Regional Expertise Networks
From Ubuntu Doctors Guild
I am in California so this article focuses on California resources. The basic principles apply to all areas of the country, however. I am a proponent of using Astronaut VistA not only as an EHR but also as a training tool for HIT education. See Ubuntu-Med.
The distribution of ARRA "stimulus" funds will be through a series of about 70 Regional Extension Centers (RECs) in the United States. (Those RECs are currently being chosen based on applications made in late 2009/early 2010.)
Those RECs have a mandate to assist 1000 providers with meaningful implementations of health information technology within the first year.
- Cal-REC -- co-operative of CMA, CPCA, CAPH (see below)
- California Health and Human Services -- created strategy for REC implementation
To do so, local community experts must be engaged by the RECs to disseminate accumulated regional knowledge and resources. This will be a system of Local Extension Centers. This works best when local stakeholders (hospital and large clinic CEOs and CIOs, small clinic administrators, and individual physician practice administrators) form co-ordinated Regional Expertise Networks as the Local Extension Centers, often with "user groups" oriented towards particular aspects of HIT implementation and usage.
In Seattle, a group project known as Paideia was formed to cross organizational boundaries and partner with medical-technology organizations (in this case WorldVistA and the VistA Software Alliance), public academic institutions (the University of Washington's Health Informatics and Health Information Management program), public health agencies (the U.S. Indian Health Service and the Department of Veterans Affairs), and individual healthcare practices, clinics, and hospitals (like Oroville Hospital in California).
Oriented around the open-source EHR WorldVistA, this group is an example of one type of user group that might be a subset of a larger regional co-operative umbrella.
Local Expertise Networks
- Redwood Mednet -- a very active expertise network located in Sonoma County
- The Health Alliance of Northern California (formerly the Northern Sierra Rural Health Network and the Shasta Consortium of Community Health Centers. Has one of the largest successful Telemedicine implementations in the state. Has a large datacenter at its hub. Has co-operated with UC Davis in the past.
- UC Davis Center for Health and Technology. Although endowed with millions of dollars in grants, the success in reaching out to rural centers and bringing them up to speed in the digital age has been quite variable.
- California Primary Care Association -- a partner with Cal-REC
- California Association of Public Hospitals and Health Systems -- a partner with Cal-REC
- California Medical Association -- a partner with Cal-REC
- The Western Clinicans Network -- education, research, training and policy in health care for the underserved. A large number of members use NextGen (and have shared some customization and service-oriented problem-solving efforts) and eClinicalWorks for their clinic EHRs. Significantly, some members have been pioneers in large clinic implementation of the VistA EHR.
Funding for Community College participation in Expertise Networks
- Community College Consortia to Educate Health Information Technology Professionals in Health Care Program
Meaningful Use, Certification, Grant-writing, and inspections
This is a common requirement for all health care organizations, and the collaboration of CEOs/CIOs of established hospitals and health care organizations can provide a directed experience in these areas.
Training Programs in Health IT careers
Major companies such as GE (Centricity) and McKesson (in San Francisco) have similar labs where complete hospital simulations have been established to to test and refine EHR processes.
Using open source tools, a similar mockup can be created (for little cost) in a community college (computer) lab. Students can even practice using virtual machines and have independent configurations.
WorldVistA and OpenVistA are two complete EHRs (derivatives of the VA's VistA EHR) that can be set up in less than a day in a computer lab, either on standalone servers or in virtual machines (or both).
There are several types of skills that can be engendered with such training programs:
- Knowledge of networking and security skills required to implement and secure industrial-strength EHRs.
- Knowledge of connectivity options for mobile users (USB drive connections and password vaults, VPN access, single-sign-on implications and mechanisms, mobile phones applications, etc.)
- Knowledge of backup and off-site replication skills.
- Knowledge of technology underlying hosted solutions (virtual machines, cloud environments) and the interaction with local networks, fail-safes, and backups
- Disaster preparedness. What fail-safes are in place in power outages, network outages, and other frequently-occurring disasters?
- Integration with technologies such as PACS (and other image jukeboxes), lab systems, billing systems, bar-code and RFID readers, scanners
- Health information exchange open source APIs (NHIN Connect, Mirth Connect). CCR / CCD exports. Exports to immunization and other public databases/registries.
- Grant writing
- Certification (CCHIT scripts, meaningful use compliance, CMS compliance, HIPAA compliance)
- Legal liability (institutional insurance)
- Contracts with vendors
There are two major open source distance teaching tools useful for an online curriculum: Moodle and Claroline.
The advantage of developing an online curriculum is that it can continually evolve and be improved accessed and also be accessed by rural students, IT administrators, and co-operating vendors and local expertise.
By combining this with webinars and screencasts, a comprehensive tool for online learning can help those not able to personally attend classes, meetings, or avail themselves of a community college. Here is a demo site of this (with integrated BigBlueButton teleconferencing capability).
Telemedicine and distance learning
Telemedicine and distance learning share technological challenges. Authorization, billing, scheduling, and availability are common problems. Common solutions exist to both environments.
- Local CEOs/CIOs
- Regional REC expert lectures
- Vendor presentations
- Screencasts of lectures (with rights to broadcast)
- Technology for local production, replication, and storage of webinars/screencasts (useful for institutional training), with or without wiki or website integration
This entire structure can be provided using open source tools. The University of North Carolina uses Moodle for its distance teaching. Ubuntu Linux (or Red Hat/Fedora/CentOS Linux) operating systems are available for free, as are all the tools needed for creating a computer lab and online learning modules.
- Website portals (Drupal)
- Document management via wikis or website portals
- Document management within an organization (order sets, care pathways, protocols, discharge instruction sets) are also known to create significant efficiencies for health care (and other) organizations. These tools are also available as free open source packages.
- Institutional accumulated knowledge with wikis
- Prevents loss of knowledge in the face of personnel turnover
(These wiki sites edited by Vincent Mazzarella, MD):
- Ubuntuguide.org and Kubuntuguide
- Ubuntu Doctors Guild
- Vistapedia -- wiki for VA's public-domain VistA EHR
- Wikipedia VistA EHR article
- Bidwell Healthcare Consulting -- with an online learning platform (in development).
- Ubuntu-Med -- a complete server platform that includes Astronaut VistA
- Ubuntu Help -- official Ubuntu help site (with many contributions by Vincent Mazzarella, MD)