Monthly Archives: September 2003

OIO Project delivers Physician-Customizable Forms, Schedules, and Workflows

Imagine a new U.S. federal law mandating that all physicians practicing in the U.S.A. must use DHS2004 form to document each encounter with their patients. How much inefficiency would this introduce into the medical workflow? Can a single form be optimal for all medical specialties and practice configurations? If not, how many forms will we need? Who should design and pick the forms to use? How do we maximize quality of care given the tremendous diversity of medical information needs? Every physician starts out as a highly qualified scientist, who is fully capable of organizing and acting on highly variable medical information. Before we deprive individual physicians of their discretion to customize their records, please consider one of the alternative solutions:


Introduction to OIO-1.0.0. Is OIO just marketing hype? Read on to find the answer to this and other questions.

  • Q: Can physicians really make their own web-forms using the OIO software?
    • A: Yes, Nandalal Gunaratne, a urologist, trained many colleagues at the Sri Lanka Teaching Hospital, Colombo South to make forms.
    • A: Yes, psychiatrists were able to learn to create forms using the OIO software during half-day courses at the American Psychiatric Association Annual meetings in 2001 and 2002.
    • A: Yes, Alex Chelnokov (Orthopaedics) and Gary Kantor (Anesthesia) learned to make forms.
  • Q: If every physician can make up their own forms, how will the resulting medical records be portable?
    • A: When the OIO system exports a patient record, it uses a simple XML format to communicate the patient information. In addition, the form(s) are included together with the patient information. Upon receipt of an OIO-generated patient record, the destination system can reproduce the form to correctly display the content of the patient record.
    • A: Just because physicians can make up their own forms does not mean they must. The OIO system enables physicians to exercise their professional judgement and decide, in the best interest of their patients, which/what forms are most appropriate. This means if there is a highly useful form for documenting severity of depression, for example, perhaps many psychiatrists will make use of it rather than making up their own. OIO software’s ability to support importing and sharing of forms makes it easy for physcians to download, try, and adopt other people’s forms. Centralized forms repositories like the OIO Library will make it easier to find and download forms.
    • A: We are in the process of designing form-to-form translators that will support reporting and information aggregation functions. Please let us know if you like to work on this.
  • Q: May I ask more questions?
    • A: Yes, post a comment below or send email to aho@ucla.edu or open-outcomes-general@lists.sourceforge.net
    • A: By challenging us with your question(s), you become a contributor to the OIO Project. Therefore, please ask, especially if you disagree with our approach, claims, or conclusions. 🙂
    • A: For a quick overview, take a look at the Introduction to OIO-1.0.0 article published on Zope.Org.

    • MAGE-ML Project on SourceForge

    This paper in Bioinformatics points to a project on SourceForge.
    The project is to develop a SOAP/Axis based query service for DNA microarrays. Hopefully you will be able to incorporate microarray data into all your apps regardless of platform!

    Microarrays are an important research tool for the advancement of basic biological sciences. However this technology has yet to be integrated with clinical decision making. We have implemented an information framework based on the Microarray Gene Expression Markup Language (MAGE-ML) specification. We are using this framework to develop a test-bed integrated database application to identify genomic and imaging markers for diagnosis of breast cancer.

    Wrap-Up Of UCLA’s ‘Think tank of Disruptive Technologies’

    ‘A unique forum for professionals seeking expert opinions and information on emerging technologies’ in medicine was held last week at UCLA’s Lake Arrowhead conference center last week. It was the kind of gathering of intellects that made you feel proud of being in medicine. Here’s the very short condensation of 4 days of conferences: The trend toward democratization in medicine will continue, Application Service Providers (ASP’s) are being discussed a great deal. Wired networks will always have a role, but wireless is so convenient that it may take over. Handhelds are preferred over tablets because in an ICU there is no place to put a tablet down without contamination (think pool of secretions) however, the screen size of a tablet is superior. Wireless in a hospital means that there is much wiring but it is hidden in the infrastructure. Speech recognition is still almost, but not quite, there. Free and Open Source in medicine communities are characterized by those who think that FOSS is The How for getting things done in medical software. ZOPE is a compelling platform for medical records. FOSS is a ‘weather system’ which needs more points to connect with each other. IBM is ready to support FOSS in medicine whenever a worthy product emerges. There are many, many good FOSS imaging software available. The DICOM imaging standard recently celebrated its 20th birthday. Peer 2 peer has some potential in medicine. Microfluidics is just amazing, keep your eye on it! Software data navigation needs to take into account at least 5 dimensions and perhaps more. Workflow analysis is becoming important clinically. ICBM is a far more accurate brain map than Talairach and will soon be available. Flat panel displays are here to stay, vary widely in quality and like early radiology CRT’s were initially un-reliable. Few radiologists do adequate QA checking of their displays. Ergonomic design of rooms and buildings for medical begins with the architect and Interior designer. It is not an option for optimum staff performance and reduction of errors. Patient encounter time has gone from approximately 29 minutes in 1980 to 7 minutes today. Physicians by and large build up barriers to patients. Clinicians are afraid of spending more time using technology. It is a time trade-off that appears to be the biggest barrier in using technology. Your medical record may be coming to your DVD player soon and offers a number of compelling advantages.’

    ‘In Waddles the Solution’ Discussed

    Some pungent replies to Charlene Marietti’s editorial in May 2003 Healthcare Informatics have been posted. Excerpt: ‘…There are several open-source EHR projects (listed at www.linuxmednews.com). These are the result of several years of grassroots, collaborative work. The AAFP and the U.S. government would get more mileage from their dollars if they supported one or more of these projects–not just in funding, but in collaboration…’

    Medicare Wiggles on HIPAA Deadline

    Medicare is announcing that they are wiggling on an October 16th deadline to accept HIPAA non-compliant electronic transactions. Full text of the announcement is within.

    MEDICARE NEWS

    FOR IMMEDIATE RELEASE
    CMS Public Affairs Office
    September 23, 2003

    MEDICARE ANNOUNCES PLAN TO ACCEPT HIPAA NON-COMPLIANT ELECTRONIC
    TRANSACTIONS AFTER OCTOBER 16 COMPLIANCE DEADLINE

    The Centers for Medicare & Medicaid Services (CMS) announced today that
    it will implement a contingency plan to accept noncompliant electronic
    transactions after the October 16, 2003 compliance deadline. This plan
    will ensure continued processing of claims from thousands of providers
    who will not be able to meet the deadline and otherwise would have had
    their Medicare claims rejected.

    “Implementing this contingency plan moves us toward the dual goals of
    achieving HIPAA compliance while not disrupting providers’ cash flow
    and operations, so that beneficiaries can continue to get the health
    care services they need,” said CMS Administrator Tom Scully.

    CMS made the decision to implement its contingency plan after reviewing
    statistics showing unacceptably low numbers of compliant claims being
    submitted.

    “Medicare is able to process HIPAA-compliant transactions,” said
    Tom Grissom, director of CMS’ Center for Medicare Management, “but
    we need to work with our trading partners to increase the percentage of
    claims in production.”

    The contingency plan permits CMS to continue to accept and process
    claims in the electronic formats now in use, giving providers additional
    time to complete the testing process. CMS will regularly reassess the
    readiness of its trading partners to determine how long the contingency
    plan will remain in effect.

    The authority to implement a contingency plan was provided by guidance
    issued by HHS on July 24. CMS recognized that transactions often
    require the participation of two covered entities and that
    non-compliance by one covered entity may put the second covered entity
    in a difficult position. The guidance stated that covered entities that
    make a good faith effort to comply with HIPAA transactions and code set
    standards may implement contingencies to maintain operations and cash
    flow.

    CMS announced its contingency plan on September 11, but at that time
    had not made a decision on whether the plan would be implemented.
    Today’s announcement means the CMS plan will be implemented on October
    16, 2003.

    “We encourage other plans to assess the readiness of their trading
    partners and implement contingency plans if appropriate,” Grissom
    said.
    ###

    Cathy C. Benoit, HIPAA Coordinator – Atlanta
    Centers for Medicare & Medicaid Services (CMS)
    61 Forsyth Street SW Suite 4T20 -DFMPI
    Atlanta, GA 30303-8909
    404.562.7305
    404.562.7350 (Fax)
    CMS HIPAA Hotline: 866-282-0659
    OCR HIPAA Hotline: 866.627.7748 (Questions Related to Privacy)

    Royal College of General Practitioners Choose Linux

    According to this article in the NHS Health Informatics the RCGP 6,000 members will be getting their news faster. They were impressed that the Trustix mail and web server applications were able to run without causing problems to other applications that have to run on the same hardware, and by its speedy performance – as the fortnightly email delivery takes less than two hours rather than the three days required by the proprietary solution.

    AMIA 2003 Program

    The American Medical Informatics Association has posted their online program for the 2003 Annual Symposium to be held in Washington,DC November 8-12,2003 at the Marriot, Wardman Park Hotel. A search of the program for

    Open Source     yields sixteen items. Year by year we are seeing more mention of and involvement in open source at these major events.

    Dr. Julie L. Gerberding, Director of the Centers for Disease Control and Prevention, will deliver the keynote address.

    Anyone interested in attending or helping organize an open source BOF to discuss open source promotion and other issues within the healthcare community please email Tim Cook at tim@openparadigms.com
    and we will locate a suitable venue and develop an agenda.

    FreeB Billing .06 Alpha Available

    Everyone, I am proud to announce the availablility at http://www.freemed.org/FreeB/FreeBv.06.tgz of FreeB .06 Alpha medical billing software. There are two big improvements to the code.

    1. The XML-RPC interface is working. This is what the API will be based on. In order to test the code you need to run the Practice Management Simulator that is included in the tar. This is essentially a beta reference implementation of the FreeB API. So I am curious to see what everone thinks!!

    2. The X12 support now generates code that passes the X12 certification tests. Once I have tested with a broader spectrum of data, I will apply to have FreeB certified as HIPAA X12 compliant. That will be a major milestone for FreeB.

    Complete text of the announcement follows.

    Everyone, I am proud to announce the availablility at http://www.freemed.org/FreeB/FreeBv.06.tgz of FreeB .06 Alpha medical billing software. There are two big improvements to the code.

    1. The XML-RPC interface is working. This is what the API will be based on. In order to test the code you need to run the Practice Management Simulator that is included in the tar. This is essentially a beta reference implementation of the FreeB API. So I am curious to see what everone thinks!!

    2. The X12 support now generates code that passes the X12 certification tests. Once I have tested with a broader spectrum of data, I will apply to have FreeB certified as HIPAA X12 compliant. That will be a major milestone for FreeB.

    This version is the first version that other projects could actually use to bill. You can begin the development effort to support this system using this code! All you have to do is replicate the calls that the Practice Management Simulator does, and you can have your data generate X12 and hcfa files. There are some things that are still broken about the API. But the general calls are there. In the next couple of weeks the API will be finalized and there will be some billing targets
    available. I think we will try for “Web Printing” for the HCFA files and support for at least one of the clearing houses autoload functions.

    This will be the last release until the API is finalized, which will be the last release before the .1 release which will be the first fully functional release. That version will support logging, etc etc.

    If you have not already contacted me about using FreeB in your project, please let me know. I will be soon compiling a list of projects that intend to use FreeB!

    Thanks,

    —
    Fred Trotter
    SynSeer