This week's post is not about a specific company's technology, but about a concept.
My wife did something very cool for me for Christmas.
Given that 2011 was filled with Hurricanes, Earthquakes, Tornados, Floods, and Fires around the world, she decided to create something that would make us more prepared for whatever the future may bring.
She created a disaster pack for the front hall closet using a Black Diamond Speed 30 mountaineering pack as a "grab and go" answer to any disaster that strikes. It contains 72 hours of food/water, basic medical supplies. a solar powered radio, tools that can be used to harvest wood/start a fire, and extra clothes.
From the point disaster strikes to the point we're in a car with our supplies driving away could be under 60 seconds.
Think about the time it would take to assemble food/water, clothing, and medical gear after disaster strikes - 15 minutes? Half an hour?
I highly recommend a "grab and go" pack as part of your family disaster preparedness plans. Thanks Kathy for building one for us - that's cool!
Friday, 30 December 2011
Thursday, 29 December 2011
Our Cancer Journey - Week 2
It's been two weeks since my wife said "I have cancer" to my daughter.
It's been a week since we described our workup thus far on my blog.
Reaction to our blog post was diverse, ranging from the HISTalk blog to the Boston Globe.
It's a time of anxiety and unanswered questions. The diagnosis and staging phase has been described as one of the two major tension points in cancer. The other is the time after remission, when the worry about recurrence is a constant burden. One of our doctors recommended we keep a "family bottle" of anti-anxiety medication ready for those times when the stress exceeds our capacity to cope. Cancer is truly a family disease and the emotional impact extends from the patient to family caregivers.
Many friends and colleagues have offered prayers and support. A few have lamented that care coordinated by a physician-husband at a Harvard-associated hospital in Boston lacks equity since every wife/mother/daughter may not receive the same care throughout the US. Kathy and I agree. We posted these comments in response to those who speculated that Kathy's care consumes an asymmetric amount of healthcare resources.
John writes:
"At the same time I'm focused on Kathy's care, I'm also deeply committed to quality, safety, efficiency, and equity in healthcare across the country. In the upcoming weeks, I'll describe how the electronic records that coordinate Kathy's treatment provide the same protocols to every BIDMC patient, regardless of insurance status, profession, or income. My goal is the 'right care' - not too much nor too little - that follows best practices based on evidence. Decision support driven 'right care' is the only way we can hope to improve outcomes while bending the cost curve of healthcare spending that threatens the US economy. Universal healthcare supported by universal adoption of electronic and personal health records must be our guiding vision."
Kathy writes:
"My life with John has been entwined for 32 years, so to say "we have cancer" cannot be more completely and utterly correct. True that physically, only one of use has the obvious organic symptoms, but our close partnership has been irrevocably changed by the diagnosis. Whatever lies ahead, it is impossible to go back to that innocent moment before hearing the word "cancer".
I am luckier than most - I have health insurance, and access to a major urban medical center that is also a teaching and research hospital. But, as I encourage John to document our progress publicly in his blog, I am also keeping the memory of a friend close to my heart. She did not have health insurance (as a part time adjunct instructor of art). With this financial barrier, she unwittingly waited until the cancer had spread before seeking medical care, and although she fought bravely, she lost her battle with breast cancer.
Throughout my life, I have not needed medical resources beyond occasional primary care visits and the birth of one child. My first weeks negotiating the barrage of new terminology, new tests, and new doctors was significantly eased by my access to a personal health record. The hospital's electronic health record is important to me, since it empowers my doctors to work as a team with open access to all my clinical data, enabling the team to make the best decisions for my health. As I recall my lost friend, I also think about all patients with a breast cancer diagnosis, or other serious illnesses, and how they manage their care journey if they worry about health insurance, or have no access to a personal health record."
This week we continued the staging process in anticipation of finalizing our care plan (chemotherapy, surgery, radiation oncology) in early January.
On Friday, Kathy went to the operating room for a sentinel node biopsy. This is now the recommended standard of care for cancer staging as it uses radio-isotopes to identify those lymph nodes that directly drain the tumor. The surgeons harvested lymph nodes that were positive for radioactivity and one nearby node that was non-radioactive.
After the surgery I took Kathy home and the first thing she wanted to do was re-expand her lungs, avoiding post operative atelectasis. We walked a few miles around Lake Waban, watched the sunset, and discovered a family of Muskrats seeking their evening meal.
Her post operative pain was helped by gentle exercise and stretching. She took 2 Tylenol before bed. Although the anxiety of the workup has interrupted her sleep - she wakes at 3am and has a hard time failing back to sleep - her post operative course has been uneventful.
On Tuesday night, we received the pathology report from the sentinel node biopsy. It showed one lymph node (directly draining the tumor) with micrometastasis (0.1 cm) and one lymph node (not directly draining the tumor) without malignancy.
We're guessing that the staging will indicate T3, N1, M0 - a HER2 negative ER/PR positive 5cm tumor, with positive but minimal lymph node involvement, and no distant spread. This may imply Stage IIIA, but we will await a definitive statement from the care team, since staging is complex and multi-factorial.
The tumor is very aggressive. Less than a month ago, there was no lump. Today, her left breast shows skin and shape changes. We're meeting with the oncologist this afternoon to document the physical changes. In general, research indicates that outcomes are the same regardless of the order of treatment - chemotherapy followed by surgery verses surgery followed by chemotherapy. However, rapid growth and skin involvement may warrant chemotherapy as the first step. Since Kathy is continuing to heal from the sentinel node biopsy, we have to time next steps carefully. It's likely that chemotherapy will reduce her ability to heal, so we do not want to start it too soon. However, the tumor is growing rapidly, so we want to start it as soon as possible.
Mentally, cancer can be overwhelming. It is important to think about cancer treatment as "fitting into your life and schedule" verses letting the cancer control you. The care journey will take time and there are many steps ahead.
Thanks so much to all who have offered their encouragement. Kathy and I are emotional and analytic people. Our endless optimistic is only occasionally punctuated with sadness. To paraphrase Robert Frost, the forest ahead is dark and deep, but there are promises to keep and there are miles to go before we sleep. We're ready.
It's been a week since we described our workup thus far on my blog.
Reaction to our blog post was diverse, ranging from the HISTalk blog to the Boston Globe.
It's a time of anxiety and unanswered questions. The diagnosis and staging phase has been described as one of the two major tension points in cancer. The other is the time after remission, when the worry about recurrence is a constant burden. One of our doctors recommended we keep a "family bottle" of anti-anxiety medication ready for those times when the stress exceeds our capacity to cope. Cancer is truly a family disease and the emotional impact extends from the patient to family caregivers.
Many friends and colleagues have offered prayers and support. A few have lamented that care coordinated by a physician-husband at a Harvard-associated hospital in Boston lacks equity since every wife/mother/daughter may not receive the same care throughout the US. Kathy and I agree. We posted these comments in response to those who speculated that Kathy's care consumes an asymmetric amount of healthcare resources.
John writes:
"At the same time I'm focused on Kathy's care, I'm also deeply committed to quality, safety, efficiency, and equity in healthcare across the country. In the upcoming weeks, I'll describe how the electronic records that coordinate Kathy's treatment provide the same protocols to every BIDMC patient, regardless of insurance status, profession, or income. My goal is the 'right care' - not too much nor too little - that follows best practices based on evidence. Decision support driven 'right care' is the only way we can hope to improve outcomes while bending the cost curve of healthcare spending that threatens the US economy. Universal healthcare supported by universal adoption of electronic and personal health records must be our guiding vision."
Kathy writes:
"My life with John has been entwined for 32 years, so to say "we have cancer" cannot be more completely and utterly correct. True that physically, only one of use has the obvious organic symptoms, but our close partnership has been irrevocably changed by the diagnosis. Whatever lies ahead, it is impossible to go back to that innocent moment before hearing the word "cancer".
I am luckier than most - I have health insurance, and access to a major urban medical center that is also a teaching and research hospital. But, as I encourage John to document our progress publicly in his blog, I am also keeping the memory of a friend close to my heart. She did not have health insurance (as a part time adjunct instructor of art). With this financial barrier, she unwittingly waited until the cancer had spread before seeking medical care, and although she fought bravely, she lost her battle with breast cancer.
Throughout my life, I have not needed medical resources beyond occasional primary care visits and the birth of one child. My first weeks negotiating the barrage of new terminology, new tests, and new doctors was significantly eased by my access to a personal health record. The hospital's electronic health record is important to me, since it empowers my doctors to work as a team with open access to all my clinical data, enabling the team to make the best decisions for my health. As I recall my lost friend, I also think about all patients with a breast cancer diagnosis, or other serious illnesses, and how they manage their care journey if they worry about health insurance, or have no access to a personal health record."
This week we continued the staging process in anticipation of finalizing our care plan (chemotherapy, surgery, radiation oncology) in early January.
On Friday, Kathy went to the operating room for a sentinel node biopsy. This is now the recommended standard of care for cancer staging as it uses radio-isotopes to identify those lymph nodes that directly drain the tumor. The surgeons harvested lymph nodes that were positive for radioactivity and one nearby node that was non-radioactive.
After the surgery I took Kathy home and the first thing she wanted to do was re-expand her lungs, avoiding post operative atelectasis. We walked a few miles around Lake Waban, watched the sunset, and discovered a family of Muskrats seeking their evening meal.
Her post operative pain was helped by gentle exercise and stretching. She took 2 Tylenol before bed. Although the anxiety of the workup has interrupted her sleep - she wakes at 3am and has a hard time failing back to sleep - her post operative course has been uneventful.
On Tuesday night, we received the pathology report from the sentinel node biopsy. It showed one lymph node (directly draining the tumor) with micrometastasis (0.1 cm) and one lymph node (not directly draining the tumor) without malignancy.
We're guessing that the staging will indicate T3, N1, M0 - a HER2 negative ER/PR positive 5cm tumor, with positive but minimal lymph node involvement, and no distant spread. This may imply Stage IIIA, but we will await a definitive statement from the care team, since staging is complex and multi-factorial.
The tumor is very aggressive. Less than a month ago, there was no lump. Today, her left breast shows skin and shape changes. We're meeting with the oncologist this afternoon to document the physical changes. In general, research indicates that outcomes are the same regardless of the order of treatment - chemotherapy followed by surgery verses surgery followed by chemotherapy. However, rapid growth and skin involvement may warrant chemotherapy as the first step. Since Kathy is continuing to heal from the sentinel node biopsy, we have to time next steps carefully. It's likely that chemotherapy will reduce her ability to heal, so we do not want to start it too soon. However, the tumor is growing rapidly, so we want to start it as soon as possible.
Mentally, cancer can be overwhelming. It is important to think about cancer treatment as "fitting into your life and schedule" verses letting the cancer control you. The care journey will take time and there are many steps ahead.
Thanks so much to all who have offered their encouragement. Kathy and I are emotional and analytic people. Our endless optimistic is only occasionally punctuated with sadness. To paraphrase Robert Frost, the forest ahead is dark and deep, but there are promises to keep and there are miles to go before we sleep. We're ready.
Wednesday, 28 December 2011
A Look Back at 2011
2011 was a year of change and tumult. For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian.
It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.
What about the world of healthcare IT?
Federal
In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country. Every aspect of the industry was stressed along the way
*Vendors were challenged to add the features necessary for certification resulting in some "haste makes waste" lack of usability and workflow integration. GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
*IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets. Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
*Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.
However, I would argue that we achieved David Blumenthal's goal of moving the "escalator" fast enough to create rapid change but not so fast that people fell off. The one year delay in Stage 2 gives breathing room to all stakeholders to recover from Stage 1 and for laggards to catch up.
The Standards work needed for Stage 2 was completed and although there is still substantial work ahead, I believe that "good enough" content, vocabulary, and transport implementation guides are no longer the rate limiting step to healthcare information exchange.
The Policy work needed to support privacy, quality measurement, and patient engagement made significant strides. As a country, we studied the PCAST report and incorporated its best ideas into existing federal efforts.
ONC itself matured in 2011, solidifying its operations under Farzad Mostashari, transforming from largely strategic to highly tactical, implementing the HITECH programs per the regulations written in 2010. The Standards and Interoperability Framework filled the gap created when HITSP was sunseted.
State
In 2011, States were challenged to implement Regional Extension Centers, Healthcare Information Exchanges, and in some cases Beacon Communities, Challenge grants, and SHARP research programs.
I believe there will be shining examples of success in some States, while others will provide lessons learned - political and technical - that will refine future work.
The REC program has been largely successful. The HIE program is still an evolving work in progress, since HIE is technically and politically challenging, with limited alignment of incentives and few sustainability models.
It's too early in the lifecycle of the research grants to assess their success. Much hard work is being done to explore vocabularies, security, modular applications, and novel healthcare information exchange approaches.
In Massachusetts, all stakeholders - payers, providers, patients, employers, academia, and government aligned their efforts by forming an open, transparent state Advisory Committee (similar to a Federal Advisory Committee) to guide all state healthcare IT activities. The energy and commitment from all the volunteers is inspiring.
BIDMC
2011 at BIDMC was a year of compliance - meeting new regulatory requirements of Meaningful Use, 5010, code 44 (short stay/observation verses inpatient), ICD-10, and the Fair Labor Standards Act (FLSA). Major IT initiatives automated workflows to support these programs.
Infrastructure continued to grow with storage, bandwidth, and virtual machine enhancements to support Big Data.
Security challenges accelerated with more malware, more sophisticated hacking, and more regulatory penalties for data breaches. In 2011, BIDMC had two publicly reported breaches, both of which were beyond our control, as they were caused by business associates on infrastructure we did not manage. The emotional and monetary costs of breach reporting were very significant.
As I said in my post about the Joy of Success, I believe that all my direct reports accomplished everything I asked them to do - we achieved meaningful use, addressed compliance requirements, and kept the IT staff stable/happy despite the stresses of the year. They're heroes.
Harvard Medical School
In 2011, I continued to oversee the IT operations of Harvard Medical School during the CIO search process. My goals have been to keep the IT staff happy, the infrastructure stable, and the budgets on track. So far, so good. My staff at Harvard also deserve a big thank you for a job well done. My teaching, writing, and community service as a Harvard Professor continue at a brisk pace, but I've reduced my travel to the minimum possible to better balance my work and family life.
Personal
In December 2011 my wife was diagnosed with breast cancer, so my personal life has focused on family. I'm supporting my wife by helping her prepare her artist studio and art gallery business for the 6-8 month hiatus ahead. I've helped my daughter balance her college life, home life, and travel (she's in Japan now for a brief winter semester abroad) in the weeks following Kathy's cancer diagnosis. I've put aside all my own pursuits including search for Vermont farmland.
On the positive side, the first semester at Tufts transformed my daughter into a self-reliant young woman. My parents are healthy. My own physical and mental health are good. Our home and garden are well maintained and unlikely to cause a distraction over the next year. Kathy and I continue to simplify our lives, reducing our belongings, and focusing on a lifestyle that is sustainable, low impact, and fulfilling.
In summary, 2011 was filled with high highs and low lows. The pace was faster than any year in my life to date. More happens every day in healthcare IT than the human brain can comprehend and I'm working harder than ever to filter the incoming data (and email) into knowledge and wisdom.
2012 will be a year of healthcare reform, new business intelligence/analytics tools, automating remaining paper processes, and creating the standards/policy/infrastructure necessary to accelerate health information exchange locally, regionally, and federally. My only wish (beyond my wife's health) is that everyone will celebrate the problems we overcome rather than the focus on the challenges that persist. Hard work is great if everyone around you is aligned for a successful journey rather than protecting themselves from blame when roadblocks appear along the way.
It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.
What about the world of healthcare IT?
Federal
In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country. Every aspect of the industry was stressed along the way
*Vendors were challenged to add the features necessary for certification resulting in some "haste makes waste" lack of usability and workflow integration. GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
*IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets. Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
*Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.
However, I would argue that we achieved David Blumenthal's goal of moving the "escalator" fast enough to create rapid change but not so fast that people fell off. The one year delay in Stage 2 gives breathing room to all stakeholders to recover from Stage 1 and for laggards to catch up.
The Standards work needed for Stage 2 was completed and although there is still substantial work ahead, I believe that "good enough" content, vocabulary, and transport implementation guides are no longer the rate limiting step to healthcare information exchange.
The Policy work needed to support privacy, quality measurement, and patient engagement made significant strides. As a country, we studied the PCAST report and incorporated its best ideas into existing federal efforts.
ONC itself matured in 2011, solidifying its operations under Farzad Mostashari, transforming from largely strategic to highly tactical, implementing the HITECH programs per the regulations written in 2010. The Standards and Interoperability Framework filled the gap created when HITSP was sunseted.
State
In 2011, States were challenged to implement Regional Extension Centers, Healthcare Information Exchanges, and in some cases Beacon Communities, Challenge grants, and SHARP research programs.
I believe there will be shining examples of success in some States, while others will provide lessons learned - political and technical - that will refine future work.
The REC program has been largely successful. The HIE program is still an evolving work in progress, since HIE is technically and politically challenging, with limited alignment of incentives and few sustainability models.
It's too early in the lifecycle of the research grants to assess their success. Much hard work is being done to explore vocabularies, security, modular applications, and novel healthcare information exchange approaches.
In Massachusetts, all stakeholders - payers, providers, patients, employers, academia, and government aligned their efforts by forming an open, transparent state Advisory Committee (similar to a Federal Advisory Committee) to guide all state healthcare IT activities. The energy and commitment from all the volunteers is inspiring.
BIDMC
2011 at BIDMC was a year of compliance - meeting new regulatory requirements of Meaningful Use, 5010, code 44 (short stay/observation verses inpatient), ICD-10, and the Fair Labor Standards Act (FLSA). Major IT initiatives automated workflows to support these programs.
Infrastructure continued to grow with storage, bandwidth, and virtual machine enhancements to support Big Data.
Security challenges accelerated with more malware, more sophisticated hacking, and more regulatory penalties for data breaches. In 2011, BIDMC had two publicly reported breaches, both of which were beyond our control, as they were caused by business associates on infrastructure we did not manage. The emotional and monetary costs of breach reporting were very significant.
As I said in my post about the Joy of Success, I believe that all my direct reports accomplished everything I asked them to do - we achieved meaningful use, addressed compliance requirements, and kept the IT staff stable/happy despite the stresses of the year. They're heroes.
Harvard Medical School
In 2011, I continued to oversee the IT operations of Harvard Medical School during the CIO search process. My goals have been to keep the IT staff happy, the infrastructure stable, and the budgets on track. So far, so good. My staff at Harvard also deserve a big thank you for a job well done. My teaching, writing, and community service as a Harvard Professor continue at a brisk pace, but I've reduced my travel to the minimum possible to better balance my work and family life.
Personal
In December 2011 my wife was diagnosed with breast cancer, so my personal life has focused on family. I'm supporting my wife by helping her prepare her artist studio and art gallery business for the 6-8 month hiatus ahead. I've helped my daughter balance her college life, home life, and travel (she's in Japan now for a brief winter semester abroad) in the weeks following Kathy's cancer diagnosis. I've put aside all my own pursuits including search for Vermont farmland.
On the positive side, the first semester at Tufts transformed my daughter into a self-reliant young woman. My parents are healthy. My own physical and mental health are good. Our home and garden are well maintained and unlikely to cause a distraction over the next year. Kathy and I continue to simplify our lives, reducing our belongings, and focusing on a lifestyle that is sustainable, low impact, and fulfilling.
In summary, 2011 was filled with high highs and low lows. The pace was faster than any year in my life to date. More happens every day in healthcare IT than the human brain can comprehend and I'm working harder than ever to filter the incoming data (and email) into knowledge and wisdom.
2012 will be a year of healthcare reform, new business intelligence/analytics tools, automating remaining paper processes, and creating the standards/policy/infrastructure necessary to accelerate health information exchange locally, regionally, and federally. My only wish (beyond my wife's health) is that everyone will celebrate the problems we overcome rather than the focus on the challenges that persist. Hard work is great if everyone around you is aligned for a successful journey rather than protecting themselves from blame when roadblocks appear along the way.
Tuesday, 27 December 2011
The Joy of Success
As the year ends, I've spoken to many CIOs. 2011 was a hard year filled with Meaningful Use (including many upgrades to certified systems or self-certification), 5010 (the deadline for upgrading billing systems is January 1, 2012), accelerating compliance demands, new security threats, rapidly evolving technologies, and unprecedented demand for new projects driven by the consumerization of IT.
At the same time that CIOs and IT professionals are running marathons, they are being held accountable for events that are not directly under their control. They are not being congratulated for the miracles they create every day, but are being criticized for not moving faster.
What do I mean?
One CIO received a negative audit report because new generations of viruses are no longer stopped by state of the art anti-virus software. Interesting. The CIO cannot control the virus authors, nor the effectiveness of anti-virus software. No one in the industry has solved the problem, but audit firms revel in creating fear, uncertainty and doubt at the Board level as it enhances the reputation of the auditor.
Another CIO was held accountable for infrastructure demands that were not forecasted, planned, or communicated. CIOs do their best to be proactive, but in the world of Big Data, past trends may not predict future needs.
Another CIO was was given 10 goals and 5 unplanned urgent projects. She completed 8 of the planned goals and all the urgent projects, yet was told she only met 80% of expectations.
In a world that expects leaders to continuously perform miracles with constrained resources in limited time, we all need to step back and take our own steps to stop the madness.
With your own staff, celebrate the joy of success and focus on what really matters.
Did you achieve Meaningful Use?
Did you support compliance requirements on time to meet regulatory deadlines?
Did you maintain employee satisfaction and minimize turnover?
If so, you're an IT Leadership hero.
Did your Board or senior management note that a new application or website launched a few weeks late because you wanted additional testing time to minimize risk?
No one will ever remember.
Did you defer a "nice to have" project because an unplanned "must have" occurred mid year?
Good for you.
Did you have a brief infrastructure failure that led to a major improvement in security, reliability, and maintainability because the staff rallied around a tricky problem caused by a combination of rapid technology change and exponential increases in customer demand?
You'll be stronger in the future because of it.
We have to break the cycle of negativity that makes IT leadership so challenging. Create a culture that thrives on the projects you did well and does not focus on what remains undone because of circumstances beyond anyone's control.
Leaders at all levels - from Board members to team leaders need to realize that shouting louder does not make the rowing staff move the boat faster.
So celebrate the accomplishments achieved by your and your staff in 2011. It was one of the hardest years in the history of IT and we doubled EHR adoption in the US from 20% to 40%. We need to focus on that success, leveraging our energy and optimism to finish the 60% that remains.
At the same time that CIOs and IT professionals are running marathons, they are being held accountable for events that are not directly under their control. They are not being congratulated for the miracles they create every day, but are being criticized for not moving faster.
What do I mean?
One CIO received a negative audit report because new generations of viruses are no longer stopped by state of the art anti-virus software. Interesting. The CIO cannot control the virus authors, nor the effectiveness of anti-virus software. No one in the industry has solved the problem, but audit firms revel in creating fear, uncertainty and doubt at the Board level as it enhances the reputation of the auditor.
Another CIO was held accountable for infrastructure demands that were not forecasted, planned, or communicated. CIOs do their best to be proactive, but in the world of Big Data, past trends may not predict future needs.
Another CIO was was given 10 goals and 5 unplanned urgent projects. She completed 8 of the planned goals and all the urgent projects, yet was told she only met 80% of expectations.
In a world that expects leaders to continuously perform miracles with constrained resources in limited time, we all need to step back and take our own steps to stop the madness.
With your own staff, celebrate the joy of success and focus on what really matters.
Did you achieve Meaningful Use?
Did you support compliance requirements on time to meet regulatory deadlines?
Did you maintain employee satisfaction and minimize turnover?
If so, you're an IT Leadership hero.
Did your Board or senior management note that a new application or website launched a few weeks late because you wanted additional testing time to minimize risk?
No one will ever remember.
Did you defer a "nice to have" project because an unplanned "must have" occurred mid year?
Good for you.
Did you have a brief infrastructure failure that led to a major improvement in security, reliability, and maintainability because the staff rallied around a tricky problem caused by a combination of rapid technology change and exponential increases in customer demand?
You'll be stronger in the future because of it.
We have to break the cycle of negativity that makes IT leadership so challenging. Create a culture that thrives on the projects you did well and does not focus on what remains undone because of circumstances beyond anyone's control.
Leaders at all levels - from Board members to team leaders need to realize that shouting louder does not make the rowing staff move the boat faster.
So celebrate the accomplishments achieved by your and your staff in 2011. It was one of the hardest years in the history of IT and we doubled EHR adoption in the US from 20% to 40%. We need to focus on that success, leveraging our energy and optimism to finish the 60% that remains.
Friday, 23 December 2011
Cool Technology of the Week
In a previous post I described the capabilities of the Microsoft Kinect technology.
I've written about sterilizing iPads and iPhones for use in the operating room and that does work, but there are challenges with subjecting electronics to sterilization.
However, there's another cool option for examining medical records and digital images in the OR - a touch screen you do not touch. Check out this gestural interface to EHRs and PACS systems that uses an Xbox and Kinect.
Traverse pages, select tabs, and zoom into images using only body movements.
The system, called TedCas, was recently named one of the top applications for Kinect.
That's cool!
I've written about sterilizing iPads and iPhones for use in the operating room and that does work, but there are challenges with subjecting electronics to sterilization.
However, there's another cool option for examining medical records and digital images in the OR - a touch screen you do not touch. Check out this gestural interface to EHRs and PACS systems that uses an Xbox and Kinect.
Traverse pages, select tabs, and zoom into images using only body movements.
The system, called TedCas, was recently named one of the top applications for Kinect.
That's cool!
Thursday, 22 December 2011
We Have Cancer
Cancer. It's a word that creates fear and uncertainty. Many of the doctors I know use the word "hate" whenever they discuss their feelings about cancer.
Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We're approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.
She's has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.
Here's how it all started.
On Monday, December 5, she felt a small lump under her left breast. She has no family history, no risk factors, and no warning. We scheduled a mammogram for December 12 and she brought me a DVD with the DICOM images a few minutes after the study. On comparison with her previous mammograms it was clear she had two lesions, one anterior and one posterior in a dumbbell shape. I hand carried the DICOM images to the Breast Center team at BIDMC.
On December 13 she had an ultrasound guided biopsy which yielded the diagnosis - invasive ductal carcinoma, grade 3.
We assembled an extraordinary team of Harvard faculty - a primary care provider (Dr. Li Zhou), a surgeon (Dr. Mary Jane Houlihan), a medical oncologist (Dr. Steve Come), a radiation oncologist (Dr. Abram Recht), a pathologist (Dr. James Connolly), and a skilled breast imaging team. I also contacted my associates from the genomics research community.
On December 16, after my daughter's last final exam at Tufts, Kathy told Lara about the diagnosis. Lara immediately offered her love and support. We also told the grandparents.
Today, Kathy completed a bone scan and chest/abdominal CT. Both are negative for metastases.
We also received the receptor studies from the tumor tissue.
HER-2/neu gene amplification - Not Amplified
Estrogen Receptor - Strong
Progesterone Receptor - Strong
Our next step is to complete the staging via an ambulatory surgical procedure on Friday - a sentinel node biopsy to determine if the lymph nodes closet to the tumor have evidence of malignant cells.
Summarizing what we know thus far - the tumor is less than 5 cm, poorly differentiated/fast growing, not yet spread to bones or organs, HER-2 negative and Estrogen/Progesterone Receptor positive. Once the staging is completed we'll be able to finalize a treatment plan and determine an estimated 5 year survival rate.
Likely, she'll begin with chemotherapy to be followed by a left mastectomy in early 2012.
We'll also explore her genome to understand the risk factors and determine if a bilateral mastectomy reduces future risk.
We'll face many decisions ahead and many emotions. We've already assembled a community of supporters.
1 in 8 women will develop breast cancer in their lifetime. We never thought we'd be the one.
My Thursday blogs for the next 6 months will document our progress on the healing journey.
Thank you for your prayers and support.
Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We're approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.
She's has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.
Here's how it all started.
On Monday, December 5, she felt a small lump under her left breast. She has no family history, no risk factors, and no warning. We scheduled a mammogram for December 12 and she brought me a DVD with the DICOM images a few minutes after the study. On comparison with her previous mammograms it was clear she had two lesions, one anterior and one posterior in a dumbbell shape. I hand carried the DICOM images to the Breast Center team at BIDMC.
On December 13 she had an ultrasound guided biopsy which yielded the diagnosis - invasive ductal carcinoma, grade 3.
We assembled an extraordinary team of Harvard faculty - a primary care provider (Dr. Li Zhou), a surgeon (Dr. Mary Jane Houlihan), a medical oncologist (Dr. Steve Come), a radiation oncologist (Dr. Abram Recht), a pathologist (Dr. James Connolly), and a skilled breast imaging team. I also contacted my associates from the genomics research community.
On December 16, after my daughter's last final exam at Tufts, Kathy told Lara about the diagnosis. Lara immediately offered her love and support. We also told the grandparents.
Today, Kathy completed a bone scan and chest/abdominal CT. Both are negative for metastases.
We also received the receptor studies from the tumor tissue.
HER-2/neu gene amplification - Not Amplified
Estrogen Receptor - Strong
Progesterone Receptor - Strong
Our next step is to complete the staging via an ambulatory surgical procedure on Friday - a sentinel node biopsy to determine if the lymph nodes closet to the tumor have evidence of malignant cells.
Summarizing what we know thus far - the tumor is less than 5 cm, poorly differentiated/fast growing, not yet spread to bones or organs, HER-2 negative and Estrogen/Progesterone Receptor positive. Once the staging is completed we'll be able to finalize a treatment plan and determine an estimated 5 year survival rate.
Likely, she'll begin with chemotherapy to be followed by a left mastectomy in early 2012.
We'll also explore her genome to understand the risk factors and determine if a bilateral mastectomy reduces future risk.
We'll face many decisions ahead and many emotions. We've already assembled a community of supporters.
1 in 8 women will develop breast cancer in their lifetime. We never thought we'd be the one.
My Thursday blogs for the next 6 months will document our progress on the healing journey.
Thank you for your prayers and support.
Wednesday, 21 December 2011
Accountable Care Organization Measures
On December 19, CMS announced the selection of 32 Pioneer ACO organizations, five of which are Boston-based: Beth Israel Deaconess, Mt. Auburn, Steward, Atrius, and Partners Healthcare.
To participate in the shared savings model, we'll need to compute 33 different quality metrics and submit them via survey, claims or the group practice reporting web interface (GPRO).
What are these metrics?
7 measure the Patient/Caregiver Experience based on survey
6 measure Care Coordination/ Patient Safety 6 based on claims or submissions to the GPRO web interface
8 measure Preventative Health based on submissions to the GPRO web interface
12 measure care to At Risk Population based on submissions to the GPRO web interface
Here's a comprehensive list of what needs to be computed, how, and when.
At Beth Israel Deaconess, we'll use our all-payer claims warehouse and quality data center. My role as CIO has been to prepare the necessary analytics for panel and population health, as described in this overview
As I posted from IHI, our challenge ahead will be navigating the new business model while still maintaining the stability of the old business model during the transition.
From a CIO perspective, use this simple equation: ACO = HIE + Analytics and you'll be ready for whatever tomorrow will bring.
To participate in the shared savings model, we'll need to compute 33 different quality metrics and submit them via survey, claims or the group practice reporting web interface (GPRO).
What are these metrics?
7 measure the Patient/Caregiver Experience based on survey
6 measure Care Coordination/ Patient Safety 6 based on claims or submissions to the GPRO web interface
8 measure Preventative Health based on submissions to the GPRO web interface
12 measure care to At Risk Population based on submissions to the GPRO web interface
Here's a comprehensive list of what needs to be computed, how, and when.
At Beth Israel Deaconess, we'll use our all-payer claims warehouse and quality data center. My role as CIO has been to prepare the necessary analytics for panel and population health, as described in this overview
As I posted from IHI, our challenge ahead will be navigating the new business model while still maintaining the stability of the old business model during the transition.
From a CIO perspective, use this simple equation: ACO = HIE + Analytics and you'll be ready for whatever tomorrow will bring.
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