Here are some great articles I found this week.

Australian Students ditching Outlook for gMail

This is something I was really excited about, being a big fan of gMail and Google Apps for Your Domain in particular, and not a big fan of Outlook/Exchange. Basically one and a half Australian students just started using gMail. This is particularly interesting, as these students will enter the workforce familiar with a whole new set of tools.

http://www.techcrunch.com/2008/06/23/15-million-australian-students-dump-outlookexchange-for-gmail/

Patient Records Safeguarding

More on topic with health care, the article below from Ars Technica talks about safeguarding patient medical records, and extending it to cover things like Google Health and Microsoft's HealthVault.

http://arstechnica.com/news.ars/post/20080625-privacy-security-and-health-it.html

FriendFeed and Brands

In the realm of branding and social networking, I found an interesting article on FriendFeed. Now, if I can only figure out what email address I used when I signed up, I'll be happy.

http://bhc3.wordpress.com/2008/06/10/will-brands-figure-out-friendfeed/

Finally, some cool new web tools worth looking at:

Snapcasa - SnapCasa is a quick and free screen shot gatherer.

http://mashable.com/2008/06/03/snapcasa-quick-free-website-screenshots/

Embedding RSS with Google's Ajax API

Google has apparently made embedding RSS super easy, and since I am working on a bunch of feed related projects, I will be all over this. At first glance it is cool, but I'd like to be able to jut add feeds directly. I'll need to spend more time with it.

http://lifehacker.com/395354/google-makes-rss-embedding-easy

Thats it for today!

I am responding to a comment posted on my last entry:

"Didn't you just argue against your own point? The constant communication is already happening, and will continue to happen, the filtering has nothing to do with Web 3.0, or Web 2.0, or anything. I am in constant communication with everyone i know, via email, blogs, SMS, etc., and filter out simply by not checking, and only allowing certain communication methods to reach me when I choose them to. I'm not clear what your not buying."

I decided to respond with another post.

First of all, no one today is in the constant level of communication with user generated content that is described in the book.

Second, I disagree that filtering is not part of Web 3.0 (or whatever you want to call it).  Web 3.0 is also sometimes referred to the Semantic Web which means that web documents will be more structured and machine readable.  I believe this will be part of the evolution of web technologies and will ultimately create a vast world wide library of information.

Consequently, information retrieval algorithms will be more refined and filtering will be part of this refinement or users will not be able to find what they need when there are trillions and trillions of web documents.  I have observed friends and colleagues with information overload issues in e-mail and other communications.  I have experienced it myself and have set up rules in Outlook to filter e-mails into categories, generally consisting of ones to ignore, ones that are urgent and ones that don’t need immediate attention.

This information will consist of friends, family, etc. and businesses, marketers and other organizations vying for your attention, just like there are issues with e-mail spam today.  The spam will come in many different forms in the future and will use these new social networking/user generated content technologies.

This need for filtering will just grow in the future as the expanse of information exponentially increases.

I’m going to go out on a limb here and make a prediction of the future of the Internet.

I recently skimmed through a book called "Groundswell", written by Charlene Li and Josh Bernoff.  The last chapter was an extrapolation of the current state of social software that they call the groundswell.

The future that they believe will be here within five years is one where everyone is in constant communication through blogs, ratings/commenting systems, social networking software and instant messaging.  You will get notifications from friends, work, entertainment, etc. all the time.

I’m not buying it.

With all the self publishing occurring, the amount of information on the Internet is growing exponentially and as a result of this trend, users will feel information overload.  This has been discussed since the 90's when there were fewer web pages.

The Web 2.0 trend is a bubble that's going to burst and be shrunk by users filtering out all the stuff that they don't want to see or sort through manually.  Just like e-mail spam filters, there will be self-generated filters on the information you search for on the Internet.

Search profiles stored in a search engine that automatically filter your information through a point of view, a set of criteria, your past viewing history or comparing your profile to results others have searched for and viewed (Wisdom of the Crowds).

Even following a single prolific blogger can be hard because everyone is very busy trying to cram more and more into a day.  Internet filters that filter through blog posts and other information will be coming soon.  And it will be delivered to the user like RSS feeds work today.

Information retrieval improvements and information filtering will be the next new big thing on the Internet, Web 3.0 if you will.  And boxes instead of rounded corners.


"We are all interested in the future for that is where you and I are going to spend the rest of our lives." --Criswell

Community Health Network recognizes that the patient population continues to grow within a diverse culture. Each year employees face many obstacles in their quests to provide culturally competent exceptional patient and family experiences.

The network is happy to announce the start of CultureVision, an exciting tool geared toward helping employees understand the unique needs of patients with diverse cultural backgrounds. Using internet–based technology, CultureVision brings cultural competency and volumes of research and information right to the fingertips of care-providing employees.

"I look forward to an enriching next phase of our diversity education that will help each of you provide culturally competent exceptional patient and family experiences," says Deb Whitfield, network director of diversity.

The network began using CultureVision on May 1, 2008.

I recently read this article, The 411 on mobile snap technology, about a mobile phone technology and it made me think about how we could apply this to health care.

I couldn't think of anything that would fit in with what patients would naturally use.

But we are working on a mobile site that will have scaled down/phone optimized applications that make sense to use on a phone.  We will not be putting the entire eCommunity.com site on this mobile site because it won't all work effectively on a small screen with a slower bandwidth.

Which is how our team operates.  Instead of rushing to do something cool, we make the technology fit a need to process.  We make the new application fit in our existing structure and make sure it is user friendly.

A good example is our News section on eCommunity.com.  We have news stories that have an RSS feed linked to them all and the monthly news stories also have a podcast feed.  In addition to offering the podcast, we allow the user to listen to an individual story without subscribing to the podcast.

All made as user friendly as possible with explanations of what a RSS feed is.

We also use Feedburner to make the RSS feeds as easy as possible to use for users on any browser.

We added a Google Maps mash-up to our Find a Doctor application because it made sense to do so.

These are all intelligent uses of new technology that are used to benefit the application they are added to.  They were no implemented just because it’s cool and want to build something with it.  Those types of applications will disappear in a few years leaving only the truly useful ones.  Just like what happened with the tech bubble in the 90's.  The good stuff remained and the bad ideas failed.

Community Health Network and Summit Construction Co. were awarded the 2008 Outstanding Project Award from the Metropolitan Indianapolis Coalition for Construction Safety (MICCS) for their collaboration on the Community Hospital North expansion.

“This award demonstrates that our culture of safety goes beyond our core business of patient care to touch all that we do,” says Mark Hayden, senior project manager. “Winning sends a signal through the construction industry that we care and that we pay attention.”

According to the MICCS Web site, “The 2008 outstanding project team was able to manage a coordination effort that not only allowed a safe working environment for craftspeople, but also a safe working environment for the occupants of the existing structures connected to this project.”

The construction team at Community Hospital North successfully managed several challenges, including the need to prevent the development of infections and minimize noise levels for the patients in the existing hospital while meeting an aggressive construction deadline.

To create a safe environment for construction workers, the team took an innovative approach by using new technology. The Community North expansion project was the first of its type in the country to use a Magic Arm crane, which lifts construction materials onto each floor safely and efficiently without the use of scaffolding or platforms.

This is the 12th year the MICCS has presented the Outstanding Project Award and the second time a hospital has been recognized. The Indiana Heart Hospital was the winning project in 2004.

I was at the annual meeting for my homeowners' association last night and I begin to think about open communication and transparency.

There a lot of complaints and questions about what's been going on with the leadership of the community.  There is only one meeting a year, the monthly board meetings have been either closed to the public or unadvertised.  The main source of communication has been phone or email from a web site that many homeowners didn't know about.

There have been issues with the former property manager and people in the community didn't know about that or the resignations from the board.  Consequently, many felt disenfranchised, and were distrustful of the board members and how the dues have been spent.

Watching all of this I realized that if communication had been kept in the open and homeowners informed of changes in the board and property management, their distrust would have been minimized.  And giving people a chance to speak during the previous year would have lessened the complaints in the meeting.  I believe that most people respond to open honest communication.  Explanations of community issues before this meeting would have lowered the level of hostility in the room.

How does this apply to health care?

Imagine if health care providers were open and honest all the time about what a patient is experiencing.  

You arrive on time for your doctor appointment but wait forty-five minutes to see the doctor.  Why did that happen?  The doctor may have had a complicated patient case come in and needed to spend more time with someone.  Or other patients’ lateness has caused the doctor to be running behind.  I read an article somewhere I can’t remember that stated that the main reason patients need to wait for their doctor is that other patients before have been late.  I don’t think most people know that.

Would knowing one of those situations help you be less frustrated with your doctor when you have to wait?

There are many other examples that can be imagined.  Ones that apply to hospital visits or even organization decisions.  The tools and technology for open communication are different depending on the situation.  In a hospital, talking to the patients individually would be more effective then later blogging about the event; for an organization blogging about a decision or event is more effective than individually talking to everyone interested.

I believe that open, honest communication in health care would reduce complaints and malpractice suits and allow the health care industry to spend more time treating patients.

Tomorrow our team will be hosting a Web publishing workshop. We've invited members of our marketing and communications departments, leadership, and others involved in development of our brand strategy. We have also invited a couple of our external partners, Compendium Blogware and Custom Scoop, to discuss Web publishing, in particular blogging as it relates to brand strategy.

We plan to educate a bit on the Web publishing tools we have available internally and how content owners within the organization can use them to publish messages and content in a rapid-cycle manner. Our tools include a homegrown CMS, RSS capability, e-mail marketing tools, interactive/rich media, collaborative software, blogging application, etc.

We're also going to dive into how we can use our tools to create a more interactive user experience on our Web site—one that integrates our brand message and effectively communicates Community's services and exceptional experience model to patients, families and employees.

There are many viewpoints and I'm looking forward to a lively discussion with constructive takeaways to help us as we move forward with our content strategies. Stay tuned!

A crucial piece of our health care technology arsenal is a homegrown content management system (CMS) we (read: I) use for publishing our Web content. After a year of design (and redesign) sessions, the brand spanking new "CMS2008" is in production! We are still working out some kinks as is to be expected. However, there are many upgrades: The information architecture is more logical, the WYSIWYG-ness is more user-friendly and the editor functionality is more robust.

In addition to the Web content publishing piece, CMS2008 also contains administrative tools that we can use to mange user-generated content, such as that found in our eCommunity blogs, discussion boards, and SharingSites.

The big idea here is that if we can make our CMS tool easier to use, this will help the content owners distributed across the organization feel empowered to also be active content publishers.

I had the pleasure of listening to a lecture/conference call with Seth Godin yesterday talking about his book "Meatball Sundae."  I began to wonder how the health care industry fits into his model.  At first glance it seems like health care provides a meatball service, but there are unique aspects to it that work well as the whip cream, cherry and other toppings.  Health care and health care technology doesn’t seem to fit into his model.

The e-Business team has seen a lot of new media/new marketing trends that work really well in health care.  Patient blogs are one example that we have built.  Our SharingSite application allows patients to blog about their condition and treatment in or out of the hospital.  We are also using it to post our baby/nursery pictures.  This eliminates the phone calls to family and repeatedly telling relatives the same information by a patient or family member who is already stressed and busy.

Our discussion boards that we have really not promoted are gaining more and more usage because people want to talk about their health condition, ask questions and compare their experience to other patients.  This is a common patient behavior that used to (and still does to some extent) happen in person, but now you can go online and talk to many more people.

Patients also want to find out more about their health conditions so they are using online health information libraries along with just reading blogs, discussions boards, etc to find out as much as they can about their health issues.

I believe that health care is different, that it doesn't fit the Meatball Sundae model.  Maybe it has to do with all the regulations, etc. on our industry, or that we aren’t selling a product that users generally have a choice about purchasing or not.  But they do have a choice about where to purchase it.

I met with a vendor earlier this week and one of the services they are selling was Business Process Management (BPM).  I realized that the e-Business team has been doing this for several years now, before it was the new thing.  We have been building applications that are designed with the process in mind.  We build applications that improve process and workflow.  Our applications work within the process workflow already created.

On the other hand, IT in many organizations builds or buys an application and fits the process to it, or tries to.  One reason for project failure with applications and vendor product purchases is that they don't match the process previously developed in the organization.  The project fails because there is an attempt that doesn't succeed to change the process or the process isn't understood.

In our requirements gathering we review the current process and sometimes make suggestions to improve the process.  But then take the process requirements and build an application that meets the requirements and matches the predefined process.  I think that is a major factor in our success in this organization and outside it.

I believe this is especially true in the health care field.  The medical staff is very busy and there checks in place that need to be met to insure quality health care.  Processes have been created and in place for some time and it can be difficult to change them.  Health care technology systems generally don’t work together well and there are difficulties with interoperability.  Forcing a system into this environment without considering the work flows and processes already in place will ultimately fail.  Failure can mean a lack of usage of the system, a break down in work flow or issues with patient care.

In the context of this post email means: email between physicians, physician office to physician office email and organization email  to physician email.
There is a wide spectrum of technology adoption (AKA browser, keyboard and email comfort level) by physicians affiliated with our organization.  There are those who do not use email and have no desire to use ever it (this is a minority) In contrast there are physicians that use email every day, even throughout the day via notebook pcs and  hand held devices such as the Treo, Blackberry or iPhone.

The physicians’ comfort level and skill with the keyboard, mouse and Internet browser is significantly inter related to their perception of web application and intranet usability. Further, this mouse and browser comfort level is influential to the physician adoption of email into their respective daily work flow.

In our organization all physicians either have a corporate email address or are entitled to have one upon request. Corporate email addresses are more frequently used by physicians who have dual administrative  and clinical roles or frequent business communication within the organization. It would be a generalization, but relatively safe to state that the largest volume of physicians using corporate email to communicate are the financially integrated physicians. While general medical staff and specialty physicians tend to use personal email addresses to communicate with one another about non clinical topics.

To assure the protection of personal health information (PHI) our organization utilizes a secure email gateway. This provides a solution for a physician with a corporate email account to send confidential, private communications and information that may due to its referral or collaborative purpose, contain personal health information securely to another physician. The physician receiving the secure email can be using a personal email account to receive the prompt that they need to securely access the gateway to read the content within the message. For example, a physician can send a secure email by simply prefacing his / her email’s subject line with the text “secure:”. An example subject line might read, “secure: Patient j jones blood work results”.

Most physicians affiliated with our network have personal email accounts such as Yahoo, MSN, AOL. These email accounts may be specific to the physician or be a family email account that is shared. As well these personal email accounts change, new ones are added.

This train of thought leads to the discussion of; what data / information should be communicated via email and what data/information should be communicate via the intranet or a portal? Further, what criteria should be used to discern this question and whom can or should make this final determination?

 

I was reading the latest issue of Entertainment Weekly and there was an article called "Oscars: Your Burning Questions Answered!"  One of the questions was what the word chuffed meant.  Colin Farrell said it introducing another star.  I was surprised that this question was in there because I knew the meaning of the word and have heard it frequently.

Then I realized that I knew what it meant because I am an anglophile and watch a lot of British television.  Also, it occurred to me that I have had a similar experience in talking with my family doctors who sometimes seem to be speaking a different language.  The trick is to share complex medical concepts and terminology in a way the a layperson can understand.  I have found myself doing this with technology terms.  A layperson can understand information technology concepts if they are explained in a non-technical manner.

I hope that our consumer health library explains complex medical concepts in a layperson's terms.  I believe that it does but since I work in health care, I know that I'm not the typical user.

There is a spectrum of physician readiness regarding Internet technology acceptance. Some influencing factors include; physician's work and home access, perceived quality of usability, the amount of the individual physician's browser and email experience. Physician engagement in the use of technology has been a very staged and gradual process. It has taken some 8+ years (in our organization) to accomplish the current primary care adoption rate of the EMR (> 70% of total), portal and email usage (don't have definitive measures on these yet). We see ourselves as progressive, but relatively early in our physician e-culture journey. Within this spectrum there are physicians of all ages who embrace technology and are willing to expend the energy to learn "how to" get stuff done. Others, do not have the tolerance, or are at a point in their professional working lives that they do not desire to expend such time on transitioning their respective work flow and clinical practice. That is by the way a key phrase to focus upon "work flow!"

Key learnings regarding physician web based technology engagement:

• Influential peers make a difference
• Measurable, improved clinical outcomes speak volumes
• Financial incentives can play a part
• Reproducible time effectiveness drives change
• Motivated, enthusiastic office staff essential
• Temporary, focused, additional support resources a must
• Effective governance structure must be in place to achieve large numbers

Physicians highly value physician to physician, face to face communication time. As is the case with the rest of the 21st century world there is gradual decrease in real time, much less face to face communication. Physicians don't come to the hospital for professional social networking the way they used to. They still want and need data and information. They have more mechanisms to access it within an increasingly compressed time cycle to manage it.  The question at hand is "what is going to drive physicians to physician specific, secure portal/intranet or a corporate email account?" A text book answer might read like "more convenient connectivity to each other to clinical systems, more efficient workflow, CME, rapid access to reference material & to pose clinical questions / care plans / protocols / evidence based data."

The content / data we all desire to share can be broadly categorized into the categories of communication/news, relationships/political, business operations and clinical operations. These diverse categories make physician intranet / portal and email adoption challenging but, it also (we believe) holds the secret to success.  Our experience to date regarding the adoption of electronic medical record (EMR) or corporate email would indicate that a one solution approach will not be quickly accepted by the majority. There is no magic solution that will remedy all physician e-culture challenges. Progress will be achieved through an evolution of education, experience and acceptance.  Ong and Polkowski et.al. 2001 writes that "It is possible to create and diffuse an Intranet in a multi-hospital system in a cost-effective manner. However, the key challenges were selling the potential of this new technology to opinion leaders and other stakeholders...."

This is an admittedly incomplete list of topic related articles, and I will promise to continue to add to this list as we may find relevant.

Online Physician Communications Related References

Medical intranet success factors
Healthcare Financial Management,  July, 1998 by Edward Fotsch
Obtained from the World Wide Web June 9, 2007
http://findarticles.com/p/articles/mi_m3257/is_n7_v52/ai_21045765

Medical intranets: new technologies expose old problems
Healthcare Financial Management,  March, 1998 by Edward Fotsch
Obtained from the World Wide Web June 9, 2007
http://findarticles.com/p/articles/mi_m3257/is_n3_v52/ai_20633688
 
Intranet Dashboard a Lifesaver for Sentara Physicians, March 16, 2007
Obtained from the World Wide Web June 9, 2007
http://www.intranetjournal.com/articles/200703/ij_03_16_07a.html
 
Building and Growing a Hospital Intranet: A Case Study
Kenneth R Ong, 1 Michelle Polkowski, Geoff McLemore, Mark Greaker, and Malcolm Murray, Kenneth R Ong
Obtained from the World Wide Web June 9, 2007 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1761884
 
The portal advantage. Hospitals lure docs with easy access to medical records
Greene J., Hospitals & Health Networks / AHA [Hosp Health Netw] 2001 Oct; Vol. 75 (10) pp. 56-8

I can't find where I read it but I remember reading a discussion, I think it was in Wired Magazine, about how the presidential candidates were using the Web and Web 2.0 technologies.  I remember a chart of the candidates and what they were using.  And one of them, Edwards I think, said something like blogs, wikis, rss, Twitter..too..much...Web 2.0 (I always imagine this with the voice of the best Captain Kirk impression).

I like Web 2.0 technologies and they can be useful in health care if applied intelligently to problems, but they can be abused.  Just like Flash was abused in the 90's, a site can have an overload of these applications and overwhelm the user.  We try to use them where appropriate to solve business problems.  One of the best examples is the Google Maps mash-up we incorporated into our find a doctor application.  It displays a map of the office locations in a physician profile.

Five years from now...text messaging will replace web sites.  I don't believe that.  I had a meeting with a vendor today and we were discussing text messaging and uses in health care.  It was a good discussion and one thing that was stressed is that text messaging is for very small discreet messages or interactions with a user.  It won't replace a web site but it can support a web site strategy.  One of the advantages is that it is easier to, in some cases, use your phone to interact with a site than to log on to the Internet and then a web site and then interact with it.  Convenience is an advantage but there is a lack of user interface and it's difficult to supply user feedback or correction.  So if the task is small, like recording a single piece of numeric data or being sent a reminder, text messaging works great.  If the interaction is complex and involves several pieces of data text messaging is not a good medium for the interaction.

Like Marshall McLuhan says, “The medium is the message.”  To create a text messaging application, you need to consider the medium, its benefits and its constraints.  Then select a project that benefits from the medium and could not be done as effectively in some other medium.  Work with the process and not try to impose a technology on situation and force a new process.

In another meeting there was a discussion about using Internet technology to accomplish a goal but the methodology was from another medium.  The idea was to use the internet but in a way that would be better accomplished in another older technology.  The medium is the message and the medium should be part of the determination of the tools used to accomplish a goal.  You can use a screwdriver to hammer a nail but a hammer would be more effective for that task.  Why are we trying to hammer Internet nails with screwdrivers?

Dan shared this really great video below, as both of us attempt to catch up on eMail at 10:30 at our homes. We here at Community are constantly attempting to sum up the vastness of our collective knowledge, and Dan seems to have found a video that does it in 5 minutes.

…I now have more time to start blogging.

The title of this blog comes from the meme that I have frequently heard that health care technology is five years behind other industries. I have heard this many times from many different sources. The goal is to discuss technology that is happening today in other industries and how it can apply to health care.

My name is Michael and I am a Senior Web Developer for Community Health Network. I develop the applications that run these web sites. I have focused on the Internet sites we maintain, including eCommunity.com and hearthopital.com.

I have always tried to look to other industries for ideas about what we can do on our web sites. If the five years behind idea is a truism, then by focusing on only what is happening in health care our group will be constantly trying to catch up or stay current with other health care web sites. By looking at what other industries are doing, we can be more innovative and work on projects that use current ideas for health care uses.

One clear example of a technology we are trying out for health care is blogging as evidenced by this blog itself. We wanted to try it out and see how we can talk about health care issues and not violate HIPAA rules and not allow competitors to see what we are doing before we have completed it. Transparency is a new trend but transparency in health care can be tricky especially when it comes to patient privacy. Mistakes in health care can be more serious that a software bug or not shipping a purchase. It involves patients’ lives and health, obviously.

We are also working on podcasting and RSS feeds. We have implemented some but are moving slowly so that they are integrated into our website, are easy to use and make sense to the user. We don't implement technology just to do it, but we want to insure that the user can find it, understand it and easily use it.

I plan to discuss health care topics, challenges with implementing technology, projects we have put into production and anything else I think would be of interest to health care technology readers.