Dr. Joel Diamond, a family practitioner for over 20 years and currently an active partner at Handelsman Family Practice, in Pittsburgh, PA., as well as Chief Medical Officer for dbMotion, discusses his experiences with interoperability in his blog Health Interoperability Exposed.
Follow Dr. Diamond on Twitter or read his musings from HIStalk Practice.
Won’t the UMLS Solve Everything?
July 12, 2010
I recently submitted a speaking proposal on a practical approach to achieving semantic interoperability, and was shocked to see the response from one of the reviewers. He intimated that the Unified Medical Language System (UMLS) is all that is needed to solve this complex problem. Furthermore, he indicated a disdain for any proprietary solutions. (Somewhat disingenuous, given that much of UMLS is proprietary—SNOMED and CPT amongst others). I thought I would take some time to discuss the common misconception of the UMLS as a panacea, for this is a banner that is commonly raised by well-meaning, but naïve individuals who dream of simple solutions to complex problems. I certainly understand the appeal of the National Library of Medicine’s open source efforts....
Canadian Healthcare and HIE
May 27, 2010
I have been fortunate to travel and interact regularly with my physician and HIT colleagues in Canada, and am always surprised by the difference between political rhetoric and real life....
Viewing Medical Information on a Mobile Device: Why Semantics Matter
April 21, 2010
The recent hoopla surrounding the release of the Apple iPad has been fascinating. Many of the most reticent PC users are beginning to see how revolutionary this is. Even in the very early days of EMR use everyone clamored for portability. The problem is not with the technology of rendering the EMR information to a Blackberry or even an iPhone, it’s the issue of screen real-estate...
HIMSS 2010
February 26, 2010
I am looking forward to the annual Healthcare Information and Management Systems Society (HIMSS) meeting this year. From my vantage point, interoperability is at the forefront. There are literally thousands of vendors present. The incredible display of varied and new technologies only serves to underscore the ever-deepening silos of medical information.
The Medical Home and Interoperability (Follow-Up)
December 17, 2009
This post is directed to the comment from my previous dialogue on Medical Home and Interoperability as a deeper explanation to encourage a continuing discussion.
In response to a real world example, diabetes mellitus serves as an excellent model for the need for semantic integration and population-based decision support...
The Medical Home and Interoperability
November 19, 2009
The patient-centered medical home concept has generated tremendous discussion during this dynamic period of proposed healthcare reform. Whether or not this model will finally take hold remains to be seen. It is clear, however, that a new paradigm in chronic disease management must occur. The combination of an aging population, increase in co-morbidity, and an emphasis on ambulatory management, places a heavy burden on technology to come to the rescue...
Avoiding the Seven Deadly Sins
October 6, 2009
I am anticipating the upcoming Webinar entitled Avoiding the Seven Deadly Sins That Can Derail Your Interoperability Strategies. I like this theme as a metaphor. After all, it seems that "Lust, Gluttony, Greed, Sloth, Wrath, Envy, and Pride” all eventually find their way into HIT projects. It is the recognition and management of these traits of human frailty that ensure successful implementation...
"Meaning" Full Use: How Many MS's do you know?
April 30, 2009
Take Ms Magazine, Master of Science, Microsoft, just to name a few. Now step into an EMR.
I have seen the abbreviation MS used in the medical record so many ways. Here are just a few:
• Morphine Sulfate
• Magnesium Sulfate
• Ms. (as a term of address like Mr. and Mrs.)
• Mississippi
• Millisecond
• Mental Status
• Mandibular Series (X-ray order)
• Mitral Stenosis
• Musculoskeletal
• Medical Student
• Multiple Sclerosis
• Motor Strength
To a computer, the same 2 letters can mean vastly different concepts, including medications, demographics, diagnoses, procedures, and measurements. Furthermore, the 4000 mg of morphine sulfate used to treat preterm labor, would be a fatal overdose of morphine sulfate in a routine post-op patient (where 10 mg is often a sufficient dose to treat severe pain)...
Who Wouldn’t Want Life to be Easier While at the Same Time Improving Patient Care?
March 9, 2009
Providing better care for patients and making the work day easier. All too often, these are opposing goals in the life of a busy clinician. I think that this is the reason why interoperability without regard to semantics will not be widely accepted in the long run. Every day when I see patients, it seems like there is more and more information that I need to review, but so much less time to do it in. Which corner will I cut…time spent with patients, reviewing critical data, or getting home on time to my family?...
What about Standards?
February 25, 2009
“I am not here concerned with intent, but with… standards, especially the ability to tell the difference between a fact, an opinion, a hypothesis, and a hole in the ground.”
- Serge Lang, Mathematician
“The problem with standards, is that there are so many of them.”
-Anonymous
Most clinicians would agree that other than gross negligence, transition of care accounts for the greatest potential for medical error. If only there were standards, both clinical and technical, between venues of care. Isn’t that the fix we desperately need?...
If You Build It, They Will Come
February 17, 2009
Much is being written about the current economic stimulus plan and its impact on healthcare IT. This has resurrected an old debate on whether subsidizing EMRs will actually increase adoption and lead to lower overall healthcare costs. Many years ago, I was frequently asked to lecture family physicians on why they should get an EMR. The common objections were: 1) too expensive 2) too difficult to implement 3) won’t integrate with other systems. Like many others, I showed that my EMR had a positive return on investment and significantly improved my efficiency, while improving care. Unfortunately, I had to concede on the interoperability issue...
Confusing Theuth for the Truth? Don’t Feel Badly…It’s Been Going on For Centuries!
Jan. 28, 2009
Imagine being at a meeting, where 100 participant each speaks a different language. How could they have a meaningful conversation?
Ideally, everyone could learn a common language. This, unfortunately, is a naive and somewhat arrogant construct. I remember traveling to Italy many years ago and observing an angry tourist yelling at the proprietor of a charming trattoria, “The world would be a whole lot better if you people would all just speak English!”...
My “Geeky” Obsession Confession
Jan. 9, 2009
I have been a Family Practitioner for almost 20 years. When I decided to implement an EMR in my 4 office, 5 doc practice 8 years ago, the term “interoperability” was not one that I frequently used. None-the-less, I was increasingly frustrated when patients saw me in more than one office, and I did not have their medical records. Instead, I had to fax a portion of it. The sheer coolness of an EMR was surprisingly matched by a first year ROI of $60,000 and a huge increase in productivity. But “interoperability” between offices was the biggest benefit...