During 2011, I have been an active "committed" participant on several workgroups in the Standards and Interoperability Framework (S&I) effort which filled the gap when the Health Information Technology Standards Panel (HITSP) was sunseted. I currently am a member of workgroups involved in the Data Segmentation Initiative, which was established to address standards for the ability to exchange parts of medical record ― often called data segmentation. The goal of the project is to enable the implementation and management of health information disclosure policies originating from a patient's request, statutory and regulatory authority or organizational disclosure requirements. Of particular note is the effort to define the current need for data protection services, such as a patient's directive not to disclose substance abuse records in accordance with 42 CFR Part 2.
I have placed a link on my website (http://www.metasteward.net/) to the S&I Framework Wiki which is open to anyone. My participation and the participation of all involved can be followed in detail on the Wiki. Participation by others is definitely encouraged with an easy to follow process for joining the initiative. I encourage others to participate.
Sunday, January 1, 2012
Saturday, August 14, 2010
Today is the 75th Anniversary of Social Security
Remarks of President Barack Obama
As Prepared for Delivery
August 14, 2010
Washington, DC
Seventy-five years ago today, in the midst of the Great Depression, Franklin Roosevelt signed Social Security into law, laying a cornerstone in the foundation of America’s middle class, and assuring generations of America’s seniors that after a lifetime of hard work, they’d have a chance to retire with dignity. We have an obligation to keep that promise; to safeguard Social Security for our seniors, people with disabilities, and all Americans – today, tomorrow, and forever.
Now, we’ve been talking for a long time about how to do that; about how to make sure Social Security is healthy enough to cover the higher costs that are kicking in now that baby boomers are retiring. And I’m committed to working with anyone, Democrat or Republican, who wants to strengthen Social Security. I’m also encouraged by the reports of serious bipartisan work being done on this and other issues in the fiscal commission that I set up several months ago.
One thing we can’t afford to do though is privatize Social Security – an ill-conceived idea that would add trillions of dollars to our budget deficit while tying your benefits to the whims of Wall Street traders and the ups and downs of the stock market.
A few years ago, we had a debate about privatizing Social Security. And I’d have thought that debate would’ve been put to rest once and for all by the financial crisis we’ve just experienced. I’d have thought, after being reminded how quickly the stock market can tumble, after seeing the wealth people worked a lifetime to earn wiped out in a matter of days, that no one would want to place bets with Social Security on Wall Street; that everyone would understand why we need to be prudent about investing the retirement money of tens of millions of Americans.
But some Republican leaders in Congress don’t seem to have learned any lessons from the past few years. They’re pushing to make privatizing Social Security a key part of their legislative agenda if they win a majority in Congress this fall. It’s right up there on their to-do list with repealing some of the Medicare benefits and reforms that are adding at least a dozen years to the fiscal health of Medicare – the single longest extension in history.
That agenda is wrong for seniors, it’s wrong for America, and I won’t let it happen. Not while I’m President. I’ll fight with everything I’ve got to stop those who would gamble your Social Security on Wall Street. Because you shouldn’t be worried that a sudden downturn in the stock market will put all you’ve worked so hard for – all you’ve earned – at risk. You should have the peace of mind of knowing that after meeting your responsibilities and paying into the system all your lives, you’ll get the benefits you deserve.
Seventy-five years ago today, Franklin Roosevelt made a promise. He promised that from that day forward, we’d offer – quote – “some measure of protection to the average citizen and to his family against poverty-stricken old age.” That’s a promise each generation of Americans has kept. And it’s a promise America will continue to keep so long as I have the honor of serving as President. Thanks for listening. Thanks for watching. And have a nice weekend.
As Prepared for Delivery
August 14, 2010
Washington, DC
Seventy-five years ago today, in the midst of the Great Depression, Franklin Roosevelt signed Social Security into law, laying a cornerstone in the foundation of America’s middle class, and assuring generations of America’s seniors that after a lifetime of hard work, they’d have a chance to retire with dignity. We have an obligation to keep that promise; to safeguard Social Security for our seniors, people with disabilities, and all Americans – today, tomorrow, and forever.
Now, we’ve been talking for a long time about how to do that; about how to make sure Social Security is healthy enough to cover the higher costs that are kicking in now that baby boomers are retiring. And I’m committed to working with anyone, Democrat or Republican, who wants to strengthen Social Security. I’m also encouraged by the reports of serious bipartisan work being done on this and other issues in the fiscal commission that I set up several months ago.
One thing we can’t afford to do though is privatize Social Security – an ill-conceived idea that would add trillions of dollars to our budget deficit while tying your benefits to the whims of Wall Street traders and the ups and downs of the stock market.
A few years ago, we had a debate about privatizing Social Security. And I’d have thought that debate would’ve been put to rest once and for all by the financial crisis we’ve just experienced. I’d have thought, after being reminded how quickly the stock market can tumble, after seeing the wealth people worked a lifetime to earn wiped out in a matter of days, that no one would want to place bets with Social Security on Wall Street; that everyone would understand why we need to be prudent about investing the retirement money of tens of millions of Americans.
But some Republican leaders in Congress don’t seem to have learned any lessons from the past few years. They’re pushing to make privatizing Social Security a key part of their legislative agenda if they win a majority in Congress this fall. It’s right up there on their to-do list with repealing some of the Medicare benefits and reforms that are adding at least a dozen years to the fiscal health of Medicare – the single longest extension in history.
That agenda is wrong for seniors, it’s wrong for America, and I won’t let it happen. Not while I’m President. I’ll fight with everything I’ve got to stop those who would gamble your Social Security on Wall Street. Because you shouldn’t be worried that a sudden downturn in the stock market will put all you’ve worked so hard for – all you’ve earned – at risk. You should have the peace of mind of knowing that after meeting your responsibilities and paying into the system all your lives, you’ll get the benefits you deserve.
Seventy-five years ago today, Franklin Roosevelt made a promise. He promised that from that day forward, we’d offer – quote – “some measure of protection to the average citizen and to his family against poverty-stricken old age.” That’s a promise each generation of Americans has kept. And it’s a promise America will continue to keep so long as I have the honor of serving as President. Thanks for listening. Thanks for watching. And have a nice weekend.
Saturday, July 31, 2010
45th Anniversary of Medicare and Medicaid
Yesterday, July 30th, 2010, marked the the 45th anniversary of Medicare and Medicaid.
July 30th, 1965, brings back memories.
My experience goes back before that point in time, to the Kerr-Mills Act of 1960. That act established the Medical Assistance for the Aged (MAA) program.
I began working as a public welfare worker (PWW2) in Iowa in 1963. At that time, Iowa was one of only a few states to implement MAA.
It all brings back memories.
President Barack Obama's proclamation:
July 30th, 1965, brings back memories.
My experience goes back before that point in time, to the Kerr-Mills Act of 1960. That act established the Medical Assistance for the Aged (MAA) program.
I began working as a public welfare worker (PWW2) in Iowa in 1963. At that time, Iowa was one of only a few states to implement MAA.
It all brings back memories.
President Barack Obama's proclamation:
Saturday, June 26, 2010
eHealth Privacy and Security
The first six months of 2010 have gone by ever so quickly. I started my blog in May 2009 - Older Americans Month - and intended to have a "year in review" entry in May of this year, but in the amount of time I've allotted for computer related activities, I've just been too busy attending meetings (mostly teleconferences), reading transcripts and minutes of meetings, reading whitepapers, reviewing nutrition literature and entering data for the McFarland Senior Outreach Program via the Social Assistance Management System (SAMS) application to find the time to write the "year in review" entry.
On March 27, 2010 I filed a HIPAA privacy and security complaint with the Office for Civil Rights (OCR) based upon my belief that the Dane County Area Agency on Aging (AAA), the Bureau of Aging and Disability Resources (BADR), the Administration on Aging (AoA) and Harmony Inc. in its use and configuration of Harmony Inc.'s SAMS system violated (and continue to violate) HIPAA privacy and security rules. A complete copy of my complaint can be found on my website at: http://www.metasteward.net/.
At the state level, I have been closely following the deliberations of the Wisconsin Relay of Electronic Data (WIRED) for Health Board that was created in December 2009. At the national level I am following the deliberations of the new Privacy and Security Tiger Team that was organized by the Office of the National Coordinator for Health IT (ONC) under the auspices of the HIT Policy Committee. The new tiger team is composed of members from the HIT Policy Committee, the HIT Standards Committee and the National Committee for Vital and Health Statistics (NCVHS).
Many who have membership on the federal advisory committees are also members of Wisconsin's WIRED Board and/or its subcommittees. As a member of the HITSP Consumers Preferences Tiger Team (that directly reported to the ONC)I have come to know a several individuals who now participate on Wisconsin's e-Health Board and/or subcommittees.
I am very pleased that the NCVHS has formally been acknowledged for its ongoing efforts and is participating in the deliberations of the Tiger Team. Walter Suarez co-chaired the Consumer Preferences Tiger Team and is a member of the NCVHS Security and Privacy Sub-Committee that has addressed many of the same issues that the new work group will be addressing.
The National Committee on Vital and Health Statistics brings a different perspective to considerations in that membership is based on expertise in subject matter rather than representing an organization. NCVHS brings to the discussion the concept of "Health Data Stewardship".
Toward the end of the June 22 meeting of the Privacy and Security Tiger Team, I made the comment that the Administration on Aging should be involved in discussions of security and privacy. It has been nearly three years since I became aware of the absence of a sense of "data stewardship" by the administrators in the aging programs.
(to be continued)
On March 27, 2010 I filed a HIPAA privacy and security complaint with the Office for Civil Rights (OCR) based upon my belief that the Dane County Area Agency on Aging (AAA), the Bureau of Aging and Disability Resources (BADR), the Administration on Aging (AoA) and Harmony Inc. in its use and configuration of Harmony Inc.'s SAMS system violated (and continue to violate) HIPAA privacy and security rules. A complete copy of my complaint can be found on my website at: http://www.metasteward.net/.
At the state level, I have been closely following the deliberations of the Wisconsin Relay of Electronic Data (WIRED) for Health Board that was created in December 2009. At the national level I am following the deliberations of the new Privacy and Security Tiger Team that was organized by the Office of the National Coordinator for Health IT (ONC) under the auspices of the HIT Policy Committee. The new tiger team is composed of members from the HIT Policy Committee, the HIT Standards Committee and the National Committee for Vital and Health Statistics (NCVHS).
Many who have membership on the federal advisory committees are also members of Wisconsin's WIRED Board and/or its subcommittees. As a member of the HITSP Consumers Preferences Tiger Team (that directly reported to the ONC)I have come to know a several individuals who now participate on Wisconsin's e-Health Board and/or subcommittees.
I am very pleased that the NCVHS has formally been acknowledged for its ongoing efforts and is participating in the deliberations of the Tiger Team. Walter Suarez co-chaired the Consumer Preferences Tiger Team and is a member of the NCVHS Security and Privacy Sub-Committee that has addressed many of the same issues that the new work group will be addressing.
The National Committee on Vital and Health Statistics brings a different perspective to considerations in that membership is based on expertise in subject matter rather than representing an organization. NCVHS brings to the discussion the concept of "Health Data Stewardship".
Toward the end of the June 22 meeting of the Privacy and Security Tiger Team, I made the comment that the Administration on Aging should be involved in discussions of security and privacy. It has been nearly three years since I became aware of the absence of a sense of "data stewardship" by the administrators in the aging programs.
(to be continued)
Saturday, January 30, 2010
January 2010 Has Gone So FAST!
This month has passed so quickly! The last panel meeting of HITSP was held on Monday January 25 and I felt a sense of saddness that the intense activity was drawing to a close. I will participate in a few HITSP meetings during February as I am on the HITSP Foundations Committee. For this entry I'll enter copies of a few closing emails that I've received that summarize the past and look to the future.
The first is from Dr. Walter Suarez who is the leader of the Consumer Preferences Tiger Team:
Dear Consumer Preference TT members, colleagues and friends,
On Monday of this week we delivered the final report on the status of our Consumer Preference work to the HITSP Panel, which was received quite well. While we were not seeking action on our RDSS on Consumer Preferences, and our document will not be vetted in public, given its 'draft' condition, we stronlgy believe that the body of work we built around this important topic will pave the way for any future efforts to advance the harmonization and selection of interoperable standards related to the electronic creation, execution and exchange of consumer preferences.
What's next? at the Panel we heard from HITPS Leadership on the plans for HITSP beginning next month. Several details were offered about ongoing support for HITSP's website, its listservs (they will probably become moderated lists), the comment tracking system, which will continue to capture comments on several documents, and other items. No formal meetings of the Board, Panel, TCs or TTs will be convened after February 1 (except perhaps for the Foundations Committee). A more formal announcement will be provided to all in the coming days.
Congratulations and thank you to each and everyone of you for your active involvement and participation in this Tiger Team. A very special thank you goes to our Workgroup Co-Chairs, Janie Bowman-Hayes and Terry Heam (Content Preferences), and RIchard Frank and Don Jorgenson (Privacy Preferences) for their willingness to share their time and experise in leading these groups, and to our Tiger Team Facilitators, Johnathan Coleman, Elliot Sloane and Michael Nusbaum for helping us keep on track, on time, and on point. It was our priviledge to have serve as co-chairs of this group.
Much work remains on consumer preferences and we fully expect that any future harmonization will include the continuation and conclusion of the work we started in HITSP.
Best regards,Mureen Allen, ActiveHealth Management
Walter Suarez, Kaiser Permanente
The second is from Dr. Halamka who is the Chair of HITSP:
FROM JOHN D. HALAMKA, MD, HITSP CHAIRMAN:
Folks:
Thanks for a great meeting on Monday. It was great to see you all, thank you all, and reaffirm our commitment to stay engaged as we await the ONC RFP. I've listed all the ONC grant programs on my blog and you'll notice that $64.3 million has been allocated for Standards Harmonization, Certification, and the NHIN:
http://geekdoctor.blogspot.com/2010/01/grant-programs-from-onc.html
Here's the kind of press we've received about the Panel meeting and about the continuance of HITSP:
http://www.healthdatamanagement.com/news/standards_onc_stimulus_hitsp-39683-1.html
I summarized my comments from the January 20th meeting of the HIT Standards Committee about the Interim Final Rule, Implementation Guidance and HITSP on my blog. You'll see that most of the base standards recommendations from the HIT Standards Committee (based on a foundation of HITSP work) were included in the IFR. The IFR is a regulation, which means that the details provided in it are hard to change. By providing base standards but enabling implementation guidance to be published separately from the regulation itself, ONC allowed evolution and refinement of more specific guidance. The comment period on the IFR closes March 15 and we'll see revisions of the NPRM that are directly related to comments. I think you'll see substantial work on vocabularies and implementation guidance including security/privacy over the next 6 months. The sense of the HIT Standards Committee is that ONC did a great job on a tight timeframe. The comment period will add the final polish.
See my blog for more details:
http://geekdoctor.blogspot.com/2010/01/january-meeting-of-hit-standards.html
I look forward to speaking with you during our monthly check in/education calls.
I'll see you at HIMSS10!
If you have questions or concerns, please email me at jhalamka@hms.harvard.edu
HITSP Administrative Information:
1. As reported this week, ANSI announced that the Government has granted HITSP a no-cost extension to the current contract which will continue through April 30th, 2010. Among other things, this will enable HITSP to have a presence at the upcoming HIMSS conference, and support the quality reporting activities being demonstrated in the Interoperability Showcase there. For full details of the extension please see HITSP 10 N 459 http://tinyurl.com/y8m2lgb
2. As noted, there will be HITSP informational conference calls over the next few months. These will be announced through this listserv. Please stay tuned.
3. The Foundations Harmonization Subcommittee will be wrapping up their work in early February and have the following wrap up meetings scheduled:
· Wednesday, February 3 at 10:30AM/ET
· Monday, February 8 at 2:00PM/ET
· Wednesday, February 17 at 10:30AM/ET
4. All the recordings of the HITSP webinars are posted at hitsp.org/webinars.
If you have questions about the administrative items, please email the HITSP Secretariat at mmaasdeane@ansi.org.
-----------------------------------------------
Michelle Maas DeaneHITSP SecretariatAmerican National Standards Institute25 West 43rd Street - Fourth FloorNew York, NY 10036
T: 1.212.642.4884F: 1.212.398.0023E: mmaasdeane@ansi.org
During the HITSP hiatus, I plan to participate on the HL7 Personal Healthcare Records (PHR)workgroup co-chaired by John Ritter and Gary Dickinson.
The first is from Dr. Walter Suarez who is the leader of the Consumer Preferences Tiger Team:
Dear Consumer Preference TT members, colleagues and friends,
On Monday of this week we delivered the final report on the status of our Consumer Preference work to the HITSP Panel, which was received quite well. While we were not seeking action on our RDSS on Consumer Preferences, and our document will not be vetted in public, given its 'draft' condition, we stronlgy believe that the body of work we built around this important topic will pave the way for any future efforts to advance the harmonization and selection of interoperable standards related to the electronic creation, execution and exchange of consumer preferences.
What's next? at the Panel we heard from HITPS Leadership on the plans for HITSP beginning next month. Several details were offered about ongoing support for HITSP's website, its listservs (they will probably become moderated lists), the comment tracking system, which will continue to capture comments on several documents, and other items. No formal meetings of the Board, Panel, TCs or TTs will be convened after February 1 (except perhaps for the Foundations Committee). A more formal announcement will be provided to all in the coming days.
Congratulations and thank you to each and everyone of you for your active involvement and participation in this Tiger Team. A very special thank you goes to our Workgroup Co-Chairs, Janie Bowman-Hayes and Terry Heam (Content Preferences), and RIchard Frank and Don Jorgenson (Privacy Preferences) for their willingness to share their time and experise in leading these groups, and to our Tiger Team Facilitators, Johnathan Coleman, Elliot Sloane and Michael Nusbaum for helping us keep on track, on time, and on point. It was our priviledge to have serve as co-chairs of this group.
Much work remains on consumer preferences and we fully expect that any future harmonization will include the continuation and conclusion of the work we started in HITSP.
Best regards,Mureen Allen, ActiveHealth Management
Walter Suarez, Kaiser Permanente
The second is from Dr. Halamka who is the Chair of HITSP:
FROM JOHN D. HALAMKA, MD, HITSP CHAIRMAN:
Folks:
Thanks for a great meeting on Monday. It was great to see you all, thank you all, and reaffirm our commitment to stay engaged as we await the ONC RFP. I've listed all the ONC grant programs on my blog and you'll notice that $64.3 million has been allocated for Standards Harmonization, Certification, and the NHIN:
http://geekdoctor.blogspot.com/2010/01/grant-programs-from-onc.html
Here's the kind of press we've received about the Panel meeting and about the continuance of HITSP:
http://www.healthdatamanagement.com/news/standards_onc_stimulus_hitsp-39683-1.html
I summarized my comments from the January 20th meeting of the HIT Standards Committee about the Interim Final Rule, Implementation Guidance and HITSP on my blog. You'll see that most of the base standards recommendations from the HIT Standards Committee (based on a foundation of HITSP work) were included in the IFR. The IFR is a regulation, which means that the details provided in it are hard to change. By providing base standards but enabling implementation guidance to be published separately from the regulation itself, ONC allowed evolution and refinement of more specific guidance. The comment period on the IFR closes March 15 and we'll see revisions of the NPRM that are directly related to comments. I think you'll see substantial work on vocabularies and implementation guidance including security/privacy over the next 6 months. The sense of the HIT Standards Committee is that ONC did a great job on a tight timeframe. The comment period will add the final polish.
See my blog for more details:
http://geekdoctor.blogspot.com/2010/01/january-meeting-of-hit-standards.html
I look forward to speaking with you during our monthly check in/education calls.
I'll see you at HIMSS10!
If you have questions or concerns, please email me at jhalamka@hms.harvard.edu
HITSP Administrative Information:
1. As reported this week, ANSI announced that the Government has granted HITSP a no-cost extension to the current contract which will continue through April 30th, 2010. Among other things, this will enable HITSP to have a presence at the upcoming HIMSS conference, and support the quality reporting activities being demonstrated in the Interoperability Showcase there. For full details of the extension please see HITSP 10 N 459 http://tinyurl.com/y8m2lgb
2. As noted, there will be HITSP informational conference calls over the next few months. These will be announced through this listserv. Please stay tuned.
3. The Foundations Harmonization Subcommittee will be wrapping up their work in early February and have the following wrap up meetings scheduled:
· Wednesday, February 3 at 10:30AM/ET
· Monday, February 8 at 2:00PM/ET
· Wednesday, February 17 at 10:30AM/ET
4. All the recordings of the HITSP webinars are posted at hitsp.org/webinars.
If you have questions about the administrative items, please email the HITSP Secretariat at mmaasdeane@ansi.org.
-----------------------------------------------
Michelle Maas DeaneHITSP SecretariatAmerican National Standards Institute25 West 43rd Street - Fourth FloorNew York, NY 10036
T: 1.212.642.4884F: 1.212.398.0023E: mmaasdeane@ansi.org
During the HITSP hiatus, I plan to participate on the HL7 Personal Healthcare Records (PHR)workgroup co-chaired by John Ritter and Gary Dickinson.
Thursday, January 7, 2010
Dr. Peel is Right!
Dr. Peel is right!
Because the proposed rule on "meaningful use" doesn't specify that consumers and patients should have control over their personal health information, billions of stimulus dollars will be wasted to purchase obsolete, unethical "clunkers" and worse. My experiences, as a former in-house data administration consultant with the Wisconsin Department of Health Services (DHS) and current member of the U.S. Health Information Technology Standards Panel (HITSP), confirm her observations and expectations of wasted money for the future.
Wisconsin's DHS is slated this year to receive over nine million dollars from ONC to plan for health information exchanges (HIEs). Wisconsin then expects to receive eighty or so million dollars for related HIE projects over the next few years. A request for information (RFI) for the DHS Long Term Care Infrastructure HIE project was released in August 2009. DHS has indicated that it will likely release a request for proposal (RFP) for the infrastructure project in 2010.
I live in the Village of McFarland, located just outside Madison, and have been a volunteer data entry clerk for McFarland's Senior Outreach Program since August 2007. My duties involve data entry of the personal health information of individuals and nutritional risk self assessments into the Social Assistance Management System (SAMS). I also enter the number of meals that they eat during a month. The information is collected from participants on paper forms. Being elderly or disabled are the basic eligibility criteria for the programs. I participate in the congregate meal program and complete the same forms as others do but I then enter my personal health information into the system, myself.
From 1998 until 2005, when the unit was disbanded due to budget constraints, I held the position of data administration consultant for DHS' Center for Uniformity, Security and Privacy (CUSP). CUSP's mission was primarily driven by two federal laws enacted in 1996. The first was the Clinger-Cohen Act having to do with the Federal Enterprise Architecture (FEA) and the second was the Health Insurance Portability and Accountability Act (HIPAA).
During that period, I participated in HIPAA standards development as a public sector representative to HL7 and as a participant in the HIPAA Metadata Registry Coalition and United States Healthcare Information Knowledgebase (USHIK). I was a beta tester of MetaPro sponsored by the EPA and the then Health Care Financing Administration (HCFA). MetaPro was a distributable metadata registry based on the ANSI X3.825 Metamodel for the Management of Sharable Data and ISO/IEC 11179 Specification and Standardization of Data Elements. I was the eForms coordinator for the Department, the primary staff person for the Department's Data Stewardship Council and development of the Common Core Data Standards that it adopted. I maintained the HIPAA Now! Website and provided consultation to IT projects on data security, privacy, and quality.
Because the proposed rule on "meaningful use" doesn't specify that consumers and patients should have control over their personal health information, billions of stimulus dollars will be wasted to purchase obsolete, unethical "clunkers" and worse. My experiences, as a former in-house data administration consultant with the Wisconsin Department of Health Services (DHS) and current member of the U.S. Health Information Technology Standards Panel (HITSP), confirm her observations and expectations of wasted money for the future.
Wisconsin's DHS is slated this year to receive over nine million dollars from ONC to plan for health information exchanges (HIEs). Wisconsin then expects to receive eighty or so million dollars for related HIE projects over the next few years. A request for information (RFI) for the DHS Long Term Care Infrastructure HIE project was released in August 2009. DHS has indicated that it will likely release a request for proposal (RFP) for the infrastructure project in 2010.
I live in the Village of McFarland, located just outside Madison, and have been a volunteer data entry clerk for McFarland's Senior Outreach Program since August 2007. My duties involve data entry of the personal health information of individuals and nutritional risk self assessments into the Social Assistance Management System (SAMS). I also enter the number of meals that they eat during a month. The information is collected from participants on paper forms. Being elderly or disabled are the basic eligibility criteria for the programs. I participate in the congregate meal program and complete the same forms as others do but I then enter my personal health information into the system, myself.
From 1998 until 2005, when the unit was disbanded due to budget constraints, I held the position of data administration consultant for DHS' Center for Uniformity, Security and Privacy (CUSP). CUSP's mission was primarily driven by two federal laws enacted in 1996. The first was the Clinger-Cohen Act having to do with the Federal Enterprise Architecture (FEA) and the second was the Health Insurance Portability and Accountability Act (HIPAA).
During that period, I participated in HIPAA standards development as a public sector representative to HL7 and as a participant in the HIPAA Metadata Registry Coalition and United States Healthcare Information Knowledgebase (USHIK). I was a beta tester of MetaPro sponsored by the EPA and the then Health Care Financing Administration (HCFA). MetaPro was a distributable metadata registry based on the ANSI X3.825 Metamodel for the Management of Sharable Data and ISO/IEC 11179 Specification and Standardization of Data Elements. I was the eForms coordinator for the Department, the primary staff person for the Department's Data Stewardship Council and development of the Common Core Data Standards that it adopted. I maintained the HIPAA Now! Website and provided consultation to IT projects on data security, privacy, and quality.
During 2002 I provided consultation to Wisconsin's Mental Health Data Infrastructure Grant (DIG) Project and developed a data quality protocol to measure the quality of mental health data in the Department's data warehouse. At that time I analyzed the data included in all mental health fields for over 139,000 individuals collected through the Human Services Reporting System (HSRS). The mental health module in HSRS and associated fields in the data warehouse organized each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability.
Wisconsin is the only state to configure SAMS so as to display individuals' most sensitive information in “user fields” on the summary screen (copy attached). Information can be directly entered and edited from the summary screen and since “user fields” are not regular data base fields, no audit trail is created or maintained. Entries in the “user fields” can be made by any person with access to an individual’s record and information from other databases or data warehouses can be entered without a person’s knowledge or approval.
Among the most sensitive “user fields” available for entry are those related to mental health diagnoses. Although the data entries that I make are limited to demographic information and assessments of nutritional health, ADLs and IADLs, others with access to the system can make entries with regard to the most sensitive personal information.
The group of five diagnostic fields, shown on the attached summary screen likely relate to the multi axial system of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The mental health module in the Human Services Reporting System (HSRS) and associated fields in the MEDS data warehouse organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability. A definition can be found at: http://tiny.cc/x3JZ5
As I mentioned above, I recognize the five diagnostic fields being included in the MEDS data warehouse from my work on data quality related to the Data Infrastructure Grant (DIG) in 2002. Concern during that period was expressed by counties as shown in minutes from a 2003 meeting of the Wisconsin Council on Mental Health: http://tiny.cc/nbP7T . Additional “user fields” provide drop downs for various diagnoses including the one for depression that I’ve shown on the attached summary screen. The linkages between physical and mental health is explored in the Behavioral Risk Factor Survey: http://tiny.cc/nyo9J
When a data entry operator enters information for a new participant, the SAMS application executes a broad search that brings back a listing of all participants, from communities across the state, having similar sounding names. The summary screens from all matching records, with the most sensitive information plainly visible, can be viewed without actually opening records by any one with access rights to the SAMS system. There does not appear to be an audit trail relating to who views records. Concerns expressed in 2003 by the Wisconsin Council on Mental Health appear to have been well founded
Currently the State Data Infrastructure Coordinating Center (SDICC) is discussing participation of states’ mental health units in health information exchanges (HIEs) being developed by states under the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009 commonly referred to as the Stimulus Bill. A summary of the October 2009 SDICC regional calls can be found at: http://tiny.cc/k8nRV .
Wisconsin is the only state to configure SAMS so as to display individuals' most sensitive information in “user fields” on the summary screen (copy attached). Information can be directly entered and edited from the summary screen and since “user fields” are not regular data base fields, no audit trail is created or maintained. Entries in the “user fields” can be made by any person with access to an individual’s record and information from other databases or data warehouses can be entered without a person’s knowledge or approval.
Among the most sensitive “user fields” available for entry are those related to mental health diagnoses. Although the data entries that I make are limited to demographic information and assessments of nutritional health, ADLs and IADLs, others with access to the system can make entries with regard to the most sensitive personal information.
The group of five diagnostic fields, shown on the attached summary screen likely relate to the multi axial system of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The mental health module in the Human Services Reporting System (HSRS) and associated fields in the MEDS data warehouse organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability. A definition can be found at: http://tiny.cc/x3JZ5
As I mentioned above, I recognize the five diagnostic fields being included in the MEDS data warehouse from my work on data quality related to the Data Infrastructure Grant (DIG) in 2002. Concern during that period was expressed by counties as shown in minutes from a 2003 meeting of the Wisconsin Council on Mental Health: http://tiny.cc/nbP7T . Additional “user fields” provide drop downs for various diagnoses including the one for depression that I’ve shown on the attached summary screen. The linkages between physical and mental health is explored in the Behavioral Risk Factor Survey: http://tiny.cc/nyo9J
When a data entry operator enters information for a new participant, the SAMS application executes a broad search that brings back a listing of all participants, from communities across the state, having similar sounding names. The summary screens from all matching records, with the most sensitive information plainly visible, can be viewed without actually opening records by any one with access rights to the SAMS system. There does not appear to be an audit trail relating to who views records. Concerns expressed in 2003 by the Wisconsin Council on Mental Health appear to have been well founded
Currently the State Data Infrastructure Coordinating Center (SDICC) is discussing participation of states’ mental health units in health information exchanges (HIEs) being developed by states under the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009 commonly referred to as the Stimulus Bill. A summary of the October 2009 SDICC regional calls can be found at: http://tiny.cc/k8nRV .
Because the RFI for the Long Term Care Infrastructure HIE Project involves connecting all systems including the DHS data warehouse, the privacy of many of Wisconsin's elderly and disabled will be systemically breached by technology "wrongfully used".
Dr. Peel is right!
Friday, January 1, 2010
2010 - It's A New Year!
My time since my last blog entry in October has been filled with Health Information Technology Standards (HITSP) meetings. January 2010 will be filled with wrap-up meetings as the HITSP contract with the Department of Health and Human Services (HHS) comes to its conclusion. The contract was for four years running from September 2005 through September 2009 with an extension granted through January 2010.
Of particular importance, are the final meetings for the Consumer Preferences Tiger Team (CP-TT) which provided comments, at the request of the Office of the National Coordinator for Health Information (ONC), relating to the draft specifications for Consumer Preferences. The draft specifications can be found at: http://tiny.cc/9Sk51 .
On December 30, 2009, CMS announced a notice of proposed rulemaking (NPRM) to implement provisions of the Recovery Act that provide incentive payments for the meaningful use of certified EHR technology. In a related announcement, ONC has issued an Interim Final Rule (IFR) that specifies the Secretary’s adoption of an initial set of standards, implementation specifications, and certification criteria for electronic health record (EHR) technology.
Dr. John Halamka's summary of how both documents should be used together provides an excellent overview of "meaningful use" for consumers.
Of particular importance, are the final meetings for the Consumer Preferences Tiger Team (CP-TT) which provided comments, at the request of the Office of the National Coordinator for Health Information (ONC), relating to the draft specifications for Consumer Preferences. The draft specifications can be found at: http://tiny.cc/9Sk51 .
On December 30, 2009, CMS announced a notice of proposed rulemaking (NPRM) to implement provisions of the Recovery Act that provide incentive payments for the meaningful use of certified EHR technology. In a related announcement, ONC has issued an Interim Final Rule (IFR) that specifies the Secretary’s adoption of an initial set of standards, implementation specifications, and certification criteria for electronic health record (EHR) technology.
Dr. John Halamka's summary of how both documents should be used together provides an excellent overview of "meaningful use" for consumers.
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