Archive for the ‘EMR’ Category

15 Year Dawg

Sunday, April 28th, 2013

This is pretty surreal to admit:

Anniversary date 4/28/1998

Drumheller Fountain

I was a temporary employee for several months before my April 28th hire date and have blazed through a combination of fixed duration appointments and ‘acting’ assignments, so I have no idea how my years of service to the University of Washington have officially been calculated. It all depends on what type of employee classification you are. My anniversary hasn’t been acknowledged by UW since 2003 due to a number of reasons, but I don’t care and am taking myself shopping to commemorate the occasion anyway! How many Dawgs can say they’ve been continuously employed by the home team for 15 years and aren’t yet 40?

May 1st marks 5 years since my library career change and the 6th is taking some shifts I didn’t know about until recently – away from health informatics and electronic health records (EHRs) and towards new directions including patient engagement. It’s exciting to grow in new directions yet bittersweet to let go, but let go I must for the sake of learning my focus areas well. I’ll still blog here if something about health informatics catches my eye and of course there’s a lot of intersection, but EHRs are one of the tools used to involve patients with their healthcare and do not constitute actual patient engagement. This is something I’m seeing a lot of misunderstanding with current discussions about this area and I’m looking forward to bringing my health informatics background to this direction!

Crashing and Phoenixing: Data MOOCs

Monday, December 10th, 2012

That social network analysis MOOC (Massive Online Open Course) I signed up for that initially went so well? I started having technical problems (not being able to view the videos at all, or seeing them without sound) on both Internet Explorer and Firefox. Updating browser versions, Flash & Java weren’t being able to fix it and I quickly learned closed captioning alone isn’t enough for me to ‘get it’ with videos, so I called it quits.

That said, there are several other MOOCs that have caught my attention for 2013 that may be of interest to you especially for data management and visualization. Things like the Electronic Health Records Infographic from healthit.gov don’t create themselves, although my quibble is the source data at the bottom needs to actually be legible.

Introduction to Infographics and Data Visualization – January 12 – February23, 2013. This is the second offering of the class from the Knight Center for Journalism and the course platform is Moodle. I teach using Moodle so I’m studying the design and management closely – currently there are over 3,400 of us in there when I often cap my classes at 50 to keep things manageable. Enrollment was painless and provided immediate access after account setup to the main page and an introduction video, syllabus, instructor bio and even links to the first week reading assignments to get a head start. Course objectives include

  • How to analyze and critique infographics and visualizations in newspapers, books, TV, etc., and how to propose alternatives that would improve them.
  • How to plan for data-based storytelling through charts, maps, and diagrams.
  • How to design infographics and visualizations that are not just attractive but, above all, informative, deep, and accurate.
  • The rules of graphic design and of interaction design, applied to infographics and visualizations.
  • Optional: How to use Adobe Illustrator to create infographics.

As with most MOOCs no academic credit is offered, and a completion certificate is available for $30 if you meet the requirements for finishing the class. Thanks to Susan Kistler of the American Evaluation Association for the tip!

Data Management for Clinical Research – April 2013 for six weeks (this seems to be a standard MOOC course length) by Vanderbilt University on Coursera, the same platform that was crashing & burning for me so I’m hesitant to give it another go plus I’m not directly involved in clinical research or supporting it. The course description is

This course is designed to teach important concepts related to research data planning, collection, storage and dissemination. Instructors will offer information and best-practice guidelines for 1) investigator-initiated & sponsored research studies, 2) single- & multi-center studies, and 3) prospective data collection & secondary-reuse of clinical data for purposes of research. The curriculum will balance theoretical guidelines with the use of practical tools designed to assist in planning and conducting research. Real-world research examples, problem solving exercises and hands-on training will ensure students are comfortable with all concepts.

It would definitely be of interest to those new to working in clinical research , and thanks to Amy Donahue for alerting the Twitter #medlibs community to it!

Speaking of Twitter #medlibs chats, they has been consuming the vast majority of my personal bloggage time – I can apparently either do that or this blog well/regularly but not both at the same time. Be sure to stop by this Thursday, December 13th (last organized #medlibs chat of 2012) and check the #medlibs blog for details and transcripts of the great conversations your colleagues have been having.

Opportunities: OpenNotes Results Published

Wednesday, October 3rd, 2012

From when I first heard about the OpenNotes Project (research to have patients access their doctors’ notes as part of their medical record) and included it in my June 2010 entry of Electronic Health Records: Not All About the Machine to meeting up with Dave again last month in Listen Again to the Ideas – The Role of the Patient, I’ve been looking forward to learning the results of the research.

Got under 5 minutes, appreciate great narratives and like videos? Here you go.

Like reading overviews with results pulled out in bullet points for easy reference? Go to e-patients.net’s coverage.

Like reading original publication data (of course you do!) ? Annals of Internal Medicine has it freely available.

Unfortunately I haven’t had a chance to read the full article yet. Questions I’ll have in my mind as I do will involve a focus on the experience of the research at Harborview, and opportunities for medical librarians to become involved with patients’ access to resources to understand the notes containing their health information. For as much as I love ePatient Dave he still is referencing Google as a starting point for health information research online. We medical librarians know there are much better ways, including the integration of health information resources within electronic health records such as MedlinePlus Connect, but it doesn’t help if others don’t know about and use them!

Education in Medicine lecture

Thursday, May 3rd, 2012

A long time ago (February) in a place not so far away (upstairs a few floors at work) I attended a lecture entitled Medical Education in the Era of Ubiquitous Information by Charles P Friedman, which focused on the knowledge cloud concept increasingly supporting both medical education and then practice with it factoring into clinical decision making well beyond the current concept of clinical decision support (CDS) in electronic health records (EHRs).  Here is my Google docs notes coverage.

That was the first time I gave a Google-docs-via-iPad-with-Kensington-keyboard note-taking strategy a try and I wasn’t all that impressed. I’m a relatively fast typist and there was a strange lag resulting in missing letters numerous times. Google Docs then crashed outright several times, wiping out a line or so of notes with each fall. Other experiments since February haven’t been all that much better, so while I’ll probably iPad most of the MLA meeting here in Seattle I’ll go old school and haul in my heavy old laptop from home when I’m Twitter Jockey for the Top Tech Trends session because I’ll stand a fighting chance at being able to keep up. Let us keep our fingers crossed for steady wireless connectivity!

Blasting off 2011

Friday, December 30th, 2011

a triptych of our son launching his stomp rocket

I’ll admit it – 2011 has been a very challenging year for me both personally and professionally, and no one except the members of my household knows the full scope although it is a miracle we’ve all survived with our sanity somewhat intact. When life demands increase time is reallocated to priorities, and while my family & work are the top ones my blog has not been very often. I’m exhausted. I thought two weeks off from work at the end of the year would be enough to recharge (well ok, maybe not with Christmas & painting!), but mentally I’m still quietly staring at the marble along with Dean in Quiet Contemplation.

Am I stopping blogging in 2012? Of course not. If anything I see the increased value of writing only when I’ve developed something purposeful to say vs. increasing the noise for the sake of frequency in order to keep to a schedule or repeating information that’s announced elsewhere.

I try to have an eye out on the Twitter #medlibs/@medlibs communities to help but with work demands sharply increasing (I have not one but two major surveys to develop simultaneously when I return) my time for social media seems to be decreasing as well.  I’m encouraged by seeing more medical librarians getting involved with Twitter hashtag chats, and was frustrated in November that the Medical Library Association still doesn’t seem to get the value of them.  I agree with Carol Perryman’s reflections in What is the role of the Medical Library Association in a time of crisis? I have echoed this several times too – for example, why isn’t MLA tapping Woods Hole alumni for a task force or related activity, especially with the recent curriculum change there heavily involving electronic health records (EHRs)? So many are being highly effective change agents on their own and/or at their institutions. Surely more can be done on a national level to bring their collective energy together for the benefit of all especially now with the rapid implementation of EHRs to meet meaningful use incentives.

I’m hopeful we’ll see more progress in these directions and am looking forward to 2012 for many reasons, not the least of which is welcoming everyone to Seattle to attend MLA 2012 either in person or virtually. There is a lot of work going on behind the scenes by many great people and I can’t wait to share more once the website is further developed for the Local Assistance Committee to show what we’ve got!

PNC/MLA Day 2

Tuesday, October 18th, 2011

For today I was only able to cover Dr. Ted Epperly, our phenomenal morning speaker (Google Doc link), because of  some rather intense technology issues that I was in charge of handling. He definitely reinforced the thread of relationship being of strong importance and I am still struck by a quote he found and wrote on a napkin:

Too many specialists are as dangerous to the quality and quantity of medical care in a community as too few.

That was from 1949!

I had to run to catch a flight home so I could enjoy the rest of a gorgeous Seattle afternoon and evening with my family and missed the NN/LM PNR and MLA updates, and at this point don’t know if the NLM update slides (see above technology issues) will be available later.

My apologies but I’ve never been inspired to blog our morning business meetings. Thanks for a wonderful time in Boise, PNC Annual Meeting Committee!

MedlinePlus® Connect Webcast

Tuesday, July 19th, 2011

The webcast recording is one of the best explanations of MedlinePlus Connect I’ve seen and lasts for a half hour at https://webmeeting.nih.gov/p92647717/

I’m currently on vacation and rethinking a lot of my blogging directions, but (as much as I loathe listservs) had to share this as soon as I saw it post to the one for MedlinePlusConnect (what’s that?) (how to subscribe to that high signal/low noise channel).

 

The next UMLS Webcast will be held on July 27, 2011 at 2:00 pm US Eastern Time.  The topic is “MedlinePlus® Connect: Linking Patient Portals and EHRs to Consumer Health Information”. MedlinePlus Connect (http://medlineplus.gov/connect) allows patient portals, electronic health records (EHR), and other health IT systems to link to relevant, authoritative consumer health information from MedlinePlus.gov. MedlinePlus Connect accepts requests based on problem codes, medication codes, and lab test codes. It also supports the HL7 Context-Aware Knowledge Retrieval (Infobutton) standard. Stephanie Dennis, MedlinePlus Connect project manager, will give an overview of MedlinePlus Connect, explain how to implement it, and explain the National Library of Medicine’s behind-the-scenes work to support it.

Webcast Information:
. Date/Time:  July 27, 2011 – 2pm US Eastern Time
. URL:  https://webmeeting.nih.gov/medlineplusconnect_essentials
. Requirements:
Adobe FlashT enabled web browser
Speakers or headphones (audio will be broadcast over the internet)
.  Captioning will be provided for this Webcast

They don’t mention if it will be recorded for playback later but I hope it will be. If so I’ll update this entry with a link to the recording afterward. Edit: Thanks Patrick! It will be recorded and included in the list here, but I’ll also post the individual recording link. :)

Of Informatics and Twitter Evolution: Woods Hole

Thursday, June 2nd, 2011

Long time readers may remember that I was in the Spring 2009 MBL/NLM BioMedical Informatics cohort and I blogged my brains out about it. Back then I intermittently used Twitter to connect with a few people during it mostly as an additional information seeking tool to clarify or expand on the subjects we were learning about.

My stated purpose in attending there was to create the online class Making Connections: Librarians & EHRs. The problem new development that happened in the meantime and caused an enormous delay in launching the class until this year was that a whole new political angle emerged (see the week 2 module) that medical librarians need to understand as part of their involvement with electronic health records.

From what I’ve seen from our medical librarian colleagues on twitter (#BMISpring2011) attending the Spring 2011 MBL/NLM BioMedical Informatics cohort, the curriculum there has been substantially overhauled since Fall 2010 to include a wealth of information about the current political background and specific EHR components. Their group project involves hands-on work with an EHR system. This is so exciting!

Also exciting is the evolution of how the medical librarians there, recently fueled by connecting with the greatly expanded use of the #mlanet11 Twitter at the recent Medical Library Association annual meeting in Minneapolis, have taken it a step further with sharing information from Woods Hole. I caution them to not burn out in the process as information overload hits heavily right about now, and am resurrecting one of my concluding statements from when I was there in 2009:

Why isn’t MLA collectively tapping Woods Hole alumni for the Vital Pathways project?

A commenter kindly pointed out that was an over & done project but my question remains: Why is the collective energy of medical librarian Woods Hole alumni not being tapped to help share our knowledge with the field? What kind of change agents are we if we’re not, you know, out there changing things together?

Do I need to spell it out in MLA meeting themes that the ReThink has already happened and we’re supposed to be Growing Opportunities and Changing Our Game now?

Picture by Clare Leibfarth

You may never know what results come of your action, but if you do nothing there will be no result. ~Mahatma Gandhi

I’m trying. Who’s with me?

Rethinking failure: Google Wave

Thursday, August 19th, 2010

For a blogger, covering the demise of Google Wave as announced on August 4th several weeks later is rather slow but it’s given me time to reflect. Laikas did a great job getting the news out quickly to the medical library community, especially the part about where there is still perceived value in Wave from a health information technology perspective for electronic medical records.

I am glad I wrote up the coverage of Seattle’s use of Google Wave during a chaotic manhunt last fall from a community emergency communication perspective and hope Google is taking the lessons learned about how people used Wave to seek and add information into new communication channels to experiment with.

Was Wave an “outright failure” on Google’s part? Perhaps not.

Posted on Slate’s The Wrong Stuff the day before the Google Wave announcement was an interview with Peter Norvig, Google’s director of research. If you’re not familiar with The Wrong Stuff it was supposed to be a brief series of eight people discussing the role of error in their lives and professional fields. Thankfully they have agreed to continue the series and I highly recommend adding their RSS feed to your reader since they are fairly intermittent but well worth checking out when they publish.

Part of the first answer alone should grab you, bold emphasis mine:

If you’re a politician, admitting you’re wrong is a weakness, but if you’re an engineer, you essentially want to be wrong half the time. If you do experiments and you’re always right, then you aren’t getting enough information out of those experiments. You want your experiment to be like the flip of a coin: You have no idea if it is going to come up heads or tails. You want to not know what the results are going to be.

and further on down:

I’ve been at both ends. My previous job was at NASA, where you really don’t want your shuttles to blow up very often. So there they spend hundreds of millions of dollars to protect their astronauts’ lives. Here, we’re kind of at the other end. Failure is always an option at Google.

I encourage reading the whole article for some reflection, especially where he has an interesting take on library sciences technology (hint: not favorable or accurate in my opinion). From my limited time and perspective in the field thus far I see a lot of the library field as fearing and avoiding failure at almost all costs. Perfectionism can sometimes run so rampant that it squelches any hint of innovation in its path, yet it is innovation that leads to experiments in the first place.

Are libraries so NASA-caliber that failure can never be an option? No. Mark Funk reminded us in 2008 that “We Have Always Done It That Way” isn’t an answer, it’s an excuse. At the same time library science journals seem to follow suit with not publishing about failure often as other journals do in not publishing when drug experiments failed.

I can understand why: it takes a lot of extra time and effort that many librarians do not have to write for publication, and who wants that to highlight a failure? Is there an opportunity for a Wrong Stuff resource of library-related errors and experiments gone wrong so we’re not all reinventing the wheel in isolation from one another? The publish button in WordPress makes the process pretty painless!

Electronic Health Records: A snapshot of ephemeral chaos

Thursday, July 1st, 2010

Last month I wrote about how electronic health records (EHRs) are not all about the machine with perspectives from others combined with my own and the launch of the OpenNotes study.

The ADL Librarian continues with EHRs and Librarians part 2, giving us a snapshot of the rush to figure out how medical librarians can be involved as part of EHR implementation initiatives. He identified 3 core librar* (I like to think both libraries as institutions and librarians as people have places here) roles of Information Retrieval, Information Organization, and Information Access and includes

This is an ideal time to offer to help organize the piles of forms and documentation. We mustn’t assume that the librarians role in EHR implementation is obvious to the professionals handling the implementation.

Indeed, not much regarding EHR implementation is clearly obvious at this point in time when the final 53 page PDF Temporary Certification Rule was just published (and summarized well at Life as a Healthcare CIO) and applications to be an Authorized Testing and Certification Body (ATCB) are open beginning today. Final Temporary Certification Rule. A Final Permanent Certification Rule by this fall, the permanent certification program in place by fall 2012.

My mind boggles thinking about the amount of time and energy involved in that process alone, and when it comes to implementing the ‘meaningful use’ requirements of EHRs 80% of hospital chief information officers (CIOs) don’t think they’ll be ready to meet the 2015 deadline as covered by the Wall Street Journal Health Blog.

Specifically, they’re worried about the requirements that will actually mean changing how care is delivered — such as using computerized evidence-based guidelines when ordering tests or procedures — says Bruce Henderson, leader of the electronic health records practice at PwC. “There’s lots of focus on the technology, but this is really about standardizing care processes at the highest level of quality with an eye towards the reduction of costs,” he tells the Health Blog. That means changing how doctors, nurses and other personnel work — and changing how anyone does his or her job is not easy.

Very true. In my previous entry I wrote about an experience with one doctor who was clearly very familiar with the electronic workflow; I also had an experience with another doctor last month who clearly was not and vocalized frustration in not being able to locate what she was seeking from the order set.

E-Patient Dave came to the realization that we are human (I reject his claim that he’s not as observant as he thought) and do not recall everything from doctor’s appointments a week later, and found out how helpful access to visit notes are. Read about his first experience as a result of participating in OpenNotes to see what he did.

This is how it should be: everything about our healthcare information accessible in one place, without having to wage a war in the process. Despite what sounds like a long stretch of oppressive heat and humidity in the other Washington, I wish I could be there for Regina Holliday’s e-Patient Ephemera: 73 Cents meets the world of data capture art exhibition on July 29th in Georgetown. She writes:

For too many years the medical record has been viewed as only a billing document and a piece of daily medical ephemera. Hundreds of pages of vitals, imaging results, medical reconciliation and surgeries are distilled into the few pages that form a transfer summary. At each facility this process continues; each set of daily records entering the ether of a payment structure. A daily accumulation of data that will remain untouched by many, if a lawyer and a potential lawsuit is not involved.

How did a document originally intended to facilitate communication and the medical history of a patient become a piece of billing ephemera? How dare institutions consign this living document a role as nothing more than a receipt of services rendered? With the advent of health information technology, the electronic medical record has the potential to leave its old role of medical ephemera and enter the virtual eternity of cloud based computing. Ah, the ability to create a lifetime electronic medical record consisting of transferable and actionable data is within our grasp. Or does this really matter?

I pointed to a picture of my then 7, now 8 year old son on my laptop when I met Regina in May.

All of his healthcare information since the day he was born (my prenatal care is in mine) to now are contained within an electronic medical record.

It really matters to me. I appreciate the struggle and chaos of the work being done now so that one day almost everyone can have them as well. Edit: Let’s hope that soon information about EHRs is in a format as easy to understand as the new HealthCare.gov site is!