Over the past few months, Beth Israel Deaconess Medical Center (BIDMC) has been exploring the use of wearable computing. In the emergency department we’ve been evaluating an early unit of Google Glass, a high tech pair of glasses that includes a video camera, video screen, speaker, microphone, touch pad, and motion sensor. We have been able to access our internal web-based ED dashboard on Glass, in a secure manner that ensures all ...

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Over the next few months, Jacob Reider will serve as the interim National Coordinator for Health Information Technology (ONC)  while the search continues for Farzad Mostashari’s permanent replacement. What advice would I give to the next national coordinator? David Blumenthal led the ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the “regulatory era.” Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were ...

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Now that Labor Day has come and gone,  I’ve thought about the months ahead and the major challenges I’ll face. 1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of hospitals, clinics, pharmacies, labs, and imaging centers.  As the Affordable Care Act rolls out, many accountable care organizations are realizing that the only way to survive is to create “systemness” through mergers, ...

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5 ways Google Glass can be used in a hospital I recently had the opportunity to test Google Glass. It’s basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses.  The small prism “screen” displays video at half HD resolution.  The sound features use bone conduction, so only the wearer can hear audio output.   It has a motion sensitive accelerometer for gestural commands.   ...

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In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic.   Boston Medical Center is replacing Eclipsys (Allscripts) with Epic.   Lahey Clinic is replacing Meditech/Allscripts with Epic.  Cambridge Health Alliance and Atrius already run Epic.   Rumors abound that others are in Eastern Massachusetts are considering Epic.  Why has Epic gained such momentum over the past few years? Watching the implementations around me, ...

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Recently, my family and the hospital care team have been guided by my father's healthcare proxy to avoid painful, invasive, or aggressive care at time when his multiple medical issues have combined to make his health decline irreversible. The healthcare proxy was extremely clear and enabled us to finalize the do not resuscitate and do not intubate orders.   We agreed to stop monitoring and stop all medications except ...

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Earlier this year, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC.   Here's my list of top risks for 2012: 1. Old Internet browsers. Many vended clinical applications require specific versions of older browsers such as Internet Explorer 6, which are known to have security flaws.  We've worked diligently to eliminate, upgrade or replace applications with browser specificity.   At this point we ...

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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 ...

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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 ...

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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 ...

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