PS C:\Users\vaibhavb\Desktop> Import-Module HvPosh
PS C:\Users\vaibhavb\Desktop> Grant-HVaccess

Is auth done?
Is Auth done – (Y)?
[Y] Yes  [A] Yes to All  [N] No  [L] No to All  [S] Suspend  [?] Help
(default is “Y”):y

PS C:\Users\vaibhavb\Desktop> Get-Things weight | Format-Table

When        Value       Key         TypeId      TypeName    EffectiveDa       State       Flags  IsPersonal IsDownVersi
te                                                     oned
—-        —–       —         ——      ——–    ———–       —–       —–  ———- ———–
10/12/2011  175 pounds  f7931e43… 3d34d87e… Weight M… 10/12/20…      Active        None       False       False
10/12/2011  385         d4b2e3ab… 3d34d87e… Weight M… 10/12/20…      Active        None       False       False
8/5/2011… 160         382e9e1f… 3d34d87e… Weight M… 8/5/2011…      Active        None       False       False
7/7/2010… 250 pounds  1a76d859… 3d34d87e… Weight M… 7/7/2010…      Active        None       False       False
…

PS C:\Users\vaibhavb\Desktop> Add-Things weight 170
PS C:\Users\vaibhavb\Desktop> Get-Things weight | Format-Table

When        Value       Key         TypeId      TypeName    EffectiveDa       State       Flags  IsPersonal IsDownVersi
te                                                     oned
—-        —–       —         ——      ——–    ———–       —–       —–  ———- ———–
10/13/2011  170 pounds  45abc16d… 3d34d87e… Weight M… 10/13/20…      Active        None       False       False
10/12/2011  175 pounds  f7931e43… 3d34d87e… Weight M… 10/12/20…      Active        None       False       False
10/12/2011  385         d4b2e3ab… 3d34d87e… Weight M… 10/12/20…      Active        None       False       False
8/5/2011… 160         382e9e1f… 3d34d87e… Weight M… 8/5/2011…      Active        None       False       False

So what is the cool thing going on above? Well in five commands we are able to authenticate, get and put weight readings in to HealthVault!

This is all possible owing to the magic of powershell, and a powershell HealthVault module (HvPosh). This is just a start, there all kinds of nerd scenarios this HealthVault command line shell can do! Think about command line automation for getting in all that data in to HealthVault, working with test data, understanding the healthvault xml, and doing all sorts of quantization on your personal health data!! The possibilities are limit-less, well at least for the command line nerds .

So what is HvPosh?

HvPosh is a HealthVault powershell module currently running as a desktop client application. The source for this module is up on github and you are welcome to contribute more functions, cmdlets, test data or infact various analysis modules!

Take HvPosh for a spin, and yep! this is right out of oven so be gentle!

Fig 1. HvPosh On GitHub.

I showed an interesting LINQ query which sort the HealthVault items returned from a getthings. Well actually turns out that we can do this more efficiently by using the max attribute on group filter in the getthings. The items returned by HealthVault are sorted by eff-date and if we get the first one it should be the latest item!

        public static void GetThings(string typeId, int maxItems,
            EventHandler<HealthVaultResponseEventArgs> responseCallback)
        {
            string thingXml = @"
            <info>
                <group max='{0}'>
                    <filter>
                        <type-id>{1}</type-id>
                        <thing-state>Active</thing-state>
                    </filter>
                    <format>
                        <section>core</section>

Before we get to the topic of this post and discuss how we can put new items in to HealthVault, here a screen shot of how the application looks like once we have enabled the put and prettied up the last reading a little bit –

Fig 1. MoodTracker with put enabled!

We can see that for each of the states i.e mood, stress and wellbeing we have a nice slider which lets the user capture their state and we can want this information uploaded with current time stamp once the user hits Save!

        // Save the reading to HealthVault
        private void button1_Click(object sender, RoutedEventArgs e)
        {
            EmotionalStateModel model = new EmotionalStateModel();
            model.Mood = (Mood)c_MoodSlider.Value;
            model.Stress = (Stress)c_StressSlider.Value;
            model.Wellbeing = (Wellbeing)c_WellbeingSlider.Value;
            model.When = DateTime.Now;
            HealthVaultMethods.PutThings(model, PutThingsCompleted);
            SetProgressBarVisibility(true);
        }

Lets get a bit deeper in how the PutThings call works. It fetches the relevant information from the base object and submits that to HealthVault. The design in this case might be a little wary since the put parameters are coming from the emotional state object as well.

        /// <summary>
        /// PutThings Method
        /// </summary>
        /// <param name="item">The health item to upload</param>
        /// <param name="responseCallback">Function to resolve callback</param>
        public static void PutThings(HealthRecordItemModel item,
            EventHandler<HealthVaultResponseEventArgs> responseCallback)
        {
            XElement info = XElement.Parse(item.GetXml());
            HealthVaultRequest request = new HealthVaultRequest("PutThings", "2", info, responseCallback);
            App.HealthVaultService.BeginSendRequest(request);
        }

Voila!! We have an application which can read and update information to HealthVault!

Next Time: We will focus on adding the History or Charting aspects of this application!

In this multi-part series, I’ll try to cover the details of building a Windows Phone 7 mobile application for HealthVault.

Now, the first question is what should we build?
Our product management team has recently been tracking their happiness and stress level on a daily basis. I have been thinking of providing a tool which helps them to track their happiness & stress levels and of course build great products..

Having said above there are a few applications in the Health & Fitness category of WP7 application store which help a user to track mood, but none of them combines happiness and stress, and stores it in HealthVault.

Fig 1. Mood swing application in Windows Phone 7 Store

Hopefully over-time we can make the application a fun one, may be add a social game aspect to it!

Well, how will the application look like?

The application would allow the user to input their happiness and stress level, and perhaps look at history and may be display a social game avatar of their well-being.

Here is a sketch of what the app might look like –

Fig 2. White board wire-frame of our mood application

Where to store the data?

While developing a HealthVault application a relevant question is which part of the HealthVault data store the application should store data in. As we browse the HealthVault Data Types, we immediately see a relevant data type – Emotional State.

Turn out there is also a handy tool to input sample data for this data type after clicking the “View & Edit” button next to the type -

Fig 3. Emotional State Data type

On further analysis it turns out that this type is almost perfect for our use, except the fact that we have to use a scale of 1-5 and there is an additional element – well-being, which we can ignore for now.

Next Step?

Now that we have defined this application, the next step would be to get our hands dirty and start working with Windows Phone 7 tools for Visual studio and the HealthVault WP7 library.

Next Post: Mood Tracker – Getting Started #2

I’ll be presenting and speaking at the Microsoft Connected Health conference on Thursday, April 28th with my colleague – Eric Gunnerson,  our talk is titled Developing HealthVault Enabled Solutions in 2011 and Beyond. We will be demonstrating and explaining plethora of features released (or to be soon released) in the Microsoft HealthVault product line over the last year!

Its always exciting to mingle with consumers of your products. Sometimes its reflective, sometimes its fulfilling and most of the time its insightful!

I’m looking forward to meet our partners and customers over the next few days. So if you are at the conference feel free to reach out!

• OskiHealth — Using data from CHDI and information on fast food restaurants in each county to show a color coded map of health of counties.
• Healthy Commute — Using data from Factual, some engineers built a way to discover healthier commuting routes!

Ron has a good summary of the event as well. Check out the pictures of the event at — http://www.flickr.com/photos/healthtap/. Thanks to the good folks from Healthtap and Health2.0 for spearheading the event!

You can find links to my talk and other data resources at – http://www.vitraag.com/hacking4health.

Health2.0 Developer Challenge hopes to spur developer creativity around newly about data on Healthcare. To help developers prepare and collaborate for this challenge Health2.0 and other along with Healthtap are running a developer Hackathon — Hacking for Health on Sep 11 in Palo Alto, CA. I’m planning to speak and present about some of our work on these datasets and help developers get started with HealthVault and other Microsoft offerings.

So mark the date, and if you are planning to be there drop be a note. I’m really excited to enable collaborative and creativity on these valuable datasets. If you are interested in knowing more about the datasets and collaborators, check out the Hacking for Health data, tools and references.

So how did my talk go?
My talk went reasonably smooth, overall I was happy with what I could put together in limited time. According to the polls and some in person conversations people seemed to like the fact that I attempted to break it down with a technical deep dive, especially taking time to go deeper on on-the-wire protocols and standards.

UPDATE: The talk was recorded by Robert Wood Johnson foundation and you can view it online — http://bit.ly/silos-talk-video.

OSCON Healthcare Track
I attended most of the talks at OSCON HealthCare track. This was the first Healthcare track at the conference, in my opinion it turned out splendid! Andy Oram has a good summary of the first, second & third day, and Fred Totter has links to interviews of some of the presenters. Over the three days of Healthcare track I learnt a lot about various NHIN and VistA projects.

Sessions
In addition, I attended a few session and a couple of tutorials. I’ll summarize some of them below with key take-away or interesting links :

• Cloud computing  – “Situation Normal, Everything Must change”: If nothing else I would highly recommend watching this key-note, no new content but the Simon Wardley is very effective in communicating his point about Cloud computing and managing technology in general.
• Asynchronous Programming – I learnt a lot about nginx web-server and the principles behind node.js. Ilya’s talk was specific to Ruby but learnt a lot about the perf gain PostRank has gotten owing to Asychcrony. He was gracious to have lunch with me and one of interesting things he mention was use of AMQP. AMQP is near real-time (low latency, high throughput) general purpose message standard used by most of the guys on Wall-street! An open source implementation of the same is RabbitMQ.
• Another Go at Language Design: Since I’m a compiler wonk and systems’ programmer, it was great to see Rob Pike’s presentation on Go language and specially see the fast Go compilers, most optimizations are owing to managing the dependencies for linking.
• jQuery – The presentation on jQuery was very detailed even for a novice. I particularly liked the show-casing of selectors to write succinct iavascript code.
• Graph Database – Neo4j : At fore front in the NoSQL camp Neo4j offers up to 1000x performance gain over relational database for implementing applications like a social network. Key different from RDBMS is that the Graph itself is the main index!
• Android: I learnt a quite a bit about Google Android and their development methodology. Android developers in general focus a lot on remove perceivable slowness from the application (called “Jank” in Google lingo).Anything which takes more than 200ms to process is considered bad. A good rule of thumb to prevent “Jank” is to never stall the event loop.  To spur further Android excitement Google gave away the soon to be de-commissioned Nexus one devices in one of their workshops. 
• Open stack:Open source system for creating Amazon EC2-like clouds. In fact this project is open sourcing of the RackSpace cloud system.
• An interesting project to cross-compile Android projects to iPhone.

Birds of feather session on Healthcare Standards
I participated in the BOF on Healthcare Standards.

The conversation started by highlighting the classic problem of how people who have been in the industry want semantic interoperability  and how the new entrants in the area want simple systems. I contribute to this conversation by pointing out that if standards get developed with industrial strength open implementations they are more tend to be more sane (read NHIN-D).

The conversation then drifted towards terminologies. Everyone in the room was outraged with CPT and AMA’s greed J. David Riley (head of NHIN project) added to the conversation saying that ICD-10 procedures are designed to replace CPT. I contributed to the conversation detailing how it’s difficult to develop a coherent system with all the different vocabularies with different licensing requirement and incomplete  mappings to each other. David was then gracious to detail a project done in the federal government where they attempted to come up with a common terminology service by inventing something akin to OIDs for each terminology. He is hoping that he can open source those terminologies sometime soon. Brian Bhelendorf then added to the conversation asking how can we enable or create open source terminologies. I was suggested that may be can do something like RxNorm to create a uniform mapping system which the terminology licensors can adopt. There was more discussion on this topic, no one felt that UMLS was adequate.

PS: I’ll update the this post with more links and thought-blocks as I remember .

CCR or Continuity of Care Record is a standard meant to ease the exchange of clinical information with a relatively easy to read and practical data-format and schema. There is ton of great information about CCR on its resource site. CCR document format is supported by majority of personal Health clouds, both – Microsoft HealthVault & Google Health.

The CCR specification comprises an implementation guide, XML schema definition and a guidance spreadsheet for each data element that makes up the standard. These resources can be bought from ASTM.

The document format of CCR is very straight forward, consisting of a header, body and a footer with the following top-level elements:

Google Health supports only a limited set of entities from the above, while HealthVault supports the entire standard and also allows transformation of some of these entities in to native HealthVault types. You can read more about working with CCR in HealthVault and various input mappings, output mappings, and CCR vocabularies.

Here are some illustrative CCR figures from Dr. Waldren’s presentation (see end of article).

Using the SNOMED-CT concepts one can write the Systolic Blood pressure reading in CCR as the following (UPDATE: Well-formatted the CCR to include source, object-id and actors, thanks to Matt Wagner):

<?xml version="1.0" encoding="utf-8"?>
<ContinuityOfCareRecord xmlns='urn:astm-org:CCR'>
  <CCRDocumentObjectID>Doc</CCRDocumentObjectID>
  <Language>
    <Text>English</Text>
  </Language>
  <Version>V1.0</Version>
  <DateTime>
    <ExactDateTime>2008</ExactDateTime>
  </DateTime>
  <Patient>
    <ActorID>Patient</ActorID>
  </Patient>
  <Body>
    <VitalSigns>
      <Result>
        <CCRDataObjectID>0001</CCRDataObjectID>
        <Description>
          <Text>Blood Pressure</Text>
        </Description>
        <Source>
          <Description>
            <Text>Unknown</Text>
          </Description>
        </Source>
        <Test>
          <CCRDataObjectID>0002</CCRDataObjectID>
          <Description>
            <Text>Systolic</Text>
            <Code>
              <Value>163030003</Value>
              <CodingSystem>SNOMEDCT</CodingSystem>
            </Code>
          </Description>
          <Source>
            <Description>
              <Text>Unknown</Text>
            </Description>
          </Source>
          <TestResult>
            <Value>120</Value>
            <Units>
              <Unit>mmHg</Unit>
            </Units>
          </TestResult>
        </Test>
        <Test>
          <CCRDataObjectID>0003</CCRDataObjectID>
          <Description>
            <Text>Diastolic</Text>
            <Code>
              <Value>163031004</Value>
              <CodingSystem>SNOMEDCT</CodingSystem>
            </Code>
          </Description>
          <Source>
            <Description>
              <Text>Unknown</Text>
            </Description>
          </Source>
          <TestResult>
            <Value>75</Value>
            <Units>
              <Unit>mmHg</Unit>
            </Units>
          </TestResult>
        </Test>
      </Result>
    </VitalSigns>
  </Body>
  <Actors>
    <Actor>
      <ActorObjectID>Patient</ActorObjectID>
      <Person>
        <Name>
          <CurrentName>
            <Given>John</Given>
            <Family>Doe</Family>
          </CurrentName>
        </Name>
      </Person>
      <Source>
        <Description>
          <Text>Unknown</Text>
        </Description>
      </Source>
    </Actor>
  </Actors>
</ContinuityOfCareRecord>

Note CodingSystem element. It allows CCR to interpret various medical vocabularies.

Relevant Tools:

(Thanks to Kathleen Connor)

• The CCR Validator, is an important resource to test/validate a CCR instance, is a now available  Not only does it validate the CCR against the XSD but also the constraints of the implementation guide.
• An Open Source StyleSheet to view CCR files.
• CCR to CCD & HL7 Mappers – tools which Map CCR to CCD and HL7 V2 & V3. You can access them directly here.
• Application to embed CCR in PDF-HealthCare.

Related Article(s):

• To get familiar with CCR I would highly recommended this 13 minute video by Dr. Steve Waldren.
• Adam Bosworth posted an interesting read on standards, his take (simple, human readable, focus on known structured data, etc.) favors CCR.

In this series:

1. Understanding Vocabularies. Wait! What did you say?
2. Understanding Vocabularies #2 – HealthVault Recommendations
3. Understanding SNOMED CT
4. Understanding CCR