Cloud Computing: A Reply from Practice Fusion

Some of you may have read my comments about the  “death of cloud computing”.  My comments may be premature according to Ryan Howard, CEO and founder of Practice Fusion:

Mr. Howard sends me this quote;

“On April 21-22, there was a major Amazon EC2 outage that brought down many business and websites. Some of the data was unrecoverable and transactions were lost. The outage event, however, actually might have some unexpected beneficial effects, by raising the awareness and understanding of cloud computing – and the differences implicit in their implementation. 

In this particular case, the major distinction between two types of cloud computing is infrastructure management/control: a) cloud applications dependent upon and written on top of a utility-style service, like Amazon, where the application is susceptible to outages by its host and b) much more dependable and robust cloud applications hosted in a truly private, scalable, protected infrastructure, like Practice Fusion’s, that allow more efficient management of computing traffic and a guaranteed level of uptime for users of time-critical enterprise applications.

Ryan Howard, Founder and CEO

Practice Fusion EMR

Ryan, Thanks for the response.  Let’s hope you are correct. 

GML

del.icio.us Tags: cloud computing,practice fusion,amazon web services

A Word About SERMO

 

I had a bit of a surprise email from SERMO this week. HealthTrain received a prize, no it was not monetary, something even nicer…some recognition for all the early morning wakeups to post prior to the clinical load for the day.

It’s in the form of a ‘badge’ (of honor?).  It will be displayed on the right hand side of the ‘widgets’.

It gave me an urge to look back in HealthTrain’s Archives to read  observations HealthTrain expressed in mid 2010. :

What hath Sermo Wrought?

Average Rating  (3 ratings) 

Posted by gmlevinmd123 on June 29, 2010 - 01:06PM EDT
Author Specialties: Ophthalmology, Geriatrics

Sermo represents the best of what Matt Holt of The Health Care Blog calls 'Health  2.0'.   While some aspects of Health 2.0 are 'consumer oriented' (ie, patient oriented) Sermo has offered a network for physicians. Originally conceived as a medium for feedback from physicians regarding treatments and diagnoses, it has evolved into something much more than that.

Especially noteworthy is the cross-specialty open access to information which might not be immediately available to readers.

Some have  used the SERMO platform to seek out consultations in regard to difficult cases, or recommend treatments in response to requests from other physicians.

Others have chosen to use the SERMO platform to serve social issues, political discord, and at times allows physicians to vent and share other serious concerns.

Many comments are made in the forum that are controversial, and open to inquisitive minds and scholarly thought.

A certain banter has developed on SERMO, ( a virtual forum) humor, sarcasm, and all that human interaction one would expect at a real social occasion.  I as well as others look at SERMO daily as a routine, much like stopping by the Doctors Lounge to chat, gripe, find out who did what and to whom, and then continue the daily routine.

At times the level of discussion becomes quite academic along with references to  peer reviewed articles, and at time quite anecdotal....Frequently SERMO regulars await responses from others who have become close and respected colleagues.

As a relative old timer it keeps me current with our future generation of physician leaders, and also allows me to mentor in whatever way I can.

For physicians in relatively isolated practices it serves a commendable purpose.

The evidence is in regarding SERMO. It has played a unique role in Health Care Reform. While we still have much to accomplish, SERMO has earned national recognition in the media, and has also stimulated the AMA to become more relevant. SERMO has chastised the AMA for it's false impression that they represent physicians. At one time this may have been true, and hopefully physicians will come together in one forum to represent us all.

However just as in national and local politics, we all do not agree, and the difference in opinion are what makes us all the same.

My best wishes for continuing success to SERMO and all of us.

KEYNOTE BLOGGERS IN THE HEALTH UNIVERSE

 

About five years ago there were few physicians and/or health industry gurus who even knew what a blog was. Pedal forward a few years to today in mid-2011 and the scene has changed enormously.  Although I have been a blogger since mid 2004, using blogging to bring a newsletter to our community of IT aficionados information about our health information exchange, I am a ‘newbie’ compared to elementary, middle school and high school bloggers, FBers, and tweeps.  My own children and grandchildren have blocked me from their personal sites.  FBing, tweeting, and blogging are categorized now into personal, business, and professional. Blogging or FBing, tweeting in the wrong space is considered taboo, and marks you as ‘inappropriate’ much like being a nerd in high school or an “uncouth visitor at the local fraternity or sorority house. 

There are bloggers and then there are bloggers who use SM for purposes such as marketers, artists, musicians, politicos, writers, celebs, and even terrorists. Blogging and social media can be and is used for the writer’s own purposes.  I have seen some bloggers burn out, otherwise very capable and excellent communicators announce they are done with blogging.(like some physicians burnout on medical practice)  SM is an addiction, some who no longer have time will often recruit others to write their blog for them, or have invitees publish for them at regular intervals.

Health Train Express has long had a blogroll of the blogs that I read, however there are many other sites that are outstanding, and other venues worth following on twitter and/or Facebook. And while Twitter and Facebook are the best known SM sites, there are many others.

Blogging nor Social media is not for the lazy or faint of heart. There are readers out there that have RSS feeds and other links watching for the posts that are their favorites.  There are now awards, not unlike the Academy Awards, or perhaps a better term “The Pulitzer Prize” for blogging excellence.

                              

End Part I   Part II to follow.

Health Care & Newt Gingrich

 

Health Care Policy and reform will now take an abrupt shift into the political lane. The stage is the same and the players are about to change as they audition and pose for their own ‘stake’ in the game. Some are already withdrawing from their auditions, Trump, Huckabee, and others.  Others such as Gingrich are attempting to revive their political careers, and return to the ‘Broadway’, inside the beltway. The issues now are not ‘should we have health reform”, but should we deconstruct it before it is built. The specifics of the Obama Bill are coming at us along a planned timeline. It is complex with mandates dependent upon financial plans, exchanges, individual mandates, threatened penalties/incentives, insurability and ‘willingness’ of the electorate to accept what seems inevitable. Also key features of the legislation have been struck down by courts. However, in the United States nothing is truly inevitable (in a country that can print money whenever it wishes.

Michael Millenson paints a elaborate picture of Newt Gingrich as a manipulative persona, continuing his relentless and articulate march from politics into health care, and then back into politics, enriching himself with a ‘bogus’ Center for Health Transformation. He writes in The Health Care Blog today.

  If what Mr. Millenson writes is true, it demonstrates how politicians, and the public are misled by big names with big ideas, and how reality is turned by unscrupulous people. Five years ago Gingrich did form the Center for Health Transformation with all the ideas as explained by Millenson. Mr. Gingrich is a chameleon and seems to favor introducing chaos into the already chaotic world of politics. The current ‘transformation’ a word not used by Obama has created chaos and is forcing the health industry to change with threats of financial intimidation and a small carrot of incentives, which are truly miniscule when compared with subsidies to big agriculture, oil, the automobile industry,, the mortgage industry, and the financial markets.

Medicare is a disaster, formed over 40 years ago after a long lost battle with medicine opposed to it’s  being financed and the benefit structure which health advocates predicted would lead to possible demise of the financial integrity of the federal government.  Medicaid, a poorly operated system is not proposed to be a vehicle for expanding health care coverage. Never mind the fact that many physicians will not accept patients with Medicaid since it introduces impossibilities for reimbursement and/or adjudication of disputed claims. The eligibility process is critically flawed with unrealistic criteria and ridiculous share of cost based on a monthly share of income. The main criteria such as the poverty level is obsolete. Anyone capable of addition can see how flawed the eligibility process is. The adjustments to income are incomprehensible and imaginary (to say the least)  It is designed to disqualify eligibility. Recipients are penalized severely with threats of being overpaid.  Rather than having an annual deductible it expects recipients to be on a month to month dole which has no reality for those with fluctuating income. Based on observation it is hard to believe 47 million Americans are eligible for the SNAP program (formerly the food stamp program).It does not fly in the fact that 47 million Americans live in poverty and yet the average income for people in the U.S is near $40,000 dollars. The threshold for the SNAP is $1100/month (roughly $ 25,000/annum) for a husband and spouse living together.  The food stamp program really is no longer a ‘voucher’ or funny money chit but a modern system of EBT cards, identical to a ‘debit card’ and used in an identical manner.

Health Train’s Aggregation Today

May 17,2011

From iHealthBeat

Standards Panel Seeks Feedback on EHR Certification Program
Read more…………here   The Health IT Standards Committee's implementation work group is seeking public comment.

What Percentage of Surveyed Physicians in the U.S. Have Adopted Smart Phones?
Read more:…….here.

Hospitals launch ED online reservation systems. Plan your emergencies, sounds like an oxymoron as our health system attempts to use new technology to address basic systemic flaws in healthcare delivery. here .

Can Federal Health Care Websites Tap Best Practices from the Private Sector?  here

The new websites -- which include HHS' vaccines.gov and healthcare.gov -- are much more dynamic and consumer-friendly than previous government websites.  The complete transcript of this Special Report is available as a PDF.

WEBMD:

Causes of Fatigue and Sleepiness and How to Fight Them. This very common problem affects nearly all of us.  Read on.

Do You Color Your Hair?   Women and Men in their attempts to retain young appearance should know some of the details:

Does Your Voice Betray Your Age ? Of course, we all unconsciously respond to a mature voice differently than an adolescent’s voice or child on the telephone. What goes into this almost automatic calculation?

Med page Today

This series is brought to you by Med Page Today, Putting breaking medical news into practice.

1. Med Students Cram for Exams With Wikipedia. About half of medical students see Wikipedia as a trustworthy source of information for helping them prepare for exams.

2. Atypical Antipsychotic Use High in Kids. Almost half of children treated as inpatients for psychotic and mood disorders are given atypical antipsychotics.

3. Suicides, Stagnant Economy May Be Linked. When the red-hot Japanese economy of the 1970s and 1980s cooled off and a period of stagnation set in, suicide rates spiked, and researchers here suggested the same thing could happen in the U.S.

Weight adds to  Colon Surgery Infection Rate

:Rehab After Stenting Saves Lives.  Risk of death decreased by 47%

Tai Chi Helps Prevent Falls and aids mental health..

VA HealthCare News:
The Department of Veterans Affairs (VA) recently published the interim final rule for implementing the Family Caregiver Program of the Caregivers and Veterans Omnibus Health Services Act 2010. This new rule will provide additional support to eligible post-9/11 veterans who elect to receive their care in a home setting from a primary family caregiver..

Coalition Seeks to Raise Awareness and Help Returning Veterans 

In the coming weeks, Sen. Kirsten Gillibrand, D-N.Y., will introduce new legislation that calls on the Veterans Affairs Department to be more proactive in informing and providing veterans with the services they're entitled to receive.
The legislation is called the Pro-Vets Act and would require the VA to offer each service member a thorough assessment of benefits and the materials they need to apply. Service members leaving the military would be automatically enrolled in VA health care. Gillibrand's office says that even though they are eligible for up to five years of free care, many never claim the benefit

del.icio.us Tags: aggregation,webmd,medpage today,VA,Pro-Vets Act,health it standards,ed online appointments

Why Cloud Computing may be Dead for Healthcare and Medicine

 

Much has been said about the advantages of cloud computing, or what used to be termed ‘asp’ solutions for EMR in lieu of in house client server applications, less costly, reduced maintenance and upgrade challenges,

Despite these advantages this methodology has not caught fire in medicine. The main reason is now apparent by the outcome of a demonstrated failure of AWS (Amazon Web Servicesl)

Many EMR vendors do not own their own servers. They are rented from companies like Amazon, Microsoft, Apple, ,and other less well known data bank companies. Chances are good that your EMR flows on the same server, and hard drives as Twitter or Facebook.

The uproar over the down time in those spaces was huge….and that for what has become an income generator or marketing vehicle for what was previously a meaningless trivial pursuit during idle time.

And so while there are some advantages and convenience in cloud computing, or application server providers.  We all share the advantages and we also will suffer from the disadvantages.

On the other hand, if EMR is not affordable without the cloud, physicians if so mandated by unrealistic mandates and inadequate incentives (which do not support long term usage of EMR), since it is a one time payment) Physicians will have to make an uncomfortable decision.

How responsible can physicians or hospitals be for breaches by a vendor, or cloud system. Who will be fined…the hospital, clinic or the vendor? The cloud vendor, the EMR vendor or the individual physician?

 

IMHO it has reached the point that physicians can no longer attest, nor be the ultimate responsible party for HIPAA security nor the arbiter of it’s success.

 HIPAA becomes rather meaningless, except for the occasional well publicized incidents of large fines to large entities for their “breaches'” What about hackers? Often hackers just ‘hack’ for entertainment, just like playing an online game. Can they beat the system?

del.icio.us Tags: hipaa,aws,amazon web services,security,cloud computing,emr adoption,emr incentives

Singularity University

 

How Will Technology Impact the Future of Healthcare and Medicine? By exploring and driving the future of medicine through  exponential, game changing technologies.

A 5-day program at Singularity University in Silicon Valley in the NASA-Ames Research Park brought together participants who gave an over-the-horizon perspective in what is emerging in the lab and clinic and where opportunities in medicine are rapidly moving through disruptive, convergent technologies.

 

 

Here is a summary of day one of the FutureMed at Singularity University.

FutureMed’s Executive Director Daniel Kraft, MD presents “What’s next in healthcare?” at TEDxMaastricht’s Future of Health

 

Dan Kraft MD delivers a fast paced view into the current state of biotechnology and future of advancements.

 

The computing industry makes profits and stands to make even more profits by anticipating and meeting the technological demands from medicine and healthcare. The relationship is synergistic, each driving medicine and healthcare forward. The participants included 

-Physicians
-Bio-MedTech & Pharma Executives
-Health focused Innovators & Inventors
-Investors & Entrepreneurs

The Faculty included distinguished personalities from a wide diversity of disciplines and accomplishments.

The FutureMed Singularity University Executive Program is geared around six exponentially growing areas, each taught by world class experts from the worlds of medicine, biotech and innovation.

The Program Tracks include: Information-Data Driven Health, Personalized Health & ‘omics’, Regenerative Medicine, Intervention, Medtech/Biotech & Enterpeneurship,

Three specific Application Areas, the future of…..Medical Practice, Wellness/Prevention, and Global Health.

Planned site visits included:

• Intuitive Surgical (robotic surgery)
• NASA Life Sciences & Human Factors
• Stanford Institute for Stem Cell Biology & Stanford Medical Simulation Center
• Kaiser-Garfield HealthCare Innovation Center
• Autodesk — 3D Printing
• Google Health & Google Headquarters

 

del.icio.us Tags: singularity,futuremed,nasa,ames,data.gov,health,regenerative medicine,intervention,neuromedicine,medtech,biotech,medical practice,wellness,prevention,global health

Social Media for Physicians IV

I am continuing my literary masterpiece from Parts I-III on Social Media for Physicians.

Let’s say you have invested some time and money into a social media presence. Now you have your Facebook, Twitter and/or email sites operating.  It has been several months and you have followed 1000 other tweeters but the number of followers is 5.  Humbled by this statistic you realize this is not going to be an easy expedition to become the next Paris Hilton or Charlie Sheen of the social media medical circle.  After all medical things just don’t have the same Shock and Awe value as Charlie Sheen’s tour of “Winning”, nor Paris Hilton’s vapid face and torso in a million dollar chic dress. 

   

Marketing experts will tell us that we have about five seconds to grab attention with our web site, Facebook landing page, or Tweet before clicking on to the next site. So you need sophisticated analytics of your ‘metrics”.

Who are your users?  Five? that shouldn’t take more than a #2 pencil and a yellow legal pad, or perhaps in this instance a progress note sheet of which you have many stored somewhere since you haven’t used one since your last ‘crash’ of your EMR.

Perhaps a more sophisticated way exists for you to waste a little more of your most precious resource (dwindling reimbursements)..

Along comes another entrepreneur, selling analytics for social media users.

I write about some of these in my other blog, NEXT.IND.in . This is unabashedly an attempt to ‘market’ my other blog (3 followers), and yes it is outsourced, unlike the cataract surgery I do (or at least used to do).I may have few admitted users, but they are glued to my posts, or they have become  catatonic reading my meanderings. I have been advised to draw in my audience by interaction and meaningful discourse just  as we do in face-to-face interactions with colleagues (if they still admit to knowing me.) and/or patients (customers?). So if you can, find those 5 users and RT(rewet) or  reply to them and ‘Like” their Facebook page. (If it’s Becky or Hot lips and they really want to meet someone like you because your FB page or tweet fascinate them, don’t bother to answer them. Even I get a lot of those, and you can block them. However even their tweets and likes will boost your ratings on “Klout” a free online analytics web site 

Buddy Media-Spinback offers a possible high priced solution to analyze your social media investment to maximize your ROI. After all your EMR may pay for itself in five years, so why take the chance that social media will be another ‘failed whale’ in your portfolio of foolish investments

“For only one dollar !

..

The Walking Gallery (of Patients)

 

I just had to take a break from the endless list of challenges in health care and reform, to let you know about a friend of mine.

I think you will enjoy linking up with some of these interesting events, and also to her blog and website. 

Regina Holliday caught my eye about a year ago when she appeared at a medical meeting.  She was standing in an obscured dark corner in the back of the meeting hall, painting away.

I found her tweet address @reginaholliday  and began tweeting with her.  Like me, I think you will find her commentary about health care and some of the inexcusable gaffs that some physicians make during patient encounters. The commentary is always accompanied by a “Holliday Painting”, poignant and a visual sensation to the observer. 

Regina, forgive me for bragging about you…..you deserve it for your patient advocacy and talent.

The Scarlet Letter         The Walking Gallery        The Cake is a Lie

Give Us Our Damned Data!

del.icio.us Tags: medical art,regina holliday,health train

What’s In A Name ?

 

Pharma  has undergone tremendous changes. From a physician perspective we see cost to our patients as a large issue, as well as the length of time for FDA approval for new drugs. Another issue is sales rep access to physicians and the ever present perception of reps buying our business with luncheons, meetings and other inducements.

Hidden behind the scenes is the number of mergers, acquisitions and consolidations in the pharmacy industry, paralleling consolidations of hospitals an health plans.

 

Many innovative transformative companies have been absorbed by larger entities once it is realized the profitability is marginal and their venture capitalist backers have maximized their investments. It is also reflective of the huge cost of bringing a new compound to market. In many cases the investment is lost on a promising drug that fails in clinical trials.

  Say goodbye to many of our favorite bottle labels.

Among these companies whose logos .have changed are:  Sanofi-Aventis, Genzyme, Synthelabo, Schering-Plough, Warner-Lambert, Pharmacia, and Wyeth…..all now part of Pfizer.  Welcome and Beecham, great drug companies, now lost somewhere in GlaxoSmithKline. Biotech names like Genentech, Immunex and Imclone vanished, too.

Much of this may have been due to “collateral damage” of the 2008 market crash, investment bank fiasco such as Lehman Brothers, Merrill Lynch, Fannie Mae, and AIG.   We should all be happy the taxpayer did not have to bail out Pharma. But wait….that is coming with ObamaCare.

del.icio.us Tags: pharma,mergers,acquisitions,pfizer,obamacare,clinical trials

Inland Empire Health Information Exchange

 

For those of you who have been reading the writings here at Health Train back in 2005 when it began (as the Inland Empire RHIO) the formation of a RHIO, specifically the Inland Empire Regional Health Information Exchange.   Riverside Health February 24, 2005 will take you to the initial blog about the RHIO. Health Train (then called the Inland Empire RHIO) published several times a month as a newsletter. You can follow the stream to see how It evolved and functioned as a conduit for information for those working on RHIOs across the country. As interest lagged after several years, the name changed to Health Train  Express to more accurately describe it’s content. (little did I know I was a pioneer in Social Media Networking).  Most people back in 2005 did not know what was blogging.

Despite a small group’s interest in establishing a RHIO, and several meetings the plan lay dormant for several years. The early meetings were more educational than productive about the HIE envisioned.

Years  passed by and about 18 months ago the project arose once again, this time named the Inland Empire Health Information Exchange Collaborative which began serious work on governance, and building a sustainable business model, and a consensus for a project management. Consultants were contracted, Many more scheduled meetings were held, and hospitals and stakeholders invested considerable funding. A financial plan developed and annual subscriptions to the IHIE were offered.    With this foundation the project began in earnest.

The development of the IHIE parallels HIE development across the United States in the manner forecast by the ONC for a NHIN, beginning in 2004 and initially funded by executive order of President George W. Bush. Bush appointed David Brailer MD, who at that time was the head of the Santa Barbara RHIO (extinct).

Early on there were many failures, not because of lack of interest, but due to lack of a proven sustainable business model and confidence that such a project would come to fruition. Much has been learned from the early failure and observations of the many failure of RHIO across the country, and the  recent successes are in no small manner the results of those frustrations.

During the ensuing years vendor interest developed and technical solutions matured.

This month the IHIE will meet to select a vendor to deliver the technical back end of the IHIE.

This is very  encouraging.  Despite physician reservations about EMRs and  HIEs the effort will progress and hopefully will improve work and health  for physicians and patients alike.

Important Players in the Journey: The Medical Societies have been and continue to be very supportive in administrative matters and a physical setting for meetings and conferences.

Riverside County Medical Association

San Bernardino County Medical Society

Gary Levin MD

Technorati Tags: inland empire health information exchange,rhio,riverside,sanbernardino,brailer,rcma,sbcms,onc,nhin,bush

Social Media Backfire

Alright, you caved in and decided to give SM a try. You decreased your schedule by one hour a day to work on it.  What’s the difference? You are already operating at 25% less efficiency since your EMR went live three months ago. You have been tweeting, face booking, and are now following about 1000 tweeters. You look at the number of your followers…..what? 45? Must be some kind of mistake.

Any physician into social media, (or anyone for that matter) needs to get feedback along the way, and there are several routes to accomplishing this without investing huge amounts of time.

Social Media Examiner is a great place to start your investigations. SME is a good introduction to the subject of analyzing the responses to your social media efforts. It also sets out a plan and specific applications to utilize in your quest for the million followers.

I’m not going to waste your time and mine expounding on it here. Just click on the links and you can read it for yourself.  This is not rocket science, and it is not medical school....no more spoon feeding from Health Train Express. Explore new Universes, go where no HMO has gone before, follow William Shatner to Priceline.

Technorati Tags: social media in medicine,social media examiner,twitter,facebook,followers,you follow

Politicians and Physicians

"The New Health Law: Bad for Doctors, Awful for Patients."

                                               

Writing this particular edition has been gratifying for two reasons.

1. I took the time to research and  read the material I have linked for you  and to watch these videos, expanding my knowledge base for discussing these issues with colleagues, patients, and congressional representatives.  Our representatives are often give limited, few and inadequate choices by advisors who are self-appointed experts.

2. I enjoyed organizing my thoughts about PPCA and health reform. Admittedly it is overwhelming, too grandiose, and most likely unobtainable for many reasons, and is a subject in itself which I hope to expand upon in another blog.

Take some time to read the links, and watch the videos. There is more here than one can absorb in one sitting, and no busy practicing physician has the time to dedicate to this subject, yet to not do so would be akin to a diabetic not taking their insulin…..

The Galen Institute and Docs4PatientCare are  strong proponents for a rational health reform plan based on rational, carefully thought out measures to reduce cost in health care cost,  and to maintain the atmosphere of patient-physician trust. The Galen Institute sponsored a forum in Washington D.C. during which Rep. Tom Price, MD spoke.

 

  Jason Fodeman, MD has written  a series of  papers   regarding PPACA.at Townhall.com . Jason D. Fodeman, M.D. is an Internal Medicine Resident at UCONN and a former graduate health policy fellow at the Heritage Foundation  where he studied the etiology of rising health care costs. His … read more

The Heritage Foundation

Founded in 1973, The Heritage Foundation is a research and educational institution—a think tank—whose mission is to formulate and promote conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense.

The New Health Law: Bad for Doctors, Awful for Patients

 

The More Things Change..

 

Obama Care on the Front Lines

 

Rep. Tom Price, MD,   gives opening remarks at the Galen Institute/Docs4PatientCare event entitled "The New Health Law: Bad for Doctors, Awful for Patients." Other videos are available.

Hal Scherz and Jason Fodeman

Rep. Tom Price, MD  U.S. House of Representatives

Jason Fodeman, MD

Hal Scherz

Richard Armstrong—PPCA cannot be repaired, it must be repealed.

Technorati Tags: docs4patientcare,Rep Tom Price,Jason Fodeman,PPCA,health reform,Galen Institute,Hal Scherz,Heritage Foundation