IT Support and Hardware for Clinics
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IT Support and Hardware for Clinics
News, Information and Updates on Hardware and IT Tools to help improve your Medical practice
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BIOTRONIK Releases Most Powerful Implantable Cardioverter Defibrillator in U.S.

BIOTRONIK Releases Most Powerful Implantable Cardioverter Defibrillator in U.S. | IT Support and Hardware for Clinics |

BIOTRONIK is releasing the world’s most powerful implantable cardioverter defibrillator (ICD) in the United States. The Inventra HF-T cardiac re-synchronisation therapy defibrillator (CRT-D) can deliver 42 joules of energy in one punch to jolt even difficult to manage hearts back into a proper rhythm.

Most ICDs generate about 36 joules of energy, but larger hearts and those with a reduced ejection fraction may need a stronger shock to get their arrhythmia under control. The Inventra HF-T sends 42 joules immediately on the first shock, potentially able to save the lives of more patients on CRT-D therapy.

The implant has a lifespan of up to 7.5 years, depending on usage, is compatible with full body scanning under certain conditions, and features monitoring algorithms designed to reduce the number of unnecessary shocks.

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Scientists Use 3D Printers to Recreate Kidney's Proximal Tubules

Scientists Use 3D Printers to Recreate Kidney's Proximal Tubules | IT Support and Hardware for Clinics |

At Harvard’s Wyss Institute researchers used a 3D printer to essentially recreate the proximal tubules found within kidneys, potentially opening up the possibility of printing complex structures that can be used to replace diseased tissues and organs.

Using fugitive ink, a convoluted hollow channel is fabricated to mimic the winding shape of natural proximal tubules found inside a human kidney’s nephrons. Credit: Lewis Lab/Wyss Institute at Harvard University.

The kidney is an organ made of hundreds of thousands of functionally identical nephrons, each having proximal tubules through which most nutrients that don’t need to be filtered out reenter the blood stream.

To create these proximal tubules, the Wyss team first 3D printed a silicone mold and then cast an extracellular matrix that can host living cells. The scientists then used a special “fugitive” ink to print the windy volumetric shape of the tubules on top of the matrix. Another layer of the matrix was then placed on top and the fugitive ink washed away, leaving a hollow curvy channel within a unified matrix. Epithelial cells were then added to pervade the structure and make home in it. Once the cells settled in, the new channel began to have functional properties in many ways similar to proximal tubules.


The tubules can be stored within perfusion tissue chips for months at a time without losing their ability to host functional living cells, allowing them to be used as needed. For now they’ll be an excellent platform for studying the kidneys and how various drugs may affect kidney behaviour. In the future, though, the technology may lead the way to 3D printing of larger, more complex tissue types.

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Amputees Feel Sense of Touch Through Missing Arms

Amputees Feel Sense of Touch Through Missing Arms | IT Support and Hardware for Clinics |

A collaboration between scientists at University of Chicago and Case Western Reserve University has led to two amputees perceiving a sense of touch in their missing hands. Last month we reported on a man who was able to feel via the fingers of a robotic arm that were equipped with pressure sensors. In that study, the volunteer had a brain implant placed into the primary somatosensory cortex of the brain, but the newly published research relies on activating existing median, ulnar, and radial nerves within the arm, avoiding having to access the brain directly.

The researchers from Case Western and UChicago worked extensively with the two volunteers in the latest study, mimiking how a normal hand would encode signals and trying different stimulation frequencies and signal widths. By working through various combinations of different settings, the investigators were able to identify which resulted in tactile sensations most similar to natural feelings. In the process they developed an understanding of the programming language the body uses to create signals in the nervous system, which will help to further prepare for a future of prosthetic devices with an advanced sense of touch.

Electrical stimulation was delivered by an external stimulator (top left) through per-cutaneous leads to FINEs implanted on the median, ulnar, and radial nerves of an upper-limb amputee (bottom left). Each electrode contact evokes sensory percepts on small regions of the missing hand of the subject.
We found that stimulation pulse width and pulse frequency had systematic, cooperative effects on perceived tactile intensity and that the artificial tactile sensations could be reliably matched to skin indentations on the intact limb. We identified a quantity we termed the activation charge rate (ACR), derived from stimulation parameters, that predicted the magnitude of artificial tactile percepts across all testing conditions. On the basis of principles of nerve fiber recruitment, the ACR represents the total population spike count in the activated neural population. Our findings support the hypothesis that population spike count drives the magnitude of tactile percepts and indicate that sensory magnitude can be manipulated systematically by varying a single stimulation quantity.
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If Your Hospital Has Chaotic Desktop Support, What to Do?

If Your Hospital Has Chaotic Desktop Support, What to Do? | IT Support and Hardware for Clinics |

Sad but true. We all love our laptops, the technology sidekicks that we use for seemingly everything, and tweak with our own idiosyncratic brands of organization, file names and passwords. So, handing over a suddenly uncooperative or erratic laptop to your hospital’s IT staff for repairs — whether physically or through remote intervention — can be unnerving and for some of us, close to panic producing.

Why such apprehension? Because we’ve all had bad experiences with PC support.  We know something insidious is going on inside that laptop, but we don’t want an outsider to muck it up even more — or put us through frustrating days of confusion and non-productivity. Such experiences are unnecessary. If your hospital’s users are reluctant to use the IT department’s PC support team, than it needs to up its game. And it easily can.

Desktop computer issues are common and actually increasing. User errors, infection by malware and viruses, hardware failure, software corruption, login problems, user issues with new software, compatibility problems and more are the norm, not an exception. Regardless of the cause, problems that stop our PCs in their tracks are an instant priority for users who often need or expect instant resolution.

Self support or asking a co-worker to “take a look” is a natural response, but expensive: it not only distracts staff from their jobs, it also contributes to a proliferation of worse problems within an individual device and even across the organization’s network. Self support can hide broader problems from the central IT support team, so instead of a single investigation and resolution, the same problem may need to be resolved repeatedly. Or, compromise of the entire network may be at work, without the support team receiving necessary intelligence that will help reduce negative impact to the entire organization.

Unlike our largest multi-hospital health systems, many smaller hospitals have few or no dedicated desktop support staff, and certainly not 24X7. Small IT staffs can become overwhelmed by too many desktop support incidents, many of which may flood in simultaneously if issues are systemic. Often the choice is: do we work to get this user’s computer going, even though it will disrupt an important IT project, or do a partial fix, or even delay it a bit? Healthcare and overall operations should come first in a hospital. But what if IT project deadlines – a significant go-live, for example — must take precedence that day. Or maybe even the next day. IT service — especially complex fixes — frequently gets the short end of this stick.


Enter desktop support outsourcing, especially solutions that combine remote and, when needed, onsite support. This option has become a popular service solution for medium-size and smaller hospitals. If you can find a company with the right qualifications (especially experience with hospital environments), the dedication to being your “trusted support partner,” and the expertise and tools to satisfy your needs quickly and well, your hospital should be able to benefit through:

  • Cost savings. Using a firm that is able to leverage its staff and tools across more than one client using remote technology whenever possible, a hospital should actually spend less per incident than it would relying on internal staff. A 2013 study showed that 70% of healthcare respondents cited reduction of operating expenses as a key motivator in outsourcing. Outsourcing IT has positive downstream effects on costs in other parts of the organization, as well. Average monthly call volume is the determinant of costs – not salaries. Leaner overhead, the potential for bulk purchasing / leasing / licensing options for hardware and software, as well as potential compliance with federal security regulations, provide other potential cost savings.        
  • Fast problem resolution. An outsourced desktop / network support firm has just one job to do: fix the client’s technology infrastructure problems quickly and well. The outside vendor has to produce, or it will not survive. The best have their acts together by continuously updating knowledge banks of solutions, focusing on key performance indicators (KPIs) like call resolution times, meeting contractually agreed upon service level standards, and communicating with client leaders weekly to stay up to date with changes in the hospital. They also will offer onsite as well as remote support, when required.
  • High quality staff. Because desktop support is their core competency, outsourcing vendors hire staff with specific qualifications and certifications. Generally, there is relatively low turnover in well-managed companies where the staff enjoys a diversity of challenges and plenty of ongoing training as technologies change. Software and hardware become obsolete so quickly today that it is nearly impossible for a few in house staffers to keep up-to-date. Small hospitals’ internal support effectiveness is often hampered by technology changes because of low budgets or lack of time for training upgrades needed to meet new challenges. Outsourcing firms do not have this disadvantage; they know they have to keep up to stay in business.
  • Burnout reduction for hospital employees. The extra heavy burdens some hospitals have to put on their IT staff because “someone needs to do it” produces an environment that is ripe for burnout. Internal relationships and overall morale can be greatly improved when staff members are enabled to do what they do best, on time and within budget. Productivity is likely to increase too.

Loss of control? Not so. Ironically, some hospitals say that their IT support must be on their premises, because patient care is conducted onsite. One concern is the potential for loss of control over desktop support practices, standards and results.  Actually, the facts are virtually the opposite.


Outsourced desktop / network support has become a profession in its own right, with best practice certifications, standards for key performance factors (KPIs), and specified service levels that must be met. Because desktop (and often application) support is their only business, the best outsourcing firms have invested in robust technologies for receiving calls, ticket management, tracking results, knowledge aggregation, and getting immediate user feedback.  This information is distilled into structured reporting of performance metrics — often available real time –through dashboards, as well as other formal communications vehicles.

All this knowledge is power; the end result is that hospital outsourcing clients typically have more control over IT support services than hospitals with in-house teams. If selected carefully and held responsible for specific outcomes, their IT support vendor is a well-managed resource that consistently provides quality service. Those days of chaos when everything seems to go wrong have become a thing of the past. And — big side benefit — the hospital’s physicians are much more satisfied with their IT department.

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Philippe Thuaud's curator insight, November 14, 9:07 PM
If either your IT support team is not enough, think of outsourcing this. It is cheaper, faster to have problem solved and high quality support.

HITRUST standard to protect patient data

HITRUST standard to protect patient data | IT Support and Hardware for Clinics |

Two-thirds of healthcare business associates are not prepared to meet the Health Information Trust Alliance's (HITRUST) data security standard to protect providers’ patient protected health information (PHI), a new survey finds.

EHR vendors,, are seen as business associates who are subject to HIPAA and required to stake steps to keep a covered entity’s PHI secure. HITRUST is a privacy and security framework for organisations who create, maintain transmit or receive PHI to assess their level of readiness and soundness of their environment. Since HIPAA does not mandate in particular how to keep PHI private and secure, using the HITRUST standard is one way to do so.

Organisations can indicate their readiness either through a HITRUST CSF examination or a HITRUST CSF certification, both of which “enable vendors to communicate their good faith effort to protect patient information,” Emily Frolick, third-party risk and assurance leader for KPMG’s Healthcare practice, says in an announcement; KPMG conducted the survey.

“An increasing number of healthcare organisations are requiring their vendors to demonstrate controls for securing PHI to manage their cyber and regulatory risks, especially since healthcare information is a rich target for hackers ... the marketplace wants to reduce risks tied to cyber security with third-party assurances concerning their data protection efforts," Frolick adds.

However, the survey of 604 professionals finds that 50 percent are “not prepared” and another 17 percent have a plan but have yet to implement it. Only 7 percent said they are “completely ready,” and 8 percent are “well along implementation.”

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New BD Veritor Plus for In-Office Detection of Flu, RSV, Group A Strep

New BD Veritor Plus for In-Office Detection of Flu, RSV, Group A Strep | IT Support and Hardware for Clinics |

BD has unveiled a new portable device for rapid detection of influenza A and B, respiratory syncytial virus (RSV), and group A strep. The immunoassay device can allow physicians to diagnose patients and decide on a therapy regimen all within one office visit. This can help get the patient started taking pills earlier and so lead to better overall outcomes.


The device is an upgrade to the original BD Veritor, and promises improved quality control of the results, as well as data keeping that can help trace patients to their tests. It can be connected to the server via BD’s own platform so that results are automatically moved to the clinic’s electronic medical record or laboratory info system.


“As we are on the cusp of the flu season, it is critical that providers have the diagnostic tools they need to assist them in quickly and accurately identifying infectious diseases, like flu, RSV and strep and in assigning treatment protocols,” said Dave Hickey, president of Diagnostic Systems at BD, in a statement. “The BD Veritor Plus System’s ability to provide reliable test results and wirelessly transfer them to health records could ultimately lead to better outcomes through rapid detection and simplified workflow.”

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Next Generation: Sensor-Laden Sheath to Monitor the Heart

Next Generation: Sensor-Laden Sheath to Monitor the Heart | IT Support and Hardware for Clinics |

flexible, sensor-loaded membrane that fits snugly around the heart provides high-resolution monitoring of multiple cardiac health markers.


The device: John Rogers from the University of Illinois at Urbana-Champaign and his colleagues have created an elasticated, sensor-packed silicon membrane that fits snugly around a removed-but-still-beating rabbit heart and monitors various markers of cardiac health.

The tailor-made sheath, which is described in a paper published today (February 25) in Nature Communications, contains an array of sensors that can measure not just electrical activity, but also mechanical strain, temperature, and pH. The membrane also contains actuators for electrical, thermal, and optical stimulation.

“Currently, implantable heart devices are quite limited,” said study coauthor Igor Efimov, a cardiologist at Washington University in St. Louis. “What John has developed here opens up a whole new tool kit for high-resolution cardiac monitoring and stimulation-based therapy.”

Rogers and his collaborators previously made stretchy sensor patches that can be applied to and removed from the skin like temporary tattoos. This time, his team used optical scanning techniques to capture the precise geometry of the rabbit heart and a 3-D printer to make an accurate replica. The researchers then mounted ultra-thin electronic components and ribbon-like cables onto the surface of the model before applying a thin layer of silicon elastomer. The result is a flexible, 3-D membrane, complete with strategically placed sensors and actuators, which cloaks the organ without the need for glue or sutures.

“The membrane is a little bit smaller than the heart, so you have to stretch it to slip it on,” Rogers explained. “That’s important because you need some pressure to achieve good contact with the heart surface, but not so much that it restricts function.”

When the researchers tested the membrane on a still-beating rabbit heart in a perfusion chamber, it did not interfere with pumping ability and it performed well compared with standard lab-based monitoring tools. The device successfully measured heart rhythm, for example, as well as real-time changes in pH during restriction of bloody supply and temperature fluctuations resulting from localised burns during experimental cardiac ablation.


The innovation: “What’s new and impressive here is that they’ve integrated a number of different functionalities into a membrane that covers the entire surface of the heart,” said Michael McAlpine, a mechanical engineer at Princeton University who was not involved in the research. That spread of sensors provides a high level of spatial resolution for cardiac monitoring and offers more control when it comes to stimulation.

“The other innovation is the use of a replica of the heart to precisely tailor the shape of the membrane,” McAlpine added. “That opens up new functionality possibilities, because you have sensors in contact with the entire surface [of the organ].”


The significance: The work represents a proof of principle. “We’ve demonstrated strategies for incorporating onto the outside surface of the heart all sorts of sensors and actuators that could have broad utility in cardiology,” said Rogers. But the researchers also had specific clinical applications in mind. They proposed that their membranes could replace current implantable defibrillators and pacemakers, for example, which are comparatively less sensitive when it comes to reading cardiac activity.

Defibrillators typically position one electrode in contact with heart. That’s how they detect potentially life-threatening arrhythmias before delivering a strong electrical shock to restore a safe rhythm. But the electrodes often detect signals from another part of the heart, Efimov noted, leading to unnecessary painful shocks. With dozens or even hundreds of electrodes in contact with the entire heart, however, the new membranes could provide more accurate readings of heart rhythms and better-targeted stimulation. The same could be true for pacemakers.

Efimov added that the inclusion of pH sensors means that such membranes could be used to predict sudden cardiac arrest. That’s because pH is an indicator of ischemia, or reduced blood flow, which often precedes heart attack. “These are still prototypes,” said Efimov, “but it’s difficult to overestimate the potential.”


Needs improvement: Rogers and his colleagues must first show that the membranes can work in vivo. That presents some obvious engineering challenges: how to integrate power supply and transmit information wirelessly.

McAlpine suggested integrating piezoelectric materials to convert the mechanical motion of heart into electrical power. At the moment such energy-harvesting devices cannot produce enough power for certain components. But McAlpine said he expects them to improve over the next few years. Until then, Rogers added, the same batteries used in conventional pacemakers might do the job.

Data transfer should not be too difficult either, McAlpine said. “If you want to monitor something continuously, you would probably have to wear something on your chest,” he explained. “Or maybe you could have built-in memory storage, so you would only have to transfer information once a day.”

Rogers pointed out that there are also biological considerations when fitting the membrane to a heart in a chest as opposed to in vitro, such as how it might affect adjacent tissues and vice versa. “It’s hard to predict how those will play out until you try it,” he said.


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Next Generation: Blood-Cleansing Device

Next Generation: Blood-Cleansing Device | IT Support and Hardware for Clinics |

The technique:

A microfluidic device filled with magnetic nano-meter-sized beads that bind a plethora of pathogens and toxins was able to clear these invaders from the blood of rats with sepsis, improving their outcomes, according to a paper published today (September 14) in Nature Medicine. The design of the extra corporeal device was inspired by the small vessels and sinusoids within the spleen, through which blood “trickles slowly, almost like in a wetlands, efficiently capturing pathogens” said lead study author Donald Ingber, a professor at Harvard Medical School and founding director of the Wyss Institute in Boston.

The device has two interconnected channels, one for the flowing blood and another containing a saline solution that traps and removes the pathogens. Magnetic nano beads coated with a genetically engineered version of the man nose binding lectin (MBL) protein—which has a natural proclivity for foreign toxins and bugs, and normally functions as part of the mammalian innate immune system—are injected into the flowing blood before it enters the device.

“It’s really an impressive demonstration of sophisticated bio engineering. The combination of the bio-artificial spleen and the engineered MBL protein is really elegant,” said Mitchell Fink, a surgeon and professor at the University of California, Los Angeles, who is working to develop new approaches to treat sepsis but was not involved in the present study.


The significance:

Extra-corporeal blood cleansing is not a novel concept for treating sepsis, said Fink. An antibiotic-coated column called Toraymyxin that is approved in Japan and Europe—currently in a Phase 3 clinical trial in the U.S.—can remove endotoxins from the blood and has been shown to improve outcomes for sepsis patients.

Other dialysis-like devices have been developed to mitigate the symptoms of sepsis, and these have included hemofiltration of the inflammatory molecules that are the root of the so-called cytokine storm that spurs organ damage in sepsis patients. But previous approaches did not target the cause of the storm—pathogens.


What’s new:

The naturally occurring MBL protein—a type of opsonin known for its ability to recognise and bind carbohydrate chains found on the surfaces of a wide range of pathogens including fungi, bacteria, viruses, and parasites, as well as multiple toxins— stimulates blood coagulation and activates other components of the immune system. Ingber’s team used genetic engineering to create an MBL version that binds only pathogens, attaching the protein to magnetic nano beads. A magnetic field is applied to the device to pull the beads from the flowing blood and into the second saline-filled channel before the cleansed blood flows back into the animal.

The researchers first demonstrated the ability of the device to filter out about 90 percent of yeast, gram-negative and -positive bacteria—including four types of methicillin-resistant bacteria from blood samples spiked with these pathogens in vitro. They then hooked the device up to the jugular veins of rats with sepsis. The cleansing was able to rid the rats’ blood of about 90 percent to 99 percent of the pathogens and toxins within a few hours.

“We found that we removed both live and dead bugs, which is important because the dead ones are still a major source of toxins,” said Ingber. The team also showed that removing the pathogens quenched the release of inflammatory cytokines.

“Some already available blood-cleansing technologies have negative side effects like depletion of platelets, white blood cells, or other proteins along with the deleterious elements,” said Adam Higgins, an associate professor of bio engineering at Oregon State University. “What I like a lot about this approach is that it appears safe and there is no blood coagulation or altering of the blood composition—that is really important.”


Needs improvement:

The researchers are now exploring different formulations of the system to simply the design to advance the technology, moving it first to larger animal validation studies. For now, filtering the five litres of blood in humans would require the use of five to 10 devices in tandem.

“I think this approach could be used for non-bacterial infections such as treatment of patients infected with the Ebola virus,” said Fink. “We know that with an Ebola infection, the viral load is a big determinant of outcome and this could facilitate its removal.”
Ingber and colleagues now intend to explore just that—removal of viruses such as HIV and Ebola; MBL has been shown to bind both. 

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Five ways your physicians should use mobile devices

Five ways your physicians should use mobile devices | IT Support and Hardware for Clinics |

1. Supporting ongoing, two-way conversations

The saturation of text messaging and social media has conditioned people to expect instantaneous communication. By deploying patient engagement technology, clinicians and patients can use mobile devices for secure, ongoing, two-way conversations that are more aligned with modern communication.

The ability to engage in an ongoing discussion can break down barriers, making patients more comfortable with physicians and transforming them into true resources for health information. In addition to increased patient satisfaction, establishing ongoing communication can also lead to earlier identification of potential adverse health events.


2. Sharing tailored, bite-sized content

We live in a hyper-connected world that is measured in 140 characters, and marked by messages that disappear after 24 hours. Health content is no exception: Care information must be delivered in small, digestible chunks relevant to patients, and accessible anywhere, anytime.

Technology lets healthcare organisations share this educational content at the touch of a button, and customise it to each phase of every patient’s specific healthcare journey.

Have a diabetes patient who has just been discharged from the hospital after a life-threatening rise in blood sugar? Serve them with content that includes one low glycemic recipe a day. By using content to engage patients on a regular basis, clinicians can help proactively prevent readmission and earn the trust of patients.


3. Remote monitoring

The number of hours available to engage with patients is often severely impacted by the number of hours it takes to chart all the information from a visit. While patients may get less than 30 minutes of their clinician’s time, a physician can spend up to a third of a workday charting. Patient engagement technology allows physicians to reclaim some of those hours by making it easier to monitor patients from afar.

In addition to patient-provided health reports, HIPAA compliant monitoring devices allow physicians to monitor heart rate, blood glucose and other bio metrics. In doing so, clinicians can spot health events and address them before they lead to a costly hospital visit.


4. Granting access to real-time data

Patients and providers both are hungry for real-time data—and patient engagement technology can provide it via mobile devices.

For clinicians, the ability to answer patient questions, check in and conduct health visits via mobile devices provides a stream of data that can be collected and analysed on an ongoing basis. These modern technologies help save time by eliminating many of the hours spent manually charting, faxing records and hand-entering medical data. For patients, this technology can integrate with some electronic medical records and other health information systems to provide a more complete picture of their health.  


5. New ways to execute telehealth visits

With mobile devices, clinicians can execute virtual visits in a way that enables the patient to see the face of their doctor (making the visit feel more real) and connect with physicians that might be out of state, while clinicians save money and resources. In fact, most clinicians can actually use telehealth to bring more dollars in the door, without impacting patient satisfaction, via CPT code billing.
To stay relevant and solvent in this new world, healthcare organisations must start looking for technologies that truly integrate with the mobile lifestyle of patients, while also delivering quality, easy-to-access data to physicians.

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What Is Electronic Prescribing?

What Is Electronic Prescribing? | IT Support and Hardware for Clinics |

Electronic prescribing of medications includes the technology and processes that handle medication prescribing as a replacement to paper prescriptions.  To the patients, e-prescribing is simply the electronic version of a paper prescription order. This is true, but the supporting technology also covers order creation, tracking, fulfilment of prescriptions, as well as the database maintenance of the prescribing physicians, clinic locations, pharmacies, and benefits checking. There are also special requirements for electronic prescribing of controlled substances (EPCS). Let’s start from the beginning, and then break down the components and entities as we go.


Electronic Prescriptions

When a patient visits the doctor and is prescribed medications, a physician who e-prescribes will have already been set up with 1) an Electronic Medical Record (EMR) system that supports e-prescribing, and 2) an account with an e-prescribing technology provider which serves as a data clearinghouse for electronic prescriptions. Before writing the prescription, the doctor will ask the patient where they want to pick up their prescriptions. The patient’s preferred pharmacy is verified in the EMR and the prescription is written. An electronic transaction goes to the patient’s preferred pharmacy immediately.

The patient then visits the pharmacy to pick up the prescription. To the patient, everything is seamless, and the prescription is delivered just like any other, except that they don’t have to drop off a paper prescription at the pharmacy, then either wait or come back later.


Electronic Prescribing of Controlled Substances (ECPS)

Electronic prescribing of controlled substances (EPCS) has taken a lot longer to get off the ground for many organisations. All states now allow it, but there are additional security steps that must be taken to support the process, such as bio metric verification of the prescribing physician using fingerprint scanning. This takes an additional investment in hardware, training, and auditing. Alternatively, there are smartphone apps that also provide the needed authentication.


Refill Requests

E-prescribing is also able to support medication refill requests. The patient can initiate the medication refill request several ways:

  1. By calling the pharmacy, who then sends an electronic refill request to the doctor, who then either approves or denies it. The pharmacy or the doctor’s office may communicate the status of the prescription to the patient
  2. By using a web-based patient portal that sends a refill request message to the doctor, who then either approves or denies it, then sends a message to the patient’s pharmacy
  3. By calling the doctor’s office, who then either approves or denies it, then sends a refill authorisation to the patient’s pharmacy.


The Technical Components

The main technical setup is done by four parties:

  1. The IT staff who support the physician offices who will perform e-prescribing: This group will set up the e-prescribing configuration on the EMR software, including maintaining the list of prescribing doctors for the organisation
  2. The EMR software vendor: Assists with the set up of e-prescribing on their system
  3. The pharmacies who will fill the prescriptions: They will have their own configuration to process prescriptions
  4. The vendor who supplies the e-prescribing solution: They provide the technical infrastructure to process prescriptions, verify licenses of prescribing doctors, and maintain and publish the list of participating pharmacies.


Some of the databases or database tables that come into play are:

  1. Medications table, which are usually downloaded as a “formulary” from a third-party provider.
  2. User or Provider table, depending on what the given EMR calls them
  3. Department table, listing all the clinic and hospital locations in a Healthcare enterprise


Medication Eligibility

In addition to fulfilling prescription orders, e-prescribing services can also provide real-time checking of patients’ eligibility for medications on their own insurance plans. When the prescribing doctor writes a prescription electronically, an e-prescribing message is sent back to the EMR advising on suggested alternatives to certain medications.


Who are the e-prescribing vendors?

Far and away the largest e-prescribing provider is Sure-scripts. They are based in Arlington, VA. The graphic below was taken from their website, and you can see that they have a huge portion of the e-prescribing market.

Their payment model has them getting most of their revenue from pharmacies and pharmacy vendors. There are a few other e-prescribing vendors, but they face a huge uphill battle with most pharmacies and physicians already being live with Sure-scripts.


My Take on Sure-scripts

I spent several years in an organisation that uses Sure-scripts. They have a web-based portal where analysts like me can manage our physicians and troubleshoot issues and questions about various transactions. As for their customer service, I’d grade them about a C+ or maybe a B. That’s just my opinion. I do believe things could get interesting as a number of other e-prescribing providers offer e-prescribing on more platforms, and take different approaches to transmitting the data.


Other E-Prescribing Vendors

For years, it seemed like Sure-scripts had a lock on the electronic prescribing market. There have been some serious competitors that integrate with electronic health records (EHR) systems, as well as technology that is built into EHRs.



The next largest provider of electronic prescribing is Dr-first, based in Rockville, Maryland. They claim over 200,000 users and over a Billion medication transactions. Like Sure-scripts, they also have medication analytics and other transaction processing technologies.


Cerner ePrescribe

Cerner Corp is a large provider of enterprise clinical solutions for organisations of all sizes. Cerner’s offering in the e-prescribing space is ePrescribe, a standalone e-prescribing system that connects through an electronic data interchange.


All-scripts ePrescribe Deluxe

All-scripts is another provider of electronic clinical solutions, but they are not as large as Cerner. All-scripts ePrescribe Deluxe is a solution that allows providers to send prescription requests from the Internet, or an iPhone or other mobile device. It doesn’t require any new software install or hardware.


Practice Fusion E-Prescribing

Practice Fusion is a fast growing web-based EHR solution mainly for small to medium-sized practices. Their e-prescribing solution is an integration through Sure-scripts.

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Using Patient-Facing Kiosks to Support Quality Improvement at Health Clinics

Using Patient-Facing Kiosks to Support Quality Improvement at Health Clinics | IT Support and Hardware for Clinics |


Evidence-based services improve outcomes in schizophrenia, but most patients at mental health clinics do not receive such services. This gap in care has been perpetuated by a lack of routinely collected data on patients’ clinical status and the treatments they receive. However, routine data collection can be completed by patients themselves, especially when aided by health information technology (HIT). It is not known whether these data can be used to improve care quality.



In a controlled trial, eight medical centres of the Veterans Health Administration were assigned to implementation or usual care. 571 patients with schizophrenia were overweight and had not used evidence-based weight services. The implementation strategy included data from patient-facing kiosks, continuous data feedback, clinical champions, education, social marketing, and evidence-based quality improvement teams. Mixed methods evaluated the impact of the kiosks on utilisation of and retention in weight services.



Compared with usual care, implementation resulted in individuals being more likely to use weight services, getting services more than 5 weeks sooner, and using 3 times more visits. When compared to the year prior to implementation, patients at implementation sites saw a three-fold increase in treatment visits. Usual care resulted in no change.



Mental health clinics have been slow to adopt HIT. This study is among the first to implement and evaluate automated collection of data from patients at these clinics. Patient-facing kiosks are feasible in routine care, and provide data that can be used to substantially improve the quality of care.

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Innovation culture set to disrupt global surgical industry

Innovation culture set to disrupt global surgical industry | IT Support and Hardware for Clinics |

The emphasis will be on affordable technology for early diagnosis, portable modular equipment for minimally invasive and robotic surgery; and smart systems incorporating low-cost sensors and mobile technology to track clinical outcomes and improve team-based surgery.


The report summarises the findings of a workshop held in Boston earlier this year by product design and development firm Cambridge Consultants. It offers insight into the future of emerging markets surgical care – as seen through the eyes of industry leaders. And it looks at how these new approaches to healthcare will extend beyond emerging markets to disrupt and transform how affordable quality surgical care is delivered globally.  


“More than 85% of the world’s population lives in emerging markets, yet many of these people have no access to affordable quality healthcare, particularly complex treatment like surgery,” said Rahul Sathe, head of surgical innovation for emerging markets at Cambridge Consultants.

“Inadequate hospital infrastructure, a scarcity of qualified clinicians and fragmented healthcare ecosystems prevent successful surgical care. The surgical device industry has unprecedented growth opportunity to address the unmet needs of very large patient populations.”  


The report spells out the huge opportunities for technology disruption in emerging markets. Infrastructure and regulations are still being formed, and industry legacy is not particularly strong – offering a lower barrier to innovation compared with developed markets.  

The primary role of technology will be twofold, says the report. It can extend the ‘hospital ecosystem’ across the continuum of care from early diagnosis and surgical intervention to postoperative monitoring. It can also ensure products and solutions are robust, usable and affordable – and unlock access to care.


The workshop delegates predict that patient expectations and hospital ecosystems in emerging markets will dramatically evolve and, in some cases, leapfrog developed markets. Even today, some hospitals in India have better outcomes for cardiac surgery than top hospitals in the US or UK. And top-tier hospitals in China are now being designed to be Eco-friendly, sensor-rich.

“Emerging markets will play a significant role in transforming our industry,” said workshop delegate Agustin Zabulanes, Latin America marketing manager at Boston Scientific. “Local emerging market companies may provide stiff competition to multinational companies – but they may also prove to be powerful partners in global surgical care. Success will require industry players to evolve the way they do business, organise for innovation and use enabling technology.” 


The report says ‘reverse innovation’ offers developed markets the opportunity to benefit from emerging markets by learning new approaches to achieving healthcare affordability and efficiency – with lasting transformation coming from integrating new business models and innovation models. “As organisations evolve and succeed, innovating for emerging markets will enable industry to disrupt and transform how surgical care is delivered globally,” said Sathe.  

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The Role of Information Technology in Improving Health Care

The Role of Information Technology in Improving Health Care | IT Support and Hardware for Clinics |

Imagine your loved one has a certain chronic condition. When a doctor asks whether she’s had an MRI recently, your loved one says “no” because she doesn’t remember receiving one — even though she just had one two weeks prior at another doctor’s office across town. Let’s say there was also a prescription for follow-up care, but she never received that, either. Maybe she was also prescribed medication, but the prescription was never filled at the pharmacy.


Without a centralised record, this person might theoretically receive the same test over and over without ever following up with subsequent treatment or medicine the doctor feels is necessary. She may feel she’s doing everything in her power to do what the doctor instructs, but the record may tell another story.

What many healthy people often don’t realise is how much time and attention to detail it takes to manage your own health care when problems arise. It’s not uncommon for several different doctors to prescribe multiple medications, tests and follow-up care. Without a centralised medical record, many don’t even realise the treatment they’re receiving is a duplication of effort. That redundancy adds to the already high costs of obtaining health care.


Information technology has the potential to give doctors and providers of medical care a much more complete picture of the patient in front of them, and patients a much easier way to access their complete medical history.

That’s why Blue Cross Blue Shield of Michigan was proud to be a sponsor of the Wiring Michigan Conference, a health information technology symposium held last month in Ypsilanti.

Our Patient-Centred Medical Home program is one example of how we’re persuading providers to adopt health IT. Our PCMH program, the nation’s largest at 1,800 designated physicians, encourages doctors to implement information technology such as e-prescribing into their practices as one way to improve quality, open up access to care and help manage costs.


Here’s a rundown of what we’re doing to promote health IT:

  • E-prescribing — The Blues have collaborated with large customers and industry leaders to lead on electronic prescriptions. Physicians who use electronic prescriptions can view patient records, confirm medications and dosages listed on formularies and know what medications have already been prescribed by other doctors. E-prescribing helps eliminate problems with illegible penmanship, reduces pharmacy staff time and avoids paper waste. Michigan ranked No. 2 nationally for the number of e-prescriptions filled in 2009, according to Sure scripts.
  • Electronic transactions — BCBSM since 2008 has been helping business partners and providers prepare for the 2012 deadline to implement EDI 5010, a new, federally mandated electronic transaction standard. The changes will enhance business functionality, clarify data ambiguities and support the new National Provider Identifier number required under the Health Insurance Privacy and Portability Act.
  • New ICD-10 medical code set — With the rise of electronic medical records, e-prescriptions and connectivity between providers and specialists, the Blues have responded nimbly to maintain market leadership. For starters, the company is on track for early implementation of ICD-10 medical code billing standards, which will provide greater ability to measure health care services and monitor population health, provide better data and cut down on paperwork when submitting claims. Our process for associating the new codes in our systems have been featured at national forums and adopted by other insurers. We’ve also made our solution available to other health care entities to keep implementation costs down.
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Digitally managed clinical trials will accelerate results and reduce costs

Digitally managed clinical trials will accelerate results and reduce costs | IT Support and Hardware for Clinics |

Digitally managed clinical trials have the potential to accelerate results report and reduce costs but workflow questions and regulatory questions remain. In many facets of our lives digital data collection has improved services, eliminated errors, and reduced waste in time and resources. Think about the ticketing and check-in process at airports ten years ago vs. today: when airlines put the information in our hands we were able to do the check-in, seat selection, and other work for them. Plus, we were happy to do it. Also consider ATMs, online banking, and retail banking for how we are able to move money, get cash, and get loans by providing data ourselves and get immediate services. When we think about the medical industry, though, very little of the kind of automation created by self-service digital data collection exists. While we can see some patient portals and self-service triage apps appearing in limited uses, large scale use seems very far away. One specific area that digital data collection can, potentially, literally save lives is in clinical research. The use of digital collection tools, primarily mobile devices, in clinical studies is nascent but growing. Evidence indicates that these tools have the potential to significantly improve the quality of research outcomes and reduce the costs associated with such research, but there are still questions about how exactly these tools will work and some of the issues surrounding electronic data collection. To help answer some common questions, I spoke with James Emerson, who is a director of clinical research and helps run a variety of clinical trials.


How are mobile devices being used for digital data collection in clinical research?

For several years now, IT in the enterprise has been moving toward consumerization; that is, people are bringing their own devices to work and many of the same applications are used outside of the office. Clinical researchers have realised that same consumerization of IT that is revolutionising the way that we work can do the same for research. Trial participants using clinical trial research technology are able to use their own smartphones, tablets, and other mobile devices, which makes it much more likely they will comply with the requirements of the study.

Essentially, depending on the setup of the study, patients simply need to input information into an application, eliminating the need for paper journals or surveys.

While research indicates that most patients actually prefer this technology over other form of data collection, in particular voice response systems, there are still some challenges. One thing that researchers need to overcome are the differences among devices themselves, and how applications actually function on different devices.  Training trial participants — and providers — in the use of the application is an important task. Connectivity issues are also a concern, as is privacy. Protecting sensitive personal information is of paramount importance, and researchers are cognisant of the need for data protection protocols and security, both in terms of protecting the devices themselves and in the transfer of data.


Why are digitally managed clinical trials ideal for clinical research?

Digital data collection has many significant benefits. For starters, it reduces costs. Major clinical studies often have thousands of participants, all of whom need to be trained in how to record data and submit it to their providers. That data also needs to be collected and analysed, often manually. Digital data collection reduces or eliminates the need for many of those expensive tasks. When clinical trial participants are allowed to use devices that they already own and are familiar with, the complexity of the training and on-boarding decreases and compliance increases.

The simplified data collection process also has a significant impact on the overall quality of the study. Again, compliance is a major benefit. Studies have shown that patients vastly prefer mobile data collection over other options like paper journals or interactive voice response systems. It’s simply much easier to input your data into your mobile device and move on with your day than it is to navigate a complex menu of voice response options or fill out a paper questionnaire.

The accuracy of the data collected also improves; when patients use paper journals, for instance, they have a tendency to add additional extraneous information or skip questions, which can affect how the data is analysed. Not to mention, when the researchers have access to real-time data, they can identify compliance issues earlier on and monitor patient safety more efficiently, improving the overall outcome of the trial.

While digital data collection can improve the accuracy of the data collected, there are some obstacles to overcome. Digital data collection protocols require that researchers consider facets of study design that they might not have otherwise. For example, what happens if a device is lost or stolen? How can we protect that data and the integrity of the study? We need to use a technology infrastructure that complies with regulatory protocols, but that is also easy for subjects to use.

Many researchers are also concerned about equivalence among the devices being used. In other words, are all of the subjects having the same experience when using the application, and how do differences affect outcomes? These are all questions that researchers are considering in their study design.


Can digitally managed clinical trials really save that much money?

The short answer is yes. In 2014, the Department of Health and Human Services released a report estimating that using mobile technologies in clinical trials has the potential to save clinical research organisations (CROs) tens of millions of dollars. The greatest savings come in the later stages of trials, but even in the early stages, mobile saves money.


Are there regulatory issues related to the use of digital collection tools that CROs face?

The FDA is actually encouraging CROs to do as much electronically as possible. That being said, yes, there are some stringent regulations that CROs must adhere to that ensure the accuracy and protection of the data. The FDA has issued guidance on how CROs can capture and use data to maintain those protections.


Are there times when digital data collection isn’t ideal? What about barriers to participation?

While it might seem like everyone on the planet has a smartphone these days, the fact is that there are some people who either do not have access to the technology necessary to participate in a research study via a mobile device or have the skills to do so correctly. It’s important to carefully assess the target population of the study to determine whether digital data collection is appropriate or if more traditional methods would be a better choice.

For example, many older adults either do not have or do not use smartphones, and aren’t interested in learning how to use the application to participate in the research. For someone who isn’t a digital native, using an application to record data could be intimidating or confusing.

Another issue is a lack of access to the internet or cellular service. In many rural areas of the country, access to broadband is still limited, and cell service is limited or nonexistent. Relying solely on digital data collection via smartphone has the potential to exclude viable candidates from research studies, simply because they cannot provide data efficiently. We need to be very careful in how we design studies, and the technological requirements, or risk inadvertently creating disparities within the study population based on economic or geographic situations.

And of course, not all studies lend themselves to self-reporting — and as with any self-reported data, there will always be a margin of error. Researchers need to carefully consider their reasons for choosing digital data collection, and evaluate whether they are ideal for an individual study.


Are digitally managed clinical trials really the future of clinical research?

Yes, we believe so. The fact is, the old ways of doing things are no longer infallible. Using digital tools has the potential to solve many of the long-standing problems within clinical research, including low study recruitment numbers, gender bias, accuracy, compliance, and more. By incorporating digital tools, new, more effective treatments can get to market faster while keeping patients safe and improving their overall health.

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Robotic Needle Positioning System to Speed Up Tissue Biopsies and Ablations

Robotic Needle Positioning System to Speed Up Tissue Biopsies and Ablations | IT Support and Hardware for Clinics |

At the Fraunhofer Institute for Manufacturing Engineering and Automation engineers have developed a robotic system for performing needle biopsies and delivering ablation needles deep into the body. Current techniques are time consuming, requiring physicians to be very careful in preparing a trajectory and checking that it under the live CT guidance. The process can take up hours for something that may seem like it should only be a couple minutes.


The team modified a commercial robot to position the needle accurately based on CT scans. A procedure starts by first performing a CT scan on the patient, allowing the robot to calibrate against the scan. A virtual representation of the patient’s anatomy is then used to drive a virtual needle to see how it would penetrate the patient. The same simulation can also mimic how an ablation would happen and how much surrounding tissue it would affect. Once all the preparatory steps are taken, the calibration component where the needle would be is removed and replaced with the needle. The robot then places the needle against the skin at the agreed angle, handing over the rest to the physician who drives the needle through the channel within the robot and precisely into the target.


During insertion a fluoroscope is used to confirm the needles’s location. Since the robot is holding onto the needle, the physician can step away from the X-ray source and image the needle’s location without irradiating himself, and potentially reducing the number of X-rays taken of the patient.

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Where are the real cybersecurity threats?

Where are the real cybersecurity threats? | IT Support and Hardware for Clinics |

October is National Cyber Security Awareness month and a good time to consider what the threats to our cyber security are and what we can and should be doing about them.  Sometimes it seems like the problems of cyber security are overwhelming, but with concerted efforts by individuals, businesses and governments we can dramatically reduce the level of this threat to merely “whelming,” which isn’t a word, but should be.

Part of the problem is technology itself.  Computers and computer networks are involved with nearly every aspect of our lives.   We have seen the concern in recent days as to the potential vulnerability of our voting system where already voters’ registration lists have been subject to cyber attacks.

The plain, hard fact is that if something is connected to the Internet, it is vulnerable to hacking and data breaches. The computers, smartphones and other electronic devices used by everyone connected to the Internet are vulnerable to hacking — by which data can be stolen and used for a variety of criminal purposes such as identity theft, fraud, extortion, commercial espionage,  insider trading and more. In addition, hackers can take over computer operated systems and wreak havoc.


The Internet of Things by which devices that previously would not have been connected to the Internet are going online by the billions provides tremendous advantages, but also brings new vulnerabilities for determined cyber criminals to either control these devices or use these devices as a less protected point to gain access to data and information to be used for criminal purposes.

The list of objects that make up the Internet of Things is huge and increasing every day. By 2020 it is predicted that there will be 5.4 billion devices connected to the Internet.  Among the devices that make up the Internet of Things are cars, refrigerators, coffee makers, televisions, wearable technology, webcams, copy machines and medical devices.

In 2007, former Vice President Dick Cheney was so concerned about hackers that he had the Internet connection on his pacemaker disabled.  Earlier this month, Johnson & Johnson issued a warning that its One Touch Ping insulin pump could be hacked through the unencrypted radio signal used in the device and last August, St. Jude Medical saw its stock value drop after a cyber security firm announced that it had found security vulnerabilities in the company’s pacemakers and implantable defibrillators.

In the United States and throughout the world, critical infrastructure essential to our lives are connected to the Internet and vulnerable to hackers be they cyber criminals, terrorists or foreign states.  The damage that a successful attack on any of these areas of our infrastructure could be extensive.

Among our critical infrastructure operated by computers and networks of computers as noted by the Government Accountability Office (GAO) are “financial institutions, telecommunications networks, and energy production and transmission facilities.”  Our water supply and even nuclear power plants are also part of our infrastructure controlled by computers.  As noted by the GAO, “ as these critical infrastructures have become increasingly dependent on computer systems and networks, the inter-connectivity between information systems, the Internet and other infrastructures creates opportunities for attackers to disrupt critical systems, with potentially harmful effects.”

In 2014, a German steel mill had the computers which operated its smelting furnace hacked causing it to overheat and resulting in tremendous damage.


The Government Accountability Office issued a report in 2015 in which it concluded that the computers that make up the National Air Traffic Control System are vulnerable to hacking. The report issued 17 recommendations and 168 specific actions to address security weaknesses in security controls including – what should have been obvious – the need to encrypt sensitive data. That glaring flaw is one that is found throughout the Internet which was never developed with security in mind. Too often security has been built in as an afterthought rather than incorporated into the systems using the Internet as a part of their initial development.

The banking industry has already suffered major attacks throughout the world as evidenced by the Carbanak gang cyber attacks on banks in the United States, Russia, Germany, China and Ukraine in which a billion dollars was stolen.  As so often has been the case, the manner by which the malware necessary to accomplish these attacks were downloaded was through phishing emails that lured employees into clicking on links in tainted emails that downloaded the malware.

Technology has created dangers unprecedented in human history. However, just as technology may be part of the problem, it may be part of the solution as well.  A common thread in so many major data breaches and cyber crimes is the use of phishing and spear phishing emails to lure people into downloading dangerous malware that enables the cyber criminal to gain access to data or even control entire systems.  Computer programs called analytics that can recognise and protect computer users from phishing emails are available.  Better training of employees in safe computing, increased use of encryption and enhanced security software are among the tools that can help protect our security. Fighting cyber crime is going to be a never ending battle, but we have the tools to win this war.  We just need to commit to using them.

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Mobile Health Care: Shrinking Hospital Hardware into Doctors’ Pockets 

Mobile Health Care: Shrinking Hospital Hardware into Doctors’ Pockets  | IT Support and Hardware for Clinics |

Microsoft for Work had the pleasure of chatting with Brad Younggren, the Chief Medical Officer of Mobisante, a Seattle-based startup dedicated to creating mobile versions of medical technology—specifically ultrasound diagnostic equipment. Mobisante is blazing trails, embracing the stunning pace of technological development to fundamentally improve the kinds of care doctors can provide their patients.

Mobisante is a proof point that the pocket office revolution isn’t just for real estate agents and financial advisors. It’s helping doctors provide better care at a fraction of the cost—and improving patients’ lives the world over.

Here are some excerpts from our conversation:


MS4Work: Can you start by telling us what Mobisante offers?

Younggren: “Mobisante develops mobile ultrasound platforms. We have a phone-based platform, and are already on our second generation of the tablet-based platform in less than one year in production.

Each platform includes the ultrasound probe, the phone [or tablet], and the case.”


MS4Work: How does the mobile ultrasound platform revolutionize health care?

Younggren:  “There are large changes happening [in the medical field] right now—the mobile health market is experiencing massive growth. It’s because medical providers are looking to provide better care at lower costs—and technology has caught up to the point where a phone or tablet is now powerful enough to do what only a roomful of computers could do twenty years ago.

By offering mobile ultrasound tools at a lower price, it drastically increases access to an important diagnostic tool, and it turns it into a bedside tool. This means that more physicians can afford an ultrasound device for their practice—and before, it might have been an expensive device only available in large clinics or hospitals.”


MS4Work: What does that mean for patients?

Younggren:  “Point of care is huge in medicine, especially in areas of the world that might not have access to large, expensive hospitals. Doctors can diagnose patients at their bedside, wherever that patient might be. The device is mobile, so doctors can literally take it into the field, from clinic to clinic.

Plus, the wireless capabilities of phones and tablets allow for instant image transition—images can instantly be stored to the server.

This means that patients get better care at lower cost, and access to ultrasound technology means that potential health issues can be found and treated much sooner.”


MS4Work: Is this part of a larger revolution in health care?

Younggren:  “Health care is in a very dynamic and changing time. Outcomes and quality of care, along with cost savings, is the key conversation in the hospital space right now. If you can deliver lower-cost, higher-quality care—and measure it by improved patient outcomes—this is where health care is going.

Devices that allow for generation and analysis of data are also very important. The value of a device is in the data it generates, and how that allows for future optimization. Mobisante devices do this, which allows doctors to continue to improve their care.”


MS4Work: What are some places where Mobisante devices have been used?

Younggren:  “Mobisante devices have been used in several key disaster sites, and the low cost and mobility (and durability) make them key. They’ve supported disaster response teams, and they’re used in wilderness medicine scenarios—places where ultrasound technologies don’t normally exist.

They’ve been taken to the Everest basecamp and to Denali for field research purposes too.

Central America is another place where rural clinics often don’t have expensive technologies, and providers need complete solutions at a low cost—and our mobile devices allow for this.

Domestically, we have devices placed in hospitals and in clinic-based practices across a broad range of specialties. As an example, we have found our device to be very practical to orthopedic surgeons, physiatrists, and sports medicine physicians who do office—based joint injections.”


MS4Work: Any other thoughts?

Younggren: These devices allow for the ultrasound to go to the patient, rather than the patient to the suite or center. It’s making a real difference in people’s lives right now by raising the quality of care that people have access to worldwide.”

Talking with Dr. Younggren was an exciting look into the future of health care and how technology is having measurable effects on patient outcomes. As phones and tablets continue to evolve, companies like Mobisante will continue to find ways to innovate—and to literally save lives.

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Healthcare attorneys call cyber security a growing concern 

Healthcare attorneys call cyber security a growing concern  | IT Support and Hardware for Clinics |

Attorneys are highly concerned about the threat of IT breaches at hospitals and healthcare systems, but also fear that little is being done to address the situation.

That's the result of a survey undertaken by Bloomberg Law and the American Health Lawyers Association. It polled both corporate attorneys and in-house counsel.


According to the survey, 97 percent of respondents believe they will experience an increased involvement in cases involving cyber security; 57 percent said it will be a significant increase.

That dovetails with a report published earlier this year by IBM concluding that the healthcare sector was the top target for cyber attacks in 2015. There have been several high-profile ransomware attacks on hospitals this year, including on Maryland-based MedStar Health and Hollywood Presbyterian Medical Centre in Los Angeles. The Ponemon Institute believes such attacks are occurring against U.S. hospitals almost monthly.

Fifty-three percent of those surveyed believe that cyber attacks are where their clients are the most vulnerable. Employee negligence or insider threats ranked a close second, at 47 percent.

But only a quarter of respondents said that the healthcare organisations they represented are “very prepared” to handle a cyber attack; 70 percent said they were “somewhat prepared,” with the remaining 5 percent not being prepared at all.


"While it is encouraging that healthcare attorneys are on the front lines of preparing for and responding to cyber incidents, it is apparent from this survey that there is much more that needs to be done," Scott Falk, a vice president and general manager with Bloomberg Law, in a statement. "For example, there is overwhelming agreement from respondents that it is important to improve formal cyber security education and training for healthcare lawyers. Thus there is tremendous value in utilising external resources and professional organisations that can meet this critical need."

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Nanostructures Within Contact Lenses Help Measure Glucose Through The Eye

Nanostructures Within Contact Lenses Help Measure Glucose Through The Eye | IT Support and Hardware for Clinics |

Researchers at the University of Houston, Korea Advanced Institute of Science and Technology, and Korea Institute of Science and Technology have reported in journal Advanced Materials the development of a contact lens technology that may one day be used to measure glucose via the tears. It relies on enhancing the ability of surface-enhanced Raman scattering spectroscopy to measure glucose concentrations and other bio molecules using a special printed nanostructure.


The nanostructure consists of printed gold nano wires on top of a gold film that are integrated into a flexible contact lens. These nanostructures create so-called “hot spots” that significantly increase the sensitivity of surface-enhanced Raman scattering spectroscopy to detect what’s under them.

Any future glucose sensor based on this technology would require an external light source to illuminate the contact lens and an accompanying sensor to perform the detection. Though such devices essentially already exist, the new research may make them also useful in the field of diabetes management.

From the study in Advanced Materials:


3D stacking of plasmonic nanostructures is achieved using a solvent-assisted nanotransfer printing (S-nTP) technique to provide extremely dense and regular hot spot arrays for highly sensitive surface-enhanced Raman spectroscopy (SERS) analysis. Moreover, hybrid plasmonic nanostructures obtained by printing the nano wires on a continuous metal film or graphene surface show significantly intensified SERS signals due to vertical plasmonic coupling.

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Personalised Devices Predict Cancer Drug Response

Personalised Devices Predict Cancer Drug Response | IT Support and Hardware for Clinics |

Two teams have developed tumour-implantable drug delivery devices to study real-time responses to multiple therapies in cancer patients.


Despite advances in analysing tumour biology, choosing effective therapies for cancer patients remains difficult. This is partly because there are still no timely, foolproof ways to test whether a patient will respond to a particular treatment. Addressing this issue, two independent teams—one at the Fred Hutchinson Cancer Research Centre in Seattle and another at MIT—have developed devices that can test a tumour's response to multiple cancer drugs directly in the patient. Both devices are described today (April 22) in Science Transnational Medicine.

If validated in human clinical studies, the devices—which are being further developed by spin off companies—could be used before surgery to help identify the best course of individualised treatment for certain cancer patients.

“[These devices] are important because they capitalise on two aspects of the cancer problem. One is the fact that we have an enormous number of drugs that cannot possibly all be tested in all cancers using conventional trial methodologies,” R. Charles Coombes, a professor of medical oncology at Imperial College London who penned an accompanying editorial but was not involved in either study, wrote in an e-mail to The Scientist. The second, Coombes continued, is “the realisation that all cancers differ from one another.”


“Rather than serially treating patients until the most effective regimen is uncovered, these platforms allow fast-forwarding to the [most effective] regimen that is revealed in the tumour in which the device is planted,” noted Keith Flaherty, a medical oncologist at the Massachusetts General Hospital Cancer Centre who was not involved in the work, in an e-mail to The Scientist.

The devices could also be used to select patients for clinical trials based on their localised responses to a given drug.Jim Olson of Fred Hutchinson and Seattle Children’s Hospital, whose team developed one of the devices, called CIVO, said that one small clinical trial testing the device could potentially replace several Phase 2 trials that test drugs in cancer patients without first identifying sub populations most likely to respond to the treatment.

Right now, researchers are somewhat limited in their abilities to predict a patient’s response to certain therapies. Culturing tumour cells with a drug to test response—and resistance—fails to capture the effects of the host immune system and tumour micro environment. Mouse avatars—murine xenografts made with a patient’s tumour to evaluate personalised therapy approaches—also have plenty of limitations, including, in most cases, time. They simply take too long to develop to be clinically relevant.

CIVO, a handheld device, can be used to deliver up to eight different cancer drugs (alone or in combination) into tumours close to the skin. Along with traceable fluorescent dye, the drugs are deposited in the centre and the edges of the tumour, enabling the analysis of drug reaction in different tumour micro environments. Following drug delivery, portions of the tumour can be excised and studied. “The system is internally controlled—allowing direct comparisons of drug responses in the same tumour,” Olson told The Scientist. “What we are looking for here is whether the cancer is inherently resistant to the drugs administered.”

Thus far, Olson and his colleagues have found that localised drug responses measured by the device are well-matched to the systemic responses to therapy observed in mouse models. An initial test in four cancer patients showed that the micro injection is well-tolerated and can induce localised responses that are easily tracked. Additional trials are now underway.


The device can also be used to streamline preclinical studies. “A [mouse] study to test the efficacy of a drug that used to take my lab a year and $250,000,” said Olson. “We can now get roughly the same information in three weeks with only a handful of mice.”

Meanwhile, MIT’s Robert Langer, Oliver Jonas, and their colleagues have developed an unnamed device that can deliver drugs to tumours deeper within tissues and be left implanted in the mass up to 72 hours, allowing the drug or drug combinations to diffuse. The cylindrical device—820 micrometers in diameter—is then removed with a coring needle and the surrounding tumour cells are analysed. Thus far, the team has confirmed that the local drug responses within tumour micro environments seen in mouse models of melanoma, prostate, and breast cancer mirrored the systemic responses observed in the same models.

Jonas told The Scientist in an e-mail that his team is now working to further miniaturise the device and planning clinical trials. The end goal is to provide oncologists with treatment recommendations within a day, he said.

“This technology is ideally suited for cancer types, such as lymphoma and breast cancer, for which there are multiple FDA [US Food and Drug Administration]-approved therapies or combination regimens,” said Flaherty.


Both devices have their limitations. For one, they’re not at this time meant to evaluate long-term drug response or resistance. And they can’t be used to evaluate local response to therapies delivered as pro drugs, which must be activated in the liver, noted Coombes. Further, the devices are designed to treat the bulk of the tumour mass and may not reach sparsely distributed pockets of cancer cells, he added.

To Flaherty’s mind, these devices show greatest potential for evaluating the potential efficacy of both approved and investigation cancer treatments that may be effective for a given cancer patient, but may not have been tested in a conventional clinical trial.

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Shrimp-Inspired Cancer Camera

Shrimp-Inspired Cancer Camera | IT Support and Hardware for Clinics |

A mantis shrimp in the waters surrounding Indonesia WIKIMEDIA, SILKE BARON Mantis shrimp have a unique view of the world. The crustaceans, along with other some insects and cephalopods, can sense difference in polarised light emissions, which arrive at an observer in one or more planes of direction. Mantis shrimp also use 16 different photo receptor pigments, where mammals typically have two or three. Now, inspired by the marine organisms’ compound eyes and polarised vision, researchers have built a miniature sensor that can detect minute differences in early-stage cancerous cells that are invisible to the naked human eye. This enhanced contrast could be especially useful when paired with endoscopes to visually scan body regions, such as the colon, for developing cancers.


Reporting their work in this week’s Proceedings of the IEEE, an international team of researchers presented images of a cancerous mouse colon to demonstrate the device’s improvements over the bulkier, more complex, and expensive polarised imaging camera arrays already in existence. “We’ve moved from having multiple cameras to a single-chip solution,” Viktor Gruev, a computer scientist at Washington University in St. Louis and senior author on the paper, told Smithsonian. “It’s hard to put multiple cameras on an endoscope and take pictures. With our device, all the filters are on the camera and it goes from something that sits on your optical bench to one that goes on the end of an endoscope.”


While the technology will need to be refined and tested further before making it into the clinic, the researchers said they can envision several applications for the sensor, in cancer and beyond. “We are just scratching the surface of how we can look at biology and construct imaging systems that can help in the diagnosis of cancer and other diseases,” Gruev told Smithsonian.

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Health Care Professionals Tapping into Mobile Devices

Health Care Professionals Tapping into Mobile Devices | IT Support and Hardware for Clinics |

Mobile devices are moving quickly from convenient social gadgets to legitimate accessories for health care workers and other professionals. Doctors, nurses and hospital administrators are discovering that mobile technology can be used in a variety of practical and efficient ways to improve administrative, technical and medical tasks.

In fact, more than eight in 10 physicians in the United States own a smartphone, according to Manhattan Research. Meanwhile, 62% owned a tablet computer in 2012, with half of the physicians using the devices at the point of care. A year before, just 27% of physicians owned a tablet, Manhattan Research reported.

The advantages are obvious: mobile devices quickly deliver medical records and other information directly into the hands of the treating physician and other members of the health care team. Tasks are synced and streamlined, meaning health care professionals can focus more on patient care than on administrative duties.

As the availability, functionality and quality of handheld devices increases – at the same time as price points are decreasing – it’s a safe bet that health care professionals will be using mobile technology for many of the same functions they previously performed from behind a desk.

Also, physicians and other medical providers are increasingly likely to use mobile devices to consume medical news and information. A March 2013 report by Bulletin Healthcare found that 52% of health care professionals accessed the company’s news briefings via handheld computers or smartphones. That represented a 25% increase over 2012.


Of course, the type of mobile device used will depend on the individual professional and his or her specific needs. For some, a smartphone may provide enough bandwidth; for others, the larger screen of a tablet may be necessary. Additionally, surveys have found that specific fields may better lend themselves to the use of a mobile device, such as emergency room care and cardiology.

As mobile technology becomes a standard feature across all aspects of society, health care providers are likely to find that their patients are increasingly comfortable with the use of handheld devices to relay medical information. This may include creating simple charts on an iPad in order to illustrate test results, such as a patient’s blood pressure and cholesterol readings over time.

For doctors on hospital rounds, mobile devices offer tremendous potential in terms of patient consultations. The ability to see results – as opposed to simply hearing them recited – can be a huge step toward putting patients at ease and ensuring their understanding of their diagnosis, prognosis and treatment plan. That, in turn, helps create a relationship of trust.


Health Care Apps a Healthy Market

The array of apps used by doctors and other care providers is extensive and expanding, from anatomical apps to medical reference tools and drug information repositories. For example, the Air Strip Cardiology app gives doctors access to patients’ heart readings, while Epocrates offers diagnostic lab test tools, medical dictionaries, drug-interaction checkers and treatment guides.

Epocrates, which is owned by athenahealth, was listed as the most popular medical app in a recent study by Manhattan Research. More than one-third of physicians who use Epocrates on their smartphone launch the app at least three times a day, according to the 2013 Taking the Pulse study.


Addressing Security Issues

Despite the numerous advantages of mobile devices to health care professionals, there are information security issues that cannot be dismissed. With many physicians using their own devices for work-related purposes, concerns have arisen as to how smartphones and tablets can be incorporated into patient care while abiding by privacy regulations, such as the federal Health Insurance Portability and Accountability Act (HIPAA).

Health care providers, both individuals and organisations, must guard against hacking and unintentional dissemination of private patient data. This includes complying with rules regarding the disposal of electronic media, hardware and digital devices used to store patient information.

Even with security and privacy concerns, the shift toward digital and mobile promises to continue gathering speed across the health care industry. A February 2013 study by the information technology group CompTIA found that about 75% of health care providers surveyed believe mobile is beneficial.

As CompTIA noted in a press release, “Many health care providers are on the cusp of expanding their use of smart mobile devices from routine business activities, such as email and scheduling, to more advanced, care-specific uses.”

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What is Bar Coded Medication Administration (BCMA)?

What is Bar Coded Medication Administration (BCMA)? | IT Support and Hardware for Clinics |

Bar coded Medication Administration (BCMA) is an inventory control system that uses bar codes to prevent human errors in the distribution of prescription medications at hospitals. The goal of BCMA is to make sure that patients are receiving the correct medications at the correct time by electronically validating and documenting medications. The information encoded in bar codes allows for the comparison of the medication being administered with what was ordered for the patient.


A BCMA system consists of a bar code printer, a bar code reader, a mobile computer (with Wi-Fi), a computer server and software. Each drug in the hospital is labelled with a unique bar code. When a patient is prescribed medication, it is faxed, sent electronically or hand delivered to the hospital's pharmacy and entered into a computer system by a pharmacist. The pharmacist dispenses the bar coded dose of the drug to the patient's floor. When it's time for the clinician to administer the medication, he uses a handheld device to scan the bar codes on his identification badge, the patient's wristband and the drug. If the bar code point-of-care (BPOC) system cannot match the drug to be given with the order in the system, it alerts the clinician with a visual warning. Each patient's bar code holds all the vital information about the patient and his medication.

The BPOC system is designed to make sure that the right drug is given to the right patient via the right route in the right amount and at the right time. This information is referred to as the "Five Rights."


The Five Rights of Bar code Medication Administration:

a. The right patient
b. The right medication
c. At the right time
d. At the right dose
e. By the right route


BCMA has shown great potential for reducing medication errors, as demonstrated by the United States Department of Veterans Affairs. BMCA was created by and first implemented at the Eastern Kansas Health Care System and Colmery-O'Neil Veteran Medical Centre in Topeka, Kansas, and from 1999 to 2001 the Department of Veterans Affairs implemented the system at 161 facilities. Bar code medication administration systems have also been useful for managing inventory, streamlining billing and saving time both at the pharmacy and at the bedside.

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2 big HIPAA settlements show why hospitals must protect computers, PHI

2 big HIPAA settlements show why hospitals must protect computers, PHI | IT Support and Hardware for Clinics |

Your hospital needs to make sure it’s taking HIPAA compliance seriously, especially regarding its computers and networks. Any breaches or security problems involving patients’ protected health information (PHI) can have significant consequences for facilities – including hefty fines from the Department of Health & Human Services’ Office of Civil Rights (OCR). 

Two recent cases demonstrate just how much of an impact noncompliance can have on a hospital – and they also show which pitfalls your facility must avoid regarding PHI.


$5M mistakes

The first case involves the largest HIPAA-related settlement from a single covered entity.

Advocate Health Care, an Illinois-based health system that includes multiple hospitals and a physician-led medical group, agreed to pay $5.5 million to OCR to resolve several data breaches.

According to a news release, a federal investigation into Advocate’s HIPAA compliance began in 2013 after the health system reported three data breaches involving its physician-led medical group, which operates various outpatient, medical imaging, speciality and primary care offices.

Two of these breaches involved hardware theft, as discussed in an article from the Chicago Tribune. In one breach, four laptops containing unencrypted PHI were stolen from an administrative office. The second breach happened after another unencrypted laptop with the PHI of over 2,000 patients was stolen from an employee’s unlocked vehicle.

The third breach involved a business associate of Advocate. An unidentified, unauthorised third party gained access to the business associate’s network, which compromised the PHI of more than 2,000 Advocate patients.

After examining the circumstances behind these breaches, as well as Advocate’s general privacy-related policies, OCR found that the health system failed to:

  • conduct an accurate and thorough risk assessment for patients’ PHI
  • create policies and procedures to limit physical access to electronic information systems (including facility access controls)
  • ensure it had written contracts from business associates outlining exactly how they were protecting PHI, and
  • put reasonable safeguards into place to protect PHI in case of laptop theft.

Advocate said it was unlikely that any PHI was misused as a result of these breaches, and it’s currently trying to fix the problems uncovered by the OCR investigation.


Weak password protection

The second big settlement was reached with one hospital and its affiliated facilities, as opposed to a health system. Because of multiple alleged violations (as detailed in a second news release), the University of Mississippi Medical Centre agreed to pay $2.75 million to the feds.

Similar to Advocate, the University of Mississippi Medical Centre's issues began with a laptop theft. However, after reporting the theft of the password-protected laptop to OCR as a possible data breach, further investigation revealed the hospital had bigger problems.

Any person could log into a password-protected hospital computer with a generic username and password, which provided immediate access to a network directory with thousands of files, including files with the electronic PHI for an estimated 10,000 patients, dating back eight years.

Because of this, the OCR investigation found that the hospital didn’t:

  • create policies and procedures to prevent and correct security violations
  • implement safeguards for computer workstations to restrict ePHI access to authorized users only
  • assign a unique username and password to each computer user to identify who has access to ePHI, and
  • notify any individuals whose ePHI may have been compromised due to the hospital’s neglect.

Even worse: The investigation uncovered evidence that the University of Mississippi Medical Center may have been aware of the vulnerabilities in its system for over a decade, yet did nothing to shore up the weaknesses until after the breach was reported.

As a result, the facility entered into the settlement with OCR, and it agreed to create a plan of action to correct these problems and boost its compliance with HIPAA laws.


Keys to protect your hospital

The biggest takeaway for hospitals here: Security is of utmost importance with computers used to access PHI.

All machines should be encrypted, and each staff member should have a unique username and password to access your system and patients’ electronic medical records. In addition, staff should be trained on compliant computer usage and should exercise extreme caution when taking laptops or other hardware used to access PHI offsite.

Your hospital’s efforts to keep electronic PHI safe should be specifically documented in your HIPAA risk assessment, and policies should be reviewed periodically with staff.

Putting in the work to ensure compliance now will help your facility avoid significant problems later.

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How to Integrate Computers Into Your Practice for Maximum Patient Benefit

How to Integrate Computers Into Your Practice for Maximum Patient Benefit | IT Support and Hardware for Clinics |

Successfully implementing and using an EHR requires a significant amount of coordination with attention to components such as software optimisation, templates, workflow analysis, and many more. One challenge that faces practices is the selection and integration of computers so that they become disjunctive to the patient encounter and do not become an obstacle to delivering care.

Some practitioners may use the implementation of an EHR as an opportunity to move to a different location and build/configure new clinic space so that it is designed specifically as a technology-based practice. This has advantages in that office equipment and furnishings can be specifically purchased or built to fit the exact needs of the physicians and practice staff. If a wired local network is installed in the new practice, network jacks can be placed exactly where required for the intended hardware. Ensuring there is adequate desktop and counter space in examination rooms to accommodate computers and printers is also simple to do when designing new layouts. It is likely that any physician intending to spend a significant amount of money beyond the costs of an EHR will seek professional help from an office designer with experience working in medical practices. Certain specialities may have specific needs that differ from those of a generalist, so be sure to carefully check the references of a designer who has been referred to you and, if possible, visit a couple of practices that your contractor of choice has designed. You can use the opportunity to find out how well the office was designed and ask what they would have done differently after some experience working in the practice.

The majority of physicians who implement an EHR will upgrade their existing paper-based practices to accommodate information technology and computers. Based upon office size and layout, this can be a significant challenge. Small examination rooms can be difficult to reconfigure without losing seating space for patients or critical counter space if the room is too small to accommodate a desk. So, what are your options when integrating computers into an existing medical office?


Each clinic may differ to a small degree and, rather than providing specific examples, here are some suggestions to consider:

  • Do you need a local network to run your EHR? If you install an EHR system that has a server locally in your office, you may need to install a network to connect to workstations in the examination rooms, scanning areas, front office, hallways, etc. If your office is located in an old building, this may incur significant cost as it may not be simple to run the wires through the ceiling and walls. Check with your landlord and consider this when you are selecting your EHR and intended hardware.
  • With the growing prevalence of high-speed wireless access points and networks, it may be much more cost effective to run a wireless network for your examination room computers. However, make sure that you choose the fastest wireless network router and that you have an office survey completed to check the wireless signal strength throughout critical care areas. There is nothing more frustrating than having a great EHR and computers that continuously drop the network signal necessitating restarting the router or the computer. Also make sure that your wireless security settings are correctly configured.
  • Make sure not to place the computer between you and your patient. The computer can act as a barrier and it can be disconcerting for patients to be looking at the back of a computer monitor wondering what it is that you are writing.
  • Consider an L-shaped desk configuration enabling your patient to view the screen during the encounter. It is much more effective as a mechanism to engage patients in their own care; plus they will often identify errors or outdated information during the encounter allowing you to make the necessary corrections immediately.
  • One of the most logical form-factors for physicians is the tablet computer. Just like a paper chart, this device can be used to input data using a pen to select items from a checklist or to enter information using handwriting recognition. Particularly in examination rooms that lack space for a fixed computer station, tablets can be a godsend. However, make sure that you have somewhere to “dock” the tablet while examining your patient so that the tablet is not left lying on a counter top or at the foot of the bed. This will protect your investment with the added benefit of charging the device during the encounter so that your battery is able to last for a full clinic shift.
  • Some clinicians may opt for a second monitor screen specifically for the patient to view during the encounter. This may be a reasonable option and can be wall mounted for patient convenience. This is a reasonable option if the layout of the examination room requires a contortionist to share the computer screen while documenting clinical notes.
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