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Christina's Considerations



The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying Your Customers column, titled Engaging Staff with Social Media.  In the article I describe how successful leaders will prepare for the shifts occurring in the healthcare workplace; including the push for efficiency and new generations.  I also include a few examples of where social media is contributing to a more effective workplace in hospitals. 

Social media technologies are tools that can help increase customer, physician and employee satisfaction. I hope you will take the time to read the article and share your thoughts.

Another blog post that includes a few great workplace examples is list of 20 hospitals with inspiring social media strategies



I was interviewed for a recent article in Becker's Hospital Review that explores the common belief that older adults have more difficulty accepting and using technology.  It includes some great comments about "digital natives" and "digital immigrants" by the other interviewees.   

Speaking for myself, as a late Boomer, I can say that I certainly am a digital immigrant who has embraced technologies as I have found value to my work and life.  And, I believe that this applies to older adults in general.  There are differences in the generations and the oldest may need the most convincing and support, but it isn't that they can't incorporate technology into their daily life.

I remember older adults thinking it was a bit silly for people to carry around a cell phone.  But, once they began to realize value - they feel safer because they can call for help -- then older adults start using the technology just as anyone else.   If I'm correct, I also I believe this is how telephone adoption went.  It took a long time for it to catch on and for people to find value in the technology.  

Health IT is just one more advancement that needs to progress through the adoption cycle.




I've posted on the subject of volunteersyoung people working in hospitals and those considering a career in healthcare administration, previously.  However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.

Candy Stripers at Doctors Memorial Hospital, FL

I'd love to here your thoughts or stories about the youngest of our hospital workforce!  If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com

I'm thinking I should also start researching the Pink Ladies, too!



The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism.  I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.

  • Communication through email or other electronic means can supplement face-to-face encounters; however, it must be done under appropriate guidelines. Issuance of a prescription or other forms of treatment, based only on an online questionnaire or phone-based consultation, does not constitute an acceptable standard of care. (Exception: on-call situations) (pg 75)
  • Shifting principles guide the patient-physician relationship during catastrophes and physicians need to be prepared for decision making and the just delivery of healthcare. (pg 80)
  • Physicians who use online media, such as social networks, blogs, and video sites, should be aware of the potential to blur social and professional boundaries.  They therefore must be careful to extend standards for maintaining professional relationships and confidentiality from the the clinic to the online setting.  Physicians must remain cognizant of the privacy settings for secure messaging and recording of patient-physician interactions, as well as, online networks and media and should maintain a professional demeanor in accounts that could be viewed by patients or the public. (pg 81)


 All Changes to the Manual since the 2005 (fifth) edition

ACP Ethics Manual



Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH).  This means anyone can see the nosocomial infection rates of their local hospital by unit.  But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital.  Hospitals may be interested in using this data to benchmark themselves against other hospitals.

Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.

HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:

Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.





I participated in this morning's Gartner Worldwide IT Spending Forecast.  Gartner, the technology research giant, brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially at this moment in time.  The issues will have major revenue implications for vendors (perhaps leading to service changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.

The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to meeting demand.  There is some uncertainty about this timeline.

This means:

  • There will be storage and server component shortages.  Storage will not be cheap and providers will need to be efficient.
  • Virtualization (the cloud) may be a more affordable option.
  • We can expect longer lead times for delivery, backlogs and double ordering of products.
  • We can expect an increase in costs over the short term (re-assess those budget projections you made last year)

One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of components to help prevent business disasters like this one.  In this case all of our (the world's) eggs (hard drives) are manufactured in one basket (Thailand).

PC and software spending is down due to the downturn in the economy.  But, there was one bit of good news that I pulled from the discussion on software.  Spending on software (tools) for collaboration is increasing.  Companies are investing in technologies that will help them stay competitive and this means tools that will help their employees collaborate will reduce the need to bring on additional people. 

Now, I've been seeing this in other industries and have started to see it trickle into healthcare.  With health reform upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.

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MedTech and Devices

Medicine and Technology [part of HCPLive]


The ePharma Consumer® study found that 42 percent of online adults agree that pharmaceutical companies should be involved in online health communities for consumers.


Do you know how to monitor where your staff may be in terms of resistance or support for a new Electronic Health Records (EHR) system? Learn about the processes to ensure they have proper tools, training and support.


To get the New Year off to a healthy start, the Office of the National Coordinator for Health Information Technology (ONC) is launching the Healthy New Year Video Challenge, the first in a series of video challenges.


AMA Insurance Agency Inc., recently announced its “Take a Trip with Timmy Global Health” contest. Two winners will be selected to spend 2-3 weeks with US and developing world medical professionals working to expand access to quality healthcare in Guatemala, Ecuador, or the Dominican Republic.


Get ready for the HIMSS (Healthcare Information and Management Systems Society) annual conference where attendees will learn about topics like Meaningful Use, HITECH, HIE, standards, interoperability and more.


In the New Year, save some time out of your busy schedule. Here are 3 simple tips from Doximity physicians that can help you do that.

MedTech and Devices

Constructive Medicine 2.0

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MedTech and Devices



The US-based Electronic Privacy Information Centre and the UK-based Privacy International have released a comprehensive report on the state of privacy around the world. How solid are your privacy rights?

If you live in the US or UK you are in the same class as those living in Malaysia, Russia and China. People living in Greece, Romania (go figure, given where Romania was a couple of decades ago), and Canada fair the best, though Canada's ranking slipped two levels from "Significant protections and safeguards" to "Some safeguards but weakened protections". Among the other findings:
The study is well worth a look.


One of the business risks that come up time and time again in discussions about eHealth is the supply of people knowledgeable about both IT and health care. It seems that there are lots of one or the other, but few who understand both dimensions of a very complex business. Yet there is little effort being applied to increasing the pool of talent needed to address the demand for skilled human resources.

There are a number of university and college programs across the country (link here for a survey of HI programs across Canada published by the Waterloo Institute for Health Informatics Research (WIHIR), but they graduate relatively few health IT practitioners... certainly not enough to fill the demand.

COACH, Canada's Health Informatics Association, has recently published a list of core competencies needed by Health Informatics Professionals (unfortunately its only available to COACH members), but again, there is no strategy to provide educational opportunities for those who need it.

The Healthcare Information Management and Systems Society (HIMSS) has recently implemented a certification program (Certified Professional in Healthcare Information and Management Systems (CPHIMS)) that is taking us in the right direction.

The University of Waterloo's Health Informatics Bootcamp program developed and delivered by WIHIR is highly recommended because it addresses a critical need to quickly educate health care and IT professionals on the intricacies of health informatics.

If we are to succeed in driving out eHealth at the pace promoted by politicians and their instruments such as Canada Health Infoway (and other national equivalents), more investment is needed in the educational programs necessary to develop a competent health informatics workforce.


After a hiatus of a couple of months, I'm finally back to eHealthRisk. I have two announcements for those who are interested:
  1. Starting today I have taken on the position of President of the Canadian Health Information Technology Trade Association (CHITTA), the health care division of the Information Technology Association of Canada (ITAC). This will get me back into the game following my year long sabbatical studying all dimensions of eHealth risk.
  2. The Waterloo Institute for Health Informatics Research has posted the next series of eHealthRisk Workshops. New this year is the eHealth Information Security Workshop whose inaugural run will be from March 26 to 28, 2008 at the University of Waterloo.
And my New Year's resolution... To religiously apply myself to this eHealthRisk Blog.



Canada Health Infoway, Health Canada and the Privacy Commissioner of Canada commissioned and have published a comprehensive survey of Canadian attitudes towards Electronic Health Records and Privacy titled Electronic Health Information and Privacy Survey: What Canadians Think - 2007.

From the Press Release:

Almost nine in 10 Canadians (88 per cent) support the development of EHRs -- a five per cent increase since 2003. Other findings include:
  • 31 per cent of respondents reported they had experience with an electronic health record during an interaction with the health care system. When asked to how the EHR system compared to the paper system in terms of overall effectiveness for the health care system, an overwhelming majority (89 per cent) said the electronic system was better.
  • 87 per cent of Canadians believe electronic health records will make diagnosis quicker and more accurate, while 82 per cent believe they will reduce prescription errors and 84 per cent would like to be able to access their own medical records online.
  • Canadians want to ensure that privacy and security safeguards are in place to protect their health information. 77 per cent would like audit trails that document access to their health information. 74 per cent want strong penalties for unauthorized access. 66 per cent of Canadians want clear privacy policies to protect their health information. In the event of a security breach, 7 in 10 want to be informed and would like procedures in place to respond to such breaches.
  • Those who have had experience with an electronic health record showed an even stronger support for privacy and security safeguards.
  • A majority of Canadians (55 per cent) would like to be able to hide or mask sensitive information contained in their record.
  • While the poll shows strong support (84 per cent) for using anonymous information from electronic records for health research, this support drops dramatically if personal details are not removed from the record (50 per cent).


Alberta's Privacy Commissioner, Frank Work, is the second Canadian privacy commissioner to demand the encryption of personal health information on laptop computers following the theft of four laptop computers from a Capital Health facility. From the OIPC press release:

"The investigation outlines the following steps that must be taken to protect health information stored on a mobile device in order to meet requirements of the HIA:
  • There must be policies and procedures that users are aware of and educated on that guide proper use of the device,
  • Reasonable steps must be taken to physically secure the device,
  • There must be a business need to store health information on the device,
  • The device must be password protected, and
  • Health information stored on the device must be protected by properly implemented encryption."


US Privacy Guru Alan Westin has recently undertaken a study on behalf of the US Institute of Medicine on public attitudes concerning privacy and health research. Modern Healthcare Online has published a two part article on his findings (for part 1 click here - for part 2 click here). From the article:
"The good news for the research community is, despite a plethora of media reports on privacy and security breaches in the healthcare industry, most people still respect the aims of researchers and are willing to support their work.

The bad news is, perhaps because of these highly publicized privacy failures, people need more assurance than in the past that their healthcare information will be protected and, particularly, not end up being misused in ways that could hurt them. This new reality will necessitate some consciousness-raising on the part of researchers, who historically have seen themselves as the guys in white hats who should be above suspicion, according to Westin."

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News and Views
MedTech and Devices

eHealthNews.EU Portal / All News


EDMA, the European Diagnostic Manufacturers Association, and Eucomed, the European medical technology industry association, announced that their respective members have decided to join forces under the umbrella of a European industry federation.


EyeBrain, a company developing medical devices for the early diagnosis and monitoring of neurological diseases, announces that it is launching a new software version of its medical device, the EyeBrain Tracker.


eHealth Solutions with Potential
Changing demographics, an increase in the number of chronically ill patients and the advances in technology have brought healthcare systems to the limits of their performance. The key to sustainable healthcare lies in coordinating care delivery processes. Together with its partners, ICW strives to efficiently provide the needed IT-supported processes for providing the best possible level of care and at the highest possible level of cost efficiency:


iMDsoftiMDsoft®, a leader in clinical information systems, grew substantially during the last year. Over the past twelve months, the company has entered new territories, with first-time installations in Turkey, Sweden, and Austria. In total, iMDsoft was involved in over 45 critical care and anesthesia projects, and MetaVision went live in fifteen countries and ten languages.


eHealth Week 20127 - 9 May 2012, Copenhagen, Denmark.
eHealth Week 2012 brings together two main events: the High level eHealth conference co-organised by the European Commission and the Danish Presidency of the Council of the European Union, and WoHIT (World of Health IT Conference & Exhibition) organised by HIMSS Europe.


CetreaCetrea A/S, developer of innovative, research based hospital software, and Sonitor Technologies AS, the leading developer, manufacturer and supplier of a proprietary ultrasound Real Time Locating System (RTLS), has delivered the clinical logistics real time overview solution that is implemented at the Regional Hospital of Horsens in Denmark.

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