There’s essentially a 1-in-5 chance that a Medicare patient will be readmitted within 30 days of being discharged from a hospital.


The U.S. government estimates $17 billion USD a year could be saved by preventing unnecessary readmissions through better care coordination, not to mention the improved quality of life and lowered infection risk for patients who don’t have to go back to the hospital.


Under new federal rules, hospitals with readmission rates considered too high now carry risk of having portions their Medicare reimbursements withheld.


The hospital discharge summary is an important document to aid communication that can prevent unnecessary returns to the hospital. If incorporated into an effective workflow, it helps open a window of opportunity for patients and their normal care teams to get on the same page with the hospital on next steps, such as making follow-up appointments, monitoring to prevent complications, managing a new medication regimen, etc.


So, if each hospital creates a better discharge process, we will tackle the readmission problem, right?


Not entirely.


The problem, especially in metropolitan areas, is that patients go to several providers, and a few different hospitals. Therefore, the needed care coordination cannot be confined to one hospital alone. It needs to be spread across the community, including the patient, the patient’s primary care provider, specialists, and in some cases, non-traditional health workers. And to do that efficiently, communities need to standardize the discharge document as well as some targeted post-discharge interventions.


That’s the fundamental premise behind an important project that a small Intel team joined in the metropolitan area of Portland, Ore.  We were honored to work with a team led by Melinda Muller, MD, of Legacy Health, who directs a pilot to standardize the discharge summary and process.


We describe the project and its initial lessons in a new whitepaper: Developing Community-Based, Standardized Hospital-Discharge Summaries.


There are other efforts all over the world to improve the discharge summary process. We’re interested in your thoughts.


What’s happening in your community?

It’s vividly educational to pitch in on the front lines of a grand challenge like the Oregon Experiment, sometimes described as “ACOs on steroids.”


• How do you take a financially strapped program (i.e., Medicaid), nearly double its size, control its per capita cost growth, and deliver better care and service to its patients?


• How do you create more cost-effective clinical workflows across organizational boundaries among traditional competitors?


• And how do you use IT to support the program’s lofty goals?


Observers of the movement toward accountable care organizations (ACOs) will look to Oregon for evidence of success or failure. To be fair, it will take a few years to defensibly answer these fundamental questions.


What we can say definitively now is that the journey is as necessary as it is fascinating. We describe it in a new white paper, ACOs on Steroids: Why the Oregon Experiment Matters.


Health Share of Oregon is a lean startup organization that administers a Medicaid transformation project involving several healthcare providers and public agencies in metropolitan Portland.  Health Share of Oregon’s broad ambitions, as well as its birthing pains, demonstrate the opportunities and barriers to healthcare transformation efforts that go beyond tinkering at the edges.


I’d like to recognize the great work of Intel colleagues Stephanie Wilson and Prashant Shah, who dug in with Health Share of Oregon’s IT team for about nine months to help get the project started under very tight deadlines. We learned a lot and felt honored to work together with the Portland area health IT community.


In healthcare, it’s the long haul that matters. Although the startup phase may perhaps be the most exciting, the ultimate success of the project will be determined through the ongoing hard work to continuously improve. It will take the whole community of Medicaid providers, IT professionals and health data experts to answer the grand questions of the Oregon Experiment.


Our thanks go out to the whole Health Share of Oregon community for their efforts to create a safer, higher-quality and financially sustainable system for people with lower incomes and barriers to healthcare access.


Because of the Medicaid expansion under the Affordable Care Act, the federal-state program is in need of healthcare leaders and IT professionals willing to innovate.


Do you see innovations happening in your community? What’s working and what’s not working?

China, like the rest of the world, is dealing with a massive aging population. Add to this a rising middle class migrating to the cities and a changing family structure and the stresses to China's healthcare and social services systems are huge. China's government, recognizing these challenges, has provided leadership in its 12th 5 year plan outlining policies and funding providing for technology enabled aging services. 


I recently attended the China International Senior Services Expo in Beijing. This conference, sponsored by the Chinese Association of Social Welfare (CASW) under the Ministry of Civil Affairs (MOCA), was a combination of policy articulation and technology and service vendors offering health, wellness, spiritual, and housing solutions. In fact, Intel is working with the Chinese government on an Aged Friendly City Initiative and you can read more about this innovative venture in a new white paper.


As I walked the floors of this expo, I was struck by the innovative and comprehensive set of technologies and solutions on display. There were:


• Smart phone applications for medication reminding, calendaring and caregiver communication 

• Community-based remote patient monitoring solutions (vitals, weight, video conference); some standalone but many that provided call centers for consultation

• Many different shapes and sizes of Win8* touch and Android based mobility solutions

• Wearables (e.g. watches) that track wandering or aid with fall prevention and emergency response

• Real estate companies who were providing assisted living facilities as well as group vacations and other services for elders. 


What surprised me the most was not the Chinese uniqueness of these solutions, but the commonality of need. I could have been in any country, speaking any language. These needs are the same experienced by countries all over the world who have aging populations.


The unique aspect in China is the magnitude of deployment occurring. Many of these vendors claimed deployments in the "thousands"...still a tiny fragment of the Chinese market but significant nonetheless. It made me think that China could be the place that gets this right. It has all the elements: the need, the urgency, the policy, the funding, and the innovation.


Remember to check out this white paper on the Aged Friendly City Initiative.


What do you think?

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.

Below is a guest blog from Narayan Sundararajan, global healthcare program manager at Intel, who attended last month’s Global Midwifery Symposium.


Think about this: pre-eclampsia/eclampsia, post-partum hemorrhage and prolonged and obstructed labor together account for more than 50 percent of all maternal deaths in developing countries. That’s why the Second Global Midwifery Symposium in Kuala Lumpur last month was so important for introducing strategies to strengthen healthcare in developing regions.


One of the biggest strategies is introducing technology to the process.


A workshop that Intel participated in with UNFPA, WHO and JHPIEGO launched three key e-learning modules for training frontline healthcare workers and midwives on life-saving skills. The energy, passion and vibe from the participants during the training and workshop was tremendous; they all really want to make a positive difference in the world.


During the session, around 70 midwives, frontline health workers and others from more than 25 countries were trained on how to use the skoool™ healthcare education platform. The open access, no charge license e-learning application can be used both offline and online, and can house various types of content formats including the three modules on pre-eclampsia/eclampsia, post-partum hemorrhage and prolonged and obstructed labor with associated quizzes.


Each participant’s laptop was loaded with the platform and modules to take back to their respective countries. The sponsoring organizations challenged each of them to see how they could incorporate such a platform and modules in their own country’s health system to bridge the gap between lack of facilities and trainers and critical shortage of health workers.


In addition to the workshop, I gave an overview presentation on innovations as strategies and made the following key points:


• Innovation is defined as something new, fresh or improved but that creates value. And, it is important to understand where your innovation falls in the spectrum of incremental, modular, architectural or radical innovation and what the value it creates is.


• Doing that is not just a theoretical exercise but allows self-introspection on its novelty, the potential impact it will have and most importantly, the obstacles or roadblocks that will be faced and need to be overcome for its successful implementation and scaling.


• Traditionally, governments and development agencies are more comfortable with incremental innovations whereas more examples of radical innovations are found in the private sector. Hence, public private collaboration is a key to encouraging radical innovations that have tremendous impact.


A four-way collaboration between Intel, UNFPA, JHPIEGO and WHO is an example of a radical innovation that has the power to transform healthcare access, quality and cost as it exists now and in particular, revamp healthcare education and training as it is delivered today. That’s why innovation is no longer a choice, and applying technologically innovative solutions to address big problems in maternal and child health is an imperative.


What do you think?

Dr. Lyle Berkowitz, associate chief medical officer of innovation for Northwestern Memorial Hospital, believes that failure leads to innovation. His book, Innovation with Information Technologies in Healthcare and organization, Szollosi Healthcare Innovation Program, offer proof that innovation must be nurtured and that it often occurs under surprising circumstances. Read below in this 5 Questions interview for his insights and advice on making healthcare organizations more in tune with innovation.


Intel: What are three simple things an organization can do to encourage innovation? Dr Lyle pic.jpg


Berkowitz: The key is to change the culture of the organization, which needs to be both top down and bottom up. From the top, the first step is to get executive buy-in that failures are a good thing. An innovation mantra is fail fast, fail often and fail cheap…you will always learn a lot! So many hospital executives are scared of any failures, but they need to be embraced to encourage people to try new things. Second, identify someone whose role is to find new innovations for piloting and to support innovators within your organization. Give this person a small budget so they can try new things without having to go through the usual budget bureaucracy, while also recognizing that their job is to move from concept to pilot to figure out if a bigger project is warranted. Finally, consider an X-prize or crowdsourcing exercise in which your whole organization is challenged to come up with an idea that can create significant value.  If you promise to split any cost savings with the winners, you will likely be shocked with how many good proposals you will get!


Intel: Your book, Innovation with Information Technology in Healthcare, collects stories from more than 20 organizations that have successfully created and implemented new health care information technology processes. What is the common denominator across all of these successes?


Berkowitz: Our book allows the innovators themselves to tell us what they did, why they did it, how they succeeded, lessons learned, and their plan for next steps. It's like a big cookbook of recipes on how to innovate, with sections on EMR Innovation, Telehealth Innovation, and Advanced Technology Innovation (e.g., analytics, portals, mobile, and gaming). Some commonalities include having a physician or other champion with a passion for fixing something that is not working well, the patience for multiple iterations, and the skills to start something small and then expand it once it starts succeeding. Additionally, many of the stories focus less on the technology, and more on the process, business model, and sometimes legal changes needed to realize the full power of the innovation.


One of my favorite stories in the book describes how UPMC addressed an issue involving a patient who came in for antibiotics, but had a severe allergic reaction to the latex gloves used by the IV team. Although she had a known latex allergy, the IV team was not aware of this because it was not part of their workflow. Instead of simply saying, "We can improve this process by making the IV team always check for latex allergy,” the executives decided to do a brainstorming session and used this example as a starting point for how they might rethink the whole process of care at their hospital. Someone came up with the wild idea of "What if the room was alive and knew who entered and what information they needed based on their role?” That idea became a prototype involving a monitor and computer system, which used RFID to identify who entered a room, and then displayed relevant information and allowed them to enter data. The team found that this improved both quality and efficiency, and they wound up creating a company to deploy these at their hospital and beyond. It represented the whole arc of innovation—problem to brainstorming to piloting to spreading. Other stories describe how an EMR’s built-in functionality can be used to support care coordination, preventive care and disease management, and early warning for adverse events. Telemedicine stories range from traditional doctor-patient video calls to electronic curbside consults to ePharmacists and Teletranslators. And, finally, there is a section describing the use of analytics, mobile, and gaming technologies applied to healthcare.


Intel: What healthcare technology do you use and like?


Berkowitz: From a personal and business perspective, I loved my smartphone from the second I got it. It's critical for me to keep in touch with my email as I juggle multiple roles and travel away from my office several times a week. However, with respect to clinical care, my technology needs are different. I need a large-screen computer. I use an electronic medical record system and a secure messaging system to keep in touch with patients. I access UpToDate for most clinical reference, and use Google in the exam room when I need to show a patient a picture or video to get a point across. We also have a nice touch-and-go authentication system, and more importantly, for security is a system that locks my computer when I open my exam room door to leave.


Intel: How do you see healthcare technology changing in the next three years?


Berkowitz: I think there will be two major changes for healthcare.  First, I think the EMR will become more of a platform and we will see "EMR Extender Companies" building apps that sit on top or alongside EMRs to improve efficiency and quality in a variety of workflows. A company I cofounded two years ago, healthfinch, focuses specifically on apps to improve physician productivity by helping to automate and delegate certain repeatable tasks away from doctors and toward their staff (e.g., medication renewal requests). Second, I think we will see consumer biometrics get increasingly small, cheap, easy, and ubiquitous. What will then be important is to have a way for physicians to "use" all this data. I envision a future where this ubiquitous health data flows into a cloud that contains the protocols to help promote wellness in all, maintain health in those with stable illnesses, and identify outliers who need to come in for review.


Intel: What is the Szollosi Healthcare Innovation Program? What changes are you trying to make within the healthcare system?


Berkowitz: The Szollosi Healthcare Innovation Program (SHIP) is a charitable endeavor with a mission to use creative thinking and diverse technologies to produce a better healthcare experience for patients, physicians, and others associated with their care. Our work on care coordination has been highlighted in the Harvard Business Review and by the Hope Street Group. Our work on "information visualization" was highlighted at the Mayo Clinic's Center for Innovation Transform Conference.


Two of our care coordination projects were selected for the AHRQ's Innovation Exchange:


ExpectED: Electronic Handoff Notes to the Emergency Room

The Inflection Navigator: Tale of an Easy and Effective Care Coordination System


The Szollosi Healthcare Innovation Program is trying to help spread the word on the use of innovation science in healthcare to help others think differently about how to address issues we face every day.


For more insights, follow @DrLyleMD on Twitter and read his book, Innovation with Information Technology in Healthcare.


What questions do you have?

In my last blog, I discussed the rationale for applying privacy and security best practices to enable the benefits of personalized medicine while minimizing risks of breaches and other types of security incidents. One of these best practices involves walking through each step of the information lifecycle, from collection, to use, retention, disclosure and disposal. In this blog I take a look at the collection stage of the information lifecycle.


Collecting information for personalized medicine requires informed patient consent. Patients must be informed about the benefits, risks, who will have access to their data, how their data will be processed, and choices they have regarding their personal healthcare information. This includes both physical samples collected, such as saliva and blood samples, as well as the raw genome sequence data.


Research is needed to further the science of analyzing and deriving meaning from genetic information, and this research needs genetic data. Patients are typically presented with a choice of whether to participate in this type of research, and whether they want to authorize sharing of their genetic data, most often in de-identified form, with such researchers. Choices presented to the patient are typically either opt-in or opt out.


Opt in is where the patients data by default will not be shared with researchers unless they explicitly opt into sharing their data. Alternatively the patient may be presented with an opt-out choice where the default is for their data to be shared with researchers unless they explicitly opt out. These basic “all or nothing” opt-in / opt-out types of choices are often overly simplistic and don’t give the patient much control over their data. More sophisticated consent and choice mechanisms are required in the future for the patient to have greater control over who should have access to their data, for what purposes, how they can get access and participate, and so forth.


Some types of genetic research require more than fully de-identified data. An example is phenotype research which requires information about the patients environment, for example their zip code. This is location information about the patient and therefore Personally Identifiable Information (PII) which, when associated with healthcare information such as genetic information can cause the combination to be classified as Protected Health Information (PHI) under HIPAA and subject to legal and regulatory requirements, for example breach notification in the event of loss or theft. 


For this reason, tokenization is often used in the collection of genetic information for patients. Right from the time physical saliva or blood samples are taken they are often bar-coded to associate them with the patient, in contrast to labeling the samples with elements of the patient PII such as names, date of birth and so forth. Tokenization may also be used later to enable authorized access to limited PII, in addition to de-identified genetic data, in order to support more sophisticated research such as phenotype research.


Encryption may be used to protect the confidentiality of collected sensitive data at rest and in transit, including elements of PII stored in secure databases. Genetic data can take the form of very large data sets. For example a single raw genome sequence data can be several hundred GB or larger in size. Encrypting a volume of data such as this, while maintaining performance, requires hardware acceleration, such as Intel® AES-NI (Advanced Encryption Standard – New Instructions).


What types of privacy and security challenges and solutions do you see with the collection of data for personalized medicine?

Stop me if you have heard this story before: an organization has a paper workflow that involves keystroke entry, which results in errors and inefficiencies. Sound familiar?


That was the case with the Infectious Disease Clinical Research Program (IDCRP), a worldwide network of Department of Defense (DoD) clinical and research centers that have collaborated to investigate infectious disease challenges facing the military. IDCRP had a paper workflow that relied on double-key data entry into electronic data capture (EDC) systems with resulting errors, scanning and mailing of forms, and slow processing time.


The big question was, “how can this process work better?” To move beyond the inefficient system, the IDCRP turned to Mi-Forms Tablet forms technology running on TabletKiosk’s Sahara Slate PC i500 tablets to eliminate all paper forms.


The benefits of this switch were immediate and extensive. For example: 50 percent time savings, 80 percent of users grading the solution as more efficient, and total buy-in from the clinicians.


A new whitepaper goes deeper into this case study and shares more of the benefits that were realized. You can register and download the paper here.


What questions do you have? Would your organization benefit from a similar engagement?

Personalized medicine, or tailoring medicine to individuals based on genetic and other information, promises major benefits to improve the quality of healthcare. This key trend is also sure to accelerate in the next few years to a major change driver as DNA sequencing becomes more affordable and algorithms to derive meaning from this data become more powerful. Many new types of sensitive data and intellectual property are used through the personalized medicine information lifecycle from collection, to use, retention, disclosure and disposal.


HIPAA, HITECH Act, GINA, and state level regulations such as CA SB 1386 regarding healthcare / genetic information and breach notification present a complex legal and regulatory compliance landscape. Privacy and security concerns about regulatory compliance, breaches and theft of IP abound, and often impede realization of the full benefits of personalized medicine. Advancing the science of personalized medicine requires vast databases of sensitive healthcare and genetic information, and access for research.


De-identification, for example based on the HIPAA 18 identifiers commonly found in protected health information, is often applied to enable research and help mitigate privacy and security concerns and risks. However, there have been several successful high profile re-identification attempts that have correlated de-identified data with the correct patients.


Clearly, even with de-identification, there is residual risk. Compounding this, genetic information is far from fully understood, and the genetic “dark regions” we don’t yet fully understand, may well hold information that increases re-identification risks.


In my next few blogs, I’ll apply best practices in healthcare privacy and security to take an objective approach to assess risks, apply safeguards using a multi-layered approach to effectively reduce residual risk to acceptable levels. I’ll look at various types of sensitive data used through the personalized medicine information lifecycle from collection, to use, retention, disclosure and disposal, assessing risks to confidentiality, integrity and availability of the data.


I’ll also look at recent healthcare security research underscoring the importance of usability of solutions and security, how a lack of usability can adversely impact compliance and risk, and practical strategies to implement strong and usable security. Hardware based security is enabling stronger and more usable security controls that can be used as part of a holistic multi-layered approach to effectively mitigate risks in personalized medicine, enabling benefits to be fully realized sans privacy and security incidents such as breaches.


What approach are you using to manage privacy and security risks and enable personalized medicine in your organization?

In the past year, I’ve blogged about big data and cloud computing. Increasingly, the two are converging in ways that have transformative potential for healthcare and life sciences.


From electronic health records (EHR) and PACS (picture archiving and communications system) to genome sequencing machines, healthcare and life sciences (LS) are generating digital data at unprecedented rates. Much of the effort around “big data” is concentrated on deriving value from this information. Using distributed software frameworks such as open source Hadoop*, big data techniques will give us the analytic scale and sophistication needed to transform data into clinical wisdom and innovative treatments.


Cloud computing can help healthcare/LS organizations take advantage of big data analytics and accomplish other key objectives. Whether you focus on your own data center, work with a hosting provider, adopt software-as-a-service (SaaS) solutions, or combine multiple approaches, cloud models provide the organizational agility to access scalable computing resources, as you need them. Cloud computing offers well-recognized cost savings, but with all the changes and opportunities facing healthcare and life sciences organizations, the agility benefits can far outweigh them.


Intel recently developed two documents that can help you advance your cloud and big data strategies.


The New CIO Agenda takes a high-level look at key issues to consider as you move toward cloud-enabled transformation. It also provides quick examples of five leading healthcare/LS organizations that are using cloud computing to create value and enhance agility.

Big Data in the Cloud: Converging Technologies goes deeper into analytics-as-a-service models and identifies practical steps to advance your cloud-based analytics initiatives.


I encourage you to download these documents and use them as you evolve your cloud and big data strategies.  I’d also like to offer three specific suggestions that can move you forward and prepare you to take full advantage of cloud and big data opportunities:


1. Develop a roadmap. Start identifying what’s critical to keep in secure, on-premises environments and what functions you can move to external infrastructure-as-a-service (IaaS) clouds or consume as SaaS solutions.

2. Modernize your infrastructure. Even if you use SaaS heavily, you still need standards-based virtualized infrastructure to interface with external services and adjust to fast-changing demands. If you’ve already virtualized your servers, start looking at storage virtualization, unified networking, and software-defined networks.

3. Don’t let security concerns keep you out of the cloud.  There’s plenty you can do to keep data and resources secure in the cloud. Use your move into cloud computing to take a comprehensive, holistic approach to privacy and security. Adopt policy-driven, multi-layered security controls, and use hardware-enhanced security technologies to improve security and end-user experience.  As you talk to potential cloud service providers, make sure they are able to meet the requirements derived from your organization’s privacy and security policy.


Intel is committed to enabling healthcare and LS organizations to reap the full benefits of cloud and big data analytics. We’re designing the compute, networking, storage and software capabilities to deliver high performance solutions for large-scale cloud and analytics workloads at scale. We’re collaborating with the Open Data Center Alliance (ODCA), Cloud Security Alliance (CSA), and other industry organizations to create flexible, secure frameworks for cloud computing and big data analytics. And, we’re expanding our software portfolio with solutions such as the Intel® Distribution for Apache Hadoop*, which enables standards-based distributed analytics with robust security and management capabilities.


I think some of the most exciting use cases for big data analytics and cloud computing are coming from healthcare/LS. How about you? What are you doing and seeing? How can Intel help you reach your cloud and analytics objectives?


• Download The New CIO Agenda brochure.  

• Download the Big Data in the Cloud: Converging Technologies solution brief.

• Visit this web site to see what healthcare and life science users are doing with big data analytics and Intel® technologies.

• Follow me @CGoughPDX  on Twitter.

If you were at HIMSS this year, you saw how mobility is dominating the current health IT landscape. Today’s healthcare industry demands the latest technology and solutions from companies that are in touch with complex IT challenges. That’s why Toshiba, Intel and Microsoft have joined forces to provide next-generation mobile devices, applications and solutions that improve quality of care while reducing costs and meeting all compliance and security requirements.


The best way to understand the advancements in mobile devices is to see them for yourself. If you live or work near Dallas, Chicago, Los Angeles, or San Jose, you are invited to attend our special healthcare mobility events in June. These mobility roadshows are great opportunities to join other healthcare IT professionals in your area and hear from a panel of experts as they present the latest innovations in applications and devices. You’ll also have an opportunity to ask questions, demo new products and even win an Ultrabook.


What will you learn? The healthcare panel will give you insight on:


• The latest breakthroughs in mobile healthcare technology

• Deciding which clinical workflows are most relevant for a secure mobile solution

• How to provide a range of hardware solutions that clinicians will love

• How the right management infrastructure can support both existing and new devices as you roll them out


Find out more about the events, which start June 4 in Dallas, and register here. The event will move to Chicago on June 5, Los Angeles on June 11, and San Jose on June 12.


What questions do you have?

In my previous blog, I discussed how the 4 V’s of Big Data apply to healthcare. This time around, I would like to focus on a specific class of Big Data solutions; distributed computing solutions that utilize Hadoop. So what is it exactly? 

Hadoop is essentially a software framework that supports the storage and processing of large data sets in a highly parallelized manner.  Two of the obvious benefits that Hadoop brings to Big Data solutions are scale and flexibility:


Scale: You might remember from my last blog that “volume” is one of the key Big Data challenges facing health-IT organizations. Hadoop is typically deployed on a cluster of commodity servers. As computing or storage demand grows, the system is scaled by adding new nodes to the cluster. This is the “scale out” model, as opposed to “scale up” where an existing system is replaced with a new, more powerful system. The “scale out” model is less disruptive (and typically less expensive) for IT organizations than the “scale up” model.


Flexibility: Variety of data is another consideration that is driving interest in Hadoop. While much of healthcare data is structured, resides in a traditional relational database, and conforms to a well-defined schema, there is also a lot of unstructured information such as images, faxes, and dictated/narrative notes. This unstructured information contains significant clinical and analytical value, but many organizations are not making effective use of it today. Hadoop includes the HDFS (Hadoop Distributed File System) and HBase, a non-relational, distributed database that has no problem storing these differing data types in a schema-less fashion. Furthermore, all of this data is triple-replicated across the cluster improving the resiliency of solutions that make use of this infrastructure.


So how are healthcare organizations making use of Hadoop today? Take a look at a new paper which describes in more detail how the healthcare industry can take advantage of Hadoop. Examples from three domains are highlighted; provider, payor and life sciences:


Read Intel Distribution for Apache Hadoop Software Helps Cure Big Data Woes


You might have gleaned from the title of the link above that Intel is among the growing list of companies convinced that Hadoop is a critical component of the data center, and at Strata a few weeks ago, Intel announced the North American release of the Intel Distribution for Apache Hadoop (IDH). Details can be found here.


Do you have any thoughts or experiences to share? How has Hadoop helped your organization? Please add to the discussion below. For information on the role Intel plays in Big Data for healthcare, please visit this site: Big Data and Analytics in Healthcare and Life Sciences. You can also follow me @CGoughPDX on Twitter.

Healthcare IT is moving away from the top down, “command and control” model of 10 years ago. Back then, IT provisioned all devices and the mobile device environment was more homogeneous, strongly managed and secured, to a much more diverse heterogeneous environment including BYOD, often with less manageability and security. In this new diverse and rapidly changing environment, a strong and effective detection and response capability becomes much more important. We can compare the new environment and this security model to an immune system where when a pathogen appears it is detected by the body and an immune response starts to eliminate the pathogen and put out antibodies to prevent a future recurrence.


In this analogy a pathogen in healthcare IT security could be a new type of malware or phishing attack, or some risky healthcare worker action such as attempting to copy unencrypted patient records onto a USB key, or attempting on impulse a post of sensitive healthcare data to social media. SIEM, DLP and global threat intelligence capabilities are just a few great examples of security detection controls. An effective immune response in healthcare IT security needs to be holistic and multi-layered in the sense of incorporating several administrative, physical and technical controls complementing each other for effective risk mitigation. Administrative controls may include updates to policy, risk assessments, effective training, audit and compliance, and security incident management controls. Physical controls may include locks and other physical access and tamper proofing controls for data, assets and facilities. Technical controls may include anti-malware, IPS, whitelisting, encryption, anti-theft and many others.


Of this mix of safeguards, and with key healthcare trends such as BYOD, social media, mobile healthcare and others increasingly empowering healthcare workers with more tools and options to get their work done, the human factor and effective training is becoming incredibly important. Recent HIMSS research shows if solutions or security are lacking usability, healthcare workers use these tools and options to get their job done in workarounds that add non-compliance issues and additional risk.


Compounding this challenge, recent HHS OCR audit findings shows that many healthcare organizations lack effective training. To be effective training must move beyond the “once a year scroll to the bottom and click accept model” to a much more continuous, bite-sized, gamified, engaging form, and enable the healthcare worker to apply and solidify their knowledge as a part of their daily job. Penetration testing needs to include the human factor to help detect vulnerabilities in end user behavior that can then be remedied. Some innovators such as Wombat Security Technologies have emerged with capabilities in this area. Security safeguards such as DLP also offer special value in helping educate healthcare workers on the job in “teachable moments” where at the point where they attempt an action that is out of compliance with policy the DLP control can inform them and educate them on safer alternatives.


What kinds of trends and risks, and detection and response safeguards, are you seeing in your healthcare organization?

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.

Technology is making patient care a true team sport. Care coordination and collaboration among clinicians is now more available than ever before and a key area of emphasis for the NHS moving forward.  Security must also play a big part in this technology revolution, as patient data must be private and secure.


To address these key health IT components, Intel is hosting two seminars in London and Manchester coming up on May 14 and May 16 that will demonstrate the outcome benefits of key enabling technologies such as big data analytics, data mining, and mobility.


The full-day events give you an opportunity to listen to presentations and participate in collaborative sessions with healthcare industry experts. You will also be able to:


• Learn how healthcare organisations are developing workflows that enable sharing of information, remove barriers to care integration and support clinical and integrated governance

• See how information yielded by big data analytics can lead to improved clinical outcomes and treatment options for patients, significant research insights, improved care coordination and enhanced patient safety

• Hear from industry leaders about ways to keep mobile clinical tools (tablets, smartphones) safe from security risks.


Among the featured speakers are Antony Sumara, CEO at Royal Bolton Hospitals NHS Foundation Trust, who will be on hand in London on May 14. Most recently, Mr. Sumara has been involved in supporting failing organisations throughout the country, including University Hospital of North Staffordshire, Hillingdon and Mid Staffs NHS Foundation Trust. He was sent by “Monitor” and the DH, to rescue Mid Staffs and to restore public confidence in the Trust.


In Manchester, Bill Ollier, a Professor of Immunogenetics at Manchester University and Director of the Centre for Integrated Genomic Medical Research, will share insights on his research into the genetic basis of common complex disorders.


We hope to see you at one of the sessions. Be sure to register for one or both of the events, and let us know what questions you have. More information is available here.

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