Feature Articles

From Data Silos to Black Holes...the Story of America's Healthcare System?

The scary thing about black holes is that their gravity inexorably drags in everything within its reach. Unless you are very far away or have sufficient escape velocity, you will get pulled in, and, once you are sucked in, you are never getting out. We call it our "healthcare" system, but usually what we mean is medical care. It treats illnesses, it puts us under the care of medical professionals, it turns us into patients. A doctor's visit begats prescriptions, and perhaps some testing. Testing leads to procedures. Procedures lead to hospital stays. Hospital stays lead to....you get the idea. What we might once have thought of as "health" -- or never thought about at all -- becomes "health care," a.k.a. medical care. And once you transform from a person, whose health belongs to you, to a patient, your health is never quite your own again. You've been sucked into the medical care black hole.

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Health Organizations Implore Congress to Fund Public Health Surveillance Systems

HLN Consulting joined more than eighty organizations, institutions, and companies in imploring Congress to fund public health surveillance systems. The appropriations request letters – one to the House and one to the Senate – seek one billion in funding over ten years (and $100 million in FY 2020) for the Centers for Disease Control and Prevention (CDC). This funding would allow CDC, state, local, tribal, and territorial health departments to move from sluggish, manual, paper-based data collection to seamless, automated, interoperable IT systems and to recruit and retain skilled data scientists to use them.

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12 Open Source Tools for Natural Language Processing

Natural language processing (NLP), the technology that powers all the chatbots, voice assistants, predictive text, and other speech/text applications that permeate our lives, has evolved significantly in the last few years. There are a wide variety of open source NLP tools out there, so I decided to survey the landscape to help you plan your next voice- or text-based application. For this review, I focused on tools that use languages I'm familiar with, even though I'm not familiar with all the tools. (I didn't find a great selection of tools in the languages I'm not familiar with anyway.) That said, I excluded tools in three languages I am familiar with, for various reasons.

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Is WeWork's Ecosystems Approach a Model for Healthcare Platforms?

Maybe you don't work in a WeWork office setting. Maybe you haven't ever visited one. Maybe you haven't even heard of WeWork. In that case, then you'll probably be surprised that this audacious real estate start-up now has a valuation close to $50b, with over 400,000 "members" in 100 cities across 27 countries (and they claim to "touch" 5 million people worldwide). Or that their plans go well beyond their unique twist towards office sharing. Who in healthcare is thinking about them, and who should be worried...or intrigued?...WeWork was never just about finding people and companies office space: it wanted to "help people work to make a life, not just a living." It focused on building a culture in its spaces, complete with amenities and events to help build a community among its members.

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9 Resources for Data Science Projects

Data science, machine learning, artificial intelligence, and deep neural nets are all hot topics these days (and key terms that might help this post with some SEO, unless the AI sees through my attempts). Below I've shared several of the resources I use regularly while working on data science projects over the last few years. I don't read many books, so that I've shared even one is evidence of how important it is. There are enough resources here to get even the most novice engineer started on a path towards data science mastery in this new age where data science skills will be needed at every level. There is a tool for performing the work, a class taught by a renowned Stanford professor, websites with tutorials to give you real-life experience, and a site dedicated to making the latest research available to all for free so you can learn more if you want.

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GAO Report on Patient Matching: Nothing New Under the Sun

On January 15, 2019 the US Government Accountability Office (GAO) released a new report to Congress, Health Information Technology: Approaches and Challenges to Electronically Matching Patients' Records across Providers. This report is in response to the mandate in the 21st Century Cures Act for the GAO to study patient matching. To develop this report, GAO reviewed available literature and interviewed more than thirty-five stakeholders (who are not identified) over the course of a year. I have written several blogs and a feature article on patient matching developments in the US. Similarly, this new GAO report is an excellent retrospective on industry efforts over the past several years.

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ONC Releases New NPRM on Interoperability: How Might it Affect Public Health?

On February 11, 2019, the Office of the National Coordinator for Health Information Technology (ONC) released its latest Notice of Proposed Rulemaking (NPRM) to Improve the Interoperability of Health Information. Referred to by some people as the "Information Blocking NPRM," since this was the primary topic anticipated, the document actually covers a host of other topics related to interoperability driven primarily by requirements of the 21st Century Cures Act. Besides the initial text of the NPRM, ONC also released a set of summary slides and fact sheets to help explain the document.

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How Open Data and Open Tools Can Save Lives During a Disaster

If you've lived through a major, natural disaster, you know that during the first few days you'll probably have to rely on a mental map, instead of using a smartphone as an extension of your brain. Where's the closest hospital with disaster care? What about shelters? Gas stations? And how many soft story buildings-with their propensity to collapse-will you have to zig-zag around to get there? Trying to answer these questions after moving back to earthquake-prone San Francisco is why I started the Resiliency Maps project. The idea is to store information about assets, resources, and hazards in a given geographical area in a map that you can download and print out.

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So I Survived HIMSS19…

This was perhaps more of a fete than it initially seems. The conference was massive, with over 40,000 attendees. It centered around a trade show exhibit hall that spanned multiple football fields in length. In some ways, it was so big that I felt somewhat discouraged from attending some educational sessions because they were located so far from where I was hanging out that I could get back and forth in time. So I spent most of my time at the Interoperability Showcase since HLN was participating in two of the use cases: Immunization Integration & CDS, featuring our ICE open source immunization evaluation and forecasting system...

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Closing the Referral Problem in Distributed Care Networks

There have been any number of people and companies working tirelessly to solve healthcare's interoperability challenges. Hospitals, EHR software companies, Health Information Exchanges (HIEs), Federal and State governments, payers, and others have developed, tested, and implemented many in-house or vendor-built solutions to try to clear this hurdle. Recently, consumer technology vendors and patient-centered innovation programs have begun to make significant strides on directly expanding patients access to their own records. This is great news for patients, but when I am a patient, I also want my doctors and other caregivers to be able to communicate about me when needed. So, making me responsible for stewarding pieces of my record between them doesn't solve the challenge. Especially if I have received care in three or four different places or worse yet, become incapacitated.

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Getting started as a GitLab contributor

GitLab's open culture is one of its strongest assets and the main reason I use GitLab in DevOps transformations. The community edition's code is open source and the paid version makes its source code available for contributions. These are valuable factors rooted in the company culture its CEO has diligently maintained over the years. It doesn't hurt that its tools are great, too. I believe GitLab's sales and marketing team is the best of any company out there. They have included me as a user, customer, and friend over the last few years, and they are genuine and caring people. This was underscored last year when I wanted to contribute a feature, and GitLab's team went to extraordinary lengths to help me succeed. Here's the story of making my first contribution to GitLab.

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Fax Technology is the Cornerstone of Interoperability. Here's Why.

Fax is the dominant information exchange technology in U.S. healthcare, outpacing secure direct messaging 25-to-1. Most of that is exchanged using inefficient and unsecure machines. With the emergence of cloud-based fax technology to facilitate secure system-to-system document transfer, the use of cloud fax needs to be part of every CTO's/CIO's digital strategy...The evolution of fax from paper-based to cloud transmission and storage - Cloud Fax Technology (CFT) - is a key step that enables providers to comply with HIPAA and other regulations. Further strengthening CFT as a key component in Healthcare Information Systems (HIS) is its evolution into Direct Messaging platforms, enabling the seamless exchange of Patient Health Information (PHI) between the diverse data and document management systems used by labs, pharmacies, doctor's offices, hospitals, and billing providers. CFT supports and contributes to the goal of interoperability...

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We Don't Need No Stinking Batteries

The problem with many IoT devices, though, is similar to with our other devices: what happens when the battery runs low? It's not easy to get a charger into our gut to repower smart pills, and for anyone worried about the ecological risks posed by computer or smartphone batteries, well, imagine tiny versions of those toxic batteries floating around in your body. We'll need sensors to track the damage done by our other sensors' dead batteries. Not with rectennas. Rectennas are powered by Wi-Fi signals, like the kind you use in your house or at Starbucks to get internet access. This is not a new concept, but what is new is that MIT researchers have been able to harvest enough power to make them useful, in a device only a few atoms thick.

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AHRQ Releases Draft Guide for Registry Interoperability: Does Public Health Have a Role?

On January 11, 2019, the Agency for Healthcare Research and Quality (AHRQ) released a draft Addendum to the Third Edition of Registries for Evaluating Patient Outcomes: A User's Guide called Tool and Technologies for Registry Interoperability. AHRQ has long written about registries - largely from a research standpoint - and I have been following this from afar for some time. This new guide is focused on helping those who both create and use registries understand the issue surrounding leveraging external data to improve registry completeness, accuracy, and usefulness. This report covers lots of ground and does a good job of summarizing important subtopics. Each chapter is overflowing with footnotes and sources.

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Do Unto Robots As You...

We're going to have robots in our healthcare system (Global Market Insights forecasts assistive healthcare robots could be a $1.2b market by 2024), in our workplaces, and in our homes. Some of them will be unobtrusive, some we'll interact with frequently, and some we'll become close to. How to treat them is something we're going to have to figure out. Written by Alex Williams, Do You Take This Robot...focuses on people actually falling in love with (or at least preferring to be involved with) robots. Sex toys, even sex robots, have been around, but this takes it to a new level. The term for it is "digisexual." As Professor Neil McArthur, who studies such things, explained to Discover last year...

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