January 11,2015


50 world leaders, and tens, maybe hundreds of thousands, marched in solidarity with the French cartoonists and Jewish civilians, slaughtered by radical Islamists. You will notice that Israeli Prime Minister Benjamin Netanyahu, as well as Palestinian leader Abbas, marched to either side of French President Holland. Not present? Our own President, the so-called leader of the Free World. His lame-duck, racist Attorney General was supposed to be our representative, but he was nowhere to be seen in the very extensive coverage.

What message did we just deliver to the rest of the world? That we don't care, that we are above it all, that we don't perceive a threat? Or maybe that some in our leadership might even sympathize with the goals of the terrorists? Outrageous? Sure, but there aren't too many other interpretations to be applied to this appalling lack of solidarity displayed by our leadership.

Despite this dangerous embarrassment, the rally gives me more hope for the future than I've had in a long time. Presently, Europe is well on the path to become Eurabia, due to lax immigration and policing (not to mention individual firearm) policies. There is every chance of a recapitulation of the Holocaust under the brand of Radical Islam. But today, this very day, maybe, just maybe, Europe has awakened to its deadly trajectory, and along with the rest of the world, might just take steps to reverse the trend. Maybe, just maybe, those who died did not do so in vain, but gave their lives to awaken the world to the reality of these monsters:  they murder Jews because they are Jews, they murder cartoonists because they are "offensive," they wish to silence any dissent, they hope eventually to conquer and "fundamentally transform" the entire planet.

Maybe, just maybe, we will see a reversal of the "no-go" neighborhoods. Maybe we will see a denial of institution of Sharia law within these ghettos. Maybe we will see the realization that Israel is being demonized based on lies from those who would destroy her and her people. Maybe there will be an understanding that anti-Semitism is a harbinger of the anti-West, anti-Colonial, anti-freedom agenda of these vermin, which has been adopted by the aging Marxist revolutionary wannabes that make up much of the Left in this and other Western nations.


This is a war, not simply for territory or for treasure, but for our very souls.

There is only one response:

"Je Suis Juif, Je Suis Charlie"

January 9,2015

I will probably be one of the first in line for the Apple Watch, at least if it can be ordered online. Supposedly, the grand release will come in March, with pricing ranging from $350 for the aluminum sport flavor to $5,000 or more for the gold "Edition" version. I'll probably go for the $500 steel on steel version:

Even though the darn thing hasn't even been released yet, there are manufacturers in China who have already cloned the look and feel, if not the mini iOS experience, and you can be the first on the block to have an Apple Watch, or at least something that looks like one:

A few reporters have had a chance to play with what may or may not be the same clone, and were not terribly impressed. Apparently the fake, I mean the AW08 Bluetooth Smart Watch, runs some form of Android, and was a little unstable. Oh, well.

If you are so inclined, this little fellow is available from AliExpress.com for only $48.36 with free shipping from Guangdong via Singapore Post. Actually, there are almost 200 of these listed with AliExpress. Get yours before Apple does something about it.

December 30,2014

We've all likely had about a hundred calls from "Rachel" at "Cardholder Services". This telemarketing-robocalling scam has been around for years. Several of the vermin perpetrating this garbage were shut down, but others have taken up the call, so to speak, and "Rachel" lives on. Apparently there are quite a few idiots out there who will give out their credit card number to the piece of excrement cold-calling their phone. There is indeed a sucker born every minute.

I've reported every instance to the FTC


and of course all of my phones are listed with the Do Not Call Registry. Sadly, there is one little problem: Criminals don't seem to care about breaking the law by robocalling, nor do they seem inclined to take the time to see if my number is on the DNC or not. The cads.

Robocalls are a subset of the wider universe of criminal behavior taking place on our communication wires and airwaves. In this cesspool, I include robocalls, junk faxes, spam emails, hacking of banks, stores, and other financial operations even including the treasury of my own state. The miscreants range from lone, bored teenagers creating crude phishing emails from "Bank of Amerika" to boiler room operations here and abroad, to massive hack attacks on our financial infrastructure. The scariest endpoint is having one of these rogue operations take control of a power plant, which is at least theoretically possible via the 'net; I don't want to think about the consequences of that one.

The question we are all asking is this: Why isn't someone doing something about it!!??

Someone is, but the effort isn't even close to adequate. Both in government and industry, experts are trying to keep ahead of the criminals. The technology of our networks themselves makes it possible to cover one's tracks to the point of being invisible to law enforcement. Thus, hackers, telemarketers, and other thieves can ply their trade without fear of discovery. There is even a "dark internet" hidden from those who don't know how to access it, where what happens on the internet stays out of sight. Supposedly one can buy weapons, drugs, and other stuff you don't find at Amazon.com. Perhaps most importantly, the politics of the situation perpetuates it. Many, if not most, of the major internet hacks come from China, and are most likely government-sponsored. Ditto for Russia. There are telemarketing sweatshops in India that call via leased VOIP lines here in the US, and show up as spoofed (faked) numbers on your caller ID.

I'm particularly upset today over a message from the "IRS", informing us that we owe $4,785 dollars and are in violation of some statue or other. Calling the number in the message (generally a bad thing to do) connected us to a boiler-room operation staffed by people with a very clear Indian accent. No racist connotations here, children, but that's the accent they had. They keyed their scam by telephone number, and were quite confused when I gave them the direct line to the real IRS. More on them in a moment.

It is a sad state of affairs that criminals have access to more and better technology than their victims and our protectors.

There are a few common threads here. First and foremost, this garbage is all perpetrated by criminals, hoping to separate the suckers from their money. And because their marks are either stupid, greedy, or both, many of them actually respond, thinking they are getting something they are not entitled to have, such as Viagra without a prescription, their share of a Nigerian prince's ill-gotten oil money, a no-interest credit card, and so on. Fear of the IRS is a corollary which can get the weasels in your electronic door as well. Caveat emptor, as always.

I'm not a Big-Government supporter by any means, but this is an issue where our leaders have failed us. Yes, some of the criminals have been caught, but many more jump in to take their place, and most of these newer and nastier vermin are located overseas, immune from prosecution. Add to that, the carriers themselves, phone and broadband alike, are either too overwhelmed to do anything about this inundation, or are simply satisfied to receive the fees from the bottom-feeders or those who resell the service to them.

The Internet is supposedly an international operation, and "solutions" such as isolating Russia or China, or Nigeria from US traffic would hurt more people than it would help. (Well, OK, maybe cutting off Nigeria wouldn't be a tragedy, but I digress.) Still, I DO think there should be sanctions based on the criminal traffic coming from a particular nation.

So, we come back around to what we peons can do about all this. We can try to recruit our Congressmen to get to work on this issue. Ultimately, that is how we will have to fix the problem. In this case, it takes a government to stop the juggernaut. In the meantime, the only thing left for us victims to do is to report, report, and report. Sign up for the Do Not Call Registry, and tattle on anyone who violates it. Forward spam emails (with headers) to a service like SpamCop, which will find and notify the ISP involved. Get the telemarketer's phone number from Caller ID, and trace it down, using Google to start. In other words, Fight Back!

I did track the phone number from the IRS (Indian Robbing Scoundrels) to its VOIP provider, and that particular number was shut down. I'm sure, however, that the Banglore Bad Guys were able to crank up another US number within a few moments maximum. Just like smashing a cockroach; a dozen skitter out to take its place.

Perhaps the saddest commentary is from the IRS (the real one) itself. Its website has a link for reporting scams such as the one attempted on us. The first question:  "How much did you give the scammer?" There's a sucker born every minute, I guess, and criminals are very adept at finding them.

January 27,2015

Allow Don't Allow

How will my “Personal Information” be used?

One of the most annoying emails in my inbox is from a digital address app. Emails come from people I do not know asking me, via the app, to “update my contact information”.

Let’s take a look at the app’s privacy policy. It says, “We may choose to buy or sell assets. In these types of transactions, customer information is typically one of the business assets that is transferred. Also, if we are acquired, or if we go out of business, enter bankruptcy, or go through some other change of control, Personal Information would be one of the assets transferred to or acquired by a third party.” (Emphasis mine.)

This clearly states that “Personal Information” can be given or sold to a third party, but emails from the app tout that information is private. I never directly shared my email information with the sender, although there are numerous ways the sender or the app may have gotten my email. But I do not have a relationship with the sender or the app.

Without a relationship, there can be no trust.

The Issue: We Need a Trust Revolution

At the 2015 World Economic Forum Annual Meeting in Davos, a session in the Future of the Internet track was, “In Tech We Trust”.

“The digital revolution needs a trust revolution. Huge shifts are occurring as the world moves towards comprehensive information sharing via social media, cloud computing and big data. Systems of record (such as email) have become systems of engagement (such as social media) and are now moving towards systems of intelligence (data analytics). However, this progress cannot occur unless customers trust how their data is used. The challenge: more than 90% of consumers feel they have lost control of their data.”

Recent Privacy Concerns in Healthcare

Before I write a post for HL7standards.com, I generally have read and collected quite a few articles on a particular topic. My “Consent of the User” list was overflowing. I am going to limit this post to three timely concerns in healthcare: Healthcare.gov, “matchbacks”, and 23andMe.


In case you missed it, Healthcare.gov was saving personal health data in referrer URLs from people using the system. This personal health data was also being shared with “third parties”, at least 14, according to the Electronic Freedom Foundation:

EFF researchers have independently confirmed that healthcare.gov is sending personal health information to at least 14 third party domains, even if the user has enabled Do Not Track. The information is sent via the referrer header, which contains the URL of the page requesting a third party resource. The referrer header is an essential part of the HTTP protocol, and is sent for every request that is made on the web. The referrer header lets the requested resource know what URL the request came from. This would for example let a website know who else was linking to their pages. In this case however the referrer URL contains personal health information.

According to MEDCITYNews, “At first, the administration defended the current standing of privacy standards, but advocates and lawmakers became very vocal and demanded changes.”




According to Bloomberg News, “matchbacks” are a little known process of assigning patients unique codes based on their prescription drug records. Marketers can then send tailored Web ads to patients.  Federal regulators were not aware of this practice when contacted by Bloomberg News. It may be legal, but many do not consider it ethical. According to Bloomberg, matchbacks were also not addressed in privacy policies.

De-Identified, Anonymous and Confidential Have Different Meanings

Just because data are de-identified, that does not mean anonymous. Most people do not realize that de-identified, anonymous, and confidential all have different meanings, especially when it comes to research, which brings us to 23andMe.


What could be more personal than your DNA? One of the most confusing and ever-changing privacy policies is 23andMe.  The company recently announced tens of millions of dollars in deals with pharmaceutical companies for research. In Medium, Dr. Eric Topol asks, “Who Should Have Access to your DNA?”  He says that critics are now questioning whether customers really understood what they were consenting to at the time of their saliva data collection, “We are moving into the big data-per individual era (with your very own ‘Google’ medical map), and we have not yet established any model for the rightful ownership of all this information.”

Opt-In vs. Opt-Out

Vendors and apps often say that you can always opt-out. However, most people prefer a choice to opt-in. If technology wants to build trust, opt-in will need to be the model.


A Set of Universal Principles for Data Protection

At the WEF Annual Meeting, a set of universal data protection principles was called for.

  • First, “consent” must always be requested and granted.
  • Second, how personal data is used must be fully “transparent.”
  • Third, heightened “accountability” must accompany higher levels of data access.

Is the Enterprise Cloud a  Model for the Consumer Cloud?

Marc Benioff of Salesforce believes the enterprise cloud should be a model for the consumer cloud. Healthcare is said to be Salesforce’s next billion dollar initiative. Here’s what Marc shared at WEF in Davos:
“We all have to step up to another level of transparency, especially the vendors. So whether you are an enterprise vendor or a consumer vendor, we all need to open up a lot more to be able to say exactly where is the data, what’s going on with the data, who has the data, and if there’s a problem with the data – a security problem or some other issue with the data – immediate disclosure, complete and total transparency. No secrets. Because only through that transparency are we going to get to a higher level of trust. That is not where we are today.
“We’re the enterprise cloud. Our customers are the GEs, the Philips, the BMWs, it’s their data. We can’t do anything without our customers saying what we can do. It’s their data. They tell where they want it, how they want to use it, what applications are using it. We can’t see it, the data is black to us, it’s encrypted. But that very much is a model from where the consumer companies are going to have to go. Enterprise companies can’t do anything without their customers saying it’s okay. That’s our agreement with our customers that we sign with them. In the consumer world, you don’t know what’s going on, and that is going to have to change. Total disclosure is critical.”


Marissa Mayer was also part of the WEF panel. (Yahoo’s privacy policy was criticized by Bloomberg News regarding matchups in the above-mentioned story.) Here’s what she had to say from Davos:
Trust is about weighing trade-offs – how much privacy do I have, how secure do I feel – what are the benefits I get, in exchange for that? You need to afford the individual trace and control. The user’s own their data. They should be able to examine it, take it with them, bring it to other sites, bring it to other vendors that they trust more. Basically, have a system and a market that helps people make these trade-offs and these decisions. But they should have control over how they use the system, or whether they use the system at all. People have trouble making some of these trade-offs because the vendors are not being transparent enough, not providing enough controls and choice.”

Beneficent Apps

Tim Berners-Lee said that at MIT they are working on a new architecture for how we store data, and proposed “Beneficent Apps.”

Is what I am doing beneficent? Basically, is it good for users? Suppose we have a brand, this is a beneficent app, that means while I am writing the app, you are going to pay me for the app, and I am going to think about what you want. That’s the business model we are going to see.

Terms of Service, Privacy Policies

The moderator of the WEF panel, Nick Gowing, said the that Terms and Conditions are not the small print, “Terms and Conditions, No, that’s the Big Print.”

Terms of service and privacy policies may not identify what third parties can do with data. So even if you trust an app or service, you may not know what a third party can do with your data. This will become increasing important with the growth in consumer health data that is not necessarily patient data. In a world of convergence, the Internet of Things, wearable technologies and integrated health app platforms, we need to build with consent of the user.

Consent means, we won’t use your data for any other purpose, unless you approve it.

Categories: News and Views , All

January 22,2015


In a recent blog, the opinions of the JASON Report Part II with regards to CDA were analyzed. The review of CDA was lukewarm at best. However, the report did spend a significant amount of time talking about future possibilities. The main focus of the future possibilities was HL7 FHIR.

FHIR was discussed extensively in the report because JASON thought it lends itself well to the health IT vision which was stated as:

Focus on the health of individuals rather than the care of individuals.

Key to this vision is the establishment of a robust health data infrastructure that could also be used to enable a Learning Health System. But one major impediment that remains is the critical need for open APIs for EHR connectivity and to stimulate entrepreneurial ideas. One solution to this impediment is seen as the FHIR standard, which JASON sees as a “significant improvement over CDA.”

The JASON report describes CDA as a container for information. The problem with the container is that it is hard to sort out all the data in the container into usable chunks. FHIR solves this by organizing the data into smaller usable chunks called resources. These resources standardize the exchange of information as modular components.

Resources contain basic pieces of information and can be extended to fulfill specialized requirements. Resources can also be bundled together to satisfy the same messaging and document workflows that the health IT industry uses today. In a previous post, I detailed the interoperability paradigms of FHIR, including REST, messaging, documents, and services.  Examples of resources include Patient, Medication, and CarePlan to name a few. Like CDA, each resource has a human readable element as well as coded entries.

Because these resources are simple in structure and clearly defined, they are viewed as something that is easy to parse and extract the data. Not to mention, it is always possible to extract the human readable portion. The resources, which can be encoded in XML or JSON (not to be confused with JASON – the organization writing the report), are lightweight and easily adaptable to web applications which is something that has not existed in health IT to this point.

According to the report, of even greater importance than the lightweight and clearly defined resources is the ability to support representation state transfer (REST). There are several design features listed in the report which give evidence to REST being such a good choice:

  • Separation of concerns about the storage of data and the interface to the data
  • The communication is essentially stateless between requests
  • Load balancing can easily be employed on the server side
  • Client caching can be enabled for efficiency
  • Servers can send code to clients to extend functionality
  • Applications present a uniform interface, with four guiding principles:
    • Resources are identified via URLs
    • Clients, with permission, can modify the resources on the server
    • Messages are self-descriptive
    • Transitions of the data are performed using hyperlinks

With REST in place as a paradigm for interoperability, along with the simple modular structure of resources, JASON believes that FHIR sets the stage for a major shift in the way healthcare data is exchanged, and make data more readily available when and where it is needed to support the future vision of healthcare.

Categories: News and Views , All

January 21,2015


This is part II of my interview with Proteus Duxbury, CTO of the Colorado Health Insurance Marketplace, Connect for Health Colorado . I also encourage  you to read Part I.

As Colorado runs its own exchange, and has had what most consider a successful rollout, we’ll discuss what is next and how the exchange works to improve the long-term health of the people of Colorado. In this chat we discuss choice architectures and how to build an exchange that is really, truly consumer-centric – a great vision for health in any state, and I’m glad to see it emerging here in Colorado.

LK: Have you looked into behavioral economics and what are called choice architectures like what they describe in Nudge? Nudge has a pretty long section on creating a framework for effective decisions based on the goals of the user.

PD: Absolutely. Our marketplace solution is a good traditional transactional system, but it’s not been designed as a true engagement platform, utilizing choice/behavioral best practices, so we’ll likely need to append our architecture with some niche solutions. These could come from the startup community and non-traditional sources of innovation in the local community, and that’s very exciting.

LK: You and I have talked the opportunity for the exchange to be more of a platform, presumably with APIs that would allow outside developers to come in and build new solutions and applications using data supplied via the API combined with other outside sources. What can you share with us about that?

PD: We are implementing an API into various parts of our marketplace, hopefully in the next year or so.

Digital engagement is very important to us. We are going to move forward with a hackathon so that we can engage the local digital health community to bring innovative new ideas that could be leveraged in the long term to create an engaging, transparent experience. As CTO however, there is a balance between being innovative and having an enterprise scalable architecture. Anything that we put into production has to be robust, it has to scale well. We have recently engaged with a startup, CodeBaby, who are based here in Colorado Springs. They helped us go live today with Kyla our avatar who helps people navigate our website. For now this is limited, but we hope to integrate this further into our key, core portal marketplace screens and into our streamlined eligibility application.

LK: That’s great to see, and I can’t wait to see what comes next. I think that this kind of opportunity will be very exciting for entrepreneurs because health care is something that literally everyone has a stake, and it’s great to have these kinds of opportunities in Colorado to get more people involved in improving it, with code.

PD: Denver is a really exciting place to be in the development of new health technologies and new innovations given the work that Mike Biselli is doing (creating Stride, an emerging digital health campus with some big soon-to-be-named digital health tenants) to establish Denver as a hub.

LK: Yes, the Prime Health Collaborative and Stride and Health 2.0 Denver do seem to have started something special in the community here. It seems like a great fit because people do come here to be active, and the active, consumer-centricity has started to show with the startups that have formed here. It’s a great confluence of forces around digital health and consumer-focused solutions.

So let’s talk a little about what makes this environment unique and how we’re going to sustain it. Connect for Health Colorado is a non-profit that will need to be self-sustaining. What are the opportunities for extending the business model?

PD: We do need to be self-sustaining in January of 2015 and we do have a plan to do so based on a broad market assessment and our carrier-fee billing for plans that we offer on the marketplace.  In the future however there may also be opportunities for monetizing our (anonymized) information assets and our technologies thereby funneling additional resources back into the exchange to support our ongoing vision and mission. Perhaps to other, newer exchanges.

LK: What improvements are you going looking to roll out in the near future?

PD: In addition to what we’ve already discussed, a key focus area for us will be the utilization of user preferences to identify the important decision-making criteria for individuals.

We’re also putting in an out-of-pocket calculator so people can understand what kind of plan they should choose given their predicted healthcare expenditures for the year.

We do have a provider search tool, so people can see which providers are in-network for individual plans. However there are opportunities to make these searches broader and more inclusive, with real-time information on which providers are taking new patients and the exact services they are providing. For example so someone could find a child ABA (Applied Behavioral Analysis) provider in Denver that also has current openings within their practice. That’s just not possible using the provider search tools in use.

We have recently gone live with a formulary tool to help people find out which medications are covered by individual plans. In the future I would like to see the development of richer decision-support tools around formulary, linking in efficacy and safety information for particular drugs, given the genetic pre-disposition of the individual. Quality ratings for plans, carriers and providers are also areas that exchanges are looking to move into in the future. Amazon-like consumer-driven payer/provider ratings. The ACA has driven a number of initiatives to introduce more transparency in the marketplace. We’ve discussed a little about the All Payer Claims Database, or APCD, here in Colorado, which was driven by the ACA. Transparency and quality metrics is an area (CMS) will be providing guidance on in 2016. The establishment of the health insurance exchanges themselves is, in and of itself, a broad move toward applying more transparency to the marketplace by creating a common benefit package for qualified health plans. So, it’s easier for the consumer to compare plans like they are comparing apples to apples. CMS and ACA are playing a large role in helping to make the healthcare marketplace more transparent.

LK: Despite the hype to the contrary, it really is a free-market approach, and for the free market to work, you need transparency. If we want to fix health care, we need to make all of it more transparent and that creates a lot of opportunity for health IT that can facilitate that transparency.

PD: Reflecting on the success of PatientsLikeMe, that builds communities of patients to share information. There’s no reason we couldn’t explore providing similar communities for people in Colorado.

LK: So more of building a community and helping people connect with others in the state? That sounds great.

PD: In parallel the development of storefronts for the provision of direct to provider services including Telehealth and concierge medicine seem like a natural future evolution for exchanges.

LK: Seems like there are a lot of niches that could be provided and make this more of a communications system between patients, providers, payers and between many different stakeholders in the system, as well as a face to the health care system in Colorado.

One other thing I wanted to ask about is, have you received any interesting demographic trends about who is signing up for insurance on the exchange?

PD: Some interesting facts from our last open enrollment period (2013-14) was that 38% were in 0-34 age range. 35% were in the 35-54 age range. More than 73% of our consumers were under 55. Only about 26% were in the 55-64 age range. The other surprising thing was that 40% of those who enrolled received no financial assistance (tax credits or cost sharing reductions) indicating that people are choosing us as a trusted place to shop for their insurance.

LK: I see a lot of entrepreneurs have been getting their insurance through the exchange, so we’ll look forward to seeing how having this kind of access has improved the labor market, as people no longer need to be tied to a traditional job to qualify for affordable insurance.

PD: And, of course, the other big benefit is that people with pre-existing conditions can no longer be discriminated against, and a lot of people have come to us for that reason.

LK: Well thanks for the interview and all the great work that you’ve done. We are fortunate to live in a pretty progressive state in terms of health care and have some really great people working to improve things in Colorado.

Read Part 1 of this Q&A.

Categories: News and Views , All

January 6,2014

GNUmed now supports the following workflow:

- patient calls in asking for documentation on his back pain

- staff activates patient

- staff adds from the document archive to the patient
  export area a few documents clearly related to episodes
  of back pain

- staff writes inbox message to provider assigned to patient

- provider logs in, activates patient from inbox message

- provider adds a few more documents into the export area

- provider screenshots part of the EMR into the export area

- provider includes a few files from disk into export area

- provider creates a letter from a template and
  stores the PDF in the export area

- provider notifies staff via inbox that documents
  are ready for mailing to patient

- staff activates patient from inbox message

- staff burns export area onto CD or DVD and
  mails to patient

- staff clears export area

Burning media requires both a mastering application
(like k3b) and an appropriate script gm-burn_doc
(like the attached) to be installed. Burning onto
some media the directory passed to the burn script
produces an ISO image like the attached.

GPG key ID E4071346 @ gpg-keyserver.de
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

November 26,2013

Here it is

0.) do a full backup. Save it on some other media then your harddisk ! Do it,

1.) Install PG 9.3 ( I tried with 32bit but should not matter).
- http://get.enterprisedb.com/postgresql/postgresql-9.3.1-1-windows.exe

2.) Run the installer and select (English_UnitedStates) for locale (others
might work as well). Make sure it installs itself on port 5433 (or other but
never ! 5432).

3.) Make sure both PG 8.4 and PG 9.3 are running (e.g. via pgadmin3 from PG

4.) open a command shell (dos box) - "run as" administrator (!) in Win7

5.) type : RUNAS /USER:postgres "CMD.EXE"
- this will open another black box (command shell) for user postgres
- for the password use 'postgrespassword' (default)

6.) type: SET PATH=%PATH%;C:\Programme\PostgreSQL\9.3\bin;
- instead of Programme it might be Program Files on your computer

7.) type: cd c:\windows\temp
- changes directory to a writable temporary directory

8.) type: pg_dump -p 5432 -Fc -f gnumedv18.backup gnumed_v18

9.) type: pg_dumpall -p 5432 --globals-only > globals.sql

Important : Protect your PG 8.4 by shutting it down temporarly

10.) type in the first command shell : net stop postgresql-8.4
- check that is says : successfully stopped

11.) psql -p 5433 -f globals.sql
- this will restore roles in the new database (PG 9.3 on port 5433)

12.) pg_restore -p 5433 --dbname postgres --create gnumedv18.backup
- this will restore the database v18 into the PG 9.3 on port 5433

Congratulations. You are done. Now to check some things.

Here you could run the fingerprint script on both databases to check for an
identical hash



13.) Open gnumed.conf in c:\programme\gnumed-client\
For the profile GNUmed database on this machine ("TCP/IP": Windows/Linux/Mac)]
change port=5432 to 5433.

14. Run the GNUmed client and check that it is working. If it works (no wrong
schema hash detected) you should see all your patient and data.

15. If you have managed to see you patients and everything is there close
GNUmed client 1.3.x.

16.) in the first command shell type: net stop postgresql-9.3

17.) Go to c:\Ptogramme\PostgresPlus\8.4SS\data and open postgresql.conf. Find
port = 5432 and change it to port = 5433

18.) Go to c:\Programme\Postgresql\9.3\data and open postgresql. Find port =
5433 and change it to 5432. This effectively switches ports for PG 8.4 and 9.3
so PG 9.3 runs on the default port 5432.

19.)  Open gnumed.conf in c:\programme\gnumed-client\
For the profile GNUmed database on this machine ("TCP/IP": Windows/Linux/Mac)]
change port=5433 to 5432.

20.) Restart PG 9.3 with: net start postgresql-9.3.

21.) Open the GNUmed client and connect (to PG 9.3 on port 5432).

22.) Leave PG 8.4 in a shutdown state.

So far we have transferred database v18 from PG 8.4 to 9.3. No data from PG
8.4 is touched/lost.

23.) Now you are free to install gnumed-server v19 and gnumed -client 1.4.
Having installed gnumed-server v19 select 'database upgrade' (not boostrap
database) and it will upgrade your v18 database to a v19 database.

In case you experience problems you can always shut down PG 9.3, switch ports again, install client 1.3.x, start PG 8.4 (net start postgresql-8.4) and work with your old setup.

November 13,2013

The release notes prominently tell us that GNUmed 1.4.x requires at least PostgreSQL 9.1.

If you are running the Windows packages and have let GNUmed install PostgreSQL for you you are good to go since it comes with PostgreSQL 9.2 already.

If you are on Ubuntu or Debian Chances are your system still has PostgreSQL 8.x installed.

First check if you run any software that requires you to continue using PostgreSQL 8.x. If so you can install PG 9.1 side by side with it. If not let PG 9.1 replace PG 8.x

It usually works like this.

sudo apt-get install postgresql-9.1
sudo pg_upgradecluster 8.4 main

Then if you don't need PG 8.4 anymore you could

sudo pg_dropcluster --stop 8.4 main
sudo apt-get purge postgresql-8.4

Have fun.

February 5,2013


[...] medical practice billing software  encourage [...]

January 22,2015


I’ve been involved in building many life-critical and mission-critical products over the last 25 years and have found that, finally, cybersecurity is getting the kind of attention it deserves. We’re slowly and steadily moving from “HIPAA Compliance” silliness into a more mature and disciplined professional focus on risk management, continuous risk monitoring, and actual security tasks concentrating on real technical vulnerabilities and proper training of users (instead of just “security theater”). I believe that security, like quality, is an emergent property of the system and its interaction with users and not something you can buy and bolt on. I’m both excited and pleased to see a number of healthcare focused cybersecurity experts, like Kamal Govindaswamy from RisknCompliance Consulting Group, preaching similar proactive and holistic guidance around compliance and security. I asked Kamal a simple question – if cybersecurity is an emergent property of a system, who should be held responsible/accountable for it? Here’s what Kamal said, and it’s sage advice worth following:

Information Security in general has historically been seen as something that the organization’s CISO (or equivalent) is responsible for. In reality, the Information Security department often doesn’t have the resources or the ability (regardless of resources) to be the owners or be ultimately “accountable” or “responsible” for information security. In almost all cases, the CISO can and must be the advisor to business and technology leaders or management in the organization. He could also operate/manage/oversee certain behind-the-scenes security specific technologies.

If your CISO doesn’t “own” Information Security in your organization, who should?

At the end of the day, everyone has a role to play in Information Security. However, I think the HealthIT managers and leaders in particular are critical to making security programs effective in healthcare organizations today.

Let me explain…

Of all the problems we have with security these days,  I think the biggest stumbling block often has to do with not having an accurate inventory of the data we need to protect and defining ownership and accountability for protection. This problem is certainly not unique to Healthcare. No amount of technology investments or sophistication can solve this problem as it is a people and process problem more than anything else.

Healthcare is unfortunately in a unenviable position in this regard. Before the Meaningful Use program that has led to rapid adoption of EHRs over the last five years, many healthcare organizations didn’t necessarily have standard methods or technologies for collecting, processing or storing data. As a result, you will often see PHI or other sensitive information in all kinds of places that no one knows about any longer, let alone “own” them –  Network file shares,  emails, a legacy application or database that is no longer used  etc. The fact that HealthIT in general has been overstretched over the last five years with implementation of EHRs or other programs hasn’t helped matters either.

In my opinion and experience, the average Healthcare organization is nowhere close to solving the crux of the problem with security programs – which is to ensure ownership, accountability and real effectiveness or efficiencies.

Most of us in the security profession have long talked about the critical need for the “business” to take ownership among business and technology leaders. For the most part however, I think this remains a elusive goal for many organizations. This is a serious problem because we can’t hope to have effective security programs or efficiencies without ownership and accountability.

So, how do we solve this problem in Healthcare? I think the answer lies in HealthIT leadership taking point on both ownership and accountability.

HealthIT personnel plan, design and build systems that collect/migrate/process/store data, interact with clinical or business leadership and stakeholders to formulate strategies, gather requirements, set expectations and are ultimately responsible for delivering them. Who better than HealthIT leaders and managers to be the owners and be accountable for safeguarding the data? Right?

So, let’s stop saying that we need “the business” to take ownership. Instead, I think it makes much more pragmatic sense to focus on assigning ownership and accountability on the HealthIT leadership.

I present below a few sample mechanics of how we could do this:

  1. Independence of the CISO. For a start, Healthcare CIOs or leaders should insist on independence for the CISO (or equivalent) in their organizations. Even if the CISO or security director or manager happens to be reporting to the CIO (as it still happens in many organizations), I think it is absolutely critical that you reorganize to make the role one of an advisor and support role and not an IT function itself. The CISO and his may also have their own operational responsibilities, such as management of certain security technologies or operations,  performing risk assessments, monitoring risk mitigation or remediation programs,  assisting with regulatory compliance and so on. Regardless, they must be an independent function with a strong backing or support from the CIO.
  1. IT (Data) Asset Discovery, Classification and Management. To start with, all IT assets (hardware and software) that collect, receive,  process,  store or transmit data (CRPST) need to be identified,  regardless of whether these assets are owned/leased/subscribed or where they are hosted. Every physical or virtual asset (network device, server, storage, application, database etc.) must have one assigned owner at a manager/director/VP level who is ultimately accountable for security of the information CRPSTed by the asset. As the owner may choose or need to delegate responsibilities (see #3 below)  the asset meta-data should also include information regarding personnel that have delegated responsibilities. If you are a smaller organization,  you may have one person being the owner that is “accountable” as well as “responsible” .
  1. Directives to HealthIT executives and managers. It is important that Healthcare CIOs send a clear message of sponsorship and accountability to their executives and managers regarding their “ownership” related to security.  The asset owners (see #2 above) may in turn delegate “responsibilities” to other personnel (not below a manager) in her department. For example, the VP or Director of IT Infrastructure may delegate responsibilities to Manager of Servers and Manager of networks. Similarly, the VP/Director of Applications may delegate responsibilities to the Database Manager and Manager of Applications and so on. Regardless of the delegation, the VP or Director retains the “ownership” and “accountability” for security of information CRPSTed by the asset.
  1. Bolted-in Security. The HealthIT strategy and architecture teams need to work in close collaboration with the CISO’s team. It is critical that security is an important planning and design consideration and not something of an afterthought. It is much more cost effective to plan, design and implement secure systems from the start (hence bolted-in) than trying to look for a patch-work of controls after the systems are already in place.
  1. Need for HealthIT managers with “responsibilities” to be proactive. Let me explain this with a few examples of the Server Manager’s role in #3 above.
    • The Server Manager must at all times know the highest classification of the data stored on his servers so he is sure he has appropriate controls for safeguarding the data as required by the organization’s Information Security Policy and standards. If a file server is not “authorized” to contain PHI or PII on its shares, he should perhaps reach out to the CISO with a request for periodic scans of his servers to detect any “sensitive” data that users may have put on their file shares, for example.
    • If a file server is authorized to store PHI for use by the billing department for example, the Server manager must work with the billing department manager to have her periodically review the access that people have to the billing file shares. If your organization’s Identity and Access Management (IAM)  solution or program has capabilities for automating these periodic access reviews,  the Server Manager must work with the CISO (or whoever runs the IAM program)  to operationalize these access reviews as part of your Business-As-Usual (BAU)  activities. The key point here is that it is the Server Manager’s responsibility (and not the Billing Manager or the CISO’s) to ensure that the Billing Manager performs the access reviews in compliance with the organization’s policies or standards for access reviews of PHI repositories.
    • The Server Manager must all times be aware of who all have administrative access to these servers, so he must look for ways to get alerts for every change that happens to the privileged or administrator access to the servers. If your organization has a Log Management or a Security Information Event Management(SIEM)  solution,  the Server Manager should reach out to the CISO or his designate so the SIEM solution can collects those events from your servers and send email alerts for any specific administrator or similar privilege changes to the Server Manager. While we are on SIEM, the Server Manager should also work with the CISO and the Billing Manager so the Billing Manager gets an email alert every time there is a change to the access privileges on the file shares containing PHI or PII used by the billing department.
    • If one of the servers happens to be a database server, the Server Manager may be responsible for the operating system level safeguards while the Database Manager may have the responsibility for the database “asset”.  She will in turn need to work with the CISO and the relevant business managers for automation of access reviews, monitoring of potential high risk privilege changes in the database etc.


I hope these examples from Kamal illustrate how HealthIT can have an effective ownership and accountability for security.

Drop us some comments if you agree but especially if you don’t.

December 15,2014


John Lynn, prolific blogger and health IT media magnate, and I are teaming up again for the second year to produce and deliver a marketing conference focused on helping digital health, health IT, and medical device innovators. We’re going to be providing actionable advice and specific techniques you can use to cut through the noise when trying to market healthcare and medical tech products to physicians, hospitals, health systems, ACOs, patients, and similar customers. Called The Healthcare IT Marketing Conference, last year’s event covered very important subjects by some of the world’s best experts on those topics and we’ll continue the tradition again in 2015.

Learn the difference between Marketing, Advertising, PR, and Branding

Everyone tells small companies that they need to “do marketing” but that’s really hard to do so I started with a quick visual to explain what it means. It comes from Marty Neumeier on pages 24 and 25 of ZAG by way of the Brand Autopsy Blog (which I highly recommend reading) and illustrates the differences between Marketing, Advertising, PR, and Branding. It’s a wonderful visual and clearly shows that small companies should focus on marketing and free PR, shoot for branding and probably eschew advertising until they have enough money. Our expert speakers at HITMC know the difference and will teach you how to make sure you’re not taking the wrong steps.

Learn how to conduct appropriate market research

Lots of (even innovative) companies don’t do basic market research so we will cover:

  • Find the right search terms for your industry or product. Don’t be esoteric. Because most products will only be found through word of mouth or on the Internet, don’t choose terms to describe yourself that no one else understands. Selling to hospitals is not about creativity, it’s about value. If the customer doesn’t understand what you’re selling give up now.
  • Use competitive intelligence to locate your competitors and existing firms.

Learn about the different kinds of of Business Models to consider

  • Software as a Service (SaaS) and subscription model — best model for startups with something they can maintain in their own data centers
  • Consulting and Solutions model — when you can provide packaged help
  • Licensed model — when privacy or complexity requires solutions to be installed in house
  • Freemium model (and open source)

Learn about major healthcare industry fallacies

Selling to the healthcare community is very hard and there are many myths that our conference will dispel:

  • Healthcare folks are neither technically challenged nor simple techno-phobes. Because they are in the business of saving lives and improving health, they care about technologies that help them achieve their mission.
  • Most product decisions are no longer made by clinical folks alone, CIOs are fully involved. Don’t try to sell just to the clinical folks — make sure the IT side is engaged and on your side.
  • Complex, full-featured, products are not easier to sell than simple, stand alone tools that have the capability of interoperating with other solutions are much easier to sell. Software as a service is a good approach.
  • Hospitals will not buy unless one proves value. This seems obvious but many companies think that because they think something is important, their customers will just agree.
  • Selling into doctors offices is not easy. There were a few startups looking to sell to individual physicians’ offices. Selling to to your first dozen physicians is pretty easy since we all know doctors. Just be careful, though, since selling to the next dozen and beyond is where companies fall.

Learn how to align the Payers, Beneficiaries, and Users (PBU) of your Health IT or MedTech product

There are three distinct groups you’re marketing and selling your products to:

  • The payer or the person/entity that writes the check for your product.
  • The person or group that benefits most from the use of the product.
  • The person or group that actually uses the product.

I call this the “PBU alignment” problem. In a complex environment like healthcare, the three groups are often not the same — if you can find a market in which the payers, the beneficiaries, and the users are all the same then your sales job is easy. However, that’s commonly not the case. Let’s take a look at the typical example of a complex product like an electronic medical records (EMR) software package in the era of ARRA, HITECH, and meaningful use (MU). The “payer” may ultimately be government reimbursements through Medicare, the “beneficiaries” are the healthcare insurance firms and the government agencies that need the MU data, and the “users” are the doctors and staff at physicians offices and hospitals. Why has it taken decades for EMRs to be sold to just a tiny fraction of the total industry? Because the PBU alignment hasn’t been reached — until the users, beneficiaries, and payers of the products all understand the value and are willing to work together to achieve a goal it will be tough.

Join us at the conference to talk with experts on the PBU lesson and advice for your product. Figure out the PBU alignment problem and see how you’ll sell to each of the groups and make the right arguments — you do it right and you’ll make money. If you forget the complexities of the PBU and you’ll be languishing, too.

Go home with many tips and tricks:

  • Make sure your company and its value is easy to explain
  • Make sure your value is defendable and differentiated (but without being esoteric)
  • Make sure that you have ability to attract partners and can either create or be part of an ecosystem
  • Ensure that you have word of mouth opportunity
  • Have scaleable staff and systems
  • Have a scaleable product — build once, sell many times
  • Have an uncomplicated pricing and deployment model
  • Be very focused — you can’t “solve healthcare” but you can solve very specific problems
  • Try to own the relationship with and information about customers — don’t rely on partners that won’t give you access to customers


November 9,2014


Earlier this year NueMD created a nice looking Meaningful Use Infographic — asking the question whether MU was helping or hurting EHR Adoption. I loved the summary but I wanted to dig in a little further so I asked Dr. William Rusnak, a resident physician in radiology and a healthcare IT writer for NueMD, to tell us what that infographic meant for innovators and folks building solutions. Here’s what Dr. Rusnak said:

When the Centers for Medicare and Medicaid Services (CMS) launched their Electronic Health Records (EHR) Incentive Programs, coined “Meaningful Use” (MU) back in January 2011, the main goal was to reward healthcare practitioners and administrators for adopting EHRs and increasing efficiency within their practice. NueMD, a medical billing software company, decided to take a closer look at the effectiveness of this program. They compiled research from the Department of Health and Human Services (HHS), CMS, and the American College of Physicians (ACP) looking to identify adoption trends and determine potential obstacles to successful implementation.

The results are quite interesting and have shed some light upon the massive opportunity for technical breakthroughs in healthcare. If tech innovators want to join the movement, they should be continually searching for processes in medicine that still involve some sort of manual transmission of information. Talk to your friends that are nurses, doctors, office managers, billers, or administrators. You would be surprised simply by the amount of information still being written on papers and stuffed in pockets throughout the day!

Adoption, attestation, and a younger generation of physicians

According to a survey of more than 1,200 physicians, EHR adoption is certainly taking place, but when it comes to officially attesting to Meaningful Use – the numbers suggest there’s still room for improvement. Practices with more than 50 physicians had the highest rate of EHR adoption at 85%, with 62% attesting to MU. The big disparity exists among small practices (less than 10 providers) in which half have implemented EHR technology, while only 25% have attested to MU.

This will improve, though. With younger physicians beginning to practice and take on leadership positions, it is very likely that adoption rates will increase substantially over the next decade. In the past, one of the biggest challenges EHR vendors have faced is working with a userbase that wasn’t keen on technology. Soon, however, the majority of practicing physicians will be of the generation that was introduced to technology much earlier in life. Additionally, Medical Economics states that even many older physicians have become comfortable in using technology in their practices, claiming that this age-group has begun to see some of the highest rates of EHR adoption. Thus, the market, not only only for EHR, but also nearly any kind of health technology, is just about ready to surge.

User satisfaction and efficiency, or lack thereof

Although this data suggests EHR adoption is on the rise, providers’ feelings about implementing and using EHRs is showing another trend. Between March 2010 and December 2012, user satisfaction decreased 13% from 61% to 48% while dissatisfaction rose 14% from 23% to 37%. What’s to blame? Of those surveyed, 67% claimed system functionality as their primary reason for switching EHR vendors.

One could look at this on the surface and think that since satisfaction is decreasing, healthcare information technology (HIT) is a struggling industry. But, let’s not kid ourselves. HIT is here to stay and most of the gripes and complaints about EHR are typical for any developing technology. If anything, these data suggest that within this storm of inefficiencies exist ample opportunities for improvement. Developers should take this into consideration for future healthcare software. More emphasis needs to be the true effectiveness of the software. This problem could be solved rather quickly with focus groups consisting of healthcare providers. Let them pick apart your software and find bottlenecks, set-backs, and other negative features. In the end, the electronic version of any process must absolutely be less time-consuming than the old-fashioned paper method.

Another very common complaint of many EHR systems is that the usability is far from intuitive. This could be the lowest-hanging fruit in the tree of improvements to this kind of software. Although each user will differ in education — from patient to nurse to physician — all of them should be able to easily access any and all of the health information stored from the patient encounters. Innovators can easily overcome this obstacle by make a significant effort to create simple, user-friendly interfaces. Again, use focus groups or chat with current clients and find out where users struggle with simple tasks. Are there too many unused features on the “home” page? Is there are particular action that users frequently perform, but must search through several menu options to get to it?

The data entry dilemma

The next problem is rather complicated and that is of data entry. Currently, physicians and other providers are using either dictation software or typing to get information into the EHR. Streamlining this process even further will decrease the time necessary for documentation, thus providing more time for the patient interview. Innovators should be looking to try to design alternative ways input information into EHRs.

Since most devices now have voice recognition, an app that could allow physicians to quickly record the patient interview then allow for review and submission into any EHR would be an amazing product. It would be even more impressive if the app could create custom documents and help to avoid repetition. For example, physicians could record physical exam findings while s/he speaks them during the exam. This eliminates some documentation after the interview.

In the future, similar apps for wearables will be even more helpful. Imagine devices, such as otoscopes, thermometers, blood pressure cuffs, and stethoscopes recording data directly into the EHR as you use them. This reality is not too far off and any software that facilitates this data collection is likely to thrive.

Government intervention: Does it help or hurt?

Let’s get back to the question at hand. Is the government’s intervention helping or hurting? Unfortunately, the positive effects of the incentives seemed to have plateaued, given the lower amount of attestations in 2013. Furthermore, in a few rare instances, they have actually indirectly caused some healthcare leaders to commit fraud. A hospital CFO in Texas aided the hospital in receiving $800,000 in MU incentives, yet the system barely used its EHR. He was also reported to commit identity fraud in order to receive MU incentives. Additionally, on the innovation side of things, much of the funding in the form of grants, has run out, leaving most of the HIT companies that received them struggling to sustain themselves.

There are some good points. MU has initiated the transition to EHR for both vendors and providers. It was a surge of development in healthcare. In the process, providers were given software that was quickly designed and lacked key features. Therein lies the opportunity. Innovators now have customers with large demand for features such as usability, interoperability between software packages, and mobile implementation. Even though the EHR space in particular is crowded, there is still room for companies to create better patient portals, educational apps, analytics apps for wearables, and additional software that can be integrated into existing EHRs. And as far as the drought of government funds, venture funding for healthcare start-ups and companies is still plentiful.

Bad news can be good news

Overall, this data should be a wake-up call to everyone in the industry. Hospitals and smaller practices are struggling with the transition to a completely electronic system. Not to mention, they are unable to achieve true interoperability – open communication channels between everyone involved in patient care. However, this massive amount of problems is really a gold mine for HIT entrepreneurs. My advice to these innovators in the industry is to start connecting with physicians (or any other healthcare professional) willing to provide constructive input. Being that kind of doctor myself, I can tell you that I want nothing more than for developers to collaborate with those of us on the front lines of patient care. It’s only going to result in better software and devices.

March 12,2010

This blog is now located at http://blog.rodspace.co.uk/. You will be automatically redirected in 30 seconds, or you may click here. For feed subscribers, please update your feed subscriptions to http://blog.rodspace.co.uk/feeds/posts/default. Rodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com0

March 3,2010

I've just heard about the Information Technology and Communications in Health (ITCH) which will be held February 24 - 27, 2011, Inn at Laurel Point, Victoria, BC Canada.I'd not heard of this conference before but the current call for papers looks interesting.Health Informatics: International Perspectives is the working theme for the 2011 international conference. Health informatics is now a Rodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com0
The report of the Prime Minister’s Commission on the Future of Nursing and Midwifery in England sets out the way forward for the future of the professions which was published yesterday, calls for the establishment of a "high-level group to determine how to build nursing and midwifery capacity to understand and influence the development and use of new technologies. It must consider how pre- and Rodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com0

June 9,2013


“Large collections of electronic patient records have long provided abundant, but under-explored information on the real-world use of medicines. But when used properly these records can provide longitudinal observational data which is perfect for data mining,” Duan said. “Although such records are maintained for patient administration, they could provide a broad range of clinical information for data analysis. A growing interest has been drug safety.”

In this paper, the researchers proposed two novel algorithms—a likelihood ratio model and a Bayesian network model—for adverse drug effect discovery. Although the performance of these two algorithms is comparable to the state-of-the-art algorithm, Bayesian confidence propagation neural network, by combining three works, the researchers say one can get better, more diverse results.

via www.njit.edu

I saw this a few weeks ago, and while I haven't had the time to delve deep into the details of this particular advance, it did at least give me more reason for hope with respect to the big picture of which it is a part.

It brought to mind the controversy over Vioxx starting a dozen or so years ago, documented in a 2004 article in the Cleveland Clinic Journal of Medicine. Vioxx, released in 1999, was a godsend to patients suffering from rheumatoid arthritic pain, but a longitudinal study published in 2000 unexpectedly showed a higher incidence of myocardial infarctions among Vioxx users compared with the former standard-of-care drug, naproxen. Merck, the patent holder, responded that the difference was due to a "protective effect" it attributed to naproxen rather than a causative adverse effect of Vioxx.

One of the sources of empirical evidence that eventually discredited Merck's defense of Vioxx's safety was a pioneering data mining epidemiological study conducted by Graham et al. using the live electronic medical records of 1.4 million Kaiser Permanente of California patients. Their findings were presented first in a poster in 2004 and then in the Lancet in 2005. Two or three other contemporaneous epidemiological studies of smaller non-overlapping populations showed similar results. A rigorous 18-month prospective study of the efficacy of Vioxx's generic form in relieving colon polyps showed an "unanticipated" significant increase in heart attacks among study participants.

Merck's withdrawal of Vioxx was an early victory for Big Data, though it did not win the battle alone. What the controversy did do was demonstrate the power of data mining in live electronic medical records. Graham and his colleagues were able to retrospectively construct what was effectively a clinical trial based on over 2 million patient-years of data. The fact that EMR records are not as rigorously accurate as clinical trial data capture was rendered moot by the huge volume of data analyzed.

Today, the value of Big Data in epidemiology is unquestioned, and the current focus is on developing better analytics and in parallel addressing concerns about patient privacy. The HITECH Act and Obamacare are increasing the rate of electronic biomedical data capture, and improving the utility of such data by requiring the adoption of standardized data structures and controlled vocabularies.

We are witnessing the dawning of an era, and hopefully the start of the transformation of our broken healthcare system into a learning organization.


Source: FutureHIT

June 7,2013


I believe if we reduce the time between intention and action, it causes a major change in what you can do, period. When you actually get it down to two seconds, it’s a different way of thinking, and that’s powerful. And so I believe, and this is what a lot of people believe in academia right now, that these on-body devices are really the next revolution in computing.

via www.technologyreview.com

I am convinced that wearable devices, in particular heads-up devices of which Google Glass is an example, will be playing a major role in medical practice in the not-too-distant future. The above quote from Thad Starner describes the leverage point such devices will exploit: the gap that now exists between deciding to make use of a device and being able to carry out the intended action.

Right now it takes me between 15 and 30 seconds to get my iPhone out and do something useful with it. Even in its current primitive form, Google Glass can do at least some of the most common tasks for which I get out my iPhone in under five seconds, such as taking a snapshot or doing a Web search.

Closing the gap between intention and action will open up potential computing modalities that do not currently exist, entirely novel use case scenarios that are difficult even to envision before a critical mass of early adopter experience is achieved.

The Technology Review interview from which I extracted the quote raises some of the potential issues wearable tech needs to address, but the value proposition driving adoption will soon be truly compelling.

I'm adding some drill-down links below.

Source: FutureHIT

Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.

via www.annfammed.org

One bit of good news about the Patient Centered Medical Home (PCMH) model: here is a study showing that in spite of considerable challenges to PCMH implementation, the transformations it embodies can be and are being implemented even in small primary care practices serving disadvantaged populations.

Source: FutureHIT

January 10,2015

Dear colleague,

The Difference That Makes a Difference 2015 (DTMD 2015) is the third in a series of biennial workshop on the nature of information. The theme of this event is Information and values: ethics, spirituality and religion. It forms part of a larger summit on information organised by the International Society for Information Studies, held on the 3rd-7th June at the Vienna University of Technology, Austria. DTMD 2015 is organised by The Open University, UK.

This workshop starts from the premise that information and values coexist in a relationship of tension, and that they engage in a dialectical process in certain key areas of human society. Within these areas, information and values co-construct a synthesis which includes but transcends both aspects. This synthesis is particularly expressed in the fields of ethics, spirituality and religion.

Particular inspirations for this workshop include the work by West Churchman on The Systems Approach and its Enemies, which argued for a dialectical relationship between the rationalist ‘hard’ systems approach and perspectives such as morality, politics, religion and aesthetics which are apparently opposed to it. Ethics and religion have also been long-standing interests in various areas of cybernetics, which is the starting point for this exploration of information, and were central concerns in the later work of Norbert Wiener, Heinz von Foerster and Gregory Bateson. In this sense the workshop is continuing an ongoing stream of work.

As well as leading to new insights into ethics, spirituality and religion, this work also acts as a further lens through which to explore the nature of information. The language of information is increasingly used in many different disciplines, and comparing the usage in different fields contributes to a better understanding of information in its own right. The areas of spirituality, ethics and religion are somewhat less examined in the context of information than many other disciplines, and so this workshop will continue the ongoing process of exploring multi-disciplinary aspects of information.

This workshop follows two international workshops held in Milton Keynes, UK, in 2011 and 2013, both entitled The Difference that Makes a Difference. These workshops explored the nature of information in a range of disciplines (including physics, biology, sociology, computing, systems thinking, philosophy, geography and art, among others). Proceedings of both workshops can be found at http://www.dtmd.org.uk/.

Key questions which the workshop will address include:
  • Can newly-emerging insights into the nature of information inform ethics, spirituality and religion? And does our understanding of ethics, information and religion contribute to a new understanding of the nature of information?
  • If information is the new language of science as Von Baeyer suggests, can it also be a new language of ethics, spirituality and religion?
  • If we are re-ontologising the world as an infosphere, does that make information ethics the new universal macroethic, as Luciano Floridi suggests?
  • Is the language of information effective in talking about spirituality?
  • Can we interpret the theologies, mythologies and praxis of religion using the language of information? How do religions use information and informational concepts? Conversely, what might it mean to think about information as theological or mythological?
  • Can a theory of information provide a weltanschauung to replace or supplement religion as the motivation for ethics, spirituality and community, and if so, is such a replacement necessary and / or desirable?
The workshop organisers welcome submissions which address themselves to the above and related questions through the medium of art as well as traditional academic formats – DTMD 2013 had a major focus around the interplay between art and information, and we hope to continue this in the current workshop.

Submission deadline (extended abstracts of 750-2000 words): 27 February 2015
Notification of acceptance: 20 March 2015

Workshop organisers (all at The Open University, Milton Keynes, UK):

David Chapman, Magnus Ramage, Chris Bissell and Mustafa Ali (Department of Computing and Communications)
Derek Jones (Department of Engineering and Innovation)
Graham Harvey and Paul-Francois Tremlett (Department of Religious Studies)

Online version of call for papers: http://summit.is4is.org/calls/call-for-papers/the-difference-that-makes-a-difference-2015

Submission site: http://summit.is4is.org/submission

Hope to see you in Vienna in June!


[ I have previously had the challenge and pleasure of presenting at DTMD 2011 and attending in 2013 and found the experience stimulating and rewarding. In 2015 the location and the larger summit are exceptional bonuses, (as per usual I enjoyed the New Year's Day Concert), but I will have to consider whether I can attend.

If the concept of 'information' if of interest to you, within the is4is.org site check the Repository of Documents PJ ]
Categories: News and Views , All

January 4,2015

I read Nortin Hadler's Missing the Forest For the Granularity (July, 2014) on The Health Care Blog with great interest. The article draws attention yet again to the risks and preoccupation with processes and systems. This provides me with another opportunity to highlight the 4P's within Hodges' model: Process, Policy, Practice and Purpose and add some of the points that Dr Hadler addresses.

The 4Ps by themselves might have meaning but they can't do work. For that we need a context and several perspectives. As Dr Hadler points out big data intrudes on the clinical encounter determining not just what is collected, but how it is captured and structured.

There are frequently two datasets at the practitioner level: one is administrative and managerial in form and purpose; the other is clinical - patient, person centered. Effective communication already presents a challenge. On top of that then how relevant are the IT systems. The holy grail of IT systems still seems to be benefits for clinicians and patients - the public. Until then will the IT continue to push the patient-clinical relationship as if it is some wobbly toy? You bet it will!

Where exactly should the “Physician’s Dashboard” reside? Is it a case of "the ayes have it" but only on the right?

Nortin also refers to the United States postponing ICD-10. From Wigan Pier I clearly do not understand the issue, but this seems from here more like a very prolonged delay. A delay that perhaps says more; not just about the healthcare 'system(s)', but the many interfaces to be found there.

Many thanks to Dr - Prof. Hadler for his article.

humanistic ------------------------------------------- mechanistic
“cognitive” specialists, the care of the patient revolves around the “granularity” of the narrative.
individual attention and focus
ability to share purposes
 Using individual differences and idiosyncrasies

patients as widgets (here)?
Can you see the dashboard here?
 data gathering
big data, ICD-10
Electronic Medical Record -
 templates and “smart sets”

Patient - BIG DATA - Doctor
 empathy 'NOISE' empathy
life-course (“social”) epidemiology
Europe, health care systems, United States, health economists, hospital administrators, patients as “units of care”, physicians as “providers”, clinical demand = “throughput.”
common denominators

Categories: News and Views , All

December 4,2014

humanistic ------------------------------------------- mechanistic

"All patient and care records digital,
real time and interoperable by 2020."
"Clinicians in primary, urgent
and emergency care, and other key transitions
of care contexts will be operating without paper records by 2018."
"Patients have access to their hospital,
community, mental health and social care services records by 2018."

"By April 2016, commissioners and providers
must publish "road maps" showing how they
will develop interoperable digital records
and services by 2020."

Report: Personalised Health and Care 2020. National Information Board. November 2014.

Illman, J. (2014) National tech blueprint sets greater role for regulators - Personalised Health and Care 2020: selected recommendations, Health Service Journal, 21 November. 124: 6424; p.13.

Categories: News and Views , All

October 14,2012


Image of clipboard with checklist


Twitter, like the Internet in general, has become a vast source of and resource for health care information. As with other tools on the Internet it also has the potential for misinformation to be distributed. In some cases this is done by accident by those with the best intentions. In other cases it is done on purpose such as when companies promote their products or services while using false accounts they created.

In order to help determine the credibility of tweets containing health-related content I suggest the using the following checklist (adapted from Rains & Karmikel, 2009):

  1. Author: Does the tweet contain a first and last name? Can this name be verified as being a real person by searching it on the Internet?
  1. Date: When was the tweet sent? If it is a re-tweet when was the original tweet sent?
  1. Reference: Does the tweet reference a source? Is this source reliable?
  1. Statistics: Does the tweet make claims of effectiveness of a product or service using statistics? Are the statistics used properly?
  1. Personal story or testimonials: Does the tweet contain claims from an individual who has used or conducted research on the product or service? Is this individual credible?
  1. Quotations: Does the tweet quote or cite another source of information (e.g. a link) that can be checked? Is this source credible?

Ultimately it is up to the individual to determine how to use health information they find on Twitter or other Internet sources. For patients anecdotal or experiential information shared by others with the same illness may be considered very credible. Others conducting research may find this a less valuable information source. Conversely a researcher may only be looking for tweets that contain reference to peer-reviewed journal articles whereas patients and their caregivers may have little or no interest in this type of resource.


Rains, S. A., & Karmike, C. D. (2009). Health information-seeking and perceptions of website credibility: Examining Web-use orientation, message characteristics, and structural features of websites. Computers in Human Behavior, 25(2), 544-553.






June 26,2012


The altmetric movement is intended to develop new measures of production and contribution in academia. The following article provides a primer for research scholars on what metrics they should consider collecting when participating in various forms of social media.



If you participate on Twitter you should be keeping track of the number of tweets you send, how many times your tweets are replied to, re-tweeted by other users and how many @mentions (tweets that include your Twitter handle) you obtain. ThinkUp is an open source application that allows you to track these metrics as well as other social media tools such as Facebook and Google +. Please read my extensive review about this tool. This service is free.


You should register with a domain shortening service such as bit.ly, which will provide you with an API key that you can enter into applications you use to share links. This will provide a means to keep track of your click-through statistics in one location. Bit.ly records how many times a link you created was clicked on, the referrer and location of the user. Consider registering your own domain name and using it to shorten your tweets as a means of branding. In addition, you can use your custom link on electronic copies of your CV or at your own web site. This will inform you when your links have been clicked on. You should also consider using bit.ly to create links used at your web site, providing you with feedback on which are used the most often. For example, all of the links in this article were created using my custom bit.ly domain. In addition, you can tweet a link to any research study you publish to publicize as well as keep track of how many clicks are obtained. Bit.ly is a free service.


Another tool to measure your tweets is TweetReach. This service allows you to track the reach of your tweets by Twitter handle or tweet. It provides output in formats that can be saved for use elsewhere (Excel, PDF or the option to print or save your output by link). To use these latter features you must sign up for an account but the service is free.


Buffer is a tool that allows you to schedule your tweets in advance. You can also connect Buffer to your bit.ly account so links used can be included in your overall analytics. Although Buffer provides its own measures on click-through counts this can contradict what appears in bit.ly. This service is free but also has paid upgrade options available that provide more detailed analytics.

Web presence

Google Scholar Citation Profile

You can set up a profile with Google Scholar based on your publication record. The metrics provided by this service include a citation count, h-index and i10-index. When someone searches your name using Google Scholar your profile will appear at the top before any of the citations. This provides a quick way to separate your articles from someone else who has the same name as you.

Google Feedburner for RSS feeds

If you maintain your own web site and use RSS feeds to announce new postings you can also collect statistics on how many times your article is clicked on. Feedburner, recently acquired by Google provides one way to measure this. You enter your RSS feed ULR and a report is generate, which can be saved in CVS format.

Journal article download statistics

Many journals provide statistics on the number of downloads of articles. Keep track of those associated with your publication by visiting the site. For example, BioMed Central (BMC) maintains an access count of the last 30 days, one year and all time for each of your publications.


Other means of contributing to the knowledge base in your field include participating on web-based forums or web sites such as Quora. Quora provides threaded discussions on topics and allows participants to both generate and respond to the question. Other users vote on your responses and points are accrued. If you want another user to answer your question you must “spend” some of your points. Providing a link to your public profile on Quora on your CV will demonstrate another form of contribution to your field.


Paper.li is a free service that curates content and renders it in a web-based format. The focus of my Paper.li is the use of technology in Canadian Healthcare. I have also created a page that appears at my web site. Metrics on the number of times your paper has been shared via Facebook, Twitter, Google + and Linked are available. This service is free.


Twylah is similar to paper.li in that it takes content and displays it in a newspaper format except it uses your Twitter feed. There is an option to create a personalized page. I use tweets.lauraogrady.ca. I also have a Twylah widget at my web site that shows my trending tweets in a condensed magazine layout. It appears in the side bar. This free service does not yet provide metrics but can help increase your tweet reach. If you create a custom link for your Twylah page you can keep track of how many people visit it.

Analytics for your web site

Log file analysis

If you maintain your own web site you can use a variety of tools to capture and analyze its use. One of the most popular applications is Google Analytics. If you are using a content management system such as WordPress there are many plug-ins that will add the code to the pages at your site and produce reports. WordPress also provides a built-in analytic available through its dashboard.

If you have access to the raw log files you could use a shareware log file program or the open source tool Piwik. These tools will provide summaries about what pages of your site are visited most frequently, what countries the visitors come from, how long visitors remain at your site and what search terms are used to reach your site.


All of this information should be included in the annual report you prepare for your department and your tenure application. This will increase awareness of altmetrics and improve our ability to have these efforts “count” as contributions in your field.

June 24,2012

  1. The following provides a timeline of articles that appeared in newspapers and blogs from January 2011 to present. The articles demonstrate a progress from patient engagement in online communities to those that include reference to increasing provider involvement.
  2. January 5th, 2011
  3. February 3rd, 2011
  4. February 22nd, 2011
  5. March 23rd, 2011
  6. April 2nd, 2011
  7. April 25th, 2011
  8. May 14th, 2011

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