it really is very rare to see something like this, someone who is deeply moved to post these facts. kudos to you. i will bookmark this for future references.

Agree or Disagree: 16  11 (+5)

I hope that you continue your advocacy towards optimum health care programs. You have my support and prayers.

Hot debate. What do you think? 14  11 (+3)

Rarely have I seen anyone express the importance of keeping requirements simple to gain users expressed as succintly as Clay Shirky. This applies not only to standards but to meaningful use requirements. This is an important concept for medical groups and hospitals as well in how much they try to adopt at once. The relationship between complexity and number of users is one of the most important concepts for all interested in adoption rates. Complexity is one of the the most important barriers to adoption. It is one of the major causes of low adoption rates of EHRs today. Getting users to use and getting vendors to build and sell innovative systems is more important than the number or type of meaningful use criteria or the exact specification of standards. Get ‘em in, keep ‘em in and slowly ratchet up the requirements. That is perhaps the most effective path to get what we need in terms of adoption, meaningful use and interoperability. At this early juncture the number of providers, health care institutions and patients connected is atleast as important as all the other considerations. Getting everyone connected and using their systems even if only rudimentarily at first should be an important goal of policy. As complexity rises each year, those who are unable to adopt now will find it harder to adopt in the future.

Hot debate. What do you think? 14  12 (+2)

[...] Read Chopra’s reflections on progress and what is to come in his FAC blog post. [...]

Agree or Disagree: 15  11 (+4)

It would definitely be a good exercise to consider what infrastructure is typically either available or easily made available for the different scenarios of use, and to decide what are the minimum levels of data access and speed to provide any value, what levels are preferable for typical use and what levels would be ideal if sufficient resources are available.

With respect to DICOM, a supplement called WADO (Web Access to DICOM Objects) was added to the Standard to address the case you describe, as well as others such as simple image linking from EMRs. The supplement can be found here:
ftp://medical.nema.org/medical/dicom/2008/08_18pu.pdf
In particular, Section 1 and Annex C provide a couple paragraphs describing what it does and what it’s for.

WADO is one of the image access methods included in XDS-I.b (the imaging extension to the most recent IHE Cross-Enterprise Document Sharing specification).

Best Regards,
Kevin

Agree or Disagree: 16  10 (+6)

I think Clay hits the mark. History bares that out, IMHO.

Thanks Dr. Blumenthal, Mr. Chopra, and esteemed members of the HIT Standards Implementation Work Group for tackling in an open way these key and difficult issues.

Agree or Disagree: 19  12 (+7)

If we are to maximize the cost-effectiveness of our expanding Medical Home concepts, “meaningful use” must address the issue of file size and slow bandwidth for mobile and rural users. Unless we either restrict file size to something like 500kb (making DICOM unusable) or exempt mobile/rural users from selective CCHIT requirements (like client/server functionalities when you cannot be online in a patient’s home), our HIT policies will prohibit the very medical delivery system innovation we are trying to promote with health reform…low cost care in the home.
This is no idle topic: housecall physicians take care of the top 5% high-cost Medicare patients who consume 66% of the entire Medicare budget, (according to CBO).

Agree or Disagree: 19  12 (+7)

[...] Article Aneesh Chopra, Charles Jaffe, Clay Shirky, Federal Advisory Committee Blog, 19 November 2009 SHARETHIS.addEntry({ title: "Aneesh Chopra Reflects on Progress to Date & What is to Come", url: "http://articles.icmcc.org/2009/11/20/aneesh-chopra-reflects-on-progress-to-date-what-is-to-come/" }); [...]

Hot debate. What do you think? 17  15 (+2)

I want to thank each of the volunteers on this committee. Their willingness to give of their time and talent to improve healthcare in our nation is exemplary. I think it would be very nice if the administration did something special for them in recognition of their efforts.
I will be digesting the contents of the meeting an posting my reactions later.

Agree or Disagree: 45  14 (+31)