Feature Articles

A Public Health Perspective on the CMS Quality Payment Program

I have seen several pretty good summaries of the recently 0release Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program (one from AMIA, one from CDC). Here are just a few additional tidbits I picked out of the NPRM. Of course, this document is written like stereo instructions so I welcome any corrections or comments to my interpretation of what’s in the rule. I put page numbers (from final FBO version referenced above which has just been released) where relevant in parenthesis. And I apologize in advance as much of what’s here is cryptic to anyone who has not been exposed to this before and I don’t make much of an attempt to explain the context (or even the acronyms)...

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Been there, Done that, Doesn’t Work: Veterans Health Administration IT goes back in time

If you have an interest in the worlds of economics, healthcare or technology, here’s a story that’s emerged this month that is worth noting for the record books. In the US, amidst the chaos of the Trump administration, yet another mistake has been made this month. For the record, it is worth noting that the US Department of Veterans Affairs (VA) Veterans Health Administration (VHA) ended up with a contract for a large IT solution for the next 10 years worth about $10 billion as of May 2018. On the face of it that may appear to be unremarkable news: just another big expensive contract for an IT system. Yet there is a part sad/part silly dimension to it that is well worth flagging up at this point.

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A Tale of Two Health Systems

We need a different health system for the majority of us, if only so that we can devote the necessary resources to the people who need to use our health care -- aka medical care -- system the most. My vote is for a public health system. You know, public health. Like clean water. Like vaccinations. Like safer food. Like reducing smoking. It includes a variety of efforts that, intentionally, do not usually look much like medical care but which have drastic impacts on health and longevity. In a recent article in The Upshot, Aaron E. Carroll and Austin Frakt make the case for why we should spend more money on public health. As they detail, we spend very little -- depending on what you count, as low as $10 billion and as high as $100 billion or so, either of which is basically a rounding error in our overall health spending -- but which often have dramatic paybacks.

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HLN and Oregon Health Authority Present Optional Approaches to Oregon's School Immunization Reporting Process at Atlanta Conference

At the 2018 National Immunization Conference (NIC) held in Atlanta May 15-17, HLN co-presented Diverse Stakeholder Perspectives to Improve Oregon’s School Immunization Reporting Process in collaboration with the Oregon Immunization Program (OIP). Aaron Dunn, Oregon’s Immunization Program Manager, and Marcey Propp, HLN Project Manager, presented the project context, approach, and outcomes as part of the segment for Improving measurement and reporting to foster clear vaccine communication. The project context included antiquated technology, the growing complexity of vaccine requirements, and excessive, redundant and unnecessary workload that culminated in making the current school immunization reporting process unsustainable.

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Too Many Poor Excuses

I am so tired of reading yet another story about how we -- Americans -- cannot afford things. Not luxury items, not splurges, not nice-to-have items. Increasingly, it seems like too many of us can't afford what most people would consider basics -- food, housing, child care, transportation. And health care, of course. A new study by the United Way ALICE Project (a collaboration of United Ways in 18 states) found that 51 million households can't afford a basic monthly budget that includes food, housing, health care, child care, and a cell phone. That is 43% of all U.S. households.

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Top 8 Open Source Artificial Intelligence (AI) Technologies in Machine Learning

Artificial intelligence (AI) technologies are quickly transforming almost every sphere of our lives. From how we communicate to the means we use for transportation, we seem to be getting increasingly addicted to them. Because of these rapid advancements, massive amounts of talent and resources are dedicated to accelerating the growth of the technologies. Here is a list of 8 best open source AI technologies you can use to take your machine learning projects to the next level.

Edge computing and the importance of open infrastructure

The "edge" is diverse, dispersed, often independently owned and operated, and comes with a set of constraints not addressed in the average data center. Old sci-fi films painted a picture of how computers would permeate every facet of life in the future. It has come to pass, and it happened almost without us noticing: having PCs at home became commonplace, our mobile phones turned into small smart devices, and our cars began making decisions for us, controlled by thousands of sensors and controllers. Self-driving cars, augmented and virtual reality, smart homes and more all underscore our rapidly emerging dependence on distributed computing infrastructure.

A Look at Open Source Image Recognition Technology

Image recognition technology promises great potential in areas from public safety to healthcare...At the Supercomputing Conference in Denver last year, I discovered an interesting project as I walked the expo floor. A PhD student from Louisiana State University, Shayan Shams, had set up a large monitor displaying a webcam image. Overlaid on the image were colored boxes with labels. As I looked closer, I realized the labels identified objects on a table. Of course, I had to play with it. As I moved each object on the table, its label followed. I moved some objects that were off-camera into the field of view, and the system identified them too.

How Citizens Become Scientists with Open Hardware

Eymund Diegel, a research coordinator for Gowanus Canal Conservancy, shares this tidbit during the first clip of the new Open Source Stories documentary, "The Science of Collective Discovery." He's setting out in a canoe on an inner-city canal that is polluted and struggling to get the help it needs. That's the theme of citizen science it seems: people and places in need who are not getting the help and resources they deserve taking matters into their own hands. Why are they not getting the help they need in the first place? The reason is shockingly simple yet a typical problem: Where's the evidence?

Challenges to Expect When Open Sourcing your SaaS Business

In my previous article, I walked through scenarios to help you determine whether to open source your SaaS solution, and discussed the cost-benefit analysis that goes along with this decision. From an open source point of view, there's no point in just chucking code over the wall, slapping on an open source license, and calling it a day. You want to create an inviting community where people want to collaborate and spend time-even socialize!-with you. Chucking code over the wall accomplishes nothing, besides giving others insight into how you do things. Although that may be interesting and beneficial for them, you don't get much benefit unless you create the pathways of collaboration and communication that unlock a thriving community. Thus, you have an inherent interest in doing this The Right Way™.

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How to Decide Whether to Open Source Your SaaS Solution

Should a SaaS provider open source its primary platform, and if so, what is the best way to do it? The decision to open source code requires a fair bit of planning if you want to do it right, especially when it comes to user support and documentation. In the case of SaaS, the required planning is different, although it shares some factors with any open source effort. In my series, How to Make Money from Open Source Platforms, I focused on software that exists solely to be deployed on a computer, whether on a local machine, in a data center, or in a cloud platform (yes, I know the last two are redundant).

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12 Students Picked to Work on OpenMRS Projects as Part of the Google Summer of Code 2018 Program

Congratulations and a warm welcome to the 12 students selected for Google Summer of Code 2018, and extended thanks to our fantastic group of OpenMRS project mentor volunteers, as well as all students that submitted applications this year! A total of 1,264 students from 64 different countries have been accepted to work with more than 200 open source projects for GSoC 2018. Since 2007, OpenMRS has enjoyed participating in this great program, and we’re thrilled to be involved again this year, marking our 12th year of participation. We’re looking forward to working with a diverse set of students and mentors across a range of exciting and impactful projects.

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On the Need to Improve User-Centered Design (i.e. Design Thinking) for Healthcare IT Usability

The lack of usability of electronic health records (EHRs) and healthcare IT applications, in general, has been in the news a lot again. This time it is a research report published in the Journal of the American Medical Association (JAMA) on March 27. The study analyzed voluntary error reports associated with EHR systems and found that problems with EHR usability may have directly resulted in patient harm. Unfortunately, this situation is all too common in the healthcare industry. Numerous health care systems are designed and created ad hoc, or with a very engineering-centric approach. End users are dissatisfied and often systems or workflows are abandoned and/or dangerous work-a-rounds created. A lot of people are saying Healthcare IT needs a disruption. What HealthIT needs is to begin to learn about and understand the needs, goals, and methods of the actual end-users, like doctors, nurses, medical assistants, etc.

US Core Data for Interoperability Task Force Delivers its Recommendations

On April 18, 2018 the HHS Health Information Technology Advisory Committee (HITAC) US Core Data for Interoperability Task Force delivered its recommendations on the draft US Core Data for Interoperability (USCDI) and Proposed Expansion Process which had been published for public comment back in January 2018. HITAC promptly accepted the Task Force’s recommendations. The Task Force focused almost exclusively on the process for identifying the USCDI rather than the proposed USCDI data itself. I especially appreciated their introduction of some key concepts related to how USCDI should be organized and understood.

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Why the VA Should Stick with VistA and Not Waste $16 Billion on an Attempt to Replace It

This VA leadership lull provides an opportunity for reflection. Specifically, it’s worth asking while we have the time whether Cerner is the right path for the VA to take. While the decision may seem like a no-brainer to some, the VA’s situation is unique and arguably calls for a singular approach to both existing organizational issues and a major healthcare IT decision. Specific to the Cerner decision, what should the new VA secretary consider?

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