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Scribes Are Back, Helping Doctors Tackle Electronic Medical Records

Scribes Are Back, Helping Doctors Tackle Electronic Medical Records | IT Support and Hardware for Clinics | Scoop.it

Like many other doctors across the country, , a Dallas orthopedic surgeon, recently made the switch from paper to electronic medical records. This meant he no longer had to just take notes when he was examining a patient — he also had to put those notes into the computer as a permanent record.

"I was really focused on just trying to get the information in, and not really focusing on the patient anymore," Ramnath says.

In fact, he found he was spending an extra two to three hours every clinic just on electronic records. So he hired medical scribe Connie Gaylan. Acting a bit like a court reporter, Gaylan shadows Ramnath at every appointment. As the doctor examines a patient, Gaylan sits quietly in the corner, typing notes and speaking into a handheld microphone. Once she's finished with the records, she gives them to Ramnath to check and approve, saving him hours of administrative work and allowing him to concentrate on his patients.

"I would more than happily sacrifice a significant chunk of my income for the improved quality of life I have," Ramnath says.

Medical scribes are in high demand nationally. Any doctor who doesn't make the switch from paper to electronic records by 2015 will face Medicare , and this deadline is fueling the demand.

As the doctor examines a patient, medical scribe Connie Gayton records the visit using a microhone tethered to her laptop.

Brandon Thibodeaux for NPR

, the country's first scribe staffing company, is on the second expansion of its Fort Worth, Texas, headquarters and has opened another office in Chicago. , the company's CEO, says the firm is growing by 46 to 50 percent every year. In 2008, PhysAssist had 35 scribes; now it has 1,400. The other big scribing companies — and — each have thousands more, and the demand keeps growing.

PhysAssist trains scribes from across the country every week in its Fort Worth mock emergency department, where instructor Brandon Torres shows students the right way to fill out an electronic medical record. There are thousands of record systems, and scribes need to know how to put in the right billing codes and medical terminology at lightning speed. Torres says it's important not just to be able to multitask, but also to be able to listen to multiple things at the same time.

"You're listening to the physician, you're listening to the nurse, you're listening to the patient," Torres says. "And you're gathering all that information and presenting it back to the physician."

That last part's crucial. The physician has to approve the scribe's notes, because ultimately the doctor is responsible for the record.

Medical scribes make $8 to $16 an hour. Many of them are medical students who say they find it an invaluable experience. But it's not clear that scribes make things better for patients.

with in Washington, D.C., points to one done in an emergency department in New Jersey that found that doctors with scribes were able to see more patients on average — which means more money for the institution. But that same study found that the amount of time a patient spent in the emergency department didn't decrease. Medical scribing also raises some privacy concerns, O'Malley says. Some patients may not like having an extra person in the exam room.



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Thank XP: Desktop PC sales take off again in Western Europe

Thank XP: Desktop PC sales take off again in Western Europe | IT Support and Hardware for Clinics | Scoop.it

PC sales in Western Europe have risen after 13 consecutive quarters of decline, according to market research company Gartner. The market research company said government spending and the replacement of machines running Windows XP contributed to the growth.

Across the whole of Europe, the Middle East and Africa, PC sales grew by 0.3 percent after eight quarters of decline.

[ Windows 8 left you blue? Then check out Windows Red, InfoWorld's plan to fix Microsoft's contested OS. | Want a new PC? InfoWorld picks the 12 best Window 7 PC models available today. | Cut to the key news for technology development and IT management with the InfoWorld Daily newsletter, our summary of the top tech happenings. ]

PC shipments in the region totaled 22.9 million units during the first quarter, compared to 22.8 million in the first quarter of 2013. The impending end of support for Windows XP boosted commercial sales, while delayed government buying in large western European countries also helped, according to Gartner.

"Funnily enough the growth was driven by desktops. The main reason is that a lot of enterprises and smaller and mid-sized companies in Europe are lagging behind with the migration from Windows XP," said Meike Escherich, principal analyst at Gartner.

Manufacturers and resellers won't be able to live off the migration from Windows XP in the long term, but in a PC market that has been struggling for two years as a result of the growing interest in smartphones and tablets, it will provide a welcome boost for a few of quarters to come, according to Escherich.

The economic situation in Europe is also improving, and business and governments are adjusting their spending to match. However, not all segments looked as good as commercial sales of desktops. The notebook market was stagnant, and sales to consumers were sluggish, Escherich said.

Hewlett-Packard held on to the largest share of the market: Its shipments grew by 15.3 percent year-on-year. Lenovo cemented its number-two spot as sales increased by 35.6 percent. The company has now had seven consecutive quarters of strong growth, Gartner said. Acer retained the third place even though its sales dropped by 2.7 percent.

"Companies who specialize in the business segment like HP and Fujitsu, for example, did much better than the pure consumer vendors like Acer," Escherich said.

Worldwide PC shipments fell by 1.7 percent to 76.6 million units. Lenovo, HP and Dell were the three largest vendors, Gartner said.

Send news tips and comments to mikael_ricknas@idg.com


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Life as a Healthcare CIO: The March HIT Standards Committee

Life as a Healthcare CIO: The March HIT Standards Committee | IT Support and Hardware for Clinics | Scoop.it

The March HIT Standards Committee focused on the Standards and Interoperability (S&I) Framework projects for 2014, an overview of the 2015 Certification Notice of Proposed Rulemaking, and a first review of the standards maturity for the proposed Meaningful Use Stage 3 criteria.

Doug Fridsma presented the S&I update.  Importantly, a new initiative has been launched to coordinate decision support and clinical quality measures as related activities. EHRs should provide alerts and reminders from pathways, protocols, and guidelines intended to improve quality.  Also, a new initiative will connect EHRs and the Prescription Drug Monitoring Program (PDMP) to improve workflow, hopefully supporting single sign on and patient context passing so that PDMP data is one click away from any EHR.

Steve Posnack reviewed the 2015 Certification Notice of Proposed Rule Making, highlighting the changes from 2014.  He noted that the concept of the Complete EHR is no longer needed.   Providers buy the certified technology they need to attest and it may be that modules, an EHR, and an HIE meet all the attestation needs, not a single monolithic product.  The Implementation Workgroup will review the impact of the 50 new proposals in detail and we will discuss them at the April meeting.

I presented a task force review of the 19 Meaningful Use Stage 3 proposals.

Below are a few comments from the task force and the Standards Committee members.   Although the bulk of our comments focused on standards maturity, we also commented on provider impact and development difficulty, hoping to offer helpful “in the field” feedback to the Policy Committee.

Clinical decision support - it would be very challenging for an EHR to track every response to every decision support intervention and no standards exist for such tracking.  Maybe the best way to encourage decision support is via payment reform which links outcomes to pay.

Order tracking - there are standards for closed loop lab ordering but not closed loop referral workflow.   The Harvard Risk Management Foundation recently funded a project to define all the steps in closed loop referral management, pictured below.   Given the lack of standards and the development burden of this workflow, a focus on lab seems most appropriate.


Demographics/patient information - although standards exist for occupation and industry, other new demographic standards such as gender identify and sexual orientation are a work in process.  Here’s a great reference describing one approach. There could be a significant impact on EHR development if new demographics selections affect patient education materials, decision support, and quality measures.

Advance directive - a pointer to an advanced directive such as a URL would require little development and the standards are mature.

Electronic notes - Although the standards to transmit free text within a clinical summary are mature, the “high threshold” (likely over 50% of patients to have notes) could be a high burden first step.

Hospital labs - The HL7 2.51 standards are mature but a minority of hospital reference labs support comprehensive LOINC codes.

Unique device identifiers - The standard is well described but the implementation difficulty could be high if the electronic record had to validate the UDI against a national database and enable reporting on UDIs in the case of recalls.

View, download, transmit - the standards for clinical summaries are mature except for the representation of structured family history.  The requirement to make data available to patients within 24 hours could present workflow challenges.

Patient generated health data - certifying multiple methods of data capture creates a burden on developers.  Maybe a less prescriptive approach, focusing on the ability to receive patient data in some fashion would be best.

Secure messaging - overly prescriptive workflows could force the retooling of existing high functioning products.    Maybe a less prescriptive approach, focusing on the ability to support effective patient communication would be best.

Visit Summary/clinical summary - the nature of the clinical summary text (structured, unstructured, timeliness) could have workflow and development implications.

Patient education - the requirement is for only one language other than English and the Infobutton standard can support this.   A single language other than English may not achieve the policy outcome desired.

Notifications - although the HL7 admit/discharge/transfer standards are mature, the notion of gathering the Direct addresses of care team members and sending event data via Direct is a novel workflow.

Medication Reconciliation - identical to stage 2, no concerns

Immunization history - The HL7 2.51 content and CVX vocabulary standards are mature.  The transport specification created by the CDC (SOAP) is well tested.   The questions we raised - is there a role for Direct in transmitting immunization data to registries since Direct is used for other transmissions in Meaningful Use?   Is REST an alternative to all Meaningful Use “push” and “pull” transactions.   The public health community is passionate about the use of SOAP.   There are pros and cons to using something different for public health transport than other areas of Meaningful Use, so it is likely there will be further discussion.

Registries - the development effort required to submit provider chosen data elements to  registries would be significant.   Standards do not exist for this purpose.

Electronic lab reporting - identical to stage 2, no concerns

Syndromic surveillance - identical to stage 2, no concerns

There will be more discussion in upcoming meetings as both FACAs recommend iterative improvements as input before rule making.

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Security Risk Analysis | Providers & Professionals | HealthIT.gov

Security Risk Analysis | Providers & Professionals | HealthIT.gov | IT Support and Hardware for Clinics | Scoop.it
Technical Dr. Inc.'s insight:

A security risk assessment is required under the HIPAA Security Rule. Learn about planning, conducting and reviewing the risks and vulnerabilities in your healthcare organization, and how regular risk assessments can protect your practice and your patient data

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The critical, widespread Heartbleed bug and you: How to keep your private info safe | PCWorld

The critical, widespread Heartbleed bug and you: How to keep your private info safe | PCWorld | IT Support and Hardware for Clinics | Scoop.it

No matter how hard you try to stay safe, some aspects of securing your online data are completely out of your hands. That fact was made painfully obvious on Monday, when the Internet got caught with its collective pants down thanks to a critical vulnerability affecting a fundamental tool for secure online communications.


Called Heartbleed, the bug has been in the wild for more than two years now. It allows attackers to exploit a critical programming flaw in OpenSSL—an open source implementation of the SSL/TLS encryption protocol.

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From AHIMA: Look Closer at Vendor HIPAA Compliance

From AHIMA: Look Closer at Vendor HIPAA Compliance | IT Support and Hardware for Clinics | Scoop.it

With stronger HIPAA privacy and security requirements now in effect, health care providers need to ensure that their information technology vendors and their business associates understand and are compliant with the provisions.

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Some Linksys routers targeted by TheMoon malware

Some Linksys routers targeted by TheMoon malware | IT Support and Hardware for Clinics | Scoop.it

Security researchers have discovered a flaw in the firmware of some Linksys routers that could allow a hacker to gain control remotely, possibly turning a group of infected routers into a botnet.


The vulnerability has been exploited by malware dubbed TheMoon, according to a story at Computerworld, and the SANS Institute’s Internet Storm Center reports it has spotted Linksys E1000 and E1200 routers that were scanning the Net for other routers to infect.


Linksys routers have the ability to be managed remotely via a Web page or a smartphone app. The flaw involves a one or more scripts used in this process. Once the malware is installed, it tells the router to begin looking for others to infect in the same way. The malware also appears to contain code that may have it looking for a command and control server that would tell it what to do.


A PC World story lists these Linksys models as being potentially vulnerable, based on details posted to Reddit by a user who created a proof-of-concept exploit:


The following models are listed: E4200, E3200, E3000, E2500, E2100L, E2000, E1550, E1500, E1200, E1000, E900, E300, WAG320N, WAP300N, WAP610N, WES610N, WET610N, WRT610N, WRT600N, WRT400N, WRT320N, WRT160N and WRT150N. However, Rew notes that the list might not be accurate or complete.


A spokesperson for Belkin – which now owns Linksys – confirmed the exploit to PC World, and said it can be prevented but making sure Remote Management Access is turned off. She said the routers ship with that feature disabled by default.


Linksys has posted information about how to update its routers to the latest firmware and make sure that Remote Management Access is turned off. If you’ve got a Linksys router, you should read it and take action ASAP.



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Patient Experience: What happens when the phone rings?

Patient Experience: What happens when the phone rings? | IT Support and Hardware for Clinics | Scoop.it

As long as the Harvard Business Review continues to not ask me to write an article for them then I will continue to refuse to do so.


True story.  Flying yesterday at thirty-six thousand feet I was able to exchange a look of terror with the passengers on the other plane.  A near-miss is defined as being within a thousand vertical feet of the other plane and within three nautical miles.  We were so close to the other plane that we felt our plane move from the plane’s slipstream.


Enough of my problems.


I was in the hospital’s cafeteria watching people before my meeting about reinventing patient experience with one of the hospital’s executives.  Two people stopped by my table to tell me how much they liked my socks.  It occurred to me that if my socks were noteworthy enough to warrant comments from two strangers that they may be the wrong socks to wear to meet with the executive.  I was wearing sensible shoes, so at least I had that going for me.


So, I did some work for an organization that felt it needed a call center.  And for that call center they wanted to talk about ACD’s, IVR’s, CRM, and a suitcase full of other technical things.  I thought the best way to be of service would be to stop at Costco and buy them the call-center-in-a-box startup kit.  Maybe I’d also get them the all-in-one-EHR.


This is what happens when someone reads something they shouldn’t, something which they believe gives them instant credibility on a subject of which they previously knew nothing.  I watch one of those shows about goofy problems in the ER, but even so I remain hesitant about thinking I am the right guy to insert a chest tube.  I did buy some scrubs and a white jacket just in case someone feels the need to pull me in on a procedure.


When I asked why they felt they needed to design a call center their reasons were legion.  Too many numbers, too much wait time, too many dropped calls, too many call backs.  They want job descriptions, training manuals, a system for scheduling the people who were taking the calls, and they want scripts written for every conceivable type of call.  Call-center-in-a-box.


I asked what business problem they were trying to solve, a question which branded my immediately as a heretic.  Burn him at the stake the pink-faced call center director shouted.  All I could think of was that I was glad I had not worn my fancy socks.


If they proceed along this course they will have a very efficient call center—phone rings, it is answered, both parties disconnect.  Rinse and repeat.

I am not a fan of efficiency.  Efficiency is about speed, and speed kills.

I once did some work for one of the largest telecommunications firms in the US.  They wanted a call center strategy.  I told them that they should close all of their call centers, and then I closed my laptop.  (I sensed that they wanted a little more detail so I went to the white board.)


They told me it cost about thirty dollars to answer each call, and they received millions of calls.  I then had them create an exhaustive list of the reasons people called.  I was the scribe—in consulting lingo we refer to the in the work plan as facilitation because you can charge more for facilitating than you can for writing.


We created a pretty substantial list.  We then worked through each of the reasons on the list.  For an item to remain on the list, the people in the room were asked to defend why a customer should have to call about that item.


They learned that phone calls fell into one of three areas; people needed something, people had a question about something, or people had a complaint.  They learned that whatever it was people needed should have been handled at some point upstream in the process.  They learned that the information that was needed could have been provided at some point upstream in the process.  And they learned that complaints arose from something that did not happen correctly at some point upstream in the process.


Of the few items that remained—I gave in on some to make them feel better—I asked which of those could be handled through a customer portal.


Each item that is addressed at some point upstream in the process takes the cost of the call from thirty dollars to zero dollars.  The same is true with handling an item in the customer portal.  Eliminating a call ensures there are no call-backs, no waiting time, and no abandoned calls.  It also ensures that everyone gets the same answer, the same right answer to the same question.


It also ensures and insures the brand.


Your hospital gets hundreds if not thousands of calls each day.  Your hospital has dozens of phone numbers.  Each phone number is answered differently by people with different skills and experience and having different objectives.  People are placed on hold, transferred, given other numbers to call, and given the wrong information.


The other thing this hospital wants to do is to have one phone number people can call; a noble idea and a very bad idea.  They want it to handle two-dozen different call origination types, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.


In effect, they want their call center to be the same as their web site.  Their web site has more than fifty clickable links, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.


There should be a number for patient stuff and a website for patient and prospective patient stuff—a customer portal which is not even close to what EPIC and Cerner mean by patient portal.  There should also be a number or numbers for other stuff and maybe, just maybe a single link on the customer portal for all of the other stuff.



Designing patient experience so that the experiences on the web and on the phone are similar is only beneficial if those experiences are remarkable. Designing a call center experience that mimics the lack of functionality of your website is a waste of money.


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Children’s Hospital Leverages Telehealth For Newborn Care in Rural Areas

Children’s Hospital Leverages Telehealth For Newborn Care in Rural Areas | IT Support and Hardware for Clinics | Scoop.it
Children's Hospital Leverages Telehealth For Newborn Care in Rural Areas

By Wendy Grafius, contributing writer

UC Davis Children’s Hospital plans to use grant to expand telehealth services to nursery clinicians at rural hospitals, study long-term impact on neonatal outcomes

UC Davis Children’s Hospital of Sacramento has received a grant from the U.S. Department of Health and Human Services Office for the Advancement of Telehealth – Health Resources and Services Administration (OAT-HRSA) which will be used for the new Pediatric Emergency Assistance to Newborns Using Telehealth (PEANUT) program. Approximately $750,000 over a three-year period will be disbursed to the nationally ranked hospital for the expansion of its telehealth services to nursery clinicians at rural hospitals and to study the program’s long-term impact on neonatal outcomes.

UC Davis Medical Center, which houses its center of excellence – UC Davis Children’s Hospital – is a pioneer in telehealth programs, providing academic specialty and subspecialty access to hospitals in rural communities. Four hospitals in rural counties with a shortage of health professionals, particularly in pediatric subspecialist areas, were selected to participate in the PEANUT program. The use of UC Davis’ award-winning videoconferencing will give those clinicians access to neonatologists, pediatric cardiologists, and other specialists for guidance in an attempt to address rural disparities in newborn care.

 “Rural doctors and hospitals deliver great care. But they have limited access to pediatric subspecialists,” said Madan Dharmar, assistant research professor in the UC Davis Children’s Hospital pediatric telemedicine program and principal investigator for the PEANUT program. “Without subspecialty guidance, newborn infants may be undertreated, receive inappropriate therapies, or face unnecessary transfers. By providing immediate access to neonatologists and other pediatric experts, PEANUT will provide a safety net for rural clinicians and their patients.”

Education will also be a major component of the PEANUT program. Technicians at the four rural hospitals will be trained in techniques for newborn emergency care and will receive help in implementing new care standards that are required at the state and national level, such as the Critical Congenital Heart Disease Screening Program for neonatal echocardiograms. Ruling out congenital heart defects can eliminate neonatal transfers, while properly identifying them will allow appropriate treatment. “We view this program as an important step in delivering high-quality and cost-effective care throughout California,” said Robin Steinhorn, UC Davis Children’s Hospital’s physician-in-chief, pediatric department chair, and grant co-investigator.

Part of the UC Davis Health System, 619-bed UC Davis Medical Center is the Sacramento region’s only academic health center, and is a “Most Wired” hospital, a Leapfrog Group “Top Hospital”, and ranked Sacramento’s top hospital by U.S. News & World Report. UC Davis Children’s Hospital boasts more than 120 physicians in 33 pediatric subspecialties serving infants, children, adolescents, and young adults with primary, subspecialty, and critical care. A total 129 beds include 36 general, 49 Neonatal Intensive Care Unit (NICU), and 24 Pediatric Intensive Care Unit/Pediatric Cardiac Intensive Care Unit (PICU/PCICU). In addition, the hospital provides the Central Valley’s only Level 1 pediatric trauma center and pediatric emergency department.



Technical Dr. Inc.'s insight:
Need expertise in this area? Technical Doctor can help. Contact the #1 medical technology implementor, email us at inquiry@technicaldr.com to get help today!- The Technical Doctor Team
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Keeping medical device designs relevant in a big data world migrating to outcomes-driven payment models

Keeping medical device designs relevant in a big data world migrating to outcomes-driven payment models | IT Support and Hardware for Clinics | Scoop.it

Last week I presented the closing keynote at the Medical Design & Manufacturing (MD&M) West Conference & Exhibition in Los Angeles. MD&M has always been about what’s next in medical device design and this year’s event didn’t disappoint. While still being primarily focused on hardware, many smart device manufacturers came out to MD&M looking for advice on next generation architecture and thinking so that they could point their product roadmaps in the right direction. The questions at the end of keynote were astute and thought provoking. Below is what I shared with the crowd in both the main presentation and through answers to their questions; you can find my presentation deck at SpeakerDeck.com as usual.

Today we’re accustomed to going on the Internet to visit websites, send e-mails, shop online, run mobile apps, and even get up to the second and down to the inches directions from satellites orbiting the earth. We’re seeing medical devices and related hardware moving faster towards the same kinds of consumerization, their sensors switching from analog to digital native, becoming more mobile, and perhaps most importantly, becoming part of the “Internet of Things” (IoT) by generating enormous amounts of coveted clinical data.

What’s going to be even more spectacular is that you’ll soon be wearing smart watches that can know your vital signs, electronic “bandaids” that can sense whether wounds are healing, and many other personal medical devices that continuously monitor things going on within and around your body. These kinds of devices will make up what will soon become the “Medical Internet of Things” (mIOT). mIOT devices will generate significant amounts of data and managing this data becomes what’s known as a “big data” problem. The reason is obvious – data flowing continuously from your body comes in rapid velocity, large volumes, and many different kinds of variety.

IoT, Big Data, mIOT, and analytics will certainly transform the medical device landscape and those that don’t adapt won’t be around to enjoy the spoils. The way next generation devices will be designed must adapt so that new devices generate the right kinds of data that are easier to analyze and utilize – the specific traits that buyers of clinically useful equipment will use when making purchasing decisions. New health system purchase decisions will be made era of value-driven decision-making due as the fee for service (FFS) payment models get augmented by outcomes based payments in so-called Accountable Care Organizations (ACOs). As our customers of medical devices get paid less for the services they perform and more for the patient outcomes they improve, their expectations of data generated from our devices also gets more sophisticated.

As we create and upgrade future devices, our designers must realize that they’re no longer just making standalone devices, they’re likely crafting a system component that fits into a larger system of systems ecosystem that is creating and moving around enormous amounts of coveted data. Coveted because that data can be used to improve diagnostics, tailor clinical workflows, improve patient safety, and advance care coordination. All of these kinds of tasks and the data that will make them possible become even more important as payment models move from FFS to outcomes-driven.

If you’re a company making an analog device living in a digital world, your days are numbered and you need to be worried. If you’re making digital devices and you’re not sharing data with IT systems, your competitors will be selling more products than you will because ACOs and outcomes-driven organizations have an insatiable appetite for data. Because next generation health systems will be paid for outcomes, they will not settle for aging, expensive, stand alone equipment when connected alternatives are available. If you’re selling digital devices that are sharing some data but not capturing enough data to make it useful for analytical purposes, you’ll see limited revenue growth and margin pressure along with loss of sales as your customers phase out your products in favor of those that generate clinically valuable data for improving their workflows.

Most medical devices, like other IOT devices, will be disrupted by the business-value focused Big Data movement at some level. How much your company’s products are disrupted will depend on whether your devices are built around the idea of enabling agile clinical workflows and whether your devices generate patient outcomes improvements in a measurable way. Think about the mobile phone and digital devices world in 2007 vs. 2014 – almost none of the same players that were big back in 2007 are still big today. Now, think about the world in 2021. Will your company be around or will it be disrupted out of existence by Big Data, analytics, and new payment models?



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Google envisions Glass in businesses

Google envisions Glass in businesses | IT Support and Hardware for Clinics | Scoop.it

Google wants to put its Glass headmounted computer system to work.

The company is looking to partner with enterprise software developers and businesses as part of a push to get Glass into the hands of companies who could use it in their operations.

[ Also on InfoWorld: 7 hidden dangers of wearable computers. | Understand how to both manage and benefit from the consumerization of IT with InfoWorld's "Consumerization Digital Spotlight" PDF special report. | Subscribe to InfoWorld's Consumerization of IT newsletter today. ]

Through its "Explorer" program, Glass is already used by thousands of software developers and early adopters who are tinkering with the product and creating applications for consumers. Now, Google wants to replicate that initiative for business applications.

Google calls the effort the "Glass at Work Explorer Program," and companies and software developers interested in participating can apply online. "If you're a developer who is creating software for U.S. based enterprises, we'd love your help in building the future of Glass at Work," Google said.

Since its unveiling, Glass has generated questions over what it's supposed to be used for, including what advantages it could offer over a mobile smartphone. Some businesses like bars have banned it so their patrons don't feel uncomfortable around those wearing Glass, which has a voice-activated camera.

Others are already using Glass in ways that seem productive. Wearable Intelligence, for instance, is working to customize Glass' default Android software for health professionals and energy workers. In one scenario, a paramedic in an ambulance could use Glass to access a patient's vital signs and medical history, as depicted in a YouTube video posted by the company.

Schlumberger, an oilfield services company, has also partnered with Wearable Intelligence to use Glass to increase the safety and efficiency of employees in the field, Google said. The Washington Capitals professional hockey team, meanwhile, has partnered with the software company APX Labs to deliver real-time stats, instant replay and different camera angles to fans via Glass.

There is a lot of hype around wearable devices like Glass, but over the next 10 years more businesses could employ the technology in concrete, useful ways, according to a recent report from Forrester Research.

Zach Miners covers social networking, search and general technology news for IDG News Service. Follow Zach on Twitter at @zachminers. Zach's e-mail address is zach_miners@idg.com


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Life as a Healthcare CIO: Wearable Computing at BIDMC

Life as a Healthcare CIO: Wearable Computing at BIDMC | IT Support and Hardware for Clinics | Scoop.it

I’m now able to publicly write about the work that Beth Israel Deaconess Medical Center has been doing with stealthy start up, Wearable Intelligence. We’ve been working over the past 4 months on pilots that I believe will improve the  safety, quality  and efficiency of patient care through the integration of wearable technology such as Google Glass in the hospital environment. I believe that wearable tech enables providers  to deliver better clinical care by supporting them with contextually-relevant data and decision support wisdom.

 One of our Emergency Department physicians, Dr. Steve Horng, said it best:

 "Over the past 3 months, I have been using Google Glass clinically while working in the Emergency Department. This user experience has been fundamentally different than our previous experiences with Tablets and Smartphones. As a wearable device that is always on and ready, it has remarkably streamlined clinical workflows that involve information gathering.

For example, I was paged emergently to one of our resuscitation bays to take care of a patient who was having a massive brain bleed. One of the management priorities for brain bleeds is to quickly control blood pressure to slow down progression of the bleed. All he could tell us was that he had severe allergic reactions to blood pressure medications, but couldn’t remember their names, but that it was all in the computer.

Unfortunately, this scenario is not unusual. Patients in extremis are often unable to provide information as they normally would.  We must often assess and mitigate life threats before having fully reviewed a patient’s previous history. Google Glass enabled me to view this patient’s allergy information and current medication regimen without having to excuse myself to login to a computer, or even loose eye contact. It turned out that he was also on blood thinners that needed to be emergently reversed. By having this information readily available at the bedside, we were able to quickly start both antihypertensive therapy and reversal medications for his blood thinners, treatments that if delayed could lead to permanent disability and even death. I believe the ability to access and confirm clinical information at the bedside is one of the strongest features of Google Glass.”

As procedure oriented specialists, emergency medicine clinicians must stay visually engaged with their patients while also using their hands to complete critical tasks.  Wearing a device that enables clinicians to view different forms of information without having to disrupt workflow to access a computing device is  empowering.

 This video demonstrates the value and impact that the technology can have.

 Here’s how we are currently using it:

When a clinician walks into an emergency department troom, he or she looks at bar code (a QR or Quick Response code) placed on the wall. Wearable Intelligence’s software running on Google Glass immediately recognizes the room and then the ED Dashboard sends information about the patient in that room to the glasses, appearing in the clinician’s field of vision. The clinician can speak with the patient, examine the patient, and perform procedures while seeing problems, vital signs, lab results and other data.

Beyond the technical challenges of bringing wearable computers to BIDMC, we had other concerns—protecting security, evaluating patient reaction, and ensuring clinician usability.

We have fully integrated with the ED Dashboard using a custom application to ensure secure communication and the same privacy safeguards as our existing web interface.  All data stays within the BIDMC firewall.

Wearable Intelligence has designed a custom user interface to take advantage of the Glass’ unique features such as gestures (single tap, double tap, 1 and 2 finger swipes, etc.), scrolling by looking up/down, camera to use QR codes, and voice commands. Information displays also needed to be simplified and re-organized.

We implemented real-time voice dictation of pages to staff members to facilitate communication among clinicians.

 After several months of testing, we have deployed the product to clinical providers in the ED and are completing the first IRB approved study (to our knowledge) of the technology’s impact on clinical medicine.

Working on novel technology with Wearable Intelligence provides respite from an agenda that has been filled with meaningful use, ICD-10, ACA, and the HIPAA Omnibus rule.   I look forward to reporting further about our experience.

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Is Your Health Insurance Portability and Accountability Act (HIPAA) Compliance Program Going Out the Window with XP? | The National Law Review

Is Your Health Insurance Portability and Accountability Act (HIPAA) Compliance Program Going Out the Window with XP? | The National Law Review | IT Support and Hardware for Clinics | Scoop.it
April 8, 2014 marks the end of Microsoft’s support for the Windows XP operating system, which means the end of security updates from Microsoft and the beginning of new vulnerability to hackers and other intruders into systems still utilizing the operating system. But does the end of Windows XP support mean that HIPAA covered entities and their business associates using Windows XP are automatically out of compliance with HIPAA as of April 8th? Not necessarily.
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Encore Presentation: WEDI's 10 Recommendations for Next-Generation HIE

Encore Presentation: WEDI's 10 Recommendations for Next-Generation HIE | IT Support and Hardware for Clinics | Scoop.it
Twenty years after the Workgroup for Electronic Data Interchange issued the WEDI Report that ushered in the HIPAA standards to automate health care administrative and financial transactions, the group in December 2013 released a roadmap to guide the next generation of health information exchange.


Patient Engagement: Standardize the patient identification process across the health care system.

Convene industry to identify best practices for patient matching, launch consumer awareness and education campaigns, initiate pilots and explore dissemination strategies, and launch an adoption campaign


Patient Engagement: Expand health IT education and literacy programs for consumers to encourage greater use of health IT to improve care management and wellness.

Identify curriculum and deployment strategies for standardized materials, pilot the materials, and launch educational and literacy programs.


Patient Engagement: Identify and promote effective electronic approaches to patient information capture, maintenance and secure appropriate access that leverages mobile devices and “smart” technologies.

Convene business and clinical experts to define the standard technology, data content and dissemination strategy. Identify mobile technologies and apps that easily provide users information in a timely manner. Pilot best practices and effectiveness.


Innovative Encounter Models: Identify use cases, conventions and standards for promoting consumer health and exchange of telehealth information in a mobile environment.

Map electronic encounters (telemedicine, email, text & care monitoring) by typical use, then develop a matrix showing how innovative encounters are typically used. Evaluate and prioritize the effectiveness of technology initiatives.


Innovative Encounter Models: Adopt and implement best-in-class approaches promoting growth and diffusion of innovative encounters that demonstrate value for all stakeholders.

Evaluate encounter models in terms of patient support & satisfaction, outcomes, ease of integration into workflow and liability issues. Assess and prioritize existing protocols and payment methodologies for electronic encounters. Survey consumer willingness to use and pay for electronic encounters.


Innovative Encounter Models: Identify federal and state laws that create barriers to innovative encounters, including licensure.

Continue monitoring for potential regulatory barriers and best practices. Create policy mechanisms and partnerships to get supporting legislation.


Data Harmonization & Exchange: Identify consistent & efficient methods for electronic reporting of quality and health status measures across all stakeholders, with initial focus on recipients of quality measure information.

Review existing methods and standards for electronic clinical quality measurement, develop a plan to get consensus on methods & standards, design and launch awareness campaigns, pilot standards and develop a plan to get industry adoption.


Data Harmonization & Exchange: Identify/promote methods & standards for HIE that enhance care coordination.

Review existing methods, standards and implementation guides to identify gaps that impede connectivity and timely sharing. Develop a plan for industry consensus on methods and standards, test them, and develop a plan for adoption.


Data Harmonization & Exchange: Identify methods & standards for harmonizing clinical and administrative information reporting that reduce data collection burdens, support clinical improvement and population health, and accommodate new payment models.

Review existing methods, standards and implementation guides to identify impediments to linking clinical and administrative data. Develop consensus on methods & standards supporting claims attachments and quality reporting in Stage 3, then pilot.


Payment Models: Develop a framework for assessing core elements of alternative models such as connectivity, eligibility/enrollment reconciliation, payment reconciliation, quality reporting and coordinated data exchange.

Assess technology needs to facilitate implementation of alternative models and educate stakeholders. Assess the technology market for existing solutions to aid implementing and adopting alternative models.

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What is the future of computerized physician order entry? | EHRintelligence.com

What is the future of computerized physician order entry? | EHRintelligence.com | IT Support and Hardware for Clinics | Scoop.it

Earlier this year members of the Office of the National Coordinator for Health Information Technology (ONC) pointed to the abundance of published research demonstrating the positive influence of the EHR Incentive Programs and their meaningful use requirements on care quality, safety, and efficiency. One significant takeaway from this literature review was strong evidence supporting the favorable effects of computerized physician order entry (CPOE) on patient outcomes.


With CPOE a cornerstone of the EHR Incentive Programs and its role increasing in future stages of meaningful use, how is CPOE adoption going to evolve over time? That was one of the questions posted to Methodist Health System’s SVP and CMIO/Chief Quality Officer Sam Bagchi, MD, during a sitdown interview at Wolters Kluwer booth at HIMSS14 in Orlando.
In this second and final installment of a two-part CPOE Q&A, Bagchi describes what lies ahead for his health system as it moves forward with CPOE and looks to increase adoption and improve the functionality of this health IT tool. As he explains, getting physicians to adopt CPOE is a necessary first step, but it is only the beginning of an ongoing process of optimization.
What’s next for CPOE at Methodist Health System?

We’re seeing a lot of organizations, ourselves included, running into high-adoption CPOE projects because of various deadlines that are out there and initiatives that are related to this. As we look back, we see people sometimes unhappy with how the system works or how their content is organized.
Our key in the first phase is getting physicians into the system, comfortable with the content, and generally standardizing evidence-based elements. The key to the optimization phase is comparing similar content and refining our content so that we only have one heart failure order set and four heart failure order sets at hospitals, so that it’s easier to find what you need and that we can count on getting the right care to the right patient at the right time every time.
What kind of input are you getting from physicians and how do you turn feedback both positive and negative into CPOE improvements?

We take every complaint as a request for improvement. We take input from all the physicians. We set up email addresses and we have frontline staff out at the hospitals soliciting feedback. We use our training sessions as feedback sessions so we’re not just telling you how it is today is how it has to be but we want to know what you want to improve. We take that feedback to an integrated informatics IT change management meeting that happens once a week that didn’t exist last year and now exists so that we can organize our changes, be aware of our changes, and rapidly improve our current system.
How does this approach to soliciting feedback and rolling out enhancements also work to benefit the organization’s health IT systems and services?

It also helps us deploy innovations or new elements of the enterprise EMR that we want to use and not wait two to three months to do it. We’re doing 50-60 changes a month based now on this process, and if you don’t listen and move quickly after you go live on a project like CPOE, your physicians that you have engaged so heavily to get there can sometimes get off the bus. So we’re trying to keep everybody on the bus.
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Clinical Mobile Apps Lead To Speedy Data Turnaround

Clinical Mobile Apps Lead To Speedy Data Turnaround | IT Support and Hardware for Clinics | Scoop.it
Magazine Article | January 28, 2014
Clinical Mobile Apps Lead To Speedy Data Turnaround
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By Katie Wike, contributing writer

At Rockdale Medical Center, clinical mobile apps are accelerating the transmission of data among departments, meeting HIPAA requirements and pleasing physicians.

In 2012, Epocrates Research group found 34 percent of physicians used a tablet computer and 75 percent planned to buy one within a year. Eighty-one percent of those who owned a tablet owned an iPad. Tablets continue to gain popularity due to their unmatched mobility and ease of use. Despite the trend, connecting these mobile devices to existing EHR platforms in a way that meets HIPAA security requirements may prove to be a tricky task.

For Rockdale Medical Center (RMC) in Rockdale County, GA, the answer was a clinical mobile app already approved by the FDA as a diagnostic aid. Since 1954 RMC has made its mission to provide the best care possible for all the patients in the 138-bed acute care facility. The need for a means of transmitting patient data from the emergency department to the lab and at night with a smaller staff available spurred RMC’s search for a HIPAA-compliant datasharing technology.


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TD Sync - Benefits of using our cloud solution!

TD Sync - Benefits of using our cloud solution! | IT Support and Hardware for Clinics | Scoop.it

Universal file access; sync across stationary and mobile devices

What this means for your clients:

“No more dependency on FTPs, VPNs, or file servers. This cloud software allows you access your files at home, in the office or on any mobile device, including iOS and Android devices. Because files are uploaded to ‘the cloud’ there are no large file-sharing issues.”

 

448-bit Blowfish encryption on-device and in-transit

What this means for your clients:

“Consumer cloud products -- Dropbox, Box, Google Drive, Microsoft SkyDrive and SugarSync -- were built to protect insensitive documents, and some of those documents aren’t securely transferring across devices. TD Sync has the highest level of security for any cloud platform, ensuring that your sensitive documents (contracts, designs, client history) are safe from hacking and breaches. Note: some consumer products, like Google Drive, do not encrypt your data at all.”

 

Private encryption key management

What this means for your clients:

“Consumer cloud products -- Dropbox, Box, Google Drive, Microsoft SkyDrive and SugarSync -- are hosted publicly, meaning that everyone shares the same encryption key; when that encryption key is compromised, your businesses’ documents, your clients’ documents, and your personal documents will be vulnerable. This happened with Dropbox in August, 2012, when users had their logins and passwords stolen. With TD Sync, you’ll have an encryption key that is exclusive to your business and documents, and not shared with anyone. You won’t have to worry about data loss.”

                       

Remote wipes of endpoints and mobile devices

What this means for your clients:

“Access to business documents is a privilege. With the FTP, VPN and file server, it is difficult to revoke the access that employees have. TD Sync allows you to perform remote wipes of desktops for clients, former employees and rogue employees. This is complete control that businesses really need. Additionally, when an employee leaves, all files are auto deleted).”

 

Custom deleted file retention periods

What this means for your clients:

“Consumer cloud products perform file trimming -- that means that your deleted files are preserved for a very limited amount of time. If an employee (accidentally) deletes a file, it will be gone in a matter of weeks, or even days. With TD Sync you can conveniently extend or shorten the deleted file retention periods, so that it you will never lose a file again.”

 

Granular user-access and security controls

What this means for your clients:

“Each business has an organizational structure. TD Sync allows you to set policies for individuals within your company, including which employees can share files, can delete files and revisions, access certain files, and what types of files they can upload. This administrative feature allows companies to provide certain employees with unique privileges.”

 

Revised file backup

What this means for your clients:

“One of the biggest problems with VPN’s, FTP’s and file servers is the fear of file revision: when employee change/edit and upload a file, that file is permanently changed. Previous drafts and revisions are lost, permanently. TD Sync stores file revisions which allow your employees to collaborate without worry.”

 

Managed file sharing for internal/external parties

What this means for your clients:

“You can share files with external parties through TD Sync and through unique web addresses. However, TD Sync also allows you to monitor the files you shared within the company and externally. For example, you can see how many times the file has been downloaded, and set file expirations. Both of these features protect the propriety of your documents.”

 

Multiple folder backup (Documents, Desktop, Pictures, etc.)

What this means for your clients:

TD Sync is customized for business needs, which means you’ll be able to sync all different file types. But because it’s tedious to sync and backup file-by-file, with TD Sync you’ll be able to backup entire folders and the files within them.

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For our solution information contact us here

Rachel Roberson's comment, October 3, 2016 10:18 PM
Google Drive, formerly Google Docs, is a file storage and synchronization service created by Google. It's is a safe place for all your files and puts them within reach from any device. Google Drive including Google Docs, Google Sheets, Google Slides, Google Drawings and more.
To access and manage your files in Gdrive, you have to sign in to your Google Account. This tutorial shows you how to log into Google Drive.
http://google-drive.loginnsignup.com/
Rachel Roberson's comment, October 3, 2016 10:18 PM
It’s not easy to truly become an expert-level user of Google Drive, though. There are a ton of keyboard shortcuts and features that are tough to master. These little-known features and shortcuts are actually going to save you a boatload of time, though.
http://google-drive.loginnsignup.com/google-drive-cheat-sheets
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iPad Receives Negative Reviews

iPad Receives Negative Reviews | IT Support and Hardware for Clinics | Scoop.it
iPad Receives Negative Reviews

By Katie Wike, contributing writer

Residents at one hospital were not impressed with the iPad’s clinical abilities

The Journal of Mobile Technology in Medicine published a study conducted by the Department of Medical Education, Riverside Methodist Hospital, stating, “The use of handheld computers by medical trainees isn’t new. A review published in 2006 found that 60 to 70 percent of medical students and residents were using handheld computers for educational purposes or patient care. The most commonly accessed applications included medical reference tools, electronic textbooks, and clinical computational programs. A review in 2009 found 90 percent of residents with personal digital assistants (PDAs) accessed pharmacological prescribing programs and medical calculators on a daily basis. Time management was dramatically improved for house staff who relied on PDAs for laboratory data retrieval.

“Since the iPad release in 2010, two independent market research studies have evaluated digital trends in medicine. In 2011, the Manhattan Research group reported that 81 percent of U.S. physicians own a smartphone, 30 percent were using an iPad, and 28 percent planned to purchase an iPad within six months. In 2012, Epocrates Research group found 34 percent of physicians used a tablet computer and 75 percent planned to buy one within a year. Eighty-one percent with a tablet also owned an iPad.”

This led the authors to “evaluate residents’ perceptions of the iPad’s clinical and educational utility, and examine differences of perceived value between medicine-based and surgical-based residents.” To achieve that goal, during the 2011-2012 academic year, 119 residents at Riverside Methodist Hospital were given a 16GB iPad2 with Wi-Fi “along with a $100 stipend to purchase auxiliary equipment such as case covers and keyboards. After a comprehensive orientation that included directions for accessing the hospital’s medical records, residents were instructed to use their iPad both in and outside the hospital as they saw fit throughout the year.”

A total of 102 residents - 86 percent - participated and the results were less than overwhelming. Low marks were given to the iPad for daily clinical utility and efficiency in documentation, and “all resident groups noted problems with iPad log-in and connectivity/Wi-Fi. During the academic year, 98 tickets specific for iPad set-up and connectivity issues were reported to Information Technology services.”

The iPad was most valued for its ability to source article from outside the hospital and its use as a research tool. There were very few reports of issues with portability or software applications.

The authors conclude, “Residents in this study did not attribute high value to the iPad as a clinical rounding or educational tool. Additionally significant differences existed between medical and surgical residents’ perceived value of the iPad’s utility. Institutions should consider these differences and address connectivity and support issues before implementing iPad programs across all disciplines.”

“Institutions should consider these differences and address connectivity and support issues before implementing iPad programs across all disciplines. Additionally, factors such as hardware/software cost, vendor support, on-going training, in-house support, and connectivity should be considered prior to implementation of a mobile computing program."

FierceHealthIT notes earlier research published in the Journal of Medical Internet Research similarly “found that the use of iPads for certain tasks in an internal medicine residency program fell short of initial high expectations, although users reported overall satisfaction with the tools. Residents who reported more ‘hype’ prior to iPad deployment were more likely to use the iPad to enter orders, according to researchers. Moreover, those residents who used Apple products prior to iPad deployment also were likely to report higher usage of the iPad.”



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