1/
Participating in #HITAC call and will summarize here.
CDC rolling out eCR more rapidly & working on an eCR Now FHIR app for electronic case reporting. Epic streamlining implementation to 3 days.
May 1st for delivery of FHIR app...
@JoshCMandel are you involved?
Participating in #HITAC call and will summarize here.
CDC rolling out eCR more rapidly & working on an eCR Now FHIR app for electronic case reporting. Epic streamlining implementation to 3 days.
May 1st for delivery of FHIR app...
@JoshCMandel are you involved?
2/
There's a process for submitting eCR triggers emergently & it seems to work, across a relatively small network.
Not clear if eCR Now is CDC Hooks based, will get the community rev'd up on this one. cc: @aneeshchopra @JoshCMandel @Farzad_MD @GrahameGrieve
There's a process for submitting eCR triggers emergently & it seems to work, across a relatively small network.
Not clear if eCR Now is CDC Hooks based, will get the community rev'd up on this one. cc: @aneeshchopra @JoshCMandel @Farzad_MD @GrahameGrieve
3/
Speakers in the public health community explicitly noting that the Promoting Interoperability (née MU) program established the baseline for syndromic surveillance & dropped many of the feeds in place.
Speakers in the public health community explicitly noting that the Promoting Interoperability (née MU) program established the baseline for syndromic surveillance & dropped many of the feeds in place.
4/
Call for Ask at Order Entry to collect demographics, case onsite, and send more complete order information.
Also labs have the sads because there are too many reporting mandates.
Call for Ask at Order Entry to collect demographics, case onsite, and send more complete order information.
Also labs have the sads because there are too many reporting mandates.
5/
Maybe we should have focused on upgrading EHRs to use standard order & lab specifications? Oh, and labs need to support too.
Maybe we should have focused on upgrading EHRs to use standard order & lab specifications? Oh, and labs need to support too.
6/
Quest noting it takes a day to build a new interface (& that's best case) because of lack of adoption of standards for catalog & electronic order/result.
Quest noting it takes a day to build a new interface (& that's best case) because of lack of adoption of standards for catalog & electronic order/result.
8/
Confusing but correct dialog noting that the employer will be the next point of disease surveillance, but no/limited guidance for how to enable employers to do this while protecting privacy.
Confusing but correct dialog noting that the employer will be the next point of disease surveillance, but no/limited guidance for how to enable employers to do this while protecting privacy.
9/
@AaronMiri talking about UT scaling up contact tracing via home monitoring, issues with code consistency, ICD10 use "hit or miss", no uniform guidance & set of standards.
ONC should make sure everyone:
- adopts the same terminology.
- has a standard data format.
@AaronMiri talking about UT scaling up contact tracing via home monitoring, issues with code consistency, ICD10 use "hit or miss", no uniform guidance & set of standards.
ONC should make sure everyone:
- adopts the same terminology.
- has a standard data format.
10/
Themes
- @aneeshchopra need to use the infrastructure that works rn, CCDA, Biosense feeds, while we enable new stuff. - @AaronMiri terminology need to be upgraded
@Sasha_TerMaat comments that there are breakdowns in demographic flow on orders.
Themes
- @aneeshchopra need to use the infrastructure that works rn, CCDA, Biosense feeds, while we enable new stuff. - @AaronMiri terminology need to be upgraded
@Sasha_TerMaat comments that there are breakdowns in demographic flow on orders.
11/
Impassioned plea to fix demographic information flowing to ELR -- whether not collected on order, or lost in transit, it's an issue b/c can't do contact tracing if you don't get the demographics.
Impassioned plea to fix demographic information flowing to ELR -- whether not collected on order, or lost in transit, it's an issue b/c can't do contact tracing if you don't get the demographics.
12/
@AaronMiri - sharing stories on contact tracing
- most vulnerable don't know how to download an app from AppStore/Google Play
- go multi-lingual out of the box
- train your contact tracers.
@AaronMiri - sharing stories on contact tracing
- most vulnerable don't know how to download an app from AppStore/Google Play
- go multi-lingual out of the box
- train your contact tracers.
13/
Another plea for @CDCgov or other organization to declare on national basis that CCDA/USCDI the minimum necessary for ph reporting.
Another plea for @CDCgov or other organization to declare on national basis that CCDA/USCDI the minimum necessary for ph reporting.
14/
Cynthia Fisher How do employers on the front line in the food supply, grocers, etc., test employees when testing capacity is devoted to acute care? And how do employers help report to public health?
Cynthia Fisher How do employers on the front line in the food supply, grocers, etc., test employees when testing capacity is devoted to acute care? And how do employers help report to public health?
15/
Gloss on the @AaronMiri point on terminology b/c some have misunderstood. The terminology is there but systems haven't all upgraded at the time frames required b/c they are focusing on patient care.
Gloss on the @AaronMiri point on terminology b/c some have misunderstood. The terminology is there but systems haven't all upgraded at the time frames required b/c they are focusing on patient care.
16/
(I also want to note that good standards are insufficient: ecosystem, capacity, policy & incentives matter, as does adequate funding for public health).
(I also want to note that good standards are insufficient: ecosystem, capacity, policy & incentives matter, as does adequate funding for public health).
17/
Shorter HIE panel: if you had an HIE in place for 10 years, you are in better shape.
Shorter HIE panel: if you had an HIE in place for 10 years, you are in better shape.
I'm having HIE flashback now, and not good ones. But HIEs that are in place and functional are doing good things, which seems like a tautology.
Another theme: lack of coordination.
Another theme: lack of coordination.
19/
EHR vendor panel: lots of work going on, not sure how much of that work is being coordinated? athenahealth: decision support, Cerner: supporting front line workers, importance of telehealth, Epic, supporting eCR & telemedicine
EHR vendor panel: lots of work going on, not sure how much of that work is being coordinated? athenahealth: decision support, Cerner: supporting front line workers, importance of telehealth, Epic, supporting eCR & telemedicine
20/
EHRA, multiple CDC projects in multiple departments that don't seem to know the other project.
Many shoutouts to SANER on this panel.
Need to coordinate data feeds..
EHRA, multiple CDC projects in multiple departments that don't seem to know the other project.
Many shoutouts to SANER on this panel.
Need to coordinate data feeds..
21/
Lahey Clinic is manufacturing swabs, and recycling PPE to keep ahead.
ONC should work on standards, convening, coordinating.
Telehealth standards are a BFD.
Lahey Clinic is manufacturing swabs, and recycling PPE to keep ahead.
ONC should work on standards, convening, coordinating.
Telehealth standards are a BFD.
22/
Most technology vendors helping, some upping charges, would like ONC to shine a spotlight on price gouging.
Most technology vendors helping, some upping charges, would like ONC to shine a spotlight on price gouging.
23/
Oh, hey, more remote work & telemedicine. Seems like a theme.
VPN capacity is a big issue, as well as remote authentication.
Oh, hey, more remote work & telemedicine. Seems like a theme.
VPN capacity is a big issue, as well as remote authentication.
24/
EHRA is helping to turf & coordinate multiple requests & have gotten support from ONC.
SANER project is helping to standardize measure definition for #COVID19 & lots of support & additional emphasis behind it.
cc @motorcycle_guy
EHRA is helping to turf & coordinate multiple requests & have gotten support from ONC.
SANER project is helping to standardize measure definition for #COVID19 & lots of support & additional emphasis behind it.
cc @motorcycle_guy
25/
CMS asking about documentation requirements relating to PE, vitals, etc in a telehealth context.
@Cerner talking about use of existing platforms, use of IoT, that some things that didn't seem to be possible are working OK.
Deployable technology in advance of a visit.
CMS asking about documentation requirements relating to PE, vitals, etc in a telehealth context.
@Cerner talking about use of existing platforms, use of IoT, that some things that didn't seem to be possible are working OK.
Deployable technology in advance of a visit.
27/
Shorter me: we think clinical requirements drive E&M reimbursement, but really E&M reimbursement standard drive the parameters of clinical care despite clinical evidence.
Shorter me: we think clinical requirements drive E&M reimbursement, but really E&M reimbursement standard drive the parameters of clinical care despite clinical evidence.
28/
Need standards to get documentation back into EHRs from telemedicine providers.
(so many flashbacks here from integrating telemedicine via secure messaging into EHRs from forever ago).
Need standards to get documentation back into EHRs from telemedicine providers.
(so many flashbacks here from integrating telemedicine via secure messaging into EHRs from forever ago).
29/
Forgot big theme that telemedicine ain't going away. Need regulatory flexibility to see what works before we regulate emerging "best practices"
Forgot big theme that telemedicine ain't going away. Need regulatory flexibility to see what works before we regulate emerging "best practices"
30/
Themes: additional @HHSOCR guidance on "minimum necessary", flexibility in notification, telemedicine standards & associated E&M coding, upgrading the infrastructure that already exists (e.g., demographics from order to result to ELR), more wood behind fewer arrows.
Themes: additional @HHSOCR guidance on "minimum necessary", flexibility in notification, telemedicine standards & associated E&M coding, upgrading the infrastructure that already exists (e.g., demographics from order to result to ELR), more wood behind fewer arrows.
31/
(I keep hearing that privacy is a barrier - beyond the "minimum necessary" issue, not hearing anything concrete here.)
(I keep hearing that privacy is a barrier - beyond the "minimum necessary" issue, not hearing anything concrete here.)
