The Healthcare IT Guy

As I travel around the country and speak to CTOs and CIOs about their hospitals infrastructure, implementing radio frequency identification (RFID) technology is one of the major items in everyone’s plans. While I’m always happy that RFID is taking hold in the minds of my clients, what worries me is that RFID is not mature enough yet to protect healthcare IT data but most vendors are not telling their customers during demos and pitches.

The security protocols used in today’s RFID systems risk compromising your infrastructure if they are not used properly (and many times even if they are used properly). When reviewing systems you need to make sure you ask vendors to specifically identify and review the inherent security risks of today’s RFID systems. I’ve seen many RFPs and RFIs where security is not mentioned at all or is given less importance so vendors who respond with proposals don’t supply enough information about vulnerabilities.

RFID is of course designed to bring positive changes to healthcare practice and processes but you need to anticipate the potential threats that can arise with these (often misunderstood) new changes and know the limitations of a vendor’s RFID systems.

With HIPAA and associated medical lawsuits we have already started thinking about privacy so just make sure to extend that analysis to think about confidentiality, integrity, and access to your RFID devices and data. RFID is promising lots of cost savings in the future but if you can’t maintain your security standards with what’s available today it’s better to wait until the RFID manufacturers are ready.

 I saw an interesting service offering recently. Check Autoriginate: Intelligent testing made convenient. Here’s how they describe themselves:

HostedQA is the industry’s first web-based QA solution. With a focus on making automated testing convenient and ensuring that the resulting test scripts are intelligent, HostedQA is generations ahead of the competition. No longer do you have to settle for automating only the playback of your tests. HostedQA automates the entire automated testing cycle. We’ll guide you through everything from setting up your databases and application servers to taking simple-to-understand visual screenshots of each step in the test.

I haven’t had a chance to play with it yet, but I’m going to check it out further.

Business 2.0’s The $100 million giveaway article has an offer of $10 million for “an engineering team to design implantable wireless devices capable of 24/7 patient and data monitoring for conditions such as heart disease and diabetes.” It seems there’s decent startup money available if you’ve got the right ideas and can execute. Here’s the snippet from the article in case you’re interested:

Patient Monitoring to Go

The Investor: Corey Mulloy, general partner, Highland Capital Partners
What he’s backed: AccentCare, Archemix, Yoga Works

What he wants now: An engineering team to design implantable wireless devices capable of 24/7 patient and data monitoring for conditions such as heart disease and diabetes.

Companies like Medtronic and Boston Scientific have multibillion-dollar R&D pipelines for medical devices but are increasingly finding it cheaper to simply acquire early-stage companies–so a startup need only get a product to an early testing stage, and can then let a bigger player worry about taking it commercial. Mulloy considers implantable hardware an ideal target market, since it can exploit recent advances in low-power wireless chipsets, materials, and microelectromechanical systems, or MEMS. A device designed to monitor a diabetic patient, for instance, might trigger a bedside alarm for spikes in blood sugar levels, send continuous data to a doctor, or both.
“HMOs are looking for ways to proactively manage individual diseases like congestive heart failure and diabetes,” Mulloy says. “These kinds of devices take us toward that.”

What he’ll invest: $10 million over three years for a functioning prototype, software to manage wireless data, and early-stage trials

Send your pitch to: lmontilla@hcp.com and don’t forget to CC me.

The healthcare sector manages an estimated 90 billing healthcare transactions globally; unfortunately, more than 90 percent are happening via phone, fax, or postal mail.

In order for healthcare organizations to better manage today’s information technology requirements, they require modern tools that are designed to work with legacy infrastructures in a service oriented approach/architecture (SOA) where middleware is able to get information to and from multiple systems and applications that have likely been around for decades.

SOA is not a tool, it’s not a library, and it’s definitely not something you can buy and toss into your stack. If you’d like to get an executive summary of SOA, take a look at my Enabling the Service Oriented Enterprise - Overcoming the hype, misconceptions, and pitfalls of SOA PowerPoint presentation.

Even though SOA makes a good deal of sense in the healthcare IT industry, be careful of the hype and existing vendors simply “SOA enabling” their existing software suite. It’s not going to be easy to convert closed legacy healthcare systems into open service oriented applications and databases. Cerner or IDX won’t be able to become “service oriented” by slapping on a label. Epic and Meditech can’t become service oriented given that they couldn’t even make the move to object oriented quickly. Eclipsys and Seimans can’t just put in a messaging system and tell you that they’re now service enabled because they can pass messages between systems.

Before your existing vendors come to you with their SOA message, have them explain to you what they think about SOA, why they think you should care, and why systems that they’ve had around for years are now, suddenly, service oriented. Almost all complex healthcare IT are integration oriented (by utilizing standards such as HL7) but won’t be easily converted to a service oriented quickly or without major changes.

I just installed a new rating system that uses some cool AJAX functionality to allow you simply click on a star and rate the quality of the postings you read here. 1 star means the article is very weak and 5 stars means I’ve done great and that you found the article useful.

My objective on this blog is to give unique, actionable advice and pointers to tips and views you won’t always get on other news sites so please take a moment when you read the articles to let me know what you think of each one.

I’ll be watching the ratings and focusing more attention in subject areas with postings that get the highest ratings and staying away from those that get lower ones.

Thanks for reading and thanks in advance for taking 3 seconds and clicking on a star to let me know how you like my postings. Be brutally honest

I ran across an interesting press release from earlier this year reporting that “Physicians, nurses, pharmacists equally prone to fault” for medication errors. The general findings in the article are pretty obvious but they have broken out the information in some useful ways. Here are some highlights from the article:

“One of the more interesting findings was that drug-administering errors, such as giving the patient the wrong drug or the wrong dose or at the wrong time, were quite common,” Lehmann says. “We had focused in the past on ordering errors. This finding made us look for possible interventions on the administration side.”

About near-miss errors:

Of the 1,010 originally reported errors, 173 (17 percent) were near-miss errors, which researchers describe as an error that didn’t harm the patient but would likely cause serious harm if it occurred again. A typical near-miss scenario would involve a physician prescribing the wrong dose, followed by a pharmacist dispensing the wrong dose, but a nurse catching the error before giving the wrong dose to the patient.

They claimed that none of the errors they tracked actually killed or seriously harmed a patient. I’m not sure that even if they did find those numbers that they would easily reported it.

About the errors breakdown:

Nearly one-third were prescribing errors, one-quarter were dispensing errors, 38 percent were administering errors, and 8 percent were documentation errors. Most errors occurred with anti-infective medications, such as antibiotics or antivirals (17 percent), followed by pain relievers and sedatives (15 percent), antihistamines for allergies (15 percent), nutritional supplements and vitamins (11 percent), gastrointestinal medications (8 percent), cardiovascular medications (7 percent) and hormonal medications (6 percent).

Web conferencing, instant messaging, blogs and wikis, messaging platforms, team collaboration, collaborative document management, email to fax, and barcoded documents can transform your health IT strategy. Unlike most knowledge management and other collaborative tools of yesteryear, most of the current tools are either free or very cheap. And, they don’t require much technical know-how to comprehend or install (because they don’t require any installation onto desktops in many cases).

End users are already experimenting with collaboration tools and if IT departments don’t get a hold of what’s going on, they will lose control. Records management requirements for HIPAA, FDA, and other regulatory concerns are some things that users don’t consider when “trying something out”. You can manage all your emails but do you have a strategy to manage instant messages retention? If Wikis are updated by anyone, is anyone doing editorial review? While many of these things can frighten an IT shop, you shouldn’t be afraid of the progress, just be sure to keep an eye on things and advise end users appropriately. 

IT organizations need to regain control by implementing enterprise collaboration strategies but not hamper any of the efforts started by the end users. Be sure to stay in front of all these tools before they bite you from behind.

I’ve been meaning to write an article on design of healthcare applications and devices for some time. Instead, I decided to go to an expert and get this thoughts. John Trenouth has a masters in design from Carnegie Mellon University and over a decade of experience designing interactive products and systems in both telecommunications and healthcare. Currently he blogs at niblettes and runs a boutique design firm Spire Innovation specializing in product innovation and design research. I interviewed John to get his ideas about why it’s so hard to get designs right. Hopefully the answers might be useful to everyone. This is the first of two posts on this subject.

Why are so many healthcare applications and devices so poorly designed?

The simple answer is because the design discipline usually isn’t invited to the table. In most cases only engineering and marketing contribute to a product’s design—whether that product is hardware, software, or services. The problem is that engineering concerns itself primarily with technical feasibility and marketing with market viability, which excludes the role human experience plays in the success or failure of products. This results in many poorly designed healthcare applications and devices.

Contrary to popular misconceptions design is not about style or aesthetics. Design is about people, real people. Design is about understanding and solving real problems real people experience. It seeks to deliver solutions that are the most useful, usable and desirable. Integrating design with engineering and marketing yields a more balanced, holistic and hence more effective model for delivering consistently great products.

This however is a relatively new model, and as many of us know, healthcare can be very slow to adopt new things. 

Why do you need a new model when the old ones have been working so well?

Poor design is not a competitive disadvantage in an environment where it is the norm. It is however a huge disadvantage when both markets start rejecting poor design and new players start delivering good design. Where competitors quickly match functionality, and solid quality initiatives have improved reliability across the board, good human-centered design is the next battleground for competitive advantage.

For instance, both Philips and GE have deep competencies in design for consumer markets where human experience is often the prime differentiator. They are now beginning to leverage these competencies for their healthcare efforts to boldly drive preference for their products and brand among patients, clinicians and administrators.

The consequences of poor design include delivering products that may exceed quality expectations, but that miss what people truly need, that cannot be differentiated from competitors, that are hard to learn, that are hard to use, that are less compelling for both clinicians and administrators, that increase patient safety risks and that ultimately damage your company’s brand.

So what can you do to help deliver better design?

Simply make design part of how you do things. Focus on people rather than technology. Judge your design ideas on how useful, usable and desirable they are. Open up your culture to appropriate change by introducing your people to design thinking and methods through training. Use personas and scenarios to help keep you focused on people. Foster in-house design talent. Cultivate a trust relationship with a quality design firm who can not only deliver but also educate. And most importantly for many in healthcare, give design some teeth by making design targets part of your quality system. Think big, but start small.

Some companies staff clinicians to help design products. This is a fantastic idea. But it is no substitute for an explicit competency in design. Users are not designers and more often than not don’t understand their own needs. Just like patients, users are only partially aware of symptoms and not root causes. They cannot therefore provide a diagnosis or a treatment on their own. Henry Ford famously said “If I had asked people what they wanted, they would have said faster horses.”

What are some useful design resources? 

• Design of Everyday Things
  By Don Norman
• The Inmates are Running the Asylum
  By Alan Cooper
• ISO 13407 Human-centered design processes for interactive systems
  By International Organization for Standardization

As many of you know, last year I co-founded the International Association of Software Architects’ Mid-Atlantic Chapter and we’ve had some great events in the DC area. This Thursday we’ve got Jeff Nielsen, Chief Scientist at Digital Focus, talking to us about Agile Architecture. Jeff trains and mentors teams and individuals in the use of agile methodologies and has over 19 years of commercial software development experience; he has architected a number of mission-critical and enterprise-level systems.

Jeff’s talk on Thursday, which is being held in Reston from 6 to 9p, is called “Profiling the Agile Architect.” Based on years of experience leading development in a prominent all-agile company, Jeff describes “the ideal architect on an agile software development team”. According to Jeff, “in my work leading and coaching agile teams, I have observed that having an effective architect on the project is essential to the overall success of the project and of the system being built.”

Check out the announcement. 

We’ve all seen it: we spend weeks or months in the “sales and demo cycle” for our applications. If we’re lucky we consider all workflows, if we’re even luckier we test drive the UI and make sure training goes smoothly, if we’re smart we also try to ensure that deployment will be easy. However, what we all seem to forget is to figure out how to get out of an application or system after it’s been installed for a while.

Why is getting out important? Because every application becomes “legacy” sooner or later. Every system will be replaced or augmented at some point in time. The cost of acquisition (”barrier to entry”) is well understood now as something we need to calculate. How about the barrier to exit or switching cost? Do we calculate that when we decide what systems to purchase? Why not?

If you can’t answer the “how, in 24 months, will I be able to move on to the next-better technology or system?” question then you’ve not completed your due diligence in the sales cycle.

When preparing an RFI or RFP, ask vendors specific questions about how easy it is to get out of their technology (rather than just how easy to it is to deploy and interoperate). Put in specific test cases and have your folks consider this fact when they are looking at all new purchases. Here are some specific factors to consider:

• Do you own your data or does the vendor?
• Is the database structure and all data easily accessible to you without involving the vendor? If only your vendor can see the data, you’re locked in so be very wary.
• Are the data formats that the system uses to communicate with other vendors open? If not, you don’t own your data.
• How much of the technology stack is based on industry standards? The more proprietary the tech, the more you’re locked in.
• Are all the programming APIs open, documented, and available without paying royalties or license costs? If not, when you try to get out you’ll pay dearly.

If you have other considerations, share them here.

Dr Aniruddha Malpani, MD, an IVF specialist (Malpani Infertility Clinic), is an ardent patient advocate. He is the founder of what he has dubbed the world’s largest free patient education library, HELP (Health Education Library for People) in Bombay, India; and has authored the book, How to Get the Best Medical Care. I invited him to write a guest article here to talk about Information Therapy; he believes healthcare is too important to be left completely up to the doctor and I found his ideas intriguing.

The reason the healthcare system today is sick is because it is so doctor-centric. The best way to heal the system is by putting patients at the center of it; and the most efficient way of doing this is by allowing patients to own their PHR - personal health records. The web allows us to provide everyone with a free PHR; and this is a major business opportunity, as healthcare undergoes a dramatic change over the next few years. PHRs are likely to be a major catalyst , because they will allow patients more control over the healthcare they receive. Patients are the largest untapped healthcare resource and armed with a PHR, they won’t feel so powerless any more !

For example, let’s see how much better a visit to your doctor could be if you had an online PHR.

One day before your appointment, you receive an automatic email reminder. You review your personal health records on the internet, and take a printout which summarises your past medical history and your medications. An intelligent program on the site asks you questions related to your headaches, which you can review and answer . It also guides you about what questions you need to ask your doctor, and you can print these out to take with you to your doctor. It also provides you with more information about headaches and self-management options.

During the consultation, in case you forget some minor detail, you can always refer to your records using your mobile.

At the end of the consultation, when your doctor enters your medical data in the clinic’s medical record ( EMR) system, because your personal health record ( PHR) is integrated with the clinic’s medical record management system, your PHR is also automatically updated. Your doctor prescribes your medications as well as your laboratory tests online, so that this is sent electronically to the lab and the pharmacist. You don’t need to go to the chemist or the lab – the lab and the chemist come to you ! The information is also electronically sent to your insurance company for billing and payment. Everything is done by the time you leave the clinic – the care is focused around you !

Why is the PHR so important ? To understand this, remember that to the IRS, you are your tax return; to your bank, you are your bank statement; and for the healthcare system, you are your medical record . At present, this is on paper, fragmented , all over the place ( in hospitals and clinics) and incomplete. ( Traditionally, the medical record consisted of the notes the doctors and nurses made about the patient when he was in hospital ). Today, the modern version is the EMR or electronic medical record). The medical record is a representation of the patient’s story – as seen from a medical perspective. ( This is a fallback of the old-fashioned biomedical viewpoint of the medical establishment, which treated all patients as “cases”).

However, ideally the health record should be the patient’s story – from the patient’s point of view ! A patient-owned health record ( which includes the patient’s personal views and social background as well) can enable a true partnership and collaboration between patient and doctor. Unfortunately, for most of us, our financial records are in better shape than our health records ! This is a sad state of affairs, and we can correct this by using technology intelligently to help patients to store their medical records on their personal website.

We all have a PHR – only the sad fact it that it is disorganized; incomplete; and most of it is tucked away in obscure corners of your brain. There are clever models for organizing this on paper , but doing it online is much more effective and efficient. There are many companies which offer online PHRs and there is a list at http://www.myphr.com/resources/phr_search.asp.

How can we get enough patients to keep a PHR? We need to provide them clever incentives to do so ! We can use either a top-down approach ( for example, health insurance plans can require their subscribers to keep PHRs ; and provide a discount for those who do so faithfully ); or a bottom-up approach – by creating communities of empowered patients.

Patients will do this because they have so much at stake ! We can show them that keeping this record will help them to get better medical care. The message is simple – “ PHR = organised medical information = improved medical care “ . Patients own this information. Part can be secure, private, and confidential; part can be public ; and by allowing varying levels of access , portions can be shared with whomever they choose.

I feel a novel benefit of the PHR is that patients can add a lot of value to the healthcare system by Patient to Patient ( P2P) networking. This has never been tapped so far ! They can share their own experiences ( for example, patient diary as a blog ) for other patients. This will facilitiate Patient to Patient ( P2P) networking , as they share experiences and tips. “Experienced “ patients can act as mentors and email buddies. Patients can grade their doctors and hospitals ( using the amazon.com review model ) and compare treatments ( www.askapatient.com). This is an important form of social networking and building a powerful , organized community , in which patients can intelligently share information with each other and their doctors ( “social networking for patients”). This network will allow the building of bulletin Boards, virtual patient support groups, and patient advocacy. Patients can link to each other’s websites; and can allow others to comment on your record and provide advise and feedback as well ( if they so desire).

Information Therapy ( “ The right information to the right person at the right time to help make better health decisions”) can be powerful medicine.

What information do patients want ?

• To choose doctors and treatments with good outcomes
• To communicate effectively with doctors
• To know what the doctor should do

Their PHR can help them do all this ! We all need information to make medical decisions. At present, most of us rely on our doctors to filter the relevant information and provide it to us in an actionable format, so we know what to do next This model works well when you have a good doctor. What if you have a bad doctor ? ( vested interest ? does not understand your perspective? Too busy ? who does not communicate ? incompetent ?) At present, information on the net is intimidating, confusing and unreliable. By providing this information through the PHR, we can make the information relevant to the patient’s needs ( customized; personalized; rated and screened for quality)

Many patients would also be converted to keeping PHRs because their doctors would request them to do so. A PHR can help doctors to provide much better care to their patients. It will make the doctor’s life a lot easier The doctor will be able to access all the information about the patient’s health in one place ! Because patients are better organized; and the doctor has easy access to all the relevant medical records, the doctor’s productivity will improve, and he will be able to see more patients, more efficiently. This is a type of PRM – Patient Relationship Management ! The PHR will also help doctors to see the patient as a complete person – not just a record ! Good medical records have also been proven to reduce medical errors, and this will help in risk management , and thus reduce the doctor’s medicolegal liability as well.

Today, the primary mode of communication between the doctor and patient is either :

• telephone ( no documentation; miscommunication; doctor may not remember all your details, which you may not provide)
• real world visits (at the clinic, with the waiting and the waste of time)

Both have problems ! They can be supplemented with secure messaging/email.

The doctor can instantly pull up your PHR when replying to emails ( PRM !); everything is documented, so there is no scope for errors; and it is much more productive and convenient. You no longer need to play phone tag; and you can interpret your doctor’s jargon and share his insights and advise with your community ( for their comments and feedback).

The major concerns with online PHRs today are privacy issues and security issues. As we get comfortable with doing financial transactions online and accessing our bank accounts through a website, patients will become comfortable with online PHRs too as we incorporate the same safeguards for these.

If you’re looking for Inter-Enterprise storage of large files such as RIS images (where images need to be securely shared between organizations), check out Amazon Simple Storage Service (Amazon S3). This inexpensive service may have the right mix of price, performance, and scalability take care of your requirements. Here’s what Amazon says about it:

• Write, read, and delete objects containing from 1 byte to 5 gigabytes of data each. The number of objects you can store is unlimited.
• Each object is stored and retrieved via a unique, developer-assigned key.
• Authentication mechanisms are provided to ensure that data is kept secure from unauthorized access. Objects can be made private or public, and rights can be granted to specific users.
• Uses standards-based REST and SOAP interfaces designed to work with any Internet-development toolkit.
• Built to be flexible so that protocol or functional layers can easily be added. Default download protocol is HTTP. A BitTorrent(TM) protocol interface is provided to lower costs for high-scale distribution. Additional interfaces will be added in the future.

Pricing is very reasonable since you only pay only for what you use. There is no minimum fee, and no start-up cost. 15 cents per GB-Month of storage used. 20 cents per GB of data transferred.

One of the foremost requirements of an Inter-Enterprise data interoperability (sending data between organizations) solution like a RHIO or even NHIN is to have a solid messaging service or technology. Buying a messaging engine for inside the interprise is fairly easy but setting one up for cross-organizational use is not trivial.

One of the services that Amazon offers, called the Simple Queue Service (Amazon SQS), is a great option for multiple organizations that want to share data but don’t know how to do reliable messaging. Here’s what Amazon says about it:

Amazon SQS offers a reliable, highly scalable hosted queue for storing messages as they travel between computers. By using Amazon SQS, developers can simply move data between distributed application components performing different tasks, without losing messages or requiring each component to be always available. Amazon SQS works by exposing Amazon’s web-scale messaging infrastructure as a web service. Any computer on the internet can add or read messages without any installed software or special firewall configurations. Components of applications using Amazon SQS can run independently, and do not need to be on the same network, developed with the same technologies, or running at the same time.

The pricing is pretty reasonable, too: no startup costs and just 10 cents per 1,000 messages queued plus 20 cents per GB of data transferred. Not bad at all.

Check it out and start interoperating without all the hosting headaches.

What can the healthcare industry learn from the gaming industry? Plenty. Tiny, superfast computers with 3-D technology, highly usable interfaces, and the fact that almost anyone can play even complex games can teach us a thing or two. The Games for Health 2006 Conference, being held near me in Baltimore, is the third annual installment of the gathering that is is designed to strengthen the intersection between health care and gaming. From their announcement:

Games for Health, 2006 features over 30 sessions on the latest and most innovative ways that video and computer gaming are becoming a powerful influence on health and healthcare. Sessions will cover products and projects aimed at personal health, exergaming, professional health care training and skill development, epidemics and disaster response, obesity, and health messaging. Last year the event drew over 200 researchers, developers healthcare professionals and journalists.

You can learn more about the event at http://www.gamesforhealth.org.

If you need to process business rules or triggers based on large amounts of data that stream in from one or more sources, you probably need a tool like Esper. I’ve followed their development for a while and friend of mine just reminded me about its use in healthcare. Here’s what Esper does (from their website):

Complex Event Processing, or CEP, is technology to process events and discover complex patterns among multiple streams of event data. ESP stands for Event Stream Processing and deals with the task of processing multiple streams of event data with the goal of identifying the meaningful events within those streams, and deriving meaningful information from them.
The Esper engine has been developed to address the requirements of applications that analyze and react to events. Some typical examples of applications are:

• Business process management and automation (process monitoring, BAM, reporting exceptions)
• Finance (algorithmic trading, fraud detection, risk management)
• Network and application monitoring (intrusion detection, SLA monitoring)
• Sensor network applications (RFID reading, scheduling and control of frabrication lines, air traffic)

Esper could easily be used in applications that read volumes of lab, radiology, EMR, or other data streams. It can act on events that, based on certain rules, automatically trigger alerts. It can also act as a traffic cop for what data should be sent to a database for long-term storage versus an ESB for service processing or just discarded because it’s not important.

Lots of uses, and it’s free. Music to my ears.

Tom Eng, founder of a the health search engine company Healia, recently informed me that his new service has launched as a beta site. Tom said Healia is different from other search engines because: 1) it only provides high quality results, 2) it lets you filter your results to fit your profile and needs, and 3) it shows relationships among medical terms to help you search more accurately. Of course, the definition of “high quality” and results “fitting your profile” are subjective but it looks like a good start.

He also mentioned that Healia was developed under a grant from the National Cancer Institute and recently received an award from the Emerging Technologies and Healthcare Innovations Congress.

I’ve tried the search engine and it does a pretty good job finding things Google, Windows Live Search, and Yahoo Search actually missed. You guys should check it out and let me know what you think. Since they’re in beta they could use our feedback.

Last year I wrote about ConceptDraw, a diagramming tool for creating healthcare graphics. I just ran across another tool, The SmartDraw Healthcare Solution. It could certainly use a more catchy name but it seems pretty nice. It provides over 50,000 ready-to-use graphics, including over 3000 medical illustrations from Lippincott and 50 Netter images (which seems unique to them since ConceptDraw I don’t think has those). It’s only a few months old but it’s worth checking out if you’re getting tired of Visio because you have to hunt for your own healthcare-specific images.

Dmitriy over at The Medical Blog Netwok, an excellent blogging netwok for healthcare professionals who want to reach consumers, has been hard at work setting up the Healthcare Blogging Summit 2006.

He asked me to join a panel on Strategy & Tactics and I said “of course” mainly because I believe in what he’s doing but of course also because it’s in my backyard. I think it’s going to be a great event and I look forward to seeing you guys there. These kinds of events need our help so please spread the word to anyone looking to learn more about healthcare blogging.