The Results Are In: Pioneer ACO Model

Last week, The Journal of the American Medical Association (JAMA) published the results of a study that showed that the Pioneer Accountable Care Organization (ACO) Model achieved almost $400 million less spending for patient care than fee-for-service (FFS) Medicare patients over two years. These cost savings were attained without deterioration in the quality of care.

Achieving Semantic Interoperability: Point-to-Point Versus Centralized Mapping

Our philosophy at 3M is to approach terminology mapping and semantic interoperability using a centralized terminology server. With a centralized source of terminology management and maintenance, each data source needs to be mapped only once. Once this single mapping occurs, all the other systems that are mapped to the centralized server can leverage the mappings so data can be translated and exchanged without losing meaning. Therefore, for n systems that need to be mapped, only n mappings need to be performed.

On the other hand, in a point-to-point mapping approach, each system is mapped directly to every other system. While this is a feasible approach when dealing with a few systems, it becomes unwieldy as the number of systems increases. For example, given three systems to map, the total number of mappings that need to be created is three. However, if we increase the number of systems to five, the point-to-point mappings increase to 10. This is illustrated in Figure 1.

Report from AMDIS: Top CMIO Issues

Last week we attended the 2014 Physician-Computer Connection Symposium sponsored by AMDIS, the Association of Medical Directors of Information Systems. It was our first time attending the event, held this year in Ojai, California. The conference is geared toward the needs and concerns of Chief Medical Information/Informatics Officers (CMIOs), and we learned a great deal about the issues that are top of mind for today’s CMIOs. This is a relatively new role within hospitals, health systems, and corporations. In the past, the CMIO was primarily seen as a liaison or bridge between providers and IT; more recently, however, the role has transformed into a leadership position that plays a key role in IT decision making, managing people, and even managing its own budget.

Behind the scenes at HIMSS14

We’re back to our “normal” routine after attending HIMSS last week in Orlando, Florida. The show is growing every year, and the number of cities capable of handling its size seems to be down to 3: Orlando, Las Vegas, and Chicago.

As usual, the 3M booth and its staff were kept busy with a steady stream of walk-up visitors interested in our terminology, computer-assisted coding, consulting, and other products and services. We also had many productive, scheduled meetings with vendor partners and potential customers. Stage 2 of Meaningful Use and ICD-10 seemed to be on many people’s minds.

Re-connecting at the AMIA Annual Symposium

We’ve just returned from our trip to the Annual AMIA Symposium held November 16-20 in Washington, DC. 3M sent one of our largest groups ever to the conference, with a total of thirteen 3M’ers attending. It was great to re-connect with old friends, meet new people, conduct business, and have fun.

The conference kicked off with a keynote by Dave deBronkart, also known as “e-Patient Dave,” discussing the empowerment of the patient consumer and how the Internet has facilitated that. His interesting anecdotes and charisma really brought home the importance of patient engagement in the healthcare process.

An Insider’s Look at the HIMSS13 Interoperability Showcase

Last week, 3M Health Information Systems participated in the 2013 HIMSS Interoperability Showcase with the 3M Healthcare Data Dictionary (HDD). It was our first time participating in the Showcase with the HDD. The Showcase was organized into several different use cases of hypothetical clinical scenarios. Each use case had its own pod on the Showcase floor. Within each pod each vendor had its own kiosk.  We were one of the vendors in Use Case #3:  Biosurveillance Monitoring and Detection. The Saturday and Sunday before HIMSS were spent setting up our systems, testing, and rehearsing our presentations, with t. he Showcase itself running Monday through Wednesday of HIMSS.  I like to think of the Showcase as a place where vendors come to “walk the walk,” not just “talk the talk” about interoperability.  Vendors there were able to demonstrate the fruits of their collaboration efforts with each other to get their various systems to work together based on standard specifications.

Why Not Use Standards Directly to Encode Clinical Data?

By: Kasey Poon

There are some good reasons for organizations to use a terminology server instead of using standard vocabularies directly to encode their clinical data.

One reason is that standards are not comprehensive.

LOINC Mapping

By: Kasey Poon

We’ve been getting a lot of requests from customers who need help mapping their laboratory codes to LOINC. They want to be compliant with the LOINC standard for a variety of reasons, including meeting Meaningful Use requirements, public health reporting, and participation in health information exchanges (HIEs). Often these customers’ EHR vendors have created new fields in their code tables to accommodate the LOINC codes. The customers request flat files from us containing their lab codes paired with the LOINC codes that we suggest. They then load these LOINC codes into the EHR tables.

While we’re happy to meet these immediate needs for our customers, we also remind them that providing LOINC codes to them in this manner only provides a “snapshot in time” of their laboratory codes and the LOINC codes. Beyond the initial mapping that we do for them, there is also the issue of maintenance to consider. Maintenance includes updates coming from the Regenstrief Institute to the LOINC standard itself. These updates occur 2-3 times a year. Maintenance also includes changes coming from the customers. These changes can include new lab codes or updates to existing codes. Unfortunately, using flat files for terminology maintenance is not a very robust system for keeping track of changes and updates.

In addition to providing the initial mapping service for our customers, we like to point out the maintenance issues for them to consider. We also remind them of other standards with which they may want to be compliant, such as SNOMED CT.

Kasey Poon is a Physician Informaticist, Clinical Terminology, with 3M Health Information Systems.