The Social Credit Card [presented at IdeaBlob]

Posted by ED

IdeaBlob started out as an internal collaboration/innovation engine. It has since been turned outward to benefit from remunerated crowdsourcing (you get $10,000 if you win the contest). Since I'm always whining about the fact that fed taxes don't account for hours donated to NGOs/NPOs I thought this was a cool approach to track "social capital". This would be an excellent way to do a "census" of how much healthcare related volunteerism goes unnoiticed/uncompensated. Why, yes, open source/standard healthcare programming would count. Think also about the impact it could have on HSAs -- or a whole new class thereof. Oh, and if you wonder how to implement it just determine at what rate a federal employee would be compensated to complete the same or similar task. Also, accountants could volunteer their time to NGOs/NPOs to help track these things (and of course the shift to international accounting standards and adoption of extensible business reporting language and standard universal charts of accounts could be utilized as well).

The Social Credit Card

Credit card companies and banking institutions develop a social credit system whereby activities like volunteer hours are tracked and compensated. Every time we make a social contribution (helping a neighbor, volunteering at a homeless shelter, donating to charity, etc.) we accumulate points that appear on our monthly statements. These points are then redeemable, similar to frequent flyer miles, for the purchasing of goods or services. The points can also be used to pay down debt or donated to other individuals or charities as a financial contribution. By combining social with financial capital we create incentives for good works and a more comprehensive picture of our net worth.

James Nennemann on Harkin Healthcare Reform Town Hall Today [Update]

RE: what to ask about new bill?

Ed,

I subscribe to your LinuxMedNews feed and appreciate you being a hub of info for OSS Medical Software. I am concerned about the development of a cartel system with certification and even more concerned that so many people are missing the boat when it comes to healthcare reform. Review the expenses of any small rural hospital (like the one I work at) and you will find all sorts of archaic uses of technology by government agencies. For instance, paying a company to act as a secure bridge between medicare and the hospital's billing department just to transmit billing info. Haven't these people ever heard of SSL? WebDAV? SSH?... and on? There are still some services we use that use a dial-up connection to transmit info!

Today at 4 p.m. central, Senator Tom Harkin (ed. toward bottom) will be holding a Town Hall meeting about health care reform at my facility. What are some talking points and questions to put to him? Are there some issues with the current bill that are in favor of or are against the OSS movement? How can we get more people to recognize that we don't need 100+ EMR software companies trying to re-invent the wheel?

Best regards,

-James Nennemann
Hamburg, IA
[email protected]

BWT - I hope to record the meeting in HD and post it publicly. I will send you a link if the recording comes out.

# # # #

My response:

James:

I think the most prudent thing for me to do is pass this inquiry on to lists of contacts who are active in reform in their various spheres of influence. I'll also post to my LinkedIn Medical Banking and Open Health Care groups, blog it at MBlog, etc. Thanks for the heads up.

I'd suggest using #HarkinHealthcare and #HealthcareReform as hashtags on twitter and identi.ca for any folks who tweet and/or post (does laconi.ca have a"cool post verb" yet?).

Best regards,

Ed Dodds

Evangelist, Strategist, Web Developer, Writer

collaboration communication convergence

Conmergence.com

http://www.conmergence.com

http://delicious.com/ed_dodds

http://www.linkedin.com/in/eddodds

http://www.facebook.com/ed.dodds

http://tinyurl.com/ed-dodds-resume

http://identi.ca/eddodds

http://twitter.com/ed_dodds

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Dr. Larry Ozeran response:

Hi James.

I received your email too late to send anything before your meeting, but thought I would send you some comments from one California community's perspective in case you have another opportunity. I am personally a trauma / general surgeon involved in Health IT for 20+ years and healthcare reform for 10+years (http://www.DrOzeran.com/policy.php). Our YSHC consortium includes both health providers (all types) and economic / education / workforce organizations. This is our message:

Washington is again considering temporary healthcare reform, and at great cost. Negotiating to the center of the proverbial table which is tilted heavily in favor of health insurers to the detriment of patients, providers and employers, has not worked in the past to lower cost, improve care, or insure more Americans. "Cost containment" for its own sake, whether Medicare's SGR, "managed" care, capitation, or "Pay for Performance", has not worked to contain costs. By ignoring our fundamental health system problems, past "reform" efforts have caused the American healthcare system to be the most expensive system in the world even as it leaves 15% of our population without good care.

To get true health system reform we must:

1) Get everyone in our nation's capitol to agree with Albert Einstein on two key points:
* "We can't solve problems by using the same kind of thinking we used when we created them."
* "Everything should be made as simple as possible, but not simpler."

2) Define the healthcare system that we want by identifying the principles necessary to make it effective and sustainable one actionable example: http://www.YubaSutterHealthcareCouncil.org

Please forward this message in the hopes that more Americans will seek to promote fundamental change to Congress and the White House.

Regards,

Larry

Dr. Larry Ozeran
Chair, Yuba-Sutter Healthcare Council

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James' follow on comments:

I just want to make it clear; there was no Tom Harkin present, just a staff member from a state office. The information I received was unclear on this point.

The talk was generally pointed at the finance side of things and the conversation never veered from 'how do we pay for changes'.

Thanks, fellows, for your input but as they say 'nothing to see here folks, please move along'

Best regards,

James N.

Ignacio Valdes Editorializes on HIMSS response to HR 6898

Ignacio Valdes is the editor of Linux Med News and has been a proponent of open source in health care. He recently posted this notice of his editorial to the Open Source Working Group of the American Medical Informatics Association. It (and associate posts at LMN) may or may not be of interest:

"Health Information and Management Systems Society HIMSS has presented their response http://linuxmednews.com/PDFs/Final_HIMSS_Response_to_HR_6898.pdf to H.R. 6898 which favors open source software and Veterans Affairs VistA: '...The private sector makes significant investments in research and development for healthcare IT products. Healthcare IT is available via a competitive market in which vendors compete on the basis of price, quality, and functionality of a product. The development, routine updating, and provision of an open source "healthcare information system" is not the role of the federal government and such product development should remain in the private sector...'

I have penned a saucy little editorial response here: http://linuxmednews.com/1222727586/index_html

-- IV

Medsphere and Tolven to 'Surround, Supplement, and Renew' VistA

Posted by ED

Ignacio Valdes [[email protected]], editor of Linuxmednews.com, sent a pointer and some comments out to the American Medical Informatics Association Open Source Workgroup which might be of interest to those in the Medical Banking industry. Tolven participated in a recent Medical Banking Project event.

Medsphere and Tolven announced ( article here ) at the annual HIMSS show that they will form a new partnership to "Surround, Supplement, and Renew" VistA as a viable platform for forward thinking health care organizations. The announcement is loaded with buzz-words, but a close read implies that Medsphere is attempting to reach out to other providers to include them in their currently non-existent ecosystem.

This has potentially very interesting ramifications for VistA which has been languishing for nearly a decade. I believe it is a race to save the patient with renewed and collective investment versus being overwhelmed into irrelevance by the blistering pace of other, newer technology. This should be a STAT! page to the entire VistA community that more effective collaboration will be required to save this valiant trialblazer.

Link to article: http://linuxmednews.com/1204042379/index_html

Semantic Interoperability on Steriods

Posted by ED

<note>RE: Our friend John Hardin -

Dear Members and C.O.M.B.A.T. Advisory Board,

We received sad news this morning and I felt it was important that you hear it from me. John Hardin, a good friend and confidant, passed away on Friday night. We have few details right now but I talked to his wife, Meggan, this morning and she wanted to relay how much John enjoyed working with our members at MBProject and how much he believed in our cause.

As you may know, John presented at our 3rd National Medical Banking Institute and was instantly recognized with an unusually gifted talent in the area of open source technology. In fact, John was a open source warrior, holding key positions in a number of open source organizations to advance the cause (OASIS, OMG). His final position was at Sun Microsystems, an open source advocate, where he managed B2B initiatives. Most recently, John wrote an analysis of how an innovation in UDEF, created at Lockheed, could facilitate semantic interoperability of medical records. You can find this analysis in our last issue of The Medical Banking Report, July/August 2007, Vol. 4 No. 3.

John chaired our Planning & Design Subcommittee for the C.O.M.B.A.T. Initiative. He architected the design for a medical banking platform that could be used by banks for provisioning healthcare records, fully incorporated in MBProject's response to ONCHIT's RFP in 2005. His work defined "C .O.M.B.A.T. Version 1", and we formally recognized his efforts by awarding him with MBProject's Person of The Year Award in 2006. John introduced MBProject to General Motors, Walt Disney, and the Automotive Industry Action Group, paving the way for the formation of our Joint Taskgroup for Value In Health. His contributions in the new arena of medical banking will be memorialized in our website.

I will personally miss our stimulating and encouraging talks about how to link open source to medical banking, align the stakeholders and how small unknowns can create a "disruptive" force in healthcare that can have ripple effects all over the world for the better. I would be most appreciative if you joined with me in extending our sincerest condolences to the Hardin family during this time of loss. He is survived by his wife, Meggan, and his two sons who live in Kansas City.

Sincerely,
John Casillas
Chair, Medical Banking Institute
Executive Director, Medical Banking Project

John Hardin's colleague from SUN, David Lee Todd, adds this post.</note>

This article was written by MBProject Member, John Hardin, Product Manager, B2B Platforms, Sun Microsystems, Inc. John was MBProject’s “Person of the Year Award” in 2006 due to his work in the Planning & Design Subcommittee of MBProject’s C.O.M.B.A.T. Initiative. This article appeared originally in The Medical Banking Report, July/August 2007 Vol. 4, No. 3

As the stage is being set for widespread adoption of clinical record document sharing capabilities, sometimes referred to as Regional Healthcare Information Organizations (RHIOs) or Healthcare Information Exchanges (HIEs), there is a growing number of standards that are competing to provide the payload document formats. These standards include the Continuity of Care Record from ASTM, the HL7 CDA and the XDS-Medical Summary from IHE, among others. Additionally, the interview published by Health-IT World. The article provides excellent insight to many of the issues and opportunities associated with EHR.

As adoption grows, the number of disparate formats creates a lack of interoperability across platforms and applications. If your E.H.R. application produces a CCR as output to share information about a patient, but the care provider that you are sharing with uses an E.H.R. that accepts / produces a HL7 CDA format, then the two can’t communicate electronically. This then creates the requirement for a mapping, transformation and integration project to link the two documents, translating from one to the other and back again. Multiply this times the size of the medical industry, even in a single region, and the result is such a lack of interoperability that the applications become ineffective at sharing data, and the entire objective of the build out becomes difficult to meet.

Some collaboration between these groups is happening, however, there may still be a condition where we don’t have a single standard.... Obviously, this is a problem across all of IT, encompassing most software applications and nearly every industry. It has single-handedly spawned the entire Integration software industry, and complex frameworks are being built to facilitate the processes of transformation and delivery of documents that are different in format, and use different terms to name the data elements. A further difficulty arises as each of those standards bodies improve on or change from one version of the document format to the next. These changes can break the mapping and transformation code, which then require more development to stay current. This is an exponentially increasing problem, which won’t be solved until either every software application that needs to exchange data uses the same formats, or a bridging solution can be implemented to cross the gap between formats.

The problem has a simple explanation: different names for the same data concepts, and is closely related to the formation of ontologies or taxonomies. The solution is termed Semantic Interoperability. The Universal Data Element Framework (UDEF) proposes to solve this problem by adding an attribute, in the form of an alphanumeric tag, to every data element in each format. This would provide a common identifier for each data element concept in each document, which can then be programatically analyzed and matched, then transformed, by software. This will be a major change from the mostly human-based analysis, coding, testing and implementation effort that characterizes current integration projects. Also of note is the fact that the UDEFID’s are alphanumeric, allowing them to also provide bridges across language translations (from English to Korean, for example).

As an example, let’s take a few data elements from the healthcare ontology and make a comparison, then explain how the UDEF tag will help bridge the gap:

UDEF ID’s are assembled based on trees of Object words and Property words, such as: Person (object word...) and Name (property word...). These top level words then have infinitely expandable trees under each, where we can use the deeper level detail to specify a more accurate description of the exact data element concept. Each word in the trees is assigned a letter or number, and these are then strung into tags where an underscore separates the Object side from the Property side.

Some examples from the recent additions to the UDEF trees, meant to support the Electronic Health Record interoperability:

So where we might have one format that calls the Patient Identifier <patientid>, and another format calls it <identitynumber>, there would be a match found when each added the UDEFID attribute to the data element:

<patientid UDEF ID = au.5_13.35.8>, and <identitynumber UDEF ID = au.5_13.35.8>

This then allows software companies to develop applications that automatically find the matches and transform from one format to the other with much greater efficiency. One estimation of time savings, coming from a very large integration project that used a similar method to the UDEF, found that nearly 60% of all data elements could be matched. This saved a tremendous amount of time and effort on the human programmer side of the project.

The UDEF was originated in the Aerospace Industry, by Ron Schuldt at Lockheed Martin. It matured in the Aerospace Industry Association’s Electronic Enterprise Working Group, who exposed the idea to standards bodies as a potential solution to the growing problem of semantic interoperability. It was eventually picked up to be promoted, improved and stewarded by the Open Group. Information on the project at Open Group can be found at http://www.opengroup.org/udef/. Chris Harding ([email protected]) is the project manager for the UDEF.

Current efforts for the UDEF include an Electronic Health Record Vendor Challenge, and a broader Vendor Interoperability Challenge. There are also a number of subject matter experts working to expand the trees of the UDEF so that it is usable by a wide variety of industries, projects to build globally available registries for the UDEF trees, and efforts to create online tools to manage the trees and any updates to them. Eventually, the UDEF will live permanently in the internet cloud, acting much as the DNS system now behaves. From the E.H.R. Vendor Interoperability Challenge email sent out recently:

The challenge to vendors is to deliver semantic interoperability, and to demonstrate this by using Electronic Health Record Data Exchange as an example problem area. Many companies and government organizations are in the process of making plans to support Electronic Health Records as part of the President’s Health Information Technology Plan announced during his State of the Union Address in January 2004 http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html

The problem is that many existing data exchange standards exist for the medical field such as those listed at http://www.ushik.org/registry/x/ and medical systems used today, within hospitals and doctor’s offices, do not support the same set of standards. These disparate systems are now expected to feed an electronic health record for each individual. The detailed scenario and other requirements are available from The Open Group UDEF Project Web site after self-subscribing for free to the UDEF Interested Parties – see http://www.opengroup.org/udefinfo/ for the link.

The Open Group believes that the UDEF can help solve this dilemma but vendors need to step forward with UDEF-based solutions that enable semantic interoperability between disparate systems.

Overall, the entire concept and project is maturing rapidly, and is gathering an enthusiastic following of developers, managers and others. I would suggest that the Medical Banking Project could provide an additional proof of the usefulness of the concept, by encouraging adoption of the UDEF by healthcare IT vendors, and potentially demonstrating it’s advantages within the COMBAT or a related MBP project.

You can download the UDEF definitions, in XML or in RDF format, for use in your enterprise. To do this, you must join the UDEF Interested Parties Group. Membership in this group is free. As well as enabling you to download the UDEF definitions, it will give you access to more information about the UDEF, and allow you to contact other users of the UDEF, and UDEF experts.

For more information, please refer to the UDEF home page at the Open Group, and consider joining the effort.