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ADVANCE Perspective: HIM


As the economy continues to squeeze donors, a recent report conducted by Campbell Rinker showed disturbing results-that nearly 7 in 10 Americans say they will give more sparingly to charities in the coming months. As a result, people are looking for other...(read more)


(Editor's note: This guest blog was submitted by Life Coach Teri Johnson. She is a writer, speaker and personal growth expert who is the founder and President of Keeping it Personal. Here she provides tips for surviving less than perfect holidays.) For...(read more)


The American Health Information Management Association (AHIMA) proudly announced that the National Commission for Certifying Agencies (NCCA) granted accreditation to AHIMA's Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician-based...(read more)


(Editor's note: This guest blog is written by M. Christine Kalish MBA, CMPE, Executive Consultant, Beacon Partners.) Recently the American Medical Association (AMA) passed a resolution at their 2011 Interim Meeting, mandating the group to "vigorously...(read more)


(Editor's note: This blog was written by Scott Warner, author of the "Stepwise Success" column for ADVANCE for Medical Laboratory Professionals . He has been a hospital laboratory generalist for more than 30 years and manager since 1998.) According to...(read more)


The Association of Health Information Outsourcing Services (AHIOS), an organization committed to promoting excellence in the handling and dissemination of confidential, patient-identifiable information, held its annual meeting in Salt Lake City, Utah,...(read more)
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MedTech and Devices

Fred Trotter


Lately I have become interested in running motivation.  I am launching a <a href=’’>running motivation</a> app next week, and I thought I would give my readers a little taste of the process that brought me to design and build the new site. Running is one of the best exercises. There are several that really compete [...]


Just so my RSS feed readers know, I will now be blogging at Programmable Self and at O’Reilly Radar. I hope this helps everyone to keep track of what is going on. -FT


Over on the Society for Participatory Medicine mailing list we have been discussing the recent Readers Digest blog post titled: 50 things your nurse wont tell you. You really have to read it before reading this article, this post will only make so much sense without that. I suggested that part of being an epatient [...]


Joe Conn, one of the best Health IT reporters I know, has been denied FOIA access to breach data reported to the Office of Civil Rights. Honoring FOIA requests is a critical part of how the people ensure that the government is not abusing its power. That might sound paranoid, but blanket rejections like this [...]


Today, Steve Jobs died. This blog post will be only one among thousands of posts devoted to his drive and his genius. Thousands will celebrate a technical legacy that almost no technologist can hope to replicate. The original Macintosh, those early films from Pixar, the iphone… hell I am typing this on a Macbook Pro [...]


[Update 2011-10-19 Many of the issues here applied only to the initial launch of OSEHRA and began to be addressed almost immediately. Do not assume everything you read below still applies] As typical, I was alerted to the fact that Tiag, the winner of the Open Source VistA custodial agent competition, has launched a website [...]
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News and Views
MedTech and Devices




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.





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.



Since I’ve always been interested in the mechanics of customer experiences, when I try a new service I like to break down what works and what doesn’t. I’m going to do this on the blog periodically under the title “What’s Worth Copying”.

So here’s WWC #1. The other day I had to get rid of a bunch of old furniture that was living in my wife’s soon-to-be-former garage. We’d arranged for a charity to come pick it up, but they screwed it up twice, and we were left with just a few days left on the lease and a big pile stuff we were never going to use. If I had all the time in the world I’d have tried to get rid of it on FreeCycle or Craigslist, but that’s not realistic when you’re also trying to launch a startup.

I know nothing about junk removal, but I had seen the ads for 1-800-Got-Junk. Here’s how it went:

What worked well:

  • It was extremely easy to schedule. I went on the web site, picked a time slot (for just six hours later) and got a confirmation of my time slot.
  • The web site signup gathered the minimum information necessary. They didn’t try to get me to create an account, for instance – they created it for me and sent me a randomly generated password by email. All they asked for was name, email address, cell phone and the address where the junk was.
  • Pricing was transparent. They charge by volume, and have a nice little widget on the reservation page that lets you see how much furniture can be crammed in a given amount of truck. It’s very well done, and highly accurate – I was able to tell exactly how much things would cost.
  • The people who do the work were very polite and efficient – they called ahead of time as they were running early, and were willing to wait until the scheduled window if I needed them to. They also spoke excellent English and could clearly communicate the service and understand the instructions I’d given them.We’ve gotten a lot of deliveries recently and this has been a real problem.
  • Payment was easy and flexible.

What didn’t:

  • There wasn’t an obvious tipping policy. At the end of the transaction I realized that I probably should tip, but since I barely ever carry cash anymore, I didn’t have anything to give them. I should say that the guys did not hit me up for a tip or in any way act as if they expected one, which is one of the reasons felt like they deserved one. Since this is a service that most people don’t use on a regular basis, it’s not immediately obvious what you’re supposed to do. I tip movers, right?

So overall, it was a very smooth experience. I feel like I got a good deal – even though I probably could have found the same service for less money if I really looked. So here’s what I think applies to other businesses:

  1. Make it very easy for people to get in and start engaging with your service. When I’m asked to create a password I don’t feel like I’m accomplishing my primary task (in this case, getting rid of a pile of junk). Entering my address does feel productive because I know the truck is going to have to find the house.
  2. Don’t let customers be unpleasantly surprised. Transparent pricing is even more helpful when the customer doesn’t use the service very often. The “how much fits” applet on the reservation page is a really nice touch, since it meant that I didn’t have to spend the day worrying that I’d be charged $1,000 for rubbish removal.
  3. If people are a vital part of the service delivery loop, make sure that they’re trained well enough to avoid frustrating the customer. In this case, there was a pile of stuff in the garage that wasn’t supposed to go, and I felt comfortable pointing that out and then going upstairs to do something else while they loaded the truck. And lo, they didn’t screw it up.  I suspect I paid a premium for this.

At this point, the temptation is to sign off the post with “And that’s What’s Worth Copying.” But I won’t.




I have a long and complicated relationship with blogs. My first attempt was in 1997, hosted on my personal site at Yale. The term “blog” was a couple of years from being coined at that point, so the site was a set of essays in the style of Philip Greenspun, who had recently invented Internet-based exhibitionism (in a good way). This was all wonderful but lead to one major problem – I didn’t really have all that much to say. I was in college, and still working on my first startup. So I was learning a lot, but I hadn’t come to very many firm conclusions. When I graduated and that site slipped off the Internet and was not much missed.

Subsequent blogs included a personal blog (2001-2003), an O’Reilly Network blog (now apparently lost to the web as well, although it did feature a great review of various trade show tote-bags), and blog I started when I went to MIT for graduate school. The latter was essentially killed when I took a job working on healthcare IT policy for the US Government, and was told that I really couldn’t publish on any topic which was in the general remit of my job or my agency. At the time, that was almost everything I was likely to have a comment on.

The original incarnation of info.rmatics (this blog) was a group effort with some colleagues. That worked pretty well, but we never came up with a consistent voice or focus. Readers who were interested in hearing about JavaServerFaces didn’t want to wade through discussions of FTC disclosure rules for breaches of confidential patient data. The reverse also applied.

The strange thing is that in more than ten years of blogging I never really allowed myself to just sit down and write about what was interesting to me at the time. If my ruminations are useful for other people, that’s great – I hope they are. But I’m not going to worry about making every post interesting for every potential reader (although you can always subscribe by category).

Here’s the list. Off the top of my head, at 1:10 pm, Friday, December 30th, 2011, as I sit in a Starbucks in Southborough, Massachusetts, waiting for the nice people from 1-800-Got-Junk to call me to confirm that they’ll be coming to pick up a large pile of old furniture from my wife’s old house down the road. This is a unique moment in time, and I reserve the right to be distracted by other bright, shiny ideas at any point:


  • What’s fundable and what isn’t? What makes a start-up likely to succeed?
  • Angel Investing. How can you create a strategy around small investments in very early stage companies?
  • Sales and marketing. Simple products solving common problems are great. But what happens when you have a (moderately) complex product that solves a complex problem? How do you reach and educate your potential users.
  • Measurement – how can you tell when a team is doing well? What metrics are most useful for companies at any given size?
  • Customer Service – how can you create the best possible experience for your customers even if your resources are highly limited?


  • How can we make the healthcare system more consumer-friendly?
  • How can we take waste and repetition out of healthcare delivery?
  • How can technology make life more fun and rewarding for physicians? Today’s electronic health records and related tools are a burden for clinicians – rare indeed is the doctor who will tell you that their tools make them a better physician.
  • What’s the government up to?


  • What makes a software development team successful?
  • How can groups of stakeholders – developers, users, designers, testers, managers and others – communicate their ideas cleanly and effectively? Previous experiments in this area helped spawn the Clickframes project.
  • How do you hire and retain a talented software development team?
  • What’s the best way to use Microsoft technologies to build a scalable web-based application?
  • What’s up with HTML5 and JavaScript? The old patterns for building web applications are clearly obsolete. Books that I wrote six or seven years ago (and which provided great advice back then) are not merely out of date, they’re positively dangerous.

Everything Else

  • Cameras. Cool technologies. Current affairs.

And so that’s the agenda for 2012 and beyond.




I hadn’t heard of Expensify before I saw a TechCrunch piece on the company this afternoon. I happened to have several expense reports outstanding for a consulting client. I hate doing expense reports – scanning all the pieces of paper, putting together a cover document and putting everything into a PDF. Except during the relatively rare interludes in my career where I’ve had an assistant I can thrown receipts at and then race out of the room (Hi Andrew!), I’ve always been really bad at these. I have no excuse: my first boss taught me many useful skills, and precise receipt keeping was one of them. I just hate doing the reports. For that matter, I was never all that good at getting the receipts to my assistants.

Expensify LogoSo after reading the TechCrunch article I logged into Expensify, and half an hour later all my consulting expense reports but one were done and sent off. All of my expense reports for Linked Medical, our new startup, were done too, and filed in the “pay when we have more money” bin. I don’t think any web based tool has ever become so essential to me so quickly. One of the first “ASP model” web applications I ever used was the Ariba purchasing system, after my early-2000s startup became part of a much larger company. It was truly terrible. Fortunately I had an assistant.

Expensify’s product is pretty far from that original Ariba system. Sure, the software isn’t perfect, and a few of the rough edges are downright weird considering the overall level of polish (uploading a “.htm” file receipt gives you an error message, while “.html” works just fine). But they did at least six things right, and those six things are relevant for lots of different applications:

  1. Make it brain-dead easy to start. I typed in my email address and was done. They sent me an email which I later clicked through to set my password. There was zero friction, which is incredibly important. I could also have logged in with my Google credentials, which is a nice touch – but this was actually faster.
  2. Make it easy to explore. The home screen is a series of big boxes identifying common interests for new users. I’d heard about the mobile tool first, and it was one click to learn more. The basic navigation is very simple, and maps to things like “Receipts”.
  3. Use Mobile for the right things. This is really important. I do not want to create an expense report on my Android phone. I probably don’t want to create one on my iPad either. When I’m mobile, I want to do one thing: easily record expenses. So the mobile app does that very well – I can photograph a receipt with my phone, and/or enter expense details on a simple screen. There are two big buttons when I open the application, one for each option. It’s very responsive. And I don’t need to keep the small receipts anymore.
  4. Integrate seamlessly, but don’t make me do it first. Another box on the home page is “Link Credit Cards.” It took two minutes to link in my American Express, and then I had a huge list of transactions to choose from.
  5. Give me multiple avenues to learn the software. I can add expenses to a report from the report, or I can look at expenses and add them to a report. Same with receipts. I never found myself having to go back into the wrong area of the application. When I looked for a feature, it was there.
  6. Don’t make me learn the whole thing. Expensify supports “policies” for corporate expenses. There are some other features there too around submissions and approvals. I don’t need those yet, so I didn’t have to use them, learn about them, or worry about them. As it happens I have looked at them, and they’ll be useful in the future – I just don’t need them now. Complexity kills, especially when you want casual users to adopt a system without external support. Expensify landed me as a customer because I was able to finish an expense report in 15% of the time it would have otherwise taken.

They also do a good job of thinking about ways that new technology lets you change the underlying workflow of an old process. In this case, it’s expense reports for receipts under $75. If you link a credit card, you can import expenses and the system generates an “eReceipt” for that charge. Expensify prints it in the report and adds a bar-code, and it can be verified with the site later. The company will stand behind the fact that the expense was imported from a credit card statement, up to and including during an audit from the IRS. If your corporation accepts the eReceipts, you can stop carrying around those little printouts from taxis. This is something that the old Ariba system – or any non-cloud expense account system – simply can’t provide, because it relies upon the trusted connection to the credit card company, and on Expensify’s willingness to stand behind the integrity of that data.

When turning workflows into products, it makes to ask what capabilities are available now that weren’t available on paper or weren’t possible electronically with the technology of a few years ago. The eReceipts are a great example of this. Development for the iPad should be triggering a lot more of this kind of lateral thinking, as we all adjust to touch-and-swipe interfaces instead of keyboards and form fields.

Naturally there are a few things Expensify can improve on. I’m glad I didn’t need to take a training course to use the tool, but a five-point introduction to the core concepts would have been nice. The most opaque thing about the system is the relationship between receipts and expenses. It’s not actually all that hard to figure out, and the system gives you helpful messages. But an introduction presentation would have made things clear from the get-go. Dropbox does a great job with that.

Any time you’re asking users to think about the attributes of a data model you’re asking for a certain amount of trouble. In this case, the idea of “reimbursable” and “unreimbursable” expenses also needed some clarification. Since I was in consultant mode when I was doing today’s reports there’s no concept of “unreimbursable” – but I’d unclicked the default when I was linking my credit card because I thought that leaving it as “reimbursable” would make more work for me as I filtered through expense lists. It turns out this is useful for corporate cards, which makes sense – but I’ve never carried a corporate card where I didn’t get the bill myself (oddly, this was true even when I worked for the Federal government).

The bottom line: a very useful service and a great source of ideas for making other web applications easier to use. Oh, Expensify guys -please add an “email receipt” feature like TripIt’s, if you haven’t already.



First off: the blog is back. I will refrain from commenting at any length on why it had gone away, as introspective blog posts about the process of blogging are boring. Sometimes you’re blogging a lot, sometimes you’re not.

I’ve been thinking a lot lately about hiring programmers. I’m launching a new venture, and I’ve been very luck to bring one of my favorite people on board to lead our development team. He’s brilliant, hard working, polymathic and generally willing to dive into things which have to be done but may not be massively interesting. I’ve hired a few other people like this in the past, and when I have the opportunity to hire them again (and the role is appropriate) I always go for it.

I do that because it’s a complete crap-shoot otherwise.  I’ve got it easy – since I wrote a few books on software development between the late 90s and middle 2000s I have a good reputation as a boss who knows how software gets developed. That’s made it easier for me to attract top tier people – much easier than if I was a pure business guy, regardless of however good a business guy I may have been.

So I enjoyed reading Jon Evans’ Why The New Guy Can’t Code. It’s a nice overview of some of the pathologies, particularly the idiocy of the brain teaser interview. Evan’s suggestion is that you don’t even bother interviewing people who can’t say “I got this done” where “this” is a self-contained project. And I basically agree.

The guy I brought back for the new company has been a friend for fifteen years. We went to high school together. So when I hired him I was cheating – I knew exactly what I was getting into (and I made sure my then-business partner was on board so that I had a check on any desire to hire a friend). After that point, however, I was out of rock-star friends who were looking for jobs, so I had to go looking the more conventional way. And in each case, the interview went the same way – we sat in a room and talked about projects for an hour. In some cases I had other people on the team do more conventional technical interviews, but I usually found I didn’t need them – by having someone clearly explain what they had done to build an application I could easily tell whether they actually had the skills they claimed. I could also tell how they worked in teams, and how they thought about problems.

The sample size is pretty small – maybe 30 people interviewed over the last five or six years. And everybody we hired wasn’t perfect. In those cases we usually had some misgivings to start, and we corrected fast. But by and large, we got the rock-stars, or at least the guys in the band. And we never had an issue with competence.

Of course, having a good HR department that knew how to source candidates properly (by going after the already employed at companies that were closing up and filtering out the top few people) helps. But the best people can have a conversation. And phone screens help – you can start this discussion on the phone, and if they can’t start telling you about a project they did within the first few minutes, time to move on.

Another good take on this issue is Why Can’t Programmers.. Program? which describes a great simple test to weed out the obvious non-coders in five minutes or less. Surprisingly, it excludes quite a few people with C/S degrees.


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News and Views
MedTech and Devices

Healthcare IT Insider



With the significant increase in smartphone and mobile device adoption in the health care setting in recent years, 2012 will definitely add more emphasis on mobility integration at the organizational and enterprise strategy level, as well when looking at an organization’s technology budget. The new capital commitment needed to support mobile device management, security assurance and security updates, as well as the evaluation of different mobile apps that can help with patient care must be top of mind considerations as an organization continues to map its strategy in the coming years.

In this same vein, another area that may require some additional consideration is in terms of planning for upgrades to a hospital or health system’s interactive television system. Similar to how consumers, patients and clinicians continue to drive the adoption of smartphones in the arena, a similar trend may be on the horizon with interactive TV in the health care setting. Except, this time, the device in question is in a majority of living rooms across the nation.

Television has seen some drastic changes and great technological advancements over the past decade.Projection TV, plasma, LCD, and 3D TV have all been part of the evolution of television technology. But it does not stop there; TVs are now turning to mobile platforms to become smarter, more interactive units.

While traditionally you can connect a PC or gaming console to your TV to take advantage of the integrated, advanced capabilities, Apple and Google took different approaches. Sony and Logitech partnered with Google to implement Google TV in some of their devices. Sony was the first to embed the actual Android based platform in its televisions, with Android being the platform of choice for many smartphone users in the market. Google TV also provides the ability to develop and deploy apps (native, HTML5, or a mix) and make them available for use on any Google-capable TV.

The integration of mobile platforms and interactive programming with television technology seems to hold great potential for the health care industry. Personally I have been using Google TV for about a month now and the feedback I’ve gathered from both colleagues and family, as well as the many potential uses I’ve considered, support the incredible promise this technology has for health care and the future of pateints who will use and interact with programs and content at the bedside.

For hospitals who currently have interactive TVs in their patient rooms, there are many possibilities for Google TV:

  • Interactive patient education
  • Customized hospital content feeds (news, community based events)
  • Online and interactive dining services
  • Interactive patient charts or health records (integration with PHR or hospital EHR)
  • Patient surveys
  • Teleconferencing with family, friends and care givers (Medical home can contact patients and do conference calls regardless of TV hardware used)
  • Social media services (Facebook, Twitter and other social sites accessibility).
  • Access to commonly used apps
  • Remote control from any smart phone device (iPhone, Android based remote control)
  • Health & fitness tracking, interactive/reward based capabilities
  • Interactive schedules
  • Access to clinicians for hospital based and health apps used in the enterprise from anywhere in the network
  • Interactive entertainment and on demand (watch your own movies from your own Netflix subscription
  • Gain access to work related items without the need of a laptop on hand
  • Cost effective
  • Integration capability with IP-based TVs and other online TV providers

While not all TV stations are available via the internet, many are considering moving in this direction.Andd should this trend continue to take off, this would one day mean that all TV programming will be IP (internet protocol) based, significantly justifying the use of a smart TV. And with the use of Android and iOS platforms, this add more content availablity and other possible uses for the larger displays.



For a while now, Google has been the front runner when it comes to web-based productivity applications.  With their Google Docs application, the company released a 100% browser-based solution that allows end users access to and use of a cost effective substitute to the Microsoft Office suite. But Microsoft was not about to throw in the towel to Google, and after a long beta phase has finally released its own version of web-based business productivity tools called Office 365.

The Office 365 products and services go well beyond the simple creation of presentations, web pages and spreadsheets via web tools.  They contain a valuable set of features and functionalities that end users are dependent on for day-to-day work.  And as we look at health care and its own line of applications that enable better, more connected patient care, one must wonder if there will be a time where electronic health records (EHRs) will learn from the lessons that companies such as Microsoft and SalesForce have identified as critical for success in the software industry.

The following is a list of eight takeaways from cloud-based applications that EHR vendors should consider as part of their long term software development strategy:

Make it cloud or browser-based: Given the pace at which technology change is moving today, IT is more focused on aligning organizational objectives and ensuring compliance rather than managing physical servers and the downtime associated with them.  For that reason alone, many organizations are now looking to leverage cloud-based or browser-based products that require low up-front costs and offer higher up time, availability and redundancy.  Vendors such as Cerner, AthenaHealth and others provide a full hosted application model where there is very little need for a full infrastructure in-house to maintain the application.  In addition, with this model, a cloud-based application requires very little maintenance and experiences very little downtime that could be associated with upgrades, conversions or system updates.

Low up-front cost: In every EHR implementation, there are several items that contribute to the high costs.  From workflow redesign, training and hardware procurement, to software licensing, maintenance and product support, many see the future in solutions that are provided at a monthly fee per user or business unit.  This reduces the up-front costs and allows for the organizations to appropriately budget and justify the use of the new products and solutions.

Scalability: For products that are offered through SalesForce, Google, or Microsoft office 365, it takes the same effort to sign up 5 users as it does to sign up 5000 users; the system is designed to easily scale out.  This is all done behind the scenes, where the client is ready to start using the application right away.  This capability would benefit EHR vendors greatly as their products continuously need to have the ability to scale out, especially when there are clear indicators of health systems mergers, acquisitions and growth.

Easy to use UI: One of the critical success factors for any user-facing product in the market, including EHR packages, is an easy to use, functional and feature rich user interface (UI).  Many EHR systems fail to impress clinicians simply due to the busy and cumbersome UI.  These products must be  easy to use and allow health professionals to attend to their patients without feeling lost in the software.

Integration: As we move toward a health care model that rewards for outcome measures, complete patient care and care team collaboration, many applications are starting to look for ways to allow for protected health information (PHI) to be exchanged, safely and securely.  For Google docs and Office 365, having the ability to connect to other systems, as well as the collaboration platforms, was a useful function in the products.  This would also be a significant feature for EHR packages.  While some do provide the ability to receive and submit health information across a given HIE, there is still a significant lack of adoption from physicians.

Collaboration: Microsoft and Google chose their own collaboration platform as part of their products.  Within Office 365 and Google Docs, there are capabilities for end users to use video conferencing and chatting capabilities.  This provides a useful method for users to communicate beyond the simple email messages.  As accountable care organizations (ACOs) begin to implement their collaboration platforms, there will be a clear demand for chat, audio and video conferencing capability.

Platform agnostic: For software vendors in today’s market, the big question from the majority of prospects and potential buyers is: “Do you have an app for that?”.  That said, for many of these products, having the mobility capability as part of their offerings is now a must-have for clinicians.  Whether it is a hospital system or a small independent physician practice with two physicians, a medical application should have some sort of mobile application that will allow its user access to the information from smartphones, tablets and many other mobile devices.

Power is in the numbers: There are clearly some very powerful players in the EHR marketplace.  These are the groups of vendors that are well established and have had incredible success with high number of users.  However, this does not always mean that there would not be a place for a disruptor.  And in the world of technology, especially the world of software products, it is all about the new, functional differentiators that a product brings to the table and the perceived the value that the software has from users in the market.  Similar to SaleForce, AthenaHealth, Facebook, Chatter, LinkedIn and the other very successful sites, there will continue to be room for new innovators that can disrupt the marketplace and continue to push the technology buck forward, especially in health care.



In June of 2011, I wrote an article about how visualization will be right around the corner for mobile devices and will most likely change the way we view business mobile apps. In my article, I discussed the top 10 reasons why this would be an incredibly valuable technology to have in IT departments in health care and available to enterprise mobile users.

Fortunately, we did not have to wait too long. On Oct. 19, 2011, VMWare announced that it has partnered with Verizon Wireless to develop smartphones with dual personalities, basically developing a product suite with an Android platform that will enable a user to use their personal smartphone as their work phone. These devices will enable enterprises to efficiently manage the content of work phone “profiles” without mandate on user’s personal phone specific corporate requirements.

This simple yet powerful functionality will allow IT departments across enterprises, including health care, to securely provision and deactivate some of the application and configurations that are unique to the enterprise over the air.

This also provides a great security advantage for enterprises. The work profile or work phone is completely hosted in a central data repository, and therefore nothing is stored directly on the device itself. For health care providers and hospital CIOs, this is a significant improvement on securing and controlling access to health related apps and data. By centralizing the data and securing it, lost devices would not pose a data breach, as they do not contain actual data on them.

This is a very significant technology for the health care industry, recognizing that many physicians and HIT professionals are using iPhone or iOS based devices. We still need to see what are VMWare’s plans are for the iPhones and iPads, as Android based smartphones and tablets will be the first to receive a significant boost from this technology.

And as this is VMWare’s first product to have a major role in the mobile area, there is no doubt that there may be additional innovations coming down the road, ones which will allow for apps to run on devices across multiple platforms. Similar to the existing product called ThinApp, where you can run any application on any platform without its installation (the application runs on a central server or data center), this is another possibility that we may end up seeing in the mobile world from VMWare. Mobile ThinApp!



The Centers for Medicare and Medicaid Services (CMS) issued its final ruling last week for Accountable Care Organizations (ACOs). The proposed ruling was initially released in March and after public comment period, some significant changes were made and released last Thursday.

Within the 696 page document, there are sections that outline the measures on which reporting will be required. Currently the number of measures has been decreased from the original count of 65 down to 33.

In addition, HHS has also announced that it has reduced its requirements for the number of physicians required to use a certified EHR system. Now, only 50% of participating members will need to be meaningful users for ACO participation, welcome news by many groups still in the laggard adoption phase. There was also the announcement for a new program that will provide funding for care providers to hire staff and upgrade IT infrastructure with EHRs in order to support their participation in an ACO.

Several health care associations welcomed the news and noted that HHS seems to have taken into consideration much of the feedback from providers and health care professionals as they’ve taken steps toward the meaningful use journey but have yet to reach the pot of incentives gold.



Often when discussing outsourcing in health care, the first things we tend to think about are outsourcing software development, billing, call center and general helpdesk functions. But given the curren model of care, the reality is that we will eventually see more outsourcing in the form of care delivery, where outside groups step in to provide specialty care.

As medical information becomes readily available to clinicians, regardless of their location and via health information exchanges that connect provider networks, certain groups will lead by providing services that will both benefit the patient and organization through outsourcing care delivery.

As patients, we are already seeing some of these services in action today. For many of the small to mid size primary care providers, the use of outsourced radiologists to read x-rays is a common practice. This basically means that the reading of x-rays taken at the primary care physician’s office is being outsourced to an outside service provider. What is interesting here is that we will actually see a slightly more advanced flavor of outsourced care that brings value to both patients and provider.

Kaiser Permanente, for one, has long been using telemedicine to get patients to see a specialists without their even needing to leave their primary care provider’s office. So if you need to be seen by a dermatologist or orthopedic specialist, you can simply connect with them via video conferencing immediately after your visit with your PCP. So long, waiting for the referral!

This expansion of the care continuum opens the door for a new model of delivery and structure. It means that physician groups can now compete for patients across state lines (keeping in mind the different state accreditation requirements and such). This means that a patient can request to be referred to a specialist of their choice  — or the one that has to most persuasive TV ads – which may create more competition for the local private groups. Right now, most large private specialists groups tend to have a significant percentage of the patients in their community. But if care providers from out of state provide the same professional care, same day appointments, reduced fees, and virtual visits, then patients may just simply opt for the virtual office visit instead.

Several years back, this would have been an impossible scenario, but with today’s connected health environment and increasing adoption of electronic health records and standards for interoperability, physicians are able to do more remotely. Teleconferencing technology has also enabled users to do this quickly and easily. This does not mean that virtual office visits would eliminate the need for one on one with care providers, but for follow-ups and simple “minute clinic” types of illnesses, it only makes sense to seek alternatives that reduce cost, increase efficiently for everyone.



For many physicians who are not currently using electronic medical records are constantly being told through one form or the other of how EHR will help improve patient’s health, reduce their operational costs and allow them to see more patients. And study after study shows the benefits of capturing patient health information electronically.

But as we continue to see EHR flyers and marketing brochures outline the benefits of not using paper charts, we can pause and recognize that there are factors other than the typical benefit that will eventually drive physicians to seriously consider adopting EHR. There are several reasons that can put a medical organization who still relies on paper chart at risk. Especially when we are seeing the transformation that is currently happening the US healthcare system.

Following is a list of 6 items that can put the paper based practice at risk in the near future if they don’t adopt an EHR?

More patients will be asking for it: As more patients get exposed to the benefits of their physicians using EHR and see how a healthcare providers who uses EHR can communicate as well as share medical information with them electronically (such as: X-Rays Lab results, treatment plans, e-prescriptions, and PHR), many of these health service consumers will begin to ask and look for physicians who are using these technologies. This would provide many organizations with a competitive edge and enable them to differentiate themselves from others. This could potentially penalize physicians who are not using electronic health records by losing new patients to their competitor.

Telemedicine and servicing a broader geographic area: Several large health systems are beginning to provide basic health services and specialists consults over video conferencing and for a reduce rate. Many of these services are provided via secure communication channel and do not require for the organization to have a physical office near the patient they are servicing. But many of these physicians that will provide telehealth services will be in need for an EHR to be able to share information quickly. This provides them with a competitive advantage as they can efficiently service a broader patient base outside of their immediate community.

Everyone will be collaborating but you: Some states have already implemented an HIE and as more adopt the health information exchange and some of the care delivery models, many physicians are starting to exchange and collaborate on care. These physicians are able to receive complete patient summary of record electronically and share their information about a patient with others as well. This is also the vehicle that will used by physicians to communicate and collaborate on care as well. But for physicians who are still paper based, they may encounter more challenges when attempting to collaborate and be a member of the care team for certain patient population.

Using remote health monitoring to manage chronic conditions: With the increase in patients with Chronic disease and the current competitive market, many health organizations are looking to adopt technologies to assist with remote patient monitoring services. These would be ways to capture health information and monitor patient’s vitals real time. These technologies would require physicians to have some sort of EHR in place to be able to transmit the information to.

Recruiting new physicians: As part of the medical school curriculum, many new graduating physicians have had exposure to electronic medical records. This would most likely suggest that many of them would favor practices and health organizations utilizing EHR for their future employment opportunities. This would make it difficult for paper-based practices to recruit talent.

Penalties, employers and payers will demand it: Some of the current incentives through MU may not fully cover the costs associated with software and hardware for a new EHR, however some predict that penalties and lower reimbursements may cause more heartburn for physicians who elect to stay with paper charts.These pressures will continue to mount, as there is an increasing push for modernizing the US healthcare.

Blog url:

The Ozmosis Blog


At this year’s forthcoming HBA Leadership Conference being held in Washington, DC, we will explore how social business tools are being used to drive innovation throughout the healthcare industry.  From medical education and clinical trial development to clinical research and disease management, our panel will share specific examples and key learnings needed to accelerate the adoption and use of the right social strategy and tools.


The U.S. healthcare system desperately needs an "innovation" injection and startup accelerators such as Healthbox and RockHealth aim to do just that. Founded earlier this year by business incubator Sandbox Industries, Healthbox, an accelerator program for healthcare startups, is accepting final applications for its inaugural class in Chicago.


The September edition of our newsletter is available here: Ozmosis Insights. In this edition, we examine the rising use of social tools by 65% of physicians, share how 54% of CIOs believe email will be replaced by real-time communication solutions within five years, explore why 57% of enterprises are making investments in deploying social tools within the enterprise in 2011 and look at how leading social business vendors (Salesforce, Jive, IBM, etc) are shaping the future of business interactions. If you'd like to receive future editions of the Ozmosis Insights newsletter, click here to signup.


According to Forrester, 57% of enterprises are making some investment in enterprise social in 2011.


Two recent surveys explore how physician’s use social media for personal and professional use.  What was interesting from the data is how actively physicians are now using social tools for professional purposes, particularly their affinity for closed, private communities.


According to a recent survey from Robert Half Technologies, More than half (54 percent) of chief information officers (CIOs) interviewed recently said real-time workplace communication tools will surpass traditional email in popularity within the next five years.  At Ozmosis, we see this shift already taking place with early adopters spread across the healthcare industry.

NPA Think Tank



This is the 5th in a series of posts investigating how to leverage technology:

  1. RSS and Web2.0
  2. Google Reader
  3. Selection of Content
  4. Blog Reviews

In the previous blog posts I have outlined how information is pushed directly to you via RSS feeds and Web 2.0. I explained how to access information from journals and blogs without searching the net. I even discussed which journals and blogs you may want to follow and why. But, to truly engage, retain, critique, and apply this information to our clinical practices and research we must move beyond just reading. We need to discuss and analyze and integrate….but…

How do we do this when we are sitting by ourselves on a computer? There are a variety of built in tools that we can utilize to accomplish this within Google Reader, in the comments sections of blogs, via Twitter and Facebook. Most of the technology presented in this post series can be linked and utilized simultaneously. All of this from you office, laptop, tablet, or smart phone. In this post, I have bolded words, phrases, or concepts that I think are important throughout this post. This includes the concept of “pushing” information, modifying a tweet, micro-blogging, and discussion via blog comments.

The exact topic of blogs and the discussions stemming from them was recently written about on the CasesBlog: Medical and Health Blog. In the post, Blogging is good for you – and for most people who read blogs it is stated:

The back-and-forth between bloggers resembles the informal chats, in university hallways and coffee rooms, that have always stimulated economic research, argues Paul Krugman, a Nobel-prize winning economist who blogs at the New York Times. But moving the conversation online means that far more people can take part.

The post links to an article from the Economist Website titled Economic Blogs: A less dismal debate. Interestingly, they assert that papers that are blogged about and/or authors who blog may be considered more respected:

Academic papers cited by bloggers are far more likely to be downloaded. Blogging economists are regarded more highly than non-bloggers with the same publishing record.

I wonder if in the future, features such as track back or blog presence will be utilized to calculate a journal’s impact factor or rate researchers and academics.

TWITTER, with it’s 140 character limit for tweets and profile descriptions, is truly a micro-blogging medium. Everyone who is on Twitter is a micro-blogger. It forces succinct communication. Twitter offers a variety of opportunities and ways to access and discuss information. Obviously, you can read the tweets and go to the links that others post. You can reply to tweets to initiate a dialogue. RE-TWEET is when you tweet someone else’s tweet with RT before their twitter handle (name).

Here I re-tweeted @BodyinMind's link about research and blogging. The link is the article I mention earlier in the post.

Now, you can also tweet a MODIFIED TWEET (MT). Essentially, with an MT you are changing or editing the content or message of a tweet. Below is an original tweet about manual therapy from @DenverDPT regarding manual therapy effects from the 2011 AAOMPT Annual Conference:

I then modified the phrasing and content to deliver a similar, but more specific message based on my understanding of manual therapy. I preceded the tweet with MT to communicate that I had modified an original tweet by Denver Lancaster.

I view FACEBOOK as a personal mini-blog. Links, videos, and articles can be posted with ease. Similar to a blog, friends can comment and discuss. Through pages, individuals can connect on a specific topic, cause, or organization. For example, the American Academy of Orthopaedic Manual Physical Therapists has a Facebook Page: AAOMPT Facebook Page. Beyond networking and professional connection, Facebook is an also a means to access, read, and talk about information.

It is not necessary to have your own BLOG to utilize the medium to discuss and learn. You can utilize BLOG COMMENTS to write your insights and questions. If you disagree with a conclusion you can formulate a more thorough, researched response. Often, I find myself more intrigued and challenged by the discussion that happens in the comments section of a blog post. Especially if you do not publish your own blog, posting well researched and thoughtful comments is essentially blogging! You can have online discussion with links to other blogs, research articles, and online resources with the blog’s author and commentors. Professionals, researchers, and students from across the world can have in-depth, passionate debates at their convenience. Want to stay plugged into a debate? Many blogs offer the option to SUBSCRIBE TO COMMENTS via e-mail or RSS. You will automatically be alerted when a new comment is posted.

After dabbling in blog engagement, you may even desire to publish your own blog. This process is actually quite simple. There are many free resources including Blogger and WordPress. Blogger is Google’s free blog hosting service. A very professional looking blog can be started in an afternoon utilizing free templates and helpful layout designs. As I have mentioned previously, I am disappointed in the lack of blogs surrounding neurologic and acute care physical therapist practice. I remain hopeful that this segment will grow.

PUSHING is an interesting concept in the current social media landscape. All of us has experienced pushing whether we realize it or not. E-mail is a pushing service. Information is pushed to our in-box, and we push information to others. As discussed in previous posts, we utilize Google Reader to have information pushed directly to one location (our RSS Reader). Further, information chosen specifically by our Facebook friends and the tweeps we follow on Twitter is pushed automatically to our news feeds. Conversely, we can push information between our social media accounts through certain applications or linkages. For example, I have a twitter application that allows me to push any tweet to my Facebook account by putting the hashtag (#) FB at the end of my tweet > #fb.

Some pushing and linking features are automatically available. You can “like” an item on Google Reader and then make comments. Then, individuals who follow you on Google Reader can see your comments. Information can be pushed or shared directly from Google Reader to Facebook and Twitter (via the “Send To” button). A post can also be made directly to Google+. There is even a button to e-mail the link!

Most journals are now publishing content and articles online before the print version of the journal is available. E-PUB AHEAD OF PRINT simply means that article was electronically published online ahead of the print version. Journals, including Physical Therapy Journal, even have RSS feeds for E-Pub content. Now, people can blog, comment, Tweet, and Facebook about articles before the print version is published. By the time someone who subscribes to a print journal reads an article, it has probably arlready been shared, critiqued, analyzed, and discussed for weeks to MONTHS.

Interestingly, as widgets and applications evolve the line between various forms of social media and Web2.0 principles becomes more blurred. For example, Twitter feeds and tweets can be seamlessly integrated on the sidebar of a blog. Applications allow for the automatic pushing of tweets to Facebook profiles. And with tools such as HootSuite you can control both from one dashboard. Many Twitter applications allow the scheduling of Tweets into the future, so you do not overload followers with 1,249 tweets in 5.9 seconds. Facebook also allows users to create a badge, or snapshot, to have the sidebar of blogs.

Imagine networks of students, researchers, and clinicians connecting through Google Reader, Twitter, Facebook, and blogs to diseminate and discuss research, blog posts, newspaper articles, and legislation. Imagine the proliferation of professional networking, learning, and discussion. The potential exists for clinicians to collaborate remotely on patient care and research projects. If you have not already, check out PHYSIOPEDIA. Physio-pedia is the model for the future fusion of technology with education, learning, and research.

All of these tools have the ability to elevate our individual knowledge base, care delivery, and research. On a grand scale, it gives us the opportunity to improve professional growth and patient care for all regardless of geographical location. I imagine technology integration and colloboration as the basis for the future of “continuing education” and professional learning…

I envision a future where professionals from across the globe are accessing, disseminating, discussing, critiquing, and even performing research and clinical practice.

In the next post, I will illustrate these principles from a real life scenario. As a preview, I responded to a Tweet that linked to a performance and injury risk reduction program aimed at decreasing ACL injury rate AND improving performance. In that interaction, I utilized and pushed an article via Google Reader to Twitter. I was able to engage in a virtual conversation with a handful of individuals regarding the topic. After I present the interaction, I will discuss and analyze the encounter and research evidence surrounding the specific topic of ACL injury risk reduction and performance improvement.



So, this series has had a long, long hiatus between posts for which I apologize!! Time to start the new year off right. This is another dense post with a ton of resources and links. I hope you enjoy. In the previous post, I presented which research journals publish the most and highest quality clinical trials of interventions. I also discussed what research journals we should consider following. The preceding posts in this series were:

  1. Web 2.0 and RSS
  2. Google Reader
  3. Selection of Content

But, research journals are not the only way for us to engage information relating to clinical practice and scientific research. Blogs are another great online resource. With the advent of Web2.0 principles physical therapists, students, and researchers from around the world can critique research, discuss science, and debate clinical practice through the blog format (And, the micro-blog format such as Twitter, but more on that in the next post!). Disagree with a bloggers interpretation of the evidence? Comment on the post! If utilized civilly and with proper logic blogs (and social media like Facebook and Twitter) are a great platform for learning, discussing, and reviewing. And, as I have mentioned in previous posts with RSS feeds the information is pushed directly to you. Then you decide what to skip, what to skim, what to read, what to push forward through Twitter or Facebook and what to comment on!

There are many blogs relating to physical therapy, rehabilitation, training, science, exercise science, training, and research. I stumble upon new ones all the time. Some of them are great, some are bad, and some are just ugly. Below I am going to review some of the blogs that I follow.

I love the interactive nature of the blog format. You can participate in high level discussions regarding research and clinical practice from anywhere in the world. This type of crowd sourcing has the potential to elevate our knowledge dissemination, discussion, and growth. In fact, the proliferation of blogging and micro-blogging will (I believe) fundamentally change not only how information is disseminated, but how we learn, discuss, and collaborate on clinical care and research.

For each blog, I have included the title/subtitle hyperlinked to the actual blog as well as the author(s) twitter handle with a hyperlink to their twitter profile. Please comment on your thoughts of these blogs.

What blogs do you follow? Let us know in the comments section! Speaking of, follow @PTThinkTank as well as all the authors, including the creator @EricRobertson and humble contributors @MPascoe and @Dr_Ridge_DPT

I have to start off with some student blogs. As a student this is how I became exposed to and involved with leveraging technology!

AAOMPT sSIG: Blog of the Student Special Interest Group of AAOMPT

The AAOMPT sSIG Blog is where I got my start blogging about such issues as the doctor of physical therapy degree, direct access, physician owned physical therapy services, and grass roots political advocacy. The blog provides information on the happenings of the student special interest group. If you are a student, or know a student, send them to the blog for more information on getting involved in the sSIG. It is a great group of motivated, high energy students. Unfortunately, the AAOMPT sSIG is not on twitter, but you can e-mail the students directly with comments, suggestions, and questions:

Colorado Student Physical Therapy Advocacy: Act now to protect the future of your profession

Author: @COSPTAdvocacy

I may biased since these students are from my Alma Matter, but these students are truly organized and accomplished. Not only did they WIN the APTA’s Student Advocacy Challenge they are leveraging technology through Blogger, Twitter, and Facebook to create a sustainable and visible student movement.

Below are some of the blogs that I regularly read and definitely have in my RSS Feed. Most of them deal directly with physical therapist practice, and are authored by physical therapists. Others are authored by other professionals, but still very applicable to physical therapy. Enjoy!

Better Movement: Learn to Move with More Skill and Less Pain

Author: @ToddHargrove

Todd is a Seattle based Feldenkrais Method movement instructor who used to be a lawyer. He writes about a neurocentric approach to movement, training, and pain. In Both Sides Now, he discusses research investigating the training, or treating, one side of the body and the effect on the contralateral side.

Body In Mind: Research into the role of the brain in chronic pain

Authors: @bodyinmind @NeilOConnell

This is the blog of Lorimer Mosely and crew out of Australia. They provide research summaries and discussions regarding the mechanisms of pain and the treatment of chronic. Probably one of the most robost blogs on the net regarding pain physiology and current research. Why Things Hurt is an outstanding Tedx video by Lorimer Moseley on the neurophysiology of pain. They even discuss if Chronic Pain is a Disease.

Categories: Pain Science, Chronic Pain, Neuroscience, Physiology, Research

Leaps and Bounds: Perspectives from a physical therapist

Author: @ForwardMotionPT

Corey provides unique insight into physical therapist practice, and is obviously a very deep thinker. He has produced many videos illustrating the use of novel movements of various body regions. Here is a great post about The Movement Diet.

HealthSkills: Skills for health living for health professionals working in chronic pain management

Author: @adiemusfree

Healthskills is a blog for health providers who want to read about research related to self managing chronic pain. Topics include chronic behavior therapy, measuring outcomes, patient education, and many other topics. The author was originally trained as an occupational therapist. In this post, she discusses what to do when a patient is “inconsistent” with their pain behavior or presentation.

Categories: Pain, Chronic Pain, Cognitive Behavior, Clinical Treatment of Pain

The Manual Therapist: Promoting the highest level of physical therapy practice

Author: @The_OMPT

Dr. E posts very regular providing links to other blogs (including this one, thank you!), videos on techniques he uses, clinical cases, and clinical reasoning. He has a very expansive background being both a fellow of AAOMPT and MDT diplomat. See the post What is the Mechanism Behind Rapid Change? for a discussion we had regarding mechanisms of manual therapy. (Here is the comments section)

Mike Reinold: Rehab | Sports Medicine | Performance

Author: @mikereinoldblog

The most up to date information related to evaluation and treatment of athletes, specifically overhead athletes. Good citation of clinical research for evaluation and exercise treatment. Lots of links to different courses/products. Mike is the head of athletic training for the Boston Red Sox, and is well published on issues regarding the shoulder and injuries in throwers. In the post Rotator Cuff Fatigue Increases Superior Humeral Head Migration, Mike discusses the importance of not training the cuff to fatigue.

Categories: Athletes, Shoulder, Knee, Sports, Orthopaedics

Move It: The New Professional’s Collaboration Blog

A group of young physical therapists (<5 years experience) discuss clinical practice, clinical development, and issues regarding being a new professional. It has been a while between posts, but they have some excellent content. Check out A Generation with Challenges, Vision, and Debt.

Categories: Young Professionals, Professional Development, Legislative Advocacy, Professional Issues

My Physical Therapy Space: Evidence in Motion Blog

Authors: @EIMTeam

The blog of the Evidence of Motion crew. Great information regarding private practice, legislative issues, and research pertaining to orthopaedics. Discussions regarding the overuse of imaging and surgery, as well as the how physical therapists can provide value to society and healthcare. In a Blast from the Past, John Childs illustrates how some clinicians and researchers cling to old models of pain and treatment despite evidence to the contrary. Tim Flynn discusses how access to early, cheap care (physical therapists!) for low back pain is Not Rocket Science, and could have HUGE implications for our society. Larry Benz deconstructs poor logic about Physician Owned Physical Therapy Services (POPTS) that appeared in Advance Magazine.

Categories: Professional Issues, Private Practice, Orthopaedics, Research, Professional Development

The Sports Physiotherapist: Resource for physiotherapists (or physical therapists) with a passion for assessing, diagnosing, and rehabilitating the sports injuries of the world’s athletes

Author: @TheSportsPT

Extremely well cited articles discussing the evaluation, assessment, and treatment of athletes including surgical approaches and their implications on rehabilitation. Their blog and website is maybe the most comprehensive sports physical therapy resource on the net. In this post, they review the diagnostic accuracy of tests used to identify Acetabular Labral Tears of the Hip.

Categories: Sports, Athletes, Research, Examination

Physical Therapy Diagnosis: Make Decisions Like Doctors

Author: @timrichpt

Private practice owner in Florida discusses clinical decision making as well as leveraging decision support tools/software. Lots of discussion of Medicare flaws, clinical decision making, and issues in private practice. Tim recently authored a book detailing bullet proof decision making processes to improve documentation and efficiency in outpatient practices. Tim presents The Art and Science of Physical Therapy by analyzing the Oxford Debate from the American Physical Therapy Association’s Annual Conference in 2011

Categories: Private Practice, Legislative Issues, Clinical Decision Making, Outpatient

Save Yourself: Science powered advice about your stubborn aches, pains, and injuries

Author: @painfultweets

A massage therapist by training who turned to science focused blogging regarding painful problems. Skeptical analysis of pain, pain syndromes, and treatment techniques. Great information for patients and practitioners alike. Although I very much respect Paul’s work and critiques, there is a very apparent bias towards trigger points as a significant pain complaint and treatment target. Paul talks about MRI Overuse and how MRI is too sensitive of a diagnostic tool. He also does a nice job of summarizing some of the Science Surrounding Stretching.

Categories: Pain, Chronic Pain, Manual Therapy, Science

SomaSimple: The so simple body. A place for physical & manual therapy.

@SomaSimple Contributors: @jasonsilvernail @dfjpt @BarrettDorko @wrtrohio @JohnWarePT @ForwardMotionPT among others

You will not find a more thorough or logical analysis of manual therapy, physical therapy, and their relation to people with painful problems anywhere. The folks over there are true skeptics in their thought process, and challenge all. Be ready to be challenged, even if all you do is read the forums! This site is such a density of information and discussion you could read for months. Whether you troll or join in on the discussion it will deepen your analysis and understanding of pain, pain physiology, and clinical practice. Enough is Enough is a well written piece by Jason Silvernail talking about how we need to stop looking for the magical technique or tissue and focus on deeper models of understanding pain. In Crossing the Chasm, he absolutely shines in his ability to tie current clinical research to a deeper, neurophysiologic understanding of pain as he describes his process of evaluation and treatment utilizing sub-grouping in low back pain.

Categories: Pain, Neuroscience, Discussion Board, Manual Therapy

The blogs above are more specific to physical therapy principles. But, it also useful to engage information from other disciplines or sources. For example, decision making, principles of science, behavior, and psychology are all integral parts of physical therapy practice. These topics relate to how we treat patients, but maybe more importantly how we make decisions and analyze/integrate literature.

Science Based Medicine: Exploring issues and controversies in the relationship between science and medicine

I believe this is a must read blog for all health care professionals. It discusses the application of scientific principles to improve evidence based practice. These principles include prior plausibility, physiologic plausibility, and an increased focus on the integration of basic science into the understanding and practice of medicine. Although, much of it is not related directly to physical therapy, the lessons and principles discussed are applicable to research interpretation and clinical practice of all health care professions. In fact, physical therapists receive a mention in the post Subluxation Theory: A Belief System that Continues to Define the Practice of Chiropractic.

Check out these posts:

  1. About Science Based Medicine
  2. Announcing Science Based Medicine Blog
  3. Does Evidence Based Medicine Undervalue Basic Science and Overvalue Randomized Control Trials?
  4. Is it a Good Idea to test Highly Implausible Health Claims?

Eric Cressey: Performance and health on a whole new level

A personal trainer with a masters degrees in kinesiology with a highly successful persontal training facility targeted towards baseball players. Collaborates with Mike Reinold. Although targeted for personal trainers and fitness specialists, he provides amazing information on training athletes that is very applicable to physical therapists.

Very detailed information about the training of high level athletes especially baseball players. Eric exhibits in depth understanding of kinesiology, training, and anatomy specifically as it relates to baseball players and overhead athletes. Although, he does seem to have a poor understanding to mechanisms and effects of manual therapy and at times “plays doctor” in regards to client’s pain complaints. In How Much Rotator Cuff Work is Too Much? Eric discusses the implications of training the rotator cuff in throwing athletes both in season and during the off season. He highlights the fact that many throwers overuse their cuff musculature.

Categories: Sports Training, Baseball, Shoulder

  1. Do you read any of the blogs above? If so, what is your critique?
  2. Did we miss a good resource? Please comment and enlighten us!
  3. Do you have a blog? Comment with a link and a brief summary!

Unfortunately, there seems to be a lack of physical therapist focused blogs relating to in-patient acute care, neurologic physical therapy, and in-patient rehabilitation (hint, hint, any takers??). Most focus on outpatient, orthopaedics, sports, and private practice.

I hope you have enjoyed the leveraging technology series thus far! We have covered a ton of information as these posts are are very dense. The next post will discuss the use of social media tools including Twitter, Facebook, and Blog comments to move beyond RSS into active sharing, discussion, and engagement of information! Remember, we always value your feedback and comments.




Earlier this year I had a very positive experience attending my first physical therapy conference – CSM 2011, in New Orleans, LA.

Twitter was instrumental in the success of my experience. I thought I would take a moment to show you what I did leading up to the conference. Using twitter, I was able to break-the-ice with several attendees in advance so that when I got to the event I had several conversations waiting to happen.

Use this post as a checklist to prepare for your next PT conference. For me this will be the 2011 AAOMPT Annual Conference, Oct 26-31 in Anaheim, CA.

1. Create your twitter account

  • Choose your name carefully. You want to avoiding changing your name down the road as this will force your followers to find you again once the change is made
  • Choose a name that represents the content of your tweets – JSmithDPT for professional content; JoeSmith22 for personal; XFactorPT for clinic content, etc…
  • Really consider including PT or DPT in your twitter name, especially if you’ll be tweeting about #physicaltherapy
  • Enhance your profile. Add a picture, write a brief biosketch (you are limited to 160 characters), add your location, paste in your homepage URL (university profile, facebook page, a zapd page, etc…)

2. Follow other people on twitter by mining a twitter list

  • Twitter has a way you can group twitter profiles with a common interest called lists
  • If you find someone has created a list of conference attendees, you can view the list and find some interesting people you can start following and maybe even reach out to
  • Here’s the list I’m putting together for 2011 AAOMPT Annual Conference
  • This is a good way to find people on twitter because someone else has already done all the work for you
  • You might also want to check out my list of physical therapy related twitter accounts and ask me to add you if I haven’t already

3. Create your own twitter list

  • Once you have seen the usefulness of a twitter list, I suggest you start your own for the conference
  • Start looking for people you know or would like to get to know by using the “Who to follow” feature
  • Also search for an official conference account and add that to your list – AAOMPT actually has one
  • If you find the conference organizer has an account, your can also mine their followers, here are the >1,000 people that follow @AAOMPT, do any of them look familiar to you?

4. Search twitter

  • Twitter is a powerful way to find information instantaneously about topics you’re interested in, so start searching for content related to your conference, “AAOMPT” for example
  • For large conferences, attendees will include a hash-tag to specify that their tweet is related to the conference, such as #AAOMPT11 or #CSM2012
  • As you find people tweeting about the conference, add them to your list

5. Broadcast your plans

6. Even if you’re not going

  • Watch the hash-tag (#AAOMPT11) to see what people are sharing
  • Ask questions, say hello
  • Help promote the event by tweeting: “hearing lots of good chatter from #AAOMPT11 this week!”

7. Go mobile!

  • Everything mentioned above can be done in a browser on a laptop or desktop computer, however, I found that I was much more likely to interact with twitter from my smart phone
  • In fact, I barely looked at twitter for the first 6 months I had my account. It wasn’t until after I got setup on my iPhone 3GS that I really got immersed
  • The screenshots in the gallery below were all taken from the iPhone app Tweetbot ($2.99 in the app store), but I suggest trying the free Twitter for iPhone app first (those on other smart phone platforms can chime in with links to your favorite apps in the comments below)
  • Plancast also has a free mobile app
  • It is also easier to share photos from your smart phone, assuming most smart phones have a camera these days
  • One free photo sharing app that is on fire right now is instagram, which also connects to your twitter account

Gallery of screen shots from my iPhone shows some of the features mentioned above:

Here is my account on twitter complete with a profile pic, location, link to website, and a brief bio of what I am about. Here are all of my public lists on twitter. Here are a few of the accounts I have added to my twitter list called "Physical Therapy" Here are some of the account I have added to the twitter list "AAOMPT". These are people I plan on meeting with at the conference. Here is a list of all of my saved searches on twitter. I'll be checking them once a week leading up to the conference. Here I have entered the term "AAOMPT" into the search field of my twitter app. Here is the event on plancast for AAOMPT 2011.

In closing…

I hope this was helpful and easy to digest. As usual, we want your feedback on this post in the comments – what did you like, what was explained poorly, what is your story with twitter at PT conferences, did I leave anything out, etc…

If you’d like to read more about social networking in physical therapy, I suggest reading this recent article on the Australian Physiotherapy Association website – “Why social media matters for physiotherapists”

Mike Pascoe - @mpascoe



In the first two posts of this series I discussed the concepts of RSS and Web 2.0 as well as detailing the set up of Google Reader.

  1. The Basics: Web 2.0 and RSS
  2. Google Reader

This post will discuss which journals we should be following and reading as physical therapists. Obviously, there is Physical Therapy Journal as well as population and practice area specific physical therapy journals published by the sections of the American Physical Therapy Association:

Click on the picture to visit the Acute Care Section's Website!

Definitely subscribe to some (or all!) of those journals via RSS. Remember, if the journal website does not have an RSS icon or url, you can create an RSS  for a PubMed search for that specific journal. I outlined how to do this in my previous post.

Following physical therapy specific journals seems quite obvious. But, an interesting article published in Physical Therapy Journal detailed some specifics regarding journals that publish physical therapy and rehabilitation specific trials. The article, Core Journals that Publish Clinical Trials of Physical Therapy Interventions, analyzed journals that published clinical trials of physical therapy interventions. The journals were then ranked by

  1. Total Number of Trials
  2. Quality of Trials ranked via PEDro Score
  3. Impact Factor

Most Trials of Physical Therapy Interventions

  1. Archives of Physical Medicine and Rehabilitation
  2. Clinical Rehabilitation
  3. Spine
  4. British Medical Journal
  5. Chest

Highest Quality Trials Based on PEDro Score

  1. Journal of Physiotherapy
  2. Journal of American Medical Association
  3. Stroke
  4. Spine
  5. Clinical Rehabilitation

Highest Quality Trials from 2000-2009

  1. Journal of Physiotherapy
  2. Journal of American Medical Association
  3. Lancet
  4. British Medical Journal
  5. Pain

Highest Impact Factor: 2008

  1. Journal of America Medical Association
  2. Lancet
  3. British Medical Journal
  4. American Journal of Respiratory and Critical Care Medicine
  5. Thorax

The authors conclusions:

  • Physical therapists must read more broadly than physical therapy specific journals
  • High quality trials are not necessarily published in journals with the highest impact factor

Surprised? The only physical therapy specific journal is the Journal of Physiotherapy, which is published by the Australian Physiotherapy Association.

NOTE: Take into account the data is only in regards to Randomized Control Trials (RCT’s) of interventions. It does not include information regarding articles on basic sciences, physiology, or neuroscience. Further, it does not include case reports, clinical perspectives, and other manuscript types. Regardless, it provides us with guiding information on where we should be looking for research to guide our practice and understanding. In addition, I believe it reiterates the point that we need to continually look to other areas of research to deepen our mechanistic understanding of physiology especially neuroscience. I think it is absolutely imperative we stay up to date on basic science research especially as it relates to neuroscience, the physiology of pain, and exercise science.

For example, in October of 2009 Critical Care Medicine devoted an ENTIRE supplemental issue to Intensive Care Unit Acquired Weakness (ICU-AW) including clinical and physiologic studies examining neuromuscualr impairments, clinical examination, and clinical treatment. In all, there were 20 articles, reviews, and manuscripts in this supplement. That sounds like something a physical therapist practicing in acute care should follow!!

Now, although Physical Therapy Journal failed to make the Top 5 in any of the categories above a recent investigation in Journal Citation Reports gave PTJ high marks: #1 Among physical therapy specific journals. #3 Among ALL rehabilitation journals. #7 of 61 Among orthopaedic journals. Please visit this post via PT in Motion: News Now for a summary. Paul Ingraham, a massage therapist and writer covering science based pain care over at Save Yourself, compiled his own Top 10 List based on the results of the PTJ study. His list is very similar to the ones above.

Below you will see journals that I think are applicable to clinical practice and scientific understanding. I organized them by a few practice areas and topics. I also provide the RSS link next to the journal name. I did not include any of the physical therapy specific publications, but the links to those journals are earlier in the post. In the instances where the journal does not have an RSS, I have included an RSS for the PubMed search for that particular journal. If you want to follow any of the journals below all you have to do is copy and paste the RSS url into the ‘Add Subscription’ box of google reader! I have also hyperlinked to the journal websites, so please also visit the journal websites to explore other potential RSS options on content including online ahead of print and podcasts.

General Clinical Practice and Basic Sciences

Medical Journals

Acute Care


Orthopaedics: General

Manual Therapy


Now, this is not an exhaustive list. Depending on your practice area and the populations you work with other journals may be more applicable. For example, if you work at a rehabilitation hospital that specializes in the treatment of spinal cord injury Spinal Cord and Journal of Spinal Cord Medicine are obviously more applicable journals. Also, I did not include lists for Pediatric, Geriatric, or Women’s Health practice areas. But, if you practice in these areas or have suggestions please provide us some information by leaving a comment!

Hopefully, the information and journals listed were helpful. Spend some time over the next week analyzing which journals you subscribe to, follow, and read. Ask yourself “WHY?”

  • What journals do you read?
  • What would you add to the above lists?
  • What did I miss?

In the next post, I will provide a brief overview and evaluation of some of the blogs I follow. Do you have favorite blogs that you read? Please comment and let us know. Stay tuned!



In the last post, I introduced the basics regarding RSS and Web2.0. In this post I will go over how to set up and utilize Google Reader, a specific RSS reader. Watch the video below for a an explanation and visual demonstration of Google Reader:
Google Reader in Plain English by Google

Before you can use Google Reader, you must have a google account. If you have a gmail e-mail address or use any of the other products from the google suite including calendar or documents then you already have a google account. Once you are logged into your google account find the link to “Reader.” This link lives either on the top menu or under the “More” drop down menu.

Click the "Add a Subscription" button!

The ‘Add a Subscription‘ box of of Google Reader is where you paste RSS feed urls. Once added, the RSS feed delivers new content from the website directly to your Google Reader: Your Internet Inbox! (FYI > click on any of the images in the post and bigger version will appear in a new window)

Now, adding RSS Feeds from your favorite websites, blogs, and journals is very easy. There are 2 ways to add feeds.

  1. Click on the RSS Icon of a website
  2. Search for RSS Feeds in the ‘Add a Subscription’ box

Most websites, including blogs and major journals, will have an RSS icon. Click this icon to access the url for the website’s RSS feed url. Some websites, such as Physical Therapy Journal, have multiple RSS options.

Physical Therapy Journal has multiple RSS options. You can subscribe to current issue, ahead of print e-publication, case studies, commentaries, etc.

When you click the RSS icon it may take you to a page that looks like code and/or a preview of the RSS feed. If this is the case, copy and paste the url. Or, it may have a bunch of buttons, one of which says ‘Add to Google Homepage’ or ‘Add to Google Reader.’ If that is the case, then click the ‘Add to Google Reader’ button.

Click the Add to Google Reader button!

Clicking the button will either add the feed to your google reader and/or open the RSS feed in google reader (as if you had found it through the add a subscription search box). Do not forget to click ‘add a subscription’ button! The ‘Add a Subscription’ box doubles as a search. You can type in keywords to search for RSS feeds of websites that match your topic, and easily add them to your Google Reader line up.

Unfortunately, not all journals have RSS feeds (what?!). For example, the International Journal of Sports Physical Therapy does not have an RSS feed for new content, issues, or articles. Luckily, there is an easy fix to this. You can turn any PubMed search into an RSS feed.

Turn any PubMed Search into an RSS feed including topic specific, author, or journal. Have new results automatically pushed to Google Reader!

To construct a specific search for journal click the advanced link which will take you to a new window. Under the heading search builder there is a drop down containing such search options as author, journal, title, or abstract. Select the journal option and then type the journal name in the search box. Once the search is complete click on the RSS link, which conveniently has the orange RSS symbol to the left. This will pop out a box with some options for the RSS feed including what you want to name. Click “Create RSS” once your have picked your settings. An orange box labeled “XML” will now appear. Click on this to obtain the url for your new RSS feed. Then copy and paste this url into the add subscription box of Google Reader. Now, you the results of a PubMed search delivered right to you. Remember, you can create an RSS feed for any search including author, journal, or topic!

Click the Create RSS button, and an orange box labeled XML will appear. This is the url for the RSS feed of your PubMed search.

That’s the basics for Google Reader. Be sure to play around with the different options. You can create folders, edit feed names, and share items with people who follow you on Google. Check out the videos below for more in depth demonstrations and explanations of Google Reader. In our next post, I will discuss which Journals we should be following and why. Some of the recommendations may surprise you…

In the video below, our very own Mike Pascoe demonstrates using Google Reader including how to make an RSS feed for a specific PubMed search.

Monitoring Physical Therapy Research Using Google Reader from Mike Pascoe on Vimeo.

For a very detailed explanation of how to set up and start using Google Reader, watch the 10 minute video below.
Google Reader: Getting Started by Capture the Conversation

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MedTech and Devices

MedTech and Devices

Health Informatics Blog



Web 2.0 was coined as a cool name for a conference about the state of the internet back in 2004. Kind of a play on the fact that software is released in ‘versions’ (1.1, 1.4,, etc, etc) whereas the web is clearly evolving and branching in a way that defies this kind of classification.

Web 2.0 draws an arbitrary line that says the current state of the web is significantly different now from how it was a few years ago.

There’s been a lot of talk about what Web 2.0 really means and what it doesn’t (here’s the official line from Tim O’Reilly who coined the term).

Here’s an anthropological take on Web 2.0:



Learn about heart anatomy and physiology through the power of song…

More medical videos.



This online app could be use for students creating their own learning projects or for staff to create course notes and resources for their students.



Revolution Health

Revolution Health is a new startup from Steve Case, former CEO of America Online and chairman of AOL Time Warner.

The website is an amalgamation of several startups purchased by Case and aims to offer an information portal about healthcare with medical tools and a database of doctors and clinics which users can rate.

Visiting the site, the main emphasis seems to be on the ability to rate your own physician. It also offers users blogs, forums and other ways of posting their opinions about health problems and health delivery.

The site has information from several insitutions including the Mayo Clinic, Cleveland Clinic and Harvard.

The site is only just launched so the effects of the social networking and user generated content has not kicked in yet. It will be interesting to see whether the site provides professional evidenced based advice on health issues or just ends up being a repository of anecdotal evidence generated from it’s users.



I’ve just been updating Doctors’ The site has news and discussion about PDAs, EMR and other gadgets that doctors use.

It’s also the host to the video tutorials that accompany the RSM Press book, “The Doctors’ PDA and Smartphone Handbook“.



Dr. Karim Keshavjee from McMaster University has written an article entitled ‘Oh no! Half of all current EMRs Fail’.

PDF of Full Article

Via Canadian EMR.

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MedTech and Devices

Australian Health Information Technology


Tiger Balm Teams, NEHTA's new remedy that works where standards processes hurt. A name that has been trusted by governments to provide specifications for over 6 years. With their unique formulation specially selected from NEHTA architects and industry experts which are proven safe and compliant, Tiger Balm Teams' standardisation processes and soothing relief from meetings and more meetings restore balance to modern standards processes, and give a sense of wellness to NEHTA and DOHA. Suitable for young and old standards, the authority we’re familiar with has also diversified into a range of PCEHR-specific solutions like B2B Gateways, Repository Interfaces and Basic Vendor Repository that address varying needs of the different methods of access. With apologies to ----- A little Friday comment! Love the e-Health logo on the tin! Thanks to the anonymous author! David.

This is the initial part of the post - read more by clicking on the title of the article. David.


This release appeared a little while ago. The release is dated 19 Jan, 2012. Medical Director Launches eHealth Initiatives Health Communication Network (HCN), the market leading clinical software vendor, has today announced the release of 3 key components relating to Australia’s eHealth strategy.  Health Identifiers (IHI, HPI-I, and HPI-O) have been introduced in Medical Director and PracSoft, and Clinical Document Architecture (CDA) handling for discharge summaries and specialist letters (reports) have also been released to market with Medical Director.  This is a strong indicator of HCN’s commitment to the National eHealth strategy with regard to improving clinical outcomes at the point of care. This release enables over 5,700 medical practices nationally to start using Health Identifiers and is a big win for the National eHealth Transition Authority (NEHTA) and DoHA in driving the National eHealth Strategy to fruition. John Frost, HCN CEO, comments:  “HCN is...

This is the initial part of the post - read more by clicking on the title of the article. David.


The following popped up very late last year. It is of special interest as one of the countries covered was good old OZ! Eight-country survey shows worldwide agreement on Health IT benefits, but a generational divide does exist. Overview While the majority of doctors are convinced that “Connected Health” brings benefits, a surprising amount of doctors are skeptical of the associated healthcare IT benefits. Research among more than 3,700 doctors in eight countries reveals ripe opportunities to accelerate a broad national Connected Health initiative, according to a new survey from Accenture. The survey illuminates prevailing perceptions (based on demographics and geography) among doctors today over the future of Connected Health. While the survey illustrates similarities and differences in perceptions of healthcare IT, the findings clearly show that the broadest, fastest path to integrated, effective health practices requires outreach, education and changing mindsets among some...

This is the initial part of the post - read more by clicking on the title of the article. David.


The following appeared today our time. Study: Web-based tools not effective for diabetes management January 17, 2012 — 12:59pm ET | By Sara Jackson The idea of using online tools to manage patients' diabetes is a good one, but few of the tools available today actually live up to that potential, according to researchers at the University of Toronto. That's the upshot of a recent study published in the January issue of the Journal of the American Medical Informatics Association. Researchers reviewed 92 web-based tools, and 57 studies about them, and found that most weren't simple enough, had problems with usability, and didn't provide enough interactivity or feedback. They also experienced "high attrition rates," or patients simply not using them.  ..... To learn more: - read the JAMIA study - check out CMIO's coverage  More of the article here: So much for all...

This is the initial part of the post - read more by clicking on the title of the article. David.


First we have this: Why Personal Health Records Have Flopped It's not a security, privacy, or data-sharing problem. It's a patient problem. By Paul Cerrato,  InformationWeek January 13, 2012 What's holding people back from signing up for a personal health record? According to Colin Evans, former CEO of the PHR provider Dossia, it's the unwillingness of healthcare providers to give them control over their medical data. I couldn't disagree more. The main reason the public doesn't sign up for PHRs en mass is they don't really care that much about their health. Yes, concerns about security and privacy and the reluctance of providers to share patient information slow things down, but at its core this is about apathy. Just look at the statistics. Despite the push by medical and technology industry stakeholders over the years, only about 10% of Americans now use an electronic PHR. And let's not forget the recent demise of Google Health, the search giant's attempt to get the...

This is the initial part of the post - read more by clicking on the title of the article. David.
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