The Healthcare IT Guy

Medication errors account for a larger portion of deaths than they should. As part of my work for various firms I’ve been involved in designing, architecting, and installing drug safety systems in hospitals and IT systems. Reducing medication errors is a big goal for everyone these days but it’s not easy for a patient to do much about it on their own. Until now.

I was pleased to learn about iGuard. It’s one of the first web-based services that will help you take medication safety into your own hands instead of relying only on healthcare professionals. iGuard claims to be “the fastest and easiest way to get personalized, safety alerts and updates about your medicines.” Very nice idea.

Recent studies by the Institute of Medicine and the US Food and Drug Administration reveal that the FDA does not focus enough attention on monitoring drugs once they are approved. Most drug approvals are based on clinical trials involving a few hundred or a few thousand patients, but many uncommon side effects don’t emerge until a drug is being used by millions of people. Through a quick online enrollment on the iGuard website (www.iguard.org), patients who regularly take medications can choose to receive patient-specific updates about the safety of the medications they are taking from an independent source. And participants in iGuard will receive these updates whenever new information is learned about their medicine, allowing them to make the most informed decisions about their healthcare.

There’s an event on the October 4th online (a webcast) that will introduce the concept of iGuard and why it’s important. I plan to check it out, you guys should too.

I got a note recently from Scott McQuigg, CEO of PeerClip, about their new social bookmarking tool. At first I thought “oh, no - not another bookmarking site.” But, I’m a sucker for any new startup in the Health 2.0 space so I took a look. It is one of the first bookmark sharing sites I’ve seen designed for specifically for physicians; I thought it was a great idea.

Today, all social bookmarking tools are peer generated content. Meaning the community selects bookmarks, ranks them, etc. But, the twist with PeerClip is that it’s designed for physicians to do the bookmarking. Basically, professional social bookmarking. I loved it.

PeerClip allows physicians to bookmark, organize and share medical information that they (as opposed to patients) feel is relevant and/or authoritative.

Using PeerClip, physicians can store their favorite online articles, blog postings, podcasts and videos on a personal home page for easy future reference for themselves or others to view. Physicians can also view bookmarks, comments and ratings on content their peers have bookmarked in PeerClip. This is pretty nice since they don’t have to wonder if the information has been vetted — it has, by their peers.

Nice idea, implemented well.

One nit - PeerClip designers need to simplify the home page a bit — it’s got lots of text on there and tries to convey too much, which means it takes a while to get the gist. The message to physicians should be pretty simple: “Share what you find on the Internet with your colleagues and in return they share their findings with you.”

Docs are busy and while they do read a lot visuals go a longer way. PeerClip should put up more screen shots to show the value of their tool instead of trying to describe it. A 30 second screencast may be even better.

Naoum Issa at Medical Resource Group showed me a neat little tool at NetDoc which is basically a mashup of Google Maps and HHS hospital database. It uses publicly available data from the Department of Health and Human Services, and displays a summary of the information on a GoogleMap. Although the information shouldn’t be see as canonical, it’s a quick and easy way to access hospital quality data by locale, and the ability to drill down for more detail if necessary.

I love tools like this which basically take mountains (or even molehills) of data already available and make them more accessible to the public.

Thanks for pointing it out, Naoum.

Here’s how hospitals in my area fare.

Fred Trotter sent me a note about the second annual “Demonstrating Open Source Health Care Solutions” (DOHCS) Open Source health care conference. It will be held on February 8, 2008, prior to the 6th Annual So Cal Linux Expo and will allow health care professionals to learn about opportunities to implement Open Source software solutions in their field. They are requesting:

If you’ve already implemented an Open Source solution in a health care environment, please consider sharing your experiences with us.

There is a call for papers out already.

In a nice interview with Gary Hamel, Allan Alter at CIO Insight writes:

The efficiency-focused management model has run its course, says strategist Gary Hamel. To see the future of management, look to the Internet, open source, free markets and democratic institutions.

It’s a good article. Some other interesting snippets:

Has management as we know it reached the end of the road? Strategy expert Gary Hamel thinks so. Yes, traditional management approaches have led us to achieve great things. “If you have a couple of cars in the garage, a television in every room and a digital device in every pocket, you can thank the inventors of modern management,” he writes in his upcoming book The Future of Management (Harvard Business School Press, October 2007; $26.95). But our century-old emphasis on planning, organizing and controlling won’t help companies solve their 21st century problems. In an era marked by global competition and commoditization, adaptability, speed and creativity are essential for survival, says Hamel, whose previous books, “Leading the Revolution” and “Competing for the Future” (with C.K. Prahalad), earned him a reputation as one of the great strategic thinkers of our time. “The old management model is simply not good enough.”

The future management model is taking shape, but some aspects are already evident, Hamel told CIO Insight executive editor Allan Alter. Companies will finally begin to be as open and democratic inside their doors as societies are outside those doors. Go/no-go decisions on projects and investments now made by a handful of executives will be made collectively by hundreds of employees.

Talent will matter far more than titles. And one of the most important catalysts and models for 21st century management will be the Internet.

If you’re a manager today, especially an IT manager, it’s a good article to check out.

We’ve all been hearing pundits rave about how SaaS (software as a service) is the next wave of technology (mainframes, desktop PCs, and client/server systems being earlier waves). I certainly agree that software running “in the cloud” is a great idea for lots of reasons. However, companies in general, and healthcare enterprises particularly, need to be careful putting any mission-critical data into the hands of other firms no matter who they are.

By now most of us have probably heard that the Microsoft Windows Genuine Advantage (WGA) system that verifies users have valid Windows licenses went down for over 19 hours on Friday evening and began to disable operating systems around the world. This service, which Microsoft explains is an “entitlement solution” is usually a good idea for businesses with lots of client PCs to manage but if the outage would have lasted into Monday it would have wreaked untold havoc (even more than any dangerous virus would have). Millions of PCs would have been told they were no longer “authentic” and been told to disable themselves.

So, what does this have to do with healthcare? Well, lots of healthcare IT firms are selling SaaS solutions (WGA is also SaaS). As long as the network is working things are fine but if the network is having problems or the vendor is having server issues, business literally stops. You need to have worked out backup plans for what you’re going to do if your business critical online app suddenly becomes unavailable. Will you go to paper? Wait until it comes back up?

Another problem with SaaS is given your data over to another firm — and then the firm going out of business. What happens to that data? Will you ever get it back? In what format and will it be usable? What about if their servers get hacked and your data is modified? If you are a regulated entity, will their policies about data loss affect you?

My strong suggestion is for everyone who is doing any business with online vendors is to ask for their appliance strategy and roadmap and if they don’t have one, think twice. What that means is that if they have created great software to “run in the cloud” they should be able to create a version that runs on an appliance (basically a server) that can be installed within your own datacenter or IT closet. By getting the same software and running it locally you get the benefits of online access but without losing control or being at anyone else’s mercy. If you run the software in your environment it costs you a little in power and IT management but if the data is important enough and the job the software is doing is mission-critical then it’s certainly worth it.

If you’re dealing with a reputable vendor with a good technology strategy they should be able to give you some ideas of what their appliance strategy (if there is one) looks like. If they don’t have an appliance strategy, ask them to explain why not and what they will do about an outage, data loss, hacking, etc.

The lesson here is that even a company like Microsoft, which definitely knows what they are doing in the server space and online applications arena, can have business-critical outages certainly the smaller vendors can, too. Better to take a lesson now and be prepared.