Below are the ICD-10 talks:

10:00 am to Noon
Talks from:

Richard Saulsgiver – COMSYS
Joe Nichols – Health Data Consulting

12:45 pm to 3:15
Talks from:

Katheleen Peterson – Sr. Lecturer UW
Cheron Vail – VP/CIO Regence Blue Shield
Kellie Henderson – 3M HIS
Speaker Q & A

Each of the sixty Regional Extension Centers (REC) has the ambitious goal of assisting at least 1,000 healthcare providers with their transition to EHRs (electronic health records) and achieving Meaningful Use during the next two years.  While businesses in the healthcare industry have primarily focused on more traditional marketing media, at least one REC, Tri-State Regional Extension Center in Ohio is promoting their services using a well crafted and informative video on You Tube.

In 5 ½ minutes, this video explains  the services that Tri-State REC provides, as well as the challenges and benefits healthcare providers encounter when transitioning to an EHR.  Are healthcare providers dialed into You Tube?  Will they seek out professional resources using You Tube?  Only time will tell.  However, kudos to Tri-State REC for thinking outside the traditional marketing box.

We recently found these wonderful documents, and after reading through the ones that pertain to Nimbus eRelease, we realized a couple of them require the use of explicit data formats where none are warranted.  Namely, they require health information that must be presented to patients in an electronic, human-readable format, be done so via a CCD or CCR.

We wrote up our thoughts and posted them to hit-tst-fdbk@nist.gov today.  For anyone interested, our comments are below.  We’ll let you know what they say.

—

To whom it may concern:

We have a question regarding the test procedures for the “Electronic copy of health information” criteria.  According to the Meaningful Use Interm Final Rule, the objective of these criteria is to “Provide patients with an electronic copy of their health information.”  While the IFR mentions the use of CDs, USB drives, and providing online access to the information, it neither mentions nor requires the use of a particular health record format when storing, transmitting, or displaying the information to patients.

Knowing that, we were surprised by what appears to be, an explicit requirement in the test procedures (§170.304 (f) & §170.306 (d)) to structure the underlying health information in the HL7 CCD or ASTM CCR formats.

Question: Assuming all of the required information (e.g. diagnostic test results, problem list, medication lists, allergies, discharge summary, and procedures) is shared with the patient electronically in a human readable format, does it matter what the underlying format of the data is?

Note: the testing procedure for “Electronic copy of discharge information” (§170.306 (e)) has the same electronic delivery and human readable requirements, but appropriately, in our opinion, does not explicitly require the use of a particular standard for the underlying data.

Why We’re Asking

We have a module that enables sharing health information with patients from any EHR, even if the EHR doesn’t know how to produce CCD or CCR-formatted data.  We’re able to do this by offering an online service that redirects printed output from EHRs to our secure portal, where is it turned into a PDF that is accessible by the patient.  With this service, providers can securely share health information with patients electronically online, and in the same human-readable format as if it was printed directly from the EHR.

Due to the “plug-and-play” nature of the service, and to ensure it works for all EHRs (even ones that will see little investment going forward), we cannot customize the service to build a CCD or CCR out of the data, en-route to creating a PDF.  Not only would it be prohibitively expensive, it would ultimately be of little value since the final objectives are only that the health information be complete, electronic, and human readable.  Clearly, all of these objectives can be met without requiring a specific format for the underlying data.

Please let us know if we’re misinterpreting the draft procedures or if there’s an opportunity to adjust them before they are finalized.

Thank you for your time, and for the great work you’re doing preparing providers and vendors for certification.

As mentioned in the video, we have two goals with Nimbus eRelease:

1. Tackle Meaningful Use
2. Help providers tap into the Release of Information (ROI) revenue stream

While the ground beneath the healthcare industry is still moving quite a bit, we’ve tried to embrace the principles of Customer Development, as evangelized by terrific Steve Blank, as much as possible.  So far, we’re hearing a lot of positive responses to eRelease’s value prop, let’s hope they keep coming as Meaningful Use solidifies.

Google Docs
A free service for people to store documents online and share them with other people.  Simple, easy to use, and you can set it up yourself without any help.

Note, Google docs is not just for sharing files, it also has online editors for them (e.g. you can edit Excel, Word, files, etc. via their website), although it doesn’t have all of same functionality as Microsoft Office.

OffiSync
Awesome Microsoft Office plug-in that lets you share documents with anyone you like, work on them simultaneously, and merge them all within your favorite office app (e.g. Excel, Word, PowerPoint).  Uses Google Docs as your back end and it’s free!

Google Apps
The same functionality as Google Docs, but also enables you to provide email, calendar & other services for your teammates.  Feels a bit more official since people would log in with their business email addresses, but if you don’t want/need that, stick with Google Docs to start.

Considering we store sensitive information like electronic medical records in the cloud, they asked me to speak on how AWS can be HIPAA compliant, as well as how we scale our services.  Here’s the presentation I put together:

It covers:

• Who is Nimbus Health & what we’re building
• Why we chose AWS over traditional hosting
• Why we prefer virtual servers over physical servers
• Why we think cloud hosting is more secure from a HIPAA perspective than traditional hosting
• How we use EC2, S3, Elastic Load Balancing, Auto-Scaling and Cloud Watch to automatically resize our infrastructure based on load

Some of the above won’t come through without my commentary, but perhaps when I get a moment I’ll record some.

Questions, comments, concerns?  Let’s hear ‘um.

I decided to record the talk after the fact for anyone who wasn’t able to make it.  Questions and comments are welcome as always,  and I want to send  one more huge thanks again to the WSHIMA conference organizers and attendees; I had a blast.

Fullscreen version.

Guess what, LinkedIn can do that!  Not sure how long it’s been able to, but I just found it and figured I’d share.

Full screen version.

I did want to expand a bit on the lessons we learned during our Auto-Scaling experience.  If you’re thinking about going that route, which I highly recommend for the right kind of problems, be able to answer these questions about your architecture before diving in too deep:

How will your machines “start their work” when they come up?

You need to have a way for the machines to know what to do and when, once they come to life. We use TopShelf to run services that periodically ping some web services asking for records to process.

How will your auto-scaled machine get your latest bits?

You don’t want to have to rebundle your AMIs every time you make a change that’s to be deployed on an auto-scaled server. Instead, build a way for auto-scaled machines to auto-update themselves when they come to life.

For example, our AS machines have a simple batch script that downloads a zip file with the latest processing bits, deploys them, and restarts the appropriate services.

Can you save money by leveraging different size machines?

We have one Auto-Scaling group that’s a single small machine with a min and max count of one machine. That means no matter what, we always have one small instance running. Let’s call this the “small auto-scaling group.”

We also have another Auto-Scaling group that consists of medium instances with a min of 0 and a relatively large max. Let’s call this the “medium auto-scaling group.”

The number of machines Auto-Scaling spins up within the “medium” auto-scaling group is actually determined by the performance of the “small” AS group. That enables us to keep the cost of our idling servers low with a single small instance, but provide extra power in the form of 0-N medium instances when records are available for processing.

Note: since small & medium instances are both 32-bit servers, we can use the same AMIs for both groups. We do have custom code in our processing service however that changes the number of processes we run based on the number of processors the machine has. You should consider doing the same.

What happens when your machine is terminated?

Make sure whatever processing you’re doing on your auto-scaled machines isn’t affected by having a particular machine terminate at any point. Since Auto-Scaling is determined by machine performance metrics, once you’re below your load threshold, machines will start terminating automatically. Make sure your infrastructure is prepared to cope with processing services that terminate mid-job.

Wouldn’t it be great if there was a way to track who you’ve followed-up and who you haven’t, assign yourself follow-up reminders, track your on-going discussions with contacts, and be able to use it for both conference connections and new customers?  Lucky for us, there are apps that do just that.

Customer Relationship Management systems (CRMs) do precisely what they sound like they should – they help you manage your customer relationships.  We’ve started using one, Highrise, and we’ve had such a good experience with it, I wanted to share a little about it.

Quick Demo Video – full screen version here: http://bit.ly/bfLFaG

It’s well hidden, just beneath the “Basic” plan, but you can sign up for a free Highrise account which will support two users here: http://highrisehq.com/signup

Other inexpensive CRMs are:

• Zoho CRM
• Salesforce.com
• Sugar CRM

We’d love to hear other techniques/tools you use to track your customer and contact interactions, so fire away!