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Mar 3, 2011

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.

Mar 1, 2011

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]



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

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