About Korchek technologies

Info taken from the Korchek website: www.korchek.com

Korchek is a Trumbull based healthcare software and service provider. The company provides the CareChek Patient Identification System, as well as blood bank validation and data conversions.

They are partnered in - The Partnership for Patients: Better Care, Lower Costs is a new public-private partnership that will help improve the quality, safety and affordability of health care for all Americans.

Korchek’s services

Data validation

Our three-step method will ensure your validation is thorough and compliant.

• Plan All validation projects must start with a master plan. The plan defines the project, assigns responsibility for tasks, and outlines the methodology to be used.
• Script Test scenarios that are customized to your site. These test scenarios guide the validator through the data entry and the expected results.
• Execute Once the scenarios are written they must be executed. Scenarios are performed and the input and outputs are documented.

Data conversion

Korchek's conversion process is a turn-key solution.  Korchek will work with your hospital to:

• Establish connectivity to your legacy system
• Extract data from your legacy system
• Develop a repeatable process to transform that data into vendor's file specifications
• Perform a complete "mock" or test conversion of the data prior to the activation of your new system
• Make changes and revisions to the process until you are satisfied with the results
• Schedule and plan a final extraction and conversion with the aim of minimizing downtime while the data is migrated

CareChek

The CareChek™ patient identification system uses bar code scanning to ensure positive patient ID at the bedside. The system uses handheld computer technology at the point-of-care to positively match the patient to a specimen, blood product, or medication.

The system is modular to give you the flexibility of implement any combination of modules.

• CareChek Tx™ - Blood Product Administration
• CareChek Sp™ - Specimen Collection
• CareChek Rx™ - Medication Admin
• CareChek Lc™ - Breast Milk Collection & Feeding

Utilizing a standard HL7 interface enables the system to transmit and receive orders for specimen collection, blood product administration and medication administration. Activities are completed at the point-of-care and records of the activity are transmitted to an electronic medical record or printed. CareChek has the ability to customize chart reports, error logs and clinical occurrence reports.

Report system

Does your blood bank system provide the reports that you need? Have you recently converted to a new system and found that reports that document essential processes are missing? The Korchek Report System provides you with reports every blood bank needs for the most widely-used computer systems. Our reports are designed by blood bankers, for blood bankers. We offer support plans which will give you automated access to a growing library of reports.

Report types:

• Audit
• General
• Inventory
• Patient
• Transfusion

Other information:

A study in 2003 found that 1 in 165 blood samples is mis-labeled. Another study found mis-transfusion with 1 in 400 units of blood. Improving patient identification has been a JCAHO and CAP initiative for the past 2 years.

In any data migration, there are three steps:

• Extract data from the legacy system
• Transform the data to vendor's file specifications
• Import the data into the new system or database.

The Joint Commission's (TJC) number-one National Patient Safety Goal (NPSG) for 10 years running expects hospitals to "improve the accuracy of patient identification." "The intent for this goal is two-fold: first, to reliably identify the individual as the person for whom the service or treatment is intended; second, to match the service or treatment to that individual."

Currently, the goal does not require utilizing positive ID technology. However, when matching blood products with patients, an accompanying note in the most recent "standards of performance" reads: "If two individuals are not available, an automated identification technology (for example, bar coding) may be used in place of one of the individuals."

Bar coding has slipped, almost unnoticed, into The Joint's playbook. However, I believe it won't be too long before bar coding will be moved from an example to an expectation for fulfilling the first NPSG. In the meantime, I anticipate that over half of our nation's hospitals will have voluntarily implemented bar coding at the point of care (BPOC) before TJC actually presses the issue. We're somewhere near the 30 percent mark today.

So, what is your hospital doing to improve the accuracy of patient identification? Does your game plan include implementing BPOC?

Use of QR codes for patient ID

Take a look at my idea: http://myhitthoughts.blogspot.com/2010/11/my-device-proposal.html

Patient ID QR codes:

• Scannable in all directions
• Small size
• Can be repeated
• Better read when bent
• More information

 

On wrist band:
This has already been done!
http://salmapatel.com/healthcare/qr-code-on-hospital-wristband

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Using problem steps recorder in Windows 7

Not HIT related exactly, but here's a hidden tool that could could be helpful - Windows 7 has a problem steps recorder.  It might be helpful for tracking errors in a software program or used to create a how-to document. 

View the MS help page

To record and save steps on your computer:

1. Open Problem Steps Recorder by clicking the Start button , and then typing psr. In the list of results, click psr.
2. Click Start Record. On your computer, go through the steps on your computer to reproduce the problem. You can pause the recording at any time, and then resume it later.
3. Click Stop Record.
4. In the Save As dialog box, type a name for the file, and then click Save (the file is saved with the .zip file name extension).
   To view the record of the steps you recorded, open the .zip file you just saved, and then double-click the file. The document will open in your browser.

To save the problem steps in e-mail:

• After recording and saving a .zip file, click the help down arrow , and then click Send to E‑mail recipient. This will open an e‑mail message in your default e‑mail program with the last recorded file attached to it.  Note: You won't be able to click the Send to e‑mail recipient option until you've recorded and saved a file.

To annotate problem steps:

1. Open Problem Steps Recorder by clicking the Start button , and then typing psr. In the list of results, click psr.
2. Click Start Record.
3. When you want to add a comment, click Add Comment.
4. Use your mouse to highlight the part of the screen that you want to comment on, type your text in the Highlight Problem and Comment box, and then click OK.
5. Click Stop Record.
6. In the Save As dialog box, type a name for the file, and then click Save.
   To view the record of the steps you recorded, open the .zip file you just saved, and then double-click the file. The document will open in your browser.

To adjust settings:

When you adjust settings for Problem Steps Recorder, they're only saved for your current session. After you close and reopen Problem Steps Recorder, it will return to the regular settings.

1. Open Problem Steps Recorder by clicking the Start button , and then typing psr. In the list of results, click psr.
2. Click the help down arrow , and then click Settings.
3. You can change the following settings for Problem Steps Recorder:
   • Output Location. If you don't want to be prompted to save a file after recording, click the Browse button to set a default output file name.
   • Enable screen capture. If you don't want to capture the screen shots along with the click information, select No. This might be a consideration if you are taking screen shots of a program that contains personal information, such as bank statements, and you are sharing the screen shots with someone else.
   • Number of recent screen captures to store. While the default is 25 screens, you can increase or decrease the number of screen shots. Problem Steps Recorder only records the default number of screen shots. For example, if you took 30 screen shots during a recording but only had 25 screen shots as the default, you would be missing the first five screen shots. In this case, you would want to increase the number of default screen shots.  

How to have Windows 7 log you on automatically without entering a password

See the forum entry - http://www.sevenforums.com/tutorials/377-log-automatically-startup.html

 

1. Open the Start Menu.
2. In the search line, type netplwiz and press Enter. (See screenshots below)

3. To Turn On Automatic Log On for a User Account

A) Check the Users must enter a user name and password to use this computer box. (See screenshot below)

B) Click on the user account name, that you want to have automatically log on at startup, to highlight it. (See screenshot above)
C) Uncheck the Users must enter a user name and password to use this computer box. (See screenshot below)

D) Click on OK. (See screenshot above)
E) Go to step 6.

4. To Turn Off Automatic Log On

A) Check the Users must enter a user name and password to use this computer box. (See screenshot below step 3A)
B) Click on OK. (See screenshot below step 3A)
C) Your done.

5. To Change the User Account to Automatically Log On to
NOTE: For this step, you would have already had a user account selected to log on to automatically in step 3.

A) Check the Users must enter a user name and password to use this computer box, and click on the Apply button. (See screenshot below step 3A)
B) Select the other user account name, that you want to have automatically log on at startup instead, to highlight it.
C) Uncheck the Users must enter a user name and password to use this computer box. (See screenshot below step 3C)
D) Click on OK. (See screenshot below step 3C)

6. Enter the User Account Password

A) In the Password field, enter the selected user account's password. (See screenshot below)
NOTE: If the user account does not have a password, then leave this field empty. See the WARNING at the top of the tutorial.
B) In the Confirm Password field, enter the selected user account's password again to confirm that it is the same as in step 6A above.
C) Click on OK.

Programming your Comcast remote:

Want to know how to make your Comcast remote do more stuff?  Here is the most useful features.

Comcast remote wiki:

http://en.wikibooks.org/wiki/How_to_use_a_Motorola_DVR/Programming_the_Remote

Similar programming process:

http://www.rockabilly.net/manuals/rs-l.shtml?15-1994

 

Add a Macro Button

A "macro" can also be created that will simulate hitting a series of buttons from the single press of a button. See the CJH Engineering Motorola HD Cable STB Info Pages remote section for an illustrated version.

1. Press the "Cable" button at the top of the remote to put it into Cable Box control mode.
2. Press and hold the "Setup" button until the "Cable" button blinks twice.
3. Type in the code 995. The "Cable" button will blink twice.
4. Press the button you want to map the macro to (ex: PiP CH-) (Optional: You can push Setup first to have a "shifted" button. See above).
5. Press the sequence of buttons you want executed by the macro (ex: AUX, POWER, TV, POWER --- turns on/off the Aux and TV equipment without turning on/off the cable box when PiP CH- is pressed --- useful to avoid some of the bugs).
6. Press and hold the "Setup" button. The "Cable" button will blink twice if successful.

-This will allow you do do several functions with just the touch of ONE key. A macro can hold up to 15 key presses.

-Macros cannot be programmed to the device button or the SETUP button.

-When you hit the key you put the macro on it will automatically start the sequence.

 

Erase a Macro from a Button

The following technique can be used to erase a macro programmed on a key. You are essentially creating a macro with no steps.

1. Press and hold the "Setup" button until a device button blinks twice.
2. Type in the code 995. A device button will blink twice.
3. Press the key with the macro you want to delete.
4. Press and hold the "Setup" button until a device button blinks twice.

.

Remap a Key (move) or enter an Extended Function Code (follow step 5.2)

This is the general procedure for remapping. Several common mapping options specific to the Motorola DVR are listed below.

1. (Option) Press and release the device key to make it the default.
2. Press and hold the "Setup" button until a device key blinks twice.
3. Type in the code 994. A device key will blink twice.
4. (Option) Press and release the device key for the source device.
5. Press the key to get the code from. This can be:
   1. Another button with an existing code or,
   2. Press and release "Setup", then type in a 3- or 5-digit code. The code is called an 'Extended Function Code' (EFC). Most of the silver remotes use 5-digit codes. Most others use 3-digits. In most cases, you just add '00' to the front of the 3-digit code to get a 5-digit code (00173 = 173).
6. (Option) Press and release the device key for the destination device.
7. (Option) Press and release "Setup" to create a shifted key.
8. Press and release the button you want to put the code on.
9. If the remap is successful, a device key will blink twice.

A list of Extended Function Codes (EFC's) for many device codes can be found at hifi-remote.com Advanced Codes. See Checking your Device Code if you do not know the code for your device.

To find out more you can post your device and your Comcast remote models and ask for the EFCs on this (or other) blogs to see if you get a response.  http://www.remotecentral.com/cgi-bin/mboard/forums.cgi

 

Using a Shifted Key

A Shifted key is a second code stored on a key. It is access by pressing and releasing the "Setup" key, then pressing the desired key. The "Setup" key acts like the Shift key on a keyboard. A common use is to put the DVR's own Mute code as a shifted Mute. A normal press of the Mute key will mute/un-mute your audio device (TV or amplifier), but the shifted-Mute will mute or un-mute the DVR.

Using shifted buttons is a very good idea for macros as macros are effective in all device modes. If you program a power macro (ie, one that will either turn everything on, or turn everything off, you might want to program this macro to the shift/POWER button.

NOTE: Shifed numeric keys:
You can program functions to shifted numeric keys using the procedure outlined above, but in order to actually use the shifted function you will need to press the SETUP button twice before pressing the numeric key that holds the shifted function, otherwise the remote thinks you are about to enter an advanced code.

 

Create a SHIFTed Power key

1. Press the "Cable" button at the top of the remote to put it into Cable Box control mode.
2. Press and hold the "Setup" button until the "Cable" button blinks twice.
3. Type in the code 994. The "Cable" button will blink twice.
4. Press (do not hold) the "Setup" button.
5. Type in the code 00144.
6. Press and release the "Setup" button.
7. Press the "Power" button.
8. You will get 2 blinks if successful.

To send the Power command, press and release the "Setup" key, then press the "Power" key.

 

Disabling Channel Control Lock

Disabling Channel Control Lock will allow the number, Channel +/-, Enter, and last keys to be used with the currently selected device.

1. Press and release the device key for the device you want to lock the keys to.
2. Press and hold the "Setup" key until the device key blinks twice.
3. Type in the code 973. The device key should blink twice.
4. Press the Channel Down (CH -) key.
5. If successful, the device key should blink 2 times.

How to use your Xbox 360 controller on your PC to play ANY Windows PC game

Not related to HIT, but it is much needed.

If you have any comments, suggestions, or praise – Please make a comment (no sign-in required).  Share the wealth!

This tutorial will show you how to use your Xbox 360 controller with your PC by assigning keystrokes and mouse motions for free.

Leave it up to Microsoft to not work with its own hardware. The claim that the controller works with your PC is a half-truth. I bet every Xbox 360 owner, or non-owner, has tried plugging in their purchased wired 360 controller to their PC and even perhaps tried playing a game only to be disappointed.

This tutorial will tell you how to actually USE your 360 controller to play a game.


                  New YouTube tutorial

     Xpadder can be run with Windows 7 using compatibility mode!

Download the free version of Xpadder
and my Xbox 360 controller configuration file at:

http://bit.ly/lMEP58

My YouTube tutorial from http://bit.ly/iEmvYV

Step-by-step tutorial about how to use your Xbox 360 Controller with your Windows 7 PC for free using Xpadder.

 

Button Layout





Previous instructions for Joy2Key


Step-by-step

1. Plug in your controller and let the driver automatically install. If not, try installing the useless Accessory software at http://www.microsoft.com/hardware/en-us/d/xbox-360-controller-for-windows.

2. “Semi-calibrate” your controller by using Microsoft’s generic Joystick control panel wizard. If you have Windows 7, click the Start Menu, type in “Joystick” then to “Set up USB game controllers”, then double click the 360 controller, then the Settings tab, then Calibrate.

*NOTE*
The “D-pad” is the left stick, the “Z Axis” is the left trigger (moves up) and the right trigger (moves down), the “X axis” is the right stick (pushing it left moves down and pushing it right moves up), the “Y axis” is the same thing only its up and down. It also doesn’t center your axes very well. Yes, thank you Microsoft.

3. Download the free software JoyToKey at: http://www.electracode.com/4/joy2key/JoyToKey%20English%20Version.htm (click to launch). No installation needed, just run it from the zip file (or unzip it if you like).

4. Create a profile by clicking on the Create button on the bottom, or use the “First Configuration” profile on the left.

5. Click the Others tab on the right then select the check boxes for “Use Axes other than X and Y” and “Use POV switches”. Then go back to the Joysticks tab.

6. Assign the buttons below by clicking each Button description. The button assignments below are grouped by category. Each one is the “subcategory” followed by the corresponding controller button, and a suggested keystroke. You can use Auto Setting Wizard to enter some of the buttons.

*NOTES*
-Check if your game supports stick controls and trigger button throttles
-If anyone knows if a throttle control can be applied to the trigger buttons with this software – please comment

-When assigning a button below – to repeat a keystroke, click on the Mouse tab and change the Automatic Shooting slider, then go back to the Keyboard tab and move the Automatic Shooting slider to any position.  This is a glitch!

-You can assign more key presses to a button.  For example adding a second key will execute a second command after the first.  Don’t assign shoot and “talk" keys to the same button or you will shoot that person in the face then you will have no one to talk to when the “talk” command is later executed. XD  (Note: Haven’t actually done this.)

-The trigger button can be used simultaneously as a aim button by assigning the shift key.  Any other button can be used as a shoot button except for the other trigger button. 


AxisX – Left stick

(<0), Left, Arrow-Left
(>0), Right, Arrow-Right 

AxisY – Left stick
(<0), Up, Arrow-Up
(>0), Down, Arrow-Down

Axis3 – Trigger buttons
(<0), R-Trigger, > or R-Ctrl (Assign Special keys drop down list)
(>0), L-Trigger, < or L-Ctrl (Assign Special keys drop down list)
*ALTERNATE*
When assigning, click on the Mouse tab and assign the left or right mouse button.

*NOTE*
Both trigger buttons cannot be used at the same time because they are considered together to be one axis.

Axis4 – Right stick
When assigning, click on the Mouse tab
(<0), Left, Slide horizontal bar left to -30
(>0), Right, Slide horizontal bar right to 30 

Axis5 – Right stick
When assigning, click on the Mouse tab
(<0), Up, Slide vertical bar up to -30 {inverted or glitch – should be 30}
(>0), Down, Slide vertical bar down to 30 {should be -30}

POV1 – D-pad
Up, Up, U or 8
Down, Down, D or 2
Right, Right, R or 6
Left, Left, L or 4

Button – All other buttons
1, A, A
2, B, B
3, X, X
4, Y, Y
5, L-Shoulder, L-Alt (Assign Special keys drop down list)
6, R-Shoulder, R-Alt (Assign Special keys drop down list)
    *NOTE*: ( and ) would work if the program accepted it
7, Back, Esc or Backspace
8, Start, Enter or Home
9, Left stick press, [ or L-Shift  (Assign Special keys drop down list)
10, Right stick press, ] or R-Shift (Assign Special keys drop down list)



Additional advanced controller software:

Keystroke and mouse:

PinnacleGameProfiler $20 – http://pinnaclegameprofiler.com/

Xpadder $10 – http://xpadder.com/

Xpadder Free (v5.3) – http://xpadder.en.malavida.com/
*NOTE: Will not install on Windows 7, shame because it could be run in compatibility mode

Controller emulator:

Emulator: http://www.tocaedit.com/IB/index.php?app=downloads&showfile=54

Makeshift email usage and calendar management using only SMS/MMS (eg. text)

Another non-HIT post. X-)

Word of caution: You need a texting plan that can support your usage.

If you don’t have a data plan (or smartphone) here is how you can add some functionality to your phone while saving money by preventing your phone from burning a hole though your pocket and then having to buy a new one when it gets lost. XD

Email:

To receive messages:

Using the email-to-text (SMS) gateway does not work for email because it truncates long messages.  The trick is to use multi-media messages (MMS). 

To find your email-to-MMS gateway go to http://en.wikipedia.org/wiki/List_of_SMS_gateways.

Common carrier addresses:
Verizon: number@vzwpix.com
AT&T: number@mms.att.net
Sprint: number@pm.sprint.com
T-Mobile: number@tmomail.net

Set up your email options to forward or redirect all messages or those from specific people to the gateway email address obtained above.  Redirecting your email is preferred because that person’s email is sent as the reply to address.

If you are using Office – go to http://kb.iu.edu/data/anfv.html for how to set up rules for incoming mail.

If you are using Verizon, when you reply to an email, your reply to address will be number@vtext.com.  If you want your reply to address to have YourName@vtext.com instead of your cell phone number do the following:

1. Log into My Verizon
2. Click on Send a Text Message under Extras
3. Click Preferences
4. Click Nickname
5. Click Edit Nickname

You can also personalize a one-way public texting page here as well.

To send messages:

1. Open a new picture message (or SMS message)
2. Put the recipient’s email address in the “To:” field
3. Put the subject in the “Subject:” field (in an SMS your message body will be the subject)
4. Put your message body in the “Text:” field

Calendar

Setting up Google Calendar:

1. Sign up for Google Calendar

2. Register your phone
    How to: http://www.google.com/support/calendar/bin/answer.py?answer=45351

3. Change your default alert page – Suggestion: Add two reminders at 0 minutes and 2 hours before by SMS
     How to: http://www.google.com/support/calendar/bin/answer.py?answer=37079

4. Create a new appointment by SMS (using Quick Add)
   How to: http://www.google.com/support/calendar/bin/answer.py?  answer=36604 
   NOTE: Save your fingers –Typing 10.00 will be interpreted as 10:00

6. Retrieve appointments by SMS
    How to: http://www.google.com/support/calendar/bin/answer.py?answer=37228

Note to Google: Remove/Delete appointment is much needed.  “Delete sat 12:00” will do because it is not likely you will schedule two appointments at the same time.  If there are, then a SMS from Google with the appointment headers numbered for which you can text back the number of the appointment to delete, will suffice.  Another option would to write delete followed by the appointment title.  To edit an appointment, you can delete the appointment by SMS, then edit your message in your phone’s sent folder and resend it.  A quick find feature might also be useful for retrieving the time and date of an appointment.

Sync your calendar with Outlook:

Download and install Google Calendar Sync –http://www.google.com/support/calendar/bin/answer.py?hl=en&answer=89955

Note on SMS reminders from what it appears: 
    - Reminders are not sent from Outlook created events
    - Only one SMS reminder is sent, the first choice in Google Calendar Notification settings
    - Default reminder setting on appointments is not sent to Outlook

Note to Google: Please work on this!

A work around to send SMS reminders from Outlook is to use a VB script, though it only works when your computer is on, so it’s semi-useless.  See the instructions below about how to do this:

1. Go to the Developer tab then to Visual Basic

2. Enter the code at http://www.lehsys.com/2010/12/microsoft-outlook-2010-how-to-get-email-reminders/ into ThisOutlookSession on the left and then save
NOTE: Use your email-to-MMS gateway email (see Email topic)

3. To enable macros:
     a. Go to File > Options > Trust Center > Trust Center Settings (on right) > Macro Settings
     b. Select “Notifications for all macros”
     c. Restart Outlook
     d. Select Enable Macros on security pop-up dialogue

How do environmental factors affect project implementation

4 pitfalls to avoid

1. Unsatisfactory project management control
2. Lack of communication
3. Incomplete goal specifications
4. Underestimation of project complexity

10 critical success factors

1. Select the right internal leadership team
2. Communicate the “what’s in it for me?”
3. Analyze the current office workflow
4. Create specific and measurable goals
5. Develop a strategy for entering existing data
6. Develop sufficient time to training
7. Plan to create “power users”
8. Create an ongoing plan for answering questions
9. Leave time buffers throughout the day
10. Plan to succeed and you will

More information can be found at: http://www.providersedge.com/ehdocs/ehr_articles/Critical_Success_Factors_for_Practice-Wide_EMR_Implementations.pdf

Say what?!

Say that again?  Did I hear you correctly?  Apparently not!

See how easy our brain can be tricked. So is the song sung by Lady Ba Ba or Lady Da Da? Copyright belongs to PBS. You can purchase the entire "NOVA ScienceNOW: How does the brain work?" from ShopPBS.org or call 1-800-PLAY-PBS.

“The McGurk effect is a perceptual phenomenon which demonstrates an interaction between hearing and vision in speech perception. It suggests that speech perception is multimodal, that is, that it involves information from more than one sensory modality. The McGurk effect is sometimes called the McGurk-MacDonald effect. It was first described in a paper by Harry McGurk and John MacDonald in 1976.

This effect may be experienced when a video of one phoneme's production is dubbed with a sound-recording of a different phoneme being spoken. Often, the perceived phoneme is a third, intermediate phoneme. For example, a visual /ga/ combined with an audio /ba/ is often heard as /da/. Further research has shown that it can exist throughout whole sentences.  The effect is very robust; that is, knowledge about it seems to have little effect on one's perception of it. This is different from certain optical illusions, which break down once one 'sees through' them.

Study into the McGurk effect is being used to produce more accurate speech recognition programs by making use of a video camera and lip reading software. It has also been examined in relation to witness testimony; Wareham & Wright's 2005 study showed that inconsistent visual information can change the perception of spoken utterances, suggesting that the McGurk effect may have many influences in everyday perception.”

http://en.wikipedia.org/wiki/McGurk_effect

Fellow blogger

Here is another fellow blog and twitterer! 

http://www.myhealthtechblog.com/
http://twitter.com/dleyva08

IBM's Watson could usher in new era of medicine

'Dr. Watson' could act as a physician's assistant, sorting electronic medical histories and even diagnosing patients.

The game-show-playing supercomputer Watson is expected to do much more than make a name for itself on Jeopardy.

IBM's computer could very well herald a whole new era in medicine.

Siegel, who refers to the computer not as the champ of Jeopardy but as "Dr. Watson," says he expects the computer, which can respond to questions with answers rather than with data and spread sheets, to radically improve doctors' care of their patients.

"If all Dr. Watson did was allow me to organize electronic medical records and bring to my attention what's most important and summarize it, that would be incredibly valuable to me.”

The ability to deliver a single, precise answer from these documents could go a long way in transforming the healthcare industry. Watson, the IBM computing system designed to play Jeopardy, could deliver such a solution.

She also said she believes that at some point Watson will have a speech-recognition capability so it can actually go into an exam room and listen to a patient talk about his symptoms while it runs through his medical records.

Doherty said that having a supercomputer that can ingest and analyze loads of data and then answer questions much as a human would could radically change not only medical diagnostics, but also medical research and pandemic recognition and management.

"Spotting trends could save lives and save money," he said. "What humans can't always see, Watson may be able to.”

"I think we're on the cusp of a revolution," Doherty added.

http://www.computerworld.com/s/article/9209899/IBM_s_Watson_could_usher_in_new_era_of_medicine?taxonomyId=67&pageNumber=2 

---

The ability to deliver a single, precise answer from these documents could go a long way in transforming the healthcare industry. Watson, the IBM computing system designed to play Jeopardy!, could deliver such a solution.

Anatomy of an IT disaster: How the FBI blew it.

"Freeze! This is the FBI! We have no intelligence!"

The IT disaster for the FBI is a good example of an epic project failure.  The entire project was named Trilogy, which had three parts which entailed enterprise wide upgrades in hardware, networking, and software involving case information. 

Four years and half a billion dollars later, Trilogy provided little benefit to the FBI.  The software included in the project, Virtual Case File (VCF), maybe the biggest IT disaster in history, essentially "[a] train wreck in slow motion."

Without VCF, the FBI had its mainframe-based Automatic Case Support (ACS). Before Trilogy was the User Applications Component (UAC) to "Webify" five applications that were picked only because they were the most commonly used. This was a significant mistake. Then the September 11 attacks came that changed the course of development for VCF.

The FBI did not have the technical staff to do the project and soon outsourced to DynCorp and Science Application International Corporation (SAIC). After the September 11 attacks, the FBI was reshaped to deal with intelligence in addition to law enforcement, therefore the UAC requirements changed to a collaborative environment for evidence and intelligence.

The FBI told SAIC to start over with no requirements and SAIC would need to help them with it. This is called "flash cutover" and is very risky.

SAIC had a cost-plus award contract. "[T]hese types of contracts estimate the real cost of a project and add a profit margin that is awarded annually to the contractor -- in full, in part, or not at all, depending on the government's rating of the contractor's performance for that year … In the beginning, you never want to say no, because you'll get a bad rating. It essentially incents the contractor to be much more accepting of out-of-scope changes. It's kind of like a mass-suicide pact, except you're hoping a miracle is going to occur later on."

SAIC delivered an incomplete system for evaluation. The new CIO of the FBI, the fifth one in four years, determined to pin down a set of requirements that was performance based and created a two track plan. SAIC would deliver an initial operating capability (IOC).

The IOC met all the requirements, yet the FBI CIO still had objections to the software. In fact, there were other components of the IOC that were simply turned off.

The fun is not over yet. At this point, the FBI and the Department of Homeland Security were working on a Federal Investigative Case Management System (FICMS) that renders VCF obsolete. If the contract is awarded, VCF will be abandoned.  Case closed.

This article was written in 2005. I do not know what happened after this.

http://bit.ly/ec3XNZ 
http://bit.ly/fHLPax

Building an EHR

Source: http://blog.pchealthstop.com/?p=68

The reality of electronic health record (EHR) implementation draws closer and medical staffs are ramping up.  They wonder:  what impact will this have on day-to-day practice?  Some health care professionals tapped as project leaders are already planning the steps necessary to set up an EHR system.  They’ve realized that an EHR implementation roll-out will take time and the investment of a team to coordinate the entire system. 

The EHR system must be a benefit rather than a burden to the medical office.  It’s not an easy task — as a best practices article published in the American Medical Informatics Association’s Annual Symposium Proceedings in 2006 indicates, only about 50% of EHR implementations are successful.  Averting failure requires the proper alignment of people, processes and technology.

To achieve an effective EHR implementation, adoption can be organized into three phases, each of which has three steps.

Phase I: Organizational Phase

The initial phase of an EHR roll-out charts the course and gathers the people and technology needed to carry out the EHR implementation.

Step 1 — Planning
The planning step involves gathering (and possibly hiring) staff members who will participate in setting up the EHR system.  Planning also involves identifying the needs of the users and casting a general vision of how the system will be used in the medical office.  Although this step may seem less intense or time consuming than other steps, shortcuts or ineffective planning can have consequences that aren’t easy to fix later in the time line.

Step 2 — Identifying an EMR vendor
Finding an electronic medical record (EMR) vendor that will work with you, providing both user and technical support, is essential.  Shopping around for the right company to match your needs is an investment for the long-term success of the EHR implementation.  The information in an EHR system are too valuable for a medical practice to jeopardize with a company that lacks experience.

Step 3 — Installation
Whichever EMR company you choose, they should handle the installation of the hardware and software as well as ensuring the integrity and security of a network that must be accessible 24/7.

Phase II: Construction Phase

The construction phase begins with a heavy emphasis on learning the software and builds up to the launch of the system.  During this phase, the focus should be on the details as the system is fine tuned and tested.  Additionally, it is during this phase when the conversion of records takes place.

Step 1 — Customization
EMR software alone will not be enough to meet the needs of medical staff.  Optimization of the EMR software means creating templates, hammering out protocols, and communicating with doctors and staff to ensure that the system provides the right information in the desired way.

Step 2 — Testing
The system must be tested and tested again.  Remember: anything that can go wrong, will on a long enough time line.  Fixing what is fixable and being prepared for what isn’t will improve the user experience.

Step 3 — Conversion
As part of an EHR implementation, all paper medical records will need to be entered in the system by converting them to digital records.  This step may involve temporary hires.

Phase III: Operational Phase

The operational phase includes not only the launch of the system but also the ongoing support provided to staff and users.  This phase never actually ends as training and maintenance will continue as needed.

Step 1 — Launch
A successful launch of the EHR system is contingent upon the effort that went into the first two phases.  Getting the system live may take more than flipping a switch, so be prepared to contact your EMR vendor for assistance.

Step 2 — Staff Training
Integration of the EHR system into the day-to-day procedures of the office involves training.  Since the system has been customized for the practice, it is best if the training is conducted by designated staff members who know your particular system well.  Remember, it’s not necessarily those who know EMR software in general who will be best able to train your staff — training needs to be as customized as possible.

Step 3 — Maintenance and support
Ongoing technical maintenance will be necessary to keep the EHR system healthy.  Over time, how the practice uses EHRs may shift or change dramatically.  It’s important that support, both by internal staff and the outside vendor, is ready to help when a problem arises.

Overall, an EHR implementation may initially seem like a daunting task.  Hopefully, following these steps will help medical offices avoid the common pitfalls that have contributed to EHR failure in the past.

David Hill
PC Healthstop Blogging Team

Image source: This is a freely licensed work, as explained in the Definition of Free Cultural Works.

Epic Systems Corporation on Wikipedia

Epic Systems Corporation is a privately held health care software company founded in 1979 by Judy Faulkner.^[3] Originally headquartered in Madison, Wisconsin, Epic began moving staff to a new $300 million campus^[4] in Verona, Wisconsin in late 2005. Nearly all of Epic's staff are based in the greater Madison area. Epic has a European office in 's-Hertogenbosch (Den Bosch), Netherlands.^[5]

Epic's target market is large health care organizations who are making substantial investments in technology. Epic offers an integrated suite of health care software centered around a hierarchical MUMPS/Caché database. Their applications support all the functions related to patient care, including registration and scheduling systems for clerks; clinical systems for doctors, nurses, emergency personnel, and other care providers; ancillary systems for lab technicians, pharmacists, and radiologists; and billing systems for care providers as well as insurers. All applications leverage the same central database.

Epic had a partnership with Philips to develop a scaled-down version of Epic's software, called Xtenity, which was marketed to mid-sized health care organizations. This partnership ended on September 29, 2006, and no organizations used Xtenity in a production environment. Epic hired many of the former Philips employees from the Netherlands who helped establish Epic's European location.

Since 2006, Epic has increasingly been working on expansion into the international health care market. In 2007, Epic established a subsidiary in the Netherlands to market Epic software.

In 2010, Epic announced its intention to pursue green energy sources including solar, biomass, and wind power. The company hopes to eventually obtain 80-90% of its energy needs from alternative sources.^[6]

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Products

Current applications developed by Epic include:

• ADT (Inpatient and Outpatient Admission-Discharge-Transfer Application)
• ASAP (Emergency Department Application)
• Beacon (Oncology Application)
• Beaker (Clinical Laboratory Application)
• BedTime (Bed Management Application)
• Bridges (Interface Application)
• Cadence (Scheduling Application)
• Cardiant (Cardiology Application)
• Care Everywhere (Information Exchange Application)
• Clarity (RDBMS Management Application)
• Data Courier (Data Environment Propagation Utility)
• EpicCare Ambulatory (Ambulatory Medical Record Application)
• EpicCare Home Health (Specialized Home Health Application for use in Patient Homes)
• EpicCare Hospice (Specialized Hospice Application)
• EpicCare Inpatient (Universal Hospital System)
• EpicCare Link (Web-based Application for Community Users)
• EpicWeb (Web-based Clinical Application)
• Haiku (Device Mobility Clinical Application)
• HIM (Chart Tracking, Chart Deficiency Tracking, Release of Information Application, Coding & Abstracting)
• Identity (Master Patient Index [MPI] Application)
• Kaleidoscope (Ophthalmology Application)
• MyChart (Patient Chart Access)
• MyEpic (Dashboard Application)
• OpTime (Surgical Application)
• Phoenix (Transplant Application)
• Prelude (Inpatient and Outpatient Registration Application)
• Radiant (Radiology Application)
• Reporting Workbench (Operational Reporting Application)
• Resolute (Billing Application)
• Stork (OB/Gyn Application)
• Tapestry (Managed Care Application)
• Welcome (Patient Self-Service Kiosk)
• Willow, formerly named EpicRx (Hospital Pharmacy Application

http://en.wikipedia.org/wiki/Epic_Systems

New bookmarks added

• Blog
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NOTE: These have been removed

Epic Systems has apps!

Click on the intro photos to view iTunes info page

Haiku provides authorized clinical users of Epic’s Electronic Health Record with secure access to clinic schedules, hospital patient lists, health summaries, test results and notes. Haiku also supports dictation and In Basket access. Haiku works on both the iPhone and iPod touch.

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MyChart gives you access to your lab results, appointment information, current medications, immunization history, and more on your mobile device.

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With Ukiah, project team members and system administrators of organizations using Epic Haiku can preview upcoming development before it is released to clinicians.

Epic Systems Corporation

St. Raphael and Yale hospitals are planning to install EPIC systems.

www.epic.com

91% of HIMSS Stage 7 Hospitals Use EpicCare
-HIMSS Analytics

Inpatient Clinicals

The EpicCare Inpatient Clinical System spans all hospital departments and specialties, giving providers the tools they need to deliver safe, high-quality care. EpicCare's role-based navigators simplify relevant information access for physicians, nurses, therapists, dietitians and any other provider in the hospital setting. Integrated tools include:

• Wizard-guided Med Rec
• Collapsible/Expandable Flowsheets
• Electronic MAR
• Interdisciplinary Care Plans
• Hospital Outpatient Support

• Clinical Pathways
• ICU Support
• Barcode Administration via Rover
• Pharmacy Integration

EpicCare Inpatient shares user-friendly documentation and CPOE features with the rest of Epic's clinical suite, making it easy for users to place orders, minimizing the documentation workload and maintaining a consistent, familiar user interface. At every point in the care process, clinical decision support works to protect patient safety and encourage compliance with organizational best practices.

The integrated design approach translates into a system nurses, physicians and pharmacists embrace. KLAS^** noted:

"The typical Epic hospital uses CPOE at a wider and deeper level than other hospitals. Epic has the highest number of hospitals performing closed-loop medication administration, and by a wide margin, the highest per-hospital percentage of physicians that enter notes electronically."

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 Inpatient Registration, ADT and Hospital Billing

Enterprise Registration - Inpatient Access
ADT/Prelude Enterprise Inpatient Registration improves bed utilization and gives users the tools to manage hospital stays from pre-admission through discharge. Clinicians can access an efficient census workspace that allows them to view and update current information on patients in their care. Flexible workqueues help nurses and other staff members plan for upcoming ADT events, follow up on missing or inconsistent data and assess utilization.

Enterprise Scheduling
Cadence Enterprise Scheduling makes it easy for users to schedule any type of visit or procedure from anywhere in your organization. It also enhances your ability to keep appropriate slots open, take patient preferences into account and deliver high-quality service that will distinguish your organization.

Cadence serves as an intelligent partner for users, providing context-specific instructions, conflict checking and solutions for complicated appointment searches. Comprehensive rules-based scheduling features accommodate the needs of each clinician, room and piece of equipment – optimizing the use of staff and capital resources throughout your organization.

Hospital Billing
Resolute Hospital Billing coordinates inpatient and outpatient billing for hospitals. It gives your front- and back-office staff the tools they need to streamline billing and collection processes, reduce payor denials and minimize A/R days. Resolute's features support billing staff throughout the hospital, helping you improve your financial performance and encouraging excellent patient service.

Drawing information directly from the EpicCare clinical system, Resolute automatically completes appropriate fields and submits claims in HIPAA-compliant transaction formats. Extensive rules-based claim scrubbing accelerates reimbursement and minimizes rejected claims, even with the most demanding payors. Comprehensive reporting tools help executives track and report on all aspects of financial performance.

Call Management
Customer Relationship Management/Call Management enhances customer service communications by storing patient information, service issues and contact histories in a central location. The system allows users to effectively document, route, monitor and resolve customer service inquiries from patients. The system's integrated reporting tools help you conduct detailed analysis of your organization's customer service, from evaluating individual patient/staff relationships to measuring the overall responsiveness of an entire facility, entity or department.

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Integrated Ambulatory EMR

Connecting Affiliates
Epic provides large organizations with structured methods for extending a shared electronic record system to affiliated physician practices and community hospitals. Participating in an Epic shared record solves many of the challenges community providers have with Meaningful Use and interoperability. It does so in a way that's better for patients and less expensive to implement.

You share patients. It makes sense to share their records.
Care quality and continuity are the most obvious benefits of a single shared record, but patients also appreciate the self-service conveniences of MyChart, which can be made available to patients seen in community physician offices. A complete community care record contributes to safer care in the hospital, and conversely, a complete hospital record in the physician's office builds trust and improves follow-up.

Sharing costs less and is less risky.
Depending upon the pricing and subsidy decisions at the host organization, community physicians can have all the benefits of a shared record at a lower cost than implementing a free-standing EHR. They also have the benefit of piggybacking on the technical resources of the host organization, which simplifies hosting, support and upgrades. Small practices can be confident that they are joining a successful implementation and avoid the risks of starting from scratch. Referral workflows are as simple as sending e-mail and require no costly interfaces.

Details for community practices:

• Makes use of our pre-built Model System to extend the best clinical content, order sets and workflow navigators of our customer community.
• Shares clinical data freely with appropriate providers, but privately partitions finances and scheduling.
• Includes turnkey e-learning content for self-guided user training and assessment.
• After configuration, enables rollout to as many as 2 practice sites per business week.
• Supports specialists with appropriate order sets and documentation tools.
• Includes one-time and monthly licensing options for end users.

Details for community hospitals:

• Takes advantage of a structured build that can be fitted to individual hospitals with minimal configuration... in as little as 48 days.
• Supports closed-loop medication workflows via Epic's integrated inpatient pharmacy system.
• Uses, in many cases, the existing external interfaces of the host organization. Adheres to HL7 standards for others.

Thank you Google

Note: “Dashboards in radiology” is second on Google's search results: Dashboards in radiology

Some of the other individual post hits are from links on Facebook I believe.

I’m going to remove the page split on the search engine post and see if I get any more hits.

Case/Real-Life Problem-Based Learning with Information System Projects

While teaching courses on computer information systems, in particular Systems Analysis and Design, it is easy to spot students' difficulties in incorporating what they have learned in one course into a different course or project. When subjected to testing how well they mastered the required prerequisites, students are surprised to realize that:

• Introduction to management information systems has already covered much, if not most, of the basic terminology and concepts needed in subsequent courses on information systems.
• Economics, accounting, production operations management, quantitative methods, marketing, and finances have provided the necessary business background with regard to how organizations should and do operate. Such a background is indispensable for developing viable business or administrative information systems. Relevant technological issues can be addressed later.
• Statistics, the basic tool in management science and the theory of information, is also indispensable for any meaningful quantitative analysis of business or administrative entities.

[T]here are several drawbacks with information system group projects within an academic environment, for instance:

• A student group does not provide an opportunity for a controlled selection of individuals possessing proper professional skills and knowledge to combine them for their synergy. If it happens, it does by chance.

• Accountability for individual contributions can be thwarted by wrongly understood camaraderie or “false friendship” with the consequence of undermining the learning process for academically weaker individuals.

• Students must be instructed how to implement a division of labor that does not compromise academic objectives, and how to react effectively from the very beginning to inevitable differences in quality and speed of individual contributions, before these differences endanger the entire project and the cohesion, morale, and performance of the team as a whole.

v2p357-365-128.doc

Why Health Care Information Systems Succeed or Fail

In all, we can identify four main forms of HCIS failure:

• The total failure of a system never implemented or in which a new system is implemented but immediately abandoned. A much-reported example is that of the London Ambulance Service’s new computerised dispatching system. This suffered a catastrophic failure within hours of implementation, leaving paramedics unable to attend health care emergency victims in a timely manner (Health Committee, 1995).

• The partial failure of an initiative in which major goals are unattained or in which there are significant undesirable outcomes. Anderson (1997:87), for instance, cites the case of “An information system installed at the University of Virginia Medical Center [which] was implemented three years behind schedule at a cost that was three times the original estimate.”

• The sustainability failure of an initiative that succeeds initially but then fails after a year or so. Some of the case mix systems installed under the UK National Health Service’s Resource Management Initiative fall into this category. They were made fully operational and achieved some partial use but with limited enthusiasm from staff for using them. Ultimately, they were just switched off (HSMU, 1996).

• The replication failure of an initiative that succeeds in its pilot location but cannot be repeated elsewhere. Although presenters may not realize it at the time, every health informatics conference is jam-packed with replication failures about to happen; The with wonderful innovations that are tested once and then disappear without trace. As an audience, we hear all about the pilot, but we tend not to hear about the replication failure.

Source: Why Health Care Information Systems Succeed or Fail

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Central to e-health success and failure is the amount of change between 'where we are now' and 'where the e-health project wants to get us'.

'Where we are now' means the current realities of the situation.  'Where the e-health project wants to get us' means the model or conceptions and assumptions built into the project's design.  eHealth success and failure therefore depends on the size of gap that exists between 'current realities' and 'design of the e-health project'.

The larger this design-reality gap, the greater the risk of e-health failure.  Equally, the smaller the gap, the greater the chance of success.

Analysis of e-health projects indicates that seven dimensions - summarized by the ITPOSMO acronym - are necessary and sufficient to provide an understanding of design-reality gaps:

• I nformation
• T echnology
• P rocesses
• O bjectives and values
• S taffing and skills
• M anagement systems and structures
• O ther resources: time and money

Putting these dimensions together with the notion of gaps produces the model for understanding success and failure of e-health that is shown below.

Source: http://www.egov4dev.org/health/evaluation/drgmodel.shtml

Pano System

Found this on a LinkedIn conversation.  The website mentions that this could be used for EMRs.  This is the description below.

http://www.panologic.com/pano-device

The heart of the Pano System is the Pano Zero Client, a whole new class of desktop computing hardware.  Pano endpoints are referred to as "zero clients" because, unlike traditional thin clients, they have no CPU, no memory, no operating system, no drivers, no software and no moving parts.

They simply serve to connect peripheral input-output devices – a keyboard, mouse, VGA display, and audio output – along with other USB peripherals to a virtualized Microsoft Windows desktop virtual machine running on a hypervisor server in your data center.

Pano Zero Clients not only help you cut the costs of hardware and IT support - they also conserve electricity, using as little as 5% of the energy consumed by even an EnergyStar certified desktop PC.

Connecting using the purpose-built Pano Direct Protocol over standard UDP protocols on your Ethernet LAN, Pano Zero Clients also leverage your DHCP and Directory Services servers, making it easy to integrate them into your existing LAN and security management infrastructure. 

Pano Zero Clients are also stateless – in other words, they do not store anything at all about the user, the desktop virtual machine, or any data used by it. This provides both enhanced data security, since they never contain data that might be lost or stolen, and productivity benefits.   It saves you time shutting down and booting up, and you can immediately resume work with the same set of open applications and files – for example when moving from your office to a conference room to make a presentation or when finishing up work at home in the evening.

The clean and functional design of the Pano was created by Whipsaw, one of the world's leading industrial design firms, helping it fit into modern office and public environments unlike bulky PCs.

Experiment in search engine exposure

I have posted some common search words found on the internet.  Let’s see if I get more page hits!

Example of a hospital information system

In the textbook Object-Oriented Systems Analysis and Design by Ashrafi details how a hospital information system works.  If you are interested about the future of medical information systems, check out this book!

Textbook on Amazon

Is HIT all wrapped up in red tape?

Medcity article

This journalist thinks so.  She thinks that HIT may do more harm than good. 

“Can health information technology transform the healthcare system? With an expansive, multi-year plan to digitally overhaul the nation’s medical records systems, the federal government is betting it can.
But doctors aren’t so sure. Most see value in digital recordkeeping. But many are also worried that the government’s efforts could undermine the doctor-patient relationship by forcing physicians to spend more time untangling Washington’s red tape — and less time treating the sick.”

I think it will be both.  It will do both harm and good, as with every technology.  The good side of the internet allows us to find out information about anyone, but the bad side is it lets us find out information about anyone.  It won’t be easy to get HIT up to speed where it will mesh seamlessly.  The revolution is coming, so the tape will be cut.