I have been reading a article on linkedin about Google and Microsoft's jousting for the Health IT dollar. It is suggesting that ChromeOS may be the key for Google. First 99% of all EHRs, PMS and Health Financial Systems run on Microsoft. Many of these are desktop applications that use Citrix to emulate an enterprise system. ChromeOS and Google Health is all about Cloud computing. It is a bit of a step to see Google in any health business in the near future besides PHR (Personal Health Record) and they have quite a bit of catch-up to do to equal the features of MS Health Vault. But, with enough money and time you can do anything.
Many Healthcare facility HIT departments are run by desktop IT personnel and the Cloud architecture is quite a leap. In saying that, people can be trained and things do change but very slowly and at a cost. I know of one hospital in Central Oregon that is looking at implementing their third EMR because the wrong people were making the wrong decisions.
Cloud technology is not new, It has been in every major industry for a long time. It could save the healthcare industry hundreds of millions of dollars. By hosting a system you reduce your personnel overhead, maintenace, and capital equipment cost. You gain "Ecomomies of Scale" by utilizing shared resources. With a true cloud architected system, you reduce the cost of your client machines, i.e., netbooks or mobile devices instead of tablets and laptops. This is where ChromeOS comes into play and provides a considerable cost saving for the client. The Operating System is free just like Android for the Smartphones, which reduces your cost considerably. Ask your IT department for a report on MS licening for your facility if you do not believe me. Another feature is increased security. With no storage on the clients machine (netbooks, smartphones) you know longer have to worry about laptops being lost or stolen.
The potential for HIT saving with cloud technology is just starting to be realized. Think about this example. You pay for your EMR via subscription which run via Cloud, the patient data is stored in a HealthBank where the customer owns and pays for the storage, and you can access the data from anywhere because it is all in the Cloud.
Jeff
Monday, July 13, 2009
Thursday, July 9, 2009
PHR Comparisons, there is one for everybody
PHR Comparisons, there is one for everybody
There is much confusion about Personal Health Record (PHR) in the market these days. I became aware of this by an analyst review of our mobile PHR (mPHR). He compared our mobile PHR with a Web App /cloud/browser based PHR. He then proceeded to give our mPHR a undeserved low rating. This is understandable if you do not know the difference in a Smartphone app mPHR and a Web App also known by the new name Cloud applications. There are numerous Cloud PHRs on the market today with different capabilities, strengths, weaknesses and cost. From a high level, it can sometimes be difficult to tell the difference between applications and their platforms. When making a selection of any tool you need to know what are the requirements and how you want to use it.
The PHRs today are divided into three groups; Mobile SmartPhone (mPHR), Cloud Apps, and other devices such as USB and smartcards i.e., credit card with memory chips. Each type of PHR serves a different purpose and provides a useful and needed service. I will speak to the strengths and weaknesses of each of them.
Web Apps/Cloud PHR:
These are browser/server based systems that need to be connected to the Internet to operate. There is no store and forward capability and if you are not connected to the Internet you have no access to your data. They provide convenience for entering and reading data and some have a simple client interface so that at least some of your critical data may be viewed on a Smartphone Web browser if an Internet connection is available. The client smartphone option is usually offered for an additional cost. Internet browsers on smartphones tend to be slow and have limited area access. Mobile PHRs normally provide fewer features than Cloud based systems, but this too will be changing as bandwidth availability grows larger and smartphones acquire more memory capabilities.
Smartphone and mPHR:
Smartphone are cellphones that are more of a computer than standard cellphones, e.g., iPhone, Android, Blackberry... Today, mPHR's run on these smartphones. As I mentioned before Smartphones of today do not offer as much computing power, memory, or bandwidth as Cloud/WebApp systems. Inprovements in memory and computing power in smartphones is improving rapidly. Remember your first computer? Smartphone's differentiating feature is that they are totally portable and can go literally anywhere you go. Which means that your health data is always with you when you need it. There are many areas all over the world that do not have Internet service and you will likely find dead zones within ten miles of your home. http://www.deadcellzones.com/ If you need access to your medical record in one of these areas you will need a mPHR or USB device that is not tethered to the Internet, i.e., Your health data is on your phone and with you. At a minimum important health information such as Medications and Allergies should be carried with you at all times. In most cases, when you need your health information the most, you do not have it with you and you are not sitting in front of your computer at home.
A mPHR that connects to a browser based Cloud PHR is a good option, you can manage your health at home and carry your most important data with you on your mPHR. Note that most mPHR's do not contain as much information as Cloud PHRs because of memory constraints. Some mPHR's, like motionPHR a product of Communication Software, Inc. also offer an ICE (In Case of Emergency). ICE is a feature that provides first responders, such as EMTs, with much needed data about your health and contacts. With the exception of the data you decide to provide with the ICE feature, a mPHR that is password protected will be of no help to first responders.
One of the drawbacks of a mPHR can be security. Most of the mPHR's on the market today have little or no security or they just have simple password protection which does not protect your data on the phone. When selecting a mPHR make sure that the data is encrypted and password protected.
USB and SmartCards Devices
These devices are based on a USB connection to a PC. They are produced in all shapes and sizes from key fobs to credit cards with USB connectors. These devices are good alternatives to a mPHR if you do not have a Smartphone. They are cost effective, small and very portable. The major drawback that I have encountered is that doctors offices will not let you plug in a USB device into one of their computers because of the potential risk of a computer virus. My recommendation to medical facilities is to disable their USB ports for this reason. Hopefully trauma centers have computers available that can read their patient electronic devices if the need arises. I do not have any information on first responders ability to read these devices in a emergency situation.
PHR's are fairly new concept in the Medical world and I expect a significant evolution to occur in the next few years due to the current and intense focus. Whether you have a USB device, Cloud PHR, or mPHR, having a PHR is the first step to taking charge of your health. The cost of these systems to you, the consumer, is quite low and the government has considerable interest in making them an integral part of your care. Expectations are that the PHR and your participation will improve health care outcomes and reduce your overall costs. I suggest that you try one, the investment of time and a small amount of money may save your or a family members life.
Jeff Brandt
CTO
MotionPHR a mPHR for the iPhone
MyMobileMedBox for Android
There is much confusion about Personal Health Record (PHR) in the market these days. I became aware of this by an analyst review of our mobile PHR (mPHR). He compared our mobile PHR with a Web App /cloud/browser based PHR. He then proceeded to give our mPHR a undeserved low rating. This is understandable if you do not know the difference in a Smartphone app mPHR and a Web App also known by the new name Cloud applications. There are numerous Cloud PHRs on the market today with different capabilities, strengths, weaknesses and cost. From a high level, it can sometimes be difficult to tell the difference between applications and their platforms. When making a selection of any tool you need to know what are the requirements and how you want to use it.
The PHRs today are divided into three groups; Mobile SmartPhone (mPHR), Cloud Apps, and other devices such as USB and smartcards i.e., credit card with memory chips. Each type of PHR serves a different purpose and provides a useful and needed service. I will speak to the strengths and weaknesses of each of them.
Web Apps/Cloud PHR:
These are browser/server based systems that need to be connected to the Internet to operate. There is no store and forward capability and if you are not connected to the Internet you have no access to your data. They provide convenience for entering and reading data and some have a simple client interface so that at least some of your critical data may be viewed on a Smartphone Web browser if an Internet connection is available. The client smartphone option is usually offered for an additional cost. Internet browsers on smartphones tend to be slow and have limited area access. Mobile PHRs normally provide fewer features than Cloud based systems, but this too will be changing as bandwidth availability grows larger and smartphones acquire more memory capabilities.
Smartphone and mPHR:
Smartphone are cellphones that are more of a computer than standard cellphones, e.g., iPhone, Android, Blackberry... Today, mPHR's run on these smartphones. As I mentioned before Smartphones of today do not offer as much computing power, memory, or bandwidth as Cloud/WebApp systems. Inprovements in memory and computing power in smartphones is improving rapidly. Remember your first computer? Smartphone's differentiating feature is that they are totally portable and can go literally anywhere you go. Which means that your health data is always with you when you need it. There are many areas all over the world that do not have Internet service and you will likely find dead zones within ten miles of your home. http://www.deadcellzones.com/ If you need access to your medical record in one of these areas you will need a mPHR or USB device that is not tethered to the Internet, i.e., Your health data is on your phone and with you. At a minimum important health information such as Medications and Allergies should be carried with you at all times. In most cases, when you need your health information the most, you do not have it with you and you are not sitting in front of your computer at home.
A mPHR that connects to a browser based Cloud PHR is a good option, you can manage your health at home and carry your most important data with you on your mPHR. Note that most mPHR's do not contain as much information as Cloud PHRs because of memory constraints. Some mPHR's, like motionPHR a product of Communication Software, Inc. also offer an ICE (In Case of Emergency). ICE is a feature that provides first responders, such as EMTs, with much needed data about your health and contacts. With the exception of the data you decide to provide with the ICE feature, a mPHR that is password protected will be of no help to first responders.
One of the drawbacks of a mPHR can be security. Most of the mPHR's on the market today have little or no security or they just have simple password protection which does not protect your data on the phone. When selecting a mPHR make sure that the data is encrypted and password protected.
USB and SmartCards Devices
These devices are based on a USB connection to a PC. They are produced in all shapes and sizes from key fobs to credit cards with USB connectors. These devices are good alternatives to a mPHR if you do not have a Smartphone. They are cost effective, small and very portable. The major drawback that I have encountered is that doctors offices will not let you plug in a USB device into one of their computers because of the potential risk of a computer virus. My recommendation to medical facilities is to disable their USB ports for this reason. Hopefully trauma centers have computers available that can read their patient electronic devices if the need arises. I do not have any information on first responders ability to read these devices in a emergency situation.
PHR's are fairly new concept in the Medical world and I expect a significant evolution to occur in the next few years due to the current and intense focus. Whether you have a USB device, Cloud PHR, or mPHR, having a PHR is the first step to taking charge of your health. The cost of these systems to you, the consumer, is quite low and the government has considerable interest in making them an integral part of your care. Expectations are that the PHR and your participation will improve health care outcomes and reduce your overall costs. I suggest that you try one, the investment of time and a small amount of money may save your or a family members life.
Jeff Brandt
CTO
MotionPHR a mPHR for the iPhone
MyMobileMedBox for Android
Wednesday, June 24, 2009
EMR have to many buttons, what a mess
http://mobihealthnews.com/2917/kibbe-successful-emrs-will-be-like-the-iphone-platform/comment-page-1/#comment-5771
Answer to this request for "iPhone like" EMR
What is being asked for, is a well designed system. Many EMR systems available today have been hacked together, not designed with Engineering principles. I hear these complains from both HIT and from Domain/caregivers experts. What is needed when creating any system is tried and true engineering process. Start with the domain experts, doctors, nurses, lab tech, etc. add an group of software system architects and develop the requirements. Then design a system based on requirement and build system. The domain experts and system architects also develop a test and acceptance plan that is used to determine if the system works per design. It takes both sides of the equation to build a good system, domain expertise and engineering.
This is the first generation of real EMRs. Like most new technologies the domain expert has a great idea and learns how to program a prototype (a few buttons) which evolves into a product. The products are introduced to the market, many more functions and more buttons are added until you have a mess. Second generation, the idea's are taken to the next level, this usually comes after an influx of money. Some companies start over using standard engineering practices. Other companies keep the original system and keep hacking away. Look how long it took Microsoft to get rid of DOS. Almost all software companies face these problems from time to time. Ebay started as a small program that was written in a guy's garage to sell his wife figurines.
The good new is that Enterprise system in HIT are relatively new and the market will wash out the bad EMR or they will redesign to meet the needs of their customers. The problem is that these systems are very expensive and it will cost us all to flesh them out. Make sure that when selecting such an important system that you have done your due diligence.
Jeff Brandt
CTO motionPHR mobile Personal Health Record for the iPhone
MyMobileMedBox for Android
Answer to this request for "iPhone like" EMR
What is being asked for, is a well designed system. Many EMR systems available today have been hacked together, not designed with Engineering principles. I hear these complains from both HIT and from Domain/caregivers experts. What is needed when creating any system is tried and true engineering process. Start with the domain experts, doctors, nurses, lab tech, etc. add an group of software system architects and develop the requirements. Then design a system based on requirement and build system. The domain experts and system architects also develop a test and acceptance plan that is used to determine if the system works per design. It takes both sides of the equation to build a good system, domain expertise and engineering.
This is the first generation of real EMRs. Like most new technologies the domain expert has a great idea and learns how to program a prototype (a few buttons) which evolves into a product. The products are introduced to the market, many more functions and more buttons are added until you have a mess. Second generation, the idea's are taken to the next level, this usually comes after an influx of money. Some companies start over using standard engineering practices. Other companies keep the original system and keep hacking away. Look how long it took Microsoft to get rid of DOS. Almost all software companies face these problems from time to time. Ebay started as a small program that was written in a guy's garage to sell his wife figurines.
The good new is that Enterprise system in HIT are relatively new and the market will wash out the bad EMR or they will redesign to meet the needs of their customers. The problem is that these systems are very expensive and it will cost us all to flesh them out. Make sure that when selecting such an important system that you have done your due diligence.
Jeff Brandt
CTO motionPHR mobile Personal Health Record for the iPhone
MyMobileMedBox for Android
Saturday, June 20, 2009
Remote medicine
This is a reposted comment to telemedicine article in India where oncologist are providing medical to remote India.
This is the future of medicine, 10 years from now your doctor may be located thousands of miles from you. I have been discussing remote medicine with a surgeon friend of mine for several year, last year while providing services to the PGA tour he got a opportunity to visit a northern universities virtual surgery center. He was very excited with he told me of the realistic feel of selecting a tool from a screen and cutting into a cadaver. I envision the future of surgery to be similar to a self checkout line in the grocery store. You have 4 patients on operating tables with one surgeon and a anesthesiologist, the surgeons performing surgery are not on location. Today some eye surgery are done remotely with the surgeon in the next room with robotic gloves. The outcomes are proven to be better for this type of precision surgery.
It is fun to dream, see the future make the future.
Jeff Brandt - motionPHR for the iPhone
This is the future of medicine, 10 years from now your doctor may be located thousands of miles from you. I have been discussing remote medicine with a surgeon friend of mine for several year, last year while providing services to the PGA tour he got a opportunity to visit a northern universities virtual surgery center. He was very excited with he told me of the realistic feel of selecting a tool from a screen and cutting into a cadaver. I envision the future of surgery to be similar to a self checkout line in the grocery store. You have 4 patients on operating tables with one surgeon and a anesthesiologist, the surgeons performing surgery are not on location. Today some eye surgery are done remotely with the surgeon in the next room with robotic gloves. The outcomes are proven to be better for this type of precision surgery.
It is fun to dream, see the future make the future.
Jeff Brandt - motionPHR for the iPhone
Monday, June 15, 2009
Not convinced about EMR?
When you have such a disruptive technology as EHR/EMR hit a vertical market such as Healthcare you are bound to have push back, and rightfully so. The early adopters are easy, then comes the convincing and the proof. I have a saying that I have been using for many years, "What is the best word processor on the market? The one you know.". Remember the last time you had to replace a favorite tool, whatever it was. The new one is not as comfortable, it is a piece of S... then you get to know it, use it more, it's not so bad, even better than an old friend. Jimmy Conners had the same problem in the 70's when he would not give up his old Wilson racket. Finally he did and he played better. He thought he needed that old racket to play well. It wasn't the racket, it is the person using it that really counts. Things change and EMR/EHR are here to stay, so embrace them, be a champion. You may as well.
Jeff Brandt
motionPHR for the iPhone
mymedbox for Android
Jeff Brandt
motionPHR for the iPhone
mymedbox for Android
Secuity and EMR, Will Cloud Help?
It will depend on management and their IT department. I was consulting for a hospital in Central Oregon that had 40 application running an 40 Microsoft machines to host. This is not an Enterprise system. The change to Enterprise Cloud will take time and training of desk top IT staff.
Cloud computing has been around for a very long time it is proven to work. It is basically client server or a WebApp. The security will always remain in the hands for the decision makers to know how to make the correct choices and implement the control policies. For laptops and desktops that do not have hard drives Cloud will provide much security. But again the implementation must be correct.
On the subject of EMR security, Cloud security can be very safe but you must do your homework on the hosting facility and their policies. Most EMR's are on a server in a closet in doctors offices or in the developer of the EMR offices. One of the biggest risk is server snatching, when at ID thief breaks into the Doctors office and just takes the servers.
Jeff Brandt MotionPHR Personal Health Record for the iPhone
myMedBox PHRlite for Android
Wednesday, June 10, 2009
repost: which Smartphone will lead
Our company Communication Software Inc. develops Medical apps for the iPhone and Android. We were deeply involved in development of the first Internet Boom in the 90's were I saw the same situation as the apps today. The first websites as are the apps of today were whatever anyone thought were cool with very little business planing to back them. Also, if you remember the 90's online businesses were offering non sustainable business models, example pricing models that lost money which is the same in today's app market. Most apps are free and with many of these; free is not cheap enough. This will change as the market matures and these poor business models companies and developers disappear.
As for which phone will lead the market in the future, it is hard to tell. Like so many new ideas, the leader fail behind as followers learn from the leader mistakes.
I believe Android is the wild card. It is open source and the development is in Java, the OS is free and manufactures are getting behind the platform because of cost. There are 18 new Android phones to be released this year. One thing you can count on it is going to be a good fun ride so hang on.
Jeff Brandt
motionPHR a Personal Health Record for the iPhone
myMedBox a Personal Health Record for Android/Google Phone
As for which phone will lead the market in the future, it is hard to tell. Like so many new ideas, the leader fail behind as followers learn from the leader mistakes.
I believe Android is the wild card. It is open source and the development is in Java, the OS is free and manufactures are getting behind the platform because of cost. There are 18 new Android phones to be released this year. One thing you can count on it is going to be a good fun ride so hang on.
Jeff Brandt
motionPHR a Personal Health Record for the iPhone
myMedBox a Personal Health Record for Android/Google Phone
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