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Wednesday, May 6, 2009
This Just In From Wishard:-
The following is an e-mail from Wishard EMS, Indianapolis, italics added for clarification purposes:
Tuesday, May 5, 2009
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!
Medusa Medical would like to congratulate the Regional Municipality of York, Ontario, on going live with their new Siren ePCR system! Today!
Wednesday, September 10, 2008
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
I figured I would start this article off with something grandiose - I thought I would coin my own terminology!
Friday, August 8, 2008
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:
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:
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.
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
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.
Friday, July 18, 2008
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
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!
Monday, June 2, 2008
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
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. ArchivesJune 2008 July 2008 August 2008 September 2008 May 2009
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