IT Support and Hardware for Clinics
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IT blamed in Athens EHR debacle | Healthcare IT News

IT blamed in Athens EHR debacle | Healthcare IT News | IT Support and Hardware for Clinics |

Who's to blame when EHR implementations go south? There's often enough fault to go around. But when the fallout is bad enough, sometimes self-interested parties are all too ready to point fingers.

[See also: CEO resigns amid troubled EHR rollout]

In late May, we covered the story of a $31 million Cerner rollout at Athens Regional Health System in Georgia that didn't go as planned.

Thanks to what was described by clinicians as a rushed process, doctors nurses and staff were up in arms about a series of medication mistakes, scheduling snafus and other communication glitches.

[See also: IT and informatics play well together]

"The last three weeks have been very challenging for our physicians, nurses and staff," wrote Athens Regional Foundation Vice President Tammy Gilland, Athens Regional Foundation vice president, in a letter to donors explaining the situation. "Parts of the system are working well while others are not."

The complaints lodged by clinicians were soon followed by the resignation of President and CEO James Thaw and, less than a week later, Senior Vice President and CIO Gretchen Tegethoff.

This past weekend, on June 15, the Athens Banner Herald reported that Athens Regional's chief medical officer – as well as executives from Cerner – were pointing fingers at the health system's IT team, complaining that they made strategic decisions that should have been the bailiwick of clinicians.

"Could there have been more information shared at the administrative level? I suppose you could make that argument," Senior Vice President and CMO James L. Moore told the paper. "The implementation was through the CIO, and so that's where the information was held."

The Banner Herald's Kelsey Cochran also quotes a Cerner vice president, Michael Robin, who noted that while some end-users were involved in the rollout, it seemed primarily to be led by Athens Regional's IT team, which he said was "atypical" of Cerner sites.

Another Cerner VP, Ben Hilmes, told the paper that successful EHR implementations are "clinically driven, not IT-driven." At Athens Regional, he added, "it came out of balance toward the IT side of things."

Moore has since taken the lead on the project. Cerner has pledged to do "whatever we need to do" to help the process get back on track, Hilmes told Cochran.

Whether or not this is a matter of three different parties – IT, clinicians, vendors – circling the wagons around their own and casting blame on others, one thing is certainly true: On big projects like these, the technology side and the clinical side need to be committed and communicative partners from the get-go

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Will Apple's Swift Make mHealth App Development Easier than Ever? | MDDI Medical Device and Diagnostic Industry News Products and Suppliers

Will Apple's Swift Make mHealth App Development Easier than Ever? | MDDI Medical Device and Diagnostic Industry News Products and Suppliers | IT Support and Hardware for Clinics |

Swift, Apple's new programming lanugage, wants to make coding mobile apps easier for everyone-including digital health developers.


Swift is designed to lower the barrier to ent anyone looking to creates apps for iOS or Mac OS X [image copyright Apple Inc.]

It's “Objective-C without the baggage of C” according to Apple's senior VP of software engineering Craig Federighi. Apple promises its new programming language, Swift, will make developing apps for OS X and iOS of all kinds, from games to health and fitness, easier and faster than ever. But will Swift live up to its name?

“We don't see a strategic downside from Swift, although as a youthful language, it maintains the risk of global adoption,” says Dr. Chuck Thornbury, CEO and founder of meVisit, an iPhone- and Android-based app that remotely connects patients to their doctors. “Swift is relatively new and maturity is something that has to be considered; it is especially true for those features like mix-and-match and interoperability with old (legacy) code.”
The first thing you have to understand is why this is such a big deal from a developer's perspective. Mac and iPhone-based apps are typically created using an older, legacy programming language called Objective-C that first appeared back in 1983 and has carried over through Apple products since the early days. Being an older language however, Objective-C is arguably not best suited for most modern computing applications. After all, it was created in a time when all the computing power of a smartphone would take up an entire desk.
“Swift has many excellent features that have been learned from other programming languages. It offers a more similar syntax than other leading languages–especially, those that are script-like, dynamic languages,” Thornbury says. “The mix-and-match between Objective-C and Swift may be expected to attract developers to begin engineering in Swift quickly, as they wouldn't be expected to have concerns regarding the legacy code in Objective-C."
Ned Fox, a software engineer with AliveCor, makers of the mobile ECG and accompanying app of the same name, agrees with this assessment. Fox believes that it will be most advantageous for developers to use Objective-C in conjunction with Swift. “In terms of syntax, [Swift has] some pretty big differences that people are using....I'll probably stick with [Objective-C] for a while and use features of Swift,” Fox says. “I don't think it's quite as short a line from Objective-C to Swift.” However he adds that there are new features in Swift that could speed up app development significantly. One such feature is Playground, which allows programmers to test individual snippets of code without having to test the entire app at once.
Swift vs. Android
However there are conflicting reports on the efficacy of Swift. According to an article from InfoWorld [] Swift performed markedly slower in benchmarks compared to other programming languages, Objective-C included. However Swift has only been released in beta so it is unclear how valuable such benchmarks are at this point, particularly since Swift and Objective-C will have to co-exist for the time being.
“We do not believe that Objective-C will diminish from the landscape in the immediate future, as there remain many committed developers that many not see an immediate value in amending their preferred engineering language unless it is absolutely necessary,” Thornbury says. “For new projects, developers may have a passion for using a new language (Swift). Based on the feedback that we've received, engineers may be expected to gradually migrate from Objective-C to Swift as we revisit the old code...The learning curve should be shorter for those with no prior experience in iOS development.”
The idea of an easier programming language for Apple platforms has to have raised eyebrows with Android developers. It doesn't take a mastermind to see how clearly advantageous it would be for Apple to lock developers into an exclusive programming language for its platforms. A recent article in Fast Company [] argues that Swift's low barrier to entry and simpler syntax could easily win developers over to Apple's side and keep the ones already there from drifting over into Android-infested waters.
However Android is not likely to easily give up its market share and developers who want to reach the broadest audience would still be best served to develop for both platforms. “Swift appears to be most promising; however, the majority market that Android and other platforms command may act as a firm headwind, against which, it would have to pilot,” Thornbury says. “
“The iPhone has always been a little bit easier to code for,” Fox says. “But Android has been gaining market share in an important population that I don't believe third-party developers will want to ignore. If Google doesn't come out with something similar to Swift I think someone else will.” The AliveCor ECG is compatible with iPhone and Android phones, though the Android version was released much later.
Taking the Next Steps
Fox's theory bares some fruit given how widely competitive the digital health app space has gotten this year. Later this month, Google is expected to announce Google Fit [], its own digital health platform similar to Apple's HealthKit []. For hardware companies like AliveCor platforms like these can be key ingredients to allow companies to move into the market quickly. “HealthKit is a really great step,” Fox says. “It makes it really easy to collect health data and take data out. If a company is focusing on hardware they can focus on hardware and you can import all of this data.”
Apple has already released a free instructional eBook [] that gives programmers a tour of Swift and its functionality. While the company has certainly taken a step in the right direction in encouraging future app development it will be the developers themselves that ultimately decide where the market goes. Ultimately, coders want the largest audience possible and will use any tool at their disposal to get it. “Large markets, by their very nature, offer incentives for app developers to provide content. Platform-independent development tools might be expected to attract continued innovation and motivate developers,” Thornbury says.
Apple demonstrates Swift at the 2014 Apple WWDC.

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Big Data, My Data - iHealthBeat

Big Data, My Data - iHealthBeat | IT Support and Hardware for Clinics |

"The routine operation of modern health care systems produces an abundance of electronically stored data on an ongoing basis," Sebastian Schneeweis writes in a recent New England Journal of Medicine Perspective.

Is this abundance of data a treasure trove for improving patient care and growing knowledge about effective treatments? Is that data trove a Pandora's black box that can be mined by obscure third parties to benefit for-profit companies without rewarding those whose data are said to be the new currency of the economy? That is, patients themselves?

In this emerging world of data analytics in health care, there's Big Data and there's My Data ("small data"). Who most benefits from the use of My Data may not actually be the consumer.

Big focus on Big Data. Several reports published in the first half of 2014 talk about the promise and perils of Big Data in health care. The Federal Trade Commission's study, titled "Data Brokers: A Call for Transparency and Accountability," analyzed the business practices of nine "data brokers," companies that buy and sell consumers' personal information from a broad array of sources. Data brokers sell consumers' information to buyers looking to use those data for marketing, managing financial risk or identifying people. There are health implications in all of these activities, and the use of such data generally is not covered by HIPAA. The report discusses the example of a data segment called "Smoker in Household," which a company selling a new air filter for the home could use to target-market to an individual who might seek such a product. On the downside, without the consumers' knowledge, the information could be used by a financial services company to identify the consumer as a bad health insurance risk.

"Big Data and Privacy: A Technological Perspective," a report from the President's Office of Science and Technology Policy, considers the growth of Big Data's role in helping inform new ways to treat diseases and presents two scenarios of the "near future" of health care. The first, on personalized medicine, recognizes that not all patients are alike or respond identically to treatments. Data collected from a large number of similar patients (such as digital images, genomic information and granular responses to clinical trials) can be mined to develop a treatment with an optimal outcome for the patients. In this case, patients may have provided their data based on the promise of anonymity but would like to be informed if a useful treatment has been found. In the second scenario, detecting symptoms via mobile devices, people wishing to detect early signs of Alzheimer's Disease in themselves use a mobile device connecting to a personal couch in the Internet cloud that supports and records activities of daily living: say, gait when walking, notes on conversations and physical navigation instructions. For both of these scenarios, the authors ask, "Can the information about individuals' health be sold, without additional consent, to third parties? What if this is a stated condition of use of the app? Should information go to the individual's personal physicians with their initial consent but not a subsequent confirmation?"

The World Privacy Foundation's report, titled "The Scoring of America: How Secret Consumer Scores Threaten Your Privacy and Your Future," describes the growing market for developing indices on consumer behavior, identifying over a dozen health-related scores. Health scores include the Affordable Care Act Individual Health Risk Score, the FICO Medication Adherence Score, various frailty scores, personal health scores (from WebMD and OneHealth, whose default sharing setting is based on the user's sharing setting with the RunKeeper mobile health app), Medicaid Resource Utilization Group Scores, the SF-36 survey on physical and mental health and complexity scores (such as the Aristotle score for congenital heart surgery). WPF presents a history of consumer scoring beginning with the FICO score for personal creditworthiness and recommends regulatory scrutiny on the new consumer scores for fairness, transparency and accessibility to consumers.

At the same time these three reports went to press, scores of news stories emerged discussing the Big Opportunities Big Data present. The June issue of CFO Magazine published a piece called "Big Data: Where the Money Is." InformationWeek published "Health Care Dives Into Big Data," Motley Fool wrote about "Big Data's Big Future in Health Care" and WIRED called "Cloud Computing, Big Data and Health Care" the "trifecta."

Well-timed on June 5, the Office of the National Coordinator for Health IT's Roadmap for Interoperability was detailed in a white paper, titled "Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure." The document envisions the long view for the U.S. health IT ecosystem enabling people to share and access health information, ensuring quality and safety in care delivery, managing population health, and leveraging Big Data and analytics. Notably, "Building Block #3" in this vision is ensuring privacy and security protections for health information. ONC will "support developers creating health tools for consumers to encourage responsible privacy and security practices and greater transparency about how they use personal health information." Looking forward, ONC notes the need for "scaling trust across communities."

Consumer trust: going, going, gone? In the stakeholder community of U.S. consumers, there is declining trust between people and the companies and government agencies with whom people deal. Only 47% of U.S. adults trust companies with whom they regularly do business to keep their personal information secure, according to a June 6 Gallup poll. Furthermore, 37% of people say this trust has decreased in the past year. Who's most trusted to keep information secure? Banks and credit card companies come in first place, trusted by 39% of people, and health insurance companies come in second, trusted by 26% of people. 

Trust is a basic requirement for health engagement. Health researchers need patients to share personal data to drive insights, knowledge and treatments back to the people who need them. PatientsLikeMe, the online social network, launched the Data for Good project to inspire people to share personal health information imploring people to "Donate your data for You. For Others. For Good." For 10 years, patients have been sharing personal health information on the PatientsLikeMe site, which has developed trusted relationships with more than 250,000 community members.

On the bright side, there is tremendous potential for My Data to join other peoples' data to drive better health for "Me" and for public health. On the darker side, there is also tremendous financial gain to be made by third-party data brokers to sell people's information in an opaque marketplace of which consumers have no knowledge. Individuals have the most to gain from the successful use of Big Data in health. But people also have a great deal to lose if that personal information is used against them unwittingly.

Deven McGraw, a law partner in the health care practice of Manatt, Phelps & Phillips, recently told a bipartisan policy forum on Big Data in health care, "If institutions don't have a way to connect and trust one another with respect to the data that they each have stewardship over, we won't have the environment that we need to improve health and health care." This is also true for individual consumers when it comes to privacy rights over personal health data.

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Enhanced eRx Features Land on iPad EHR

Enhanced eRx Features Land on iPad EHR | IT Support and Hardware for Clinics |

One of the earliest pioneers in mHealth is making headway with electronic prescriptions for iPad EHR.

iPatientCare announced Thursday the enhanced functionality for the ePrescribing / eRx in iPatientCare iPad EHR app.

The app is available on the App Store.
According to a provided statement from the company, hundreds of medical practices already use the iPatientCare iPad EHR app. Now, we’re told, physicians can use the app for advanced electronic prescriptions.

iPatientCare says its fully-integrated EHR system streamlines the prescription process and reduces errors with eRx.

“iPatientCare’s Electronic Health Records software integrates a breakthrough patient care platform with the mobility of the iPad to help medical practice triumph in every setting. With just a few clicks, providers will be transmitting safe and efficient prescriptions through iPatientCare eRx on iPad”, explains Kedar Mehta, CTO of iPatientCare.

“In addition to that,” Mehta adds, “iPatientCare has been awarded with the SureScripts White Coat of Quality for 2013. White Coat program is part of a larger effort to increase e-prescribing quality and accuracy, by recognizing the organizations that excel in those areas.”

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Why the cloud is imperative to image sharing

Why the cloud is imperative to image sharing | IT Support and Hardware for Clinics |

As new payment models increase physician accountability, cloud-based technology for sharing resources such as patient images will become an absolute necessity, according to Keith Hentel, executive vice chairman in the department of radiology at New York-Presbyterian Hospital-Weill Cornell Medical Center.


"In today's fee-for-service model, imaging practices don't really benefit financially from the use of cloud technology because we're not doing as many scans," said Hentel (pictured), whose facility embraced the cloud more than four years ago. "But as we move into an accountable care model, things will completely change. Physicians won't have the luxury of being able to perform unnecessary tests."

In an exclusive interview with FierceMedicalImaging, Hentel discusses New York-Presbyterian's adoption of cloud technology, why physicians love it, and how it can improve doctor-patient relationships.


FierceMedicalImaging: How is your facility using cloud technology?

Hentel: We use it both to get information out of our practice and to get information into our practice. Getting information into our practice was a no-brainer. We started doing that for trauma patients, patients that needed to be transferred into our institution to one, expedite care; and two, eliminate any repeat imaging that we needed to do, which was just wasteful.

FMI: What was the image-sharing process like prior to the cloud?

Hentel: For patients who were transferred out, we would create CDs and tape them to a patient's chart. For incoming patients, we would have to wait for them to physically show up to evaluate their imaging.

Conversely, when it's in the cloud, the minute they decide to start sharing those images with you, you can start reviewing files and get a sense of what's wrong with a patient. You can get a sense if you're the right institution to transfer the patient to; if you have the expertise to deal with their problem. Having images available in the cloud has really streamlined our processes.

Read more: Why the cloud is imperative to image sharing - FierceMedicalImaging 
Subscribe at FierceMedicalImaging

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3-D printing: Healthcare's new edge | Healthcare IT News

3-D printing: Healthcare's new edge | Healthcare IT News | IT Support and Hardware for Clinics |

3D printing is set to become a disruptive technology across many sectors, including healthcare – and a money saver too. Employing 3D printing, one medical wearable startup tallied savings of more than $250,000 in one year.

“A lot of people think [3D printing] is going to be the next industrial revolution," Stuff You Should Know co-host Charles Bryant said in a recent podcast.
“If [3D printing] does take off, and it’s becoming increasingly possible that it [will] as costs come down for materials and the actual printers themselves, …more and more barriers [will come] down and if it becomes widespread,… so long manufacturing and transportation sectors as we know them."

Currently, the price tag associated with 3D printers varies but market researcher Gartner expects worldwide shipments of 3D printers priced less than $100,000 will grow from 56,507 units in 2013 to 98,065 units in 2014.

[See also: Triple aim.]

"The 3D printer market has reached its inflection point," said Pete Basiliere, research director at Gartner, in a press release. "While still a nascent market, with hype outpacing the technical realities, the speed of development and rise in buyer interest are pressing hardware, software and service providers to offer easier-to-use tools and materials that produce consistently high-quality results."
The healthcare sector is gearing up to put stock into the burgeoning technology. For example, the Queensland University of Technology in Brisbane, Australia, along with three other research universities in Europe and Australia, have jointly launched a master’s program in bioprinting, the technique of using 3D printers to grow human tissue.

Beyond bioprinting, 3D printing could assist to revolutionize administrative costs for healthcare organizations. In September 2013, Michigan Technology University researchers published their findings in Mechatronics that open source 3D printing technology could save a consumer a range from $300 to $2,000 a year by printing 20 products annually.

Dulcie Madden, CEO and co-founder of Rest Devices, a medical wearable start-up, stated that the Boston-based company saved “well over” $250,000 in a year after purchasing a 3D printer in 2011 for about $2,000.

Beginning as a medical device development company, Rest Devices bought the printer  to assist rapid prototyping for research and development. The company began to develop sensors for an adult shirt that would log an individual’s respiration, temperature and body position and the data to diagnose sleep apnea. However, the company quickly found new use for their technology for infant respiration monitors and shifted prototyping focus for that use. Using 3D printers for more than hundreds of sensor prototypes, Rest Devices was able to save on production costs.

“Instead of having to spend on injection molding for plastic, which can cost thousand of dollars, we can spit out 3D prints in an hour for pennies or dollars,” says Madden.
Similarly, Jennifer Mann, lab manager at the Derisi Lab at University of California, San Francisco, has noted that 3D printing allows users from graduate students to post-doctorate students to quickly customize and build designs for a variety of lab equipment.

The lab, which studies infectious diseases such as malaria, employs two printers (they cost about $15,000 each) in which users can use or customize open source designs for equipment as small as a pipette holder or a minifuge rotor to a cutaway model of a malaria parasite showing a new drug target site in a molecular structure.

Mann states that the lab saves approximately $6,000 a year by using the 3D printers to make items that are either customized or more expensive in catalogs.

“We can either order a part or take a few minutes and design it,” says Mann. “For instance, instead of paying $50 for a gel comb, we can make our own for about $1 worth of materials.”

Customization is attractive because not all workspaces are created equal. Thus, one pipette holder to smooth workloads for one lab worker’s work space could need to be changed for another’s.

[See also: Boston Children's Innovation Showcase.]

“In the past, we were limited to either purchasing what vendors offered (with one- to two-day delivery time) or custom machining (one- to four-week delivery time),” says Mann. “Now, if already designed, a part could be ready in one hour to overnight." Having a 3D printer allows the company to save money and time in the long run, he says.

And with the promise of open source customization comes the promise of rapid development and quick exchange of ideas.

“I think 3D printing is going to change the way all product development is done in the future where …. smaller companies can get to market faster is a huge step…mean[ing] there will be more innovation coming into the healthcare space,” says Madden.

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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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BYOD advice: Start simple, include clinicians, and be nimble | mHealthNews

BYOD advice: Start simple, include clinicians, and be nimble | mHealthNews | IT Support and Hardware for Clinics |

Crafting a BYOD policy for your hospital or health system? Start simply, include users in your planning committee, and expect problems.

That's the advice of IT security experts who have been through the process: Michael Boyd, chief information security officer for Providence Health & Services, a Seattle-based system with 32 hospital and more than 550 other sites; and Clark Kegley, assistant vice president of information services for the Scripps Health, a San Diego-based four-hospital system.

Speaking at the HIMSS Media Privacy and Security Forum this week in San Diego, Boyd said hospital executives charged with crafting a policy for mobile devices need to approach this not as a security concern, but as a new means of bringing technology into the workplace. In other words, work with the clinicians who are using their own devices, instead of against them.

"It's a behavioral thing," he pointed out. "It's all about people."

More than 60 percent of all industries worldwide embrace BYOD, said Mac McMillan, CEO of the information security company CynergisTek and chairman of the HIMSS Privacy and Security Task Force. In healthcare, he said, that number stands at around 85 percent, with 92 percent of that number saying personal mobile devices are in use multiple times every day.

McMillan offered some sobering numbers as well: 41 percent of users in the healthcare space don't use a password to access their device, 52 percent access unsecured networks, and 52 percent say their devices are Bluetooth-enabled and on all the time.

"Basically they are a walking accident looking for a place to happen," he said.

That's why it's important, McMillan said, to get clinicians to buy into a BYOD policy that sets ground rules and penalties. He offered a five-point plan:

  1. Start with a strategy – accept all devices or certain ones?
  2. Establish an appropriate use agreement – no jailbreaking, no turning off security apps installed by the hospital or preventing remote management in case of an emergency. Make sure the users know what they can and can't do.
  3. Containerization – develop a platform that separates the corporate apps from the personal ones, so that users can continue to store personal data on their devices and not interfere with their work responsibilities.
  4. Monitoring – make sure the users know that the health system has the right to protect its interests on the personal device. That may mean remote-wiping the device of corporate information if it's lost or stolen, or monitoring certain functions while in use.
  5. Expect that this isn't a foolproof policy – be flexible, expect mistakes, and be prepared to fix them.

Boyd pointed out that he's already learned that lesson.

"Four years ago nobody was thinking that doctors were going to show up in the operating room wearing video cameras as eyeglasses," he said, but Google Glass has emerged in the hospital four times.

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How one ACO used mHealth to beat the odds | Government Health IT

An Indiana-based ACO is using mHealth tools to connect providers and home health patients in a new program that keeps them out of the hospital, helps them live healthier lives, and qualifies the health network for extra Medicare incentives.

The 13-hospital Franciscan Alliance Accountable Care Organization, one of the first ACOs in the country to partner with Medicare, is reportedly seeing success on several fronts using Honeywell's Genesis DM and Genesis Touch RPM devices. 

Franciscan VNS, in fact, is partnering with one of the ACO's physician groups in what is called 'The Coaching Program," according to a Honeywell HomMed whitepaper, to target patients with chronic illnesses, typically the most expensive population and one that doesn't traditionally qualify for home health services.

"The Coaching Program was designed to provide the right level of education to patients to empower them to take the management of their healthcare into their own hands and improve the overall health prognosis long-term," the whitepaper states.

Physicians, home health aides and telehealth nurses involved in this program use the Honeywell devices to keep regular tabs on enrolled patients and track long-term health progress with Honeywell's LifeStream Management Suite of analytical software. In all, 70 percent of the program's patients are monitored daily, the whitepaper states, with results compared against general population patients and those using traditional telehealth monitoring tools upon their discharge from the hospital.

According to Franciscan officials, The Coaching Program has resulted in a 5 percent readmission rate (the national average for a Medicare population is 20 percent), medication reconciliation rates above 40 percent, and a patient retention rate of 95 percent. As a result, Franciscan officials report that they've qualified for a higher bonus from the Centers for Medicare and Medicare Services.

"In order to qualify for a piece of this 'shared savings pie,' a hospital or ACO has to know every patient, what services they're getting, what it costs, and how it compared to the" contract that Franciscan has with CMS to treat Medicare patients, the whitepaper points out. "Telehealth solutions are the perfect companion to hospitals and ACOs in the new world order because they have the same overarching goal: Making healthcare delivery more efficient while simultaneously increasing quality of patient care."

The Coaching Program consists of four parts:

1. The creation of a personal health record that connects all members of the care continuum to one patient record;

2. Identifying red flags that key in telehealth nurses and other providers to points of early intervention;

3. A medication reconciliation and self-management process that ensures that the patients understand what medications are prescribed to them; and

4. Preparing patient to be involved in their own health management, including during follow-up visits.

Patients have also reported life changes due to The Coaching Program. They're exercising more often, according to the whitepaper, decreasing their caloric intake and involving themselves in more heart-healthy activities.

The key takeaway is that mHealth programs like The Coaching Program can help providers and ACOs not only reduce hospital readmissions among their most expensive populations, but they can demonstrate an improved quality of life for those patients and optimize new revenue streams.

Those benchmarks will prove vital as the nation's healthcare system transitions from a fee-for-service model to the more inclusive fee-for-value system.

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Hospital IT execs increasingly embrace the cloud

Hospital IT execs increasingly embrace the cloud | IT Support and Hardware for Clinics |

Hospital IT executives increasingly turn to the cloud to lower maintenance costs while trying to meet their growing technology needs, according to a new surveypublished today by HIMSS Analytics.

Of the 150 respondents to the survey--a majority of whom were hospital CIOs--close to 83 percent indicated that they use cloud technology; half of those providers said they use the cloud to host clinical applications. The exchange of patient data and disaster recovery efforts also were among top reasons for both current and future use by providers.

Privacy and security were top of mind for providers both already using cloud technology and those considering adoption. Close to 60 percent of respondents said that physical security of a cloud service provider would factor into their cloud purchasing decisions. The same number said that a vendor's willingness to enter into a business associate agreement was also important. Provider business associates can now be held accountable for data breaches under HIPAA.

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Mobile security: Is antimalware protection necessary?

Mobile security: Is antimalware protection necessary? | IT Support and Hardware for Clinics |

There's been a fair amount of discussion about whether mobile devices needantimalware protection. With my employees using their own devices at work, for work, I want to make sure my company is adequately protected. Is the antimalware investment a necessary one? If not, is there a better product to use?

Over the past decade, mobile device management and mobile security have been two extremely difficult issues for enterprises to address. Whether an investment in antimalware is necessary might be the wrong question to ask. There are many different risks presented by mobile devices, and organizations would be wise to perform a threat assessment to better understand which threats are the highest risks for their specific business and therefore a priority to address.

The potential list of attacks against mobile devices for enterprises is very long, but the list of attacks or security incidents that make the news is relatively short. The most common mobile security threat to enterprises is lost or stolen devices. And the truth of the matter is that antimalware will not help if a device is lost or stolen and doesn't have basic mobile device security controls implemented on it, such as a PIN or remote wipe capabilities. If your organization does not require a PIN or hasn't adopted remote wipe yet, I would say these are higher priorities than antimalware.

Implementing a mobile device management (MDM) tool that includes antimalware along with other security controls (e.g., PIN enforcement, remote wipe, encryption or containerization) might be a good enterprise investment. However, before evaluating MDM tools, enterprises should ask a number of questions:

  • Do we have an inventory of mobile devices to secure?
  • Will the tool be implemented on employee-owned devices?
  • Will our employees allow us to install such a tool on their personally owned devices?

If you cannot answer these questions, deciding to implement a mobile device management tool might not actually provide the protection expected.

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New mHealth Eco-System Will Be Formed by ‘Connected Elite’ of App Publishers, Sensor Vendors, and Enabling Companies

New mHealth Eco-System Will Be Formed by ‘Connected Elite’ of App Publishers, Sensor Vendors, and Enabling Companies | IT Support and Hardware for Clinics |

Three groups of mHealth app market players will form the inner circle of the new mHealth app ecosystem. Vital data like steps, calories burned and glucose readings will constitute the core value of the emerging mHealth app market. Traditional healthcare companies have to find their role not to be left aside.

There is a growing number of mHealth publishers who make use of the third party data in order to enrich the capabilities of their apps. Thanks to opening up their APIs, such publishers may better serve their core value propositions (e.g. weight loss support by incorporating diet plans and high quality food recognition tools) and gain a substantial competitive advantage over rivals. The more such companies, the more competitive the market and better app offering for the users.

In fact, 71% of mHealth of app publishers connect or plan to connect to an API in order to import or export health data. This is one of the results of the mHealth App Developer Economics 2014 study conducted in Q1 2014. A free copy of the 42 pages report on the state of the art mHealth app publishing can be downloaded.

Sensor vendors such as Wahoo and Zephyr as well as a group of companies which enable interconnectedness (“Enabling layer”), support these publishers whose core value propositions rest on open APIs. 

The new layer of “enabling” companies capacitates app-app, app-sensor and app-database connections. In general, such companies can be classified into three main segments:

  1. API aggregators which provide “one stop connecting models” for the health data APIs
  2. App aggregators which serve to collect mHealth apps in one place, and
  3. API Managed Service companies which provide the technical infrastructure to facilitate the connection of apps and sensors and medical databases

All of these, i.e. “open” app publishers, sensor vendors and the enabling companies constitute the three pillars which will form the core of the connected mHealth app economy.

The mHealth app economy is going to be fuelled by the accessibility of the vital (patient) data accessed via APIs. The majority of today’s captured and shared data is fitness and nutrition information like steps and calories. However, with the growing number of app users who regularly track e.g., glucose or blood pressure levels, or consult their apps for the purpose of medical examinations, we are going to witness an explosion in the amount of the aggregated and shared health data.

Strong market pressure e.g. rising healthcare costs and user demand, will facilitate this disruptive market change. The company which is going to be the first to skilfully make meaningful use of this big, aggregated health data might become the Facebook of the healthcare industry. Moreover, this market disruption will presumably take place rather sooner than later.

All healthcare market players must understand the impact of the new mHealth ecosystem on healthcare in general and, in particular, on their own business models. If they do not wish to be left out from the emerging, new healthcare delivery ecosystem, traditional market participants already need to start to reconsider their role in the market landscape.

The free “mHealth App Development Economics 2014” report provides information on the state of the art of the mHealth app market with an overview of its leaders.

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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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