The Internet can be a swamp of hackers, crackers, and hucksters attacking your systems for fun, profit and fraud. Defending your data and applications against this onslaught is a cold war, requiring constant escalation of new techniques against an ever increasing offense.Clinicians are mobile people. They work in ambulatory offices, hospitals, skilled nursing facilities, on the road, and at home. They have desktops, laptops, tablets, iPhones and iPads. Ideally ...
John Halamka, MD
Public and private cloud computing at a hospital
In a meeting with senior management at Harvard Medical School, one of our leaders asked, "What is our cloud strategy?"My answer to this is simple. The public cloud (defined as the rapid provisioning and de-provisioning of CPU cycles, software licenses, and storage) is good for many things, such as web hosting or non-critical applications that do not contain patient or confidential information.At Harvard Medical ...
Top IT implications of healthcare reform
I'm often asked how healthcare reform will impact IT planning and implementation over the next few years.First, some background. The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872) were passed to to address several problems with healthcare in the US. We're spending 17% of ...
Medication lists need to be shared in a meaningful way
Recently, I spent a few days in California when both my parents ended up in the hospital with different issues. They're home, settled and doing well at this point.Just as when I first wrote about experiencing healthcare with my family, there are important lessons to learn about this trip.As we strive to achieve meaningful use and create health information exchange in the US, the ...
What meaningful use stage 1 will mean to patients
As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I'm often asked "but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I'm lying unconscious in the Emergency Department and cannot give a history?"Here are ...
Senior leaders need to periodically reflect on their role
Leaders often think about succession plans for their direct reports, but what about themselves?What if I had a serious health problem or accident that impaired my ability to lead my IT organizations? Here's my brief analysis.Beth Israel-Deaconess Medical Center My role at BIDMC is to document the strategies prioritized by our governance groups, ensure our organizational chart structure is optimized for executing the strategies, ...
10 tips for troubleshooting complex EHR infrastructure problems
I recently joined my team while troubleshooting a complex infrastructure problem affecting our community EHR hosting private cloud.From years of experience doing this, here are my lessons learned.1. Once the problem is identified, the first step is to ascertain the scope. Call the users to determine what they are experiencing. Test the application or infrastructure yourself. Do not trust the monitoring tools if they indicate all is well but the ...
Meaningful use letter for the hospital board and senior leaders
In January, I wrote a Do it Yourself presentation on meaningful use for folks to use with their Board and Senior leaders.Now that its August, there is a different kind of Do it Yourself document - a letter to your Board and Senior leaders outlining your plan and timeframe for certification, measurement of meaningful use, and collection of your stimulus funds. We cannot be completely certain about every detail, ...
How to implement CPOE successfully at your hospital
One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes. This has created a new urgency for all hospitals in the state to install computerized physician order entry (CPOE).At BIDMC, we implemented CPOE in 2001 and have not had a handwritten order in most areas, except for the 2 days of our network outage in 2002. Implementing CPOE is challenging and requires ...
What is the best way to record allergies in hospitals and clinics?
I was recently asked about the best way to record allergies in healthcare environments.At what point should allergy verification be occurring for a planned hospital admission? Should it be prior to admission or at the time of admission?Is there any data yet to support decreased adverse drug reactions when the patient is asked to complete their own history initially through a patient portal?Should data entry of allergies into smaller best ...
How Massachusetts can lead health IT modernization
Although healthcare reform has its supporters and detractors, healthcare IT reform - the use of technology to improve the quality, safety and efficiency of healthcare throughout the country - has broad support from all stakeholders.The passage of last year’s $787 billion economic stimulus bill brought with it a healthcare IT modernization program that could inject about $30 billion into the economy. Since Massachusetts is a leader both in the use ...
