jaredsinclair + com

Great 2010 Congressional Election Infographics

Sun, 05 Sep 2010 10:44:24 -0500

Great 2010 Congressional Election Infographics:

The New York Times has some helpful interactive infographics on this year’s congressional elections. Notice how slim the margin is between a Democrat and a Republican controlled House. Also, despite how much their executives must despise the Internet for what it has done to the newspaper industry, the Times consistently makes outstanding use of this new medium.

Smartphones Will Outsell PCs Next Year

Fri, 03 Sep 2010 12:37:50 -0500

Smartphones Will Outsell PCs Next Year:

Asymco calls it like it is:

If the 1 million/day benchmark holds, and all indications are that it will, then the total smartphone/iPad/touch market will be greater than the total PC market next year.

The healthcare IT industry seems oblivious to this seismic shift. Eclypsis, Epic, and Cerner are the only EMR vendors whose products really meet meaningful use criteria. How many of them have iOS or Android apps? Two: Eclypsis and Epic. Of these apps, how many offer functionality for nurses and ancillary staff? Zero.

Technology company executives take heed: the future is touch. Now is the time to pour resources into this new market. If you don’t, your companies will soon be muscled out of relevance by upstarts who get it.

Racist TN Republican on The Daily Show

Thu, 02 Sep 2010 11:59:22 -0500

Racist TN Republican on The Daily Show:

Tennessee Republicans have been protesting the expansion of a local Islaamic center down in Murfreesboro on the grounds that it is a terrorist training camp in disguise. They actually believe this, as a Daily Show interview with local opposition organizer Laurie Cardoza-Moore reveals. Since appearing on the show, Cardoza-Moore claims that she’s been receiving death threats on her cellphone. I have my doubts. Judging by her Daily Show interview, she looks about as divorced from reality as one can get without being a candidate for an involuntary admission.

Apple Debuts New iPods, iTunes, Apple TV, and More

Wed, 01 Sep 2010 13:52:47 -0500

Apple hosted it’s yearly iPod event today from California, debuting lots of new products. Interested parties can visit Apple’s homepage to see it all firsthand. Here are the items that excited me the most.

iPod Touch: Thinner, Video Chat, HD Video/Photo Camera.
This is the christmas present this year. There are plenty of people you know who don’t want an iPhone but would enjoy having an ultra-portable, ultra-slim video camera + internet device + video chat device in their pocket or purse. FaceTime video chats work internationally, and without any phone carrier charges. The audio quality is better than any other type of international call as well (mobile call, Skype, AIM, Google Voice, etc.). Coupled with the same Retina Display and dual camera setup as the iPhone 4, the new iPod touch is easily worth the $229 entry price.

iOS 4.2 Wireless Printing, Wireless Audio/Video Streaming to your TV & Stereo.
Steve Jobs previewed some killer features of iOS 4.2 today during his iPad round-up. The notable additions include the ability to print documents directly from an iPad to a wifi-networked printer, and the ability to stream audio and video from the iPad wirelessly to your home stereo or television (Airport Express base station or soon-to-be-released, next-generation Apple TV required). Although the website doesn’t yet explicitly state as much, it isn’t a stretch to assume that these features will be extended to the iPhone and iPod Touch as well.

Orange Introduces HD Audio Mobile Phone Calls

Wed, 01 Sep 2010 07:52:00 -0500

Orange Introduces HD Audio Mobile Phone Calls:

Orange, a UK mobile phone carrier, has debuted a new high-definition phone service called HD Voice. Although the service requires that you purchase a new mobile phone, the calls themselves don’t use any hardware not already present in most phones. Orange has made HD Voice an open standard in the UK. I hope that something similar follows in the states.

I’ve been waiting for something like this to happen for years. If you’ve ever owned a mobile phone with a memo recording feature, then you know that the clarity of the phone calls we make has nothing to do with the hardware in our devices and everything to do with the amount of bandwidth that our carriers are willing to expend on voice calls. We’ve had mobile phones for decades without any appreciable improvement in sound quality.

Will Healthcare IT Embrace the iPad?

Tue, 31 Aug 2010 08:34:54 -0500

iMedicalApps reviews some recent news articles regarding business/enterprise adoption of the iPad as a legitimate alternative to Windows machines in the workplace, taking it as a sign that healthcare IT is poised to adopt it, too:

All in all, these developments bode well for the adoption of the iPhone and iPad as a mainstream, IT-blessed mobile healthcare solution.

iPad enthusiast medical bloggers, and there are many, have been making optimistic predictions like these since the iPad was first revealed. I wish that I could share in their optimism, but I think that they too easily confuse a vision of what is possible with what is probable.

In the abstract, the power of touchscreen iOS devices could be the best thing to happen to healthcare IT ever. I see it benefitting nurses and pharmacists as much, if not more than, physicians. But there are a lot of things that would need to happen to make this vision a reality. Unfortunately, the history of healthcare IT is a story of under-planned implementations of misguided ideas, followed by pessimistic refusals to implement demonstrably better alternatives. Here are the obstacles I see:

1) For the iPad to become ubiquitous in healthcare, IT departments would need to overcome decades of unease with Apple products. Many IT guys I know flat-out refuse to touch them, despite the fact that they are much easier to manage than Windows machines.

2) EMR vendors would need to develop genuinely useful, native apps, and not just for physicians to review records. For the iPad to make an impact, EMR apps would need to offer a complete set of features, including support for nursing, pharmacy, and ancillary personnel. These apps cannot be one-to-one ports of legacy software. UIs designed for mouse clicks won’t work on a touch screen. I need not mention the poor track record of the usability of EMR software up to now. Do we really think that the same guys that gave us our existing crap software can produce compelling apps on an unfamiliar platform?

3) Interoperability is key. Vendors for everything from call-light systems to materials management equipment need to make it easy for new apps to interface with their solutions, either directly or through convenient middleware.

4) Last, and most important, how do we convince healthcare executives and shareholders that the costs of development and implementation are worth the benefits? As a bedside nurse, having a dreamy piece of slick iOS EMR software on an iPad with a barcode scanner would revolutionize the way I work, but how could that translate into terms that executives would appreciate? Will it reduce costs and improve quality? If so, and that is a big if, then the iPad has a chance. But it isn’t possible to reach that brave new world by rehashing the same ideas that brought us to the status quo. Healthcare needs more than an iPad. We need fresh talent and new ideas.

Flight Sim Software Limitations to Blame for Half of all Commercial Crashes

Tue, 31 Aug 2010 07:38:57 -0500

Flight Sim Software Limitations to Blame for Half of all Commercial Crashes:

USA Today reports:

However, as realistic as they may seem, simulators are only as good as the data used to program them. Current simulators aren’t accurate when a plane goes out of control, which has prevented their use in training for the leading killer in commercial aviation.

The computing power necessary to simulate that kind of turbulence is more readily available than ever. There’s no excuse for training programs to not to develop more realistic simulators, especially if it could reduce accidents by half.

Progress Report On Electronic Health Records In U.S. Hospitals

Mon, 30 Aug 2010 11:39:25 -0500

Progress Report On Electronic Health Records In U.S. Hospitals:

Health Affairs has published an article on EMR adoption rates across all U.S. hospitals. Their findings more or less reinforce what other similar studies found, in particular:

We found that public and rural hospitals had 40 percent lower odds of having adopted at least a basic electronic record in the year before the survey, compared to private nonprofit and urban hospitals, respectively.

I’m curious to know why smaller hospitals are slow to adopt EMRs. Is it simply a matter of cost? Or are their existing paper systems functioning well enough that they see no need to change?

Video: Adorable Robot Delivers Hospital Meds

Sat, 28 Aug 2010 21:41:00 -0500

Video: Adorable Robot Delivers Hospital Meds:

This is a video of the TUG robot by Aetheon, used instead of a vacuum tube system to deliver medications and other items throughout a hospital. It’s cute.

Huber Needles Recalled for Coring

Sat, 28 Aug 2010 05:28:16 -0500

Huber Needles Recalled for Coring:

MedPage Today reports that the FDA has recalled several brands of Huber access needles because of “coring,” which means they punch a thin sliver of silicone out of an otherwise self-healing access port when being inserted.

“Coring may lead to infection, damage or death of tissue, swelling, or other serious adverse health consequences, occurring as a result of the core traveling through blood vessels into the patient’s lungs. These issues may potentially cause death,” the FDA said in its recall notice.

Rapid Response Team Reduces Inpatient Cardiac Arrests 57 Percent

Sat, 28 Aug 2010 05:15:00 -0500

Rapid Response Team Reduces Inpatient Cardiac Arrests 57 Percent:

A retrospective study has demonstrated that the introduction of a rapid response system at a particular Veterans Affairs hospital reduced cardiac arrests by 57 percent. Way to go!

Imagining a Universal Health Record

Wed, 25 Aug 2010 10:28:00 -0500

Heather Leslie (a.k.a @omowizard) on her concept of a universal health record:

A uhr is simply a non-proprietary pool of standardised health data which can be used for any purpose we want – PHR, EHR, EMR, SEHR, IEHR, research, epidemiology, reporting & stats, shared care, clinical decision support & more. There is no particular EHR application associated with it; in fact it works with any and every software program, vendor and healthcare provider.

She’s exactly right. I think the shortest analogy is to compare it to Twitter. Twitter provides a core set of data (user accounts, tweets, and some meta data), along with the APIs to access and manipulate them. Anyone is free to develop software that takes advantage of their framework, as long as they agree to certain rules of fairness and privacy.

The result is a diverse marketplace of Twitter apps. Some of them offer the full set of Twitter features (Twitter, formerly Tweetie for iPhone), while others focus on one particular aspect (Peephole for iPhone). If something similar were developed for health records, it would allow both all-encompassing EMRs and more narrowly-focussed apps (medical imaging comes to mind) to be useful in any context. Hospitals could switch EMRs without being trapped in a proprietary data-silo. Best-of-breed software would rise in market share based on merit instead of technical limitations.

Your Patient is My Patient, Too

Tue, 24 Aug 2010 16:22:00 -0500

While on my way back to the unit after transferring a patient to a medical/surgical floor, I was stopped in the hallway by another patient’s wife. I could hear an IV pump beeping from her husband’s room. “Are you a doctor?” she asked. “No, ma’am,” I replied, “I’m a nurse. Can I help you?” She asked me to come see why the IV pump was beeping.

This wasn’t my floor. I didn’t want to delay getting back to the unit, but I also didn’t want this lady or her husband to have to listen to that awful pump alarm for ten minutes, especially if it only needed simple fix. There were other nurses around, but they were already tied up in other patient’s rooms. The alarm was not of a critical nature. It sounded like an “Infusion Complete” message. I knew the alarm wasn’t critical, but it was clear that this lady did not.

I followed her into the room and found what I suspected. The bag of normal saline was low and the pump was awaiting new instructions. I found the patient’s nurse in the next room. She was focused on starting a new peripheral IV line. I told her that the pump in the other room needed a new bag of saline and that I would take care of it for her. “Are you from night shift?” the nurse asked, wondering why she didn’t recognize me. “No, I was just dropping off a patient,” I replied, “and your other patient asked me for help.” Her face looked a little shocked. I could tell she was wondering why a nurse from another unit would take the time to hang a new bag of saline for her.

I think it’s sad that we’re prone to assume that turf divisions between different nursing units are immutable facts of life. They’re arbitrary, and we can ignore them if we want. Your patient is my patient, too. Why wouldn’t I want to help?

Nurses Need Better EMRs

Thu, 19 Aug 2010 02:08:00 -0500

There’s always a lot of stink from physicians over usability problems with EHRs: too many clicks, too many contextual menus, etc. The gist of these complaints is, “Physicians aren’t data entry clerks!” The computer is getting in the way of their interactions with their patients.

So what about nurses? Aren’t we laboring under the same demand to eat our cake and document it, too?

Nurses are expected to document innumerable facts: vital signs as often as every fiften minutes, turning a patient, fluid intake and output, medications, pain questionnaires, etc. Hospitals require that these data be entered into a computer for all patients by the end of each shift. Many nurses have to stay late after their shift ends to complete their charting. This costs hospitals a lot of money and employee satisfaction.

We can’t avoid the need for thorough documentation. To some extent, data entry is part of every nurse’s job description. Physicians need the facts that we document in order to make informed decisions. Hospitals need them to measure cost-effectiveness and to demonstrate commitments to safety.

What do nurses need in an EMR?

Nurses need an EMR that doesn’t exist yet. We need one that enables us to document more data in less time. Existing EMRs are notoriously user-unfriendly. They seem designed by developers with no understanding of bedside nursing, and whose primary concerns were compliance and cost. Workflow efficiency came last, if it came at all.

Contemporary EMRs are only contemporary insofar as they are being sold in 2010. They are otherwise relics of the 1990s (or worse). One finds endless tabs of little grey boxes and drop-down menus without any visual cues to separate the meaningful facts from the JCAHO-compliant fluff.

Companies like Apple and Nintendo have spent decades reinventing and refining the way that we interact with technology. Apple has even published a lengthy document detailing the human interface guidelines they encourage app developers to follow to make their apps more user-friendly. Documents like these are widely available. Why don’t EMR developers take advantage of them? Could rounded corners and simplified interfaces really be that expensive? Wouldn’t ease of use be a marketing point that spurs widespread adoption?

If the best UI design practices were integrated into our EMRs, it could allow nurses to fully document their day, in real time, and in less time, freeing us to spend more time doing what we went to nursing school to do: care for our patients.

Where are All the iPhone EMRs?

Thu, 19 Aug 2010 02:03:00 -0500

Where are All the iPhone EMRs?:

EMR & HIPAA Dot Com are putting together a wiki of EMR vendors with information on OS and device compatibility. So far out of the thirty-one they’ve counted, how many are natively supported on MacOS? Nine. How many on iOS devices? Zilch.

Google launching a Chrome OS Tablet on Verizon

Wed, 18 Aug 2010 12:12:00 -0500

Google launching a Chrome OS Tablet on Verizon:

There’s really no more room for doubt; touchscreen tablet devices are not going to be a passing fad. They’re the way forward. So to all you EMR developers out there… cough-cough… quit screwing around already. There’s lots of money to be made.

Learning About EMR Database Encryption the Hard Way

Wed, 18 Aug 2010 11:47:00 -0500

Learning About EMR Database Encryption the Hard Way:

Robert J. Rogers, MD on EMR database encryption:

In an informal survey of my physician friends, none of them understood the importance of encryption. None had asked their vendors about encryption. Many of these doctors host their own servers.

I blame the developers and vendors. Encryption should be the default setup.

Twifficiency Actually not a Scam

Tue, 17 Aug 2010 21:10:19 -0500

Twifficiency Actually not a Scam:

Did you get hooked by that “Twifficiency score” thing today on Twitter? Well it wasn’t a scam. It was a rookie coding mistake by some 17-year-old Scottish bloke learning oAuth.

Great Design of the Week: Field Notes County Fair Boxset

Tue, 17 Aug 2010 13:00:00 -0500

My Field Notes County Fair boxset came in the mail last week. I haven’t bought any of their special editions before, but this one was on sale for 33% less than the regular Field Notes. A set of 50 memo books, one for each US state, comes together in a nice package with a decorative ribbon and some free pens.

Click here and here to see photos.

I depend on Field Notes in the hospital. They fit nicely in my pocket, and the graph paper is quadrilled at just the right size for jotting down MAR schedules, H&Ps, labs, and non-scheduled to-dos. The County Fair edition is bound with linen paper, too, making them especially durable. All told, for 100 bucks I’m set for the next year’s worth of patients.

Cleveland Clinic Redesigns the Hospital Gown, Makes Men Look Even More Like Women

Tue, 17 Aug 2010 08:58:00 -0500

Cleveland Clinic Redesigns the Hospital Gown, Makes Men Look Even More Like Women:

From a Newsweek interview:

“I’ve been a nurse for almost 30 years, and the [traditional] gown leaves much to be desired,” says Jeanne Ryan, who works at Cleveland Clinic and has led the redesign project for the past three years.

Three years? Healthcare efficiency at work. (Via @drves.)