After my last post about mobile site development, I found two other resources that I thought were good and expanded on my basic thoughts about designing a mobile site.

Mobile Web Developer's Guide which I found on Network Solutions' web site.

And Get your website ready for the Mobile Web in 10 steps which I found in a Google search.

What I find the most interesting about developing sites for mobile devices is that it takes me back to when I was learning web development in the late 90's when dial-up was the norm and broadband the exception.  But it also adds more form factor challenges because of the size of the devices.

When creating a mobile website, several adjustments or considerations need to be made.  Obviously, you don’t just port your current website, optimized for a monitor, over to a mobile site.

You need to build the site as if you were building a site for dial-up users.  The download/upload speeds on smart phones are not yet comparable to the speed of a broadband connection.  Image sizes need to be minimized and html simplified.

The page layout needs to be more vertical than the page design for display on a monitor.  The user on a smart phone will be scrolling up and down to look at the page and the screen resolution is not very wide.  Also, the page length should be kept as short as possible to avoid long, endlessly scrolling pages.

Applications need to keep this rule in mind also.  The forms should only contain a few fields of data entry because it is more difficult to enter data on a phone than a keyboard and the load times will be slower.

The most important consideration, I feel is to make sure that what you put on a mobile makes sense for the user to use.  An obvious example is that you wouldn’t put an application on a mobile site that requires the user to print a page.  Less obvious is applications that can be built with all the other requirements in mind, but don’t consider whether the user will use them or not, don’t consider the process.  We can build a mobile site that has the full features of our Find a Doctor application, including the ability to compare physicians and request appointments, but we realized that a patient would not be doing that on their phone.  A patient would be looking up a doctor’s phone number, location, office hours, etc.  

So that’s what we built:  http://mobile.eCommunity.com.

Take a look at the site and see if you agree or disagree with what I’ve said here, or have comments about the site.

Mark Dixon, president and CEO of Community Hospitals of Indianapolis, recently became a Fellow of the American College of Healthcare Executives (ACHE), the nation's leading professional society for health care leaders. Dixon is privileged to use the FACHE credential, which signifies board certification in health care management and ACHE Fellow status.

"Because health care management ultimately affects the people in our communities, it is critically important to have a standard of excellence promoted by a professional organization," says Thomas C. Dolan, Ph.D., president and CEO of ACHE. "By becoming an ACHE Fellow and simultaneously earning board certification from ACHE, health care leaders can show that they are committed to providing high-quality service to their patients and community."

Fellow status represents achievement of the highest standard of professional development. In fact, only 7,500 health care executives hold this distinction.

To obtain Fellow status, candidates must fulfill multiple requirements, including passing a comprehensive examination, meeting academic and experiential criteria, earning continuing education credits and demonstrating professional/community involvement. Fellows are also committed to ongoing professional development and undergo recertification every three years.

"I'm thrilled to be recognized as Fellow of the American College of Healthcare Executives," Dixon says. "This is such an amazing honor and I am so pleased to be able to serve our patients and our organization at Community Health Network."

ACHE is an international professional society of more than 30,000 health care executives who are leaders in a variety of health care settings.

Indiana artist Debbie Reichard has completed the installation of an outdoor sculpture in the circle entry of Community Hospital North. This installation is an extension of the Community Health Network Foundation’s initiative to incorporate art into the healing process for patients and families.

Titled A Torrent of Pleasantries (in plaid), the installation is five feet tall and 15 feet long and is made of garden hose and steel. This installation is the first in a series of planned projects created by art students at the Herron School of Art and Design at Indiana University-Purdue University Indianapolis. Later this year, more temporary sculptures will be installed as part of an ongoing relationship with students and faculty. Visitors can enjoy this installation through October 2009.

According to Reichard, this installation is her satirical view of suburban life. “Sentimentally, we can be intrinsically connected to specific objects, colors, sounds and smells,” she says. “Even though many of these triggers seem unremarkable to most, everyone can think of an object that reconnects them to a memory.”

Reichard is a former visiting assistant professor of sculpture at the Herron School and has also taught at the University of Washington and the University of Colorado. She is known for creating unique sculptures and ceramics. “I want to change normal,” she says. She works in metal, wood and ceramic, found objects, castable polymers, and sound.

I just uploaded some new video from the Community Hospital South Groundbreaking, last night we pushed out the actual ceremony footage, and today introduced a new video album featuring employee videos about the new facility. 

We just made an update to the Find a Doctor application on eCommunity.com, basically an update to correct some application flow issues.  One of the major issues was our attempt to stop users from using the back button because it was causing issues with the session and search results of the application.  It was causing several unintended effects like not being able to come back to a profile page or leave a profile page each occurred in a different set of circumstances.

Shouldn't have done this in the first place.

Attempting to stop back button use is a major usability must-not-do.  There are many articles and books and web pages discussing this usability problem.  Probably the most famous is Jakob Nielsen's "The Top Ten Web Design Mistakes of 1999" which still applies today.

I recently read his book "Prioritizing Web Usability" (written with Hoa Loranger) which was published in 2006 and many of the usability problems that he wrote about in 1999 are still relevant today and relevant for the future.  It shows how timeless design issues can be and that developers who don’t understand the past are doomed to repeat design mistakes of earlier developers.

From PEDIATRICS Vol. 119 No. 1 January 2007, pp. e124-e130 doi:10.1542/peds.2006-1222)

This study looked at the effectiveness of Lactobacillus Reuteri in the treatment of  Infant Colic (10⁸ live bacteria per day).  Infants receiving L reuteri showed a significant reduction in daily crying time by day 7, compared with infants treated with simethicone. On days 14, 21, and 28, crying times were significantly different between the 2 treatment groups. At the end of the study (day 28), the median crying time in the probiotic group was 51 minutes/day (range: 26–105 minutes/day), compared with 145 minutes/day (range: 70–191 minutes/day) in the simethicone group, with a difference of 94 minutes/day.  On day 28, 95% were responders in the probiotic group and 7% were responders in the simethicone group.

Are you using probiotics in infant colic?  Please relate your experience in the comments below.

Community Health Network was a presenting sponsor for the inaugural Race Around the Reservoir Geist Half Marathon and 5K, which occurred on May 17.

Dan Hodgkins, vice president of health promotion and community benefit called the event “an incredible success.” In all 4,500 people participated in the event—the most ever for an inaugural race in the state of Indiana.

One of the largest successes was the involvement of children. Last year, Community along with The Lawrence Township Foundation started the Kids Up and Running program in the Lawrence schools. The goal was to combat sedentary lifestyles and get children and their families moving. More than 1,200 students raced in the half marathon and for more than half, it was their first organized race. “I think we had more success than anyone ever thought about,” Hodgkins says.

All proceeds raised from the race will go to support the Up and Running program as well as other similar programs in the Metropolitan School District of Lawrence Township and Hamilton Southeastern School District.

“This is a great example of how our Community Health Network contributions “pay it forward” to the broader community,” Hodgkins says.

Community programs awarded for addressing childhood obesity
The U.S. Surgeon General, Steven K. Galson, M.D., has singled out two model programs in Indiana to be awarded for successfully addressing the issues of childhood obesity. A news conference was held Wednesday, May 28, at Douglass Park in order to present the awards to Lawrence Township Foundation’s “My Community Gets Healthy” program and Indianapolis Public Schools Howe Academy’s “Fit4life” program.

Both of these programs have been supported by Community Health Network. “I am very proud of the work my department staff has provided to make both of these programs a reality, especially Karen Shirey, Lutrell Lauderdale, Todd Williams and Marcia Plant Jackson and others,” Hodgkins says.

The Surgeon General asked some of the student runners from the Geist Half Marathon, including a student at MSD Lawrence, who came in 14th out of the entire field of 4,500 runners, to be present at the awards ceremony and press conference. He was able to compete in the race with the support of the school clinic staff including, Denise Schnell, family nurse practitioner at Brook Park.

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.

Earlier this year, Community Hospital East demonstrated that its stroke care program follows national standards and guidelines that can significantly improve outcomes for stroke patients. The Joint Commission’s Primary Stroke Center certification is based on the recommendations for primary stroke centers published by the Brain Attack Coalition and the American Stroke Association’s statements and guidelines for stroke care. The Joint Commission launched the program—the nation’s first—in 2003.

A celebration was held Thursday, May 15. “As part of the celebration and in recognition of Stroke Awareness Month, members of the stroke team will host a stroke education table. The team will explain stroke risks, sign and symptoms. Give-away items and contest prizes will be awarded to individuals who participate in interactive quizzes and drawing. We hope to see many of our employees as well as visitors stop by to celebrate with us,” commented José Longoria, Vice President of neuroscience/pulmonary services.

Established in 2004, Community East’s Stroke team is led by clinical nurse specialist Deb Ferguson, M.S.N., R.N., C.C.R.N., C.N.R.N. and Doug Strobel, M.D., medical director for the Stroke Program. This team is comprised of multi-disciplinary clinical team members from throughout the hospital that care for the stroke patient along the path of recovery. It meets regularly to review, discuss and evaluate patient safety and quality goals, education and training, new policies and protocols to achieve The Joint Commission Accreditation as a Primary Stroke Center. 

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.

Congratulations to Community Hospital Anderson and The Indiana Heart Hospital for being selected to receive 2008 Leadership Awards for Clinical Excellence from VHA Inc., a national health care alliance based in Irving, Texas.

Community Anderson and The Indiana Heart Hospital were recognized at the VHA Leadership Awards Recognition Banquet on Sunday, May 4, at the 2008 VHA Leadership Conference in Philadelphia.

• Community Anderson received an award for Clinical Excellence for Acute Myocardial Infarction Care
• TIHH received awards for Clinical Excellence for Congestive Heart Failure Care and Surgical Care

The 2008 VHA Leadership Award for Clinical Excellence honors VHA member organizations that have distinguished themselves by meeting or exceeding national performance standards in specific clinical activities. To be selected for a Clinical Excellence award an organization’s composite score must be in the top 10 percent for at least the core measure category beginning third quarter 2006 through fourth quarter 2007. All information was based on data from the Joint Commission. VHA serves more than 1,400 not-for-profit hospitals nationwide.

Community Anderson: Acute Myocardial Infarction Care

See how Community Health Network compares for heart attack care >>

Community Anderson is one of 16 VHA member hospitals nationwide to receive a 2008 Leadership Award for excellence in treating heart attack patients.

For heart attacks, best practice standards include:

• Aspirin prescribed at time of patient’s arrival
• Aspirin prescribed at time of patient’s discharge
• ACE inhibitors or beta blocker administration for left ventricular systolic dysfunction
• Adult smoking cessation advice/counseling provided to patient prior to discharge
• Beta blocker prescribed at time of patient’s arrival
• Beta blocker prescribed at time of patient’s discharge
• Amount of time until thrombolysis administered
• Amount of time until PCI administered

"At Community Hospital Anderson and throughout Community Health Network, we treat common health care problems uncommonly well, always focusing on quality and safety, which leads to better outcomes for our patients." says Bill VanNess, M.D., president and CEO of Community Hospital Anderson. "We are proud to be recognized for these high standards and to provide exceptional health care in Madison County and across Central Indiana."

TIHH: Congestive Heart Failure Care

See how Community Health Network compares for congestive heart failure care >>

TIHH is one of 20 VHA member hospitals nationwide to receive a 2008 Leadership Award for excellence in treating congestive heart failure. The best practice standards for treating congestive heart failure include:

• ACE inhibitors or beta blocker administration for left ventricular systolic dysfunction Detailed discharge instructions provided to patient
• Left ventricular function assessment performed on patient
• Adult smoking cessation advice/counseling provided to patient prior to discharge

"Our participation in VHA helps us achieve a higher level of performance both operationally and clinically, and we are pleased to receive recognition from VHA for our work in cardiac care," says Tom Malasto, president of TIHH.

Surgical care

TIHH is one of 13 hospitals nationwide to receive a 2008 Leadership Award for surgical care. These steps toward quality include:

• Administering antibiotic within one hour prior to surgical incision
• Selecting appropriate antibiotic for surgery patients
• Discontinuing antibiotic administration within 24-hours after surgery (within 48 hours for cardiovascular procedures)

"The award validates the dedicated focus of our clinical staff and physicians to pursuing excellence in the care provided to our surgical patients," Malasto says. "Preventing infections following surgery is a key objective of our surgical team. To ensure the proper outcome, our staff focuses on national indicators of quality."

Today I read an article from Jakob Nielsen "How Little Do Users Read?" and I began thinking about my experiences as a web developer.  The concept of text scanning and that users read between 20 and 28% of the text on a web page feels right to me.  One thing that I have learned and that I always say:


This is part of what I call the paradox of content.  There exists the desire to fix usability issues with an application by adding more instructions.  When that doesn’t help, even more instructions are added.  All the time, the user is not even reading them.

The way to fix usability issues is by fixing the real issue with application design, flow, etc. and by not adding more content.

This idea obviously can also be applied to content, information architecture, and web site design. 

Actually, I would like to call it a methodology.  The Paradox of Content Methodology. 

Or maybe I can create a movement.  The Paradox of Content Movement.

Besides just creative and non-creative people, I think there are two types of creative people:  Those who think of lots of ideas and those who think of ideas that they can execute.  I believe that I am one of the latter.  I have at times thought that I am not a creative person, but I recently realized that I have thought of creative ideas, bringing together concepts, etc. and my ideas are ones that we can create or that we have created.  I build off of work that we have already done or have a vision that I work towards.  Just because I don't have lots of ideas (including some that can't be done), doesn't mean I'm not creative.  One of the benefits of the person who has lots of ideas is that they can inspire ideas in others.  I filter the ideas that I have and don't spend time working out ideas that can't be actualized.

I have said this many times.

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.

Community's bariatric services has partnered with Medical Animatics, LLC, to provide weight loss surgery patients with access to an online, interactive, media-rich educational program. The program's tools help patients and families learn about upcoming procedures, manage their post-surgical lives and "make healthier lifestyle choices." A highlight of the online tools is a self-paced informed consent agreement that guides patients through the details; this replaces the traditional paper-based consent form. Bariatric patients simply log in to My Informed Choice to interact with the product.

I used to work in the e-learning industry, so I find this company and program interesting, particularly the niche approach the company takes by focusing on scientific and medical content. It will be interesting to see the measurable outcomes of this program in terms of patient understanding and knowledge application as well as any process improvement in bariatric surgery services.