The effort to keep the chickens/ducks/guinea fowl safe from the hawks has had its own complications. We originally built the coop (10x16) and pen (10x20) to hold less than 50 birds. Although it�s easy to limit population growth of chickens and ducks (collect the eggs), the guineas lay eggs in hidden forest nests. Our 25 guineas became 70 guineas over the Summer. The coop today has 64 guineas and 11 chickens - 75 birds in close proximity. Normally they roost from dusk to dawn and are running around the farm during daylight hours. By limiting them to the coop during hawk hunting hours, they have less free outdoor time. The consequences are that they have increased proximity and less fresh air movement.
Chocobo, one of our Buff Orpington chickens, is low on the pecking order. This week, while confined, she was pecked by other birds and had mild bleeding of her comb. We cleaned her up, applied Vetericyn (a spray on antibiotic), and isolated her into the mini-coops we use for raising young birds. She�s healed nicely.
Snow, one of our Brahma chickens, developed an upper respiratory infection and began sneezing violently. We�ve done our best to keep the coop open on cloudy days. We�ve dug out all the bushes (buried under 7 feet of ice) that the poultry uses to hide from hawks. Given that Boston just broke all historic winter records, that�s been an ongoing battle. Snow the chicken is doing well now that she has more outside time.
I�ve tried very hard to minimize travel this year, but I was asked to join an important strategic planning session at a foundation in California, support one of our industry partners by giving a keynote in Dubai, and chair the Standards Committee in Washington. Kathy has had to keep the farm running during my time away. The dogs miss me and we tend to defer maintenance tasks and the more physical projects until my return. Balancing my various work tasks, my farm tasks and travel makes me want to use Skype as much as possible, minimizing travel time so that I can serve all the organizations, people, and creatures in my life instead of sit in airports.
As a farmer, my role is maximize the life quality of every creature on the farm. As a CIO, my role is to make a difference with my staff, my country, and the world. In 2014, we acquired all the technologies necessary to maximize farming efficiency, enabling me to use my nights and weekends most wisely. As we ramp up production and scale, we may need to bring on some part time help to support Kathy when my job responsibilities fill the 24 hour day.
Our Spring planting is now done, both hoop house seed planting and indoor seedling germination. The BIDMC COO asked why my fingertips are cracked. My upper extremities are now farmer�s hands and not surgeon�s hands.
I look forward to the thaw of the next few weeks and exciting projects we have planned for late spring including new mushroom production, tree planting, fence mending, wiring the cider house to support the move from hand cranked tools to powered tools, and replacing the 30 year old farm driveway.
In our modern era, each of us will have 5 or more jobs. My heart leads me to farming but my brain drives me to make a difference on as large a scale as possible. For many years to come, I will shovel manure on nights and weekends while �fertilizing� ideas in my technology day jobs.
Kamis, 19 Maret 2015
Rabu, 18 Maret 2015
The March HIT Standards Committee
The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had. No, it was not the release of Meaningful Use Stage 3 or the certification rule. It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman�s work in both areas.
We started the day with an overview of current security risk presented by Ron Ross, National Institute of Standards and Technology (NIST). Admittedly I missed that presentation. Although my flight from Dubai to Washington was early, Metro was shutdown due to an equipment failure at the Rosslyn station. I�m told it was a sobering overview of the increased threats we all are facing.
Next, Dawn Heisey-Grove provided an overview of progress on the most difficult aspects of Meaningful Use Stage 2 - transitions of care, patient/family engagement, electronic medication administration records, and public health data submission. Progress is being made in all areas.
Evelyn Gallego-Haag presented a progress update on the Electronic Long Term Support Services (eLTSS). Committee members offered two kinds of advice. Care plan development and exchange maybe an �app� and not a standard. If a standard is needed, existing standards should be leveraged instead of creating a new approach.
Stan Huff and Arien Malec presented a work of art - the Standards and Interoperability (S&I) Initiative Task Force Recommendations . Their guiding principles were welcomed by all - ONC does need a convening function for aligning SDO work and national priorities, but standards making should be left to SDOs. Prioritization must be multi-stakeholder and not dominated by any one entity. We must align demand with the reality of the supply of mature standards. The S&I Framework can be re-chartered with these new guidelines and will represent the third generation of standards harmonization efforts, building on the lessons learned from HITSP and the existing S&I efforts.
Next we heard a series of reports from workgroups reviewing the ONC Interoperability roadmap.
Liz Johnson and Cris Ross provided the perspective of the Implementation, Certification, and Testing workgroup. The most important aspect of the presentation was the cleanup of CCDA, reducing optionality. CCDA R2 will be much easier to parse than CCDA R1.
Andy Wiesenthal and Rich Elmore summarized the work of the Content Standards workgroup.
Jamie Ferguson presented the work of the Semantic Standards workgroup.
Dixie Baker and Lisa Gallager presented the recommendations of the Transport and Security Standards workgroup.
Next we heard the most important presentation thus far in 2015, Arien Malec and David McCallie presenting the work of the Architecture, Services, and APIs workgroup. The key recommendation was aligning healthcare standards with the approach that has been used by the groups creating internet standards - bring running code and embrace phased improvement in real world implementations. They elegantly categorized the work to be done on existing standards while transitioning to a broad implementation of future standards - FHIR, OAuth2, and REST. The entire Standards Committee applauded the effort which contains enough detail to implement now. It provides all the interoperability planning detail that Congress has been asking for. We declared the effort, a yellow brick road leading to standards nirvana, with courage, wisdom and heart (ending with finished FHIR specifications from the land of Oz)
The day ended with a roadmap for Quality Measurement standards presented by Julia Skapik.
After the Standards Committee meeting, many joined the Argonauts steering committee meeting to hear and updated on the accelerated effort to bring FHIR/OAuth2/RESTful application program interfaces to most mainstream EHRs. It�s on track through the diligent efforts of many dedicated participants.
Today was a banner day for healthcare interoperability. In the next days to weeks as Meaningful Use Stage 3 NPRMs are released, we all hope that the frameworks presented today can be applied to the policy goals of emerging regulations.
We started the day with an overview of current security risk presented by Ron Ross, National Institute of Standards and Technology (NIST). Admittedly I missed that presentation. Although my flight from Dubai to Washington was early, Metro was shutdown due to an equipment failure at the Rosslyn station. I�m told it was a sobering overview of the increased threats we all are facing.
Next, Dawn Heisey-Grove provided an overview of progress on the most difficult aspects of Meaningful Use Stage 2 - transitions of care, patient/family engagement, electronic medication administration records, and public health data submission. Progress is being made in all areas.
Evelyn Gallego-Haag presented a progress update on the Electronic Long Term Support Services (eLTSS). Committee members offered two kinds of advice. Care plan development and exchange maybe an �app� and not a standard. If a standard is needed, existing standards should be leveraged instead of creating a new approach.
Stan Huff and Arien Malec presented a work of art - the Standards and Interoperability (S&I) Initiative Task Force Recommendations . Their guiding principles were welcomed by all - ONC does need a convening function for aligning SDO work and national priorities, but standards making should be left to SDOs. Prioritization must be multi-stakeholder and not dominated by any one entity. We must align demand with the reality of the supply of mature standards. The S&I Framework can be re-chartered with these new guidelines and will represent the third generation of standards harmonization efforts, building on the lessons learned from HITSP and the existing S&I efforts.
Next we heard a series of reports from workgroups reviewing the ONC Interoperability roadmap.
Liz Johnson and Cris Ross provided the perspective of the Implementation, Certification, and Testing workgroup. The most important aspect of the presentation was the cleanup of CCDA, reducing optionality. CCDA R2 will be much easier to parse than CCDA R1.
Andy Wiesenthal and Rich Elmore summarized the work of the Content Standards workgroup.
Jamie Ferguson presented the work of the Semantic Standards workgroup.
Dixie Baker and Lisa Gallager presented the recommendations of the Transport and Security Standards workgroup.
Next we heard the most important presentation thus far in 2015, Arien Malec and David McCallie presenting the work of the Architecture, Services, and APIs workgroup. The key recommendation was aligning healthcare standards with the approach that has been used by the groups creating internet standards - bring running code and embrace phased improvement in real world implementations. They elegantly categorized the work to be done on existing standards while transitioning to a broad implementation of future standards - FHIR, OAuth2, and REST. The entire Standards Committee applauded the effort which contains enough detail to implement now. It provides all the interoperability planning detail that Congress has been asking for. We declared the effort, a yellow brick road leading to standards nirvana, with courage, wisdom and heart (ending with finished FHIR specifications from the land of Oz)
The day ended with a roadmap for Quality Measurement standards presented by Julia Skapik.
After the Standards Committee meeting, many joined the Argonauts steering committee meeting to hear and updated on the accelerated effort to bring FHIR/OAuth2/RESTful application program interfaces to most mainstream EHRs. It�s on track through the diligent efforts of many dedicated participants.
Today was a banner day for healthcare interoperability. In the next days to weeks as Meaningful Use Stage 3 NPRMs are released, we all hope that the frameworks presented today can be applied to the policy goals of emerging regulations.
Kamis, 12 Maret 2015
Unity Farm Journal - Second Week of March 2015
The thaw has begun. This week, for the first time in 2015, we�ll have daytime temperatures above freezing. The 8 foot snowbanks are starting to recede, although the Great Pyrenees can still look down on the 6 foot fences.
As the snow melts, creatures are becoming more active. Birds are gathering hay for nesting (I cleaned out all the birdhouses in February), skunks have wakened from the dormant state and are wandering around the farm (I can smell them), and the fisher cats are prowling around the barn at night looking for prey. The dogs have been barking for hours every night, keeping the barnyard animals safe from predators. This morning, I noticed fisher cat tracks around the entire poultry area. Everyone is safe and healthy.
It�s Spring planting time, and last weekend was spent creating our transplant stock in anticipation of hoop house planing over the next 2 months. Although I directly seed many of the vegetables into raised beds, the heat loving plants are germinated indoors. This year that includes
Cucumbers - 12 large pots
Peppers - 24 small pots
Broccoli - 12 small pots
Eggplant - 12 small pots
Zucchini - 4 large pots
Kabocha Pumpkin/Squash- 5 large pots
This weekend, I�ll finish planting the spring greens - 3 different kinds of spinach and 5 different kinds of lettuce.
The Federal Alcohol and Tobacco Tax and Trade Bureau is nearly ready to approve our cider making application as a bonded cider winery. I�ve made 8 different kinds of hard ciders as test batches for personal consumption and once licensed, we can ramp up production. We�ll have 6000 pounds of apples each season in the next few years. I�ve been designing a premium beverage - Halamka�s India Pale Ale with Apple - HIPAA. It builds strong bodies twelve ways and protects your privacy!
I�m off to Dubai on Saturday night to give a keynote and Kathy will be running the farm until Tuesday. I really hope the fast melting snow does not become a fast melting flood in my absence.
As the snow melts, creatures are becoming more active. Birds are gathering hay for nesting (I cleaned out all the birdhouses in February), skunks have wakened from the dormant state and are wandering around the farm (I can smell them), and the fisher cats are prowling around the barn at night looking for prey. The dogs have been barking for hours every night, keeping the barnyard animals safe from predators. This morning, I noticed fisher cat tracks around the entire poultry area. Everyone is safe and healthy.
It�s Spring planting time, and last weekend was spent creating our transplant stock in anticipation of hoop house planing over the next 2 months. Although I directly seed many of the vegetables into raised beds, the heat loving plants are germinated indoors. This year that includes
Cucumbers - 12 large pots
Peppers - 24 small pots
Broccoli - 12 small pots
Eggplant - 12 small pots
Zucchini - 4 large pots
Kabocha Pumpkin/Squash- 5 large pots
This weekend, I�ll finish planting the spring greens - 3 different kinds of spinach and 5 different kinds of lettuce.
The Federal Alcohol and Tobacco Tax and Trade Bureau is nearly ready to approve our cider making application as a bonded cider winery. I�ve made 8 different kinds of hard ciders as test batches for personal consumption and once licensed, we can ramp up production. We�ll have 6000 pounds of apples each season in the next few years. I�ve been designing a premium beverage - Halamka�s India Pale Ale with Apple - HIPAA. It builds strong bodies twelve ways and protects your privacy!
I�m off to Dubai on Saturday night to give a keynote and Kathy will be running the farm until Tuesday. I really hope the fast melting snow does not become a fast melting flood in my absence.
Rabu, 11 Maret 2015
Outcomes as a Service
On Monday, I wrote a brief op-ed for the Wall Street Journal about the reality of cloud computing. You can read the full article here.
I classified cloud computing in three different concepts
Infrastructure as a Service (IaaS) - your applications outsourced to someone else�s servers.
Platform as a service (PaaS) - a set of foundational software tools for building your applications on someone else�s servers and software.
Software as a service (SaaS) - a set of applications, created and operated by a third party which does not require installation of local hardware or software. You subscribe to comprehensive remotely hosted functionality.
I concluded that outsourcing your mess to someone else to host is not cloud computing.
Instead IT leaders should focus on a variation on SaaS, which I called �Outcomes as a Service�. Software and hardware are one component, but the combination of business processes, people, and technology work in concert to achieve a desired result. Payment is made when that result is delivered. Examples are the athenahealth EHR/practice management/billing service, the Cornerstone Learning Management System service, and the Workday financial applications.
CIOs throughout the country are struggling with IT scalability - the capacity to meet the automation needs of the business given regulatory demands (ICD10, Meaningful Use, HIPAA Omnibus Rule, Affordable Care Act), limited time, and relatively fixed resources.
Often IT is asked to delivered unplanned work, within current budgets, and without disrupting current projects in process. It�s like asking 9 women to gestate a baby in 1 month.
One of the few ways that a CIO can stay sane (other than resource leveling and governance, which I discussed last week ) is to have the flex capacity to deliver outcomes for a price.
The business can be told that an Outcomes as a Service provider exists and the business can have as much of that service as they can pay for. The CIO enables the service but does not provision it or operate it.
As I�ve written about before, the CIO�s role is increasingly diverse. I�ve watched CIOs crumble under the strain the job, which often seems overwhelming - demand exceeding supply, constant change with complete reliability, and perfect security with ubiquitous access.
Relying increasingly on Outcomes as a Service vendors, freeing up the CIO to spend more time with business owners and governance activities, is likely one of the most successful tactics to enhance CIO job retention and satisfaction.
I classified cloud computing in three different concepts
Infrastructure as a Service (IaaS) - your applications outsourced to someone else�s servers.
Platform as a service (PaaS) - a set of foundational software tools for building your applications on someone else�s servers and software.
Software as a service (SaaS) - a set of applications, created and operated by a third party which does not require installation of local hardware or software. You subscribe to comprehensive remotely hosted functionality.
I concluded that outsourcing your mess to someone else to host is not cloud computing.
Instead IT leaders should focus on a variation on SaaS, which I called �Outcomes as a Service�. Software and hardware are one component, but the combination of business processes, people, and technology work in concert to achieve a desired result. Payment is made when that result is delivered. Examples are the athenahealth EHR/practice management/billing service, the Cornerstone Learning Management System service, and the Workday financial applications.
CIOs throughout the country are struggling with IT scalability - the capacity to meet the automation needs of the business given regulatory demands (ICD10, Meaningful Use, HIPAA Omnibus Rule, Affordable Care Act), limited time, and relatively fixed resources.
Often IT is asked to delivered unplanned work, within current budgets, and without disrupting current projects in process. It�s like asking 9 women to gestate a baby in 1 month.
One of the few ways that a CIO can stay sane (other than resource leveling and governance, which I discussed last week ) is to have the flex capacity to deliver outcomes for a price.
The business can be told that an Outcomes as a Service provider exists and the business can have as much of that service as they can pay for. The CIO enables the service but does not provision it or operate it.
As I�ve written about before, the CIO�s role is increasingly diverse. I�ve watched CIOs crumble under the strain the job, which often seems overwhelming - demand exceeding supply, constant change with complete reliability, and perfect security with ubiquitous access.
Relying increasingly on Outcomes as a Service vendors, freeing up the CIO to spend more time with business owners and governance activities, is likely one of the most successful tactics to enhance CIO job retention and satisfaction.
Kamis, 05 Maret 2015
Unity Farm Journal - First Week of March 2015
The snow, ice and sleet continues. February was the snowiest month we have ever had in Boston had with 64.8 inches. It was also the second-coldest February on record.
I�ve attacked the endless frozen tundra of Unity Farm with the Terex front loader,an ice chipper, and a stainless steel SnowEx salt/sand spreader. I try to use Calcium Chloride or a Magnesium Chloride mix which is safer for the plants and animals. We�ve gone through 250 pounds of salt and 250 pounds of sand every weekend in 2015. The March weather thus far has varied between a high of 43 and a low of zero F. The snow melts a bit, then refreezes. It�s like chunky concrete at this point. The industrial sized snowblower attachment for the Terex arrives this weekend, but I�m not sure a snowblower can help with the glaciers that now surround the farm. Next year, I�ll move the powder before it becomes a solid.
The bees continue to struggle with the record low temperatures and precipitation. We started the winter with 11 living hives and now we have 7. In the Spring, we�ll refill a few of the hives by moving a portion of the bees and queens from existing hives to empty hives - a kind of forced swarming. The queen-less hives will make new queens. We�ve also ordered some �mini-hives� of overwintered Russian bees from Western Massachusetts. These small hives are called a �nucleus� or �nuc�. I�m sure that folks overhearing our conversation were worried when my wife announced that she purchased two Russian Nukes.
Last week, I wrote about my conversation with the hawk that visited the chicken coop and killed a guinea. The hawk did not return, but unfortunately, it told two even larger friends about the coop. Kathy noticed an enormous hawk sitting on the coop roof one morning. Last weekend, I found the dismembered body of Belle, the duck who we nursed back to health after a serious eye infection. The hawks broke her next and ate about half of her upper body. I buried her under 6 feet of snow, since I cannot dig the frozen ground.
We�ve changed the daily schedule for all the poultry at Unity Farm. During the lean times for the predators, when all natural food sources are covered with snow, we�ll keep all the coops and pens locked until 4pm each day, since the peak of the hunting seems to occur between 9am-3pm. Once the snow melts and the trees begin to leaf out, we�ll restore the usual daylight freedom that the poultry have always enjoyed. Our task as farmers is to maximize the quality of life of the creatures at Unity farm, while also keeping them alive!
We�ve ordered all our seeds for 2015, so hopefully I can plant peas next week and begin to prepare the overwintered raised beds for the Spring growing season ahead.
I�ve attacked the endless frozen tundra of Unity Farm with the Terex front loader,an ice chipper, and a stainless steel SnowEx salt/sand spreader. I try to use Calcium Chloride or a Magnesium Chloride mix which is safer for the plants and animals. We�ve gone through 250 pounds of salt and 250 pounds of sand every weekend in 2015. The March weather thus far has varied between a high of 43 and a low of zero F. The snow melts a bit, then refreezes. It�s like chunky concrete at this point. The industrial sized snowblower attachment for the Terex arrives this weekend, but I�m not sure a snowblower can help with the glaciers that now surround the farm. Next year, I�ll move the powder before it becomes a solid.
The bees continue to struggle with the record low temperatures and precipitation. We started the winter with 11 living hives and now we have 7. In the Spring, we�ll refill a few of the hives by moving a portion of the bees and queens from existing hives to empty hives - a kind of forced swarming. The queen-less hives will make new queens. We�ve also ordered some �mini-hives� of overwintered Russian bees from Western Massachusetts. These small hives are called a �nucleus� or �nuc�. I�m sure that folks overhearing our conversation were worried when my wife announced that she purchased two Russian Nukes.
Last week, I wrote about my conversation with the hawk that visited the chicken coop and killed a guinea. The hawk did not return, but unfortunately, it told two even larger friends about the coop. Kathy noticed an enormous hawk sitting on the coop roof one morning. Last weekend, I found the dismembered body of Belle, the duck who we nursed back to health after a serious eye infection. The hawks broke her next and ate about half of her upper body. I buried her under 6 feet of snow, since I cannot dig the frozen ground.
We�ve changed the daily schedule for all the poultry at Unity Farm. During the lean times for the predators, when all natural food sources are covered with snow, we�ll keep all the coops and pens locked until 4pm each day, since the peak of the hunting seems to occur between 9am-3pm. Once the snow melts and the trees begin to leaf out, we�ll restore the usual daylight freedom that the poultry have always enjoyed. Our task as farmers is to maximize the quality of life of the creatures at Unity farm, while also keeping them alive!
We�ve ordered all our seeds for 2015, so hopefully I can plant peas next week and begin to prepare the overwintered raised beds for the Spring growing season ahead.
Rabu, 04 Maret 2015
Resource Leveling
In an era when demand for IT services always exceeds supply, it�s important to triage incoming requests and allocate existing resources to completing the highest priority projects in the shortest time.
Time, scope, and resources are the only three levers available to a CIO. Scope can be set by governance and steering committees, but time and resources often fall to the CIO to allocate.
I have long used the concept of resource leveling, which sets project start and end dates based on available resources.
This year, I�m bringing resource leveling dashboards to all my governance committees so that as new projects are requested, it is clear which projects will be delayed (or not started) by the insertion of new scope.
Expectations of service delivery in 2015 are compounded by the instant gratification of �there�s an app for that, how hard can it be�. Cycle times of 18 months are no longer acceptable. I can reduce the scope of projects by moving as many applications to Software as a Service subscriptions, relying on the scalability of vendors rather than the relatively fixed pool of IT staff, but for the many tasks still only available through internal building, I need to expand the resource leveling accountability beyond the office of the CIO to the business owners, so that the start/end times for projects are not �my� plan but �our� plan.
When the stakeholders have visibility into the allocation of resources, understanding the trade offs that must be made as new regulatory requests, urgent incident response, and unplanned strategic projects are added to the plate, hopefully there will better alignment between expectations and service delivery.
As the entire healthcare industry experiences accelerating change, and pressure to perform in a resource constrained environment increases, it is easy to single out IT as the rate limiting step to success. Over the next 6 months, I hope to turn that conversation around as stakeholders have a role in resource leveling and can broadly communicate the decisions made collectively, providing the greatest IT good for the greatest number of stakeholders in the shortest time.
Time, scope, and resources are the only three levers available to a CIO. Scope can be set by governance and steering committees, but time and resources often fall to the CIO to allocate.
I have long used the concept of resource leveling, which sets project start and end dates based on available resources.
This year, I�m bringing resource leveling dashboards to all my governance committees so that as new projects are requested, it is clear which projects will be delayed (or not started) by the insertion of new scope.
Expectations of service delivery in 2015 are compounded by the instant gratification of �there�s an app for that, how hard can it be�. Cycle times of 18 months are no longer acceptable. I can reduce the scope of projects by moving as many applications to Software as a Service subscriptions, relying on the scalability of vendors rather than the relatively fixed pool of IT staff, but for the many tasks still only available through internal building, I need to expand the resource leveling accountability beyond the office of the CIO to the business owners, so that the start/end times for projects are not �my� plan but �our� plan.
When the stakeholders have visibility into the allocation of resources, understanding the trade offs that must be made as new regulatory requests, urgent incident response, and unplanned strategic projects are added to the plate, hopefully there will better alignment between expectations and service delivery.
As the entire healthcare industry experiences accelerating change, and pressure to perform in a resource constrained environment increases, it is easy to single out IT as the rate limiting step to success. Over the next 6 months, I hope to turn that conversation around as stakeholders have a role in resource leveling and can broadly communicate the decisions made collectively, providing the greatest IT good for the greatest number of stakeholders in the shortest time.
Jumat, 27 Februari 2015
What is the Optimal Future Role for ONC?
As Meaningful Use winds down and incentive dollars are fully spent, what is the optimal role for ONC going forward?
Some pundits have suggested that ONC step aside and return all aspects of HIT policy and technology to the private sector. Others have suggested top down command and control of HIT including centralized governance to ensure interoperability.
Harmony is when all parties feel equally good about the path forward. Compromise is when everyone leaves the table equally unhappy. Here�s my view about the future of ONC that includes points from both sides.
The Argonaut initiative is a good exemplar of the private sector working to enhance interoperability in response to the market demands of accountable care organizations, which depend on data to succeed in a risk contracting world. There is clearly a role for the private sector to lead innovation and standards adoption, and this role will continue to grow as demand for richer interoperability increases and technology matures. However, even the best innovations require a regulatory and ecosystem context to enable the marketplace to blossom. The health care sector is the most fragmented industry in our complicated economy, both on the demand side (patients, insurers, employers) and on the supply side (physician practices and hospitals). ONC can be a focal point for the discussion of regulatory barriers to data liquidity, novel workflows, and alignment of incentives.
In Massachusetts, opioid abuse is a critical public health problem. We believe that collecting all opioid prescriptions at a state government level and sharing that data with licensed caregivers is appropriate. Yet, right across the border in New Hampshire, it�s illegal to share such data with government entities. Similar prohibitions exist on sharing immunization data to prevent measles outbreaks or syndromic survellience data to detect Ebola. Extrapolate this problem out to the various combinations of 56 states and territories and it's an interoperability nightmare for patients, providers, and vendors. ONC can provide national frameworks that enable regional variation but can suggest guardrails so that a federated national network of interoperability and functionality is not impeded.
Canada has 35 million people. Sweden has 10 million. Healthcare IT policymaking that takes into account stakeholder opinions in these countries is easier than resolving the difference of 320 million US residents. Someone needs to be a convener to give voice to the myriad stakeholder priorities of a country that glorifies individual freedom. ONC can be such a convener.
The US government is a large player in the health care market, even aside from any oversight role it might play. Medicare and Medicaid are the largest health insurers in the country. The US government has over 20 million employees whose health benefits it covers. The DoD, VA, and Indian Health Services are large providers of care. The number of federal agencies and the many and varied ways that they affect health care delivery and health information technology is hard to quantify. There is no single front door in the federal government for HIT related strategic planning across agencies. ONC can serve as government agency harmonizer.
Although Accountable Care Organizations now have economic incentives to accelerate interoperability, they do not have specific incentives to focus on healthcare IT usability and the safety of IT tools. We are now at a point where everything that happens in a hospital is somehow tied to information technology. ONC can provide funding to study issues that lack a specific private sector market force, just as NHTSA and NTSB do with auto and airline safety.
Finally, although there are many federal and state laws that protect privacy and security, it is challenging to know how to measure the security of an EHR. By working with other federal agencies to identify best practices, ONC can foster data integrity and promote respect for patient privacy preferences.
Thus, although the private sector can lead innovation and accelerate standards development, the combination of government, industry and academia is needed to optimize our journey. I recently spoke with a cabinet secretary in the Massachusetts government and the person told me �the Baker Administration does not believe in less regulation or more regulation, it believes in right regulation.� The same can be said of the balance between ONC and the private sector. The list of tasks above seems like the �right regulation� to me.
Some pundits have suggested that ONC step aside and return all aspects of HIT policy and technology to the private sector. Others have suggested top down command and control of HIT including centralized governance to ensure interoperability.
Harmony is when all parties feel equally good about the path forward. Compromise is when everyone leaves the table equally unhappy. Here�s my view about the future of ONC that includes points from both sides.
The Argonaut initiative is a good exemplar of the private sector working to enhance interoperability in response to the market demands of accountable care organizations, which depend on data to succeed in a risk contracting world. There is clearly a role for the private sector to lead innovation and standards adoption, and this role will continue to grow as demand for richer interoperability increases and technology matures. However, even the best innovations require a regulatory and ecosystem context to enable the marketplace to blossom. The health care sector is the most fragmented industry in our complicated economy, both on the demand side (patients, insurers, employers) and on the supply side (physician practices and hospitals). ONC can be a focal point for the discussion of regulatory barriers to data liquidity, novel workflows, and alignment of incentives.
In Massachusetts, opioid abuse is a critical public health problem. We believe that collecting all opioid prescriptions at a state government level and sharing that data with licensed caregivers is appropriate. Yet, right across the border in New Hampshire, it�s illegal to share such data with government entities. Similar prohibitions exist on sharing immunization data to prevent measles outbreaks or syndromic survellience data to detect Ebola. Extrapolate this problem out to the various combinations of 56 states and territories and it's an interoperability nightmare for patients, providers, and vendors. ONC can provide national frameworks that enable regional variation but can suggest guardrails so that a federated national network of interoperability and functionality is not impeded.
Canada has 35 million people. Sweden has 10 million. Healthcare IT policymaking that takes into account stakeholder opinions in these countries is easier than resolving the difference of 320 million US residents. Someone needs to be a convener to give voice to the myriad stakeholder priorities of a country that glorifies individual freedom. ONC can be such a convener.
The US government is a large player in the health care market, even aside from any oversight role it might play. Medicare and Medicaid are the largest health insurers in the country. The US government has over 20 million employees whose health benefits it covers. The DoD, VA, and Indian Health Services are large providers of care. The number of federal agencies and the many and varied ways that they affect health care delivery and health information technology is hard to quantify. There is no single front door in the federal government for HIT related strategic planning across agencies. ONC can serve as government agency harmonizer.
Although Accountable Care Organizations now have economic incentives to accelerate interoperability, they do not have specific incentives to focus on healthcare IT usability and the safety of IT tools. We are now at a point where everything that happens in a hospital is somehow tied to information technology. ONC can provide funding to study issues that lack a specific private sector market force, just as NHTSA and NTSB do with auto and airline safety.
Finally, although there are many federal and state laws that protect privacy and security, it is challenging to know how to measure the security of an EHR. By working with other federal agencies to identify best practices, ONC can foster data integrity and promote respect for patient privacy preferences.
Thus, although the private sector can lead innovation and accelerate standards development, the combination of government, industry and academia is needed to optimize our journey. I recently spoke with a cabinet secretary in the Massachusetts government and the person told me �the Baker Administration does not believe in less regulation or more regulation, it believes in right regulation.� The same can be said of the balance between ONC and the private sector. The list of tasks above seems like the �right regulation� to me.
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