Measuring Happiness

It's Christmas Eve and I've put the Blackberry to bed, stopped the strategic planning, and set aside the work of worry.

My daughter does not want to discuss upcoming college tours or the cube root of 127. Instead, we're discussing our personal definitions of happiness.

For my daughter, it's the little things that make her happy. The smiles from her friends, the smell of soy hot chocolate, and the idea of sleeping for 12 hours without homework to do.

For me, I measure happiness by looking at my reflection in the people around me. Have my parents had a good year because of something I've done? Has my wife been empowered to pursue her dreams? Has my daughter gained more self confidence? Do my staff feel good about our trajectory and the stability of their work environment? Do my colleagues feel that I'm a convener who can be trusted to bring people together seeking the greatest good for the greatest number?

Measuring happiness through the eyes of others is imperfect - you cannot make everyone happy. However, you can treat them fairly, positively, and with respect, even if they are naysayers. My metric is to simply ask if I've done my best.

As I sit with my family, a snow covered wreath hanging on my front door (the photo above), the smell of chestnuts drafting through the house, sipping a cup of Graham's 1985 Port and watching The Polar Express, I have a sense that my wife, daughter, parents, friends, and colleagues are achieving their own happiness. I'm at peace with the world and thankful for the year that's passed, happy by all measure.

Happiness to you and to all a good night.

2009 in Review - Part 2

As I've said in my blog about "The Number 5" I tend to organize my life and my projects in groups of 5. My 2009 Review has five segments - Harvard Medical School, State projects, and Federal projects which I presented yesterday plus Beth Israel Deaconess and my personal life which I'll present today.

BIDMC

Beth Israel Deaconess had a turbocharged 2009 which included a new alliance with Atrius Health, numerous new applications, and significant infrastructure improvements.

Community EHR - the first step toward care coordination among all providers associated with BIDMC is to ensure all PCPs, specialists, and referring clinicians have electronic health records. In 2009 we built a data center filled with virtual servers, clustered databases, and software as a service EHR applications fully integrated into our statewide data exchange for administrative transactions, e-prescribing and clinical data sharing. It's a huge change management project as well as a technical one.

Infrastructure - Just as with Harvard, BIDMC experienced explosive growth in the need for storage, especially of medical images. We developed a tiered storage system of SAN, NAS, and Cloud Storage using EMC products. The end result is the right storage platform for the business requirements of the data. We continued to virtualize our servers, cluster our databases, build redundant electrical systems, and ensure business continuance through geographically separated data centers. We elected to move our mainframe to an external hosting facility/vendor - a major transition for us. We enhanced our security capabilities significantly, revised our network architecture for robustness, and upgraded to Exchange 2007, expanding email box size tenfold.

Clinical - We completed our ICU automation efforts, implementing Metavision through all critical care areas including fully electronic documentation and device interfacing. We completed the programming for provider order entry in the NICU and Emergency Department, our last remaining areas with paper orders (both go live in 2010). We implemented electronic Emergency Department documentation, an electronic ED Dashboard at BID-Needham, automated inpatient Oncology management that is fully integrated with our existing outpatient system, pharmacy initiated renewals as part of e-prescribing, results sign off, scanning of the inpatient record, and created a plan for enterprise image management of all modalities over the next year. We enhanced our extranet, redesigned our intranet (goes live in mid 2010), created web-based radiology workflow tools, increased our business intelligence capabilities, and brought new focus to our laboratory information systems project. Interoperability projects linking BIDMC, community providers, patients, government and payers via the NEHEN gateway accelerated and will continue to flourish in 2010 with our Boston Public Health and Community Quality Data Warehouse projects.

Financial - We built numerous additions to our revenue cycle systems preparing for the 5010 and ICD10 conversions ahead. We upgraded all our Peoplesoft platforms to the latest versions, ensuring our customers in HRMS/Payroll, Research, General Financials, and Supply Chain are served with the most modern software available. We enhanced our integration engine capabilities and investigated new platforms to ensure we can provide the connectivity required for meaningful use data exchanges.

These are just a sampling of the hundreds of projects we completed on time and on budget while maintaining 99.9% uptime. I'm very proud of my teams.

Personal

In yesterday's blog, I called 2009 the year of changing everything. In my personal life, it was the year of moving everything.

Last Christmas, I committed to move my parents from the 1970's house where I grew up to a one story, easy to maintain, more modern home. We all accumulate things in our lives and moving requires us to rethink what we own. This year, my parents and my family worked together to streamline the contents of the old house, find a new house, move everything, upgrade the old house, and sell it. A heroic effort by all.

My wife is an artist and she recently expanded her South End (the artsy side of Boston) studio and created the NK Gallery at 460 Harrison, which will open March 1, 2010. This meant that all art, furniture, and supplies had to be moved from our house to the studio and gallery.

My daughter is in the marathon of the High School junior year, getting her life ready for college applications. We'll begin college visits in April. Children grow up fast. She also became an expert archer, averaging over 200 points per round (that's a lot of bull's-eyes from 50 yards away)

This was the year that I maintained every aspect of our 80 year old house - painting the exterior, repairing all screens/storm windows/porch, planing every door, repairing every worn bit of electrical/plumbing/hardware. In addition to being a CIO, I fix toilets!

My federal and state responsibilities, especially ARRA, reduced my free time and I did little rock/ice climbing in 2009. However, I was able to hike in New Hampshire, Japan, and the Eastern Sierra, as well as my usual kayaking, biking, and nordic skiing, so I've stayed in reasonable shape.

During 2009 I was able to maintain my daily writing for my blog, my Computerworld columns, and several journal articles. I practiced the Japanese Flute every weekend to clear my mind.

As I end 2009, BIDMC projects are on track and there are governance processes in place to ensure our resources are well aligned with customer needs. My family, my home, my outdoor activities, my writing, and my flute playing seem in good shape.

I look forward to everything 2010 will bring - the final regulations for meaningful use and certification, the HIE/RHITEC/Beacon Communities grants, and acceleration of healthcare IT in every practice setting. Hard work is fine as long as it's predictable. I'm hopeful that 2010 will be more consistent than 2009. Then again, I'm the eternal optimist!

2009 in Review - Part 1

As I look back on 2009, it was a year of incredible change.

I'll post this in two parts. The first includes Harvard Medical School and State/Federal work. The second will cover BIDMC.

Harvard Medical School

Infrastructure - demand for storage increased 250%. Willingness to pay fell below $1/gigabyte. We installed 200 Terabytes of Isilon clusters for the research community. Power and cooling became real issues in our data center. We virtualized everything possible, retired legacy equipment and began using special cooling techniques for our high performance computing clusters. Network speed and reliability demands increased so we built a redundant network core and enhanced Gig to the desktop support. We gave everyone a 1 gigabyte mailbox. Security investments increased substantially.

Research - Demand for high performance computing increased dramatically. We grew our central cluster resources and software capabilities to over 1000 cores. We enhanced desktop service and offered additional security tools to ensure compliance with federal and state laws.

Administration - Workflow became increasingly important and we implemented document management and office automation tools. Business intelligence demands increased significantly and we added datamarts and web-based reports.

Education - We added inline grading, enhanced mobile offerings (Kindle, iPod Touch/iPhone) , new video infrastructure, and online collaboration tools. We built faculty disclosure of conflict of interest on the web. Increasingly, virtual microscopy using Aperio software has replaced the use of slides and oil. Demand for video and web conferencing has grown substantially and we've deployed WebEx, Adobe Connect, and real time video multicast.

CTO- Novel social networking tools in support of research became a real driver throughout Harvard Medical School.

NEHEN/State projects

The New England Health Exchange Network merged with MA-Share to create a single healthcare information exchange with a single governance for the state. A commitment to exchange data from the CEOs of the payers and providers in Eastern Massachusetts, Meaningful Use, the HIE grants, and Beacon Communities grants have created new momentum to share data among payers, providers, and patients. 2010 should be the tipping point for rapidly accelerating widespread data exchange in the state.

HITSP/HIT Standards/Federal

HITSP and its tiger teams moved from use cases to Service Collaborations/Capabilities to support the American Recovery and Reinvestment Act. The HIT Standards Committee made standards recommendations to ONC in support of certification and meaningful use. The HIT Standards Committee developed a great camaraderie among its members that promoted lively, multi-stakeholder discussion. Transparency ruled and no subject was awkward to discuss.

Summarizing these three facets of my life - 2009 represented a significant expansion of Harvard Medical School infrastructure and applications, a new momentum for statewide health information exchange via NEHEN, and convergence on standards leading to new regulations guided by completely new Federal priorities.

Not quite the year of living dangerously, but definitely the year of changing everything!

The December HIT Standards Committee meeting

The December meeting of the HIT Standards Committee was a conference call, open to the public, as are all HIT Standards Committee meetings. We discussed four major topics -

*A summary of the security standards recommended thus far and lessons learned from the security issues hearing

*Next steps for the Clinical Operations Task Force on Vocabulary

*An update on the Implementation Workgroup

*A report from the HIT Policy Committee NHIN workgroup

Dixie Baker's excellent discussion of the security standards approved thus far illustrated that they are very manageable and are mostly in widespread use today, so 2011 does not represent a huge barrier for implementers.

Comments from committee members include (note that no changes in recommendations were made at this time)

Rather than mandate a standard for an organizational audit registry (ATNA), instead use Policy to require a list of data elements such as ASTM E2147 to be reported on request

Rather than require the IHE Consistent Time profile, instead specify basic NTP/SNTP (with the time server stratum determined by policy)

Do not require XDS/XDM/XCA/XDR as transport standards.

Do note require CDA as the metadata header for unstructured data such as PDF, TIFF, and CCR.

Allow IPsec with either IPv4 or IPv6 for securing the NHIN "backbone"

Use X.509 for authenticating NHIN nodes

Use TLS for securing transactions that require more finely grained controls than IPsec provides such as authentication of, and secured path to, servers or applications within an organization

When the interim final rule is issued, many public comments will follow and the HIT Standards Committee will consider the public comments and comments of the Committee members to generate its final recommendations to ONC.

The Task Force on Vocabulary discussed those code sets and value sets that would accelerate interoperability such as a universal lab compendium that covers the majority of ordered tests, a SNOMED-CT subset for problem lists, and mappings from SNOMED-CT to ICD and CPT. There is little controversy about vocabularies - everyone on the committee agrees on the need for publicly available code sets and value sets.

The Implementation Workgroup continues to emphasize its mantra - keep standards as simple for the user as possible.

The HIT Policy Committee NHIN Workgroup presented it's early priorities - focus on Push transactions while maintain a vision for widespread use of Pull transactions eventually.

A very productive and positive meeting. Our next steps are to review the comments from the Interim Final Rule which we anticipate being published on or before 12/31/09.

Cool Technology of the Week

I recently wrote a Computerworld Column about Email Overload.

I'm a data oriented guy and was curious to learn detailed statistics about my own Blackberry use.

A found a great Blackberry application called "I Love Blackberry" from EarlySail.

Here's my Blackberry statistics:

Average Daily - 111 Times for 2 hours 24 minutes divided as 86 times for 1 hour 34 minutes during work hours and 25 times for 50 minutes outside of work hours.

Average Weekly - 482 Times for 9 hours 31 minutes divided as 431 times for 7 hours 50 minutes during work hours and 51 times for 1 hour 40 minutes outside of work hours.

This means that I spend approximately 20% of my work time doing Blackberry communications. A startling statistic.

Between work time, home time and driving time email has added 20-25% more work to my week. I am more productive, and resolve issues sooner, and I can run organizations remotely. The EarlySail applications provides great insight into the time and effort cost of maintaining this level of connectedness.

That's cool!

My Life as a Nerd

As a teen, I was awkward, a social outcast, and more focused on math, science, and engineering than sex, drugs, and rock&roll.

In 1972, I won the 4th grade science fair by building a Van de Graaff generator- the photo above. Few people know that it failed as the judges were about to review it. I noticed the power supply leads were loose and thinking I had unplugged the 4000 volt transformer, I tightened them with both hands. Whoops - 4000 volts surged through my body and knocked me across the room. My hair has been curly ever since.

Also in 1972, I received my first electronics breadboard set - the 65 in 1 Electronic Project Kit.

I taught myself how to use PNP and NPN transistors, how to use resistors/capacitors/inductors, and the basics of analog to digital conversion. Here's my December 25, 1972 picture- note the short sleeve shirt, buttoned at the top button, the white socks, and the black horn-rimmmed glasses. I was too young for a pocket protector - that came later.

Today, my CIO life is filled with glamor, thrills, and chills. From nerd to IT Buckaroo Bonzai. Geeks of the world unite!

Creating Interoperability with Atrius Health

Today, BIDMC and Atrius Health officially celebrate their collaboration - bringing together a large multi-speciality practice group with an academic teaching hospital for coordination of care, a focus on quality, and improvements in efficiency. IT is a major component of our work together. Here's what we've done:

*Any admissions to BIDMC result in automated electronic notification of Atrius PCPs

*Any ED discharges result in automated electronic care summaries sent to Atrius PCPs

*Any inpatient discharges result in automated electronic care summaries including medication data for reconciliation sent to Atrius PCPs

*All email between the two organizations is secured via TLS and is HIPAA compliant

*All BIDMC clinical data is viewable within Epic without the need for a separate username/password or the need to respecify the patient. We do this via RESTful protocols that transmit patient context, login credentials and access control information between Epic and BIDMC systems.

*All Atrius data is viewable to BIDMC clinicians via Citrix. Over the next year, we'll implement more automated methods following the standards that support meaningful use data exchanges.

*We've created a web-based automated census of all admitted Atrius patients including those in ED or hospital observation beds (pictured above)

*Atrius Case Management staff have full access to all BIDMC clinical systems

*BIDMC has provided all phones, networks (wired/wireless), desktop, printers, and seamless LAN to LAN VPN access linking the BIDMC and Atrius networks.

We've done all this over 60 days and have learned a great deal. The Atrius BIDMC relationship will be a great testbed for interoperability activities in our Healthcare Information Exchange and Beacon Community work.