The Ride-Along

2009-09-16T16:50:00.006-03:00

Is There Life Beyond Enterprise Grade?

The answer is yes. But I warn you the answer may result in Shock and Awe for your brain.

Are you ready?!

Nation Grade.

There I said it. It’s out there. There is no taking it back. The Genie is out of the bottle.

Take some time to soak it in and savor the greatness of it.

Nation Grade.

I said it again to make sure it registers with you in case you are still in Awe and/or Shock.

As your grey matter starts to recover such a mind blowing Buzzword, let me ease you into our conversation.

The definition of Nation Grade is simple at a high level and has many nuances at a bare metal level.

At the 50,000 foot level, a Nation Grade solution is when a country has chosen to use a solution for all or most of the nation. The nuances of why they chose that product for the nation are where the proof is in the pudding.

So how is Siren a Nation Grade solution? I’m glad you asked fine sir or lady.

At the high level, Siren is Nation Grade because England has secured Siren for use in over 60% of the ambulances in the country with negotiations underway to provide Siren for all of England. Based on our overwhelming success in England, we are having conversations in eight (8) other countries from Europe, Asia, Latin America and the Middle East to provide Siren on a national level.

If you rely on a solution for your country, then security is a major concern. Security is synonymous with breathing at Medusa. We have plenty of Security 02 in the office. It is our lifeblood.

As validation of that security focus, a worldwide industry leader in Information Assurance has performed several audits and penetration tests on Siren over the last 4 years. After each review, they approved Siren to be secure enough to use in the national health care solution in England (Connecting for Health).

It is important to have a product proven to accommodate the regional configurations within a nation. In many countries the State, Province or Territory administers the health care system. This requires a Nation Grade product to support multiple languages, segment data per region/organization (let’s just use region to use less words) and allow each region to have their own configuration to meet their particular needs.

Medusa has a great record of accomplishment in localizing the product. Siren is in the field in UK English, US English, and Dutch. Localization of Siren in Portuguese is underway.

Siren has a very robust system for handling multiple organizations within the same deployment of Siren. This allows for significant economies of scale in supporting less working parts than if each organization had to build and maintain their own implementation of Siren.

The key of the Siren multi-org solution architecture is that the info from each organization has an organization ID associated with it. This applies to configuration info, patient data, user data, and protocols. This allows a country to restrict access to only users that have access to that organization data. This not only allows solid data security but also allows for the creation of super users that operate at a national level that can see all ePCR data for the entire country.

The Siren Data Analytics (D.A.) solution works in conjunction with this organization structure. D.A. allows authorized users to do in depth analysis of all facets of the Siren data set.

D.A. goes a step further, built on an industry standard Data Warehouse. Medusa designed the Siren Data Warehouse to increase performance and flexibility of reporting. Think of it as reporting on steroids… but legal!

The Siren Data Analytics package provides agencies with a set of reports, data cubes, data marts and dashboards to perform detailed analysis on their ePCR data. The package offers flexibility in using existing reports as they are, copying and modifying existing reports, or creating new reports.

A huge advantage of a Nation Grade product is it effectively integrates with other parts of the regional or national solution. Medusa has been leading the industry in this area. Any ePCR solution that is worth looking at has the basic integration with CAD and Billing solutions. Medusa has taken integration to the Nation Grade level.

In England, we have Siren integrated with the government’s SPINE system. The SPINE is the core database and data services solution that all the Health Care products will interact with to ensure one commonly accessible patient care record. Therefore, whether you are in the back of an ambulance, an ER/ED, or your General Practitioner you can access your entire health care record from the day you were born. As you can imagine the security around this solution has to be top notch, which is why the security audits mentioned earlier are so important.

In the US, President Obama is unveiling his vision for Health Care and it is very similar to the English model. Siren is a perfect fit as a Nation Grade solution for the US given our track record in England. In one of President Obama’s speeches, he made mention of the Regenstrief Institute in Indiana, which manages a patient record database for the entire state.

The Regenstrief Institute has a system in place for all of Indiana that is very similar to England’s. They are very proud of their accomplishment and they should be. Medusa is also proud to be part of that solution. We have worked with Regenstrief Institute and our EMS agency partners in Indiana (“Indy ePCR Project”) to build an interface into the Regenstrief database. This will improve the quality of patient care data, save lives and reduce costs.

Another project in Indiana (they have great initiatives there!) that Medusa launched in 2008 is our integration with ESSENCE bio-surveillance software. This allows EMS agencies in Indiana to send relevant ePCR data to the ESSENCE system so they have an early warning system for any bio issues such as SARS outbreaks, small pox, anthrax, etc. In most cases, regional and national health systems rely on very out of date information to respond to such bio issues. This initiative will help end that archaic practice.

Another project we are excited about is with MedicAlert in Canada. This project is in conjunction with MedicAlert, Canada Health Infoway (Infoway), and Emergency Health Services of Nova Scotia (EHS). With this solution, medics in the field will have access to patient’s detailed medical history housed in the MedicAlert database.

What really makes the integration Nation Grade is the MedicAlert database contains data for people from the East Coast to the West Coast of Canada. Any Canadian agency that uses Siren ePCR Suite can access valuable patient data for the more than 1 million Canadian citizens.
Oh yea… did I mention that every medic in Nova Scotia (over 800) uses Siren software? Did someone say Nation Grade?

I hope that you can see a pattern here. Medusa constantly works with our customers to increase the value of their entire EMS system: Not just charting.

When large national associations recognize your offering it is another subtle indication that your solution is Nation Grade.

For the prestigious BCS IT Industry Awards for 2008, Siren won the Mobile Technology Award in conjunction with CSC for the national implementation of Siren in England. You can see details on the Award here. It is the 4th one down on the page. We had few beverages at that awards ceremony!

So if you have an ePCR solution, ask them if they are Nation Grade. And if you are evaluating to purchase an ePCR solution, ask all the vendors if they are Nation Grade. Your teams and your patients will thank you for it because Nation Grade will save lives, provide solid data privacy and increase operational efficiency.

What are the Nation Grade questions to ask? Start with these:

1. To what countries do you currently provide a National solution?

2. Can I have a copy of your 3rd party security audit for your ePCR solution?

3. What national association awards have you won?

4. How do you handle segmenting data for multiple organizations in your solution?

5. What languages have you deployed your product in?

6. Can you give us case studies on external health care systems you have integrated with such as bio-surveillance, regional patient databases or hospital systems?

7. How can I efficiently aggregate all the data in my system from all organizations to make informed decisions about patient care and operations?

If the vendor tries to change the subject, looks down at their shoes in silence, or tells you to look behind you in alarm so they can run away, you may want to give Medusa a call. :)

This Just In From Wishard:-

2009-05-06T14:44:00.004-03:00

The following is an e-mail from Wishard EMS, Indianapolis, italics added for clarification purposes:

As of 08:55 this morning (May 6th) Indy has taken another huge step forward in electronic patient healthcare. A successful test was done using the Siren ePCR system and the INPC (Indiana Network for Patient Care) system. A report from INPC was generated and attached to the patient's pre-hospital report.

Thank you to everyone for working so hard on this.
Tom Arkins
Wishard EMS

-------------------

This is a culmination of efforts between Medusa and the Regenstrief Institute which will enable paramedics et al to attach external patient data to ePCRs using the new binary file attachment functionality developed in Siren 3.07. This patient data comes from the Regenstrief Indiana state database.

Attaching previous patient data to an ePCR is useful because it avails information such as allergies, previous treatments, and/or current medications to whoever is providing care, enabling more informed treatment plans.

Yes, it's as awesome as it sounds.

Congratulations, York!

2009-05-05T09:20:00.002-03:00

Medusa Medical would like to congratulate the Regional Municipality of York, Ontario, on going live with their new Siren ePCR system! Today!

After a year of preparation and working with Medusa's deployment team, York will see its first day of live-data production on the first phase of rollout. ePCRs will be recorded in a Medusa-customized template that will match Ontario's specific Ambulance Care Report template.

Medusa veeps would like to deliver the following congratulatory statements:

"We are eager to showcase our solution with York leading the Ontario EMS industry. We are very excited to see York roll out their first phase of live production." - Dan MacDonald, VP Development.

"Welcome to the family!" - Oliver Nemeskeri, VP Solutions Delivery & Marketing.

"Yee-ha!" - Craig Fraser, VP Sales.

"Wooo!" - Scott Campbell, CEO.

“Big T” Technologies

2008-09-10T10:45:00.006-03:00

I figured I would start this article off with something grandiose - I thought I would coin my own terminology!

The little hamster in my brain started to run on the treadmill and out popped the idea of Big T Technology.

Unfortunately, a Google search showed me that the hamsters in other people’s brains already came up with this terminology. The article “Big T” Technology vs. technology" is a prime example of other hamster activity.

After this deflation of my ego, I gave my hamster some cheese and sent him back on the treadmill to come up with the content for this article.

I sat back to reflect on what technologies have had the largest impact on the organizations I have been with in the last ~5 years. A couple of technologies came to mind:

Server Virtualization

Blade Servers

Both of these technologies have much of the same brass rings we can grab as we go around the technology Merry-Go-Round. Or, better yet, the Techno-Go-Round. For this discussion, I am just focusing on Virtualization.

Virtualization, in the context of this article, is a method of taking a physical server and creating multiple virtual servers on it. Each virtual server acts and behaves just as a physical server would. It has its own memory space, disk space, IPs, etc.

The three main commercial players in the Virtualization world are:

VMWare ESX . I am surprised Microsoft did not gobble this company up in earlier days. I see them as the commercial market leader to which everyone is trying to catch up.

Citrix XenServer. Citrix has been around for many years and has had solid solutions. Much like Red Hat did with Linux [remember that crazy IPO?!?!), Citrix has based their solution on an open source solution called Xen hypervisor.

Microsoft Virtual Server . Microsoft is a new entry into this field. My experience with past Microsoft software is they often come into a market segment with a subpar solution but with the resources at their disposal they eventually create a solid product.

One of the key driving forces behind Virtualization is that system administrators have traditionally been annoyed because, as they examined all the servers in their infrastructure, administrators found a great deal of underutilization, especially in the area of RAM and CPU.
Virtualization strives to maximize the use of all available CPU and RAM.

By reducing the number of physical machines needed, a great deal of benefits arise.

Deployment Time. This is a huge benefit to us here at Medusa. By creating template virtual machines, you can quickly grab a base configuration and have it live in under a minute. Then it can be modified to meet your current needs.

Power Reduction. If you are able to place six virtual servers on one physical server you are roughly saving the power consumption of five servers. For those of us who use external data centers, power consumption is one of the primary cost drivers.

Cooling Reduction. The same logic applies to cooling that applies to power consumption.

Physical Space Reduction. Another monthly charge by data centers is rack space. With virtualization you get more virtual servers in the same amount of rack space.

Downtime/Maintenance. One of the most annoying tasks from my system admin days was having to move applications from one server to another so I could bring down and do maintenance on a server, and then have to move them all back. With Virtualization you can move an entire virtual machine from one physical server to another with the click of a button.

Multiple Operating Systems. You can easily have various operating systems at various version/patch levels with very little headache compared to the physical server model.

Segmenting Applications. If it fits into your strategy, you can effectively create a separate virtual server for each application you run in your infrastructure. This helps prevent one rogue application from bringing down other applications by segmenting the memory/CPU between them. This isn’t cost effective using physical servers, as applications won’t often make full use of RAM/CPU in the physical server. With virtualization, not only do you have better results, you can squeeze every last 0 and 1 out of your hardware.

Simplify Disaster Recovery. If you had any amount of time to respond to a disaster as it was happening, you could quickly move your virtual machines (depending on network speed) to another data center (assuming you had virtualization in standby mode at another data center).

One of the things you need to ask yourself is “do I need these technologies to add value or am I doing this just because everyone else is?”

I can’t answer that question for you; however, I believe the answer for the majority of organizations is that this technology should be pursued, even if in a pilot fashion.

You may want to call me up and ask “Dan, are you comfortable using all this in production?”

I am not quite comfortable using virtualization in production yet, but there are some great case studies you can review. Like any software and hardware, you can hit some big issues that can bite you in the posterior. For example, VMWare recently experienced a defect that stopped it from working around the world and VMWare’s CEO recently posted a letter in response. Judging by the discussions posted on the VM newsgroups, it just shows us how well-used and valuable this solution is in the industry.

At Medusa, we are highly reliant on VMWare for our testing efforts. Before using VMWare, we could spend two weeks getting a testing environment ready to test a new software release. We now complete this in hours today. The business case for Medusa was a no-brainer.

There is a good list of case studies on organizations using VMWare in production. You can review them here .

There are some case studies for XenServer on their website.

Here is another case study for a Healthcare organization using MS Virtual Server in production. Another one exists for using Virtual Server in testing/lab environments.

Here is a good Webinar on the thought process that should go into virtualization of your production environment. Virtualized Production Servers with Microsoft Virtual Server

In closing, I refuse to give up on coining my own term for this article. I promised my hamster a week off in the Bahamas if he would come through for me. Drum roll please:

“Big T” Terminology -> No hits on Google!

And what do you mean by that Dan?

“Big T” Terminology is basically those all so pervasive buzz words that seem to drive our IT vision into bizarre directions when the people using them (hamster challenged Execs like myself) don’t even know what they are or know how to apply them in a way that makes sense. Nevertheless, we make decisions to go down that path because we read it in Wired or Business2.0.

Dan MacDonald
VP, Product Development
Medusa Medical Technologies

E-Health Strategies

2008-08-08T15:54:00.004-03:00

I’ve been reading through a number of different eHealth Strategies from around the world and have come to this conclusion: albeit unusual, politicians and governments of different countries seem to agree on how eHealth can benefit the patient and on how to move the health of the nations forward over the next ten years.

Although these strategies seem to align (and I’m sure intentions are honourable), I don’t see much that points to what works well now. It might be just me but, being from a Paramedic Training Manager background, I am hardwired to think that in order to progress we must first learn from what got us to where we are today. In order to treat, you must first understand what has happened. It’s easy to dismiss what’s in front of us as “this is how it is, let’s make it better” but, without tapping into the knowledge of the people who made it what it is, we can only re-design it and not develop it. Understanding what else is out there is also a significant factor in the success of any change. Has someone done it already? Does it work? How do they do it in other parts of the world? These are all fundamental questions to ask when considering a new approach; however, without the funding to support a round- the-world fact finding mission or spending a month wading through the internet searching for unbiased opinions on what works well, it’s almost impossible to get a realistic view.

We must also decide where we sit in the “Are we an Emergency service? Are we part of the healthcare infrastructure? or “Are we both?” debate. As EMS providers it’s easy for others to see us as isolated, away from the wider healthcare system and simply providing a fast route to the nearest doctor.

"During the UK ambulance strike in 1989 Kenneth Clarke, the then Secretary State for Health, described ambulance workers as ‘glorified taxi drivers’. This statement caused outrage within Parliament but that’s nothing compared to how we felt. In true British style every ambulance operating in the city of Manchester drove around for the next month with banner’s reading ‘Ken’s cabs’. One paramedic even had some business cards printed with Downing Street’s phone number on!"

Today’s EMS has moved on so much that it’s hardly recognisable from 20 years ago. Paramedics and the services they provide are an integral part of the healthcare services within developed nations. Not only do paramedics provide the lifesaving interventions that a patient needs, they take control of emotionally charged and dangerous situations, and provide the foundation upon which the whole patient care episode is built.

When eHealth strategies such as, ‘eHealth – Making Healthcare Better for European Citizens’, ‘Transforming Healthcare: The President’s Health Information Technology Plan’ and ‘Information for Health – the UK Department for Health’s Strategy’ are put out there citing scenarios such as those noted below, they don’t seem to take into account the huge role EMS can play in achieving this vision of the future. A senario portrayed on the White House website (http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3 :)

"Arriving at an emergency room, a senior with a chronic illness and memory difficulties authorizes her physicians to access her medical information from a recent hospitalization at another hospital - thus avoiding a potentially fatal drug interaction between the planned treatment and the patient’s current medications".

"Three patients with unusual sudden-onset fever and cough that would not individually be reported, show up at separate emergency rooms, and the trend is instantly reported to public health officials, who alert authorities of a possible disease outbreak or bioterror attack".

The first call a patient will usually make in an emergency situation will be to the EMS. The EMS starts the process. They are the first contact the patient has with the healthcare system and the information collected at that point is integral to the ongoing care of that patient. Why wait until the ER before the detail of past medical history is assessed? Why wait until the ER to identify disturbing trends in recent activity when all this information is available from the EMS when collected through their ‘state of the art’ ePCR system? The importance of accurate and early information when dealing with any patient is undisputed but, in order for this information to be used to its fullest potential, it must be shared between practitioners, organisations, regions and even countries and continents.

What is easy to forget is that the technology is already available. The systems are already built, tried, tested and live. The experience has already been gained.

We just need to share it.

Ian Wilkinson
Clinical Product Manager

Stakeholder Communication

2008-07-18T13:20:00.002-03:00

Anyone who has ever read a management book knows that you need to have "effective stakeholder communication". The trick is figuring out what that really means and how to accomplish it!

The NHS in England is running what many reckon is the largest civilian IT project in the world: The National Programme for IT (NPfIT). It is very ambitious. It will link all health care providers into one seamless IT system. Communicating how this system will work and what the benefits will be is a daunting task and the NHS has published a YouTube video that does a great job of doing just that.

For those of you in North America, take note of how the whole system provides complete patient documentation for all clinicians involved in patient care. Even though our systems are more fragmented and do not have the same "centralized oversight" that the NHS provides, I think we will see more programs like this in the U.S. and in Canada. The opportunity to improve patient outcomes Continuity of care is far too important for us not to evolve in this direction.

Hopefully you noticed the ambulance system. Yes, it is Siren! Siren is currently deployed at EEAS, YAS, and WMAS, and is due to be deployed in another three Trusts in the coming year.

While the video is very good at explaining the vision, it does not answer any questions or address any concerns that stakeholders have. Like any project, the NPfIT has had its share of difficulties. Many parts of the project are late, the bill keeps growing and many people are confused about what is happening and why.

To address this need, the NHS re-shot the scenes from the video and this time had the actors bring up questions about the project, such as "Why this..." and "How will we...". The result is a video that is a both innovative and humorous. I think it is a great way of dealing with stakeholder communication.

PREDICTIONS FOR A VERY IT FUTURE

2008-06-02T13:05:00.010-03:00

I just read Gartner’s Gartner Predicts 2007 report and even though it is based upon 2006 data, it has some interesting insights.

1. Operating System
Gartner predicts, “The Windows operating system will get more frequent yet smaller updates in the future”. They also predict that Vista is the last major release of an OS from Microsoft.

I will make my own prediction: if Apple were to make a serious effort to develop business-oriented products, they would own the market. I am running Vista and I swear the boot time is longer than MS-DOS 3.1, despite the dramatic increase in hardware performance since 1984. At least back then, I did not have to worry to the same extent about viruses and all of that other nasty stuff. Unfortunately for us, I don’t see a Mac ruggedized tablet anytime soon, so we will be stuck with MS Windows for the foreseeable future.

2. Outsourcing
Gartner predicts that the big boys of outsourcing vendors would be in trouble with fewer big outsourcing contracts and a greater focus on “selective” outsourcing instead of wholesale outsourcing.

I think this is a serious issue for those running IT in EMS and from talking to a few of you, I know it is on your minds as well. On one hand, outsourcing means you get a cheaper rate than if you staffed and ran the function internally. With tight budgets, freeing up extra cash is very important. On the other hand, you become a cog in a much bigger wheel and you lose priority. Since you do not control staff directly when you outsource, you can no longer make a quick judgment call to focus on getting a particular report done instead of doing server maintenance.

One way around this might be to investigate our “multi-agency” (MA) solution. With a MA implementation, a number of agencies can band together and share the costs of running an ePCR solution. That is what the folks in Indianapolis have done. I hope to get a case study completed with them in the near future with the details of their project. Meanwhile, if you would like to know more about MA, drop me a note.

3. IT Service Providers
Gartner predicts there will not be an explosion of IT service providers from Asia any time soon. They are thinking that there is not yet the critical mass of worldly experience in the region to support the growth necessary.

The implication that I see is that the source for innovation for EMS software will continue to be homegrown. Whew! Anyway, we at Medusa remain committed to developing the best ePCR software in the world, even if we do not speak Mandarin.

4. Community Marketing and Blogs
Gartner predicts the slowing growth of blogs. Even though there are 56 million blogs (as at October 2006), Gartner says that the lifespan is only three months (and declining). They also claim that Facebook and MySpace lost visitors around the same time.

Despite this, I think many of you should (if you haven’t already) published a blog for paramedics and make sure you troll MySpace and Facebook to ensure your agency is well represented in cyberspace. Given what many of you are telling me about the shortage of paramedics, the war for talent will be fought on-line as much as anywhere.

This also ties in tightly with Gartner’s prediction that “compliance” (or good corporate governance) will continue to grow in importance. The last thing you want is one of your medics posting attention-grabbing articles on a blog that result in massive negative publicity for your agency.

5. Security
Gartner predicts, “By the end of 2007, 75% of enterprises will be infected with undetected, financially motivated, targeted malware that evaded their traditional perimeter and host defenses”.

This is truly scary. Even though we have the best security out there (Craig will be publishing a white paper shortly outlining what we do for security), the bad guys always seem to dream up new ways to do evil. We are partnering with the Telecom Applications Research Alliance (TARA) with their “InTARA” project to research and develop new IT security protocols. I’m confident that the bright lights at TARA will have a few good surprises in store for us and we will keep you all up to date on their progress.

6. Client Computing
Gartner predicts, “By 2010, the average total cost of ownership (TCO) of new PCs will fall by 50%.”

I think the benefits of this will greatly affect the use of field software in EMS. It will free up cash that you can use on strategic software, such as major incident-mass casualty. It also means that IT as a % of your overall budget should drop.

7. Mobile and Wireless
Gartner predicts, “By 2010, 60% of the worldwide cellular population will be trackable via an emerging "follow-me Internet."

We pretty much have this now in EMS with vehicle location GPS systems and the tablets running ePCR. The implications of this technology going mass market is that it will get even cheaper for us in EMS and that new technologies, such as RFID / inventory management, should start to appear.

8. Networking
Gartner predicts, “Through 2011, enterprises will waste $100 billion buying the wrong networking technologies and services.”

Ouch. Unfortunately, they are probably right. One way to reduce networking expense is through tools such as MobileAware. This tool will auto detect networks and route your traffic depending upon a set of rules that can, for example, minimize expense.

9. Data Centers
Gartner predicts, “By 2008, nearly 50% of data centers worldwide will lack the necessary power and cooling capacity to support high-density equipment.”

Well it is now 2008 and I don’t think their numbers were bang on. I do agree with their line of thinking though. I know we have had cooling and power issues in our own server room and if we didn’t install VMLabs’ VMWare, we likely would have had to outsource out server room. I’m sure many of you have also run into these problems and while VMWare may be not be a solution for you, running a multi-agency server room to spread the costs of cooling and power (in addition to all of the other overhead costs) might be quite a help.

You can get your own copy of the Gartner Predicts 2007 report here

-Scott.