phenomenalplace

This week's post is not about a specific company's technology, but about a concept. My wife did something very cool for me for Christmas. Given that 2011 was filled with Hurricanes, Earthquakes, Tornados, Floods, and Fires around the world, she decided to create something that would make us more prepared for whatever the future may bring. She created a disaster pack for the front hall closet using a Black Diamond Speed 30 mountaineering pack as a "grab and go" answer to any disaster that strikes.   It contains 72 hours of food/water, basic medical supplies. a solar powered radio, tools that can be used to harvest wood/start a fire, and extra clothes. From the point disaster strikes to the point we're in a car with our supplies driving away could be under 60 seconds. Think about the time it would take to assemble food/water, clothing, and medical gear after disaster strikes - 15 minutes?  Half an hour? I highly recommend a "grab and go" pack as part of yo...

It's been two weeks since my wife said "I have cancer" to my daughter. It's been a week since we described our workup thus far on my blog. Reaction to our blog post was diverse, ranging from the HISTalk blog to the Boston Globe . It's a time of anxiety and unanswered questions.   The diagnosis and staging phase has been described as one of the two major tension points in  cancer.   The other is the time after remission, when the worry about recurrence is a constant burden.  One of our doctors recommended we keep a "family bottle" of anti-anxiety medication ready for those times when the stress exceeds our capacity to cope.   Cancer is truly a family disease and the emotional impact extends from the patient to family caregivers. Many friends and colleagues have offered prayers and support.   A few have lamented that care coordinated by a physician-husband at a Harvard-associated hospital in Boston lacks equity since every wife/mother/dau...

2011 was a year of change and tumult.   For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian . It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage. What about the world of healthcare IT? Federal In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country.    Every aspect of the industry was stressed along the way *Vendors were challenged to add the features necessary for certification resulting in some "haste makes waste" lack of usability and workflow integration.   GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them. *IT organizations created productivity miracles to meet meaningful use timefra...

As the year ends, I've spoken to many CIOs.   2011 was a hard year filled with Meaningful Use (including many upgrades to certified systems or self-certification),  5010 (the deadline for upgrading billing systems is January 1, 2012), accelerating compliance demands,  new security threats, rapidly evolving technologies, and unprecedented demand for new projects driven by the consumerization of IT . At the same time that CIOs and IT professionals are running marathons, they are being held accountable for events that are not directly under their control.   They are not being congratulated for the miracles they create every day, but are being criticized for not moving faster. What do I mean? One CIO received a negative audit report because new generations of viruses are no longer stopped by state of the art anti-virus software.   Interesting.  The CIO cannot control the virus authors, nor the effectiveness of anti-virus software.    No one in the ind...

In a previous post I described the capabilities of the Microsoft Kinect technology . I've written about sterilizing iPads and iPhones for use in the operating room and that does work, but there are challenges with subjecting electronics to sterilization. However, there's another cool option for examining medical records and digital images in the OR - a touch screen you do not touch.  Check out this gestural interface to EHRs and PACS systems that uses an Xbox and Kinect. Traverse pages, select tabs, and zoom into images using only body movements. The system, called TedCas, was recently named one of the top applications for Kinect . That's cool!

by Brian Klepper and David C. KibbeSix months ago, who could have imagined that a large percentage of rank-and-file Americans would support the Occupy Wall Street (OWS) against special interests’ rigging of the American dream? So why not go to the next step? Why not pointedly ask political candidates, “Will you take money from lobbyists?” and “If elected, what will you do to stop special interest

Cancer.  It's a word that creates fear and uncertainty.   Many of the doctors I know use the word "hate" whenever they discuss their feelings about cancer. Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer.    She is not facing this alone. We're approaching this as a team, as if together we have cancer.  She has been my best friend for 30 years.  I will do whatever it takes to ensure we have another 30 years together. She's has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey. Here's how it all started. On Monday, December 5, she felt a small lump under her left breast.   She has no family history, no risk factors, and no warning.   We scheduled a mammogram for December 12 and she brought me a DVD with the DICOM images a few minutes after ...

On December 19, CMS announced the selection of 32 Pioneer ACO organizations , five of which are Boston-based:  Beth Israel Deaconess, Mt. Auburn, Steward, Atrius, and Partners Healthcare. To participate in the shared savings model, we'll need to compute 33 different quality metrics and submit them via survey, claims or the group practice reporting web interface (GPRO). What are these metrics? 7 measure the Patient/Caregiver Experience based on survey 6 measure Care Coordination/ Patient Safety 6 based on claims or submissions to the GPRO web interface 8 measure Preventative Health based on submissions to the GPRO web interface 12 measure care to At Risk Population based on submissions to the GPRO web interface Here's a comprehensive list of what needs to be computed, how, and when . At Beth Israel Deaconess, we'll use our all-payer claims warehouse and quality data center.   My role as CIO has been to prepare the necessary analytics for panel and population health, as des...

The December HIT Standards Committee included a discussion of the work ahead for the next year based on the priorities we've heard from stakeholders.    We'll have 10 in person and 2 telephonic meetings in 2012.   Our topics by quarter will be as follows January-February-March 1.  Assuming that the Meaningful Use Stage 2 Standards and Certification Notice of Proposed Rulemaking will be published in early 2012, the HIT STandards Committee will need to review any comments submitted.   In the meantime, we'll continue work on testing criteria and will ensure any test scripts are piloted before they are finalized. 2. Quality Measurement standards As I've mentioned in other posts, there are three key elements of work needed to improve quality measure computation and submission.   First, quality measures need to be simplified so they are based on data elements that exist in EHRs and are captured during normal workflow.   Second there needs to be a simple mec...

BIDMC has two million square feet of wireless coverage using over a thousand 802.11n/a/g access points.   We operate two separate networks - a secure network for clinical applications and a guest network for visitors. The guest network is physically separate from the secure network and uses a commercial 14 megabit per second DSL line from Sprint for internet services, reducing BIDMC's responsibility for malware control and digital millennium copyright act violations.    Like any public, unrestricted network, the guest network offers the freedom to download malware, broadcast viruses, and use insecure applications. In a world of Netflix and YouTube,  compounded by bandwidth consumptive standards such as MPEG4, the demands on the guest network are infinite.    Can the hospital afford to provide free bandwidth to every visitor (inpatient, outpatient, families, students etc) when 80% of the traffic is streaming video? If we do provide infinite free bandwidth, w...

Many of my posts lately have described the challenge of securing and managing consumer devices brought from home. In the past, I've discussed the products from Good Technologies . I recently polled the CIOs of Massachusetts hospitals and found two other products that are gaining traction - Fixmo and MobileIron Fixmo creates a secured, encrypted container, the SafeZone, providing secure mobile messaging and data for businesses. Companies allow mobile devices into their own SafeZone and can restrict application and data access ensuring device integrity and compliance. A safe, sandboxed environment is created in which mobile devices can run and access network resources without compromising the internal network's safety. With SafeZone, employees can use all the features on their iPhones and Androids while a section of those devices is secure for sensitive company data. Data within SafeZone is certified FIPS 140-2 AES 256-bit encryption and encrypted within a company's infrast...

I've written about some of the perils of using consumer devices on hospital networks  . Now add to that risk, the distraction of mixing personal activities with patient treatment. Blogs are filling with debates about patient safety in a multitasking connected world . Even the New York Times has published an article about the possible negative consequences of mobile devices . In that context, AHRQ asked me to write a balanced commentary looking at the quality, safety, and efficiency pros and cons of using multitasking mobile devices for healthcare. I hope you enjoy it and draw your own conclusions about how these devices are best used in your hospital of professional office setting.

House Budget Chair Paul Ryan (R-WI) and Senator Ron Wyden (D-OR) have embraced a Medicare reform plan that in concept borrows heavily from one championed by former New Mexico Senator Pete Domenici and former Clinton budget chief Alice Rivlin.Specifically, Wyden and Ryan are proposing to alter the earlier Ryan Medicare plan by:Continuing to offer the traditional Medicare plan—Ryan would have