Tuesday, November 7, 2017

DHIT participated in the HL7 Digital Quality Summit November 1st and 2nd in Washington, DC.  The event was jointly hosted by HL7 and NCQA and provided a unique opportunity to discuss overlapping issues between quality tracking and interoperability.  The interactive sessions were an excellent forum for peer networking, discussing challenges and showing off the latest solutions. 

The hot discussion topic at the meeting was the CMS announcement that starting with the 2019 reporting period, eCQMs would be transitioned from the current HQMF XML modeling language to the new Clinical Quality Language (CQL) standard.  CQL gives quality measure authors much more power and flexibility in creating precise definitions of quality measures that are human readable yet structured enough for processing a query electronically.  CQL replaces the logic expressions currently defined in the Quality Data Model (QDM). Going forward, QDM will include only the conceptual model for defining data elements (the data model).

Thursday, February 9, 2017

FHIR and CCDA Implementation-a-thon 4: Care Plans, Root IDs and much more

Last month, Dynamic Health IT was in attendance for another meeting of minds hosted by HL7 International down in San Antonio, TX. While these events around CCDA and FHIR have become a regular part of our travel schedule, there's nothing routine about taking a deep dive into healthcare standards. Each trip provides an opportunity to combine ground-level development with high-level policy-making, up to and including interactions with HL7 and ONC policy-makers.

Coding away.
The ultimate goal, as always, is healthcare data interoperability. San Antonio, with its backdrop of canals, struck a fitting visual metaphor. As with man-made waterways, engineering connectivity in healthcare presents challenges at ever turn. 

CCDA Implementation-a-Thon 4

San Antonio hosted the fourth-ever CCDA Implementation-a-thon. The scope of CCDA v2.1 - and its corresponding implications for 2015 Edition Certification - have made for wide-ranging discussions at each of these events. We'll focus on just a few highlights.

There was considerable interest in clarifying the links between concerns, goals and intervention. A source of confusion is that, as of this writing, there is an issue with the ONC CCDA Scorecard not scoring Care Plan documents correctly.

For health concerns, there were a number of clarifications that proved helpful. Concerns expressed by patient need not be collapsed into a code and, by nature, will often need narrative:
Health concerns may be coded, but may need to be represented in narrative form as there are likely to be terminology system gaps 
On the topic of goals, there was discussion around differentiating between patient goals and provider goals. This may not always be a fine distinction captured by codesets, but where possible it will be defined by the author concept. Goals that have both a patient and provider author are coded as shared or negotiated goals

The concept of document-level authorship in general was conceptually challenging. Vendors can generate and recognize their own document roots, but may extends only within your own vendor system in many cases.

The CCDA event also featured a presentation by the Value Set Authority Center (VSAC). VSAC offers a Support Center to promote closer collaboration with value set implementers.

For those in the midst of 2015 Edition Certification, there was a discussion of Care Plan certification test data used in 170.315 (b)(9) and 170.315(e)(1).

FHIR Connectathon 14

FHIR itself is very accessible as far as resources and the rest API is concerned. But getting a broader understanding of everything FHIR touches and how it behaves - the goal for any given Connectathon - can be more daunting. For the 14th Connectathon, our focus was on the CCDA on FHIR track.

Over the course of the weekend, we were able to get a better understanding of the current status and purpose of CCDAs on FHIR in general as well as the following key insights:
  • Difference between composition and bundles. 
  • How to reference a different server for resources used in our composition
  • How to style and render our bundle as retrieved from the server 
  • Search parameters and where to find them 
  • How CCDA on FHIR imposes additional constraints on existing resource types
The DHIT team was able to make it through all of the producer and some of the consumer scenarios, which we counted as a major success in two short days. Outside of our development track, we were able to gain quite a bit of information about strategies for integrating FHIR servers into our ecosystem, the viability of the Spark Production server, strategies for integrating OAuth, and more.

Organizationally, it is good to know for those coming into the FHIR fold that Work Group Meetings are where a lot of the development work on FHIR happens. Numerous work groups will be considering FHIR change proposals, working on FHIR profiles and resources and debating other aspects of FHIR implementation.

As well, there will be meetings of the FHIR Governance Board and FHIR Management Group discussing policies relating to FHIR. Within this framework, attendees and group members discuss items of interest such as tooling, new domains, particular technical issues, etc.

We hope to see you at the next stop!

Tuesday, December 6, 2016

New Era of CQMs, Part I: Quality Measures in The Age of MIPS

The first performance year for the CMS Merit-based Incentive Payment System (MIPS) begins on January 1 of next year, yet much of the healthcare world is still in the dark about large portions of the program. Or even unaware of its existence entirely.

Perhaps one of the most misunderstood aspects of the program: MIPS does not apply to Medicaid Meaningful Use or eligible hospital Meaningful Use (MU) programs.

With MIPS beginning in earnest and ramping up over the next few years, we wanted to provide a series of plain-language posts and address how it will affect your use of clinical quality measures.

Our goal as the program unfolds is to grow our CQMsolution software to support as many measures as possible.

MACRA sets up a new system of quality-based reimbursement for clinicians called the Quality Payment Program.  Within this new model, there are two pathways to select:
  • The Merit-based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (APMs)
For this post, we will focus on quality assessment within the context of MIPS. Multiple quality reporting programs are folded into MIPS:
  • Physician Quality Reporting System (PQRS)
  • Value-Based Payment Modifier (VBM)
  • Medicare Electronic Health Records (EHR) Incentive Program (ie, Meaningful Use)
As with the current PQRS program, multiple clinicians can participate in MIPS as an individual or a group.

Payment adjustment

In determining the payment adjustment based on MIPS, clinicians will received a composite score, weighting four different categories of performance:
  • Quality
  • Resource user
  • Clinical practice improvement activities
  • Advancing care information 

Quality Measures under MIPS
Quality receives the highest weight under MIPS and to determine quality score. The program has taken PQRS and the value-based modifier, mashed them up and provided a menu of quality measures that will determine reimbursement.

MIPS-eligible clinicians and groups can select their measures from either the list of all
MIPS measures or a subset of specialty-specific measure as identified by CMS. Unlike the current requirements under PQRS, clinicians will not be required to report a "cross-cutting measure." The program has been positioned to allow clinicians to select measures that are the most relevant to their practice.

In the transition from the current state of quality reporting (PQRS/VBM/MU) to MIPS, there are a few other key points to bear in mind:
  • Registry, EHR and QCDR reporting measures currently require 9 measures across three quality domains, but thew new requirement is 6 measures
  • Measures can now have any combination of NQF quality domains, though the 6 selected must include an outcome measure (as opposed to strictly process, for example)
  • MAV process changed (more on this in future posts)
  • PQRS registry measures group method is eliminated
  • Registry and QCDR reporting requires meeting a "data completeness" standard: 50% of patients in the denominator
There are more complexities to explore - and changes and clarifications in the coming months, as always. We look forward to staying on top of these and simplifying the process for each of our clients.

Friday, October 21, 2016

FHIR works: Notes from Baltimore Plenary Meeting and Virginia CCDA 2.1 Implementationathon

We say this every time we attend a meetup, but it remains true: interest in HL7 interoperability standards continues to grow remarkably. As FHIR in particular matures, we see proliferation of attendees, ballot comments and general buzz. As Graham Grieve mentioned over on the FHIR Directors Blog, the most recent meetup was most likely HL7's largest meeting to date.
Baltimore at night.

Members of the DHIT team traversed the DMV (that's DC-Maryland-Virginia, in Beltway-speak) last month, heading to Baltimore for the annual plenary meeting and Arlington, VA, for the C-CDA Implementation-A-Thon.

News on FHIR
As the FHIR Chief himself, Grahame Grieve, mentions over at his blog, there were some major headlines at the very well-attended FHIR plenary event:
  • FHIR release 3 is slated for release at the end of this year.
  • New communities are cropping up, including from medical disciplines that hadn't previously shown up on the FHIR scene
  • The FHIR Foundation will continue to be a key player, supporting the "implementation process of standard"
  • The site fhir.registry.org will go live soon
  • Discussion of whether to support logical reference; in short, a "URL-based view of the world," as Grahame puts it, may be incomplete.
As Grahame also mentioned, the "most significant single decision" made at the plenary was to take the specification known previously as “DAF-core” and rename it the US Realm Implementation guide. That may sound like inside baseball, but it's another symbolic leap in the maturity of the standard.

From the DHIT standpoint, we are well underway developing features in our flagship interoperability application, ConnectEHR, and across our product line to support EMR clients, including the development of testing and production FHIR servers. Our overriding goal is for our clients to move forward in interoperability as they meet the latest edition of ONC Certification Standards (2015 Edition).

We anticipate that FHIR may one day become an explicitly mandated standard and, as it stands, is a boon not only to interoperability but meeting meaningful use in Stage 3 and beyond.

We participated in the "CCDA on FHIR" track as document creator as well as document consumer, testing our implementation against multiple servers (including those of other participants as well as the reference servers from Grahame Grieve and Furore). Our coding was done in C# using the fhir-net-api provided by fellow FHIR Chief Ewout Kramer.

HL7 hosted its third C-CDA Implementation-A-Thon last week in Arlington, VA. The DHIT team kept up its perfect attendance, convening with other CCDA developers and experts just outside DC.

In addition to the usual networking and educational opportunities afforded at HL7 Events, it's always interesting to chart the development progress of the industry as a whole. And the "real-world" scenarios provided at the event - creating and exchanging live data - are worth the trip alone.

As is typical of healthcare standards-based Connectathons, clinical scenarios are laid out for participants to navigate. In this case, the exercises were related to the exchange of v2.1 documents, discharge summaries and electronic referrals. We're proud to report that we all the CCDA Homework Scenarios were accomplished. 'A+' goes to the DHIT developers on hand.

Valueset OIDs
Valueset OIDs continue to be a point of some controversy. There was a presentation at the event providing background and information on the process of creating them. For the initiated, value sets for use in EMRs, CQMs, research and other contexts are created by professionals and organizations and submitted to be approved by the National Library of Medicine (NLM), under its Unified Medical Language System (UMLS) arm. The code sets are validated and checked for duplicates. However, our development has uncovered some of the codes may be subject to duplication and we've requested some further information from NLM.

Lessons learned
We left with some takeaways on the process of generating a v2.1 CCDA and we wanted to share with our audience:
  • Often overlooked, developers should pay a little bit more attention to mood codes and their usage even though it may complicate the data that is requested from a client
  • C-CDA Scorecard is a very useful checkpoint in development
  • Having lower score in the scorecard doesn’t mean that the CCDA will fail the validation. Higher scores will determine that the CCDA is much closer to the expected standard
  • Display name should come from the code system otherwise it will lower the score. 
  • Narrative Text for all sections and textual clinical notes
  • The task of categorizing results may tolerate multiple pathways. Example: CT scans go to Procedures or Results or both
  • Allergies and problems should always have time recorded
  • For effectiveTime of immunizations, do not use low+high when moodCode=EVN

Wednesday, October 12, 2016

NTT's Optimum and Dynamic Health IT Partner on Forward-Thinking Solution for CQMs

DHIT President Jeff Robbins addressing the
NTT Data Client Conference
After wrapping up our successful ONC certification testing for CQMsolution in early September, we headed to Newport Beach, CA, for the NTT Data Client Conference. Held annually, the conference offers clients of NTT Data products and services a wide range of educational sessions, networking opportunities and face-time with NTT DATA staff.

The event was a great opportunity to meet with implementers and users of CQMsolution. We were able to provide specific education on our application through the lens of the NTT's Optimum clinical ecosystem. CQMsolution is developed as universal quality measure solution, but context always matters, of course.

In keeping with the mission of the conference, we also spent time discussing some policy specifics to help NTT users prepare for changes in quality measurement. This included a glimpse into the future to MIPS/MACRA and Meaningful Use Stage 3.

We also expressed our confidence that our solution will continue to be among the first - if not the very first - to update with each successive release of CMS measures. Among other benefits, this allows maximal testing and educational opportunities in the lead-up to submission.

As with all DHIT clients, we seek to offer a full range of development, quality assurance, support and project management resources, tailored to the environmental needs of the specific implementation and user base. Our close collaboration with NTT has yielded a solution that allows their EMR team to focus on development and customer support, while we provide an effective and aggressively-supported tool to attack quality measures.

DHIT VP Raychelle Fernandez providing
clinical background for CQM calculation process.
By way of demonstration, DHIT gave a detailed presentation on CQMsolution and showed key elements of the software using a specific clinical use case: Ischemic/Hemorrhagic Stroke (via CMS measure 102v4). With our goal of guiding clients through CQMs from start to finish, we discussed not only the calculation and display of measures in CQMsolution, but the process of submission.

It's our hope that CQMsolution, like that Southern California weather, makes everything a little sunnier.

Monday, October 10, 2016

CQMsolution blazes trail as first 2015 Edition Certified CQM product

Dynamic Health IT is proud to announce that we're the first software developer to be certified for Clinical Quality Measures under the latest ONC Health IT Certification (2015 Edition).

But don't take our word for it: our listing on the ONC CHPL website is viewable here.

The process of certification testing gives our clients confidence that our product can support eligible clinicians and eligible hospitals in meeting CMS EHR Incentive Program objectives. We have developed the product with an eye on not only the current formulation of Meaningful Use, PQRS, IQR and other quality measurement programs, but the changes to come under MIPS/MACRA.

“Dynamic Health IT remains a trailblazer in clinical quality measures software development. We’re very proud to be the first vendor to certify for 2015 Edition Quality Measures Quality Measures for Cypress 3.0,” said Jeff Robbins, President of Dynamic Health IT.

Certification is proud achievement, but also a way station to further development. DHIT continues to enhance our software to include bulk, automated practice and user adds, API access and a number of other new features.  We hope to provide our client not only quality measure compliance, but a transparent user interface that enables easy analysis.

CQMsolution 3.0 certification meets the following certification CQM-related criteria:
  • 170.315(c)(1) Clinical Quality Measures- Capture And Export
  • 170.315(c)(2) Clinical Quality Measures- Incorporate And Calculate
  • 170.315(c)(3) Clinical Quality Measures- Reporting
  • 170.315(c)(4) Clinical Quality Measures- Filter
CQMsolution Version 3.0 also includes new interface enhancements driven by 170.315(C) (4) - a brand new module in 2015 Edition - allowing users to filter report data on a number of demographic categories. In addition, we also certified our solution on:
  • 170.315(g)(4) Quality Management System
  • 170.315(d)(1) Authentication, access control, authorization
  • 170.315(d)(2) Auditable events and tamper-resistance
  • 170.315(d)(3) Audit report(s)
  • 170.315(d)(5) Automatic access time-out
The clinical quality measures to which CQMsolution has been certified include:
  • All 29 updated measures for eligible hospitals
  • All 64 updated measures for eligible professionals
  • All 64 aligned PQRS measures for EPs (additional PQRS measures can be supported)
This marks the fourth ONC-certified version of CQMsolution, the previous certification coming in conjunction with the release of Cypress 3.0 validation software.

Photo credit: MJ Boswell

Version 3.0 was certified by ICSA Labs, an Office of the National Coordinator-Authorized Certification Body (ONC-ACB) and is compliant in accordance with applicable criteria adopted by the Secretary of Health and Human Services (HHS). 

Monday, August 15, 2016

Eliminating the Hurdles of Clinical Quality Measures for the 2016 Reporting Year

Dynamic Health IT is proud to announce we have successfully pilot-tested with ICSA Labs for 2015 Edition CQM-related measures (c)(2) and (c)(3).

That's a bit of a mouthful, but it means that our software, CQMsolution, remains at the forefront in providing meaningful, submission-ready clinical quality measure output. CQMsolution supports 93 CMS eCQMs and the 64 aligned PQRS measures.

Under 2015 Edition, Clinical Quality Measure reporting has been made more comprehensive. The three existing measures (c)(1), (c)(2) and (c)(3) have been revised:
  • Cypress 3.0 validation software, which includes more robust testing relative to 2.6.1, must be supported
  • The latest set of measure versions for the 2016 reporting year, validated by Cypress, must be supported
  • Required data export capability is expanded
  • Data import should be more accessible (“without developer assistance”)
  • Exported data file must meet R2 implementation guide for QRDA
The three CQM measures are also joined by a new measure: measure(c)(4) - filtering. In meeting (c)(4), EHRs must be able to filter quality measure results at the patient and aggregate levels by a list of variables. The filtered results must be made available in a human-readable format and data file.

Not reinventing the wheel, replacing tires

Our developers put in rigorous work over the last quarter, incorporating feedback from clients, to dramatically enhance the software, making it easier-to-use, more robust and, of course, certification-ready for ONC 2015 Edition and Cypress 3.0.

We saw this development cycle as a great opportunity to take everything we have learned over the past few years - in the form of our feature enhancements and performance improvements - and integrate it fully with new development.

This meant taking the principles behind engine and UI that worked and preserving them, while using the regulatory changes in measure logic and output as a chance for a coordinated re-design. The CQMsolution calculation engine uses the eMeasure HQMF files, which are based on the Quality Data Model (QDM), as the basis for evaluation. We use these files to create the data structures through which we process patient data. 

In contrast to feature-specific roll-outs, this was a bottom-up version. It is not often you get a chance to re-write core parts of your application. This can be a perilous process, but there were two factors that made it successful:
  • The ability to create a completely new calculation engine for 2016 reporting year without altering previous reporting year calculation engines meant we were not required to maintain backwards compatibility in the new code
  • After identifying our time parameters and client needs, our development team realized complete development focus would be needed. The project was afforded development time in a distraction-free environment.

CQM data intake and calculation were worked all at once, allowing for a holistic approach. Combined with extensive testing, relying in part on a more exhaustive Cypress data set, the result was a robust upgrade, built on clean code.

-         Key changes
The changes from the 2014 release measure to the 2015/2016 release measures were dramatic, requiring a rewrite of major portions of CQMsolution. Example of these changes can be seen in the text of the measures. New subset operators were added and new temporal operators that make the measures more clear. 

The changes in QRDA format also called for a rewrite to the parsing and generating pieces that enable our clients' certification and submission of CQMs.

On top of the CQM engine, we integrated user experience changes to make both certification testing and day-to-day use of the application easier and reflective of technical changes. These changes range from easier report tracking in the UI, to one-click certification testing through single-upload "compound" report and API to Cypress.

Improvements ahead
CQMsolution 3.0 is now in beta testing with clients, pending final ONC certification. The development cycle is perpetual and we intend to stay at the forefront of CQM development. By year's end, 2017 reporting year support should be complete and a number of features are in the pipeline for the near term, including API-based data collection from client EMRs. 

We look forward to rolling those out and, of course, to our full certification on all four CQM measures. Stay tuned!

Tuesday, August 2, 2016

FHIR Applications Roundtable at Harvard Medical School

The DHIT Team has been an active participant in FHIRConnectathons during the past two years. Among the benefits of these events is the unique glimpse they provide into what the industry is delivering with FHIR and how the standard continues to evolve through active development.

Our team is also eager to find connections between out interoperability expertise and real-world healthcare problems. With those (and other) goals in mind, our President Jeff Robbins attended the 1st annual FHIR Applications Roundtable at Harvard  Medical School in Boston to learn more.  

Although FHIR is a relatively new standard, it has great potential and forward-thinking healthcare IT organizations are already deploying FHIR solutions. 
Harvard Medical School

The Roundtable consisted of a series of 15 minute presentations by academics, software developers and consultants highlighting FHIR-related projects.

The projects on display included patient and provider-facing apps, Clinical Decision Support, clinical collaboration platforms, patient education, all the way up to a complete, native FHIR-based EHR. The expansiveness of the applications and implementations discussed demonstrates just how far the standard has come from its days in draft status.

On the policy front, Steve Posnack, Director of the Office of Standards and Technology at the Office of the National Coordinator for Health Information Technology spoke about efforts to encourage interoperability through FHIR developement and the  HL7 FHIR App Ecosystem. ONC is encouraging market-ready FHIR support through its "challenges."

DHIT plans to offer a CCDA-to-FHIR converter in the near future.  Stay tuned!

Monday, July 18, 2016

Solving 2015 Edition Certification: CCDA and Common Clinical Data Set

ONC's 2015 Edition Health IT Certification Criteria mark the latest chapter in the certification process for health information technology. The roster of measures was made effective on January 14, 2016, and the certification testing process has begun in earnest. 

Despite the flurry of activity around 2015 Edition, it should be noted that there is not yet an expiration date for 2014 Edition testing, which is expected to continue through the end of FY 2017. 

While vendors are not under immediate deadline, it is highly useful to adopt and certify, at minimum, the functionality that is relevant to your user base. There are a number of early adopter advantages, including the delivery of more interoperable software to users. Now that the all-or-nothing "Complete EHR" certification is gone, developers may choose to focus "Base EHR" measures and/or those needed for their uses to meet Meaningful Use and/or other user objectives.

The 2015 measures mark a significant overhaul to the previous 2014 Edition regulations. A look at some of the major changes in the 2015 measures gives us a signal of where the industry is headed (or at least where it thinks it's going).

General themes
As Keith Boone pointed out, 2015 Edition represents a pivot “from EHR focus to Health IT focus.” ONC intends to make its Certification accessible to a broader range of health IT applications than simply those directly in line with the CMS EHR Incentive Programs, while attempting to galvanize broader interoperability.

This rationale is behind retiring the “Complete EHR” certification in 2015 Edition. It’s also why ONC has swapped out the term “EMR” for “health IT,” renamed the Common MU Data set the “Common Clinical Data Set” and provided more incentives for vendors to give patients access to their data using methods outside the traditional medical record, such as APIs and non-encrypted email.

ONC is also attempting to address health disparities by capturing more categories of race and ethnicity in EMR systems and there has been reaffirmation of the importance of privacy and security in the updated measures.

The Consolidated Clinical Document Architecture (C-CDA) format remains vital to ONC's efforts to foster interoperability and data integrity. 

To that end, C-CDA requirements have seen a major update in 2015 Edition. Vendors must support both v1.1 and v2.1 releases – and the latter must be backwards compatible. ONC is providing a “gold standard sample document” available to assist with adoption and has provided a "sandbox" of C-CDA resources, including a tool for vendors can test against the standard with a web-based scorecard

There are 3 C-CDA templates that must be supported for transition of care:
  • CCD
  • Referral Note
  • Discharge Summary (Inpatient Only)
Health IT must also support the number of preferences for display and usage of CCDA, including:
  • Display only a particular section (or sections) at a time
  • Display order
  • Number of initial sections to display
Common Clinical Data Set (CCDS)
Formerly known as the Common MU Data Set, the CCDS is a series of data stipulated for use across the 2015 Edition measures. ONC has provided a useful crosswalk, comparing the 2014 Common MU Data Set with its new incarnation.

Common Clinical Data Set is comprised of data from standards adopted by ONC, such as the CDC Race and Ethnicity Code Set Version. It is explicitly referenced in the following measures, often as a baseline that the certifying technology must receive, send out and/or make viewable:
  • § 170.315(b)(1): Transitions of Care
  • § 170.315(b)(4): Common Clinical Data Set summary record – create
  • § 170.315(b)(5): Common Clinical Data Set summary record – receive
  • § 170.315(b)(6): Data export
  • § 170.315(e)(1): View, download, and transmit to 3rd party
  • § 170.315(f)(5): Transmission to public health agencies – electronic case reporting
  • § 170.315(g)(6): Consolidated CDA creation performance
  • § 170.315(g)(8): Application access – data category request
  • § 170.315(g)(9): Application access – all data request

Stay tuned for more information on new CQM requirements and their implications for population health monitoring!

Tuesday, May 17, 2016

Matthew Dugal celebrates five years with Dynamic Health IT

Dynamic Health IT congratulates Matthew Dugal on five years with the company!

Matthew has blazed new trails with our development team. He is a dedicated, caring employee, offering a wealth of expertise on any project to which he lends his talents. 

Matthew, congratulations on your 5 year anniversary with DHIT.  I feel very fortunate to have you on our team and have really come to appreciate your huge talent for software development through seeing the success of the products you’ve developed here, particularly CQMsolution.  You are also an amazing resource and trove of information for all things related to computer software and hardware, from setting up servers to finding the right piece of software to get a task done, to security and network troubleshooting.  Finally, you are reliable, dependable and ethical --- all great qualities for an employee.  Thanks for all you do!
-- Jeff Robbins

A big 5 year Congratulations to you Matthew! You are an integral part of Dynamic Health IT’s team. Your engagement in the ‘Magic’ that occurs here at DHIT encourages our clients to count on us. Your patience and perseverance on some of the most difficult projects has contributed to our products' success. Your honesty and dedication is admired. Thank you for all you do.
-- Raychelle Fernandez

Matthew is a great resource when it comes to programming. Not only does he know how to get the job done, but he can clearly explain and teach you how it was done so you feel confident to do it again in the future. Over the past 5 years he has taught me several valuable tricks of the trade that I’ve applied here at DHIT and at school. THANKS MATTHEW!!!
-- Maria Ruiz

Congratulations on your 5 years with Dynamic Health IT, Matthew. It is a pleasure working with you. Your programming and problem-solving skills are enormous and appreciated. Your knowledge of technology is very broad and invaluable. Beyond that, you are a very kind person to work with. We are so lucky to know you as a person and have you as a team member!
-- Ozlem Kurt

Matthew is a pleasure to work with - very knowledgeable and always willing to help. He’s not only very committed to the company, he also invests time and energy to his coworkers. DHIT would not be what it is without Matthew’s support and dedication. 
-- Maureen Bell

Matthew is a great coworker and a complete professional. He always shows good results in his projects and I always learn from him when we work together.
-- Erick Lanford

Matthew is a wizard coder whose technical expertise touches everything DHIT does - from our product line to our network infrastructure. Each time we attend a conference or interact with colleagues and clients in the industry, you can see the fruits of his labor. His hard work and deep dive into quality measures is evident when you realize the kinds of unparalleled things CQMsolution can do. I'm grateful for his guidance anytime I seek information across our projects. Matthew is thoughtful and thorough in everything he does. It's fun to hear his insights, whether work-related or not.
-- Joshua Shreve