Archive for the ‘meaningful use’ Category

Halamka: Rethinking Certification

October 2, 2013

Dr. Halamka of BIDMC has been a supporter of the ONC and their quest for meaningful use. He has been a “no whining, just solutions” voice in the industry, helping the ONC gain at least a little bit of traction to test their Meaningful Use wings.  I applaud him for his patience and stoicism,   but also now welcome his constructive criticisms of the meaningful use guidelines.   He calls for the ONC to make up it’s mind on which standards to use. Hear! hear!


We have recently re-visited our schedule for meeting meaningful use and put in a list of high/medium/low priorities for what tasks we have left. The tasks that are uniformly low on our priority list are functions such as “reporting to immunization health agencies”.  We run a cancer clinic. We MIGHT give out a flu shot or two, but we are not giving assays of immunizations to two year-olds.

Another feature is the displaying of growth charts. Why do we need to clutter our interface so that you can display a pediatric growth chart when our patients are reliably all over 20? The are just two examples of the ‘plumpness’ that still exists in the meaningful use guidelines that is nearly irrelevant to the success of medical specialty software.


And it is clear why such requirements are there. Our politicians want to show us how to make software by pointing to the horizon and shooting some money out of a cannon.  All of the software vendors start running in the same direction without asking “why?”, or saying “can you check the map again’?”  Instead, they fall in and throw enough money at a problem until all the tests pass. Success.


I can’t put it better than Dr. Halamka about how to foster a better healthcare software ecosystem:

Certifying organizations would not be prescriptive about user interfaces, workflow, or exhaustively test every variation of every option.   Instead, they would certify that an EHR can securely send a precisely formatted clinical summary and securely receive a compliant but less than perfect clinical summary.


How simple, succinct, successful.

Open Medication Datasets

July 11, 2013

In our quest for CCHIT Oncology Certification, we will also be required to be CCHIT Ambulatory EHR certified. This Ambulatory certification has a good amount of overlap with the Meaningful Use requirements, including most of the medication/allergy/drug interaction requirements. I have spent many hours going through medication datasets trying to find the right combination that will give us what we need. This post serves as both a recap of my research for documentation but will hopefully provide a good starting point for others looking for open datasets for medications and allergies.


General medication list requirements include:

1.Keeping  a dataset of prescribable  medications. This list must include at a minimum drug name, generic name, dose, strength and route. This list should be comprehensive and concise enough to provide the prescriber with a terse, yet complete list of medication options.

2. A mechanism for documenting current and past medications and keeping that list up to date.

3. A way for providers to add new prescriptions and send them to the pharmacy as (non-faxed) eRx.

4. A way to provide information on any drug interactions.

5. The ability to create CCD/CDA documents for continuation of care.

6. The ability to accept continuation of care documents from other facilities.

7. Not cost a fortune.


Given the above requirements, two fundamental notions must be captured in the medications dataset: The drug list and a list indicating drug interactions.


Many of the proprietary medication datasets (FDB, Medi-span, etc.) are not open and I am sure they are not cheap.  There are no prices on their website which makes me weary of their pricing strategy. I don’t have time or energy to negotiate pricing and worry about whether I got a good deal.


There are open alternatives, the main one being RxNorm.  This dataset is very comprehensive and is freely available. however, it is more of a translation device between other datasets than a terse, canonical list of medicines.  RxNorm is constructed by collating medicines from many sources, FDA, VA, Gold Standard, SNOMED-CT, even the proprietary medications are linked.  Because of the vast breadth of this RxNorm, it is not immediately suitable for fast data entry.


This is why Kin-Wah Fung of the Lister Hill National Center for Biomedical Communications, NLM has led the effort to create RxTerms. RxTerms is a curated list of drugs derived from information in RxNorm and is designed for efficient provider data entry. The medication names are distinct, concise and include the required information for prescribing. And each medication or concept in RxTerms links to corresponding concepts in RxNorm. Here is a great demo of their work.

However, RxTerm was not designed to directly provide drug interaction data.


For medication interaction data, we will be using the NDF-RT dataset, created and maintained by the U.S. Department of Veterans Affairs, Veterans Health Administration (VHA). This dataset is linkable to both RxNorm and RxTerm and is also freely available.

The queries will be a bit cumbersome but all of the needed data is there. You can try the demo of this interaction mapping at the RxMix site.


With these two datasets, RxTerms and NDF-RT, we will be able to provide concise lists of medications to our providers, check drug interactions and transmit and receive continuation of care documents to and from external providers or HIEs.


Ankhos is Paperless; Next step: CCHIT Oncology Certification

April 30, 2013

I am proud to report that we have reached a major implementation milestone in the development of Ankhos: no new paper is going into any chart! All new patient referral material is being scanned and all incoming documents are reviewed and signed electronically… and our users love it.


We have had our nose to the grindstone for 2+ years and it is now time to look up and make sure we are headed in the right direction.


In the light of the recent meaningful use audits, I think it was a good decision to finish these core features before attempting meaningful use certification.   The physicians I work with are quickly realizing that it is much easier, desirable and predictable to squeeze money out of increased productivity than to hope that the government hands us a check (and doesn’t take it back).  While we are still headed towards meaningful use, we are going to take a short detour – to CCHIT Ambulatory Oncology Certification. 


It’s not that large of a detour either. Because we started with the fundamentals of oncology: regimens, propagating dose changes, a timeline-oriented mentality, and a strong drug administration workflow, we are probably 85-90% towards complete test script coverage.  Having the CCHIT seal of approval for both oncology and meaningful use should help this rocket take off even faster.


Are we and EMR vendor? I’m not sure anymore. I’m beginning to think of us as an Oncology Software Vendor.

NYT article on EMR profitability

January 11, 2013

An unsurprising NYT article about the undelivered promise of electronic medical records.

This apparent lack of financial benefit probably has some legs.  The fact that records become electronic is irrelevant if the underlying medical practices and workflows are inefficient.  Part of our role in developing Ankhos has been to either 1. Fit the workflow of the office or 2. Develop software around what the practice (The people: nurses, MDs, admins) want the workflow to be. The workflow will then morph to fit the space granted by the software.

I am certain that the fantastic savings are not being seen in the greater industry because they are using software that constrains them, not sets them free. You can blame HIPAA, HITECH and… the incentive money.

The MU incentive money is really just a flashy hand-wave to distract from the 2015 medicare cuts that are coming. It also allows software companies to sell software to unprepared and under-informed doctors that will only hurt their practices. I don’t smell malfeasance, just incompetence or more likely ignorance.

It is likely the case that EMR/EHR are not the profit panacea because the connection between EMR and profit is correlation, not causation. I believe it is good old fashioned leadership and employee engagement that drive success, not some computer program.

Meaningful use certification for 2014

October 4, 2012

It has come time for us to work seriously towards Meaningful Use certification.  We have decided to set our target to the 2014 certification rules. I have spent a great deal of time reading the ruling and searching for information. I’m sure others are, as well, so I am providing some of the links I have found.

Our plan is to start with a Base EHR certification and become fully certified as we implement more of the requirements.

In doing research, I investigated other certified EHR systems. It became apparent to me that these systems were developed with a mindset that started with these rules.  Ankhos has been developed from day one with the nurses, doctors and clinic staff in mind.

We have usability features in Ankhos that we will have to remove for compliance. But I would rather have that problem than the problem of making a compliant piece of software usable.

Not bad – opinion

Quick summary

Short cheatsheet

Some slides

[Edit: cleaned up the links, was in a rush]




I found a great set of slides

Illustrative EMR word cloud

March 15, 2010

A word cloud can be created by analyzing a set of words and tallying up how often each word appears. You then increase the font of the word (or other such things) and compose them together to show what the gist of this set of words is.

Here is a neat one of the healthcare debate.  I daresay that nothing here is surprising. I’m sure we could all recreate the sentences from which each of these words were pulled.

(This was linked to by my real life and Twitter friend @IamAru)  who is great about linking interesting tech, business and science articles.

For all the Health IT nerds out there…

March 9, 2010

John from EMR and EHR posted this surprisingly well-performed video of a rap… yes… a rap, (as in beatbox, Fresh Prince and Biggy) about the meaningful use guidelines. (link)

Oncology EMR: The human element

January 25, 2010

I’ve said it before and I’ll say it again. Enthusiastic clients are  a huge part in creating quality software.  I read the Daily WTF often (as most programmers should). This blog reminds me of all the things that can  easily go wrong with a software project if you don’t keep your head on straight and learn to side-step people eager to get in the way. It also makes me constantly appreciate the doctors and nurses with whom I am writing this software. Without their expert and creative input, this project would be a lost cause.

It is this human element; the creativity, expertise and enthusiasm of people that makes Ankhos great.

If you have an EMR vendor who is not excited to work with you, don’t just walk to the nearest exit. Run. If you have an EMR vendor who works very closely and listens to your needs, cherish them and count yourself lucky. If you are looking for an oncology EMR product developed by and for oncologists, stay tuned. Drop us a line, or provide feedback. Ankhos  will deliver.

More screenshots coming soon…

The future of meaningful use

January 22, 2010

As with most engineering/planning professions, part of my job is to build into my project the capability to accommodate moderate, somewhat forseen changes. In software, this requires designing data structures and logic flows in such a way that they can be easily modified to fulfill future requirements.

For many EMR product vendors, meeting meaningful use guidelines  is their requirement.  For my client, improved safety and efficiency are the main requirements. Whose requirements are more likely to change? The requirements ”standardized’ by the government?  (a entity designed to be in constant flux) or the requirements of the compounded expertise of doctors, nurses and administrative experts in the field?

As a programmer, I always assume that requirements will change to some degree and I am sure that these meaningful use guidelines are no different.  As with nearly everyone else, I think that the guidelines won’t be met to any significant degree this year, or probably by 2014. Will the guidelines stand and roll on to the penalties in 2015 or will lawmakers listen expert advice and change the guidelines?

Let’s be optimistic. Let’s say they listen to the experts. What are the meaningful use guidelines 6 or 9 months from now? How can lawmakers describe their intent to us without dictating crippling specifics that might not even be relevant with furture technologies? How can we infer  ‘Desired Functionality‘ from these ‘Meaningful Use‘ guidelines? If we can do that, maybe we can make good guesses about what future specifc requirements might be.

Cynics will say that all of this hubub is so the government can dictate your practice. A believer would tell you that the government wants to humbly ask for some patient data (and a glass of milk) so that it can make people safer. I think both the cynic and the believer are right, because they both describe a situation where the government wants your information. And they don’t want just YOUR information, but the information of with whom you consult, what drugs you use, whether they should fire one of your employees for a mis-treatment, the list goes on.

So let’s rename “Meaningful Use ” guidelines to “Information reporting ” requirements. Maybe with this mindset we can stay out of the quagmire of the specifics of meaningful use, but leave thMeaningful usee door open for the inevitable reporting requirements down the road.

From EMR and EHR: easy meaningful use matrix

January 15, 2010

John from EMR and EHR posted a link to a great 12 page pdf of the meaningful use guidelines. I thought it deserved a link.