Ticking away the moments that make up the health record

For the purposes of illustrating precision in HL7v3 Time elements (TS), no time zone information is represented. As a nice bonus, this format is easily sortable as Strings or char arrays.

HL7 TS	Meaning
20121031235959001	October 31, 2012, 999 milliseconds before midnight
20121031235959	October 31, 2012, one second before midnight
201210312359	...and again one minute before midnight
20121031	Any time on the day of October 31, 2012
201210	October 1-31, 2012
20121	October 1 - December 31, 2012 (technically valid, but never used this way)
2012	January 1 - December 31, 2012
20	Sometime in the 21st century

Get it? It's a regular expression with assumed wildcard at the end.

Sketches of mHealth Standards

A June blog post by Keith Boone (aka @motorcycleguy), Convergence: CEDD, CIMI, IHE, FHIR, hData, HL7, mHealth and ONC got me thinking and sketching this simple diagram of how some of those pieces can fit together. 

It's more stream of consciousness than companion diagram, but there it is. A REST client/server wrapped in consent rules wrapped in security protocols (only client side shown), treating health information as RESTful resources. A URI for each patient, document, and fragment. 

The other thing that stuck out to me is the fact that we need data structures which can be use by both simple clients and highly complex ones. Where a mobile app may be reading and writing a half dozen data poings per entry, an industrial strength medical information system may be processing hundreds, and yet they operate on the same record. That's the essence of the CDA XML to hData JSON downshift, to allow interoperability between devices of vastly different capability.

Conversational Context in Smart Phones

Every time I use Siri I feel better if I say hi first. I don't know if it's polite or just makes conversing with a computer seem less weird. In this example, it's 8:26pm and I want to know what time the sun is going to be up tomorrow.

Close, but not exactly what I wanted. I happen to know sunrise tomorrow is a few minutes earlier than sunrise today (as summer progresses). So I clarify, and in the process I can see Siri's context engine at work. The next single word I say is interpreted relative to facts within the larger conversation.

Aha. She understands I'm talking about a sunrise. She gets the concept of tomorrow. She just doesn't know the answer. This is standard almanac data, something Wolfram Alpha should handle easily, but that's another story.

When Siri doesn't understand me, I usually find I'm asking for something that she's not programmed to recognize as a task. How do I know? I simply ask her.

How to be Prepared for Anything

I found some really cool iPhone apps for emergency preparedness at a Red Cross training session, given last weekend to volunteers in the Community Emergency Response Team (CERT). Palo Alto as a city is more prepared than most, with a small army of volunteers, mobile response teams, and sophisticated communication and response system. 

Remember police scanners? This is even better. The 5-0 Radio app can give you a live feed from local police, fire, and other civil organizations. 

 Browse your local area, or anywhere in the country. We even have amateur radio operators. Cool!

Listen to a live radio feed.

Check out the California Road Report. You set a radius from your current location and it gives you list of road reports in the area.

The Pacific Disaster Center (PDC) monitors natural disasters around the world, and they have a mobile app, World Disaster Alerts. 

If disaster strikes, you can find the location of every open Red Cross shelter, using their app Shelter View. This screen shot was taken on a relatively quiet day.

Cell phone towers and Internet routers go dead in the event of power loss, but mobile hotspots can be set up if necessary, and mobile data may be important in a crisis. So keep your phone and a solar charger nearby, just in case.

Hello Siri, How Are You?

I know I'm late, but with the impending announcement of the next insanely great thing, I thought I'd go through my old Siri conversations to share. This was my first, when I got the phone and introduced myself to Siri.

Before I go further, let's get the silly stuff out of the way...

Yes, yes. It's only the most obvious Monty Python and Douglas Adams references in the Universe.

What happens if I simply say, "The Beatles?"

Cool.

Now let's settle into the groove of everyday life. Good morning, Siri.

Okay, so you can't read me the weather. So much for leaving you in my pocket as I walk out the door.

At least you understand me, even when I, uh... don't quite enunciate clearly.

...most of the time, anyway.

Okay, sometimes.

Er, I may need to work on my pronunciation.

Sometimes, I press the Siri button by accident, or forget what I wanted.

Back to everyday life, I'm hoping Siri can guide me to my meeting... 

...or not. I thought Siri stored a conversational context to help answer questions. Does Siri not remember my most recent questions? How do you get from this meeting to my own address? Or does she think I should skip out on my meeting and just go home?

Now where's that to-do list? 

ARGLE BARGLE!!!

I can already tell, this is going to be way more fun than autocorrect.

EMRs, iPods, and Saddlebags

I've heard that the size and shape of the modern hard-cover book was determined by the carrying capacity of 15th century saddle bags because after the invention of the printing press people had to carry those books far and wide on horseback, and the size and shape of the iPod was determined by the size and shape of your average front shirt pocket. This makes me wonder: what is the size and shape of the ideal electronic medical record?

What is a C32/CCD?

HealthUnity has a pretty good explanation of HIE technology including their HIE Use Cases. Documents on transmitted through HIE systems today typically conform to the HL7v3 Clinical Document Architecture (CDA). The Continuity of Care Document (CCD) is the most common of these, meant to be what your doctor needs to know at a glance. It looks something like this:

It's a clinical document with basic information about you and your doctors (any health care providers, really), information about the document itself (author, time of creation, purpose, etc), and a structured body which contains some number of sections - one for each category of health information being shown. For example, allergies, vaccinations, and current medications may be of immediate use, with the latest results, vital signs, and diagnoses. Much more can be documented depending on the purpose of the document.

To summarize: You (the patient) are the record "target." Every provider involved in the events documented is conveniently listed up front with contact information, followed by one or more sections. A section has a human-readable title and text followed by any number of coded entries. Each section is identified by its templateId (and so is the document itself, with its own templateId on the ClinicalDocument level).

Which sections are included depends on the document's purpose. A summary document has a bit of everything, while a lab or radiology report may have only the results section. There are many of these specified by HITSP (composite documents start with a "C" for example C32 is CCD and C84 is History & Physical).