iHT2 Health IT Summit Atlanta 2013, Michael Matthews, Chief Executive Officer, MedVirginia, Central & Eastern Virginia's Regional Health Information Exchange , Case Study “Health Information Exchange: State and National Updates”
iHT2 Health IT Summit Atlanta 2013, Michael Matthews, Chief Executive Officer, MedVirginia, Central & Eastern Virginia's Regional Health Information Exchange , Case Study “Health Information Exchange: State and National Updates”
Understanding clinical data exchange and cda (hl7 201)Edifecs Inc
On top of simple needs for doctors to be connected and be able to efficiently exchange information, there is a lot of external factors driving standardization of information exchange from market to various government initiatives and as the industry moves toward a population health model, there is more need for wider applicability of standards. This Slide share covers an introduction to CDA and establishes the importance of clinical documentation for claims and prior authorization attachments
Interoperability is one of the most critical issues facing the health care industry today. A universal exchange language is needed to assist health care providers in sharing health information in order to coordinate diagnosis and treatment, while maintaining privacy and security of personal data. Health Information Exchanges (HIE) allow for the movement of clinical data between disparate systems; they enable providers to electronically share health records through a network. This presentation provides an overview of HIE and the Meaningful Use requirement related to the exchange of clinical information as well as information about standards of exchange and the recommended "next steps" for providers.
Assist Missouri's health care providers in using electronic health records to improve the access and quality of health services; to reduce inefficiencies and avoidable costs; and to optimize the health outcomes of Missourians
Understanding clinical data exchange and cda (hl7 201)Edifecs Inc
On top of simple needs for doctors to be connected and be able to efficiently exchange information, there is a lot of external factors driving standardization of information exchange from market to various government initiatives and as the industry moves toward a population health model, there is more need for wider applicability of standards. This Slide share covers an introduction to CDA and establishes the importance of clinical documentation for claims and prior authorization attachments
Interoperability is one of the most critical issues facing the health care industry today. A universal exchange language is needed to assist health care providers in sharing health information in order to coordinate diagnosis and treatment, while maintaining privacy and security of personal data. Health Information Exchanges (HIE) allow for the movement of clinical data between disparate systems; they enable providers to electronically share health records through a network. This presentation provides an overview of HIE and the Meaningful Use requirement related to the exchange of clinical information as well as information about standards of exchange and the recommended "next steps" for providers.
Assist Missouri's health care providers in using electronic health records to improve the access and quality of health services; to reduce inefficiencies and avoidable costs; and to optimize the health outcomes of Missourians
business model, business model canvas, mission model, mission model canvas, customer development, lean launchpad, lean startup, stanford, startup, steve blank, entrepreneurship, I-Corps, Stanford
The proposed Trusted Exchange Framework supports ONC’s goals of achieving nationwide interoperability:
Patient Access - Patients must be able to access their health information electronically without any special effort;
Population-level Data Exchange - Providers and payer organizations accountable for managing benefits can receive population level health information allowing them to analyze population health trends, outcomes, and costs; identify at-risk populations; and track progress on quality improvement initiatives; and
Open and Accessible APIs – The health information technology (health IT) community should have open and accessible application programming interfaces (APIs) to encourage entrepreneurial, user-focused innovation to make health information more accessible and to improve electronic health record (EHR) usability.
2015 Edition Proposed RuleModifications to the ONC Health IT Certification ...Brian Ahier
Presentation to April 7, 2015 Health IT Policy Committee:
2015 Edition Proposed RuleModifications to the ONC Health IT Certification Program and 2015 Edition Health IT Certification Criteria
Remarks to Public Forum on National Health IT PolicyBrian Ahier
On February 4, 2010 there was a public forum on the rollout of national HIT policy under HITECH, including "meaningful use," EHR certification, and HIE. Aneesh Chopra, at the time serving as Chief Technology Office (CTO) of the United States made some remarks.
FTC Spring Privacy Series: Consumer Generated and Controlled Health DataBrian Ahier
Increasingly, consumers are taking a more active role in managing and generating their own health data. For example, consumers are researching their health conditions and diagnosing themselves online. Consumers are also uploading their information into personal health records and apps that allow them to manage and analyze their data, and utilizing connected health and fitness devices that regularly collect information about them and transmit this information to other entities.
The movement of health data outside the traditional medical provider context has many potential benefits; however, it also raises potential privacy concerns. The seminar will address questions such as:
What types of websites, products, and services are consumers using to generate and control their health data, and how are consumers using them?
Who are the companies behind these websites, products, and services, what are their business models, and what does the current marketplace look like?
How can consumers benefit from these companies’ websites, products, and services?
What actions are these companies taking to protect consumers’ privacy and security?
What do consumers expect from these companies regarding privacy and security protections?
Do consumers differentiate between these companies and those that offer traditional medical products and services that are covered by HIPAA?
What restrictions, if any, do advertising networks and others impose on tracking of health data?
On February 19, 2014, the Federal Trade Commission staff hosted a seminar on Mobile Device Tracking.
The speakers discussed how retailers and other businesses have been tracking consumers’ movements throughout and around retail stores and other attractions using technologies that identify signals emitted by their mobile devices. While the technologies differ, many work by identifying and collecting the MAC address – which is unique to a particular device – broadcast when a mobile device searches for Wi-Fi networks. Companies can use these technologies to reveal information about consumers including the path taken throughout a location, length of time in one location, whether a visitor is new or returning, and the frequency of visits to a location. According to media reports, major retailers in the United States are using or have tested the technology in their stores in order to gain insights into the behavior of their customers.
In most cases, this tracking is invisible to consumers and occurs with no consumer interaction. As a result, the use of these technologies raises a number of potential privacy concerns and questions.
Big Data and VistA Evolution, Theresa A. Cullen, MD, MSBrian Ahier
Presentation to Open Source Electronic Health Record Alliance (OSEHRA) Architecture Work Group by Theresa A. Cullen, MD, MS
Chief Medical Information Officer
Director, Health Informatics
Office of Informatics and Analytics
Veterans Health Administration
Department of Veterans Affairs
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
4. Existing environment
Little exchange occurring
• Almost three quarters of the time (73 percent) PCPs do not get discharge info within
two days. Almost always sent by paper or fax (2009, Commonwealth)
• Only 19 percent of hospitals report they are sharing clinical information electronically
outside system (2010, AHA)
Cost of exchange high , time to develop is long
• Interfaces cost $5K to $20K due to lack of standardization, implementation variability,
mapping costs
• Community deployment of query-based exchange often takes years to develop
Poised to grow rapidly, spurred by new payment approaches
• New payment models are the business case for exchange
• More than 70 percent of hospitals plan to invest in HIE services (2011, CapSite)
• Number of active “private” HIE entities tripled from 52 in 2009 to 161 in 2010 (KLAS)
Many approaches and models
• In addition to RHIOs, many other approaches emerging, including local models
advanced by newly emerging ACOs, exchange options offered by EHR vendors, and
services provided by national exchange networks
• Seeing a full portfolio of exchange options, meeting different needs
3
5. Patient Care is At Stake
• 1 in 5 discharged Medicare enrollees is readmitted
with a month
• More than 40 percent of outpatient visits involve a
transition
• Referring physicians receive feedback from
consultants 55 percent of time
• Physicians make purpose of referral clear 74 percent
of time
4
6. Today’s Situation is Unacceptable
• Patients should not have to worry about whether their health
information can be securely transferred to their point of care
when they need it most
• Clinicians should not have to worry about whether they are
going to be able to securely access a patient’s health
information when care decisions need to be made
• Health systems should not have to worry about whether they
will lose business if they share patient information with their
competitors
• Vendors should not have to worry about whether their
systems can talk to each other
5
7. We Are Here Today…
Receipt of Discharge Information by PCPs
Time Frame (n=1,442) Delivery Method (n=1,290)*
Less than 48 Hours Fax
27% 62%
2 to 4 Days Mail
29% 30%
5 to 14 Days Email
26% 8%
15 to 30 Days Remote Access
6% 15%
19 percent of hospitals are
More than 30 Days Other exchanging clinical care
records with ambulatory
1% 11%
providers outside system
(2010)
Rarely/Never Receive Adequate Support Not Sure/ Decline to Answer
6% 1%
Not Sure/Decline to Answer
4% *Respondents could select multiple responses. Base excludes those who do not
receive report. Source: 2009 Commonwealth Fund International Health Policy
Survey of Primary Care Physicians.
8. Will We Soon See this Curve?
For care summary exchange? For lab exchange?
Number of e-Prescribers in US by Method of Prescribing
400,000
350,000
300,000
250,000
Stand-alone
200,000 e-Rx System
EHR
150,000
Total
100,000
50,000
0
Mar-07
Jun-07
Mar-08
Jun-08
Mar-09
Jun-09
Mar-10
Jun-10
Mar-11
Jun-11
Sep-07
Sep-08
Sep-09
Sep-10
Dec-06
Dec-07
Dec-08
Dec-09
Dec-10
7
9. ONC’s Role
• Standards: identify and urge adoption of scalable, highly
adoptable standards that solve core interoperability issues
for full portfolio of exchange options
• Market: Encourage business practices and policies that
allow information to follow patients to support patient care
Value • HIE Program: Jump start needed services and policies
• Payment reforms
• Professional & patient
expectations Cost
• Meaningful use
Trust
Identify and urge adoption of policies needed for trusted
information exchange
8
10. What Guides Our Approach?
– Set Clear Goals – Success is measured by whether exchange
is occurring among unaffiliated providers and with patients
to support meaningful use and improved patient care
– Orchestrate not Build – ONC’s role is not to build exchange
networks but to lead the community in the development of
standards, services and policies that solve core problems
– Keep the Patient at the Center – Providers and patients must
be confident that laws, policies and processes are in place
and enforced to protest the privacy and security of their
electronic health information
9
11. What Does it Mean to Orchestrate?
– Give everyone a pathway to participate in exchange, no
matter what their level of sophistication and resources
– Acknowledge that there will be multiple
networks, approaches and business models
– Take a building block approach
– Break the problem into manageable chunks
– Re-use building blocks across many exchange
approaches
– Middle-out approach to standards
1010
12. Advancing Exchange in 2012 –
Attacking on Multiple Fronts
– More rigorous exchange requirements in Stage 2 to
support care coordination
– Initial standards building blocks are in place, with
clear priorities to address missing pieces in 2012
– NwHIN Governance increases trust and reduces the
need for one-to-one negotiations among exchange
organizations
– State HIE Program jumps starts needed services and
policies
11
13. More Rigorous HIE Requirements
In Stage 2 Meaningful Use
2009 2011 2013 2015
Outcomes
measurement &
improvement
HIE and care
coordination
Capture
structured
data
12
14. CMS NPRM – Care Coordination
Denominator: Number of transitions of care and referrals during
the EHR reporting period for which the EP or eligible
hospital's or CAH's inpatient or emergency department (POS
21 or 23) was the transferring or referring provider
Numerator: The number of transitions of care and referrals in
the denominator where a summary of care record was
electronically transmitted using Certified EHR Technology to a
recipient with no organizational affiliation and using a
different Certified EHR Technology vendor than the sender
Threshold: The percentage must be more than 10 percent in
order for an EP, eligible hospital or CAH to meet this measure
13
15. We Made Big Strides to Enable Exchange
in Stage 1
The first challenge was to make sure that information
produced by every EHR was understandable by another
clinician and could be incorporated into his EHR
With the vocabularies, code sets and content structure standards in
Stage 1 meaningful use every certified EHR can produce the
standardized content needed:
– Produce and consume a standardized care summary
– Maintain standardized medication lists
– Consistently report quality measures and public health results
– Consume structured lab results
14
16. Additional Critical Pieces Are Now In Place
Next we needed a common approach to transport, allowing
information to move from one point to another
– We now have two easily adopted standards for transporting
information – NwHIN Direct and the transport protocol used
in NwHIN Exchange
And it was clear that we needed more highly specified
standards to support care transitions and lab results delivery
– For the first time in our country’s history there is a
single, broadly-supported electronic data standard for
patient care transitions
15
17. This Year We Will Address the Missing Components to
Support Scalable Exchange
– Directories – standards and policies to make them
consistent, reliable, findable and open to be queried
– Certificate management and discovery - common
guidelines for establishing and managing digital
certificates and making the public keys “findable”
– Governance - baseline set of standards and policies
that will accelerate exchange by assuring trust and
reducing the cost and burden of negotiations among
exchange participants
16
18. Together These Form the Initial Building Blocks Needed to
Support Many Types of Exchange
• Providers need a way to send and receive patient
health information easily and securely, such as lab
results, patient referrals and discharge summaries
(i.e. Directed Exchange)
• Providers need a way to find a patient’s health
information for unplanned care (i.e. Query-based
Exchange)
• Consumers need to be able to aggregate, use and
share their own information (i.e. Consumer-
mediated Exchange).
17
19. We Need to Reduce the Cost and Ease Adoption for All Three
Forms of Exchange
Support the development and
spread of exchange capabilities that
help providers find information
Achieve widespread directed
exchange so that every provider
has way to securely send and
receive electronic health
Information to support better
care coordination
Enable consumers to aggregate,
use and share their own information
20. Governance for Nationwide Health Information
Network
• Tremendous time and legal resources needed to craft
business agreements for exchange
• Governance will provide rules of the road to guide
health information exchange
• Baseline set of standard and policies to establish the
foundation for trust and interoperability
• It is hoped that they will accelerate exchange and
reduce the cost and burden of negotiations
19
21. State HIE Program: Jumps Starts Needed Services and
Policies
• Focus - Give providers viable options to meet MU
exchange requirements
– E-prescribing
– Care summary exchange
– Lab results exchange
– Public health reporting
– Patient engagement
• Approach
– Make rapid progress
– Build on existing assets and private sector investments
– Every state different, cannot take a cookie cutter approach
– Leverage full portfolio of national standards
20
22. Evolving Conception of State HIE program
Prior Assumption Current Concept
Always one state-run HIE network There may be multiple exchange
serving majority of exchange needs of networks and models in a state
providers in the state
Key role of the state HIE program is to
catalyze exchange, fill gaps and assure
Focused on developing query-based common trust baseline, building on
exchange the market and focusing on
meaningful use
21
23. Our Challenge This Year
Guidance Provided in February, 2012
• When the conditions are right, we see HIT adoption
progressing in a steep curve
• In 2012 we expect to see a similar progression for care
summary and lab results exchange
• These are foundations requirements for meaningful use
• Every Grantee has identified and is executing the most effective
strategies to make rapid progress
• Every certified EHR can produce a care summary and
incorporate a structured lab result
• Payment reforms are providing new incentives, business cases
and market conditions for care coordination and health
information exchange
22
24. Strategies
Opportunity Strategies to Address Number
Directed Exchange - Jumpstart low-cost directed exchange
White Space 51
services to support meaningful use requirements
Shared Services - Offer open, shared services like provider
Duplication 54
directories and identity services that can be reused
Information Connect the nodes- Infrastructure, standards, policies and
25
Silos services to connect existing exchange networks
REC for HIE - Grants and technical support for CAHs,
Disparities 20
independent labs, rural pharmacies to participate in exchange
EmergingNetw Support local networks – Connectivity grants and
5
orks trust/standards requirements for emerging exchange entities
Public Health Serve reporting needs of state - Support public health and
28
Capacity quality reporting to state agencies
No Shared
Accreditation and validation of exchange entities against
Trust/Interop 17
consensus technical and policy requirements
Requirements
25. Future Challenges
• Secondary uses
• Patient matching
• Connecting exchange nodes
• Tracking sources of information
• Filtering and searching
• Automating care coordination tasks
• Provider workflow
• Liability
24