Anticlue

Healthcare Integration as a Group

Healthcare is a funny beast to tackle. Best of Breed Solutions from the 90?s and best of group solutions from the turn of the century till now. Data transmitted everywhere in all types of formats. The concept of Data Warehousing is there just in the back of everyone?s mind. It would be a nice to have, but with a falling net revenue, and view of IT as an operational tool. We just aren?t there yet.

Healthcare IT organizations team structure seems to be around either line-of-business functions, (clinical, revenue cycle, finance) or supported applications(hospital registration, hospital billing, labs) So the data gets passed every which way up down right left and side ways. We have point to point interfaces, realtime interfaces through and interface engine, realtime interfaces CICS to CICS, and the really special ones where we pass through one system just to hit another and finally the last one (the place we really wanted to go to)

I think in order to advance the quality of healthcare it we need to add a new group into the mix, the enterprise applications group. This group would have a team just dedicated to interfacing, enterprise reporting, and other enterprise level it work. This would help to standardized the transport mechanisms and format of some of the data, and provide guidelines for best practices. Also since a true understanding of the data would be occurring, this is probably the best group to maintain the enterprise reporting application, with several end users from the business side converting to IT.

Windows 2003 Server SP1

Microsoft has released the Windows 2003 SP1. To download follow the link here.

Top Enterprise Business Intelligence Vendors

Gartner release a rating of the business intelligence (BI) vendors based on the ability to execute and extent of vision. The listing in order is as follows:

1. Cognos
2. Business Objects
3. Information Builders
4. Microstrategy
5. Microsoft
6. Oracle

MySQL 5.0 Views

What to learn how to use MySQL 5.0 views, check out the MySQL 5.0 Views in the New Features Series.

MySQL is growing up

MySQL appears to be growing up with the 5.0 beta release. The new features are VARCHAR support, Elementary cursor support, views, and stored procedures.

Get an Issues List together

Here's the scenario, we are putting in a system. I got in on the project very late in the game. So I'm sitting in my cube last night, just about ready to leave and enjoy the first sunny day in recent memory. I'm going though my voice mail, and I have a call to place. I'm talking to the person, and she is listing to me all the remaining items that need to be done. Do you have an list of this stuff electronically? I can take a look and see what we can farm out. Let me finish putting one together, and I'll email it to you.

I know issues lists are a pain if you are in the front-line of a project. They seem to take time from the project and why are we wasting the time, instead of just getting it done.

Well, the truth of the matter is that you end up being too close to the problem and at the end of a tedious project, let's face it, you are worn out. The issues list helps to quickly categorize what needs to get done. But that is not really enough, one needs to have categories together like. Priority is this critical, high, medium, or low. Is this needed for live, or can it be added in shortly thereafter. Who is responsible for this issue, and if needed what team does this issue belong too.

I dislike maintaining issue lists, but it is a necessary evil to getting a project completed. It is also a blessing in communicating and managing a project.

Deploying a system Phased vs Bang

Oh the big bang approach, one has to hate it. I remember my first big bang approach a couple of years ago. At the same time we replaced the hospital registration system, interface engine, and implemented a clinical repository. It was several weeks in June, and during that time I got reassigned from the night shift to the day shift. We were staffed for the bang, had a team of consultants on site, IS support was around the clock. People where positioned on the floors. In house registrations were manually transferred from one system to the new system. Oh it was an experience. It has tainted my attitude towards Big Bang implementations.

If I have a preference, and I will strongly argue my position, I like phased implementations. It keeps the deployment manageable. The resources are dedicated to the department or system at hand, not thinly spread across the board. The risk factor is less simply by not implementing the all inclusive solution. One can carefully maintain monitors and trouble shooting is simpler. Plus by phasing in solutions, skeptics convert to true believers.

The only advantage in the big bang is that it gets it all done at once. However the support after live is probably longer than the phased implementation.

Blue Dragon 6.2 New Features and Functions

Pete Freitag has a list of the new Features and Functions in Blue Dragon 6.2.

IIS 6.0 Resource Kit Tools

I'm pretty ure most people have a copy of this running with their IIS server. However for those who don't, the tools are pretty useful, especially the log parser. Full download found here.

Avalon and Indigo Community Technology Preview

Microsoft has release the Indigo and Avalon Previews so we can preview and provide feed back. It sounds a lot like a release candidate.

Indigo is suppose to combine existing MS distributed technologies (ASMX, .Net Remoting, .NET Enterprise Services, Web Service Enhancements, and System.Messaging) and Avalon is the presentation subsystem.

Patient Discharge Status Codes

NUBC has issues a FAQ to help assist providers in determining the correct discharge status codes.

Bar-Code Point-Of-Care (BPOC)

Let’s take a couple minutes and think about bar-code point-of-care (BPOC) technology. One of the patient safety goals is to improve identifying a patient when administer drugs or blood. Having each patient uniquely identified via a bar-code would be a long step towards this improvement. Bar Coding normally is less expensive than a computerized physician order entry system, and it is a very effective way to guarantee bedside safety.

BPOC systems come in a range of flavors, first there is the simple check to ensure you have the following:
1. right patient
2. right drug
3. right route
4. right dose
5. right time

Then we can explore the advance features, for example, since we are keeping all of the administration in a computer, how about we make the information viewable as a medication administration record. Even better, let’s link it to the clinical repository with the information maintained on the patient. And let’s keep the patient’s allegry information in the medication administration record.

Another nice feature in a BPOC, would be an on-line in house formulary. This is basically a listing of all of the medications available in-house, forms, dosing guidelines, descriptions. Sorta like Epocrates for individuals hospital pharmacies.

While we are at thinking of practicalities, weight-based dose checking would be good. Wouldn’t it be easier to just know how much heparin to request?

Now, who to choose for this technology, out of the hat, I would suggest using either your pharmacy system vendor or the CPOE vendor. It would just make implementation a lot easier.

Subversion

You have to love Subversion, at times it can be a real savior. Version control has been an item that has been arising at work for the past couple of years. We don’t have a centralized repository available to all. There has been discussions of using visual source safe, and a couple of other mechanisms. However, I think I’m going to start everyone off on subversion this week. I've got an ole 1U box that I can install upon, and away we go. First, subversion really doesn’t care at all about the language. The other item is that you can using versioning for many things. My large concerns are SQL Scripts, Crystal Reports, Cold Fusion Files, and old VB Files. Although the router tables, may be a good addition. I’ve been tweaking a setup and I think I have it working for several groups. Buy in will be easy since it relates to a rather large concern lately knowledge loss related to turn-overs.

Setting up subversion is easy. First download the subversion files. This will give you command-line tools that you can utilize for specific control. Next, download the TortoiseSVN which intergrates with Windows Explorer. Now you can check out and manipulate repositories from explorer. For the MS side of the world, AnkhSVN, is the VS plugin, and for the Java side of the world, subclipse, is the eclipse plugin.

Now check out the online book, Version Control with Subversion, and the from pragmatic programmer.Pragmatic Version Control using Subversion

CFForm.com

Mike Nimer has announced the live of CFForm.com. The site is a community exchange of XML Form's skins and rules, and good tips and tricks for all Forms.

It?s yellow, might even be red, but it sure isn?t green

Our organization is moving towards a project management organization. One of the steps of this process, is that for all IT related projects there is a project summary bulletin board or dashboard to be correct. On this dashboard, we have a bi-weekly summary of the projects that are capital projects, meaning someone budgeted money for the project and the money got approved. Currently, IT just fills out the list, I believe it needs to be a responsibility of the entire community, but that is just my conjucture.

Any way, the list is now being rigorously reviewed. There are three categories:
Green - good life is great
Yellow - warning caution problems exist
Red - we are a ship that is sinking over here

Anyway, yesterday was my time to review the project list with the new keeper of the data. I have a couple of projects and they are in various green stages. However, I was lucky enough a couple weeks ago to inherit another project that was yellow (really red). The problem with the project is that there are two different camps that believe there are two different levels of work. So we are in the process of negotiating with the two camps the work needed to be done, and when resources will be available. This is a political process, not one that really can be captured in the light of green, yellow, and red. The fact that we were actually talking on what needed to be done, and not firmly entrenched in camps, I put the project to green. Explaining that to the new keeper was just funny, never really ever saw a look that captured the facial expressions of being perplexed, so wonderfully.

I guess, in places where project management is actually a practiced discipline this makes no sense setting the project to green. However, here at the newbie growing stage there needs to be a clearly defined set of requirements that states the colors of the stop light. This way when the colors are set the criteria is the same.

Understanding the project plan

I have a problem, it has to do with audience and the understanding of a project plan. It’s a complicated plan, we are basically phasing out one system, replacing a new system, and adding 3 departments to the new system with new applications, new workflow, and new billing and decision support interfaces. Complicated project, Complicated project plan. My organization is new to understanding things as projects.

I’ve been using MS Project and it seems to work well for me, but the project team, and the business leadership group aren’t embracing it. My co-PM, the business PM, wants to get the project plan into excel for the team leads. It’s a 26 page project plan in project, and I believe a lot of interdependencies will be lost in just showing the team leads the task list in excel. I’ve printed the PERT chart out of project on plotter, and once again everyone was scared by the amount of work. I did an overview, high level roll up and again why so long?

I need to get the audience to understand the project plan, and the amount of work effort needed to complete it. They also need to have a sense of ownership for the project plan. (Especially since they will be doing a lot of the work, and they already have fulltime jobs) Anyone have any ideas?

Oh the power of a blog and a whistleblower disposition

I?ve been following the following story with a little bit of interest. A former employee of Kaiser Permanente has been accused of posting personal health information (PHI). The Diva of the disgruntled is retorting that she only posted a link to Kaiser?s website that had the material posted. The material apparently is training information with actual screen shots from Kaiser?s Health Connect product.

Every story has many interpretations. Have five people involved in a meeting and there will be five different interpretations. If anything at all comes out of this David and Goliath story, one lesson should be learned. For health care institutions all public web content needs to be approved by legal, marketing, and compliance. If it is medical specific, it should probably also be reviewed by a medical informatics director. The authorization step in web content publishing is important.

Exception Workflow Applications Needed

Interfacing data from one system to another always needs to include some type of exception and comparison reporting. This reporting however really needs to be closely examined. What value is there in generating a paper report that states out of 245 inpatient cases, 237 were successfully interfaced? These 8 accounts need to be identified as to why they are on the exception list. Here is where in some places the drill down stops, and what I’m proposing should change.

In reality exception reports are just a worklist for someone to go digging in the various systems to find which information is missing. But what if instead of having an individual go digging, we actually created a systematic system to do the digging? What I am referring to is this, imagine a situation with ed charge capture. Have a tool that always multiple people to work the exception list, probably web based. But let the tool be all financial exceptions to the final completion of this account. First there is the screen listing the exception accounts, then you can categorize the exceptions to the missing inforamtion, and drilling down on the exception account yields the missing information to fully completing the account.

For example with treat and release patients, there will need to be information from patient access or registration, coding and abstracting, and charges for supplies, level of service, procedures, labs, and drugs. So the exception tool may report off of all items preventing this case from properly billing. For example let’s say in the billing system the insurance information didn’t interface properly, but it exists in the registration system. This would place the account on the exception report, categorize it as an interface issue, and maybe even try resending the info once automatically. Or for example let’s say the coding wasn’t completed, and this was one of the items in the drill down. When querying the in coding db, it is noticed that the chart has not been received yet. New category for the error, and everyone can track.

With this manner of managing by expections for the total account, it would be easier to identify trends and issues, which hopefully would improve workflow.

Project Management with Business PM and IT PM as one

At work, I’m involved in a project to implement a new coding and abstracting, case management, and quality management system. This will replace pre-existing custom db applications and the vendor supporting coding application. In my opinion, it has been a difficult project to get started due to the lack of a pm from the business community. We have been starting a new practice to have projects jointly managed by a business pm and an IT pm. One of the critical items in this pattern is to ensure both project managers actually are dedicated 20 – 40 hours a week to the project. For the business community, they have hired a consultant pm to take this responsibility. So far this has been a good move having the project jointly managed, because it has brought several key items to light.

For example, being from the technical side of the house, the draft work plan was drawn up with mainly a technical focus, with input from application analysts, interface analysts, and network engineers. There were a couple of key items, which the business pm immediately brought to light.

First, the training needed to have a competency assessment completed at the end. This is to ensure the material was digested an understood. Also a remedial training class must be created, and a plan of action for those individuals who are unable to pass the remedial class and training class.

Second, for all new workflows, not only must operational flows be documented, but new policy and procedures need to be created. If these policy and procedures are cross departmental, a cross departmental review and approval must occur.

Third, cutover policy and procedures also need to be created on the departmental level.

The good thing about these additional tasks, is that it always goes to show more heads are better than just one. People make plans based upon their experiences, and the plans improve if it comes from everyone. The business pm and myself are reviewing the project plan with the entire team next week. The goal of the meeting is to discover any additional tasks and obtain the duration of a task from the individual responsible for the task. It should be a very good meeting.

HIPAA Security Crosswalks

Another good link to HIPAA Security Crosswalks.

An Overview of Microsoft's Intermediate Language (IL)

Here is a nice link for an review of IL.

Cloudscape and PHP a marriage

Here is a good bit of news, to improve the future of the open source community.

IBM and Zend have agreed to integrate Zend's PHP environment with IBM's cloudscape. Its a good step forward for all PHP and cloudscape developers. Might even play a little with Cloudscape now.