For a long time we have pondered how to meet the needs of a segment of the community for whom a response falls somewhere between an answer that can be encapsulated in an email and a full consulting engagement.  At the same time, we are looking for a method of keeping all of our consulting up to date in our constantly evolving industry.

Our new Lantana Subscription Service offers individual service as needed over a subscription period, access to subscriber publications and webinars, and more.  The total cost per year is approximately that of our minimum engagement, so it gives us a method to work with a wide number of clients in a simple format.  Let us know if you’d like more information or to take advantage of a six month introductory offer through March 2012.  See you at HIMSS12!

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Researching The Green Revolution in Health Information Technology, to my surprise and pleasure, I found extensive research done by Kaiser Permanente on the environmental impact of electronic health records. The title of the article by Marianne Turley, Catherine Porter, et.al in Health Affairs gives away the punch line: “Use of Electronic Health Records can Improve the Industry’s Environmental Footprint”. Bottom line, they found that the environmental impact of Kaiser’s HealthConnect was positive. The major impact was on greenhouse gases which gained the equivalent in acres of carbon sequestration:

• 4,200 from decreased use of paper records
• 257 from decreased use of x-ray covers and forms
• 6,400-9,200 from fewer trips (less gasoline)

At the same time, there were negatives (again, in equivalent acres of carbon sequestration):

• 810 from print out of summaries
• 283 from PC packaging
• 13,300 from PC and data center power usage

Poking through the data we see that without the reduction in emissions from fewer trips – 16-25% — the net impact would have come out on the negative side. This is key as we look at how reproducible the results from Kaiser are likely to be as more EMRs are introduced and to the tie-in to the HL7 greenCDA.

HealthConnect is a single entity spanning the full spectrum of care with information flowing from clinic to hospital to consultant to lab to patient to pharmacy to geriatrician. It is estimated that in the care of a patient, 80% of the information needed will, at some point, need to cross an organizational boundary. So, a potentially testable hypothesis is that to reproduce the positive impact found from HealthConnect, information needs to be fluid. Standards make that possible and greenCDA, therefore, by making it easy, makes it more probable that benefits will be realized.

And there is a second, strong tie to standards in the incentive to reduce visits. The shift from payment for quantity to payment for quality is only possible through information-based measurement. Here, too, a specification that is sufficiently general to encompass all types of reporting and exchange and yet simple enough that any XML developer can work with it – that has a true claim to greenness.

It turns out, as well, that there are other things we can do while implementing our IT systems. Making smart choices for centralized infrastructure will minimize power requirements and using our purchasing power to promote non-toxic and recyclable components can help as well.

I found two major guides to green building for healthcare: LEED for Healthcare and the Green Guide for Healthcare. While both have some criteria related to HIT, it is possible to become certified in both without any effort to leverage it.

Here is the full set of slides I presented.  I’d love to know what you think of the concept.

Once again we will learn the fundamentals – fundamentally – securing that knowledge with hands-on experience under the supervision of experienced implementers (yes, we teach, and we teach because we also *do*.) 

We will also go up a notch and look at the Big Picture of how CDA and related specs – C32, CCD, Consolidation, Health Story, Healthcare Associated Infection reports – make the clinical information exchange wheels go round. And we’ll do this in lovely La Jolla – actually, La Jolla *Shores*, we like to be right up close to our venue, you can’t get closer to the beach without getting wet. Reportedly there are ways to eat, drink and explore the environs, which we’ll take advantage of each evening, extending the opportunities to learn, absorb and ponder beyond the classroom.

I wonder what Academy V will bring?

It will certainly bring Aziz Boxwala (UC San Diego), Albert Oriol (Rady’s Children’s Hospital), Dan Pollock, MD (CDC), and our own Bob Dolin, MD – our guest experts, ready, willing and more than able to talk about how all this will fit together.

What’s new in number IV? Lots.The strong positive response to greenCDA and the rising interest in templated CDA and quality reporting from the EHR has led to new material on these topics.

More significantly, we’ve taken feedback from I-II-III and augmented the core curriculum with a special track for policy makers and planners. The P&P track is shorter and combines the basics from the Implementer track with special sessions connecting the Big Picture dots with the way interoperability really works at the specification and implementation level. I’m not sure there is a better place to do this than here at the Academy and I think there is widespread need for just this perspective.

The immediate inspiration for the P&P track came from a group of folks from the DC area who attended Academy II and said, not verbatim, “It’s worthwhile for us to come up here just so that we have the quality time to talk to each other.” And of course, the Academy atmosphere supported those conversations by including students working in the trenches making the next generation products Meaningful Use-ready and preparing providers to leverage these opportunities to provide better care. Not to mention the presence of the expert panelists, instructors and special guests — our guest expert for IV is Blackford Middleton, MD who will co-present in the P&P track and join us on our Tuesday expert panel.

Just about the only pattern to the Academy that seems statistically and logically unlikely to be sustained is our amazing track record of stellar weather here in northern New England. Could it be that once again we’ll have 80 degree weather for our maiden evening canoeing and our Thetford BBQ? Possibly, as there may be some perverse dynamic in play since we had to rearrange our schedule due to weather when we met in San Diego — and that never happens out there.

Stay tuned, should be a great week.

So, we go into ballot reconciliation and then will pick up the remaining C32 templates and publish.

What then?

ONC hosts this effort, which is great, but will they also recognize it formally as the successor to the HITSP work in C32/C83/C80? If not, why not, and if so, when and through what process?

These questions are coming forward daily, and no wonder – standards are the means to achieve Meaningful Use. ONC says so, CMS says so, and the industry is bought into the concept. Great.

Phase 1 designated a number of standards, including C32.

The drive behind the Consolidation Project was three-fold:

• Put the specs for all 9 balloted CDA Clinical Document Implementation Guides in one place
• Harmonize discrepancies between HL7, IHE and HITSP C32
• Provide a one-stop-shop Implementation Guide supported by model-driven tools so that implementers no longer need to peel an onion to figure out what the specs actually say

We are on target to achieve all three objectives, with a second ballot to pick up the non-MU-required templates. We will certainly publish by the end of the year, and, if needed, could publish with the MU-required templates mid-year. This is a known and reliable timetable, the kind required to support implementation.

Vendor implementation cycles take time - just about as long, maybe even longer, than standards development. Each day, decisions are being made whether to adopt the current C32, to look forward to the Consolidation Project templates or to put standards-based development on hold until…the next new thing. The absence of a clear signal, an indication, a roadmap, heck, even a pathway forward to recognize this effort as part of the next stage of requirements leave a void.

Until ONC provides leadership and guidance, uncertainty and confusion will fill this void, despite the best efforts of industry to coalesce around common standards.