Building Unity Farm - Forestry Management

Unity Farm has over 12 acres of forest, which I manage using my Stihl 290 Farm Boss chainsaw and my Scandinavian Forest AxesI've written previously about managing firewood and logs for mushroom farmingRecently, as we've worked with Tree Specialists on a land management plan that includes an expanded orchard, bees, wildflowers, meadow, and wetland, I've  learned more about tree identification.As a mushroom expert doing toxicology consultation...[Readmore]

The March HIT Standards Committee Meeting

The March HIT Standards Committee focused on streamlining test scripts for certification, an overview of FDA Universal Device Identifier rule making, clinical summary formats for Long Term Care, and the latest updates from ONC.We began the meeting by reflecting on the recent HIMSS conference, noting that the culture and momentum for EHR and HIE adoption in the US have changed to the point that there is no longer of question achieving our meaningful...[Readmore]

The Reality of SaaS

Recently I was asked if SaaS/Cloud computing is appropriate for small practice EHR hosting.I responded"SaaS in general is good.However, most SaaS is neither private nor secure.Current regulatory and compliance mandates require that you find a cloud hosting firm which will indemnify you against privacy breeches caused by security issues in the SaaS hosting facility.Also, SaaS is only as good as the internet connections of the client sites.  ...[Readmore]

Building Unity Farm - Managing the Farm in Our Absence

Paul Harvey wonderfully captured the responsibilities of being a farmer.  Just like being a CIO, being a farmer is not a job but a lifestyle.When I called my wife and daughter in the hours after my father's death last week, we had to figure out how to manage Unity Farm during a situation that required the absence of the entire family.We created a workplan and contacted a nearby farm to ask for their help.Here's what we had to documentAlpaca/Llama...[Readmore]

A Unified Software Development Lifecycle

Recently, in response to an audit, I was asked to document our Software Development Lifecycle across all our platforms - clinical, financial, and web.    Here's what I wrote.  I hope you find it useful.1.  Project DefinitionMulti-stakeholder governance bodies of business owners and IS professionals meet on a regular basis to define the scope and requirements of new projects.    The priorities of these new projects are...[Readmore]

Thank You to the Village

From March 8 to March 17, I was focused entirely on my father - from serving as his healthcare navigator to arranging his funeral/memorial to ensuring my mother had a path forward. For 10 days, I had to minimize my roles as a CIO/professor and maximize my roles as son/clinician.I cancelled numerous meetings, speaking engagements, and classes.  I backed out of commitments made months ago.   My response to calls/emails/texts went from minutes...[Readmore]

Building Unity Farm - "Planting" the Mushroom Farm

As I mentioned last week, we're planting the orchard and developing a mushroom farm this Spring.What is the scope and scale of the mushroom farm effort?We've cut 200 feet of poplar trees that were too near our buildings for safety.   I chainsawed the trees into 12 four foot logs that 6-8" in diameter and 60 two foot logs that are 8-12" in diameter.   Poplar is an ideal substrate for oyster mushrooms.    Our mushroom farm supplier,...[Readmore]

The Use of Scribes for Clinical documentation

Given the rigors of documentation required for Meaningful Use, quality measurement, and ICD10, some organizations are adding dedicated scribes to rounding and evaluation teams.I was recently asked two questions about scribes.Does Meaningful Use allow the use of scribes?Meaningful Use does not specify who does the documentation, as long as the thresholds for data capture are exceeded.What are the best practices for scribes used at BIDMC?At BIDMC the...[Readmore]

Use of HIE Fully Integrated into the EHR

Note - while I was flying to Los Angeles to be with my father, I wrote the Tuesday-Thursday blog posts which will be automatically published this week.    I'm focused on his care now and will return to writing in real time once his needs have been met.John-------------I recently reviewed an article which lamented the low adoption of portal-based HIE that requires clinicians to log into a website outside of their normal EHR workflow to lookup...[Readmore]

Celebrating my Father's Life

As I sit at my father's bedside, managing the increasing heaviness of his breathing, I'm doing my best to keep his lips moist, his extremities warm, and the dosing of his comfort care medications appropriate so there is no air hunger.People from my parents' past are calling and emailing me, telling me their stories and reveling in the impact my father had on their lives.  They've told me:He inspired them to go into engineering (he's a patent...[Readmore]

What is Compassionate Comfort Care?

Over the past 24 hours, my family and the hospital care team have been guided by my father's healthcare proxy to avoid painful, invasive, or aggressive care at time when his multiple medical issues have combined to make his health decline irreversible.The healthcare proxy was extremely clear and enabled us to finalize the do not resuscitate and do not intubate orders.   We agreed to stop monitoring and stop all medications except those needed...[Readmore]

Serving as Healthcare Navigator for my Father

On Friday at noon, I received a call from my father's cardiologist that I should fly to Los Angeles urgently - "your father has had his third heart attack, his heart is pumping at half its usual volume, and the combination of multiple medical problems requires rapid decision making."20 inches of snow had fallen in Boston on Friday morning, delaying and canceling many flights.The beginning of Spring break meant that just about every Friday flight...[Readmore]