option in many cases is to let Medicaid subsidize private insurance premiums for low-income workers. This could encourage the formation of alliances and make it easier for small businesses to offer insurance.

A major problem of the health care system is that it serves two markets – private sector insurers and government purchasers/regulators. Forty percent of all health purchases must meet government price controls set by Medicaid and Medicare, while the rest of the system can charge market rates to insurance providers. Each sector has different benefits packages, coverage rules and financial incentives. Until the system is made less fragmented, it may be difficult to achieve high efficiencies.

In a transformed market, government rules should encourage innovative strategies to cover many of the working Americans who currently lack health benefits. They should make it easier for insurers to offer plans to large pools of employees and make it easier for small businesses to help employees obtain coverage. By extending coverage through cost-effective plans, the high cost of uncompensated care could be lowered.

Needed: A National Health Care Innovations Program

America’s current health care system is ripe for improvement and states are ready to take the lead in helping drive change. Bold ideas are needed to address the health care system’s most serious problems and change the conventional thinking that meaningful reform can only be driven from the top, through federal policy changes. Instead, similar to welfare reform, health care system change should be demonstrated through innovation and experimentation by states. States are small enough to tailor solutions unique to their cultures, institutions, and health care markets, but large enough to experiment with system-wide reforms. States also can partner effectively with health care providers, insurers, and purchasers to lead large scale pilot projects.

In 2002, the Institute of Medicine identified a set of demonstration projects that had the potential to lead to fundamental change in the health care system.5 The institute recommended a substantial portfolio of demonstration projects, including 10 to 12 chronic care demonstrations, eight to 10 information and communication technology demonstrations, and four to five state liability demonstrations. Similarly, in 2003, the National Academy of Sciences called for the federal government to commit approximately $1 billion over a three to five year period to support demonstrations on quality improvement alone6. The academy recommended the money be used to create the Health Care Quality Innovation Fund. Both of these proposals offered excellent ideas, but, to date, neither has resulted in the implementation of large-scale, cross-systems demonstrations.

To help drive change, Congress and the administration should create a National Health Care Innovations Fund capable of supporting 10 to 15 large-scale experiments over the next three to five years. The demonstration projects would incorporate multiple innovations, including information technology, disease prevention and management, quality improvement programs, and changes to the medical liability system. The emphasis of these experiments should be on achieving the following goals, in the following order of importance:

1. Increase cost-effectiveness (all demonstrations);

2. Improve quality of care (several demonstrations); and

3. Increase coverage (a few demonstrations).

Principles

The demonstration projects should adhere to the following principles:

1. All of these experiments should be public/private partnerships which may include local and federal government in addition to state governments and the private sector. The partnerships also should include both the health care delivery system and purchasers.

2. To the extent possible, the experiments should attempt to demonstrate multiple innovations, such as deployment of information technology together with programs for disease management, quality reporting, and pay for performance.

3. Funds should be used to support planning, systems design, certain infrastructure investments (with matching dollars from project partners), and evaluation. The funding should not be used to cover long-term, operational costs.

4. States should serve as the lead partner for a multi-partner project with other entities. States should compete with each other for the innovation funding.

5. An independent advisory body should review the merit of the proposals, but HHS should be the operational agency for the grants. HHS also should have the authority to coordinate Fund demonstrations with other, ongoing projects supported by HHS to maximize investments.

6. All experiments must contain a very strong evaluation component.

7. The demonstrations need not be statewide, but must stress collaboration among public and private entities. The fund should be specific regarding both the evaluation criteria and the types of potential innovations it will support. Each experiment should incorporate several elements among the categories described below. For example, a project demonstrating the use of electronic medical records also could include demonstrations of improved patient care, error reporting, disease management and price and quality listing.

Innovation Categories

The Innovations Fund should support projects demonstrating multiple elements of the following innovation strategies:

• deploying information and communications technology to improve services;

• improving quality of care, including disease prevention and management;

• creating innovative financing strategies and rules changes to expand coverage and improve cost-effectiveness;

• empowering consumer choice through price transparency, quality reporting and financial incentives; and

• reducing malpractice incidents and improving adjudication of malpractice claims.

Deploying Information and Communications Technology

Full deployment of information technology, including electronic health records (EHR), is the backbone of almost all other meaningful system improvements. Without a robust information technology infrastructure, improvements in disease management, consumer empowerment, medical error reporting, and health care quality are nearly impossible.

A number of small-scale demonstrations already are underway testing the use of information technology. In 2004, for instance, the U.S. Department of Health and Human Services awarded $139 million in grants and contracts to promote the use of health information technology (HIT). Over 100 grants were given to communities, hospitals, providers and health care systems to help them develop and use information technology. Larger contracts were given to five states (Colorado, Indiana, Rhode Island, Tennessee and Utah) to help them develop statewide networks that are secure, ensure privacy of health information, and allow sharing of records among providers.

In addition to these federally-supported demonstrations, several private health care networks, including Kaiser Permanente, have made HIT a core element of their business model and have invested heavily in these systems with beneficial results. For example, Kaiser Permanente has made electronic patient records a core element of their quality care program.

The National Health Care Innovations Fund would build on the investments and knowledge gained from these existing projects. The Innovations Fund would support efforts to bring these current projects “to scale” and demonstrate the following using HIT:

• real-time electronic access to patient health records by clinicians and patients on a right- and need-to-know basis;

• support tools for patients, including educational materials, information to facilitate self-care programs, and data systems to track health progress;

• telemedicine systems to link providers to providers and providers to patients;

• data capture and decision support tools for clinicians;

• software to improve management systems, including electronic billing, workflow scheduling and claims processing;

• data gathering, analysis, and reporting to measure quality improvements in outcomes and patient safety, and

• interoperability among systems managed by different providers and networks. Improving Quality of Care

Programs to improve the quality of patient care encourage clinicians to utilize best practices, including disease prevention and management. They also focus on reducing system waste, promoting collaboration among providers, and reducing medical errors. Finally, they require reporting of quality measures.

Both the federal government and private sector have funded research to identify best clinical practices. A number of health care providers, hospitals, and networks have put these and similar practices in place, often supported by information technology to aid physicians and the consumer. Some providers, such as Kaiser Permanente, have instituted pay-for-performance systems to reward doctors for quality and patient satisfaction. In its report, Crossing the Quality Chasm: A New Health System for the 21st century, the National Academy of Sciences recommended \ quality improvement initiatives emphasize:

• improving safety;

• improving effectiveness by providing services based on scientific knowledge;

• empowering the patient to help guide clinical decisions;

• reducing harmful delays;

• avoiding waste; and

• providing equitable care to all patients.

State demonstrations on improving quality of care would need to incorporate information technology and recommended clinical practices. The type of projects the Innovations Fund should cover would demonstrate the following:

• use of state-of-art, evidence-based care for identified patient’s conditions;

• customized care models based on patient needs;

• improved self-management of chronic conditions, including helping patients increase their health literacy;

• improved outcomes and satisfaction of patients;

• reduced clinical waste;

• cooperation among clinicians; and • use of pay-for-performance models to support quality improvements

In addition, the demonstration program would need to create a mechanism to report quality of care measures for consumers. Such a sys