February 27,2015

I guess my fingers are not quite as firmly placed on the pulse of PACS as I might have thought. I was completely blindsided by today's announcement of the acquisition of DR Systems by Merge. Oh, well, life is full of surprises.

From AuntMinnie.com:
February 27, 2015 -- One of the oldest names in imaging informatics is going by the wayside as PACS firm DR Systems has been acquired by Merge Healthcare. While the DR Systems name will be retired as part of the deal, founder and CEO Dr. Murray Reicher has been named chief medical officer (CMO) of Merge.

The deal unites two midlevel PACS providers and gives Merge additional scale to compete with larger multinational firms in the imaging informatics space. It also expands Merge's geographic footprint to DR Systems' core market in the Western U.S., while broadening the combined company's portfolio of intellectual property.

The deal was finalized on February 25, according to Michael Klozotsky, vice president of marketing at Merge.

Founded in 1992

DR Systems was founded in 1992 by neuroradiologist Reicher along with another brain imaging specialist, Dr. Evan Fram. Reicher and Fram said they founded the company out of dissatisfaction with existing PACS software available at the time.

The closely held company charted its own course over the years, remaining fiercely independent even as the rest of the radiology industry consolidated. The company gained a reputation for high levels of customer satisfaction, as evidenced by a string of top rankings in KLAS reports, as well as for its aggressive defense of its patents for PACS software.

Through the years, Reicher maintained his active role with the San Diego firm, serving as a frequent speaker at industry events and publishing peer-reviewed articles on imaging informatics. He assumed the position of CEO again earlier this year after the retirement of longtime chief executive Rick Porritt.

In announcing the acquisition, Merge cited the broad array of healthcare information technology software that will be offered by the combined firm, including DR Systems' eMix image-sharing service, RIS software, and cardiology and pathology offerings. Both companies also offer traditional PACS and RIS/PACS software and, indeed, have long been competitors in the acute care and ambulatory markets, Klozotsky said.

Merge cited the high customer satisfaction ratings of the combined entity, with No. 1 ratings according to KLAS surveys for cardiovascular information systems, hemodynamic monitoring software, and RIS software. Merge also plans to offer its iConnect Network services, including exam preauthorization, through DR Systems' installed base.

In addition to adding Reicher as CMO, Merge said it plans to keep DR Systems' San Diego headquarters open as its West Coast regional office. DR Systems employs some 180 people, according to Wikipedia. Merge will also maintain support for DR Systems' core software platform, continue with current implementations, and support and advance all product lines, the company said.

Merge expects the deal to be accretive to earnings per share under nongenerally accepted accounting principles (GAAP) in 2015 and future years. Merge financed the deal through a combination of $20 million in cash on hand and $50 million in cash raised from the sale of shares of recently issued preferred stock.

The deal is the latest in a long string of acquisitions that Merge has made over the years as it grew from a niche firm offering data connectivity software to perhaps the largest independent PACS firm. Other acquisitions have included Amicas, Cedara Software, Confirma, RIS Logic, and eFilm Medical.

Merge's most recent acquisition is designed to give the combined entity the heft to move forward in a healthcare industry where size increasingly matters.

"As healthcare continues to consolidate, scale is very, very important," Klozotsky. "This allows Merge to really operate on an entirely different level of scale."
I've met Dr. Reicher one one occasion, and he is a perfect choice for CMO. He is very well spoken, and truly a pioneer in this business.  In fact, DR holds quite a few core patents in PACS, as some other companies have painfully discovered.

It remains to be seen just how the DR products will be incorporated into the Merge palate. Will Merge PACS have a Catapult for the techs? We shall see...
Leonard Nimoy, Star Trek's Mr. Spock to generations of fans, died today at age 83. Nimoy died peacefully at home from complications of COPD, chronic obstructive pulmonary disease, caused by cigarette smoking in his younger years. How illogical.

I think the eulogy given by William Shatner as Captain Kirk in the second Star Trek movie, The Wrath of Khan, says it all:
We are assembled here today to pay final respects to our honored dead. And yet it should be noted that in the midst of our sorrow, this death takes place in the shadow of new life, the sunrise of a new world; a world that our beloved comrade gave his life to protect and nourish. He did not feel this sacrifice a vain or empty one, and we will not debate his profound wisdom at these proceedings. Of my friend, I can only say this: of all the souls I have encountered in my travels, his was the most... human.
Star Trek gave us hope of new worlds, of new ideas, in the midst of the strife of the 1960's. We need this encouragement even more today.

Spock was at once of us and foreign to us, half-human and half-Vulcan. Similarly, Nimoy, growing up an Orthodox Jew in Boston, probably felt something of the same dichotomy. When a Star Trek script called for Spock to make an "alien gesture," Nimoy reached back into his Jewish heritage, and used the Orthodox priestly blessing as the "Live Long and Prosper" sign we know so well:

I spent about 10 seconds in the presence of Messrs. Nimoy and Shatner at the Star Trek convention in 2004. We were not quite on a first-name basis, although at one point I was one of William Shatner's 5,000 Facebook friends. Still, like millions of fans today, I feel like I've lost a close friend; these actors and their characters have been part of our lives, well, for most of our lives.

But as DeForrest Kelley's Dr. McCoy said at the end of The Wrath of Khan, "He's not really gone as long as we find a way to remember him." Perhaps not completely logical, but true nonetheless.

Godspeed, Leonard.

February 24,2015


The folks who brought us the Pebble Watch are at it again, today announcing the new Pebble Time, a
"Color e-paper smart watch with up to 7 days of battery and a new timeline interface that highlights what's important in your day," on Kickstarter. Features include:
  • We're announcing a new watch called Pebble Time with a new timeline interface.
  • Pebble Time features a new (64) color e-paper display and microphone for responding to notifications.
  • No compromises on what you love about Pebble: up to 7 days of battery life, water resistance and customizability.
  • Pebble Time is fully compatible with all 6,500+ existing Pebble apps and watchfaces.
  • Three colors available exclusively on Kickstarter. Pebble Time starts shipping in May.
  • Extra special engraving for our original Kickstarter backers who support us again ♥♥♥
The first thing we notice is, of course, the color screen. Nice touch, but it is not a touch screen. The Time is still button-driven. It does have a microphone built in to allow some level of voice control or response (although for iOS, this is so far limited to Gmail notifications, but no doubt this will improve. The presence of the tiny hole for the microphone renders the Time water resistant, but not water proof like its elder siblings.

The OS is redone with WebOS underpinnings. It's nice that the now defunct revamped Palm platform has landed somewhere useful.

It's a little cartoonish, but it should be useful, customizable, and still run all the old Pebble apps (and I suppose watch faces too.)
As with all Pebble software, we’ve built an open platform. You can allow apps and developers to add ‘pins’ to your timeline, so you can keep track of things like upcoming events, sports, weather, traffic, travel plans, pizza specials and more.

The Pebble operating system has been re-imagined with a new visual style. While all existing Pebble apps will still work great, we’re inviting developers to upgrade their apps to support color. More details coming soon!
Had you been on the stick, you could have had one of the first 10,000 watches for $159, but they went fast. Pebble has raised $4 Million within hours (minutes?) of the Time's debut. You can still get in at $179 if you act fast. The retail price will be $199.

So why haven't I jumped on this? Two words...Apple Watch. In some ways, this is an apples and oranges (pun intended) comparison. The cheapest Apple Watch will be the aluminum sports version, at about $350, or so the pundits say. The stainless steel model will be $500, and the Gold Elite Apple Fan Boy edition will be $5,000.  But the AW is a whole 'nother animal. Its build quality is likely to be a step beyond the Pebble's, the functionality will be far greater, at least for iPhone owners, the screen will be better and touchable, there will be heart rate sensors (maybe not active initially), and so on. On the other hand, the Pebble Time will be cheaper and supposedly will go 7 days between charges. The Apple Watch apparently will barely make it through the day with moderate use.

I love my original Pebble, which works very well within its parameters. The Time will most likely do so as well. I have high hopes for the Apple Watch, which should be in my hands sometime in April, just before the Time ships. Time will tell, eh?

February 26,2015


Can 10 successful entrepreneurs come up with solutions to 10 of healthcare’s most “wicked” problems in 10 days?

That’s the question Denver’s Tom Higley started asking himself three years ago. Tom, a successful entrepreneur himself and tireless Colorado startup advocate, is the brainchild and chief organizer of an event, dubbed 10.10.10, happening right now in Denver that aims to learn what’s possible.

In a first of it’s kind event, 10 entrepreneurs have been brought together to create products and companies to solve 10 of health care’s wicked problems. Day 10 is today Thursday, Feb. 26th, where we’ll find out what things the CEOs will be working on in the months to come.

Think of it as an executive-level healthcare startup hackathon that lasts 10 days. If it works, it’s going to be taken on the road and into other industries such as food, water, energy and education. With 80% of outcomes linked to things such as nutrition and education, I suspect some of these future events may have an impact on health care as well!

To be sure, coming up with solutions to such problems on short order, in an area where even Apple is apparently struggling to innovate, may seem like a tall order to many on the front lines of digital health, but the expectations are appropriately muted. Higley will measure success by having at least a few solid, fundable companies in the next nine to 18 months.

Perhaps an even bigger story is the dedicated community of people are working to make Colorado a major player in digital health, with 10.10.10 as a showcase. The event and the entrepreneurs are supported by over 100 volunteers and as well as the Colorado Health Foundation, Kaiser, and many others. Bryan Sivak, the U.S. Department of Health and Human Services’ chief technology officer and entrepreneur-in-residence, sent a video in support of the event that was played at the kickoff last week.

There’s also a distrinctly consumer-centric perspective on solutions here as well. Esther Dyson, VC Brad Feld and SomaLogic CEO Larry Gold discussed as much yesterday on a panel, challenging the CEOs to come up with products and business models related to health, not health care, and providing access to data for consumer. If someone’s a patient, it’s often too late for intervention, according to Dyson.

You might want to keep Colorado on your map if you are thinking of starting a digital health company. A new state-of-the-art digital health campus called Stride, set to open in the coming year, will focus on creating a hub of digital health companies. Several major players in health care are rumored to be setting up a presence (more on this in the months to come). Places like Stride, events like 10.10.10, and the dedicated community that supports them, along with success stories like iTriage, are starting to put Colorado on the digital health map.

A cornerstone to the environment I see growing is the willingness of pitch in and help. Local VC Brad Feld talks about that helpful ethos of the Boulder startup community in his book “Startup Communities,” and it seems to have caught on among the digital health people throughout the front range.

Each element of the 10.10.10 event has a “coopetition” aspect to it, even the problems. Individuals and organizations pitched in and submitted problems and the final list was selected based value, difficulty and market opportunity.

The event so far

The first public-facing event was the kickoff where the problems and entrepreneurs were announced. The wicked 10 problems will be familiar to many in involved in digital health and certainly reflect the new realities of non-Fee-for Service (nFFS), quality-based care, public health and a few oldies but goodies:

The 10 Wicked Health Problems are:

  • Alzheimer’s
  • Childhood Obesity
  • Patient Engagement
  • Antibiotic Resistance
  • End of Life Care
  • Pandemic Weapons and Bioterrorism
  • Patient and Data Matching
  • Health Guide Maps
  • Health Data
  • Patient Mobility and Independence

Depending on how you categorize, the wicked problems are pretty evenly divided between public health, patient-empowerment, health IT, and science-focused. Now matter how you organize them, they are big, wicked and broad. It will be interesting to see how the entrepreneurs hone them down to problems to areas that are manageable.

At the midway point event, February 20, the entrepreneurs seemed to be leaning toward some solutions, but no decisions had been made. We’ll have to find out on Thursday where things are headed, I’ll tweet-report back this Thursday, so follow #101010health to find out more.

I hope the midway panel offered some insight to where things are headed. There was an excellent panel with Kaiser’s Dr. Jandel Allen-Davis, SomaLogic (Proteomics company) CEO Larry Gold and Peter Sheahan of ChangeLabs. The dynamic was great, had some great one-liners and made a few things pretty clear. I hope the 10 entrepreneurs, who were sitting in the front row during the session, use some of these takeaways as a guide:

  1. New payment models are happening, we need to reallocate that money to behavior change.
  2. People will be in charge of their health more and more, people need the power to make better decisions.
  3. Longitudinal tracking of everything will happen, but how?
  4. We need to balance security and access of all this info.
  5. There’s still too much harm that can come from the lack of security on health data.
  6. We understand what drives sickness, but not what drives health. How do we move upstream in predicting (beyond stepping on a scale?).
  7. It’s the interaction, not the visit.
  8. Make the healthy choice the easy choice.
  9. Bricks and mortar care will change, but coexist in new ways with the digital.
  10. Many of the changes needed in our health care system are social, not rational.

Peter Sheahan related the story of a meeting where a fresh-faced twenty-something told the Joint Chiefs of the U.S. military that social media would help foment geopolitical unrest. Of course, they snickered and dismissed him out of hand. This was six months before the Arab Spring.

That story makes me hope that we have some of those kinds of thinkers at 10.10.10. I wonder who will be laughed at, but keeps on building, and is eventually proven right in health care? Will it be one of these?

Craig Misrach

Founder and CEO of medical device company Freedom Meditech.

Cheryl Kellond

Co-founder and CEO of Bia Sport, a sports watch company.

Joy Randels

Seasoned executive with a long string of successful companies and an IPO.

Monique Giggy

Monique has started and grown several companies, including Swing by Swing Golf.

Lizelle van Vuuren, Denver, Colorado

Founder and CEO of marketing company Effectively.

Kelly O’Neill Dwight, Denver, Colorado

Principal consultant of KMD Consulting Services.

Zackary Lewis

Founder of Liquid Compass, a radio streaming company.

Lincoln Powers, Billings, Montana

CEO and chief data architect of Rocky Mountain Technology Group.

Best wishes to all to fix some of these wicked problems! It won’t be easy, but we’re rooting for you! Looking forward to tonight to see where things are headed!

Categories: News and Views , All

February 24,2015


On January 21, the Office of the National Coordinator for Health IT announced that Michael James McCoy, MD, would be the department’s Chief Health Information Officer, a newly created position. According to the announcement, Dr. McCoy will serve as the lead clinical subject matter expert on interoperability, and he has a background perfectly tailored to the task with experience both as a practicing physician and as a leader at the IHE for more than a decade.

Thanks to Dr. McCoy for answering the following questions about the new position and his vision for a learning health system.

Q. First, congratulations on the new appointment with the ONC. You previously practiced medicine and held various leadership positions in the private sector, what attracted you to working with the ONC and what vision do you hope to bring to the department as the industry moves into stage 3 of Meaningful Use?

Dr. Michael James McCoy

Dr. Michael James McCoy

ONC is at a crossroads, coming through a period where significant funding was applied to incentivize the adoption and use of basic electronic health information technology to one where the information can flow to help achieve better care, smarter spending of health care dollars, and healthier people. Now we need to make sure that the infrastructure we have established through the supports created in the HITECH Act can provide returns, with data and analytics capabilities that progress us, as a nation, toward a Learning Health System.

I had the good fortune to be in the right place at the right time to be able to join ONC and the great team of people here to further the goals of improving health, health care, and reducing costs of health care delivery with a person-centric view. Dr. Karen DeSalvo, the National Coordinator for Health IT – my boss – continues to be supportive about the importance of health information technology as the tool to support achieving better health (not as an end unto itself).

I hope that my experience as a practicing clinician with early EMR use in the office, as someone with vendor and implementation experiences, and with system-level knowledge of the challenges for adoption and utilization of the data available, can provide a balanced perspective across ONC.  There are many offices within ONC that have huge impacts on policies, procedures, rules, and regulations – way more than I realized before joining the team here!  There is significant coordination required between the various teams, and Dr. DeSalvo has been working to ensure the views are balanced with senior clinical and legal/legislative perspectives applied.

My vision is that I may be impactful in advancing the notion of person-centric health, and in some small way, help influence the direction that our advancement to a Learning Health System takes. I fully embrace a person-centric concept, and think announced initiatives, including Precision Medicine, will continue taking our nation’s health system down that path.

Q. Karen DeSalvo was quoted as saying you would serve as the ‘lead clinical subject matter expert on interoperability.’ This brings to mind the inclusion of patient-generated health data into the medical record. How do you think the big questions about responsibility for the PGHD (e.g., Is the physician legally responsible to monitor the data? Are patients responsible for accuracy of reported data? etc.) will be resolved? 

The subject of patient-generated health data (PGHD) has many complexities, but in reality, some of the biggest questions relate to similar concerns expressed by clinicians in reviewing “data dumps” from Transitions of Care (TOC) documents, or receiving old records from other physicians. Those concerns relate to the (receiving) physician missing some critical data element in the old record (whether paper or electronic) and their liability as a result of missing that information. There have been lawsuits on this with paper records, and now with electronic records, there is even more data (potentially) for a clinician (or attorney) to review. Whether the data comes from another EHR or from PGHD, there is some obligation for the clinician to review the information received. To what extent and how much data validation must occur (the trust or provenance of the data source) are not yet defined clearly. The legal requirements, the ethical requirements, and the practical requirements for that “minimum level of review” have not been fully established, nor has a consensus view been achieved on what is “right.” ONC is certainly not, in my view, the arbiter of such, though it could, through outreach and coordination and/or through its advisory committees, convene such discussions.

To me, the concerns, about PGHD misses the bigger picture: individuals are now beginning to drive their own health care decisions in a big, and growing exponentially bigger, way. If physicians do not choose to engage with the increased consumer demands, they may find themselves increasingly marginalized in the care delivery system.

This presents opportunities for developers and other technically savvy entrepreneurs to look at the challenge of filtering signals from the noise.  Everyone is busy these days; finding the important e-mail amongst all the other e-mails and spam received is a great thing. Physicians want the same thing from the PGHD received, and from all of the other interactions with their health information technology (rules and alerts that make sense).  Usability, and good (actionable) information, not just data or noise.

Q. A person-centered health system seems to make perfect sense when it’s talked about at the water cooler, yet I sense there is a large chasm that exists between the goings ons in the health care system and the majority of patients in the U.S. How can we be sure that patients really want to be engaged with the health care system?

Not every “patient” wants to be engaged. That is the reality. Sometimes it is exactly those patients, though, that need to be engaged.

However, looking at the opportunity from a different perspective, the way to a better, healthier country is to engage people before they become patients. Witness the growth of wearable devices, connected to the Internet of Things. The FTC report forecasts 25 billion devices communicating over the network this year and 50 billion by 2020.

Further, assuming it is just a patient that wants to engage is another fallacy. Many of us have roles as caregivers, whether for spouses, children, or parents.  Many of us live remotely from the person receiving care. Having access to be able to assist in understanding the care received, ensuring good communications with care providers, and being actively and proactively engaged is possible only through application of health information technology.

There are so many opportunities to improve the relationships between people (whether a patient, caregiver, or healthy individual) and clinicians (in hospital settings, offices, long-term care settings), and technology can help. Many physicians still seem to view patients coming in with externally garnered information (“Dr. Google”) as problematic, instead of as interested and engaged in their health.

The whole care delivery system is in the midst of transformation (even disruption), and embracing and adopting the change is a better approach than becoming obsolete.

Q. As a former board member, you obviously have a lot of interest in IHE’s activities. Where you surprised there was no mention or talk about IHE in the most recent JASON report? What role do you think IHE will play as HL7 FHIR progresses?

The November 2014 JASON report did not reference IHE, but I don’t find that too surprising given the constituency of the advising body. As in many other circumstances, one approach may be favored by those in office at one time and less so by subsequent office holders. IHE references and use was quite prominent in the HITSP days, less so until recently. One may note that in the 2015 Interoperability Standards Advisory draft, IHE is mentioned multiple times, with XDR, XDS, PIX/PDQ, XCA, XCPD, CSD, and HPD all called out.

There are many technically savvy people (aka “geeks”) that work in and with both HL7 and IHE, and harmonization and collaboration between the two groups can only help the overall advancement of health information technology. Perhaps in my simplistic (? naive ?) way, I view the constructs as HL7 and others (SNOMED, LOINC, RXNORM) providing the “ingredients” to IHE’s recipe (e.g., IHE PCC’s APS, LDS for obstetrics) on utilizing in a meaningful way the constituent parts. Much as a cake recipe calls for sugar, eggs, and flour as ingredients, the “how much sugar,” “how to mix,” “how long to bake and at what temperature,” etc. define the end product (the cake). Many different cake recipes exist, just as many different use cases for health data exists….

Q. What do you hope the health care system will look like in 5 years? 

In 5 years, I hope we are well on our way to the Learning Health System, with little or no thought required to get my health data into or out of any part of the care delivery system I am interacting with. I want to be able to take my personally derived data (from exercise on my bicycle or from monitoring my weight with my WiFi-connected scale) and have it available for those with whom I wish to share. I want to be in a health care system that is focused on wellness and general health as much as it has been focused on episodic care and illness.

The draft Interoperability Roadmap (open to public comment until April 3rd) provides the proper vision towards a Learning Health System that will achieve those goals. It may be an aggressive timeline to some. It certainly is reflective that ONC cannot carry the burden alone. Public, private, state, and federal cooperation and collaboration is essential to achieving success. Our nation’s health depends on it. I think it is the most worthy goal one could have as a health care professional. I certainly am proud to be associated with the dedicated and brilliant team here at ONC working to achieve the goal!

Special thanks to Peter Ashkenaz and Brett Coughlin from the ONC for their help facilitating this post.  

Categories: News and Views , All

February 17,2015


oliver“Please, sir, I want some more.” – Oliver Twist

In this super-sized world, we tend to believe that “more” is better than “less.” I personally believe more trumps less in many areas:

  • All things being equal, I’d rather have more money than less. Most providers seem to agree, which is likely one reason for today’s hot market for applications and services that maximize reimbursements and help providers qualify for more financial incentives.
  • I am always wishing for more time. Providers, vendors, and payors are seemingly obsessed with wanting more time. Why else would we see so much lobbying for extending Meaningful Use deadlines or the transition to ICD-10?
  • The world would be a better place with more dark chocolate.

Of course more isn’t always better. Quite often – especially in the health IT world – less is actually “more.” Consider the following:

  • MGMA recently asked CMS to consolidate its reporting programs and eliminate its use of multiple Web portals for Medicare Part B reporting. Fewer portals means fewer registrations, user names, passwords, and the like, as well as less confusion as to which portal to access for what task. Fewer portals equates to increased efficiencies and fewer administrative hassles.
  • As EMR adoption has grown, so too has the length of a typical chart note. Clinical documentation is no longer just a means for tracking a patient’s condition. Instead the chart note has become the primary tool for meeting billing requirements and justifying reimbursement. The chart note has fallen victim to “note bloat;” that is, with EMRs it’s too easy for users to paste in non-essential data, making it difficult to narrow in on the most critical elements. The American College of Physicians and other professional organizations are now calling for the redesign of EMR-generated documentation to make it is more concise and reflective of the information gather to develop an impression, diagnostic and/or treatment plan, and recommended follow-up.
  • Healthcare generates a wealth of patient data that can be analyzed during the care process, or on a larger scale to measure everything from internal quality metrics to population health trends for predictive analytics. Some may argue that more data is better, but a case can also be made that all data is not equally good/relevant/of value. When it comes to big data, perhaps more data is okay as long as we have plenty of “spam” filters to eliminate the irrelevant.
  • In terms of hardware technology, what’s not to love about less? We embrace devices that are increasingly smaller; we seek components with produce less noise and use less energy; and we’re spending less capital as more applications migrate to the cloud.
  • And of course in the general healthcare world, stakeholders often criticize the over-use of healthcare services in U.S., which not only wastes dollars and resources, but may harm the health of patients, according to a Health Affairs report. Ten to 30 percent of total healthcare spending is considered unnecessary and the waste includes everything from overprescribed antibiotics, excess testing, and unnecessary surgeries.

Oliver Twist and chocoholics may disagree, but sometimes less can be the best way to go.

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.

March 6,2013


Healthcare executives are continuously evaluating the subject of RFID and RTLS in general.  Whether it is to maintain the hospitals competitive advantage, accomplish a differentiation in the market, improve compliance with requirements of (AORN, JCAHO, CDC) or improve asset utilization and operating efficiency.  As part of the evaluations there is that constant concern around a tangible and measurable ROI for these solutions that can come at a significant price.

When considering the areas that RTLS can affect within the hospital facilities as well as other patient care units, there are at least four significant points to highlight:

Disease surveillance: With hospitals dealing with different challenges around disease management and how to handle it.  RTLS technology can determine each and every staff member who could have potentially been in contact with a patient classified as highly contagious or with a specific condition.

Hand hygiene compliance: Many health systems are reporting hand hygiene compliance as part of safety and quality initiatives. Some use “look-out” staff to walk the halls and record all hand hygiene actives. However, with the introduction of RTLS hand hygiene protocol and compliance when clinical staff enter or use the dispensers can now be dynamically tracked and reported on. Currently several of the systems that are available today are also providing active alters to the clinicians whenever they enter a patient’s room and haven’t complied with the hand hygiene guidelines.

Locating equipment for maintenance and cleaning:

Having the ability to identify the location of equipment that is due for routine maintenance or cleaning is critical to ensuring the safety of patients. RTLS is capable of providing alerts on equipment to staff.

A recent case of a hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took an average of two minutes to find a pump. This cuts down on lag time in care and can help ensure that clinicians can have the tools and equipment they need, when the patient needs it.

There are also other technologies and products which have been introduced and integrated into some of the current RTLS systems available.

EHR integration:

There are several RTLS systems that are integrated with Bed management systems as well as EHR products that are able to deliver patient order status, alerts within the application can also be given.  This has enabled nurses to take advantage of being in one screen and seeing a summary of updated patient related information.

Unified Communication systems:

Nurse calling systems have enabled nurses to communicate anywhere the device is implemented within the hospital facility, and to do so efficiently. These functionalities are starting to infiltrate the RTLS market and for some of the Unified Communication firms, it means that their structures can now provide a backbone for system integrators to simply integrate their functionality within their products.

In many of the recent implementations of RTLS products, hospital executives opted to deploy the solutions within one specific area to pilot the solutions.  Many of these smaller implementations succeed and allow the decision makers to evaluate and measure the impacts these solutions can have on their environment.  There are several steps that need to be taken into consideration when implementing asset tracking systems:

•             Define the overall goals and driving forces behind the initiative

•             Develop challenges and opportunities the RTLS solution will be able to provide

•             Identify the operational area that would yield to the highest impact with RTLS

•             Identify infrastructure requirements and technology of choice (WiFi based, RFID based, UC integration, interface capability requirements)

•             Define overall organizational risks associated with these solutions

•             Identify compliance requirements around standards of use


RFID is one facet of sensory data that is being considered by many health executives.  It is providing strong ROI for many of the adapters applying it to improve care and increase efficiency of equipment usage, as well as equipment maintenance and workflow improvement. While there are several different hardware options to choose from, and technologies ranging from Wi-Fi to IR/RF, this technology has been showing real value and savings that health care IT and supply chain executives alike can’t ignore.

February 21,2013


It was not long after mankind invented the wheel, carts came around. Throughout history people have been mounting wheels on boxes, now we have everything from golf carts, shopping carts, hand carts and my personal favorite, hotdog carts. So you might ask yourself, “What is so smart about a medical cart?”

Today’s medical carts have evolved to be more than just a storage box with wheels. Rubbermaid Medical Solutions, one of the largest manufacturers of medical carts, have created a cart that is specially designed to house computers, telemedicine, medical supply goods and to also offer medication dispensing. Currently the computers on the medical carts are used to provide access to CPOE, eMAR, and EHR applications.

With the technology trend of mobility quickly on the rise in healthcare, organizations might question the future viability of medical carts. However a recent HIMSS study showed that cart use, at the point of care, was on the rise from 26 percent in 2008 to 45 percent in 2011. The need for medical carts will continue to grow; as a result, cart manufacturers are looking for innovative ways to separate themselves from their competition. Medical carts are evolving from healthcare products to healthcare solutions. Instead of selling medical carts with web cameras, carts manufacturers are developing complete telemedicine solutions that offer remote appointments throughout the country, allowing specialist to broaden their availability with patients in need. Carts are even interfaced with eMAR systems that are able to increase patient safety; the evolution of the cart is rapidly changing the daily functions of the medical field.

Some of the capabilities for medical carts of the future will be to automatically detect their location within a healthcare facility. For example if a cart is improperly stored in a hallway for an extended period of time staff could be notified to relocate it in order to comply to the Joint Commission’s requirements. Real-time location information for the carts could allow them to automatically process tedious tasks commonly performed by healthcare staff. When a cart is rolled into a patient room it could automatically open the patient’s electronic chart or give a patient visit summary through signals exchanged between then entering cart and the logging device kept in the room and effectively updated.

Autonomous robots are now starting to be used in larger hospitals such as the TUG developed by Aethon. These robots increase efficiency and optimize staff time by allowing staff to focus on more mission critical items. Medical carts in the near future will become smart robotic devices able to automatically relocate themselves to where they are needed. This could be used for scheduled telemedicine visits, the next patient in the rounding queue or for automated medication dispensing to patients.

Innovation will continue in medical carts as the need for mobile workspaces increase. What was once considered a computer in a stick could be the groundwork for care automation in the future.

September 10,2012


This has been an eventful year for speech recognition companies. We are seeing an increased development of intelligence systems that can interact via voice. Siri was simply a re-introduction of digital assistants into the consumer market and since then, other mobile platforms have implemented similar capabilities.

In hospitals and physician’s practices the use of voice recognition products tend to be around the traditional speech-to-text dictation for SOAP (subjective, objective, assessment, plan) notes, and some basic voice commands to interact with EHR systems.  While there are several new initiatives that will involve speech recognition, natural language understanding and decision support tools are becoming the focus of many technology firms. These changes will begin a new era for speech engine companies in the health care market.

While there is clearly tremendous value in using voice solutions to assist during the capture of medical information, there are several other uses that health care organizations can benefit from. Consider a recent product by Nuance called “NINA”, short for Nuance Interactive Natural Assistant. This product consists of speech recognition technologies that are combined with voice biometrics and natural language processing (NLP) that helps the system understand the intent of its users and deliver what is being asked of them.

This app can provide a new way to access health care services without the complexity that comes with cumbersome phone trees, and website mazes. From a patient’s perspective, the use of these virtual assistants means improved patient satisfaction, as well as quick and easy access to important information.

Two areas we can see immediate value in are:

Customer service: Simpler is always better, and with NINA powered Apps, or Siri like products, patients can easily find what they are looking for.  Whether a patient is calling a payer to see if a procedure is covered under their plan, or contacting the hospital to inquire for information about the closest pediatric urgent care. These tools will provide a quick way to get access to the right information without having to navigate complex menus.

Accounting and PHR interaction: To truly see the potential of success for these solutions, we can consider some of the currently used cases that NUANCE has been exhibiting. In looking at it from a health care perspective, patients would have the ability to simply ask to schedule a visit without having to call. A patient also has the ability to call to refill their medication.

Nuance did address some of the security concerns by providing tools such as VocalPassword that will tackle authentication. This would help verify the identity of patients who are requesting services and giving commands. As more intelligence voice-driven systems mature, the areas to focus on will be operational costs, customer satisfaction, and data capture.

February 5,2013


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

February 17,2015


Our next HealthIMPACT CIO Summit will take place next Friday, February 27th, 2015, at the Union League Club in New York. Our conversation kicks off in the morning with Ed Marx, SVP & CIO at Texas Health Resources and 2014 IW Healthcare CIO of the Year, and Michael Restuccia, VP & CIO at University of Pennsylvania Health System. I will be interviewing Ed and Michael together on stage and we’ll focus on how to establish a process that will embed successful innovation into the culture of an organization. We’ll start by asking a provocative question:

Is “digital health innovation” overrated banter that we’re required to embrace for political correctness or is actionable innovation in complex health systems really possible?


Doing more with less has always been an IT leadership challenge. Population health management, value-based care, patient engagement, connecting patients and physicians, transitioning to ICD-10, data analytics for better clinical decision making, the list goes on and it gets longer every year. Just keeping up with changing requirements is tough enough but asking CIOs for disruptive innovation on top of it all may be too much.  How will CIOs handle the increasing demands for reliable and safe IT systems but also be at the forefront of “bleeding edge” technology simultaneously? I’m hoping that Ed and Michael will help us understand how to:

  • Set the right priorities and manage demands for speed, change, and innovation while resources decrease or stay the same
  • Increase the rationality and the accountability of priority setting for technology adoption to avoiding overbuying and under-utilizing
  • Strike the right balance between proposed and planned projects
  • Figure out how to evaluate which innovation projects are working and which need to be eliminated
  • Create leadership strategies that replace a culture of blame with a culture of collaborative innovation
  • Support fast and agile delivery of new ideas but retain patient safety, maintain systems reliability, and data security
  • Work with Start-Ups and other disruptive innovators to not disrupt but measurably improve care and workflow processes


Space is filling up fast so if you haven’t registered for HealthIMPACT East already, please register today.

The post Is digital health innovation overrated? appeared first on The Healthcare IT Guy & Digital Health Nexus.


The folks from HP Matter digital magazine wanted to know where I thought digital health startups, product innovators, and venture capital investors should be pointing their attention in 2015. These are some of my technology and healthcare predictions:

  1. CMS’s request for information (RFI) on new primary care models bears innovative fruit.
  2. Interoperability will move beyond talk and into sustainable business models and real technology. The healthcare ecosystem should be able to create lasting patient benefits.
  3. Risk management, compliance, and cybersecurity technologies will become important as we migrate from paper native to digital native data.
  4. EHR innovation starts to move beyond Meaningful Use (MU) by embracing the idea that MU is a floor for minimal functionality, not a ceiling for maximum value. Some of these innovations will be tied to CMS’s need for newer care models:
    • Mobile functionality in EHRs to help change the doctor/patient relationship to one that is more than transactional in nature
    • Tech for increased comprehensiveness of, and patient continuity with, primary care
    • Tech to support small PCP practices in transforming to advanced primary care
    • Advanced primary care within accountable care organizations, along with multi-payer participation and performance measurement that is meaningful to beneficiaries and clinicians
    • Analytics and solutions to track performance measurement that is meaningful to beneficiaries and clinicians,
  5. Digital health investors start to realize how hard it is for health IT companies to make money without interoperability and integration. Innovators begin moving away from small simple mobile apps, standalone solutions, and non-workflow based systems into larger services-focused enterprise tech. The new tech will understand that minimizing disruptions across workflow steps in the continuum of care is a key goal.
  6. ACOs and value based healthcare starts to affect the marketplace because solutions providers finally focus on beneficiary management and attributed populations instead of general population health.
  7. Data in healthcare (especially genomics and bioinformatics) has always been big. But, new “Big Data” tools start to offer instant analytics and predictive models that affect real patient care instead of being focused on research alone.

The January HP Matter issue has some pretty useful information. You can Register for HP Matter for a chance to win an HP SlateBook x2, an Ultrabook™ and a tablet in one. Weekly drawings will be conducted throughout January and February.

This post brought to you by HP Matter. The content and opinions expressed below are that of The Healthcare IT Guy.

Visit Sponsors Site

The post 7 digital health innovations and investments for 2015 appeared first on The Healthcare IT Guy & Digital Health Nexus.

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.

The post Who should be held accountable for risk management and cybersecurity in healthcare institutions? appeared first on The Healthcare IT Guy & Digital Health Nexus.

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

July 31,2013

By Wayne Parslow, VP Harris Healthcare EMEA.
A new and frenzied debate has opened up in the world of healthcare technology- should NHS technology be open source? A move to open source would potentially mean vast reductions in licence fees for the NHS, the ability for the NHS to develop systems to their bespoke needs, no more supplier lock-in - which results in NHS organisations struggling to get the IT products they use to work with another supplier's - and of course, no need for "one size fits" all contracts such as we saw with the National Programme for IT.
Caradigm has launched its clinical application provisioning solution in the UK. Caradigm Provisioning, the latest module which completes its Identity and Access Management (IAM) suite, has been designed to help healthcare organisations efficiently manage clinician access to applications and data while supporting their compliance with data privacy regulations.

July 30,2013

Over 100 of Europe's best digital health companies have already asked to take part in the Johnson & Johnson Digital Health Masterclass and an impressive line up of some of Europe's foremost experts in healthcare, technology, business strategy and venture capital is in place to help companies deliver on their growth agenda.

April 16,2014

Are you going to lose some weight? Here is some interesting information or you.
Via: Mocavo - Genealogy Search

November 7,2012

Here are some interesting and important facts on Men's Health. All men who care about their health, should read it.
Via: Surex Direct

May 14,2006

Three years after federal rules governing the privacy of patients’ medical records went into effect, compliance seems to have declined for 6 percent, according to an annual survey conducted by the American Health Information Management Association (AHIMA). Read more about this at here.

September 5,2014


Medicine is evolving to solve the modern epidemics of chronic disease, such as Type 2 diabetes, heart disease and a range of autoimmune diseases. The Evolution of Medicine Summit intends to not only shine a light on the work of those visionaries and innovators leading this evolution, but also set a unique vision for a more evolved healthcare system.

Unfortunately, conventional medicine has a very difficult time providing a patient-centric, empowered, proactive and participatory experience.

Fortunately, our 37 expert doctors, researchers, authors, innovators, practitioners, coaches and activists bring rich experience and thought leadership from diverse areas from within health care.

The Evolution of Medicine Summit begins on Monday, September 8, register for free now: http://bit.ly/1u6Qhao

March 22,2010


Acupuncture involves stimulating points on the body, using thin, solid, metallic needles that are manipulated by hand or by electrical stimulation. Chinese tradition teaches acupuncture practitioners that the aim is to improve levels of qi, which is considered the energy force behind all life, and restore balance in the opposing forces of yin and yang. The needles are placed along meridians, invisible energy channels described in ancient Chinese manuscripts as running the length of the body.

Building an Evidence Base: Clinical Research Progress
“Our goal is to build a house of evidence,” explains long-time NCCAM grantee Brian Berman, M.D., director of the Center for Integrative Medicine at the University of Maryland School of Medicine.
To date, much of the progress in clinical research on acupuncture has come from an interdisciplinary approach that includes experts in acupuncture, clinical trial methodology, biostatistics, and relevant diseases such as osteoarthritis or carpal tunnel syndrome.
“What we’ve learned so far is that the most promising area for using acupuncture is pain,” says Dr. Nahin. Clinical studies are showing acupuncture’s efficacy for some types of pain, such as back, osteoarthritis, and postoperative pain. For example, a systematic review supports the use of acupuncture for postoperative pain management. An NCCAM-supported Phase III clinical trial led by Dr. Berman showed that acupuncture relieved pain and improved function in patients with knee osteoarthritis when it was used with standard medical care, including anti-inflammatory medications and opioid pain relievers. In a large study published in 2009, researchers found that people suffering from chronic low-back pain who received acupuncture or simulated acupuncture treatments fared better than those receiving only conventional care. Pilot studies have looked at acupuncture in posttraumatic stress disorder and chemotherapy-induced nausea and vomiting. And, the Cochrane Collaboration reviewed 11 randomized trials and found that acupuncture may be a valuable option for patients suffering from tension headaches.
But these clinical outcomes may involve more than acupoints and needles. Other aspects of the acupuncture experience may play important roles in healing, including reassurance provided by the practitioner, expectation of benefit, and the sensory experience elicited by acupuncture needling, which has been called de qi and variously described as aching, dull pain, tingling, or a heaviness. In several recent studies researchers have carefully designed their studies to compare true acupuncture to simulated acupuncture and have tried to mimic the sensory experience of true acupuncture so that patients would be unaware of whether they were receiving true or simulated acupuncture. In some of these studies, such as the 2009 study on low-back pain, both simulated acupuncture and real acupuncture produced greater benefit than standard therapy.


NationalNCCAM, National Institutes of Health
Bethesda, Maryland 20892 USA

February 6,2010


Many people take dietary supplements in an effort to be well and stay healthy. With so many dietary supplements available and so many claims made about their health benefits, how can a consumer decide what’s safe and effective? This fact sheet provides a general overview of dietary supplements, discusses safety considerations, and suggests sources for additional information.

Key Points

  • Federal regulations for dietary supplements are very different from those for prescription and over-the-counter drugs. For example, a dietary supplement manufacturer does not have to prove a product’s safety and effectiveness before it is marketed.
  • If you are thinking about using a dietary supplement, first get information on it from reliable sources. Keep in mind that dietary supplements may interact with medications or other dietary supplements and may contain ingredients not listed on the label.
  • Tell your health care providers about any complementary and alternative practices you use, including dietary supplements. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Dietary Supplements

Woman looking at a pill bottle.
© Jupiterimages

Dietary supplements were defined in a law passed by Congress in 1994 called the Dietary Supplement Health and Education Act (DSHEA). According to DSHEA, a dietary supplement is a product that:

  • Is intended to supplement the diet
  • Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and certain other substances) or their constituents
  • Is intended to be taken by mouth, in forms such as tablet, capsule, powder, softgel, gelcap, or liquid
  • Is labeled as being a dietary supplement.

Herbal supplements are one type of dietary supplement. An herb is a plant or plant part (such as leaves, flowers, or seeds) that is used for its flavor, scent, and/or therapeutic properties. “Botanical” is often used as a synonym for “herb.” An herbal supplement may contain a single herb or mixtures of herbs.

Research has shown that some uses of dietary supplements are effective in preventing or treating diseases. For example, scientists have found that folic acid (a vitamin) prevents certain birth defects, and a regimen of vitamins and zinc can slow the progression of the age- related eye disease macular degeneration. Also, calcium and vitamin D supplements can be helpful in preventing and treating bone loss and osteoporosis (thinning of bone tissue).

Research has also produced some promising results suggesting that other dietary supplements may be helpful for other health conditions (e.g., omega-3 fatty acids for coronary disease), but in most cases, additional research is needed before firm conclusions can be drawn.


.N C C A M: The National Center for Complementary and Alternative Medicine

August 6,2009


In the past decade,newspaper was ubiquitious to news.We relied on Newspaper everyday to deliver us uptodate news about what was happening not only in the region in which we habitated but also for news from across the world.

Newspaper displayed our classified ads,and we trusted   them to sell or buy local stuff,but when Internet surfaced on the horizon,newspaper industry,never gave much importance to that,in as much dismissed it as a phenomenon which was made popular by the dot com growth,with some teenager in basement running a website.
The authority of website or the power of communities or even the power of the people was not much anticipated.
In 2009,we depend on online media to deliver our news,either through RSS or by visiting some trusted news-sites,Blogs are some of the people driven content that we read regularly then  newspaper column.
We buy and sell most of our stuff online,we buy even books regularly online,watch movies online or even watch news video online.
Why? one is the time factor as in five mins,one can absorb as much news..then spending few hours browsing through a Newspaper.
There are many other reasons..apart from these…
What does it abode for the healthcare industry.The same pattern as the Newspaper industry.
Today,patients are well informed about their medical condition then their local GPs,they discsuss about various procedures,its benefits and effects online,They read journals online and many ventures on the Internet are now surfacing which have direct patient management role.
One of the major impact Internet will have is online management of health of an individual.Personal health records which were once upon a time managed through paper based records,will now shift to web based format.
But,the major barrier to the growth has been the factor of trust,and also the loss of data.
If the e-commerce industry could grow rapdily in the past few years,to simulate online purchase-it was due to enhanced security,trust and also depersonalization of the data.So that in case if the financial transactions are manipulated,not much is lost.Yet it is not perfect.But,a step in right direction.
If the same could be replicated in health care industry in management of health care records?will it change the face of health record management?

December 1,2010


NHIN Direct, under the leadership of Dr. Doug Fridsma at the Office of the National Coordinator for Healthcare IT, is now known as The Direct Project.  According to Government Healthcare IT News, “The Direct Project is a streamlined version of the more robust nationwide health information network standards set (NHIN), and will offer physicians and small practices the ability to conduct basic health record exchanges. For example, a primary care physician who is referring a patient to a specialist can use the Direct Project to send a clinical summary of that patient to the specialist, and to receive a summary of the consultation”  Open software is available in both .Net and Java versions. Per http://directproject.org, the Direct Project specifies a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet.  It relies on the sender pushing information to a recipient, using standard e-mail protocols, and does not rely on a central registry of patients, such as would be found in the NHIN Connect solution.

See also:  http://www.govhealthit.com/newsitem.aspx?nid=75326


Categories: All , News and Views

October 11,2010




Categories: All , News and Views

August 1,2013

No HIMSS News Item found. Please visit HIMSS News page for other latest News
Source: HIMSS Live!
Categories: All , News and Views

October 10,2014

After more than 3 years away from Goomedic.com we are back , with more focus this time of the blogging about Medical Informatics , Open source , Frameworks , Games Engines , and Linux...
Source: Goomedic.com
Categories: Technical , News and Views , All

May 22,2012

An interview with ” Heart Rate Monitor Butterfleye ” The Challenges of Being a Hardware Entrepreneur . In a chat with Wamda at Qatar’s ICT conference QITCOM, Hind Hobeika, the creator of Butterfleye (http://butterfleyeproject.com/),...
Source: Goomedic.com
Categories: Technical , News and Views , All

October 30,2011

Mendels Accountant is featured project at sourceforge.net in genetics and bioinformatics , It works on Linux systems and Windows . Mendels Accountant  is a biologically realistic, forward-time, parallel, numerical simulation program which models genetic change...
Source: Goomedic.com
Categories: Technical , News and Views , All

July 17,2013


We have just published an article in The Journal of Emergency Medicine titled “CPR PRO® Device Reduces Rescuer Fatigue during Continuous Chest Compression Cardiopulmonary Resuscitation: A Randomized Crossover Trial Using a Manikin Model”

This is the first trial to test the benefits of the device I have invented and have been developing the last couple of years. This device is called CPR PRO and is intended to allow rescuers to performed better chest compressions.

Here is the summary of the article:

1. Why is this topic important?
Rescuers are often required to perform cardiopulmo- nary resuscitation (CPR) for prolonged periods of time, and their fatigue has been shown to cause significant decline in quality of chest compressions, which are crucial for survival of sudden cardiac arrest victims.

2. What does this study attempt to show?
In our randomized crossover trial, health care professionals performed continuous chest compression CPR for 10 min on a manikin to evaluate the impact of a novel CPR PRO! device for manual chest compression on res- cuer fatigue, pain, and CPR quality.

3. What are the key findings?
After using the CPR PRO device, subjects reported less pain in the hands and lower perceived exertion levels, as well as achieving lower average and maximal heart rates during testing, when compared to standard manual CPR. Reduced fatigue and pain has resulted in higher average depth of chest compressions, which declined more slowly over time, than with standard manual CPR.

4. How is patient care impacted?
In a simulated setting, a novel CPR PRO device for manual chest compression has been shown to reduce the work of CPR, which allowed rescuers to achieve signifi- cantly higher quality of chest compressions. Delivering higher quality of chest compressions with minimal interruptions in the clinical setting has a potential to result in better patient outcomes after sudden cardiac arrest.

March 8,2013


Do you know who is the infamous killer from the title?
Lung cancer? No
Breast cancer? No
All of them combined? No, its sudden cardiac arrest.

Watch a short documentary about the massive loss of life in the UK due to sudden cardiac arrest and ways that the death rate can be dramatically reduced.

Help the goal to place 500 public access AEDs across the UK.

Learn and perform better quality CPR with our CPR PRO mobile app.
Learn how AEDs work and practice using these lifesaving machines with our AED Trainer app.

October 15,2012


Tomorrow I will be travelling to Vienna, Austria to take part in the Resuscitation 2012 congress organised by the European Resuscitation Council. At this annual congress, which will take place from Thursday 18 October until Saturday 20 October 2012, I will be one of the members of the official Social Media Team. Our team will work HARD&FAST to bring you all the news and updates live during the Resuscitation 2012 congress.

Follow us across all our networks:
Twitter -  use #erc12vienna hashtag to be heard!

February 27,2015


It seemed appropriate for me to follow up with part 2 of my experience with a new wellness focused medical practice called Turntable Health, an operating partner of Iora Health. In case you missed part 1 of the journey, you can find it here.

Walking into the clinic, there was a different feel. It felt more like walking into a local coffee shop than going for a doctors appointment. The lobby was so inviting that I wondered if some in the community used it as a place to go and work on occasion. I spend a fair amount of time in the Downtown Las Vegas tech community, so it wasn’t a surprise that I actually knew a few of the people in the lobby. So, I was able to connect with some friends while I waited for my appointment.

The check in process was simple and I was invited back by my health coach. In this case the health coach acted very much like an MA or nurse in a regular medical office, but the feel was more friendly an casual. We both knew we had an hour together so there wasn’t the usual frenetic pace the accompanied a doctors office.

I had a couple paper forms to sign (yes, the signature is still often easier on paper), but no major health history to fill out or anything like that. They had a one question survey that I think was about my current state of wellness. Over the hour the health coach did ask many of the questions that would be on a normal health history form and key them into the Iora EHR system. It was a unique approach since it gave me the opportunity to talk about the things as we went through them and many of the things we talked about (ie. my family health history) came up later in my conversation with the doctor.

The exam room looked quite a bit like any other exam room you might visit. The colors and lighting were nice and they had little touches like this local art work display in the exam room (see picture below). It’s kind of interesting to think about a doctor’s office as a kind of local art gallery.

At one point in the conversation with my health coach, we talked a bit about fitness tracking and she quickly emailed me some fitness apps that she liked. Little did she know that I write about such apps and that industry for a living on Smart Phone Healthcare. It also illustrated how much of a need there is for someone to be a trusted content curator of the 30k+ mobile health apps out there. Especially if we want healthcare providers to make a dent in actual usage of these to improve our wellness.

After completing her assessment, my health coach left the room and came back with the doctor. When he came in he told me that my health coach had talked with him about me and my health (in a normal practice this amounts to “Fever in room 3″) and he wanted to talk to me about a few of the issues I was dealing with. When he did this, the doctor and my health coach came into the room and we all sat around a small table. It was almost as if I’d just sat down for hot chocolate (I don’t drink coffee) with my doctor and my health coach.

There were a few differences though. When my doctor sat down he plugged in a chord to display his computer screen (my record) on a big plasma monitor that we could all see. I’m not sure why my health coach didn’t do that too. I almost moved over next to her to watch her enter the data, but I felt like that was just my inner EHR nerd coming out. Plus, I didn’t want her to necessarily know my background in that regard and that I’d be writing about the experience later. I wanted to see what they usually did for patients.

Because we were all sitting around the proverbial exam room “coffee table” I didn’t feel rushed at all. We talked about a couple sports issues I’ve been dealing with and ways that I could make sure they don’t continue to get worse (since I’m definitely not stopping my sports playing). We also spent some time talking about how to work on some long term wellness tracking around high cholesterol and diabetes.

After the visit, I realize that in many ways it wasn’t any different than a regular doctor visit. I could have gone into any doctor’s office and discussed all of these things and likely gotten similar answers. I think part of this is Turntable Health still working on the evolution of how to really treat a patient from a Wellness perspective. However, while many aspects of the treatment were the same, the experience felt different.

The long appointment time. The health coach. The doctor that wasn’t rushed all contributed to a much different visit than you’d get in most doctors’ offices. You can be certain that had I gone to a doctor for my sports issues, we wouldn’t have talked about things like cholesterol and diabetes. There wouldn’t have been time. Was the care any better or worse? It’s the same care that would have been provided by other professionals, but the care was given room to breathe.

As I left the visit, a part of me did feel a little disappointed. You might wonder why after this glowing review of the unique experience. I think the disappointment came from some improperly placed expectations. I’m not sure I really thought deeply about it, but I wish I’d realized that they’re not going to solve your wellness in one visit.

When I think about my psyche as it relates to doctors, I’ve always approached a doctor as someone you go into and they fix you and then you go home. When applying that same psyche to a wellness based approach to medicine, it leads to inappropriate expectations. Wellness is a process that takes time to understand and address. In fact, it’s a process that’s likely never done. So I think that led to my gut reflex expectation of what I’d experience.

I think one way Turntable Health could help to solve these expectations is to do a better job on the first visit to describe the full model and plan for what they want to accomplish with a patient. Otherwise, you really just feel like you’re going in for another doctor’s appointment. I’m not sure if that’s a cool chart of all their services and how they help me improve my wellness or if it’s a list of ways that they’re working to help improve my wellness.

Basically, I wish they’d over communicated with me how Turntable Health was different and how they were going to deploy a suite of professionals and services to better help my overall wellness. It’s easy for those working at Turntable Health to forget that new patients haven’t seen their evolution and don’t know everything they’ve done to improve the primary care experience.

A few other things I’d have loved to seen. First, I filled out their 20 minute (I think it took me 10-15) survey before the appointment. I didn’t get any feeling that the health coach or the doctor had actually seen the results. In fact, the health coach asked me some of the same questions. Redundancy can be appropriate on occasion, but it could have made the visit more efficient if they already knew the answer to those questions and instead of getting the info they could have spent the time talking about the answers as opposed to getting the answers. Plus, I’m sure my answers would have triggered some other discussions. It all made me partially wonder why I filled out the survey in the first place. Were those just part of some research experiment or were they to help me improve my health?

I was quite interested in their portal and what it offered (obviously, since I’m a techguy). It seemed like the framework as opposed to a fully fleshed out solution. I could see where it could grow to something more powerful, but was disappointing on first login. In one area called measurements it had graphs of my Blood Pressure, Fasting Glucose, and Weight. Unfortunately, after one visit they only had one data point and now way for me to easily upload all my weight measurements from my iHealth scale. Hopefully integrations like that are coming since that data could definitely inform my wellness visits. I guess they need to work on the first time user experience for the portal. At least I can schedule appointments through it.

I imagine some of you are probably looking at this as a pretty major investment in my health. Some might even think an hour long appointment would be more time than they want to spend with the doctor. I get that and I don’t always want my appointment to be that long. In fact, now that I have my baseline, I hope that many visits become an email exchange or other electronic method that saves me going into the doctor at all. However, as I’m getting older, I see this as an important investment in my long term health. Hopefully this investment has a good ROI.

With that in mind, I’ll do what I can to keep you updated on my experience. Since I’m on a journey of wellness, I imagine this is Part 2 of Many. I hope you enjoyed the look into my experience.

February 26,2015


In light of yesterday’s short story post, and also my post on EMR and EHR about concierge medicine, I thought it timely for me to document might entrance into what many are calling the next generation of healthcare. They talk about it as primary care that puts people first.

In my case, it’s my recent membership in Turntable Health, an operating partner of Iora Health. When I had to switch insurance plans this year, I decided to try out this new approach to primary care. The insurance plan I chose included a membership to Turntable Health. For those not familiar with Turntable Health, it was started by the infamous ZDoggMD and is backed by Tony Hsieh’s (CEO of Zappos) Downtown Project in Las Vegas.

To be honest, I’m not sure exactly what I’ve gotten myself into, but that was kind of the point. I can’t remember the last time I went to a primary care doctor. In fact, if someone asked me who my primary care doctor was I wouldn’t have an answer or I might mention one that my wife visited. I’m a relatively healthy person (luckily I have some good orthopedic friends for my sports injuries) and so I’ve never felt the desire to go in and see my doctor. I feel healthy, so why should I go and pay a doctor to tell me I’m healthy? I think this view is shared by many.

Will Turntable Health be able to change my view on this? Will they be able to take a true Wellness approach to things that will change how I view primary care? I’ve written for years about Treating a “Healthy” Patient, and so I’m interested to see if Turntable Health is making that a reality.

One thing is for sure. They’re taking a different approach than most doctors. I scheduled my first appointment for later today (Side Note: Not sure what it says that it took me 1-2 months to schedule my first appointment.). They slotted me in for an hour long appointment (a requirement for the first appointment) so that they can really get to know me and my wellness needs. Plus, they said I’d get a chance to get to meet my care team. A care team? What’s that? I’ll let you know after my appointment, but looking at their team I’d say it includes physicians together with health and wellness coaches.

The idea of a team of people thinking about my and my family’s wellness is intriguing. Although, I’ll admit that this wasn’t the biggest reason I chose to sign up with Turntable Health. It was part of the reason, but I was also excited by the idea of unlimited primary care. With unlimited primary care, it opens the door to things like text messages or eVisits with your doctor since they’re truly interested in your wellness and not churning another office visit to get paid.

With a family of 4 kids, there are dozens of times where my wife and I debate whether an office visit is needed. Every parent knows the debate. Am I just being paranoid or are they really sick? Is that rash something that needs to be treated right away or should I give it some time? Final answer: Let’s just take them in, because I don’t want it to be something bad and then I feel like I’m an awful parent because I chose not to take them in. I’m hopeful that with Turntable Health we can alleviate those fears since we don’t have to pay for the visit and we can start with an online visit which saves us time. That’s extremely compelling to me.

I can already say that my experience has been different. After scheduling my first appointment, I got the usual email confirming my appointment, offering directions to the office, and inviting me to fill out an “Online Health Assessment.” I thought it was cool that they were asking me to fill out those lengthy health history forms electronically before the visit. Turns out I was wrong. It was a survey style assessment of my health and wellness. They asked questions about my mental and physical health. They asked about my diet and exercise. They even asked about my quality of life. There weren’t any questions about my neck issue or the pain in my hand, let alone my allergies or past medical history. I wonder if they’ll do that when I get to the office. Plus, I’ll be interested to see what questions they ask me about that true wellness assessment.

Like I said, this appointment should be interesting. To be honest, I feel like I’m learning a new healthcare system. I know what’s appropriate and how the regular doctors office works. Here I’m not sure what’s right or wrong. Take for example the list of health and wellness classes Turntable Health offers with their membership. What other primary care office offers Tai Chi, Hot Hula and Meditation courses? I might even have to start doing yoga. Why not? It’s free. Although, what a different approach to Wellness.

There you go. There’s part 1 of my introduction into a new model for primary care. How will it go? We will see. How will they handle the fact that I’m a picky eater and that doesn’t jive well with many of their perspectives on Wellness? Will they really care about my wellness enough to reach out to me beyond appointments? How will my family and I react to this outreach? Will we stonewall them or will we embrace the increased interaction? It will be a fun journey and I hope you’ll enjoy me sharing it with you.

All in all, it does feel like they’re trying to restore humanity to healthcare. We’ll see how much we like humanity.

February 25,2015


Every once in a while I come across a piece of healthcare prose that I have to share, but there’s no good way to share it in pieces. I found that once in The Old Man and the Doctor Fable. It’s a must read if you haven’t read it.

I recently had another such example shared with me called “Please Choose One“. This one took me a second to really get into it, but about a quarter of the way through, I couldn’t stop reading and had to figure out how it ended. I’m sure that many physicians will feel the heartache shared in this short story. Thank you Philip Allen Green, MD for sharing. If you haven’t gone and read it, go read it…we’ll be back here once you’re done.

Obviously, the story is told in an exaggerated worst case scenario fashion. Although, to me that’s what illustrates the point so well. The lesson I took from the story is that we can’t take the human out of healthcare. Technology should help us offer more humanity to patients as opposed to less. Furthermore, we’re at risk for doing the opposite.

What’s your takeaway? I’d love to hear your thoughts on the story.

March 29,2013


As discussed in the previous posts, the nodes use the CP Split’s patented process in template models to:

  1. Create Content Configurations in a Content File Production Grid (CFP) Grid using spreadsheet and third-party applications
  2. Transfer these Content Configurations into a Content File for storage and distribution
  3. Transfer the Content Configurations from the Content File into a Content File Consumption (CFC) Grid where (a) formatting instructions from spreadsheet and third-party applications present reports by rendering each content element based on its location within the spreadsheet and (b) the content elements may also be sent to populate databases.

This process differentiates the CP Split from all other technologies used for the distribution and presentation of reports. Following is a discussion of these differences and the benefits of using the CP Split technology.

How Does the CP Split Differ from Database Report Writers?

The CP Split technology differs from database report writers in the following operations:

  • Database report writers and the CP Split differ in the way they retrieve the content for a report:
    • With a database report writer, the end user/client (i.e., a Subscriber node) must query a database, and indicate how the returned data are to be analyzed and formatted. The user selects predefined report formats or creates new ones.
    • With the CP Split, the end user does not query a database when generating a report. Instead, a Publisher node does any required database querying, as well as any required data analyses and other non-formatting manipulations of the data returned from the queries. It then organizes the resulting content into Content Configurations in its CFP Grid. The framework (grid-based structure) for organizing the content into configurations are created when the Publisher and Subscriber/Presenter Templates are developed and assure that the Content Configurations in the Publisher's CFP Grid correspond to their Subscribers’ CFC Grids (the next post discusses best practices for building the Content Configurations). Like the database reports, the queries, analytics, and formats may be predefined for its Subscribers, or new ones may be created via instructions from Subscriber nodes.
  • Once the data queries and analytics are done, the resulting content must be formatted for report presentation. Types of report formats include columnar, crosstab, form, label, and OLAP/pivot table, and their views may include graphs/charts, lists, tables, text boxes, and more. Database report writers and the CP Split differ in the way they manage and format content for presentation:
    • Database report writers render queried content through instructions that format content elements based on their fields (and possibly other attributes). Reports can be published to a variety of file formats for distribution, including XML, PDF, HTML, RTF, Word, Excel, text, and more.
    • With the CP Split, the Publisher node places the Content Configurations from the CFP Grid to Content Files for storage and transmission, and then sends the files to its Subscriber nodes. Upon receipt, each Subscriber node places the Content Configurations from the Content File into its CFC Grid and formats the content elements for presentation through formatting instructions applied to particular content elements based on their cell locations in the CFC Grid.

Compared to database report writers, the CP Split has distinct advantages when disseminating interactive reports containing numeric values and related visualizations (e.g., charts/graphs, etc.). This is because the CP Split technology keeps the numeric content "live" – i.e., the numbers are not embedded in markup tags or converted to text – so they are ready for reuse immediately. This means there is no need to re-entry the data, use screen scrapers, or do time-consuming data parsing and transformations when using the CP Split. Furthermore, the CP Split enables content to be transmitted in its most efficient form, i.e., in delimited formats (such as in CSV files) that contain no formatting instructions, markup tags, or programming code.

How Does the CP Split Differ from Spreadsheet Reports?

To understand the CP Split more fully, it is necessary to compare it to technologies beyond database report writers.

For example, it is possible to distribute entire spreadsheet workbooks filled with the content, formatting instructions and macros. This is a very inefficient approach because every time the content is updated or used by a different model, new workbooks must be distributed, which can be very large (many megabytes). This approach also makes it difficult to track changes made to the content or models over time - for auditing purposes for example - since multiple version of the workbooks must be stored, which can require complex versioning controls.

A more sensible and elegant method for delivering report updates is to use the CP Split to distribute the content, and only the content, in delimited text Content Files. These files are a tiny fraction of the size of entire workbooks because they do not contain formatting instructions, code, or markup tags. In addition, they provide easy auditing (through change management methods) and file management (by using ID numbers to maintain the proper association between Content Files and the template files that produce and consume them). The workbooks containing the models are only redistributed if the models represented in the templates changes, which may me necessary, for example, if the schema of the source data changes.

Benefits of the CP Split Technology


The benefits of this unique approach are realized when content is shared between nodes using different template models to generate different reports, or between different nodes with the same template model to generate the same report.

The CP Split technology, therefore, offers this unique set of benefits:

  • Content from diverse sources can be integrated and stored in a uniform structure for use across multiple platforms and applications, which provides a simple, transparent (human readable), and auditable interoperable architecture

  • Different audiences can receive different portions of the content and have it rendered in particular ways based on what they need for personalized reports

  • Content can be integrated from different sources easily for distributing composite reports

  • Portions of a Content File can be sent to different data stores (e.g., to populate a data warehouse)

  • Content can be manipulated (e.g., analyzed, adjusted, transformed) without costly conversion from appearance-based text representations

  • Content can be repurposed quickly and easily for different presentation media

  • Content is transported in smaller files that consume less bandwidth because they do not contain formatting instructions, markup tags, or code

  • Exceptional speed and efficiency is achieved when dealing with numbers and computations, and when generating charts and graphs, because the Content Configurations can be distributed in their proper "serialized" order, which enables rendering engines to generate charts and graphs more quickly and easily

  • Different models with different formulas can be used to calculate the same set of data from a Content File, and sets of data from Content Files can be modified on-the-fly to accommodate different computational models (e.g., when doing real-time "what-if" scenarios, when slicing & dicing aggregated data) -- all without complex or time-consuming pre-processing, e.g., there is no need for database queries, for XML parsing and XSLT transformations, and for online analytic processing (OLAP) by the client.

  • Changes can be made to the data in a model and those changes distributed as necessary, which is important when (a) editing out mistakes or updating sets of data, (b) creating and analyzing what-if scenarios, and (c) computing the same set of data using several analytic models because these activities may require somewhat different data.

  • Data can be added to a model and those additions distributed when necessary, which is important in collaborative situations when (a) different people must input data to complete a data set, (b) automated (unmanned) nodes supply data, and (c) several analytic models are used to compute the same set of data, and certain models require additional data

  • Portions of a data set can be restricted from being accessed by particular models, which is important when different users with different roles require only a portion of a data set; it helps assure people get to see only the data they need to minimize information overload and protect data from being viewed by unauthorized persons

  • Content can be "scrambled" for a unique form of security that is forever immune to brute force attacks (see MultiCryption).

February 8,2010


The CP Split can utilize MultiCryption™ software security tools to provide a unique, multi-level, data security process for exceptional data protection.

MultiCryption software uses four special levels of encryption for a virtually foolproof way to secure data files as they move across the Internet. It sets a new standard for data protection -- that is even immune to brute force attacks -- with these unique security methods:

  1. File Decomposition/Recomposition - Breaks a data file into several sub-files for transmission and reassembles them upon receipt using keys
  2. Data Expansion/Contraction - Separates the words, punctuation and numeric data in each sub-file into individual characters for transmission and puts them back into the correct words and numbers upon receipt using keys
  3. Counter-Crypto - Adds additional characters, based on a statistical distribution analysis, for transmission and removes the extra characters upon receipt using keys
  4. Data Scrambling/Unscrambling - Mixes up all the characters in a random manner for transmission and rearranges them upon receipt using keys

Click this link for more: MultiCryption™ technology

December 27,2009


Up to this point, I described how the nodes' asynchronous publish-subscribe process works, and discussed the use of spreadsheet templates for producing and consuming content files. This post describes the inner workings of the CP Split technology.

The Publisher Template

If a node has publisher functionality, its Publisher Template must be pre-configured to execute the operations required for Content File creation and transmission. During this process, a reference tuple is created. Once CP Split is configured, the reference tuple is used in the process to ensure continuous referential integrity and entity integrity. Hence, this reference tuple promotes versioning.

One type of pre-configuration involves database queries. That is, if a Content File will contain data from one or more databases, the proper SQL/ODBC query code (macro/script) must be written in its template’s grid code layer. In an MS Windows operating system using Excel as the node’s underlying application, for example, the query for each database must be configured with the correct login ID & password, and it must use the correct ODBC drivers. In addition, the proper fields and records must be identified, as well as the particular spreadsheet cells into which the queried data are to be sent.

Using a Publisher Template’s macros to execute the queries enables them to be initiated automatically via remote request by having the Publisher node execute the correct queries for each of its Subscriber nodes based on ad hoc and pre-scheduled requests from its Subscriber(s). The following key processes occur automatically:

  • Prior to creating a Content File for a Subscribing node, a subscription manager in the Publisher Template must store the IP addresses and authorization information for all Subscriber nodes authorized to communicate with it. This can be done, for example, by distributing to each node a list of authorized nodes, by using a centralized directory, or by having information requests and responses go to intermediate nodes that do the authorization before allowing them to be sent.

  • The Publisher node must also be pre-configured to establish communication standards with each Subscriber, i.e., a “hand-shake” that ensures the nodes communicating with one another (a) are allowed to connect (i.e., their connections are authenticated) and (b) agree on how the transmission will proceed by defining how information requests from each Subscribing node must be structured and how the Content File is to be organized by the Publisher node to enable the Subscriber node’s template to read and present it as a report. For example, during the establishment of the node network, each node’s Template File would be set up with the forms, code, and metadata needed to send information requests and Content Files to each other in a way that enables each node to understand the specific data in specific cells by virtue of their cell locations in a spreadsheet.

  • For ad hoc requests – such as a doctor (Subscriber) requesting the data of one or more patients from other healthcare providers (Publishers) with a different EHR systems who treat the same patients – each Publisher node’s Template File bases its queries on the requested information sent by an authorized Subscriber’s node, including patient identifiers and requested data sets. It’s macros use this information to define the correct table, records and fields to query via metadata in the models (e.g., database schema maps) and subscription rules (e.g., rules defining allowable fields to be queried based on each Subscriber’s healthcare specialty).

  • For pre-scheduled requests, a node’s Publisher Template executes rules for performing such functions as sending certain Subscribers particular patient data automatically whenever the Publisher updates those data. These rules determine the queries to be executed and the spreadsheet cells into which the queried data are sent.

  • Whether ad hoc or scheduled, once the required data sets are queried and stored in the appropriate spreadsheet(s), these data are then processed by cell formulas (which may be in other spreadsheets) and macro functions as defined by the Publisher Template’s models. This functionality may be integrated into third-party products such as statistical/data mining applications, inferential logic engines, etc. This processing performs any required data analytics and transformations. It then organizes the resulting data value and text strings into pre-defined cellular configurations (i.e., “Content Configurations”) in a spreadsheet (i.e., the “Content File Production Grid” or “CFP Grid”), the cell positions of which are known by the Subscriber/Presenter Template as discussed below.

  • When this processing is done, the Publisher Template then saves the arrays of values and strings, without any formatting instructions and code, in a delimited text file (such as CSV format) for maximum efficiency, or in other less efficient file formats (such as spreadsheets, XML, etc.). This file is the Content File.

  • Once the Content File is created, other Publisher Template functions send it to the appropriate Subscriber nodes as an e-mail attachment or via other means (e.g., FTP).

The Subscriber/Presenter Template

If a node has subscriber and report presentation functionality, its Subscriber/Presenter Template must be pre-configured to execute the operations required for consuming and rendering particular Content Files. Using its template’s spreadsheets and macros to consume and render a Content File enables a node to composite and generate reports without ever having to query a database or connect to other data sources. Following are key processes:

  • Prior to receiving a Content File from a Publisher node, the Subscriber node’s Subscriber/Presenter Template must be pre-configured to establish a certain communication standards with the Publisher, as discussed above.

  • Once a Subscriber node receives a Content File from an authenticated Publisher node, it uses the pre-configured models that have been assigned to that Publisher node to consume the Content File. This process involves using a macro to take the data and information contained in the Content File and parsing them into specific, pre-determined cells in a spreadsheet (the “Content File Consumption Grid” or “CFC Grid”). There is a semantic correspondence between the cellular locations of the content in the CFP Grid and the CFC Grid, which enables both the Publisher and Subscriber to “know” the particular content elements stored in each cell.

  • Once the Content File’s contents are in the CFC Grid, Excel macros and cell functions format the contents of single cells or cell ranges and present them in reports as populated user forms, charts/graphs, grids, lists, text blocks, hyperlinks, etc. as specified by the template’s models. The models may limit reports to single views or provide user interactivity that enables different views of the data (e.g., data slicing/dicing/drill-down, “what-if” scenarios, choice of graphs, etc.). And if a composite report is to be generated, the Subscriber node takes multiple Content Files from one or more Publisher nodes and parses each on to pre-defined portions of the CFC Grid. It then combines parts of this content as defined by its models and renders it accordingly.

  • In addition to (or instead of) presenting reports through the Excel workbook, the Subscriber/Presenter Template could enable third-party report writers to access the CFC Grid and generate the reports. Or it can send the data from the Content File to a database the third-party report writers can access.

  • If a Subscriber/Presenter Template is configured to populate databases with the data from Content Files for report generation or other purposes, it must have the proper SQL/ODBC query code (macro/script) including the correct login ID & password and ODBC drivers. In addition, the proper fields and records must be identified, as well as the particular spreadsheet cells from which the data are to be obtained.

January 26,2012


The following just came across my Google Alerts:Healthcare Analyst Values MMRGlobal Patents at $300-800 Million. This is scary. I’ve seen this company for years; they were one of the pack trying to build personal health records in the mid-2000s, and from what I’ve seen there is nothing in their historic offering that was particularly innovative – except that unlike most of the others running around at the time, they appear to have had some budget to file some patents, and they have now commenced shaking other people down.

Now, I haven’t done a very complete review of their patent holdings, and they may well have some highly innovative, original work there that took a substantial investment to develop and realize. But that’s not the trend, and I’m very concerned that this could be problematic for a lot of small innovators in the personal and clinical health records markets. Software patents have become a real problem across a variety of domains, but so far HIT seems to have avoided the worst of it. I suspect that this is in part because of industry’s long history – most of the core capabilities were introduced long enough ago that any patents would have expired. There’s a ton of prior art: you can track a lot of personal health monitoring to 1994′s Guardian Angel Manifesto. But that’s expensive to litigate when the trolls come out from under the bridge.

As it stands, I’m looking for defensive patent structures for my own start-up so that we have some chits to trade if someone comes knocking. And that’s a shame – I have better things to do with my time.

Source: info.rmatics

January 10,2012


Just read a nice summary from OpenView on hiring your first sales manager. This is, far and away, one of the most daunting things that any technically minded startup CEO faces. If you come from an engineering or science background, it’s easy to think of the sales team as, if not actually an enemy, as something a little bit alien. I know a lot of engineers who simply don’t get on people in sales – they regard them either as ineffective suit-fillers who can’t do “work that matters” or as the latest embodiment of the obnoxious popular kid from high school.

Some companies try to get around this by making sales people out of people who aren’t naturally sales people. In the Healthcare IT space, that’s often former nurses or physicians who want a career change. In software, it’s often software engineers. There’s potential in all three groups, but it takes a certain type.

If all goes well, I’ll be going through this process again in the near future. If so, I’ll post what I learn.



Source: info.rmatics

January 3,2012


Knowing how to code is a really useful skill for anybody in business. For an entrepreneur, it means you can validate your high-tech startup idea without having to out and recruit a CTO or spend a lot of money on an external software development shop. But even if you’re running a pizza place, a little bit of coding experience can save you a lot of time when you’re playing with Excel spreadsheets late at night trying to figure out how much money all that fancy pepperoni is costing you.  Most people are in the middle. I have a lot of friends who went into management consulting – the ones who know how to write little bits of software to help them do their jobs tend to get a lot more sleep at night.

The other reason to learn programming – even a little bit of programming – is that it makes the whole process of interacting with technology a lot less scary. Computers are black boxes, and people don’t trust black boxes.

So I thought CodeAcademy was pretty cool. It’s a web site that takes you through some simple programming exercises in JavaScript, which is one of the most common programming languages on the web. In half an hour you can go from no experience at all to writing simple programs. They don’t do that much, and to solve real problems you’ll have to do more. But it’s a nice way to start out – and even if the student doesn’t go any further they’ll benefit from a more visceral understanding of how computers work. In the best case, it will teach them to recognize the kinds of patterns that can be solved with a little code.

Having written that, I suppose I should consider the opposite extreme. Just because you can write simple programs after half an hour of interactive lessons doesn’t mean that software development is either easy or low-value. It’s not. A top-tier software engineer took thousands of hours to get that way.

Source: info.rmatics

July 31,2013


The following is a guest post by Zachary Landman, M.D., Chief Medical Officer for DoctorBase.
landman fb
With the infusion of 30 million patients into the U.S. healthcare system in the coming years, the physician shortage is only going to worsen. In Massachusetts, which has had a similar healthcare legislation enacted since 2006, improvements in healthcare coverage and access are highly associated with physician shortages. Prior to the implementation of the health law in Massachusetts, internal medicine and family practice physicians were in deemed to be in “adequate” supply. Almost immediately following the legislation and in nearly every year since, however, the specialties have listed as “critical.”  While the percent of covered patients in the system has reached upwards of 95%, the result has been that physicians are increasingly difficult to visit. Appointment wait times have soared into weeks and months for some specialties and there has been frustration from both patients and providers regarding access.
MMA workforce 2006 and on
An even direr scenario is expected to play out on a national scale when 55 million people currently without insurance enter the healthcare market through subsidized exchanges. Economists predict that the current shortage of physicians will balloon to 63,000 by 2015 and escalate to 130,600 by 2025, due to both increasing demand and dwindling supply. To add salt the wound, a 2012 Physicians Foundation survey demonstrated that nearly half of the 830,000 doctors in the U.S. are over 50 meaning that as the number of patients swell, the supply of physicians will conversely retract.

Clearly, the way healthcare is provided will need to fundamentally change in order to accommodate the three main tenants of the Patient Protection and Affordable Care Act: Access, Quality, and Cost. One potential way is to simply force physicians and healthcare providers to see more patients in the current set of time or work longer or more frequently to maintain their level of reimbursement. Physician time, however, especially for chronically ill and complex patients has become a relatively “inelastic product.”

Physicians already experience significant rates of burnout, are feeling overworked, and have increased the frequency of patient visits to between and 6 and 9 minutes per encounter. Some studies suggest that trying to reduce this amount of time further may actually cause an increase in costs due to inadequate care, counseling, and increased frequency of complications. I would therefore argue that we have reached a point at which physicians cannot increase the volume and frequency of patient care without a fundamental alteration to the paradigm of healthcare.

Secure email may just be the answer. Securely messaging patients can provide a way to fundamentally alter the type and scope of care provided remotely leading to a maintenance or even reduction in the amount of patient care conducted in the office. The fundamental “if” in this scenario, however, is that it must save physician time. For example, physicians have known the value of hand hygiene in patient care for nearly two centuries, but only recently has widespread adoption been shown in an inpatient setting. What led to the main change? Time.  It takes considerable time to cleanse hands thoroughly between each visit. Only when the practice became a time-neutral or time saving event were physicians keen to alter practice behavior. With the inclusion of quick, visible, and easy to use dispensers outside each patient room, these two principles finally coincided.

It’s the same with email. Many physicians worry that by accepting patient messages, their already inelastic time will continually be stretched, forcing them to work longer and harder for a non-reimbursed activity.  After studying more than 11,000 physicians over three years, I have found that the effective use of secure messaging saves physicians on average 45 minutes per day.

Three hours and forty-five minutes per week. That’s a lot of time. And here’s where it comes from.

#1 – Triage. Physician messages should be directed to a practice manager or physician extender who triages the messages and forwards to the appropriate individual. In our case, we found that nearly two-thirds of “physician” messages could actually be handled by office staff. These messages were typically related to hours, availability, insurance coverage, consultant phone numbers, or other back office functions. Our surgeons found that by including a nurse practitioner or physician assistant could also further reduce the number of “MD-level” messages.

For example, minor concerns regarding wound or incision appearance, follow-up timing, suture removal, or questions from visiting nurses were all routinely and commonly handled by the midlevel provider. The exact nature of each question was handled in accordance with physician comfort and expectations. Ultimately, the number and quality of the messages that were directed to physicians were important, timely, and appropriate which led to fewer ED visits, sameday appointments, and phone calls.

#2 – Mobile. Physicians who are able to read, review, and send messages from their mobile device were able to find a considerable amount of “lost” time in their day. Physicians are constantly on-the-move: between patients, rounding, to the hospital and back, to lunch and back, on the elevator, etc. We found that these “micro-minutes” in each day added considerable effectiveness to mobile messaging. As discussed in #1, physician messages were already screened to be important and relevant and so a timely response is indicated. Physicians were able to answer these questions on-the-fly, leading to further confidence in the system on behalf of the patients and fewer voicemails or messages to return at the end of each day.

#3 – Voicemail. Voice messages are the bane of nearly every provider’s life. They are difficult to understand, slow, and take considerable time to review, record, and answer. Through points #1 and #2, the volume and frequency of voicemails decline considerably. The top competitor to patient portals and secure messaging is the phone. It’s universally understood, easy to use, and an immediate response is obtained. Only when patients have an easy to use portal that they can easily access anywhere (and from any device), send a secure message with confidence that it will be reviewed by the provider in a timely manner, and rewarded with a response will patients choose a new system. That’s exactly what our experience has been and there’s absolutely no reason that this cannot be replicated on a national scale.

Whether secure patient email (and ultimately our healthcare legislation) is a failure or a success relates to the patient and provider experiences and our ability to create a harmonious interplay of accessibility, ease of use, and time.

Zachary Landman, M.D. is the Chief Medical Officer for DoctorBase, a San Francisco mobile health technology company considered to be the leader in mobile cloud-based health messaging services that serves more than ten thousand providers and nearly five million patients. Landman is a former resident surgeon at Harvard Orthopaedics and graduate of University California San Francisco School of Medicine. During his career at the intersection of healthcare, technology, and industry, he has developed interactive online musculoskeletal anatomy modules for medical students, created industry sponsored resident journal clubs, and published numerous peer reviewed articles on imaging and outcomes in spine and orthopaedic surgery. Currently, he is leading the development of DoctorBase’s pioneering patient engagement and automated messaging suite, BlueData.

Source: EMR and EHR

July 30,2013


Not long ago, John posted a piece about the “Golden Age of EMRs Being Over” and how that’s playing out from an EMR vendor perspective. Since writing that piece he’s found that while the Golden Age of EMR buyer frenzy has passed, we’re entering a new EMR Golden Age which will feature amazing applications for clinicians and public health administrators. John calls these applications Smart EMR.

Today, I came across some news which I think is a perfect example of the kind of innovative applications John is predicting will emerge as EMRs mature. At the University of Notre Dame, researchers have developed a system which uses collaborative filtering of EMR records to better guide treatment, manage disease and predict disease risks across a population.

Notre Dame computer science associate professor Nitesh Chawla and doctoral student Darcy Davis call the new system the Collaborative Assessment and Recommendation Engine (CARE). CARE uses collaborative filtering to detect similarities between patients and produce personalized disease risk profiles for individuals. It does so by looking at diseases in similar patients.

“In its most conservative use, the CARE rankings can provide reminders for conditions that busy doctors may have overlooked,” Chawla said in a prepared statement. “Utilized to its full potential, CARE can be used to explore broader disease histories, suggest previously unconsidered concerns and facilitate discussion about early testing and prevention, as well as wellness strategies that may ring a more familiar bell with an individual and are essentially doable.”

Ultimately, Chawla says, such a system can produce a host of benefits. For example, he suggests, it can reduce readmission rates, improve quality of care ratings, help demonstrate Meaningful Use and improve personal and population health. On a more micro level, it can allow patients to walk out of their doctor’s office with a list of recommendations based on predicted health risks, he notes.

This is just one example of the kind of new applications that are emerging as EMRs mature and the use of big data becomes a tool for wellness. I expect to see lots of announcements of this kind over the next year or two. It’s an exciting time.

Source: EMR and EHR

July 29,2013


Late last year, the NFL announced that it was using eClinicalWorks’ EMR to standardize their healthcare documentation for players. (Around the same time, the NBA announced that it was implementing Cerner’s EMR.)

Now, we learn that the NFL is gearing up to launch eCW as part of a pilot study of data sharing. It’s also rolling out a program bringing concussion assessment to the field-side.

According to USA Today, the league is distributing iPads to every medical staff member — equipped with X-rays, imaging studies, notes and more — to boost its ongoing efforts to improve assessment of concussions.

All of the iPads rolled out to NFL clinicians will be loaded with X2 software which includes a standard concussion assessment instrument, the Sideline Concussion Assessment Tool (SCAT-3). SCAT-3 is the most advanced version available of neurocognitive test used to determine whether a player has a concussion, USA Today reports.

For most teams, the data collected on the deployed iPads will end up being printed and placed in a paper chart.

However, eight teams – the Steelers, Baltimore Ravens, Denver Broncos, Houston Texans, New England Patriots, New York Giants, New York Jets and San Francisco 49ers — are part of a pilot program in which the results collected on the iPad will be sent via Internet into the patient’s EMR.  Eventually, if the pilot works as expected, the EMR data will be shifted as needed between all 32 NFL teams.

What makes the new pilot a bit unusual is that there’s apparently some politics involved in sharing medical data across the league.

The players, agents and the NFL Players Association are apparently concerned that when team members are being scouted by other teams in the league,  the medical data could potentially be used against them. They’re also concerned as to whether certain health information could work against players in free agency or grievance hearings.

The NFL told USA Today that it’s still working out how it will handle free agent medical records, calling the pilot program a “work in progress.”  The league does not intend to use the EMR to share records between teams until the pilot is over.

Source: EMR and EHR

June 19,2013

(Editor's Note: This blog was written by Jill Hoffman, managing editor of Executive Insight .) With the sun shining in Orlando, the 2013 Healthcare Financial Management Association (HFMA) National Institute (June 16-19) kicked off with inspirational messages...(read more)

May 28,2013

(Editor's note: This guest blog was written by Cindy Doyon, RHIA, vice president, coding and client audit services, Precyse.) As the Oct. 1, 2014, ICD-10 compliance deadline looms, many providers are readying their coders for the magnitude and pervasive...(read more)

May 24,2013

(Editor's Note: This guest blog was written by Vicki J. Brown, director of HIM Solutions Marketing, Nuance Communications.) As we reflect on National Medical Transcription Week, May 19-25, 2013, I can't help but think about the waves of transition this...(read more)

April 17,2010

I'll be taking a break from Tech Medicine as Healthline redesigns its Health Experts Network. If you're interested in more musings on technology and medicine, here's how to find me:Blog: Info-SnacksTwitter: JoshuaSchwimmerNephrology and Internal Medicine: www.kidneydoctor.us

March 31,2010

Image via CrunchBaseThe first iPad reviews are out, and they're very positive. Here's a selection of the reviews (compiled by MacRumors): David Pogue, New York TimesWalt Mossberg, All Things DAndy Inhatko, Chicago Sun TimesHere's a roundup of recent medical blogs commentary on the iPad: iMedical Apps has a nice review of how 5 medical apps might appear on the iPad, including the Blausten Human...

March 30,2010

When you type a search query into Google's web search, a feature called Google Suggest will offer searches that other users have typed that are similar to the one you're typing. Sometimes, this can provide an eye-opening view of how the Internet — or at least, the people who search Google — feel about a particular topic. For example, here are the Google suggested searches for "Doctors...

July 25,2013


Those of you who have turned 50 years of age know what happens... you see your physician for your annual visit and they recommend a colonoscopy to screen for colorectal cancer.  My cousin didn't live long enough to join me in reaching this milestone this summer.  Sadly, he died of colon cancer last year ... at the age of 49.

I had my colonoscopy yesterday and thought about Keith, just 10 days younger that I.  My pitch today is to talk to your physician and get your screening when it is recommended.  Information on prevention, early detection is available from the American Cancer Society and National Cancer Institute.

My experience at the center was excellent ... from the nurses and the physician.  I can't say enough.  The clunky part of the process was getting the instructions via mail, completing the paper form and getting the check-in phone call the evening before.

Nurses, when you call and ask the question of whether the patient has any questions, please wait for the answer before proceeding to the next question on your list.  This rush to move through your list shuts down communication from the patient and may mean that something important is over looked that could impact patient safety or result in a cancellation (ie. no billings for that time slot.)

The worst part is absolutely drinking the liquid to cleanse your colon.  But, consider the alternative.

July 16,2013


This powerful video provides an overview of an app beign used by the Loyola Recovery Center in upstate New York with veterans  in outpatient recovery.   It combines patient generated data, telehealth, mobile, GPS monitoring, social media and personalized interventions for more effective and timely patient engagement.

July 15,2013

US News and World Report has produced a popular annual hospital ranking for 23 years, but it doesn't include patient engagement or satisfaction.  A new ranking system leverages publically available information to addresses this gap and focus on the patient perspective. Currently, the Axial Exchange rankings are available for hospitals in three states: California, Texas and Florida. 

The methodology used in the rankings highlights the importance of having a digital strategy to engage consumers, as well as, relying upon patient satisfaction data already being collected for the HCAHPS initiative.

I. Personal health management (max 50 points):

Health systems support personal health management by providing patients with information and tools needed for self care such as patient portals and electronic libraries of health content. Maximum points are awarded to health systems that not only offer electronic access to patient health records, but also provide resources needed for the day-to-day management of disease. The best health systems offered these tools via the device of the patient's choice: desktop, tablet, and mobile. This information is gathered from publicly available websites and mobile applications.

II. Patient satisfaction (max 25 points):

This category is based on response from public patient satisfaction data collected by Centers for Medicare and Medicaid (CMS) .  The HCAHPS data is an attempt to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. Points awarded in this category are directly driven by HCAHPS performance.

III. Social media engagement (max 25 points):

Social engagement is the the extent to which health systems engage with their communities via social networking channels. Maximum points are awarded to health systems that not only have a social media presence, but also have engaged a relatively large audience that expresses positive sentiment towards the health system.  Examples of engagement sources include Yelp ratings and Facebook likes.

To see how your state compares, visit the links below.  If your state isn't represented yet, check back periodically.

California Hospital Patient Engagement Index

Texas Hospital Patient Engagement Index

Florida Hospital Patient Engagement Index

September 2,2010

The value of the European picture archiving and communications system market is predicted to double over the next six years, driven by demand for radiology information systems.New analysis from Frost and Sullivan has found that the market was valued at €535m ($679m) in 2009 and estimates that this will reach €1,065m ($1,353m) in 2016.  For more, click here.
Source: Health tekIT
Categories: News and Views , All
Royal Bolton Hospital NHS Foundation Trust has announced that it has signed a multi-million pound managed equipment service agreement with Siemens Healthcare.  The 15-year contract will see the trust receive the latest radiology equipment alongside maintenance of its existing systems and user training. Click here for more.
Source: Health tekIT
Categories: News and Views , All
Gary Cohen has resigned as the chief executive of iSoft as the company has announced major losses in its full-year results. For more, click here .
Source: Health tekIT
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January 25,2015


Kathy Beitz, 29, is legally blind - she lost her vision as a child and, for a long time, adapted to living in a world she couldn't see (Kathy has Stargardt disease, a condition that causes macular degeneration). Technology called eSight glasses allowed Kathy to see her son on the day he was born. The glasses cost $15,000 and work by capturing real-time video and enhancing it.

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December 16,2014


Neuroprosthetics is a relatively new discipline at the boundaries of neuroscience and biomedical engineering, which aims at developing implantable devices to restore neural function. The most popular and clinically successfull neuroprosthesis to date is the cochlear implant, a device that can restore hearing by stimulating directly the human auditory nerve, by bypassing damaged hair cells in the cochlea.

Visual prostheses, on the other hand, are still in a preliminary phase of development, although substantial progress has been made in the last few years. This kind of implantable devices are designed to micro-electrically stimulate nerves in the visual system, based on an image from an external camera. These impulses are then propagated to the visual cortex, which is able to process the information and generate a “pixelated” image. The resulting impression has not the same quality as natural vision but it is still useful for performing basic perceptual and motor tasks, such as identifying an object or navigating a room. An example of this approach is the Boston Retinal Implant Project, a large joint collaborative effort that includes, among others, the Harvard Medical School and MIT.

Another area of neuroprosthetics is concerned with the development of implantable devices to help patients with diseases such as spinal cord injury, limb loss, stroke and neuromuscolar disorders improving their ability to interact with their environment and communicate. These motor neuroprosthetics are also known as “brain computer interfaces” (BCI), which in essence are devices that decode brain signals representing motor intentions and convert these information into overt device control. This process allows the patient to perform different motor tasks, from writing a text on a virtual keyboard to driving a wheel chair or controlling a prosthetic limb. An impressive evolution of motor neuroprosthetic is the combination of BCI and robotics. For example, Leigh R. Hochberg and coll. (Nature 485, 372–375; 2012) have reported that using a robotic arm connected to a neural interface called “BrainGate” two people with long-standing paralysis could control the reaching and grasping actions, such as drinking from a bottle.

Cognitive neuroprosthetics is a further research direction of neuroprosthetics. A cognitive prosthesis is an implantable device which aims at restoring cognitive function to brain-injured individuals by performing the function of the damaged tissue. One of the world’s most advanced effort in this area is being lead by Theodore Berger, a biomedical engineer and neuroscientist at the University of Southern California in Los Angeles. Berger and his coll. are attempting to develop a microchip-based neural prosthesis for the hippocampus, a region of the brain responsible for long-term memory (IEEE Trans Neural Syst Rehabil Eng 20/2, 198–211; 2012). More specifically, the team is developing a biomimetic model of the hippocampal dynamics, which should serve as a neural prosthesis by allowing a bi-directional communication with other neural tissue that normally provides the inputs and outputs to/from a damaged hippocampal area.

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November 1,2014



Nestle SA will enlist a thousand humanoid robots to help sell its coffee makers at electronics stores across Japan, becoming the first corporate customer for the chatty, bug-eyed androids unveiled in June by tech conglomerate SoftBank Corp.

Nestle has maintained healthy growth in Japan while many of its big markets are slowing, crediting a tradition of trying out off-beat marketing tactics in what is a small but profitable territory for the world's biggest food group.

The waist-high robot, developed by a French company and manufactured in Taiwan, was touted by Japan's SoftBank as capable of learning and expressing human emotions, and of serving as a companion or guide in a country that faces chronic labor shortages.

Nestle said on Wednesday it would initially commission 20 of the robots, called Pepper, in December to interact with customers and promote its coffee machines. By the end of next year, the maker of Nescafe coffee and KitKat chocolate bars plans to have the robots working at 1,000 stores.

"We hope this new type of made-in-Japan customer service will take off around the world," Nestle Japan President Kohzoh Takaoka said in a statement.

Nestle did not say how much it was paying for Pepper, which SoftBank has said would retail for 198,000 yen ($1,830). The robot is already greeting customers at more than 70 SoftBank mobile phone stores in Japan.

Among Nestle's most successful Japan-only initiatives is the Nescafe Ambassador system, in which individuals stock coffee pods and collect money for them at their offices in exchange for free use of machines and other perks. Nestle wants half a million "ambassadors" by 2020 - nearly quadruple the number now - as it expands into museums, beauty salons and even temples.

The Japanese unit has also developed hundreds of KitKat flavors including wasabi and green tea, and this year rolled out a KitKat that can be baked into cookies.

The latest creation from Aldebaran, Pepper is the first robot designed to live with humans.

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December 16,2010


Health Nuts Media - using the high tech tools kids "get" and
language they understand to help them "get" healthcare - wishes
you and yours a very, wonderful holiday season! The fun, little
animation above can be personalized with your favorite photo
or logo and a couple of your messages and, then, easily sent to
anyone and everyone you know. No ads, no email addresses
collected, no strings - just fun and free!

Happy Holidays!

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Q) Why is hunting for an EMR like looking for a new smart phone?

A) Because there are a ton of them from which to choose, most of them look and feel pretty much the same, they can all do a lot of the basics, there are some pretty cool features even in some of the less-developed ones, and even the best ones don’t do everything you might want.


Q) Why is vendor EMR enhancement sometimes akin to moving from a pig pen to a mud puddle?

A) Because when a vendor gives their old users a new feature or a slightly better interface, the users will rave and crow about how cool the new feature(s) is/are, not realizing their lot in life has only minimally improved.


Q) Why aren’t all vendors offering free online demo tool access where users can “test drive” an EMR?

A) Not sure. I only know that if I’m buying something to “drive” for the foreseeable future which may make or break my bottom line, I sure as heck am not going to pony up after a spin around the block with the salesperson doing the driving. Plus, I’m much more prone to appreciate a vendor who provides such access.


Q) What makes for a great EMR demo experience?

A) Vendor reps who really know their product, who don’t assume that they know more than their customer, who take the time to try to deliver a personalized experience and not just a rote spiel, and who TRULY understand the value of time to a busy physician.


Q) What can providers do to enhance their EMR product compatibility?

A) Look for a system “look and feel” that suits you, yes, but also look for a corporate philosophy and history that is compatible with your values. Glitz and sham abound; don’t be blinded by pseudo-science, salesmanship, or “the show.”


Q) What about those products mentioned in the post of November 30th?

A) Not forgotten. (And by the way, I really appreciate the Comments and emails I’ve received suggesting products and features I may not mention or even be aware of – thanks, and please keep ‘em coming!)

SRSsoft’s Hybrid EMR – One of the things I like best about SRSsoft isn’t just their new “app store” which allows users to add new parts and pieces in the user-friendly fashion of iPhones and Droids (which I truly, dearly love!) No, perhaps the best thing about them is straight-shooter Evan Steele, company CEO and all-round good guy. Evan actually took the time to personally show me around the SRSsoft block and describe their tool, their new app store, and their pending new version features (very cool!) What really makes him unique in my book, though, is his honest, no BS approach. Case in point: Evan has been rather outspoken in his opinion of Meaningful Use certification and its lack of value to specialists (one of his special foci.) He has maintained a clear vision about wanting to provide physician-friendly tools which are “workflow-driven.” However, as this ever-evolving process has unfolded, he has re-evaluated their corporate stance and will now get on about obtaining an ONC-certified diploma. The value to his clients of such has changed and he is open and frank about seeing the need for providing this and changing his approach. As he gave me a explanation of his changed views, I sensed no sales guy schmooze, just a plain-spoken “I’ve reconsidered.” I like his lack of guile and straight up manner.

Medicity’s iNexx – Well, I’m not sure what to say now about Medicity and iNexx. I have gotten to know several of their corporate bigwigs and really enjoy and respect them. I like their primary product a lot and am very intrigued by their approach with the open source, app-able iNexx (though it’s really still in alpha and not yet ready for prime time.) The recently announced buyout by Aetna is something that makes the physician in me cringe. Nothing particularly personal to Aetna, but after years of aggravating experience after aggravating experience, my overall insurance company Gestalt is, well, probably pretty commonplace amongst providers and not all that wonderful. I do try to maintain the bigger picture view I espouse, but whether it’s Aetna or UnitedHealth Group or MomsAndPops Hometown Insurance, most physicians don’t really feel too good about having more insco involvement in between their patients and them. It’s a “once bitten, twice shy” thing. I read on HIStalk that Medicity would stay as a separate biz unit “under the company’s current management.” I hope so. I really like those folks - and their tools.

So many products, so little blog space. Next up: Fun folks (expanded,) excitement, a true helpmate, the power of views, plus.

To be continued, from the trenches…

“Dreams are today’s answers to tomorrow’s questions.” – Edgar Cayce

Categories: All , News and Views

December 1,2010

Thought provoking EMR comment. Don't be sparing us the details of the cool features you've seen and which companies are providing the cool features you've found...show me the good stuff!”

That’s a compilation of a couple of quotes from John over at EMR and HIPAA after a recent post here where I mentioned I was starting to find some pretty cool pieces and parts amidst the waterfall of EMR/EHR demos I’ve been drenching myself within of late. I promised I would “stop the tease and show the cheese.” (John requested sharp, but it may be more along a Muenster.)

Four up front caveats:

1) I am in no way receiving any remuneration from any of the vendors I will be mentioning.

2) I have really enjoyed many, if not most, of the people who have taken their time to show me their solutions. Part of me wishes I didn’t have to end up choosing but one answer/company for our office’s needs.

3) While I am certainly keeping self-interest at the fore, I try to consider the needs of my heretofore undigitized colleagues and what my understanding of their needs might include.

4) There’s only one of me and I have a day job (well, often a day and night job,) so I wouldn’t even begin to imply I’ve seen all there is to see – but I’m trying!

OK, here we go, and in no particular order of coolness…

Ultimate Usability

Unfortunately, there’s not a system in existence today that has this feature – yet – but the hands down winner in my book goes to Medicomp’s CliniTalk and its yet-to-be-named Type/Write/Click cousin. Using their medical knowledge engine of “260,000 coded clinical concepts mapped to CPT®, DSM, ICD, LOINC®, RxNorm, SnomedCT®, and other billing codes and clinical reference terminologies,” this middleware allows truly smart data capture, integration, manipulation, and utilization. It’s coming very soon to some pretty good systems which it will help to make great. I’m so enamored with this functionality that I’m doubtful I’ll be able to choose a new system that doesn’t have it incorporated – or at least one with plans to do so. (Seriously, it does for clinical data what I’d always thought a computer should: it adds an intelligence and a level of association-making that a busy clinician really needs while helping to minimize the “Wow, I went to med school to become a data entry clerk for insurance companies” feeling.) Unconfirmed, but I hear Sage Intergy will be one of the first to engage this hyper-enhancement.


This is one of my personal “gotta be there” criteria. (It was a huge factor in my love at first site with Bond Clinician, the now life-support-plug-pulled Peak Practice.) If my “blink” upon first view of an EMR isn’t one of “OK, that’s kind of pretty,” then I know the demo from there on out will likely only yield ideas for features or functions I might want to see in the other system I do eventually choose.

Prettiest faces in this category are all iPad-ian: Quest’s Care360 and ClearPractice’s Nimble. Right up there, too, is Dr. Chrono, but I admit to enjoying the warm feel of faux leather, even if only digital, which Care360 and Nimble use. This familiar view might even assuage some of the anxiety of docs who are still pen-and-paper bound. (I especially like the slightly askew desktop look-and-feel of Care360, perhaps because my desk is usually pretty askew, too.)

Desktop systems could learn a thing or three from these iPad implementations. I mean, really, isn’t there a whole science about HCI (Human-Computer Interaction) and how to make visual content appealing, productive, and efficient? My take: Many EMR vendors could use a few less Chief Marketing Officers and a few more humanistic computer interface designers.

That said, I have seen a couple of desktop systems worth noting. SOAPware’s EMR has come miles from when I first remember its rather basic layout. athenahealth’s athenaClinicals also has evolved nicely since I joined Inga and John Smalling in a group demo about a year ago in an ill-fated jaunt into product demo reviews. (I liked it then; its look and feel is even better now.)

As this is a long, ongoing, often sleep-inducing process, I guess it’ll have to be a “to be continued.” But, before I go, here’s a few I’ll be discussing next time:

· We “get” the “App Me, Baby” idea: SRSsoft’s Hybrid EMR and Medicity’s iNexx.

· EHR vendor team who seems to have the most creative fun: Nuesoft.

· Most exciting new non-EMR EMR: Mitochon Systems mEMR.

· Best digital office preparation tool: Welch Allyn’s EHR Prep-Select.

· The value of views: DIS.

· Using exo-EMR stuff, mostly iPad apps, as really useful patient education and engagement tools: Blausen Medical’s Human Atlas, Pampers’ Hello Baby – Pregnancy Calendar, CHADIS, and Text4baby. (Pseudo -exception to caveat #1 above: I also like start-up Health Nuts Media for whom I am the unpaid CMO.) Heavy prejudice toward pediatrics, I know, but remember the source here.

· Vendor web sites: what attracts and what repels.

· “The Good, The Bad, and The Ugly” of demos and vendor/client connections.

So, while not meaning to continue the tease as I’m really trying to dole out the requested cheese, I’ll close here with the promise to grate some more fresh Parmesan soon.

From the trenches…

"The early bird gets the worm, but it's the second mouse that gets the cheese." - Jeremy Paxman

Dually posted on HIStalkPractice.com.

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May 21,2013

I’m sharing one of the slide deck which I used recently to introduce Product Management to few aspiring product managers.. Welcome your feedback & discussion on this. Product management shadzlog from Shadzlog
Source: Shadzlog
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December 12,2011

Recently, I was in discussion with couple of my friends who are Clinicians & the topic of ‘healthcare IT in India’ popped up as it has been my habit to … Continue Reading →
Source: Shadzlog
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July 15,2013

You work in an urgent care center (UCC) and your organization has chosen Epic for your electronic health record. The next question may be, “should we use the ASAP or the EpicCare Ambulatory module?” Keep reading! I will share my experience and give some helpful tips. At an organization I recently worked at, we didn’t [...]

July 2,2013

Last month Allscripts officially announced that support for ConnectR will be discontinued in future releases and will be replaced with the Common Interface Engine (CIE). The CIE solution utilizes the Orion Rhapsody Integration Engine as well as the new Reconciler feature for your HL7 messages.  As an update to the current status of the migration: [...]

June 26,2013

As more and more of our clients begin to build out the reports that help them attest to meaningful use and to certify as PCMHs; they are realizing that their data may not be as complete as they once thought. One very common example of this is the lack of LOINC codes in the Works [...]

December 20,2012

By now, it’s safe to say that the vast majority of medical practitioners have heard of electronic prescription management, more commonly known as “E-prescribing.” But for those who aren’t yet familiar with it: e-prescribing is the computer-based electronic generation, transmission and filling of a medical prescription, with the purpose of modernizing and replacing the traditional [...]
Source: DrFirst
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November 21,2012

Prescription abandonment is a growing concern in the medical community. With more and more doctors having digital access to patient medication history data through e-prescribing and electronic health record systems, it is becoming increasingly clear that patients never pick up prescribed medications. Research shows that there is a direct correlation between prescription abandonment and  an [...]
Source: DrFirst
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September 26,2012

Back in 2001 when DrFirst first developed e-prescribing, we spent a lot of time educating providers about the benefits and patient safety advantages of utilizing technology in their practices. We spent years “Crossing the Chasm” from early adopters to broader adoption. For years, the industry believed the inability to e-prescribe controlled substances (Schedule II – [...]
Source: DrFirst
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July 19,2013


As I finish up a repeat trip to the BVI, I am struck by how different this trip was than last year.  It all comes down to expectations; last year I came down with no idea of the island, how it worked, who I would meet.  This year I was set up to expect the same experiences – and thank goodness, my expectations were not met.  I visited new places, met new people.  Even when I tried to revisit last years stomping grounds and hang out with last years friends, it just wasn’t the same.  Not bad, just different.

New experiences and our ability to have them is what make us grow.  Enjoying the moment, looking for the opportunity, being open to change…these are the things, for me, anyway, that keep it interesting.

You may have done the same thing the same way 1000 times.  On that 1001st time – accept that you can do something different. Things don’t always have to work or be exactly like you expect them to be as long as you are still moving forward, accomplishing your goals, getting the job done, and enjoying what you do.  We often make things so difficult.  Look for a simpler way, even if it different. You will be pleasantly surprised.

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May 26,2013


I have this guy I hired about a year ago named Max. Max is awesome not only because of the work that he does on our marketing team, but also for things like his family (his mom is the super-woman Judy whom I love), his bow-ties, his ability to handle strange travel delays and his stories and wise sayings.  In honor of Max, and to make up for, in some small way, that his whole family is in London and he had to stay home because he has a JOB, this is a blog post about one of those bits of wisdom.  Somehow his single sentences hold clarity and meaning in a way that only Max can convey.  Why is it number 501? Because it can’t be his first (it's way to insightful) and I know it is one of many.

Recently we were working with a client and we had trouble getting them to be in the present.  There was all this talk and focus around what their system USED to do. No one wanted to think about what it was STILL doing or needed to do in the future.  No one was able to see that the goals of the retiring system were different now that it has been replaced by Epic. It was quite frustrating.

Then Max says:


it's like looking in the rear view mirror to drive forward 

And that is EXACTLY what it was.   When you put it like that, everyone lights up because THEY GET IT.  While looking in the rear view adds value, and lets you reflect on where you have been (which is important), you CANNOT look in the rear view to drive forward. You have to be looking at the front window in order to move on and get to where you eventually need to be.  You HAVE to face the reality of the road in front of you.  You have to remember that you have an ultimate destination and place you need to be.   Everyone needs to put away the map of what the old system used to do and get out the Archive Strategy Map.  It can hold some of the same sights, back roads, and detours of the original map, but it needs to be one that is driving your archive strategy forward.


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May 18,2013


If you are reading my blog, you know what my company does.  Being the guys that are handling the “go dead” of an application, we are dealing with what is, agreeably, the most difficult and disappointing time for the vendor being retired.

I get it. The customers have passed you over. Putting you out to pasture.  Picked someone younger, fresher, nicer, better suited to their business.  Your revenues are impacted. Your market position is threatened.  It makes a statement about where you are in your product lifecycle.

What I DON’T get is the attitude that comes along with it.  Most HIT vendors today sell more than one product for more than one solution.  Why would you treat a customer badly just because they are choosing to de-install ONE of your products at their work site? Raising their support fees? Refusing to help them? NOT GIVING THEM THEIR DATA? I just don’t get it.  Its like you are 12 years old and breaking up with your first girlfriend.

Do you actually think this is the right way to treat these customers? That this WON’T come back to haunt you later?  Do you know how much these customers talk to each other? Have you READ HISTalk?

Think about the bigger picture here. If you are a vendor that plans to stay in business, you had better treat each and every customer or potential customer like you would want to be treated.   The good old Golden Rule applies here.

The decisions have been made. You were or were not asked to present or even attend the party. Suck it up.  Do the right thing.  Help your customer transition to the other vendor in a positive and supportive way.  Make their data accessible and understandable.  Help them through technical issues.  Use the opportunity to find out what you can do differently next time to be the vendor that is chosen.  MAYBE, just maybe, you will get a chance to present or sell something to this customer again. And MAYBE, just maybe, they will remember the positive and professional way you handled the prior system “end of life” and take that into consideration.

Because I can promise you this – the way some of these vendors are acting – they won’t even get in the parking lot, much less a ticket to the dance, even if they are the very best at what they do or sell.  They are not only burning those bridges, they are nuking them.

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