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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Windows Admin: Understanding and Managing Windows Services

Windows Admin: Understanding and Managing Windows Services | IT Support and Hardware for Clinics |

In today’s Geek School lesson, we’re going to teach you about Windows Services and how to manage them using the built-in utilities.

Over the years, people have spent a lot of time disabling and tweaking the configuration of Windows Services, and entire web sites have been devoted to understanding which services you can disable.

Thankfully modern versions of Windows have greatly streamlined the things that run as services, added the ability to delay them from starting until later, and allowed them to run only when triggered rather than all the time. The overall footprint of Windows has even decreased due to all this work.

But people still are determined to disable services. So today’s lesson is going to teach you about services, how to analyze them, remove them, or disable them. What we’re not going to do is give you an exact list of services to disable, because for the most part, you should leave the built-in services alone.

What Are Services Exactly?

Windows services are a special type of application that is configured to launch and run in the background, in some cases before the user has even logged in. They can be configured to run as the local system account. Services are designed to run continuously in the background and perform system tasks, like backing up your computer or running a server process that listens on a network port.

Back in the Windows XP days, services could be configured to run interactively and run alongside the rest of your applications, but since Vista, all services are forced to run in a special window session that can’t interact with your local desktop. So a service that tries to open a dialog box or show you a message won’t be allowed to do so.

Unlike regular applications, which can be simply launched and run under your user account, a service must be installed and registered with Windows, which requires an administrator account, and usually a User Account Control prompt before that happens. So if you don’t allow an application to run as administrator, it cannot just create a service to run in the background.

The Services Panel

Windows has always used the Services panel as a way to manage the services that are running on your computer. You can easily get there at any point by simply hitting WIN + R on your keyboard to open the Run dialog, and typing in services.msc.

The Services panel is fairly simple: there are a list of services, a status column to show whether it is running or not, and more information like name, description, and the startup type of the service. You’ll notice that not every service is running all the time.

While you can select a service and either right-click it or click the toolbar buttons to start, stop, or restart it, you can also double-click to open up the properties view and get more information.

Disabling the service is as simple as changing the Startup type drop-down to disabled and choosing Apply, although you can also change it to Manual or automatic with a delayed start. From this dialog you can see the full path to the executable as well, which can help in many cases when you want to see what exactly the service is running.

The Log On tab allows you to choose whether the service is logged on as the local system account or under another account. This is mostly useful in a server environment where you might want to run a service account from the domain that has access to resources on other servers.

You might notice the option for “Allow service to interact with desktop”, which we mentioned earlier – by default, services are not allowed to access your desktop unless this box is checked, and this checkbox is really only there for legacy support.

But just checking that box doesn’t immediately give them access – you would also need to make sure that the NoInteractiveServices value in the registry is set to 0, because when it is set to 1, that checkbox is ignored and services can’t interact with the desktop at all. Note: in Windows 8, the value is set to 1, and interactive services are prohibited.

Services aren’t supposed to be interactive because all windows exist in the same user terminal with access to common resources like the clipboard, and if they are running along with other processes there could be an issue where a malicious application running in a normal user process could attempt to gain more access through a service, and considering that services run as the local system account, that probably isn’t a good thing.

The Recovery tab allows you to choose options for what happens when the service fails. You can choose to automatically restart the service, which is generally the default option, or you can run a program or restart the computer.

The Run a program option is probably the most useful, since you could set Windows to automatically send out an email if the service fails more than once – a helpful option in a server environment. It’s definitely much less helpful on a regular desktop.

The dependencies tab shows which services depend on a particular service, and which services depend on the one you are looking at. If you are planning on disabling a service, you should probably consult this section first to make sure nothing else requires that service.

Looking at Services in Task Manager for Windows 8.x

The regular services panel hasn’t changed much in years, but thankfully there is a much better way to look at which services are running, and which of those services are using a lot of resources.

Task manager in Windows 8 has a new Services tab, which allows you to stop and start services, but also comes with a “Search online” option, and even more useful, the “Go to details” option.

Once you’ve selected Go to details from the menu, you’ll be switched over to the Details tab, and the process that is responsible for that service will be highlighted.

As you can see, the process responsible for the Distributed Link Tracking is taking up 28,712 K of memory, which seems like a lot, until you realize that the particular svchost.exe process is actually responsible for a whole bunch of services.

Right-click it again, and then select Go to Services, and you’ll see what we’re talking about. Now many services are selected in the Services window, and you’ll notice they are all in the LocalSystemNetworkRestricted group, and they are all currently running.

So that 28 MB of memory is actually being used for a whole set of services, which makes it more understandable why it is using all that memory.

Using Process Explorer to Look at Services

If you want a much clearer view of what services are running under each process, your best bet is to pull out Process Explorer, find the service in the list, double-click it, and then go to the Services tab. This method works on any version of Windows.

Hint: in Process Explorer all the services should be in the tree underneath services.exe.

Should You Disable Services?

Unfortunately, many crapware applications install Windows Services during their installation process, and use them to keep their nonsense running in the background and re-launching repeatedly. Other applications implement a Windows Service to provide functionality that you might not need. These are the services that you should disable.

Our general rule is that Microsoft’s built-in Windows services should be left alone – Windows 8 or even Windows 7 has done a good job of cutting down the services to just really important functionality, and you won’t gain much in the way of resources by disabling those services.

What you should definitely do, however, is look for any services that are not part of Windows, and try to deal with them instead. If you don’t have any idea what the service is, or it is for an application that you don’t want running all the time, you should do some research and decide whether to disable it.

Don’t Disable, Set to Manual

One of the rules that we like to follow is to avoid disabling services, since that can cause problems and errors. Instead, just try setting the service to Manual start.

If you find that a particular service needs to be running, but maybe doesn’t need to be running immediately, you can also change it to Automatic (Delayed Start) instead, which will delay starting until the system calms down after boot.

Administering Services from the Command Prompt

Some operations just can’t be done through the graphical user interface. If you want to delete a service, for example, you can only do that through the command line.

Note: please do NOT delete services.

You can query the status of a service using the sc command, like this:

sc qc eventlog

There are many other commands and operations that you can perform, including deleting a service, which we would only recommend if you have malware on your system that is running as a service.

sc delete <malwareservicename>

Do not delete services.

You can also do other things, like stopping and restarting services from the command prompt using the sc utility. For example, to stop the distributed link tracking client, use this command:

sc stop TrkWks

To start it again, use sc start <servicename>.

Final Thoughts

If you have services running that are wasting resources and slowing your computer down, you should simply uninstall and remove the applications that put them there. There’s really no reason to delete services, disable them, or anything else.

Because why disable something that needs to be uninstalled?

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More than a Mini? Multiple Surface models tipped for May 20 event | PCWorld

More than a Mini? Multiple Surface models tipped for May 20 event | PCWorld | IT Support and Hardware for Clinics |

While Microsoft's widely expected to reveal a long-rumored 8-inch Surface Mini at its "small" Surface event in New York on May 20, the micro-tablet may not be the only new slate to surface that day.

Bloomberg reports that other models—yes, models, plural—will be announced as well, including some with Intel processors.

Further details aren't specified. If the report is accurate, the Intel-based Surface(s) could be any number of things: A mere refresh of the Surface Pro 2, a new model entirely, or maybe even a "Pro" counterpart to the Surface Mini itself.

Bloomberg, you see, also reports that the Surface Mini—or at least a Surface Mini—will run Windows RT rather than the full-blown version of Windows 8, joining a chorus of similar reports. Microsoft's full-sized Surface slates are available in both ARM and Intel flavors, with the Surface 2 and Surface Pro 2, respectively; it's easy to envision the company doing the same with a line of small-screen tablets. Bloomberg says the Windows RT-flavored Surface Mini will use Qualcomm processors, rather than the Nvidia Tegra chips found in the Surface RT and Surface 2.

The Surface Mini is expected to focus on note-taking capabilities and ship with a digitizer pen similar to the Surface Pro 2's—but it'll take more than a fancy stylus to make a smaller Surface truly shine in a sea of oh-so-similar 8-inch Windows tablets. Be sure to check out the 10 things we want to see in the Surface Mini, then tune in here on May 20 to get the news from the Surface event as it happens.

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Adoption of mHealth Monitoring Tools to Accelerate Through 2019

Adoption of mHealth Monitoring Tools to Accelerate Through 2019 | IT Support and Hardware for Clinics |

A new market reportpublished by Transparency Market Research finds that the global mHealth monitoring and diagnostic medical devices market was valued at 0.65billion in 2012 but is expected to grow at a CAGR of43.3% from 2013 to 2019, to reach an estimated value of 8.03 billion in 2019.

The report authors readily admit, however, that the mHealth monitoring and diagnostic medical devices market “is currently at its nascent stage.” But it is expected to witness a high growth rate during the forecast period owing to increasing demand for remote patient monitoring and rising adoption of wireless technology.

Additionally, mHealth industry is witnessing an exponential growth due to financial crisis across the regions which demanded the need for reduction in healthcare expenditure and deliver healthcare services effectively.

The mHealth monitoring and diagnostic medical devices market is segmented as cardiac monitors, glucose monitors, blood pressure monitors, pulse oximeters, multi-parameter monitors and sleep apnea monitors.

Of all the monitoring devices in 2012, cardiac monitors captured the majority share of this market followed by glucose monitors and blood pressure monitors. However, during the forecast period glucose monitoring devices are expected to foresee highest growth rate followed by multi-parameter monitoring devices during the forecast period reporting a CAGR of over 45%.

“Increasing sports activities and rising awareness about health and fitness are some of the factors anticipated to fuel the growth of this market,” the report summary reads. “Additionally, increasing technological advancements that enable clubbing of several vital parameters into one device is another major factor expected to propel this market growth.”

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Improving Public Health through Health IT - Health IT Buzz

Improving Public Health through Health IT - Health IT Buzz | IT Support and Hardware for Clinics |

About Public Health Reporting

You’ve heard about disease outbreaks of flu, measles, and salmonella on the news. Have you ever wondered how disease outbreaks are detected and tracked? Local and state public health departments rely on information from health care providers. Traditionally, this information was reported by paper, phone, and fax. Health IT tools can provide a faster and more accurate way of moving critical information from providers to health departments where outbreaks are identified, tracked, and managed. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides incentives for providers to adopt electronic health record (EHR) systems and to use those systems in meaningful ways. Some of those meaningful ways include public health reporting components like: lab results, immunizations, and number of cases of certain diseases.

Using health IT tools, electronic reporting of public health data replaces traditional paper-based and fax reporting. This faster, more efficient method allows public health departments to better protect the community’s health . Public health departments use the collected data from providers to understand how much disease is in a community and to develop responses more quickly and efficiently. In 2005, only eight states could accept lab results electronically. Today, 48 states can receive labs electronically. Over 1,800 provider sites nationwide have updated their EHRs to electronically send immunization data to registries. Immunization registries help providers give the right vaccines at the right time. Since the beginning of HITECH, more and more primary care providers are choosing to report public health data like lab results and immunizations electronically (refer to Figure 1). 

Select image to view in full size

Note: public health measures include immunization reporting, syndromic surveillance, and electronic lab reporting
Graphic available online at:

In conjunction with the Public Health Informatics Conference this week, the ONC is excited to release an issue brief [PDF - 678kb] demonstrating how health IT tools improve public health reporting to build healthier communities.

Looking Forward

Looking ahead, the ONC will continue to serve as the convener and central coordinator for critical health IT advancement and innovation in the nation. HITECH opened the door to align public health with the national health IT strategy. The ONC will continue to promote the use of health IT for the public health community to respond to outbreak challenges more efficiently and protect the health outcomes of Americans. The ONC welcomes and encourages the public health community’s continued engagement in standards work and emerging initiatives for population health. Health IT tools are already helping move public health data faster and more accurately so health departments can plan their responses efficiently. The work being done today will provide more innovative and rapid ways to improve public health in the future.

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3D printing will transform these five industries

3D printing will transform these five industries | IT Support and Hardware for Clinics |

The 3D printing world is currently in limbo -- the technology is developed enough to attract some attention in the real world, but not enough to bring about change on a substantial scale. New stories emerge everyday of 3D printing breakthroughs, be it through research or the development of actual products.

These breakthroughs tend to apply to a handful of markets, most of which have either used 3D printing in practice or have begun preparing for it. These are the five markets that will see the biggest immediate impact from 3D printing, in no particular order.

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Unencrpyted Laptops Prove Costly | HIPAA, HITECH & HIT

Unencrpyted Laptops Prove Costly | HIPAA, HITECH & HIT | IT Support and Hardware for Clinics |

Is the PHI on all your mobile devices encrypted?  If not, here’s another two million reasons to make encryption your top priority. The Office of Civil Rights (OCR) of the Department of Health and Human Services announced on April 22, 2014 that they had imposed nearly $2 million in penalties on two entities as a result of the theft of unencrypted laptops.

As previously noted in this blog, theft or loss of laptops or other portable electronic devices remains a predominant factor in HIPAA breaches, constituting 57.5% of the approximately 400 List Breaches that involved reported theft or loss as of August 2013.

In the first incident, Concentra Health Services was fined $1,725,220 and agreed to adopt a corrective action plan after an OCR investigation following a report of the theft of an unencrypted laptop from a physical therapy clinic.  According to the press release,

“OCR’s investigation revealed Concentra had previously recognized in multiple risk analyses that a lack of encryption on its laptops, desktop computers, medical equipment, tablets and other devices containing electronic protected health information (ePHI) was a critical risk.  While steps were taken to begin encryption, Concentra’s efforts were incomplete and inconsistent over time leaving patient PHI vulnerable throughout the organization. OCR’s investigation further found Concentra had insufficient security management processes in place to safeguard patient information.”

This isn’t Concentra’s first experience with laptop theft. The OCR list of Breaches Affecting 500 or More Individuals (also known as the “Wall of Shame”) includes two prior similar incidents, one in 2009 and another in 2011. (It is unclear whether this theft was related to the 2011 incident). Modern Healthcare reports that Concentra reported 16 additional breaches involving fewer than 500 individuals’ records.  So, although 434 out of 597 laptops had been encrypted according to, a batting average of .726 wasn’t good enough given their status as repeat offenders. Concentra’s resolution agreement, including the Corrective Action Plan, is available here and is worth reading.  Among other conditions, OCR requires that the company provide an update regarding its encryption status, including the percentage of all Concentra devices and equipment (laptops, desktops, medical equipment, tablets, and other storage devices) that are encrypted and an explanation for the percentage of devices and equipment that are not encrypted.

The company’s incomplete and inadequate implementation of compliance steps after known vulnerabilities had been identified may also have contributed to the severity of the penalty.  One of the worst things a covered entity or business associate can do is to engage in a half-hearted compliance effort that documents knowledge of uncorrected problems.

In the second case, Arkansas-based QCA Health Plan reported the theft of an unencrypted laptop containing records of 148 individuals. OCR noted that its investigation revealed that QCA failed to comply with multiple requirements of the HIPAA Privacy and Security Rules, beginning from the compliance date of the Security Rule in April 2005 and ending in June 2012. QCA agreed to pay $250,000 and implement upgraded security procedures and employee training. QCA’s Resolution Agreement and Corrective Action Plan is here. This case marks only the second time OCR has fined an entity for a breach involving less than 500 individuals’ PHI, following the Hospice of North Idaho settlement.

One lesson is clear from both incidents: if these laptops had been encrypted in accordance with NIST standards, neither entity would have been subjected to fines and additional government oversight.  As enforcement continues to ramp up and target both Covered Entities and Business Associates, and as the use of mobile devices continues to increase, there is no excuse to delay full implementation of encryption.  Encryption isn’t a panacea, but it’s as close as you can get in the HIPAA compliance world.

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The Windows 8.1 Start menu could show up this summer | PCWorld

The Windows 8.1 Start menu could show up this summer | PCWorld | IT Support and Hardware for Clinics |

The score is 2-1 in favor of the Start menu landing on Windows 8.1 while the weather's still warm. Following reports claiming the Start menu would appear this fall, two well known Microsoft watchers say the highly anticipated update could be here before the summer is out.

Both the Verge's Tom Warren and ZDNet's Mary Jo Foley report that Microsoft hopes to deliver the Start menu to Windows 8.1 users by August.

Hope being the operative word.

Microsoft wants to deliver updates to Windows more rapidly to keep pace with similar fast release cycles on Android and iOS that are progressively becoming more powerful. But there is a chance the Start menu could be pushed back to spring 2015 for the rumored Windows 9 release, Warren reports.

The return of the Start menu is easily one of the most exciting pieces of news for Windows 8.1 PC users. Microsoft announced the UI upgrade earlier in April.

Not only will Microsoft bring back a central piece of the Windows desktop interface, the revamped Start menu also makes practical use of modern UI apps for PC users. Part of the new Start menu will include live tile-like behavior where you can take a quick look at updates such as weather, calendar appointments, and news headlines supplied by modern apps, as seen in the Microsoft-supplied image at the top of this article.

Waiting for a window

If the Start menu does show up in August, however, the next Windows update won't solve all of the problems for Windows 8.1 desktop users. Both Warren and Foley say the ability to run modern apps in desktop-style windowed mode aren't expected to land until the purported Windows 9 release, codenamed Threshold, next spring.

Warren notes that Microsoft is "pushing" to release a modern app windowed mode in August along with the Start menu. Although from the sounds of it that target seems like a long shot.

Windows 8.1 users not content to wait for Micrososft to bring the Start menu and windowed modern apps to the desktop can get similar functionality today. It'll cost up to $10 after a 30-day trial, but that's a small price to pay for anyone looking to get a more familiar Windows UI without giving up the benefits of the Windows 8.1 desktop.

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What kind of tablet does $5,000 get you? | PCWorld

What kind of tablet does $5,000 get you? | PCWorld | IT Support and Hardware for Clinics |

Can your tablet withstand a 2-meter drop or be submerged in water for 30 minutes and keep functioning? The new $5,000 tablets from Xplore Technologies can.

The DMSR and the military-focused DMSR M2 are the highest performers in Xplore’s new XC6 line, and both have eye-popping hardware and durability features. A more basic XC6 model starts at US$3,299, but the DMSR tablets, priced at $5,299 and $5,599, have better components and screens.

The DMSR models both have handles and are encased in tough protective covers. They can be dropped more than 2 meters onto a plywood floor and 1.2 meters onto concrete, and can operate in temperatures between -30 and 140 degrees Fahrenheit (-34 to 60 degrees Celsius). They’ve been tested to the U.S. military’s tough MIL-STD-810G standard for extreme conditions.

The tablets run Windows and come with Intel’s latest Core i5 or i7 Haswell processors. Solid-state drive options extend to 480GB. Few other tablets offer more than 128GB, with an exception being Razer’s $999 Edge Pro gaming tablet, which has a 256GB SSD.

The DMSR and DMSR M2 have many common features, including 10.4-inch rainproof screens. They display images at 1024 x 768 resolution. That’s less than some cheaper Windows tablets, but Xplore claims to offer excellent LCD visibility in sunlight thanks to a display luminescence of 1,300 NITS.

The tablets have internal fans but can still run for up to eight-and-a-half hours on a 10-cell battery, Xplore said. They weigh a hefty 2.4 kilograms.

Other features include Intel’s GT2-4400 integrated graphics, two USB 3.0 ports, and RJ-45 ethernet and microSD slots. Wireless options include 802.11ac Wi-Fi and a slot for connectivity to AT&T’s LTE network. Display connectivity options include HDMI and VGA ports.

The DMSR M2 adds a Common Access Card slot, used by the military to read data from smart cards based on security clearance. The M2 also has U.S. military clearance to be used on the front lines and on fixed-wing aircraft, according to a specification sheet.

The tablet can also be used to operate and view images from a drone, said Mark Holleran, Xplore president and chief operating officer.

The company’s tablets were used for chemical and radiation detection during the Fukushima nuclear disaster in 2011, and are commercially used by AT&T and other companies in the field. The durability keeps maintenance costs down, and the company provides a three-year warranty.

The military won’t use standard Windows tablets in the field and Xplore has to design its own motherboards. The redesign involved shrinking a motherboard to tablet size and using industrial parts that can withstand high temperatures and vibration, Holleran said.

The Windows 8.1 option isn’t popular with customers, many of whom downgrade.

“Most buy Windows 8.1, but they ask us to ship it with a Windows 7 BIOS,” Holleran said.

The cheaper XC6 DML model, starting at $3,299, and the XC6 DM, starting at $3,999, also have rugged features but use an Intel Celeron 2980U processor and come with less storage. They also don’t offer the same visibility in sunlight as the DMSR tablets.

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Breaking News: Meaningful Use is Not Covering Costs | EMR and HIPAA

Breaking News: Meaningful Use is Not Covering Costs | EMR and HIPAA | IT Support and Hardware for Clinics |

In one of my recent interviews with a healthcare IT consulting company, they revealed some breaking news for those of us in the EHR world. They told me point blank that:

Meaningful Use is Not Covering Costs

Ok, so that’s not really breaking news. Although, it seems that very few people want to actually articulate this point. It almost feels like heresy that someone would “complain” about the fact that the government is spending $36 billion on EHR incentives and that the money isn’t enough to cover the implementation of these EHR systems.

Actually, I should clarify that last point. The EHR incentive money is covering the costs to purchase the systems. It’s not covering the costs of implementing those EHR systems and then poking, prodding and otherwise cajoling end users to show meaningful use of that system (not to be confused with meaningfully using the system).

Let me also be clear that I’m not complaining about the EHR incentive money. I’ve done enough of that previously. What I’m just trying to acknowledge is something that everyone who deals with the EHR budget already realizes, but no one seems to want to say it. Organizations are spending more money on EHR and meaningful use than they’re getting from the government.

I think this is important for a couple reasons. First, many organizations didn’t budget any EHR money beyond what the EHR incentive money. You can certainly argue this was a mistake on their part, but that’s going to leave a bunch of organizations in a lurch. We’re already seeing the fall out of this as news reports keep coming out about hospitals systems in financial trouble due to the costs of their EHR system. Plus, in each of these cases, it seems their costs continue to balloon out of control with no end in sight. It makes me wonder if the compressed meaningful use timeline is partially to blame for a rushed implementation and poor EHR implementation and cost planning.

Second, there is still a swash of providers and organizations that haven’t yet implemented their EHR. If you can’t support the cost of EHR with government money, how does that bode for those who won’t be getting any EHR incentive money? One could make the argument that they’ll actually be in a better position since they won’t have to worry about meaningful use and can just focus on getting value out of their EHR. Hopefully that’s the case, but many of the meaningful use functions are now hardcoded into the EHR systems. Even if an organization isn’t planning on attesting to meaningful use, that doesn’t mean they won’t be forced by their EHR software to do a bunch of things they wouldn’t have done otherwise.

What are you seeing from your perspective? Is the EHR incentive money covering the costs of an EHR implementation? What are the impacts if it doesn’t?

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HIStalk Advisory Panel: IT Service Management | HIStalk

HIStalk Advisory Panel: IT Service Management | HIStalk | IT Support and Hardware for Clinics |

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Does your organization use a formal IT service management program such as ITIL, and if so, what results have you seen?

Responses indicating no: 4.

[from a practicing physician] No , I am not aware of any formal IT management program used by my now very large company, but that is not to say that they do not need one.

We started with one, but we didn’t have the institutional memory to keep it alive. As new people came, it became increasingly difficult. Some good remnants remain, but only if somebody remembers to enforce them.

Yes and no. We’re a small shop, so we use ITIL and other models as a source of best practices and implement what makes sense for us. We don’t want to reinvent the wheel, but a full-scale implementation in a small organization is not cost-effective. The processes, templates, etc., that we have pulled in are extremely useful and allow us to more efficiently manage a large workload with a small team.

Not at this time. We have evaluated the use of ITIL and COBIT, but our plates are too full at this time to put any formal processes in place. Luckily the management team has experience with ITIL, so we apply the concepts to change management and service delivery as much as possible.

We have begun to install ITIL. It has been challenging given we are short on resources and when busy, people tend to fall back into the old way of doing things. We have had success with incident management, which is a good thing.

I was one of the first to enthusiastically jump on the ITIL bandwagon, many years ago, then I saw firsthand how the ITIL process became the goal, not a means to a goal. After two ITIL implementation attempts with two different teams, in which internal client satisfaction with IS declined and my employees became demoralized drones, I threw away any philosophy to implement the details of ITIL and instead focused on the concepts and the end goals. Those end goals are (1) internal customer satisfaction with IS; (2) IS employee satisfaction; and (3) achievement of both #1 and #2 at the lowest possible IS budget.  Since then, I’ve watched ITIL spread to other organizations and watched the same pattern that I experienced. There seems to be an inverse relationship, or at least a tipping point of inflection, between dogmatic adherence to ITIL and IS success and creativity.

At this time we don’t have a formal service structure methodology. We are beginning to look at this due to our organization growing and that all areas now have a major IT component. We most likely would lean towards ITIL.

Yes, we do. If you agree that using ITIL can be helpful and that every part of ITIL may not apply to your operations, it can provide consistency in support that many organizations need. We have found that it is helpful in many aspects of providing end-user services more consistently and more timely with much fewer variations.

We do not use ITIL formally. We will soon be joining a larger system and they have adopted ITIL and we are comparing our current practices to this framework.

We have been trained in the basics of ITIL and have incorporated several concepts and processes. We have not gone full out at this point.

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It's official: Nokia's phone business will become Microsoft's on April 25 | PCWorld

It's official: Nokia's phone business will become Microsoft's on April 25 | PCWorld | IT Support and Hardware for Clinics |
It's official: Nokia's phone business will become Microsoft's on April 25
Brad Chacos @BradChacos
  • Apr 21, 2014 8:22 AM
  • print

The end is nigh. Or is that a new beginning? Either way you look at it, Microsoft on Monday announced that its $7 billion acquisition of Nokia's phone business will finally close this Friday, April 25, after regulatory delays slowed the deal.

Microsoft general counsel Brad Smith also revealed some additional agreements hammered out in the months since the acquisition's announcement. Most revolve around behind-the-scenes personnel and manufacturing details, but of particular note is that Microsoft will handle the website and Nokia's social media presence for up to a year, despite the fact that the rest of Nokia is carrying on as a separate company.

Stephen Elop, the Nokia CEO who arrived at the company by way of Microsoft, will return to the Redmond company as part of the deal, where he will assume control of Microsoft's hardware division. He's just one of approximately 32,000 Nokia employees making the jump to Microsoft.


Microsoft's Nokia buyout comes in the middle of a gargantuan shift for Microsoft, which—in addition to recently replacing its CEO—is transitioning from a traditional software company to something more device- and services-oriented.

While both Nokia's Lumia line and Windows Phone as a platform have struggled to compete with the dual Android/Apple mobile juggernaut, Microsoft has said that phones are the key to everything in today's tightly controlled ecosystems. While we're skeptical that buying Nokia will pay off for Windows Phone's prospects, the hard-won lessons that the intensely consumer-focused Nokia can teach Microsoft could help transform the business that Bill Gates built into something great again, one Nokia phone at a time.

Image: Jon Phillips

Nokia's Stephen Elop at Microsoft's Build 2014 keynote.

Windows Phone itself is on the upswing right now, at least in the hearts and minds of developers, if not everyday users. At its recent Build conference, Microsoft announced a trio of announcements designed to drive a jolt of energy into its mobile ecosystem, starting with the vastly improved Windows 8.1 update, which adds a much-needed notification center and Cortana, the surprisingly useful digital assistant. Between those and the numerous other features baked into the update, Windows Phone is finally a full-fledged OS capable of taking on Android and iPhone—at least as far as the core experience is concerned. In other words, Windows Phone 8.1 finally provides a level of software polished enough to match well with Nokia's impeccable hardware designs.

Microsoft also announced universal Windows apps, which allow developers to create a single app, then easily push it out across Windows Phones, PCs, and tablets, complete with the option for users to buy the app once and have it run on any platform. The first of those have already begun appearing in Microsoft's app stores. Microsoft also now provides the Windows Phone operating system for free to phone manufacturers, as well—a move that can both push WP8 adoption and quell any discontent about Microsoft snapping up Nokia.

With all the focus on Windows Phone, though, one big question remains: What will Microsoft do with Nokia's recently announced Nokia X phones, which run on a heavily modified version of Android chock full of Microsoft services? Given Microsoft's newfound services focus—as exemplified by Office for iPadMicrosoft may just let the experiment play out, at least for a while.

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Best Laptops for Productivity | Computer Hardware Reviews -

Best Laptops for Productivity | Computer Hardware Reviews - | IT Support and Hardware for Clinics |

We are starting a new series of articles here on ThinkComputers. We define our “Mobile Arsenal” as what we would recommend to you for your mobile setup. Many of us are traveling all the time and we need to be able to be productive on the road. After using quite a lot of different types of mobile products and applications we are going to focus on the best and present them to you here.

Today we will be focusing on laptops. This is of course the core of being productive while on the road. For our Mobile Arsenal we are going to recommend laptops that are great for doing work and getting things done. If you are looking for a gaming laptop or something else we are not going to recommend that here. So let’s get started.

Lenovo Yoga 2 Pro

I am actually using this laptop as my current main laptop and I love it. The screen resolution on the Yoga 2 Pro is the main reason I use it. At 3200 x 1800 that is more than enough room for multi-tasking, working with larger images and HD video. Another cool thing about the Yoga 2 Pro is that the screen itself can be flipped completely over so you can use it as a tablet, have it propped up and more. This is perfect for the plane ride and has many of other applications as well. The Yoga I have has the Intel Core i5-4200U in it and it can handle pretty much anything I throw at it (Photoshop, Premiere, HD video, etc). As far as battery life goes you are going to get anywhere from 5-7 hours, which is pretty much any continental flight in the US.

The Yoga 2 Pro starts at $999 and prices go up from there depending on what options you want.

ASUS Zenbook Infinity

When ASUS announced the Zenbook Infinity it was all the buzz because the lid and the area around the keyboard is made of Corning Gorilla Glass 3. So as you can guess this is one pretty sexy looking laptop. Beyond that the 13.3-inch Ultrabook has a 2560 x 1440 IGZO panel and has a configuration that with the Intel Core i7-4558U processor and Iris 5100 graphics. That means you can pretty much throw anything at this Ultrabook and it will be able to handle it pretty well. This is of course a more high-end offering, but one of the best out there at 13.3-inches. Just like the Yoga 2 Pro you should get anywhere from 5-7 hours of battery life out of the Zenbook Infinity.

The ASUS Zenbook Infinity starts at $1499 and prices go up from there.

Acer Aspire S7

This has to be one of the best designed laptops that I’ve had the chance to get my hands on. Acer actually offers this Ultrabook with an aluminum chassis and glass lid or a fully metallic. The Aspire S7 is extremely small and compact, it is only 0.5 inches thick and only weighs in at 2.9 pounds. The 13.3-inch Aspire S7 features a 2560 x 1440 WQHD display and supports Intel’s latest Haswell processors. Being so compact do you only have a limited number of ports and the battery is smaller. You will probably only get around 5 hours of battery life out of the Aspire S7.

The Aspire S7 starts at a low $899, but the model we would recommend is $1499.

Apple Macbook Air

We had to include the Macbook Air on our list. Colin has one and he really loves it. Unlike the other Ultrabooks listed here the Macbook Air is not an Ultrabook, but one of the most popular ultra-portables out there and it does not run Windows, but rather Apple’s OS X operating system. Many people enjoy that operating system and it is less susceptible to viruses. As the name suggest the Macbook Air is extremely small and light, which makes it extremely easy to take with you anywhere. The keyboard and trackpad are some of the best available. Just like all the other Ultrabooks the Macbook Air is available with Intel’s latest Haswell processors. The 13-inch Macbook Air has a native resolution of 1440 x 900, which is lacking compared to other laptops that we have mentioned. The battery life on the Macbook Air is very impressive, depending on what you are doing you can get 10 to 12 hours of use out of it!

The 13-inch Macbook Air starts at $1099 and goes up from there.

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Windows Phone 8.1 Review

Windows Phone 8.1 Review | IT Support and Hardware for Clinics |
Technical Dr. Inc.'s insight:

I was an early fan of Windows Phone 7. I remember completely switching over to the platform for about a month back in 2010, and being relatively happy. It wasn’t until I needed tethering support (which didn’t exist in the first release of WP7) that I had to move away. Unfortunately, Microsoft’s software and hardware update cadence for Windows Phone couldn’t pull me back.

In its first three years of existence, Windows Phone received roughly the same number of major updates as Android and iOS. From 2010 - 2013, Google took Android from Gingerbread to KitKat, Apple revved iOS from version 4 to 7, and Microsoft gave us Windows Phone 7, 7.5 and 8.0. At best, you can consider the software release cadence competitive. At worst, it’s not enough. Windows Phone started behind both Android and iOS. To come out ahead, Windows Phone updates had to be more substantive, more frequent or both.

The same could be said about hardware. Microsoft lagged behind Apple and Google to dual-core, 28/32nm silicon, higher resolution displays, and LTE support among other things. Although the situation has improved over the past year, if the goal is to take the #1 or #2 spot, the upgrade cadence needs to be more aggressive.

It always felt like the point of Windows Phone was to be a midpoint between the flexibility of Android and iOS’ guarantee of a certain level of user experience. The platform was born during a time when Android was not yet ready for the mainstream (Gingerbread) as an iOS alternative, and when it still looked like the Windows licensing model would work for handset OEMs.

Today the world is a different place. Android is far more mature than it was in 2010, and it’s polished enough where it can easily be a solution for the enthusiast as well as the first time smartphone user. While Microsoft’s strategy in 2010 might have been one of eyeing the crown, in 2014 the strategy is more humble and focused.

Improve the platform, address issues both little and big, and continue to grow. That’s the mantra these days and today we see it put in action with the arrival of Windows Phone 8.1, the fourth major release of the platform since its arrival in 2010.

Read on for our review of Windows Phone 8.1

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Malware infections tripled in late 2013 thanks to sneaky browser plugin, Microsoft says | PCWorld

Malware infections tripled in late 2013 thanks to sneaky browser plugin, Microsoft says | PCWorld | IT Support and Hardware for Clinics |

A three-fold increase in Microsoft Windows computers infected with malicious software in late 2013 came from an application that was for some time classified as harmless by security companies.

The finding comes as part of Microsoft’s latest biannual Security Intelligence Report (SIR), released on Wednesday, which studies security issues encountered by more than 800 million computers using its security tools.

In the third quarter of 2013, an average of 5.8 Windows computers out of every 1,000 were infected with malware, said Tim Rains, director of Microsoft’s Trustworthy Computing division, which tracks security trends targeting the company’s widely used products. That jumped to about 17 computers per 1,000 for the last quarter of the year.

Rains attributed the rise to malware called “Rotbrow.” The program masquerades as a browser add-on called “Browser Protector” and is supposedly a security product, Rains said by phone Wednesday. Rotbrow was found on about 59 of every 1,000 computers using its security products, he said.

For some time, computer security companies didn’t classify Rotbrow as malicious software. Rotbrow is known as a “dropper,” with capabilities to download other software on a computer. It didn’t initially download malware to computers it was installed on, Rains said.

But then Rotbrow started downloading malicious browser extensions. Microsoft noticed the change and alerted other security companies, which then began blocking it.

The tactic, which had been used by fake antivirus programs in the past, meant that Rotbrow was already installed on a huge number of computers.

“I would characterize it as a low and slow attack,” Rains said. “They were patient and waited a long time before they started to distribute malicious stuff. I think they gained a lot of people’s trust over time.”

Rotbrow often distributes Sefnit, a type of malicious botnet code, which can subsequently download other harmful programs to a computer such as those involved in click fraud. Sefnit has also been linked to “ransomware,” which is malware that encrypts a person’s files and demands payment.

Microsoft added detection for Rotbrow in its Malicious Software Removal Tool (MSRT) last December after it raised suspicion.

Safer overall

Overall, Microsoft’s latest report concluded that security improvements in Windows such as ASLR (Address Space Layout Randomization) and DEP (Data Execution Prevention) have made it much more difficult to exploit known vulnerabilities. The report also said the number of vulnerabilities in Microsoft products that can be remotely exploited has fallen by 70 percent between 2010 and 2013.

“We are really trying to raise the cost of exploitation,” Rains said. “It’s not impossible to exploit, just hard. They have to put in the extra time, extra cost.

As a result, attackers are increasingly trying to just trick people into downloading their malware by bundling it with legitimate programs or music, he said.

The latest report does not include data on the zero-day vulnerability in Internet Explorer that Microsoft released an emergency patch for on Monday. The flaw, which affects IE 6 through IE 11, could allow attackers to execute code remotely on a compromised computer if the user views an infected webpage using the browser.

Rains said “time will tell” if its next report shows a rise in infections due to the bug. But Microsoft believes the quick release of a patch and fact users have to be lured to a malicious website mitigates the risk.

“I don’t think we will see an uptick [in infections] given the quick response and the type of vulnerability that is,” Rains said.

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Why BlackBerry has the potential to drive mHealth apps forward

Why BlackBerry has the potential to drive mHealth apps forward | IT Support and Hardware for Clinics |

There's some exciting news in world of mobile healthcare apps and at the forefront is BlackBerry, planning expand its enterprise footprint into the healthcare market.

Why is this exciting? Because BlackBerry is renowned for its business-focused devices and data security. It once had a knuckle-tight grip as a leader in smartphone technology for the business enterprise and lost that perch partly due to the bring-you-own-device trend that forced enterprises to shift and make room for users' devices. Yet, BlackBerry's security technology is why the White House, most of the stock market and top businesses still use its handsets and communications server for all things work-related.

As we've watched in the past year, data breaches have spiked, specifically within the retail market with top names, including Target, suffering from data break-ins and potential fallout with consumers, and their trust in the brand.

Financial data is valuable, confidential and needs to be protected. But healthcare data is even more valuable and just as confidential, and technology that can boost protection of that data is a welcome sight. Consumers are wary of healthcare devices and providers are nervous about putting such critical data not only on smartphones but in cloud computing environments. BlackBerry understands those concerns and has evidently mapped out a plan for the healthcare segment.

BlackBerry's foray began with its announcement, as FierceMobileHealthcare reported, that it was teaming up with NantHealth on a healthcare platform and smartphone. The players are developing a smartphone that will provide optimization for 3D images and CT scans. And just think that's just the starting point. When it arrives in 2015, I believe the smartphone will very likely be a turning point in mobile healthcare communication devices.

NantHealth has deep healthcare industry roots, with its clinical operating system now in use at 250 hospitals. As NantHealth founder Patric Soon-Shiong noted, BlackBerry's security expertise is incredibly valuable. And as BlackBerry CEO John Chen noted, the venture is a forward-looking collaboration that represents a solid starting point in driving super-secure approaches to mHealth devices and apps.

Shortly after came news that that BlackBerry is embracing healthcare apps, as well. It has now made the Axial Exchange patient engagement app available in its BlackBerry World store. It's clearly the starting point of what BlackBerry hopes to provide to the healthcare user. The Axial app lets users learn about medical conditions, track progress of healthcare efforts and can provide reminders during treatment and recovery times. It can also monitor glucose levels, blood pressure and even weight.           

I see it as just the start of a new secure mHealth frontier and it'll be of little surprise if BlackBerry ends up leading the charge as mHealth tech evolves. -Judy (@JudyMottl and@FierceHealthIT)

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Tips for getting physician buy-in to new IT | Government Health IT

Tips for getting physician buy-in to new IT | Government Health IT | IT Support and Hardware for Clinics |

WASHINGTON – “If you build it,” Edith Dees said of technology and doctors, “they won’t necessarily come.”

Many healthcare organizations learned that while implementing electronic health records systems and those lessons will come in handy when bolting on newer technologies, such as analytics and clinical decision support tools.

Dees, the CIO of Holy Spirit Health System, explained that getting doctors up to speed on new IT products and services takes coordination, diplomacy and empathy. What’s more, doctors don’t like to think they need to be told to do anything, according to Susan Kressly, MD, founding partner at Kressly Pediatrics. 

“It’s like herding cats to get doctors to change, so be careful how you engage doctors and create a partnership with them,” she says. “Pretend it’s an 80-20 partnership in the doctor’s direction and you’ll get where you want to go.”

Richard Schreiber, MD, chief medical informatics officer at Holy Spirit Health System says it’s important to find out what works best for each doctor. “The ‘how’ is the most important part” of motivating the change, he added at the Healthcare Business Intelligence Forum hosted by HIMSS Media and Healthcare IT News.

A good starting point is a low-risk conversation that generates interest rather than making physicians or IT workers feel daunted, suggested Actian Healthcare general manager Lance Speck, particularly when delving into something as seemingly intimidating as predictive analytics.

“Simply ask the question ‘do we use science to analyze our data?’” Speck recommended. Since doctors have health data, and many have the means to analyze it, there is no reason not to be doing so.

Dees said it is best to build in a support plan because doctors generally do better with one-on-one training “at the elbow.” Include an escalation plan to use if decisions about the project cannot be made at lower management levels. Bake it into the project methodology, Rees advised. Also, set up a provider hotline for your doctors, to help them with tasks like resetting passwords that might be necessary but hassle enough to discourage progress. “Anything we can do to support our doctors directly impacts patient care,” Dees added.

Kressly urged attendees to keep in mind how much pressure doctors are under. They are “on” all day worrying about keeping patients safe and don’t want to have any of their attention shift from that main goal, for fear it will compromise care.

Drawing on those lessons learned during EHR implementation, the presenters all called for a tight communication plan that focuses on doctors. Rather than selling an EHR for its potential to improve billing, for instance, focus on what a particular technology can help doctors do their jobs. “You’ll grab a doctor’s attention if you advocate for their patient,” Kressly said.

She also suggested eagerly listening to the rank and file, establishing a physician IT champion, applying continuous incremental change, and demonstrate how the technology, be it an EHR, clinical decision support, or predictive analytics can help them better treat patients. “Allow the doctors to see the power of the data,” Kressly said.

Checking back with physicians after the initial training is key, Schreiber advised, because “you have to learn how the learner learns.”

Then, you can identify quick wins and apply those to advocate for new technologies.

“After that success, get a full check-up at your organization. Where are the areas you could improve care and lower costs?” Speck said. “Get a full diagnosis. Prioritize and build a path. See what kind of outcomes you can improve.”

See also:

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Health IT Workforce Shortage Poll | EMR and HIPAA

Health IT Workforce Shortage Poll | EMR and HIPAA | IT Support and Hardware for Clinics |
Health IT Workforce Shortage Poll

Over on our Healthcare IT job board, we deal with the question of the Healthcare IT workforce shortage all the time. Although, the question of a shortage is a hard once since finding the right people to hire is always hard. Plus, in this artificially stimulated EHR adoption environment, of course many of the resources are tapped out.

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Upcoming Intel Based Motherboards from GIGABYTE, ASUS, MSI and ASRock

Upcoming Intel Based Motherboards from GIGABYTE, ASUS, MSI and ASRock | IT Support and Hardware for Clinics |

Intel has recently been awash with news about upcoming processors. In March, Intel released information on an upcoming unlocked Haswell Pentium processor, an upcoming Haswell-K processor with overclocking enhancements, an unlocked Iris Pro processor coming to Broadwell, and some details regarding an 8-core Haswell-E processor due later this year. This is a bit of an odd article – various motherboard manufacturers have posted new product images online for an upcoming platform, with all the juicy bits redacted. Here is our analysis of some of those products.

So What Are We Looking At?

The motherboards we are detailing today come from multiple sources.  In the case of GIGABYTE and MSI, both of these companies released edited images on their social media pages and gave copies to the press. In the case of ASUS, a leak from an ASUS APAC event provided small blurry images. ASRock provided some media with its image deck, only to have them leaked – we subsequently got the go ahead to publish them today. We should see a full range of images and motherboard specifications at launch.

The motherboards all use the 1150 pin socket designation, which suggests they are for Haswell processors. However the images have the chipset blurred out, but ‘Z_7’ is clearly visible giving us an overclocking chipset. On several of the motherboards we have M.2 slots as well as SATA Express, although without looking closer it is hard to see how these are configured (either via the chipset or a controller). Kristian looked at SATA Express earlier this year with a beta motherboard supplied by ASUS. mSATA seems to have disappeared almost entirely.

A lot of the motherboards adorn their name with some form of WiFi or AC, with text on the PCB all pointing towards 802.11ac 2T2R solutions. Given our past experiences, these are either Broadcom or Intel modules, with the Intel side of the equation being more expensive. Audio seems to get a revision change from Z87 across most of the manufacturers as well.

Technically the launch date of these products is under NDA. The NDA is such that we can't even mention the chipset by name, even if it is visible on some of the images we are sharing today. MSRP is still being decided on most fronts. Haswell processors were launched in June 2013, and all expectations for Broadwell are putting it at the end of the year, perhaps Q4 or later. Thus it should be straightforward to expect that this is a refresh, updating the mainstream platform to newer technology like M.2 and SATA Express. It also gives the motherboard manufacturers and system integrators a chance to upgrade their lines and offer the potential for new sales. Given that Intel has already announced an upcoming Haswell-K processor for ‘mid 2014’ and prices for Haswell refresh processors have already been leaked, it is not hard to put two and two together.

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Ask HTG: Why Is My Computer Waking Up Prematurely?

Ask HTG: Why Is My Computer Waking Up Prematurely? | IT Support and Hardware for Clinics |

Putting your computer to sleep overnight to save energy and resume your work first thing in the morning is a handy trick, but what if your computer wakes itself up early like an energetic toddler? Read on as we help a fellow reader figure out what exactly is waking his PC up.

Dear How-To Geek,

I have a sorta-strange request for help. My computer seems to be waking itself up. Every night I hibernate the computer and then every morning I wake it back up to start working where I left off. That’s how it has been for ages, but lately I’ve been going into my office and my computer is already on and waiting for me to enter my password. I’ve put it into hibernation early a few nights and hung around just to see if it was immediately coming back out of hibernation, but that doesn’t seem to be the case. Some time in the middle of the night, presumably, it just wakes up and sits there idling.

I have absolutely no idea where to begin trouble shooting this or what would even cause it. It didn’t used to happen, it now happens, what can I do? How can I figure out when it’s waking up and how can I stop it from doing so? I’m running Windows 8.1 on a pretty basic office-type desktop machine, nothing too fancy going on. Help!


Insomniac Computer

Phantom computer problems are always the most frustrating, especially when you’re not even present to see what’s happening. Thankfully Windows has logging/check tools we can use to peek under the hood after the fact to see what’s going on. Although you’re asking about a Windows 8 machine, these tricks will work on older versions of Windows too. When diagnosing a wake up problem like the one you’re experiencing, armor yourself with a dose of patience first. There are a wide range of things that can wake a Windows PC from sleep: scheduled events, mouse/keyboard input, and hardware (like the network card or attached peripherals) so solving the problem is rarely as simple as opening the Control Panel and unchecking a single box.

Let’s start with a little sleuthing in the system logs. Before you spend your time digging through system settings and trying fixes, we want to first establish that the problem is persistent and to answer your question: when is the computer waking up? For that, we’ll turn to Windows Event Viewer, a handy logging tool that will help us see when your computer turned off (be that because it was shut down, put to sleep, or hibernated) and when it woke up. We’ll be using one of our desktop machines as an example machine, but you’ll be able to follow the exact same steps on your machine to do your own sleuthing.

From the Windows Run Dialog, enter eventvwr.msc to launch the Event Viewer. In the left-hand navigation pane, navigate to Event Viewer (Local) -> Windows Logs -> System. There you’ll find a lot of information. Don’t worry, you don’t need to read through or attempt to understand it all, there’s a ton of stuff going on in the log; we’re going to filter it to just the stuff we need to look at.

Right click on the System entry and select Filter Current Log…

In the Filter Current Log dialog box, leave everything in the default setting except the Event sources box. Scroll down within the pull-down menu and check Power-Troubleshooter. This will filter out the hundreds of messages that aren’t relevant to our problem and hone right in on the thing we care about: when the computer is waking up from a hibernation/low-power state.

In the new filtered view, seen above, you can check every time your computer has woken over the duration of the log (which should be hundreds of entries). What you should focus on is the time (did it wake at a time you were at the computer or was it a random middle-of-the-night wake up call?) and what the Wake Source is indicated as in the general details pane.


If the Wake Source says Power Button, that indicates that the power button on the computer was pressed to wake it up (like you would do first thing in the morning).

If the Wake Source says something like Device – HID-Compliant Mouse (or Keyboard), that indicates the computer is setup so that key presses and mouse movements will wake it. Wake Source: Unknown, as seen here, is a bit more cryptic but at least it tells when the machine was turned back on.

Once you’ve checked the Event Log and you’ve established that there is in fact a pattern of odd computer wake up calls, you can then turn to our handy guide on keeping your computer asleep: How to Prevent Your Computer from Waking Up Accidentally. The guide covers three critical tricks: checking which devices have the capability to wake the computer (using the powercfg command), how to disable the wake ability of those devices (via Device Manager), and how to disable any software-based wake timers (via Power Options).

Between studying the Event Log to understand when (and, if the Wake Source was clear, why) the machine turns back on to using our sleep prevention guide to put a stop to the midnight wake up calls, you’ll have a deep slumbering computer in no time.

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Advisory Panel: Your Personal Mobile Device | HIStalk

Advisory Panel: Your Personal Mobile Device | HIStalk | IT Support and Hardware for Clinics |

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What brand/model of mobile device do you use most often and what do you like most and least about it?

I use an iPhone and an iPad and I am happy with the fact that I can access my email from anywhere and can respond on the fly, but for the business of medicine it is cumbersome, difficult to type, not secure, and the constant need for iOS updates makes it difficult to use and upgrade apps. I do not like the "Walled Garden" approach from Apple that does not allow certain applications on their platform like Adobe Flash and it is also very expensive. I read somewhere  — on LinkedIn, I believe — that it seems only wealthy people use iPhones and it is almost like a statement of status, sort of the same stereotype that wealthy folks drink wine and the not-so-wealthy drink beer…just saying.

Interestingly enough, I did not end up with an iPhone by my sheer choice, but it was rather imposed on me by Allscripts of all people. They bought my initial e-prescribing "I scribe" which I had on a Palm for free and when Allscripts bought them they, did away with the Palm. In order to preserve my data, I had no choice but to get an iPhone and there you have it: there is no such thing as "free" and consumer choice, is it really? Mr H touched on this on one of his posts: the fact that it looks unprofessional to respond to emails from the iPhone (folks do not correct spelling, grammar, and at times it looks like mutilating the English language) but I admit I am guilty of doing it myself because on the other hand, what is the sense of the whole mobility trend? I cannot always wait for access to a desktop to respond to my emails, but I promise to correct the spelling.

Apple iStuff. They work as a consumer device (for which they are designed). I just wish they had enterprise devices.

HP laptops >> iPhones>> iPads

Personally I use an iPhone >iPad>>MacBook Air

I have used an iPad for a few years but switched to a small Dell Iconia W5 last year. I thought the Microsoft OS would make life easier working with my corporate applications. The Iconia certainly beats lugging a laptop on and off aircraft as I travel but it still isn’t as easy as the iPad. Last month I picked up an iPad Air. The smaller size is great. I think the Iconia is going back on the shelf and the Air will be my travel companion going forward. Now if only I could find something the size and ease of the Air combined with the MS OS….

Can’t live without my iPhone 5 and my iPad 2 (with a keyboard/case combo). Allows me to stay easily reachable and to work at home without lugging a laptop every night. What I like most about the iPad – Microsoft OneNote and the ability to keep all my data and projects current across devices and operating systems. This has been a huge help in organizing an extremely busy life. I literally walk into a meeting, pop open the iPad, and jump right in. I have all the meeting notes organized, all the action items up front, and I can take notes at the same speed as if I had a full keyboard. The search feature helps me quickly find pages by keyword. I share Notebooks with my team and that is working well, too. Note: I’m ordering some Microsoft Surface Pro 2s this week to trial for potential laptop/tablet replacement.

Personally I use a HTC smart phone and an iPad. I’m not crazy about the phone mostly because of the battery life (or lack thereof). My contract is up so I need to make a decision on a new device, but I’m not sure at this point what I will choose. I am very fond of my iPad. I use it primarily for reading and distractions and very little for work. I know that Ed Marx said in one of his blog posts that he doesn’t trust anyone that uses paper, but I went back to a paper notebook for meetings. When I take my iPad, I don’t generally take a pen to the meeting. The majority of the time someone passes out paper and I need to make note on a section so that I can follow up later. If I could get the groups to move to a paperless culture I would use the iPad exclusively.  

iPhone. I love the consistency between my Mac, iPad and iPhone. Battery life and the lack of a SD slot are the downside. I also never use Siri.

Samsung Galaxy S3 and Nexus 7 tablet. The Samsung battery is dreadful, but other than that, both devices are excellent. Google’s services and products are nicely integrated. The processors are fast, multitasking works great, and the Android OS is very reliable. And I can’t live without Swype and Dragon.

Apple iPhone 4S. I use maps, social media, email, calendaring, travel (airlines), weather, stocks, search, music, text, sports updates, news (around the world to help reduce spin), shopping (Amazon), restaurant ordering, restaurant reservations, and so on. There is not much I don’t like about it except for Siri. She is not very smart and does not take a clue when I am upset with her ;-). I find it works better without the protective film on the glass, to be sure.

My iPhone 5 is my most used mobile device. I find it great for email use and I have several apps that I use for business and personal needs. My AT&T service is great for talking and browsing. With the latest iOS upgrade my battery life is terrible. 

iPhone5. I love the iPhone. I will happily pay for something that is intuitive, quick, consistent, and has a lot of people writing for it. With that said, I am starting to see the Samsung users smirk as their product may take pictures better, get better Wi-Fi access, doesn’t charge extra for some little things. I am hoping the iPhone6 has some nice breakthroughs. But I will likely stick with Apple as the service has been phenomenal if I have any problems on any device and that is worth A LOT in  my book.

I’m not a Mac person, but my iPhone is my most favored and trusted sidekick (iPad comes in a close second.) Portability is the best feature. Clearing out my email inbox while waiting for elevators, looking up info on Google on the fly, quickly populating and reviewing my ToDo list, and other mundane tasks are much faster and more fun. With aging eyes, the screen size on the iPhone is the biggest impediment, but any increase in size would make it harder to stash on my belt and therefore easier to lose.

Apple iPhone4s. I like the Apple devices because most physicians use them and I can have an intelligent conversation with them about the pros and cons. I haven’t upgraded to the 5 series because my really cool case that looks like a cassette tape won’t fit the bigger phone. 

Personally, I use Droid devices. I think the capabilities are superior to iPhones (at least at this minute)  I think the openness and “less control” that has been placed on the Droid market have created these newer capabilities.

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How to Perform a Clean Install of Windows 8.1 With a Windows 8 Key

How to Perform a Clean Install of Windows 8.1 With a Windows 8 Key | IT Support and Hardware for Clinics |

Windows 8.1 is a free upgrade to all Windows 8 users, but you normally can’t install Windows 8.1 with a Windows 8 product key. Luckily, you can get around this limitation if you really want a fresh install of Windows 8.1.

Microsoft also only allows you to download Windows 8.1 installation media with a Windows 8 key, so we’ll show you another trick that allows you to download Windows 8.1 installation media with a valid Windows 8 key.

The Problem, and How We’ll Fix It

The problem is that Windows 8.1 product keys are different from Windows 8 product keys. You can’t enter a Windows 8 product key into the Windows 8.1 installer, just as you can’t enter a Windows 7 product key into the Windows 8 installer. You also can’t install the original version of Windows 8 with a Windows 8.1 product key.

This normally makes sense, but Windows 8.1 isn’t really a different version of Windows. It’s a free upgrade to every single Windows 8 user, so there’s absolutely no reason to introduce a new product key system.

Microsoft wants you to install Windows 8 normally and use the Windows 8.1 upgrade offer in the Windows Store to get Windows 8.1. Only people who purchase Windows 8.1 can install it fresh, not people who origianlly purchased Windows 8.

That’s the theory, anyway. In reality, there’s a way we can get around this limitation. The Windows 8.1 installer refuses to accept the Windows 8 product key and won’t allow us to install Windows 8.1 with it. However, Windows 8.1 will accept the Windows 8 product key if you enter it on the desktop after installing Windows 8.1 — no, we don’t know why it works this way. If we had a way of skipping the product key prompt during the installation process and entering the key later, we could install Windows 8.1 fresh — luckily, we do have a way of doing that. We’ll just need to modify the Windows 8.1 installation media a bit.

Download Windows 8.1 With a Windows 8 Product Key

The second problem is that Microsoft only allows you to download Windows 8.1 installation media with a Windows 8.1 product key. You can’t normally download it with a Windows 8 product key. Luckily, there’s yet another confusing trick we can use to get around Microsoft’s limitations.

First, visit the Upgrade Windows with only a product key page. Click the install Windows 8 button to begin downloading Windows 8 installation media. Run the downloaded tool and enter your product key. After the download begins, close the setup tool.

Next, visit the Upgrade Windows with only a product key page. Click the Install Windows 8.1 button and run the downloaded tool. The Windows 8.1 setup tool won’t prompt you for a key, but will download Windows 8.1 normally. Select the Install by creating media option after it completes and create either USB installation media or an ISO file. We’ll assume you’re creating USB installation media for this process, as it’s the easiest way to do this.

Modify the Windows 8.1 Installation Media

If you try to install Windows 8.1 with the media you created and your Windows 8 product key, you’ll see an error message. Instead, we’ll need to modify the installation media before beginning in the installation process.

This is easiest if you’ve created USB installation media, as you can edit the files directly on your USB flash drive. If you created an ISO file, you’ll have to modify the files inside it before burning it to disc.

Open the USB drive in Windows Explorer or File Explorer and navigate to the sources folder inside it. Right-click inside the sources folder, create a new text file, and name it ei.cfg . (Ensure it’s named ei.cfg , and not ei.cfg.txt — this may require ensuring file extensions are shown.)

Open the ei.cfg file in Notepad or another text editor. Copy-paste the following text into the text file and then save it.


If you have a product key for the Professional version of Windows, replace the word Core with Professional.

Install Windows 8.1 Normally and Enter Your Product Key Afterwards

You can now install Windows 8.1 normally using the installation media you created. You won’t be prompted for a product key while installing it. After the installation process completes, you’ll see a product key prompt. You can enter your Windows 8 product key here, and Windows 8.1 will accept it for some reason.

You now have a fully working Windows 8.1 system fresh-installed with only a Windows 8 product key. The installation media you created can be used to install Windows 8.1 on other systems with a Windows 8 product key, so you can more quickly install Windows 8.1 on multiple computers.

Yes, it’s ridiculous that we even have to write an article about this. Windows 8.1 is practically a service pack for Windows 8, and it’s free to all Windows 8 users — Windows 8.1 even accepts Windows 8 keys when installed, but it doesn’t during the installation process. There’s no reason to force Windows users — especially loyal ones who purchased Windows 8 at release thanks to Microsoft’s $40 offer — to jump through so many hoops.

Thanks to Paul Thurrot for demonstrating how to download Windows 8.1 installation media with a Windows 8 key, and thanks to nate.wages on Neowin for sharing how to install Windows 8.1 with that key!

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The Programmer – Healthcare Divide | EMR and HIPAA

The Programmer – Healthcare Divide | EMR and HIPAA | IT Support and Hardware for Clinics |

’ve regularly seen the divide (sometimes really wide) between the programmer and technical people in an organization and the healthcare professionals. For example, a healthcare IT company recently emailed me about an issue they had with their main developer. They asked the insightful question, “Is it possible to find quality developers who are not, shall we say, “difficult”?”

There’s no simple answer to this question, but let me first suggest that this divide isn’t something that just happens between tech people and non-tech people. I’m sure many doctors feel the same way when dealing with other people who try and do their job. It turns out, people are hard to work with in general.

That disclaimer aside, tech people do like to think they’re in a tribe of their own. Check out this video which definitely comes from a programmer perspective and illustrates the divide that often exists.

Just the fact that the programmer feels like they’re considered a “code monkey” describes a major part of the issue. Much like I wrote about today on EMR and EHR, one of the keys is making a human connection as opposed to treating a programmer like a code monkey that’s just there to do your bidding. While there are exceptions, most people respond to someone who deeply cares about the individual and works to understand their needs as much as the project’s needs or their own needs.

The reason I think there’s usually a big divide between the healthcare people and the tech people is that it’s a real challenge for these two groups to connect. The healthcare people don’t want to talk about Battlestar Gallactica and Game of Thrones and the tech people don’t want to talk about Dancing with the Stars and The Voice. Yet, this is what needs to happen to build trust between the two different groups. It’s a rare breed that enjoys both.

If all of this fails, then try the nuclear option. Bring donuts. Most people can relate to donuts.

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Readers Write: Can Intuitive Software Design Support Better Health? | HIStalk

Readers Write: Can Intuitive Software Design Support Better Health? | HIStalk | IT Support and Hardware for Clinics |

Can Intuitive Software Design Support Better Health?
By Scott Frederick

Biometric technology is the new “in” thing in healthcare, allowing patients to monitor certain health characteristics—blood pressure, weight, activity level, sleep pattern, blood sugar—outside of the healthcare setting. When this information is communicated with providers, it can help with population health management and long-term chronic disease care. For instance, when patients monitor their blood pressure using a biometric device and upload that information to their physician’s office, the physician can monitor the patient’s health remotely and tweak the care plan without having to physically see the patient.

For biometric technology to be effective, patients must use it consistently in order to capture a realistic picture of the health characteristics they are monitoring. Without regular use, it is hard to see if a reading is an anomaly or part of a larger pattern. The primary way to ensure consistent use is to design user-friendly biometric tools because it is human nature to avoid things that are too complicated, and individuals won’t hesitate to stop using a biometric device if it is onerous or complex.

Let’s look at an example.

An emerging growth area for healthcare biometrics is wireless activity trackers—like FitBit—that can promote healthier lifestyles and spur weight loss. About three months ago, I started using one of these devices to see if monitoring metrics like the number of steps I walked, calories I consumed and hours I slept would make a difference in my health.

The tool is easy-to-use and convenient. I can monitor my personal metrics any time, anywhere, allowing me to make real-time adjustments to what I eat, when I exercise, and so on. For instance, at any given time, I can tell how many steps I’ve taken and how many more I need to take to meet my daily fitness goal. This shows me whether I need to hit the gym on the way home from work or whether my walk at lunch was sufficient. I can even make slight changes to my routine, choosing to stand up during conference calls or take the stairs instead of the elevator.

I download my data to a website, which provides easy-to-read and customizable dashboards, so I can track overall progress. I find I check that website more frequently than I look at Facebook or Twitter.

Now, imagine if the tool was bulky, slow, cumbersome and hard to navigate. Or the dashboard where I view my data was difficult to understand. I would have stopped using it awhile ago—or may not have started using it in the first place.

Like other hot technology, there are several wireless activity trackers infiltrating the market, each one promising to be the best. In reality, only the most well-designed applications will stand the test of time. These will be completely user-centric, designed to easily and intuitively meet user needs.

For example, a well-designed tracker will facilitate customization so users can monitor only the information they want and change settings on the fly. Such a tool will have multiple data entry points, so a user can upload his or her personal data any time and from anywhere. People will also be able to track their progress over time using clear, easy-to-understand dashboards.

Going forward, successful trackers may also need to keep providers’ needs in mind. While physicians have hesitated to embrace wireless activity monitors—encouraging patients to use the technology but not leveraging the data to help with care decisions—that perspective may be changing. It will be interesting to see whether physicians start looking at this technology in the future as a way to monitor their patients’ health choices. Ease of obtaining the data and having it interface with existing technology will drive provider use and acceptance.

While biometric tools are becoming more common in healthcare and stand to play a major role in population health management in the future, not every tool will be created equal. Those designed with the patient and provider in mind will rise to the top and improve the overall health of their users.

Scott Frederick, RN, BSN, MSHI is director of clinical insight for PointClear Solutions of Atlanta, GA.

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Just say yes? The rise of 'study drugs' in college

Just say yes? The rise of 'study drugs' in college | IT Support and Hardware for Clinics |

(CNN) -- Around this time of year, you're more likely to find college students in the library cramming for final exams than out partying. In an environment where the workload is endless and there's always more to be done, a quick fix to help buckle down and power through becomes very tempting.

Prescription ADHD medications like Adderall, Ritalin, and Vyvanse are becoming increasingly popular for overworked and overscheduled college students -- who haven't been diagnosed with ADHD.

Experts reevaluate ADHD drug study

"Our biggest concern ... is the increase we have observed in this behavior over the past decade," says Sean McCabe, research associate professor at the University of Michigan Substance Abuse Research Center.

FDA warns of fake Adderall sold online

Full-time college students were twice as likely to have used Adderall non-medically as their counterparts who were not full-time students, according to a National Survey on Drug Use and Health report released in 2009.

The numbers vary significantly by school, with the greatest proportion of users at private and "elite" universities. Some researchers estimate about 30% of students use stimulants non-medically.

More students think marijuana is OK

"When we look at upperclassmen, the number really begins to jump," says Alan DeSantis, professor of communications at the University of Kentucky who has conducted research on stimulant use in college. "The more time you stay on campus, the more likely you are to use."

Of course, by and large the most common use is to concentrate while studying, with more than 90% of users doing it for this purpose.

ADHD stimulants "strengthen the brain's brakes, its inhibitory capacities, so it can control its power more effectively," said Dr. Edward Hallowell, a psychiatrist and ADHD expert. "They do this by increasing the amount of certain neurotransmitters, like dopamine, epinephrine, and norepinephrine."

Students say they take these stimulants for the "right reasons," to be more productive in classes and to stay afloat in the sea of intense competition.

In a 2008 study of 1,800 college students, 81% of students interviewed (DeSantis 2008) thought illicit use of ADHD medication was "not dangerous at all" or "slightly dangerous." While the picture of a methamphetamine user has hollowed cheeks, rotting teeth, and skin sores, an amphetamine-dextroamphetamine (Adderall) user looks just like anybody else.

"It helps me stay focused and be more efficient, which is very helpful with the chaos of college," says one university student who takes Adderall anywhere from once a month to a few times a week, depending on her schedule and workload. Students did not want to be identified because of their illegal use of the prescription drugs.

Yet these drugs are Schedule II substances, sitting pretty on the Drug Enforcement Administration's list right next to cocaine, meth and morphine.

"College students tend to underestimate the potential harms associated with the nonmedical use of prescription stimulants," McCabe says.

Students may not know the stimulant's documented contraindications (situations in which a drug might be harmful) or recommended precautions or how it may interact with other drugs, McCabe says. Hallowell is also concerned that students taking controlled substances without prescriptions and physician supervision, noting that they may not know the dosage.

How will I handle this course load?

WATCH: ADHD meds don't work long-term

Short-term adverse consequences include sleep difficulties, restlessness, headaches, irritability and depressed feelings. Other side effects include loss of appetite, nervousness, and changes in sex drive.

The long term risk of psychological and physical dependence is of concern for routine users that may find they do not feel they can function optimally without it. Schedule II substances are classified by the DEA as having a high potential for abuse.

While students' knowledge of the health dangers are limited, even less consideration is given to the illegality of use. Obtaining stimulants from friends with prescriptions, as the vast majority of college students do, seems less dangerous and illegal than buying drugs off the street.

"The fact that it's illegal really doesn't cross my mind," one student says. "It's not something that I get nervous about because it's so widespread and simple."

The biggest barrier to changing attitudes is the effectiveness of stimulants on campuses where the ends justify the means, researchers believe. After those late library nights, many students praise the little pill that got them through their hefty textbooks and into the morning.

After taking Adderall, says one university student, "I just feel very alive and awake and ready for challenges that come my way."

"I'm on page 15 (of my paper) in just a few hours ... and I'm very confident in it."

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Microsoft concedes Chromebooks are work-worthy

Microsoft concedes Chromebooks are work-worthy | IT Support and Hardware for Clinics |

Microsoft on Monday conceded that Google's Chrome OS and the Chromebooks the operating system powers are capable of doing real work, a reversal of its "Scroogled" campaign that once blasted the laptops as worthless.

Almost as an afterthought, Microsoft yesterday announced it was bringing its free Office Online apps -- Word, Excel, PowerPoint and OneNote -- to rival Google's Chrome Web store, the primary distribution channel for Chrome OS software.

[ InfoWorld dishes on must-have iPad office apps, essential Android productivity apps, and road warrior standbys. Start downloading! | Get the latest insight on the tech news that matters from InfoWorld's Tech Watch blog. ]

Microsoft released Word and PowerPoint to the store Monday, and said it will launch Excel Online shortly. It published OneNote on the store last Friday, April 11.

The move was largely symbolic: The Office Online apps have long been able to run within virtually any browser, including Chrome, the foundation of Chrome OS.

But by packaging the apps in .crx format and submitting them to the automated review run by Google, and thus publishing them to the Chrome Web Store, Microsoft put its Office Online in front of Chrome and Chrome OS users and in a place they've been trained to look for Web apps.

It was also a repudiation of Scroogled, the name Microsoft slapped on its attack ad-based campaigns that took shots at Google and its practices. Last November, Microsoft targeted Chromebooks in an advertisement starring reality show "Pawn Stars" personalities who argued that the devices were not legitimate laptops.

"It's not a real laptop," the pawn shop owner said in the ad of a Chromebook a seller hoped to hock. "It doesn't have Windows or Office."

While Chromebooks do not run Windows, they do Office, or at least Office Online, the free browser-based apps that provide an increasing amount of functionality.

Microsoft's move was also reminiscent of several that Google has made, including releasing a "Metro" version of Chrome for Windows 8, 8.1 and 8.1 Update that dramatically changed the standard Microsoft user interface (UI). Google's strategy has been described by some analysts as subversive, one that tries to assimilate devices running other operating systems into the search giant's web of services.

Office is one of Microsoft's most potent weapons in its struggle to morph into a company dedicated to selling devices and services, and become the firm known for its "mobile first, cloud first" battle cry. So, with little leverage on Chrome OS owners and a customer who's running Chrome lost to IE, it's no surprise that Office is Microsoft's strongest play here.

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