Intel Healthcare IT

15 Posts authored by: John Farrell


It's always tempting to get caught up in the promise of the next, new thing. Gestural computing and 3-D printing spring to mind as recent examples, as well as a variety of wearable tech gadgets that we’re told are just around the corner from being commonplace.


While I have no doubt these technologies will find their way into the mainstream, it seems more likely that, for health care providers, the highly-familiar-yet-presently-underutilized touch computing will offer the most real-world value over the next few years.


Consider Aetna CEO Mark Bertolini’s keynote address at HIMSS14, in which he made clear that healthcare costs are rising significantly, and keeping these costs down is a task to be shared by everyone. (When payers suddenly form a palpable presence at a tech show, it’s worth taking note.)


Mobile is now the norm in healthcare settings, and touch computing directly ties in with key best practices for the use of mobile in these environments (i.e.- using the right device for the right task, rearranging workflows to enhance collaboration, and focusing on the compute model in relation to the task at hand).


If the healthcare industry is to deliver on ACA’s stated objectives of improved quality of patient care and increased efficiencies across the system, then engagement is critical to enabling clinicians to do more with less. I’m thinking tablets and 2 in 1s (all fueled by touch) could be the lynchpin that ensures engagement not only among physicians and clinical staff, but patients as well.


In terms of cost, having one device instead of two (notebook and tablet) is a less expensive mobile touch alternative and provides a better tablet experience for users, not to mention a three-year cost savings of $1,470. Read more on the costs savings here.


If you’d like to see how clinicians are using touch computing to provide better care, check out this new SlideShare overview that details the power of touch in health IT. (see above also)


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

Read John’s other blog posts

I was expecting the arrival of 2 in 1 mobile devices to make more of a splash in the healthcare space.


These slick devices, which combine a tablet and a laptop, started popping up in healthcare settings a few months back. Dell, HP, Lenovo, and others rolled out their competitive offerings, each promising convenience, lower replacement costs, easier management, and better security—and the research shows they deliver.


But healthcare CIOs tell me their selection of these devices is still largely driven by user preference, mostly because they provide both tablet and full keyboard functionality as needed.


Others, such as Linda Reed, RN, MBA, FCHIME, vice president and CIO at Morristown, N.J.-based Atlantic Health System, are quick to add that 2 in 1s haven’t been widely adopted yet because—surprise, surprise—today’s clinical applications and EMRs are still not fully developed for a tablet. The apps tend to be cumbersome and lack intuitive navigation.


“What we have found to date is that smart phone, tablet, laptop and workstation still have fairly distinct use cases,” Reed says. “Our docs will use all of the above, based on what they are trying to get done.”


But while it’s still early, health IT professionals should consider that clinical apps and EMRs will continue to evolve, and the case for device consolidation is a good one—especially when you compare Ultrabook replacement costs with the cost of replacing either an iPad or Android tablet and a laptop.


Whether a healthcare organization wants to provide staff with tablets, or simply support BYOD in-house, the upside to a single 2 in 1 device can be significant.


Beyond saving on costs (think devices + replacements + hardware support), these lighter, more energy efficient and easier to manage 2 in 1s can streamline workflows while providing greater security. The fact that they’re easier for health IT professionals to manage is gravy.


For a detailed breakdown of total cost of ownership—and why 2 in 1s may be the least expensive, most secure option for healthcare organizations going forward—check out this report. You may want to share it with your favorite clinical app or EMR vendor, too.


What questions do you have about 2 in 1 devices?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

As mobile device and app makers focus their attention on improving user experience and workflow issues, healthcare organizations continue to strive for the best mix of technology suitable for the enterprise.


Having spent the past few years deploying apps to smartphones and managing end user demand for the more feature and information rich tablets, health IT professionals are finding there’s a process for choosing the best tablet for their increasingly mobile workforces.


At Louisville, Ky.-based All Children Pediatrics, for example, CIO J. Barron Breathitt tells me his top-two criteria for laptops and tablets are reliability and durability.


The physicians practice group is using Fujitsu T730s and T731s, which typically are outfitted with the fastest i7 processors available to extend the lifespan of the units. Breathitt also has them configured with solid state drives to boost performance and durability.


Since the doctors at All Children Pediatrics require the ability to ink on the screen for signing and noting issues on charts, IT’s approach to selecting mobile devices centers largely around user acceptance and meeting interdepartmental goals--two metrics that fall in line with recent industry guidance.


Recently, J. Gold Associates released a white paper entitled, Picking the Right Enterprise Tablet: Things to Consider. Among the practical steps healthcare organizations can take to match tablet choice with end user and corporate requirements, the research recommends adopting the following seven-step approach:


• Create a strategic vision. In other words, think proactively, not reactively.

• Look beyond the device. Better to focus on the solution.

• Define requirements. Start by determining your specific goals.

• Build an app portfolio.

• User acceptance is critical.

• Support users while planning for obsolesence.

• Determining technology/infrastructure requirements.


If you haven’t read it yet, I recommend checking it out here.


Tablets offer many advantages to mobile workforces, and the technology’s role in healthcare is clearly established and growing. Formulating a sound tablet strategy, based on analysis, is the best way to support the deployment and utilization of tablets across the healthcare enterprise.


Doing so will enable the technology to achieve its full potential while helping your organization cut costs, satisfy end users, and deliver a higher quality of care.


What questions do you have about tablets in health IT?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent. See his other Intel Healthcare blog posts here.

For the past four years, I’ve watched thousands of health and technology influencers, developers, policy makers, business leaders, and others pack themselves into the mHealth Summit for a glimpse at the latest in mobile and wireless health technology. And why not? It’s a good time, and the policy changes, apps launches, and new comers to the field are always worth noting.


But this year, as we head into the 5th Annual mHealth Summit, I’m looking beyond the 300 exhibitors and 450 speakers—I’m following the money to the most promising new mHealth tech.


What choice do I have? Last quarter, as reported by CB Insights, venture capital investors deployed some $1.2 billion to U.S. mobile-related companies, making Q3 2013 the wildest VC financing quarter in history for the Mobile & Telecom sector.


Health IT overall drew $2 billion in funding this year, according to a Healthcare IT News report, but if you look at VC deal volume in mobile, the Health & Wellness sub-industry barely registered in Q3. So, yes, investment dollars are flowing to mHealth, but my take is that, despite the boom, we’re just getting started. That’s likely to be good news for mHealth entrepreneurs as they continue to bring their own innovations to market, and the money works its way deeper into the health niche.


Although VC funding is hardly the end-all-be-all for tech entrepreneurs—and somewhat less relevant to healthcare CIOs—financing trends obviously play an important role in the growth and evolution of mHealth. To the extent that new mobile and wireless devices (and apps) will need to be added, integrated, and supported by health IT professionals, these funding trends could prove very relevant to CIOs indeed.


That’s why one of the presentations I’m most interested in this year is the Venture+ Forum.


Keynoted by Qualcomm Life Fund’s director Jack Young—an electrical engineer and former EVP with the world’s fourth largest mobile phone manufacturer (ZTE)—this session should be eye-opening.


Young, who has questioned the sustainability of current funding trends, believes digital health is at a crossroads. Among other things, he’s planning to talk about the viability of today's boom in mHealth funding, and where investment dollars might trend over the coming years.


Personally, I welcome input from Young and others on this topic, as the industry prepares for the next wave of mHealth technologies that promise to span everything from mobile-clinical integration platforms, to personal genomics, to clinical research technologies.


The Venture+ Forum also will review presentations from 11 mHealth startups, which is always fun and inspiring. So, whether you have a mobile solution on the market, in the works—or you’re just wondering how the next wave of mHealth offerings will impact workflows—there should be some actionable information coming out of the Venture+ Forum. Hope to see you there!


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

Remember when the iPad arrived on the healthcare scene? As a non-enterprise device, it snuck in the back door—often in doctors’ pockets—and redefined user expectations in the process. Health IT professionals hated the idea at the time, but they slowly came around to it as Apple added basic enterprise features and let third-parties add incremental support. Of course, that was back when healthcare organizations had few viable alternatives to the iPad. Times have changed.


When I reached out to CIOs for a sense of their familiarity with some of the extreme low power Windows tablets that are coming to market, I was surprised to find that many, if not most, weren’t very familiar with them at all. But there is a sense of growing interest at healthcare organizations of all sizes.


J. Barron Breathitt, CIO at Louisville, Ky.-based All Children Pediatrics, is among those concerned with power consumption and battery life. The 57-employee physician’s practice group, which is in the process of merging two offices, upgrading its servers, and moving to a virtualized environment, currently runs on upgraded Fujitsu T730s and T731s. Right now, he’s sizing up the T734, which has the Haswell chipset, uses less power, and extends battery run time.


“It makes sense for us because our physicians require the ability to ink on the screen for signing and noting issues on charts,” Breathitt says. “They also use iPads when working remotely.”


Healthcare CIOs across the board—especially those looking to standardize away from the iPad—might want to check out the latest offerings from vendors like Dell, HP, and Lenovo.  With the combination of Intel Clover Trail and Windows* 8, devices such as the Dell Latitude 10, the HP ElitePad 900, and the Lenovo ThinkPad Tablet 2 are blending the best consumer elements of the iPad with the enterprise features that HIT professionals wants in their next generation tablets.


For starters, the new breed of enterprise tablets’ base battery life is competitive and can be configured to last twice as long as the iPad 4. They also deliver both more baseline expandability and additional expandability, with optional manufacturer-supported accessories. Plus, they offer the same PC enterprise features already deployed and in use at healthcare organizations.


These extreme low power Windows tablets also support touch-based scenarios with known IDE, while supporting backward compatibility with legacy peripherals and software. That’s a significant advantage over iPad, which requires new apps be written with new IDEs and don’t support legacy OSX apps and hardware.


When you factor in the cost of additional management tools, iPads are just more expensive. For a detailed breakdown of the latest tablets, check out a new report from Moor Insights & Strategy, entitled The Latest Extreme Low Power, Windows Tablets Now Ready for the Enterprise.


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

For the past 12 years or so, San Francisco-based MedAmerica has relied on a web portal to keep doctors in touch with other physicians and clinical staff. More recently, as the BYOD trend has helped define mobile use in the healthcare space, CIO Nancy Burghart-Hall and her team have been busy rolling out an in-house mobile app aimed at streamlining time sensitive communications among the physician practice management group’s 2,000 providers, who span 125 locations across nine states.


“Our strategy has been to manage communications among clinicians, who are located inside and outside of the hospital, as part of an overall mobile strategy,” Burghart-Hall says.


Launched in 2012, the HIPAA-secure mobile app enables communication among providers via email, voicemail, and text. It also grants access to work schedules—so physicians and clinicians can swap shifts on the fly, if necessary—and a MedAmerica directory with contacts for anyone in the organization.


With 1,500 downloads to date, Burghart-Hall feels the app’s uptake is going very well.


“Now, we want to extend it to the physicians and the communities in which we practice, to the on-call panels at the hospitals, the specialists and consultants, so that our ER doctors can talk directly, in a HIPAA-secure fashion, about a case,” Burghart-Hall says. “We’re getting ready to look at how we can include those providers in our panel groups, and allow them to download our app and use it as well.”


For Burghart-Hall, perhaps the biggest challenge associated with this project has been determining how much to invest, given that MedAmerica’s provider population is approximately 50 percent over (and under) the age of 40.


The current generational transition taking place may suggest IT is driving the adoption of technology before the other half of the physician population is ready to adopt it, but Burghart-Hall is striving for “an acceptable balance” that promises to both improve quality of care and increase efficiency.


Going forward, the IT team plans to bolster MedAmerica’s mobile app by partnering with another vendor that has a national provider directory. Such a move would greatly expand the expertise available to the physician practice management group’s ER doctors. However, the challenge here is the same as that experienced by anyone trying to exchange health information: knowing who’s on the network at all times.


Burghart-Hall says she’ll consider the project a success when providers report they’re able to communicate electronically—and efficiently—in a HIPAA-secure fashion. For the time being, though, she’s focusing on extending the app to MedAmerica’s communities.


What questions do you have?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

Count Yale New Haven Health System (YNHHS) among those healthcare organizations making major health IT changes in an effort to foster more meaningful collaboration at the mobile point of care.


I had heard YNHHS was winding down on a 36-month rip-and-replace project, swapping out its 10-year-old-plus electronic medical record for a new EMR from Epic. When I caught up with Daniel Barchi last week, the senior vice president and CIO at YNHHS confirmed the $300 million EMR implementation is now nearing completion, having launched about a month ago in a thousand-bed hospital, with roughly 600 physicians and numerous mobile practices.



The EMR switchover will deliver closer alignment among Yale New Haven’s three hospitals, the EMA, and the health system. It also will align about a thousand physicians at Yale Medical Group, an independent organization.


While this improved alignment is helpful from a cost control perspective, Barchi says what’s really exciting about implementing the single EMR is that it enabled his department to finally tear down all of the communication barriers across these different institutions.


“The EMR project was driven by our desire to better align these organizations, as well as by our knowledge that the future of healthcare is population management and the use of informatics to improve clinical care,” said Barchi.



YNHHS has deployed a good amount of technology enabling physicians to access data on mobile devices, primarily through physician portals. As part of its new EMR rollout, the health system also has activated a couple physician productivity tools for tablets and mobile phones.


“We’re starting to recognize that interconnectedness is the key to all of this,” Barchi said. “And it’s our physicians, who are caring for patients, who most need the ability to get data anywhere.”


At YNHHS, tablets are commonplace. Last year, the Yale School of Medicine rolled out a new initiative through which all medical students received their textbooks on a popular consumer tablet device. Between the student body and physicians who are using it, YNHHS has over 800 tablets deployed.


In addition to the mobile productivity tools currently enabled for physicians to assist with reviewing results and charting, Barchi expects more tools and opportunities to emerge as medical students transition from textbooks to clinical work.



It’s all well and good that YNHHS’ EMR project improved alignment among its member and affiliated organizations while supporting the hospital’s mobility plans.


Better still, though, is how this important early step is promoting truer collaboration at the point of care, as physicians gain critical access to complete medical records and become more facile at sharing patient data at the mobile point of care.


Since the IT Dept.’s goal isn’t to add technology, but to maximize the use of existing equipment and applications, they’re currently in the process of consolidating applications and reducing the number of overall systems.


Among other things, doing so has enabled YNHHS’ inpatient physicians to reduce the number of passwords they need to memorize from eight-plus to fewer than three.


“Health IT is becoming less about IT all the time,” Barchi added. “Instead of embracing the latest technology and trying to find a home for it, we watch for needs and then work with our caregivers to determine what might best meet their needs, or follow their lead if they find a tool. That’s what makes health IT so interesting; it’s not so much the technology, but finding solutions with our clinical partners.”


Is your health IT department working to advance collaboration at the POC? What steps are you taking?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

Much of the chatter coming out of HIMSS13 hinges on the concept of integration. Specifically, this idea that integrating physicians with other community care givers will naturally foster a better, less expensive quality of care. It’s an idea whose time has come. So, what are healthcare CIOs doing to facilitate better communications among clinicians working inside and outside the hospital? The short answer: not much.


Sure, the innovative ones are trying. But as a group, most are still thinking in terms of individual activities performed by individual actors in individual silos. We’re seeing push-back around data sharing. We even have people pronouncing the HIEs dead, declaring that data exchange is too hard, too complex. Yet this vital communication at the point of care is too useful and too necessary to disregard.


With HIE technology becoming dated and outpaced by newer technologies – and the added challenge that many EMRs certified as interoperable don’t really interoperate – one approach being advocated by health IT experts is the use of mobile tools for real-time voice and video communication.


Collaboration using video conferencing and real-time streaming medical data makes tremendous sense at the point of care. But it’s a hard leap for many healthcare CIOs, a destination they’re striving for but haven’t yet reached.


Atlantic Health System’s Linda Reed, RN, MBA, FCHIME, vice president and CIO, and president of her regional HIE, is among those CIOs tasked with balancing physician demands for rapid communications inside and outside the hospital against her organization’s need to maintain security and compliance.


Right now, the Morristown, N.J.-based health system, which has 2,852 physicians and 1,310 licensed beds spanning three locations, limits the use of real-time video to its telemedicine stroke program — but Reed anticipates the technology’s inevitable arrival as a widespread mobile communications tool.


“Whether it’s through Facetime, or Skype, or what have you, the real-time video wave is coming, especially with more people having iOS and Android applications,” Reed says. “For the moment though, in hospitals, we try to discourage all that because we don’t want people sending photos of patients. Everything comes back to compliance.”


Like most healthcare CIOs, Reed has embraced the BYO phenomenon, implementing Citrix and VMWare solutions that enable physicians to use their own devices while maintaining access to legacy applications that are still client/server-based.


To better facilitate rapid communication among physicians, Atlantic has begun piloting a secure text messaging app that appears promising. Currently, about 60 physicians are using the PIN-protected app, enabling them to receive PHI on-the-fly without violating any privacy rules. It took a while to find the right vendor because some of the apps were just too cumbersome to use, but it’s proven a reliable, safe tool for time sensitive communications.


“These are the things we’re doing now, but who knows,” adds Reed. “As healthcare changes and hospitals become smaller as the ambulatory side grows, what other tools will we need to support patients in their homes?”


Intel’s Worldwide Medical Director, Mark Blatt, M.D., is among those convinced that that’s where real-time voice and video technologies increasingly will come into play, enabling true POC collaboration among clinicians.


Although it will likely be another two quarters before he has the proof points he needs to offer examples of healthcare organizations that are effectively and creatively using IA mobile tools in this manner, he’s convinced we’re getting close.


Proactive CIOs who want to position their organizations accordingly, he says, should embrace three key concepts: choose the right device for the task; rearrange workflows to move toward collaboration; and, think about the compute model and how information is delivered to a mobile device.


“The mobile form factors are slate computers when you want them, laptops when you need them,” Dr. Blatt says. “And if I’m thinking about it from an operating perspective, consider that Windows* 8 is backward compatible with all your legacy equipment. All your peripherals and drivers just work, and you have the trusted security and manageability tools you’ve become comfortable with.”


What steps is your healthcare organization taking to better integrate clinicians and community-based care givers?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

Yesterday, I wrote that healthcare CIOs should take a closer looks at Windows* 8, given the operating system’s flexibility and improved functionality in dual compute model environments (keyboard and mouse/touch screen). As a follow-up, I reached out to Brock Morris, CIO at Seattle-based Pediatric Associates, for his take on how tablets and software upgrades go together in healthcare.


Pediatric Associates, a privately owned pediatric practice with 80 providers across seven clinical locations, sees about 250,000 patient visits per year. The practice was running on Windows 7 with no plans to upgrade anytime soon, but when their EHR vendor introduced a mobile app, Morris wanted to know how the OS upgrade – combined with the mobile EHR app – might help Pediatric Associates deliver the best patient care possible.


With assistance from his vendor, Greenway Medical Technologies, Brock commenced a Windows 8 pilot program that was limited in focus to three key areas: newborn rounding at local hospitals, seeing admitted patients at the local children’s hospital, and doctor-patient interaction at each of Pediatric Associates’ clinics.



Physicians making rounds had ready access to patient chart and research information, enjoying a high level of functionality and security. As an added benefit, staff were able to create electronic charts for newborns right in the hospital, before they were ever seen at the clinics.


The mobile app combined with the intuitive nature of the Modern UI in Windows 8 also benefited doctors seeing admitted patients at the local children’s hospital, granting the same levels of access, functionality, management, and security while freeing them from the need to log-in to a hospital computer and chart in the main EHR system.


Although the pilot program has only been in place for approximately nine weeks, a look into whether the use of this combined mobile app and system upgrade actually provides efficiencies at each of the practice’s clinics appears promising. The ability to switch between touch screen and desktop environments has added choice and flexibility to the physicians’ quiver.


These advantages, as well as inherent benefits such as UEFI, which eases the CIO’s struggle to keep PHI off devices, are all worth noting. However, the challenge confronting CIOs is to determine the appropriate use cases for Windows 8 before making the upgrade.


“We’re really at the beginning stages of looking at how it’s going to work for us and making sure we only apply it in areas where we see a clear benefit,” says Morris. “But we have several physicians working on Windows 8 now, and they’re having good results.”


Pediatric Associates anticipates keeping its Windows 8 devices in play and continuing the pilot for some time. In the weeks ahead, the practice will be evaluating a potential use case for its 120 medical assistants (MAs). Since the work MAs perform tends to be more templated in nature, Morris thinks it could be a good match. He’s also looking into leveraging Windows 8 devices to improve patient education in the exam room.


In the meantime, the practice plans to continue working with its EHR vendor, providing feedback that will help build out the functionality of the mobile app to enhance workflows and improve patient care.


Pediatric Associates’ start-with-the-task-you’re-trying-to-perform approach falls in line with industry guidance. As Mark Blatt, M.D., Worldwide Medical Director at Intel, reminds us: as tablets take over more and more of the healthcare marketplace, software applications purposefully built for touch environments are likely to lag devices.


“The industry is going to keep extending capabilities on the hardware platform, so it’s going to take a while for the software to catch up and deliver the experience we’ve unmasked with the features in the hardware,” Dr. Blatt says. “Don’t ask, ‘I’ve got tablets, what can I do with them?’ Identify the critical activities to your organization and proceed from there.”


What are your healthcare organization’s plans for leveraging tablets at the point of care? How do you fold in software upgrades to limit disruptions?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

As expected, HIMSS13 is abuzz with new offerings. Mobility, of course, is a central focus, and while devices and apps should garner a good deal of any healthcare CIO’s attention, don’t overlook the fact that Microsoft’s latest upgrade delivers a game-changing approach to the Windows* operating system.


Yes, it’s early. Maybe your organization is still running XP, or you’re just getting Windows 7 off the ground. Maybe you always prefer to wait on future versions. But proactive CIOs are looking at Windows 8 now because it enables them to incorporate the BYO phenomenon with all of their legacy software.


“From the CIO’s perspective, the challenge is keeping everything in synch at all times,” says Stanley Crane, CTO at Allscripts. “In Windows 8, the same management tools they use today to manage Windows 7 and XP environments translate exactly. There’s no new tool kit to get, the mechanisms are in place, you can keep everyone in synch. That, to me, is a huge plus.”


Thanks to backward compatibility, Windows 7-based healthcare organizations that may not have a lot of touch enablement (yet) can still run all of their applications in desktop mode within the Windows 8 environment without making any changes.


But in a move to accommodate the newer platforms that are touch-enabled, Windows 8 offers a choice: compute traditionally with a keyboard and mouse, or compute the way our collective consumer experience has been guiding us: with touch. Users can go back and forth seamlessly between both compute models.


For CIOs, having this capability means not having to bolt on a consumer BYO approach to their legacy environments. No need to use virtualization software in cases where it doesn’t make sense, simply because it’s the only way to prevent information from sitting on devices. They can compute natively in Windows on a mobile device.


“It’s not a forklift upgrade where I have to switch everything to touch; I don’t have to,” adds Mark Blatt, M.D., Worldwide Medical Director at Intel. “I can migrate to touch in a natural manner as makes sense. And I can let the consumer, or enduser, add their own BYO touch to the platform, fully knowing I have all the manageability and security tools that I’ve always had available to me. I’m not compromising anything.”


In addition, Windows 8 offers three interesting capabilities over the existing touch mobile device platforms currently on the market:


Live Tile: an environment in which users can communicate bi-directionally with the application that sits below it. It’s a nice innovation worthy of a little effort. For example, in the Live Tile environment, the icon could say, “You have stat lab values.” And after a certain amount of time, it could change from green to yellow to red, or it could buzz; it’s a live, interactive environment that’s pushing information to the tile, rather than telling you to go pull it from the store. Think of the possibilities here. FYI, users can right-click to turn off active tiles and make them static.


Picture password: a sign-on capability completely unique to the user, so they don’t have to remember pins or passwords. It frees users from some of the legacy constraints without sacrificing security. A welcome addition in health care settings.


Snap mode: a feature that offers the ability to run two different applications at the same time. Not just two different windows, but two applications on the screen at the same time. A physician could, for example, open a neuroanatomy program from the store that shows pictures of the brain and nervous system. On the other half of the screen, she could be running a DICOM viewer in desktop mode that shows an actual CAT scan of the patient’s brain. Having this ability to multi-task and bring up multiple apps in live environments is critical to the way health care providers think and work—and Snap mode allows this flexibility.


For functionality and flexibility, healthcare CIOs could do worse than consider a Windows 8 upgrade, given the overall gains. Is it on your organization’s radar yet? Why or why not?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

The consumerization of mobile devices poses unique challenges for healthcare CIOs, who are tasked with maintaining security, streamlining productivity gains expected of the industry’s growing mobile workforces, and implementing information technologies that ultimately lead to improved quality of care.


For a glimpse into how one leading healthcare organization is managing the bring-your-own-device (BYOD) trend, I reached out to Hal Baker, M.D., vice president and CIO at WellSpan Health Systems.


With more than 9,000 employees, volunteers, and physicians, the health system includes WellSpan Medical Group, 35 outpatient health care locations, and three respected hospitals: WellSpan York Hospital, WellSpan Gettysburg Hospital, and WellSpan Surgery & Rehabilitation Hospital.


Dr. Baker reports his organization is down to less than 40 Blackberrys, given the rise in popularity of Droid and iOS devices among physicians, nurses, and administrative staff.


While hourly administrative staff member’s mobile devices are not connected to the health system’s network because labor laws prohibit such employees from working off-hours, physicians’ and medical salaried staff’s devices are loaded from Exchange Server to ensure confidential information is adequately protected. This approach can work well for health systems, provided Exchange Server runs on the server side and the organization can provide access from client software running on a mobile device.


Virtual desktop

To better manage the BYOD trend—and to make the organization’s own devices easier to support and less expensive to manage—WellSpan has begun implementing a virtual desktop solution running Windows 7 in a server array. Unlike thin client solutions, it functions similarly to PC Anywhere, bringing up what is essentially a brand new PC for laptop and desktop users every morning.


“Our virtual desktop set-up is nice because none of the data leaves the data center,” says Dr. Baker, “so, there’s no footprint on the laptop. Users can log out and have it sit in a suspended state without worrying about anything being resident.”


In addition, Dr. Baker’s team has set up a throttled guest network that is shared by staff bringing in their own devices, as well as patients, families, and guests. Doing so has helped WellSpan reduce internet saturation due to bandwidth intensive sites such as YouTube.


As his department disables older encryption networks, such as WEP, Dr. Baker anticipates the creation of another guest network for workforce and medical staff. This additional network will run off WellSpan’s domain because he doesn’t want to put unmanaged devices on the organization’s domain for security reasons. A full-time security team prevents issues from developing among users who may seek workarounds.



For healthcare organizations, the age of accountable care hinges on being able to reach people in their homes, especially patients who are at high risk of readmission.


However, the same mobile technology that empowers staff to send photos of a patient’s condition to a physician may also place the entire health system at risk of a HIPAA violation if those images end up on an employee’s iCloud, or accidentally posted to Facebook. It’s not that a staff member would deliberately share such information, more a risk of unintentional connectivity that extends from the consumer realm into the healthcare space.


In WellSpan’s case, the health system made a business decision to connect mobile staff, such as visiting nurses, via email not text. Information shared among medical staff through mobile devices remains encrypted during transmission and does not enter the EHR until a physician forwards it to the records department so it may be added to the EHR.


“Our challenge,” says Dr. Baker, “is to try to leverage the consumerization of communications—text messaging, pictures, Skype, Facetime—to allow connectivity for the coordination of care, which is all the good stuff, while doing it in a way that protects the sanctity of security that HIPAA, I think, reasonably expects of us.”


Toward that end, WellSpan has installed a Symantec product on all laptops and USB drives, and has enforced encryption on all connected smart phones. Any file downloaded, copied, or received as an email is now automatically encrypted.


The IT team also has educated staff and physicians on why it’s necessary, for example, to enter a password to access a PowerPoint presentation.


Yes, it’s a pain, but already the approach has paid off. Last year, a WellSpan employee’s car was broken into and a laptop that contained protected health information (PHI) was stolen. The organization was able to sidestep a breach—and appearing on the dreaded Wall of Shame—because the IT Department could show the laptop was fully encrypted and in a locked state.


Mobile apps

Although WellSpan does not formally participate in an ACO program, the health system provides significant primary care through its medical group, effectively serving as an accountable care organization for the uninsured population in its community.


While many in this population don’t have a computer or high speed internet in their homes, a surprising number regularly access the Web via smart phones.  With so many patients now bringing their own devices to facilities, WellSpan has opted to develop its own mobile app for patients, a move Dr. Baker expects to further improve quality of care.


The health system’s mobile app will offer appointment reminders, directions to offices and facilities, and barcode scanning for refilling medications—for starters.


Granted, such apps are widely available through third party vendors, but Dr. Baker feels mobile offers an opportunity to stay connected with a population of patients for whom it is WellSpan’s mission to keep healthier. After all, four 15-minute visits per year aren’t as effective at keeping a diabetic patient under control as a provider who can stay in touch monthly, or weekly, via the Web.


“If we’re going to reach our patients and give them information, then lBYODet them see what their lab results show, let them communicate with us when they get off their night shift at 4:00am, or after working a second job,” Dr. Baker says. “We need to be able to reach out to them through this technology.”


What questions do you have?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

CentraState Medical Center in Freehold, N.J., recently partnered with a group of hospitals to form an accountable care organization (ACO). If their application is accepted, the fledgling ACO will get off the ground in January, so I reached out to CentraState vice president and CIO Neal Ganguly to find out just what it takes to build an HIT supported ACO from the ground up.


Solid Tech Infrastructure

For Neal, it all begins with ensuring you’ve laid a strong technology infrastructure, beginning with the in-patient EMR. That means having a strong system in place—CentraState uses Siemens Soarian—as well as making sure your health care providers are up and running, trained, and ideally using some of the advanced functionalities, such as computerized physician order entry (CPOE).


When establishing the framework, Neal and his hospital partners opted to put their own health information exchange (HIE) in place. Their goal was to avoid being prescriptive. Rather than telling physicians to settle on one EMR, such as eClinicalWorks or NextGen, the team focused on enabling connections to any EMR physicians felt would best suit their practices and workflows.


Unfortunately, that’s when they discovered some EMR vendors are just much easier to work with than others. After spending the better part of a year implementing the initial physician practices, Neal says the ACO team is now rethinking its totally-open approach. In fact, they are considering publishing a list of recommended EMRs based on their experiences with various vendors.


EMR Penetration

Despite the fact that the EMR space is widely recognized as a minefield for both CIOs and physicians, Neal believes EMR penetration is essential to building a robust ACO. Offering assistance to providers with EMR selection, implementation, and, to some extent, the Meaningful Use qualification piece, has proven worthwhile.


“We’ve been very open,” Neal said. “If providers didn’t want our help, we weren’t offended. That’s fine. But as we began to work with EMR vendors, we started seeing that either they were levying huge fees for the interfaces—anywhere from $5,000 or less, up to $20,000—or, in some cases, they just weren’t very interested in integrating easily, or their solutions lack the technical sophistication to integrate easily."


Providers who forego HIT assistance in this regard can quickly become bogged down in nightmarish technical detail that some of the larger, more established EMR vendors seem to have found a way around.


Patient-Facing Technologies

With a strong tech infrastructure in place and EMR penetration underway, Neal says the next key step will be identifying and implementing the right patient-facing technologies. Right now, he envisions a patient portal. But that decision ultimately will depend on a number of factors, shaped in part by what patients might want to have available to them as electronic touch points. Simply viewing test results, or communication with the provider? Access to health information libraries, tests, wellness surveys?


Since feedback from physicians and patients will play a role in shaping the team’s decisions, the group is researching its options, tapping resources such as HIMSS, CHIME, and listserv postings. They’re also soliciting feedback on what others in the industry are doing. Neal anticipates the next to-do item will involve sitting down with a focus group mentality, so they can better model-out how specific choices might play out in their community.


Once the patient-facing tech is in place, he believes it will be a matter of months until the ACO’s users are connected and able to explore clinical practice in a meaningful way.


As a non-clinician, he won’t speculate on how long it might take to see changes in clinical behavior. But he’s convinced that, going forward, business intelligence will be vital on the technology side, as well as from a human standpoint.


What questions do you have?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

Along with reducing paperwork, easing administrative burdens, and generating some cost savings, the rise of electronic health records (EHRs) in health care settings has significantly increased the risk of data breaches. Mobile devices alone, according to one recent industry news report, were responsible for 116 breaches between Sept. 22, 2009 and May 8, 2011—exposing the personal health information (PHI) of more than 1.9 million patients in the process.


It’s a modern fact of life that PHI is now more mobile that ever—traveling not just on smart phones, tablets, and laptops, but on a host of mobile media, including easy-to-lose flash drives.


As healthcare CIOs struggle to balance their responsibility to safeguard patient data against the need for health care professionals to access that information, they’re adopting a variety of approaches, including a return to mobile media encryption and implementation of in-house mobility management programs.


A good example can be found at Morristown, N.J.-based Atlantic Health System, which ranks among the best and most wired hospitals in the U.S. In addition to some 8,000 desktops and 1,500 laptops, the health system includes an ambulance company and a home care company. Employees across the system’s footprint, of course, carry a broad range of mobile devices and mobile media.


Linda Reed, RN, MBA, vice president and CIO at Atlantic, recalls arming all of her organization’s laptops with pre-boot encryption a few years back. “It was lucky we did,” she says, “because just after that our home care division had a couple laptops stolen and we would have been in a bind.”


Next, Reed and her team waded into doing mobile media encryption, but the technology was still a little clugey and the workforce wasn’t quite ready, so they backed away from it, focusing instead on encrypting all of Atlantic’s back-up drives. Reed also made it a matter of policy to eliminate tape storage, opting for disk-to-disk back-up right on site.


“We might need to revisit tapes at some point again for temporary back-up,” Reed says, “but right now we don’t do that; everything stays on site and it’s encrypted.”


Roughly six months ago, Atlantic revisited mobile media encryption, thanks to improved technology and a growing awareness in the healthcare industry that data breeches attributable to mobile are serious business.


Today, if you put any kind of flash drive or portable media card into any Atlantic device, you will receive a message informing you that you must encrypt it before proceeding.


As part of the health system’s budding mobility management program, Reed says Atlantic will soon be able to enforce PINs on all mobile devices, track them wherever they go, and wipe them remotely as needed.


The program itself will be rolled out in waves. The first step includes a marketing campaign, which Reed says will provide ample warning to all staff regarding the coming changes.


For health IT professionals at organizations lacking the funds to put such guardrails in place, Reed says the only thing you have in your favor is education and awareness. Her suggestions: educate senior management on the threats and consequences by referring them to breach reports published regularly via Specific to mobile, she also urges health IT professionals to implement an awareness campaign around mobile media, such as The Dangers of Flash Drives.


“Because it’s a two-pronged issue,” adds Reed. “It’s not just what you’re taking out of the organization, it’s also what you’re bringing back in.”


What do you think?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

As a HIMSS Level 7 facility, Deaconess Health System knows all about Big Data. For the past couple years, the Evansville, Ind.-based health care organization has been implementing systems that would enable it to move beyond the collection and storage of information, so it can start applying data in a more meaningful way.


With money now budgeted for this effort, CIO Todd Richardson plans to add a full-blown data warehouse, which will enable him to merge all of the organization’s data and then begin the serious business of sifting and sorting for actionable value.


“We’re making great progress with the tools we’ve got, but we see this new addition as the Holy Grail,” Richardson said. “We’re excited about it.”


But selling Deaconess on the project’s value was one thing. Change management is another.


Although the usual turf wars and overall resistance to change can make for an uphill battle, Richardson is convinced the key to winning organizational buy-in comes from making the case that everything links back to data—and then articulating that message in real-world terms to the executive team, who may not necessarily understand IT.


For the data warehouse project, Richardson recalls a breakthrough moment when he attended HIMSS with Deaconess’ Chief Medical Officer. By spending time in a booth together with a vendor, the CMO could see for himself what Richardson had been talking about for months.


“When you start with the CMO, who is responsible for the quality of patient care, you can tie back what it is you’re trying to do with why you’re trying to do it,” Richardson said. “Combine that with healthcare reform, ACOs, patient-centered medical homes, and the need to track your patients and to analyze your data and show outcomes.”


Being able to demonstrate value through data this way is also becoming increasingly relevant in a payment environment shifting from a fee-for-service model to a quality-based system.


Since each incremental step forward ushers in a series of changes that staff are likely to resent at some level, Richardson feels it’s all the more important for HIT professionals to get down in the trenches early on in the process. Soliciting critical input from the people you will need on your team as the project moves forward will help ensure the project is architected in the way that best meets staff needs and hospital objectives.


What questions do you have?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

Mobile devices are fostering greater collaboration at the point of care and helping to drive down health care costs. But as the ACO model takes hold—shifting the provision of care from acute care settings into the patient’s home—health IT professionals and providers alike are discovering that synchronous communication is the lynchpin that holds together all of the major parties comprising the health care ecosystem.


By enabling synchronous content streams—information shared and perhaps clarified in real-time—healthcare organizations are improving care, saving money, and empowering mid-level health care workers to help ensure continuity of high quality care.


For example, a patient in rural Kentucky who is struggling with medication management may not have access to a doctor, or an advanced practice nurse. Without the proper IT tool to enable synchronous communication—and the right health care worker to escalate that communication to the appropriate provider, as needed—often times the result is summoning  an ambulance and sending the patient to an acute care facility.


But with the technology currently available—and by leveraging community health workers, health navigators, PAs, visiting nurses, and others in a position to funnel patient information to the right provider in real-time—that same medication management issue could be addressed without the need for a hospital visit.


Yes, a similar approach is being implemented through various telemedicine projects, but it’s not widespread yet.


Patricia Abbott, Ph.D., RN, FACMI, FAAN, Johns Hopkins University Schools of Nursing and Medicine, thinks the hold-up is partly cultural and partly technical, with legal and financial components adding to the challenges.


But she’s hopeful, noting that cultures at acute care settings are, in fact, slowly evolving.


“Part of it is recognizing that, just as we don’t need an astronaut to fly a crop duster, we don’t need a physician to diagnose an earache,” Abbott says. “We can leverage synchronous communications by empowering others in the ecosystem, such as nurse practitioners, physician assistants, and others, with the right IT tools.”


For Abbott, the proliferation of smart phones, virtual desktops, consumer media pads, VPN connectivity, and shifting attitudes in healthcare settings that increasingly are allowing health care professionals to bring their own devices to work—provided they meet regulatory and security requirements—signals an industry moving in the right direction.


“What I think is in the process of happening is a transition to real-time, live communication and information exchange that goes well beyond just sending an email or text, or making a phone call,” Abbott says. “Geography and the type of device you use is irrelevant when the data coming from all the various sources is integrated. Being able to use technology to support a very rich view of everything that’s going on is the goal; almost like being physically present at the bedside, even though you are not.”


What questions do you have?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

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