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Pushing the Envelope

September 1, 2006
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Leading projects focused on standards development and data sharing are among John Halamka's many credits.

With areas of expertise including bioinformatics, genomics and clinical computing, John Halamka, a Boston-based emergency physician and informaticist, has responsibilities as the CIO for CareGroup Health System, Harvard Medical School and Harvard Clinical Research Institute. He is also chairman of the New England Health Electronic Data Interchange Network (NEHEN), chair of the Healthcare Information Technology Standards Panel (HITSP), and a Harvard Medical School faculty member.

A standards champion for data management and data sharing, Halamka leads HITSP's national standards harmonization process — a project he considers among his most innovative. Over the last six months, HITSP has consulted with 500 stakeholders in the quest to build a standards-based system able to exchange patient data between caregivers. In seeking the minimal set of standards, the panel has so far slashed the number of named standards from nearly 600 to 90. "We're doing further reductions and will be publishing guides — unambiguous cookbooks — as to how a vendor can accomplish the process," he says.

Standards are also related to his leadership role in the $100 million Biosense project, the Centers of Disease Control and Prevention's (CDC) first effort to create a standards-based, secure, electronic network. The nascent biosurveillance network is largely driven by the threat of a pandemic such as avian flu. The CDC realizes that it cannot cope without good information, notes Halamka.

The Biosense link to Beth Israel Deaconess Hospital's emergency department generates a real-time view of ED events every 15 minutes. "We were one of the very first hospitals in the country to link into that network," says Halamka. Currently Biosense captures chief complaint plus diagnosis, but work is under way to expand the types of data sent to the CDC. A nationwide network is planned.

Halamka was also the one to perform the honors of writing the first e-prescription to be routed across the state of Massachusetts' new e-prescribing infrastructure. "It's similar to what we did with financial transactions and HIPAA. NEHEN today is doing 90 percent of financial transactions through the state using a shared set of interoperable components we all developed together," he says. "Now we are doing the same thing with e-prescribing."

Genomics is also a center of interest for Halamka. He runs all the bioinformatics for Harvard and is very engaged in high-performance computing. And, like many scientists who have preceded him, he is actively participating in genomic research. In considering unresolved issues of privacy, data storage and preparation for a genomics future, he made the decision to have an identity chip embedded in his arm. "I felt like, 'It has to do with the chip,’” he says. "Somebody has to volunteer to explore these issues."

That led to an even more risky decision for Halamka — having his genome sequenced. When completed, his entire sequence and phenotypical information, plus all of his medical information, will be placed in the public domain. The decision has high risk, not just for him, but for other family members. "It could be that my great-grandchildren won't be insurable because I carry the XYZ gene," he notes.

"If we discover something that may help us as a family, great... but at the very least, I think it will help the world begin a dialogue about the issues of privacy, informatics, data storage and representation. If 10 years from now, when you go into a doctor's office, they scan your chip, get your whole genome and then provide you better healthcare, that's because it had to start with early experimenters."

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Frank Jossi is a contributing writer based in St. Paul, Minn.