[Hardhats-members] An incredible repository of papers on computer languages
If you're interested, you might want to take a look at http:// www.readscheme.org . In spite of the site name, there is a lot there that is not Scheme specific. === Gregory Woodhouse [EMAIL PROTECTED] "The finger pointing at the moon is not the moon." --Buddhist saying --- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! http://ads.osdn.com/?ad_id=7637&alloc_id=16865&op=click ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
Re: [Hardhats-members] [os-wg] Editorial: RHIO's and the Illusion of Health IT Success
what bothers me most about this article is that it is a kind of "when did you stop beating your wife?" style. It presents an attention getting assertion about an illusion. One expects to be provided with some objective, verifiable data that supports this assertion. What follows is mostly a flood of equally provocative questions, but not content! Where is the BEEF! It is not that I don't agree with the general sentiments which lurk in the background of the interrogatives. The author and I are probably of one mind in this area. My 35 years of exposure to the US Health Care delivery system, and on the international scene in Europe, South America, and the Western Pacific, have left me with the firm conviction that the majority of health oriented IT systems in use over the years have consistently remained in the sub-optimal range when viewed in just about any frame of reference. But, asking these questions, and using unsubstantiated characterizations to elevate the impact of these questions is fruitless. Note already that two colleagues on this list have made replies to this message that appear to accept the thesis of the article, and have begun to argue the etiology of the gap between VistA/Epic and other health care IT systems. They are quick to argue the causes of a problem that is not well characterized, and in the context of this article, unsubstantiated. The health care IT success gap is a huge issue in terms of economics, social impact, ...by what ever measures you might imagine. The forces at work that establish and nourish this situation are large, powerful and accustomed to the winds of challenge. Articles like this are not likely to have any significant impact on those forces. It is hard for me to imagine that this article would even come to the attention of those who wield power in the health care IT arena. I do have some strong beliefs about the nature of the "gap" and the processes that produce and sustain it. However, without a clear statement of the problem we want to understand and explain, that is shared and understood by all of us here on this forum, I think it would be a waste of my time and yours to launch some random arguments on the topic. anyway, the next time I drive by a medical center that isn't VistA/Epic based, I will just look away least I fall victim to this great "illusion". Regards, Richard. > From: "Ignacio Valdes" <[EMAIL PROTECTED]> > Reply-To: hardhats-members@lists.sourceforge.net > Date: Mon, 12 Dec 2005 12:25:03 -0600 > To: , , > <[EMAIL PROTECTED]>, , > <[EMAIL PROTECTED]>, "'Tia Abner'" <[EMAIL PROTECTED]> > Subject: [Hardhats-members] [os-wg] Editorial: RHIO's and the Illusion of > Health IT Success > > > "Does it bother anyone that for years, Health Information Technology > (IT) successes implied by the news and even in casual conversation may > largely be an illusion? Does it bother anyone that Regional Health > Information Organization (RHIO)'s might be failing at a very high > rate? It is important to ask the question given the United States rich > history of failure and two notable successes with large scale Health > IT." > > Read the full article at > http://www.linuxmednews.com/1134404398/index_html > > -- Ignacio Valdes, MD, MS > -- Editor: Linux Medical News > -- http://www.linuxmednews.com > > P.S.: Please link the article and the website to your page if you find > it useful. > ___ > os-wg mailing list > [EMAIL PROTECTED] > http://mailman.amia.org/mailman/listinfo/os-wg > > > --- > This SF.net email is sponsored by: Splunk Inc. Do you grep through log files > for problems? Stop! Download the new AJAX search engine that makes > searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! > http://ads.osdn.com/?ad_idv37&alloc_id865&op=click > ___ > Hardhats-members mailing list > Hardhats-members@lists.sourceforge.net > https://lists.sourceforge.net/lists/listinfo/hardhats-members --- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! http://ads.osdn.com/?ad_id=7637&alloc_id=16865&op=click ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
[Hardhats-members] Re: [os-wg] Editorial: RHIO's and the Illusion of Health IT Success
Thank you for your thoughtful and informative comment. Short reply: 1) I know, I am a member of HL7, but getting all that in would have changed the focus of the article and leaving it out completely is unsatisfactory. 2) Depending upon whose definition of 'protocol' you are using. In any case I have changed 'interoperability protocol' to 'messaging standard'. I've also changed the UI paragraph slightly to emphasize that I'm referring to the user interface, not the data layer. Again, thank you very much for your insightful interest and comment. -- Ignacio Valdes, MD, MS -- Editor: Linux Medical News -- http://www.linuxmednews.com On Mon, 12 Dec 2005 12:59:41 -0700 "Kevin M. Coonan, M.D." <[EMAIL PROTECTED]> wrote: Ignacio, Thanks for taking the time to put this comment together. I most certainly agree that the utility of commercial monolithic/integrated EHRs is yet to be published. You likely would agree that most of the documentation user interfaces are kludges that slows physicians down, CPOE systems are poorly thought out and over all design does not reflect the cognitive model of the provider or the workflow of the clinical environment. I am sure that if we had a standard "back end" or workbench (think Eclipse) then the functionality we need could be accomplished by small applications that do a few things very well, and could be swapped with another if the first wasn't what the user liked (sounds like 'nix...hmaybe onto something). Informatics is a maturing field. Given the complexity of the domain (how many banks have data dictionaries like the UMLS?) and the substantial underfunding industry wide the early (1960s even) promises of a panacea seem naïve. Hype from vendors is, well, hype from vendors. Consider the source. Press releases from a hospitals (or other) PR firms are obviously not a very realistic portrayal of reality. If you believe those, I have a new ACEi (or 'statin or SSRI) I would like to sell you. Good things come to those who wait! However, I believe you have made a few comments that are quite in error. First, HL7 isn't an "interoperability protocol"--it is an all volunteer organization of people (of which anyone is free to join). HL7 develops standards (just like W3C does) for messaging between disparate systems at the application (not user) level. The messaging standard (version 2.x) is possibly what you are referring to, is widely used (for example so and EHR can communicate w/ a laboratory system) and provides a syntactic framework, but is far from ideal. The emerging, newer, version of the messaging standard (version 3) is much more specific, much more detailed. In addition to the specification, there will be conformance criteria to assure adherence. While the interoperability protocol is not specified by HL7, most use conventional approaches (e.g. HTTP, SSL, etc.) In addition, version 3 is designed to provide semantic interoperability. Local variations and options are not permitted (although some variation between countries is permitted). The degree of specification and standardization is tremendously different between the two versions. Beyond the messaging standard, HL7 provides a standard for exchange of documents (CDA), single log-in to multiple applications (CCOW), and creation of medical logic modules (Arden syntax). In addition, HL7 is creating functional models for various systems, again with conformance criteria. The comment about users needing to learn new interfaces between systems is complete nonsense. The HL7 specifications are all at the application level, and users would have no knowledge or awareness of which (if any) messaging protocols they are using. This is like suggestion that visitors to a web site would need to adapt to a new XML Schema each time they went to a different web site. The browser needs to grok the underlying representation, but if users who see XML (or HTML) code show up on their screen there is an error somewhere. Users may have to learn the applications they use, but this is hardly a novel observation, nor restricted to the medical domain. Given the complexity of what we do, it is much acutely felt. As for the RHIOs, if they are making up standards they are doing it wrong. HHS (via the NCVHS) has specified the standards that should be used. If there are needs for specialized regional messages, that is fine, but it would make no sense to create, validate and test a new wheel. If they have a health care system interoperability need that isn't met by the available standards they need to tell someone so that it can be addressed properly. I doubt, however, this is a significant occurrence. Calling RHIOs a failure is premature, given that most exist only in MOUs at this time and those who have been functioning (some up to two years!) seem to be doing some good. I would be interested if you can provid
Re: [Hardhats-members] Editorial: RHIO's and the Illusion of Health IT Success
On Dec 12, 2005, at 10:58 AM, Kevin Toppenberg wrote: I can't remember the guy's name associated with the theory that 1 fax machine is no use, and the more fax machines that exist in the world, the better the solution it. Good one! But is the lack of systems that could potentially interoperate the problem here? This is a serious question. I do not say that it is not. There are other factors that seem to me to be important, such as a failure to come to terms with the complexity of health information systems. Yes, of course, there are complex systems like compilers, operating systems, database management systems and the like, and we are able to develop robust, reliable software in these application domains, so why not health information systems. One difference that comes to mind is that in each of these areas there is a well- developed theory: you can go to the bookstore and buy a book on compiler design or operating system internals. In fact, you'll probably have several to choose from! This means that when we set out to develop a new system (say a language implementation, or even a new language) we are not working in an intellectual vacuum, there are well established principles available to guide us, and others have isolated key problems that we know we will have to address. This is not true at all of health information systems. We are at a very early stage, and don't even have a very clear understanding of the basic problems of the field. That is why I have posted on various dry theoretical topics, and troubled you all with messages containing lambdas and other Greek letters. I think it's an important part of what is needed to make VistA, and health information systems more generally, successful. === Gregory Woodhouse [EMAIL PROTECTED] "Prediction is difficult, especially of the future." --Niels Bohr --- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! http://ads.osdn.com/?ad_id=7637&alloc_id=16865&op=click ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
Re: [Hardhats-members] Editorial: RHIO's and the Illusion of Health IT Success
I can't remember the guy's name associated with the theory that 1 fax machine is no use, and the more fax machines that exist in the world, the better the solution it. Well in the medical field, there are all these barriers between connections (i.e. HIPPA). So perhaps success depends on interconnectedness, but legitimate privacy are an antithesis to a needed flow of information. Kevin On 12/12/05, Ignacio Valdes <[EMAIL PROTECTED]> wrote: > > "Does it bother anyone that for years, Health Information Technology > (IT) successes implied by the news and even in casual conversation may > largely be an illusion? Does it bother anyone that Regional Health > Information Organization (RHIO)'s might be failing at a very high > rate? It is important to ask the question given the United States rich > history of failure and two notable successes with large scale Health > IT." > > Read the full article at > http://www.linuxmednews.com/1134404398/index_html > > -- Ignacio Valdes, MD, MS > -- Editor: Linux Medical News > -- http://www.linuxmednews.com > > P.S.: Please link the article and the website to your page if you find > it useful. > > > --- > This SF.net email is sponsored by: Splunk Inc. Do you grep through log files > for problems? Stop! Download the new AJAX search engine that makes > searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! > http://ads.osdn.com/?ad_id=7637&alloc_id=16865&op=click > ___ > Hardhats-members mailing list > Hardhats-members@lists.sourceforge.net > https://lists.sourceforge.net/lists/listinfo/hardhats-members > --- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! http://ads.osdn.com/?ad_idv37&alloc_id865&op=click ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
Re: [Hardhats-members] Editorial: RHIO's and the Illusion of Health IT Success
On Dec 12, 2005, at 10:25 AM, Ignacio Valdes wrote: "Does it bother anyone that for years, Health Information Technology (IT) successes implied by the news and even in casual conversation may largely be an illusion? Does it bother anyone that Regional Health Information Organization (RHIO)'s might be failing at a very high rate? It is important to ask the question given the United States rich history of failure and two notable successes with large scale Health IT." Read the full article at http://www.linuxmednews.com/1134404398/ index_html -- Ignacio Valdes, MD, MS -- Editor: Linux Medical News -- http://www.linuxmednews.com P.S.: Please link the article and the website to your page if you find it useful. Yes, it does bother me. One reason it bothers me, though, is that VistA is a Health IT system, too, and we haven't really come up with a convincing reason why it should succeed where other systems have failed. I don't believe the problem of finding an answer is unassailable, but neither do I think it is easy. === Gregory Woodhouse [EMAIL PROTECTED] "The whole of science is nothing more than a refinement of everyday thinking." -- Albert Einstein --- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! http://ads.osdn.com/?ad_id=7637&alloc_id=16865&op=click ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
[Hardhats-members] Editorial: RHIO's and the Illusion of Health IT Success
"Does it bother anyone that for years, Health Information Technology (IT) successes implied by the news and even in casual conversation may largely be an illusion? Does it bother anyone that Regional Health Information Organization (RHIO)'s might be failing at a very high rate? It is important to ask the question given the United States rich history of failure and two notable successes with large scale Health IT." Read the full article at http://www.linuxmednews.com/1134404398/index_html -- Ignacio Valdes, MD, MS -- Editor: Linux Medical News -- http://www.linuxmednews.com P.S.: Please link the article and the website to your page if you find it useful. --- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! http://ads.osdn.com/?ad_id=7637&alloc_id=16865&op=click ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
