2006-08-24 00:00:00

Beware of vendors bearing SOA gifts

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 ITare integration oriented (by utilizing standards such as HL7) but won’t be easily converted to a service oriented quickly or without major changes.

Filed under: — @ 2006-08-24 00:00:00
2006-08-24 00:00:00

$10 Million available to Patient Monitoring Engineering Team

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.

Filed under: — @ 2006-08-24 00:00:00
2006-08-23 00:00:00

Interesting Hopkins Study on Tracking Medication Error Reports

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).

Filed under: — @ 2006-08-23 00:00:00
2006-08-23 00:00:00

Interesting Hopkins Study on Tracking Medication Error Reports

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 interestingfindings 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).

Filed under: — @ 2006-08-23 00:00:00
2006-08-21 00:00:00

Promising Probiotics

The National Council on Complementary and Alternative Medicine (NCCAM), which is a part of the National Institute of Health (NIH) released their quarterly report this week with a big boost for probiotics.

Probiotics are helpful bacteria that live in our bodies; they assist with the breakdown of food and the absorption of vitamins and minerals.? If the body has a lack of “good” probiotics, nutrition from food will not be absorbed.

What can cause a decrease in “good’ probiotics?

  • Antibiotics, when they kill friendly bacteria in the gut along with unfriendly bacteria. Some people use probiotics to try to offset side effects from antibiotics like gas, cramping, or diarrhea. Similarly, some use them with the intent to ease symptoms of lactose intolerance, a condition in which the gut cannot digest significant amounts of lactose, the major sugar in milk.
  • “Unfriendly” microorganisms such as disease-causing bacteria, yeasts, fungi, and parasites can also upset the balance. Researchers are exploring whether probiotics could halt these unfriendly agents in the first place and/or suppress their growth and activity.
  • Probiotics have been shown to be helpful in treating a number of conditions…. read on in the NCCAM Newsletter.

    Filed under: — @ 2006-08-21 00:00:00
    2006-08-20 00:00:00

    Skin infection “super-bacteria” on the rise

    Examples of antibiotic-resistant bacteria are becoming more prevalent as science struggles to keep pace with the genetic modifications demonstrated by certain ?super bacteria.? These bacteria, through modification, have been able to make themselves immune to some if not all types of antibiotics.

    Methicillin-resistant Staphylococcus aureus, or MRSA, was once very rare and hardly seen in doctor?s offices. A recent study revealed that this once rare strain has been become increasingly more common and accounts for more than half of the skin infections treated in U.S. emergency rooms.

    A common presentation is what looks like a spider bite or pimple that is not getting better. Patients rarely understand the gravity of situation prior to visiting their doctor.

    Dr. Rachel Gorwitz of the U.S. Centers for Disease Control and Prevention, said: “I think no one was aware of the extent of the problem.”

    Skin infections can be life-threatening if bacteria get into the bloodstream.? Drug-resistant strains can also cause a vicious type of pneumonia and even “flesh-eating” wounds.

    If you or your child is experiencing a skin irritation that looks like a spider bite or a pimple that is not getting better, visit your primary care physician.? If he or she recommends antibiotic medications, question your physician about possibility of antibiotic-resistant bacteria.

    Contamination prevention tips:

    Wash hands thoroughly and often with soap and water.

    Keep cuts and scrapes clean and covered with a bandage until healed.

    Avoid contact with other people’s wounds or bandages.

    Don’t share towels, wash cloths, razors, soap, ointments or other personal items.

    Wipe down athletic gear like mats, head protectors and gym equipment with alcohol or antiseptic solution after each person uses it.
    Full story: CNN.com

    Filed under: — @ 2006-08-20 00:00:00
    2006-08-17 00:00:00

    Collaboration tools can transform healthcare IT but be careful

    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.

    Filed under: — @ 2006-08-17 00:00:00
    2006-08-17 00:00:00

    Collaboration tools can transform healthcare IT but be careful

    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.

    Filed under: — @ 2006-08-17 00:00:00
    2006-08-16 00:00:00

    Event: Profiling the Agile Architect

    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.??

    Filed under: — @ 2006-08-16 00:00:00
    2006-08-16 00:00:00

    Healthcare app and devices design

    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.

    ??

    Integrated New Product Development Model????

    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 doto 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

    ??

    Filed under: — @ 2006-08-16 00:00:00
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