When Cost and Innovation reaches a Crossroad

Digressing from normal blog, I wanted to reflect about how America could get out of this plague and see why we are in here in the first place.

HP: Is it a broken company?
http://www.zdnet.com/blog/btl/hp-is-it-a-broken-company/59293?tag=content;feature-roto

I know my blog goes away from the article to a point but it sees to reinforce the issue we are dealing with.

How does a company generate revenues and stay profitable in a dynamic environment?
To have a competitive advantage!
What competitive advantage could be focused on operations, products, and strategy.

HP has becoming the laughing stock because they have become the fool they made themselves to be especially going away from their roots.

HP was founded and focused on research and product development. HP was all about innovation and was the biggest reason for their success.

When the economy started to tank in 2000, companies got focused on business operational cost. This led to Dell and its outsourcing of their business to India. Then companies followed like HP. Seeing that it still did not resolve their budget, they cut research and development instead developing better products.

I remember how Mark Hurd was given so much accolades for his profitability. But it was clear that he was all about cut business costs (including R&D) and did not really improve on new product lines (see the past 5 years of HP product lines). Now, Mark is gone and all his directives are clear and visible in that it helped the short term but failed on the long term.

As the article points out:
"Add it up and I argued that HP’s problems will outlast Whitman’s tenure:

Whatever HP decides it wants to be when it grows up it needs to focus on research and development and carve its own path. The current model revolves around being someone else—IBM, Cisco, Apple, whoever’s next. The problem is that HP has starved R&D at 3 percent of revenue all through the Mark Hurd years. Now HP doesn’t have the financial heft to suddenly jump to 6 percent (IBM levels) or even higher. That’s why I’m arguing that Whitman can’t turn around HP. HP’s R&D problems will last longer than Whitman’s tenure if history is any guide."

So HP can't be Cisco or IBM. They do not have the manpower to research and innovate new products. They can't develop their own competitive advantage. Cost is as low as HP could focus on strategy (but that is already an issue at hand).

This is the same issue with corporations today. R&D development is in what companies do internally. Instead, it is all about acquisitions and mergers. So there is a lack of fluidity and continuity and makes innovation harder to achieve efficiently. To constantly make profits short term could hamper the long term goals and revenues.

Why I am so adamant? It is the same thing of placing American workers as commodities and expecting profits short-term. Selling goods at a premium while not fairly compensating Americans workers for their hard work. Who do you think is going to buy your goods? All I hear is that American workers are lazy but the reality is far from the truth. Do Americans have to lower their cost of living? Maybe but the extent seems a bit unfair and naive on both fences. Companies tell us to re-invest ourselves at our own cost but won't pay necessarily premium wages. Our education is by far more than the wage but that is easily justified one way (workers) but not with corporations (R&D and self-innovate)...

HP is reflective of corporations' mentality of trying to get most for little. At one point, investment has to be made and requires commitment for success. Do I think companies need to be lean? Of course but being lean and starving are two different things. It is important to understand that even well-trained athletes just can't be lean but be strong to perform. Why does corporations fail to acknowledge that?

Wait and See with Windows 8

I know there are many people who is wowing about Windows 8 but one thing caught my eye (like the author). Really? The spec requirement won't change?

Another Windows Version. Another Hardware Upgrade.
http://www.zdnet.com/blog/virtualization/another-windows-version-another-hardware-upgrade/3849?tag=mantle_skin;content

The article details how they state one thing and with every upgrade, there is a big change which require a significant upgrade..

You have to ask with Windows integrate to work in mobile or desktop, I would think it had to have same or lower requirements. But to work with multiple driver platform (from Intel to ARM), you the computation and coding has to increase.

What would it be? History seems to favor the author..

Apps are becoming a mainstay in Health

4 Best Types of Apps for Hospital Use
http://healthcareitnews.com/news/4-best-types-apps-hospital-use

At the end, apps are important for several things.. To make the life of health professionals simple, mobile, reliable, and productive..

As the article points out:
1. Those that free providers from offices or workstations.
2. Those that offer access to lab results and medical imaging.
3. Those that convert a smartphone into a medical device.
4. Those that offer practice management.

At the end, the apps help to make smartphone or tablet into a productive unit. One to keep them as wireless as they can, read results conveniently, read and obtain measurements, and do work related to the duty at hand like prescription.

Though it seems great but I take it with a fine comb.. The person who is utilizing it with be the biggest question..

Telehealth likely to increase

Growth in global telehealth forecast at more than $1B
http://healthcareitnews.com/news/growth-global-telehealth-forecast-more-1b


Looking at our current assignment, I wonder if outsourcing is the only means of hospitals being competitive. I thought about mobile units (since I dealt with some of them) but it might not easy for clients. With various industries working, the monitoring of patients could be done at their convenience and home.

The article believes the growth is substantial (1 billion by 2016) and minimize healthcare cost and expenses.

I think it is promising but it does not guarantee reduction. It might be better patient care and alerts but not guarantee healthcare improvement. I believe it could be but it all depends upon implementation. Lastly, it will apply well in rural area and how patient monitoring is being done is a bigger question.

I see healthcare industry converging... It has in dentistry and more in the health field..

Feel like this is a concern to address: Infringement

Have you noticed how many IT companies are suing and counter-suing back... I understand you are protecting intellectual property but when does it become known as universal or common knowledge? I guess that is why I had legality. You could make anything into a lawsuit if you really want to think about.. With the IT sector, it is no different.

After much lawsuit from Apple to Samsung and HTC, Oracle to Google, Google to Apple, and Real to Microsoft, this one caught my eye... Via suing Apple

Via patent suit may give Apple the most trouble
http://www.zdnet.com/blog/mobile-news/via-patent-suit-may-give-apple-the-most-trouble/4654?tag=mantle_skin;content

I found the lawsuit title to be an oddball. Via is a chipmaker (personally, I do not like their product) and Apple is manufacturer of their iProducts. The article points out one important relations to the lawsuit:

"Two, Apple makes its own chips used in the products the suit claims infringes on Via’s patents. The three patents Via claims are being infringed by Apple:

* US Patent No. 6253312, Method and apparatus for double operand load
* US Patent Nos. 6253311 & 6754810, Instruction set for bi-directional conversion and transfer of integer and floating point data

Notice those are microprocessor related? Via claims Apple infringes on these patents with nearly its entire mobile product line: iPhone, iPad, iPod, and Apple TV. What do these have in common? Apple makes its own processor for them."

I understand that it is a how the chip processes these certain tasks. But how could you really prove that process is a patent infringement? It is a process and how it processes it could seem the same but might not. Maybe I am wrong but technicality is important but to what extent?

What I am worried is that there will be copyright lawsuit on everything. It is happening in the biosector with human genome. What makes you think one code or one word could be copyright violation. Yes, I am know "you're fired" is a trademark now but saying publicly that you're fired (by mistake on television) could render a lawsuit?

Lastly, these development can't be just abstract and needs to really define how hardware and firmware works to achieve that process. If that is define, Via might have more than a lawsuit (especially if Apple products hinge on that process).

HP do not know what they want..

After reading the ousting of Leo Apotheker, I was checking back on why it does not work. With my numerous issues with HP (I had my PC shipped out for warranty a record 3 times in the past 3 months and it does not include 4 misdirections and numerous complaints to BBB), I wonder why the company has so much problem. So there is what upper management seem to have a poblem.

HP Is Having An Identity Crisis
http://news.cnet.com/8301-13924_3-20109667-64/hp-is-having-an-identity-crisis/?tag=content;siu-container

Not only did HP forget its root, it tried to change everything at once. It is like telling the whole company that we are not hardware but software. Thinking that the change is seamless and easily changeable. That is a significant issue.

As the article points out:
"You can't ignore legacy. [That's] what your value is," said Bob O'Donnell, an analyst at IDC. "They have a huge amount of value in the PC space. There's no way around it, it's just a huge, huge business."

The way HP made a dent and took market share was through hardware (especially their printers) and customer service. To me, they are horrific and numerous hardware issues are common in many blogs and postings. They seem to forget how they got big in the first place. They could say that the hardware business is not profitable but that seems to be naive when you consider it has a significant percentage of your revenues. I would have phase it out little by little.

Again,the article makes one key point:
"You just can't cherry-pick a sector that you want to be in and expect explosive growth. The genesis of the company was PCs and instrumentation. They don't have to be IBM [which sold off its PC business in 2005]. They can be different and still be very profitable."

That is the point I keep addressing time and time again to many companies.

Dual Boot the Thing of the Past with Windows 8?

I was reading more while I was downloading Windows 8 SDK when I came across an article that seems to change my eyes..

Will Windows 8 block users from dual-booting Linux? Microsoft won't say
http://www.zdnet.com/blog/microsoft/will-windows-8-block-users-from-dual-booting-linux-microsoft-wont-say/10772?tag=content;feature-roto

What has been common in the past was Windows will allow dual boot and I could run two Windows (like 2000 and XP) or Linux and Windows (which I have done). What is being noted in the article is the new secure boot process. But Red Hat developer mentions:

"Garrett’s interpretation of Microsoft’s shared information on the topic:

“Microsoft requires that machines conforming to the Windows 8 logo program and running a client version of Windows 8 ship with secure boot enabled. The two alternatives here are for Windows to be signed with a Microsoft key and for the public part of that key to be included with all systems, or alternatively for each OEM to include their own key and sign the pre-installed versions of Windows. The second approach would make it impossible to run boxed copies of Windows on Windows logo hardware, and also impossible to install new versions of Windows unless your OEM provided a new signed copy. The former seems more likely.

“A system that ships with only OEM and Microsoft keys will not boot a generic copy of Linux.”"

Is the industry going to fight the openness and go back to partnership and people having to take sides? Could this lead to competition war like VHS and BetaMax in the computer OS war and tablet war? That is the question I want to address since the dental industry has gone through that as we speak (and currently is)...

At the end, you have make your decisions wisely on what could be an EOL compare to the winner in the industry... As for me, I want to see how Windows 8 work and how could it work for me and see if I really want to jump to 8 down the road

Tablets.. Why it is not accepted except iPad

As I was going back and seeing how HP left the market and many more are flopping. I wonder why Apple is succeeding and not its competitors. Though the article is last month, I wanted to reaffirm what I thought was the answer...

Why Consumers Won't Buy tablets (unless they're iPads)
http://www.zdnet.com/blog/mobile-news/why-consumers-wont-buy-tablets-unless-theyre-ipads/3782?tag=nl.e539

The articles points out why Apple has been successful:
1) Devices are targeted to "regular folks"

"The only way for any tablet maker to hit big sales is to break through the mainstream consumer market."

2) Great Marketing
As the article points out, HP and various vendors have unclear marketing message and do not spend much marketing on their devices. Compare to Apple, it forefront and in front of you

3) Have their stores to control and hit their message from marketing to the store...

At the end, it is all about exposure and knowing what you are selling

How much do you love your computer?

As I thought about how IT has changed, I reflect and think how many doctors tell me that computers are a necessary evil.. Are computers that hated? So while searching for an article, I happen to come across how Americans feel about their computers.

We like our PCs - but love our Macs
http://money.cnn.com/2011/09/20/technology/pc_satisfaction/index.htm

The article points out:

"An American Customer Satisfaction Index report released Tuesday shows that consumers are the happiest that they've ever been with their computers. The 16-year old survey found that PCs scored a rating of 78 out of 100, matching the record score set last year."

What is surprising is that Apple satisfaction is higher than PCs
"But Apple's (AAPL, Fortune 500) satisfaction rating climber higher this year, blowing past its rivals with a score of 87, up from 86 in 2010. This year marks the eighth straight year in which Apple led the PC categories."

At the end, PC has an effect on this society and my profession is here to stay.
I guess I need to brush up more on OS X and hoping more Apple application software in the industry

Apps is another growing sector

As tablets become the norm, apps are in demands to run programs on those tablets. Companies are wooing to get app companies and makers..

Cell companies woo app makers with offices, lattes
http://www.cnn.com/2011/09/19/tech/mobile/verizon-att-innovation/index.html

Cell companies are trying to change their images of being receptive and cooperative to app companies. They are looking to increase their internal talent to make apps. At the end, people with the skill set and talent will inside an evolving and high-demand profession.

As for me, I need to get some skill set updated especially coding.
Lastly, it is a good positive sign for an industry that seems to be hurt in the US (with outsourcing)

Platform to run Windows 8?

Windows 8 opens door to new chipmakers

http://money.cnn.com/2011/09/16/technology/windows_8_chipmakers/index.htm


With the introduction of Windows 8, one event changed. It is no longer a Wintel focus but rather others.. ARM chipset has been well known for performance and battery and knocks Intel in many way shape and form. To see that it is open to them was a big change.

Though it is very welcomes and embraced, it is going to be an issue for me and the health care industry.

One obvious point is the software compatibility. "It's certainly going to be an uphill battle for the ARM group, since most legacy Windows applications won't be supported on that architecture."

If you can't run software, it is not going to work for the healthcare industry

Another point is most equipments for healthcare are manufacturer specific and tested. To change architecture changes more than just the vendor. So the transition is not a good thing nor accepted.

What is important that competition is good thing but you have to ensure what you are betting (and investing on) is going to work!

iPads applied into Medical Curriculum in Weill Cornell Medical College

iPad 2 a boon to Weill Cornell Medical College students
http://healthcareitnews.com/news/ipad-2-boon-weill-cornell-medical-college-students


As tablet infiltrate into the personal and business world, it is leaving a mark into
the educational and EMR software. First and second year medical students were given tablets and incorporated into their training, education, and grades. It has become the medium in obtaining notes.

I remember the day when it was the PDAs and then laptops. Tablets are the "new" medium to apply information exchange and education. I believe more institutions will embrace the tablets and incorporated as the mean or complements to other devices (like laptops and cell phones).

As for me, it does not change the perspective of how tablet could be used in the Healthcare sector. If EMR could be applied, I hope more directives are placed for eDR software

Change of Subject.. PC is Extinct?

I was reading CNN yesterday and today and I ponder what would the world be like without PC... I doubt it will happen but the better question dawned on me.. Well, the article hits the same point... What will Microsoft do with the changing dynamics of tablet and Apple?

Can Windows 8 save the PC from extinction?
http://money.cnn.com/2011/09/14/technology/windows_8_pc/index.htm?hpt=hp_t2

Microsoft is approaching their new OS to fit well with tablet and enhance the user experience. As the article states "With Windows 8, Microsoft is in a sense betting the house on form factor. The company believes that when people buy an iPad, what they really want is a PC on the go that's just not available to them yet.".

In some sense, I have to concur that tablet is in because it is the closest thing to a PC on the go. The only argument to Microsoft's bet is that netbook would be the closest thing but sales are plummeting.

The reason to netbook is the operating system is like "bloatware" on the computer. The operating system is wrong for netbook and why Windows 8 seems to work from tablet and then up....

For me, it is learning another OS for support and implementation. At the end, tablet is here for good.

Cable TV involve in Healthcare IT?

Time Warner Cable tests suite of telehealth offerings in Maine

http://healthcareitnews.com/news/time-warner-cable-tests-suite-telehealth-offerings-maine


Time Warner is launching a trial run of delivering healthcare services to the patients! What this details:
1) Reduce time to drive (since some of the area is rural and sparse to get to a doctor)
2) Live conference and quicker face to face interaction with doctor and patient
3) Up to date information of patient for diagnosis and education

As the article states:
"One of my patients is over 90 years old and she can’t leave the house," said Patch. With the Health Solutions technology, he can "conduct a private appointment with her over the computer and discuss her care with her family without forcing her to get into a car and drive an hour for an office visit. From a patient’s perspective it’s an added convenience that could potentially decrease their healthcare cost".

What does that mean for me? Everything is converging like telephony was back then.. And the industry is only getting bigger.. Finding solution to meet the clients' needs are greater enhanced

Watson.. From Jeopardy to Healthcare

Wellpoint to help IBM bring Watson technology to market
http://healthcareitnews.com/news/wellpoint-help-ibm-bring-watson-technology-market


I remember how well Watson competed with the Jeopardy champions and wonder how it will be used commercially. Well, it seems like the answer seems to be in Healthcare.

With Watson's "human" approach in answering question and its fast computation and power, the synergy of both could help answer millions of patients with that human touch.

As the article points out, Watson could help doctor in diagnosis of patients. The diagnosis could take longer with human computation but Watson could do it faster and promptly. ""There are breathtaking advances in medical science and clinical knowledge, however this clinical information is not always used in the care of patients. Imagine having the ability to take in all the information around a patient's medical care – symptoms, findings, patient interviews and diagnostic studies. Then, imagine using Watson analytic capabilities to consider all of the prior cases, the state-of-the-art clinical knowledge in the medical literature and clinical best practices to help a physician advance a diagnosis and guide a course of treatment," said Sam Nussbaum.

At the end is that Watson might be able to handle simple calculation but would it be able to handle harder diagnosis. That is what I am worried (wrong diagnosis, etc). For me, healthcare IT has progressed to another level of computation power. Like the calculator was in its heyday.

Social Media is popularity.. why?

Besides the obvious, social media seems to have many ways inside healthcare institutions. Is that good thing or not?

Strong popularity' of social media seen at U.S. providers
http://healthcareitnews.com/news/strong-popularity-social-media-seen-us-providers

Though many people are utilizing social media, "one-third use it as a part of their professional obligations."

As the article points out, "one-third of institutions do not allow access to social media for employees, typically due to security issues and concerns about employees’ productivity. The majority of institutions that allow access to social media employ some policies to control that access."

I always state that without a clear and define security policy, social media utilization would be high. Now, I am not saying that social media is bad but rather institutions should set parameters so that it is beneficial for all stakeholders (including the institution; the article points out about marketing and name recognition through social media).

At the end, social media is a double edge sword. It could help as well as hurt a company depending upon how it is used. At the end, I have to keep a policy definition of how social media would be used.

Physicians Could be Graded!!!

One new update from one vendor caught my eye.

How would it be nice to see your doctor's grade?


http://healthcareitnews.com/news/vendor-notebook-athenahealth-launches-real-time-physician-performance-dashboard

"Athenahealth has launched a new online dashboard to provide clear visibility into the performance of physicians on the athenahealth network against meaningful use criteria.The regularly-updated dashboard offers insight into how the thousands of providers currently participating in athenahealth’s reimbursement program are progressing toward meeting Medicare meaningful use measures. Through its cloud-based EHR, with providers sharing a single instance of software, athenahealth has a real-time view into how its providers are performing, enabling the company to identify client pain points and focus its array of client services on addressing these challenges for all clients on the network."


The only issue is how the performance is measured. As long as the definition of measurement are clear and concise, it will help us hold physicians "accountable" in taking care of their patients (proper diagnosis, time waiting, repeat visits, etc.)

Preparation is Key!

I enjoy this article and how the world needs to expect when they are getting set to deploy a project.

The 7 Deadly Sins of EMR Implementation
http://www.healthcareitnews.com/news/7-deadly-sins-emr-implementation

As the article points, signing the dotted line and going forward with eMR (or eDR) is not the final step but just the beginning. Understanding the process will help achieve a smoother transition and deployment.

Key Points the articles makes of being a deadly sin:
1) Not doing your homework:

As the article points out:
"Avoiding supplier problems means background research and thorough evaluations of vendors and products. And beware: vendors tend to make promises they can't keep."

I hate overpromises but no delivery. So you should check with your association of professionals on "reputation" and success.. It is always know the strength and weakness of the software

2) Assuming the EMR is a magic bullet
I always state that it is not the end all of everything. As the article points out, it is change of doing business. Not necessarily an improvement.

The best quote I got:
"Most people think an EMR solves problems," he said. "But an EMR will only amplify problems that already exist in the practice."

3) Not including nurses in the planning stages
Stakeholders!!!!

4) Not participating in training
Big one that they read the manual and just do it

5) Thinking you can implement the same processes as paper
I get this the most that why can't we do it in paper? I state that you could but do not expect it to be efficient nor optimal (especially if one employee who is critical on the process get sick)

6) Not asking for extra help
Doctors are smart but they got a mentality that they know everything. They are doctor in their field but not necessarily in computers. They have "pride" to not ask... It is important to know your limitation and ask. The problem could be a quick fix instead of a longer, time consuming solution that could save you more money

7) Being short sighted
As the article points out, "(according to Waldren,) it's important to find an EMR that supports not just the current healthcare industry, but what the industry will soon become."

I have seen doctors go with the cheaper solution only to purchase another solution and pay twice for the same thing (let alone time lost and utilized)

At the end, you need to know what you are buying.. You get what you buy...
As for me, I focus on these pitfalls for the doctors and most of our solutions have been successful.. Not only knowing the strength but the limitations.

Apple iPad Becoming more Universal

As Apple iPad become more mainstream, the application of utilizing it seems to be the norm..

Patient Check-in Moves to iPad
http://www.healthcareitnews.com/news/patient-check-moves-ipad

As the article writes, iPad is becoming the primary device for sign-in machine in hospital.

"Just three weeks after its iPad-native EHR made news for gaining ONC-ATCB-certification, drchrono has launched an iOS app to replace paper-based patient check-in."

As the article states, it is to optimize the sign in by letting the patient "do it themselves" and update their profile according like their photo profile and changes to their medical history.

Instead of it being on paper to write, they would take the information in. Again, the article states it best:

"That saves "time and money" says Nusimow. "Putting in insurance info and all that minutiae takes a lot of time." With medication and allergies pre-entered, "the next time [patients] go to the doctor, they can just engage with the doctor."

As for me, it is important to see how any device could apply into any client or business. Then it was the handheld device. Now, it is the iPad. Lastly, it is important to understand the capability. I do not think the iPad could do tremendous amount of calculation but it could be utilize for certain aspect of the practice.

Open Source for Patient Records

This is the great question of eDR and eMR... Will it ever be open source? At least it seems like it is going that way to a point.

VA CIO: 'When we get it done, it will be open source'

http://www.healthcareitnews.com/news/va-cio-when-we-get-it-done-it-will-be-open-source

VA Offices state that they will be open source after their implementations.

"VA is developing an open source track to modernize its VistA electronic health record and will incorporate the approach with DOD in the joint system. DOD has become more excited by open source and “sees it as a strong contributor as we move ahead,” said Roger Baker, VA CIO.

How did they reach the objectives? By making the vendors comply with the institutions.

"VA and DOD are also requesting that vendors with proprietary standards move them into the public domain or assure that they are publicly available if they want to be used so that both departments can rely on them to communicate and exchange information."

That is a big step but the question is to what extent with vendors do that? Will the private sector head that direction? I believe once a mandate has been established, records will head to that direction.

One thing of concern is that my selection of technology to apply into offices have to be thought out. My analogy is getting BetaMax instead of VHS.. Token compare to Ethernet. Trying to ensure that the technology gets it ROI and minimize re-investment of technology into my clients and my company.

Is Centralized Patient Record the Solution?

As I go back to the importance of Patient Records, the question were addressing the critical question as shown in the title...

We see the benefits but there comes a lot of concerns:

One Medical Journal speaks of the matter and centralized or non-centralized (or they call demand aggregation).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068075/?tool=pubmed

Some of the concerns and issues are:
1) Security in terms of access, modification, and lost

"For many years, the authorities have understood the risk of losing all of the data of a centralized system if the system is destroyed."

Meaning that if he destroy the brain, the body will be lost. Their analogy of comparing the ARPANET and the defense mechanism was to have a "independent but heads" network. So if one head is out, they still have other heads to execute objectives. In laments term, there is no one central spot if destroyed would place the system below life support. Also, the question is authority (Security, privileges) and who has access becomes a great issue since the user level is on a national level.

Another note is what about changes to the data... Concurrency issues are increased since there are more users who could access, modify, and write.

2) Lack of flexibility and maintenance
Since most organization has the standardization of terminology, does the coding have to be "standardization"? That is the question... Some would argue it would make everything easier but when there are many various organization, groups, and associations that dictate the standardization for their industries. When there is a conflict, who dictate the standardization? Since a platform has to be universal, cost of upgrade, maintenance, and performance could be extremely high. This is why I believe universal interface will be emphasized (and pay as a service like cloud computing services)

3) The infrastructure investment is higher. The argument (the journal) is that dedicated service is not better than on-demand.

"Finally, to maintain the completeness of the EMR, every single actor has to be connected to the centralized system to notify it of every single operation he makes. Regarding the case of drug prescriptions, for example, the regulation of traffic load and security could be very difficult to manage."

The workload to change instantly, would require a bigger investment in capital, human capital for performance and maintenance, and protection and monitoring

The other listed are in addition to the article that came up when thinking and analyzing

4) Operational and Procedure issue. Will the data generate locally and poll into the database? Instantly? You see the issue on how the national EMR database is utilized with produce another set of question (as well as contingency plan issue when a disaster occurs). Added the issue of HIPAA and how the data is made, sent, or changed is questionable.

5) Unwarranted access and cost to the patient (like insurance). With a complete patient record, insurance and other parties could charge a higher premium because they could base it on your whole record. (See it like credit report could generate a higher premium even if the information is right or wrong. Another example, higher premium because you are in higher incidents though no fault of your own.) There are a lot of ethical question in have a patient profile and potential denial of service (higher concern and liability though treatment might be crucial).

These are some concerns and the importance is how important that data is, who has access, how they utilize the data, and checks and balance. If those could be addressed, some of the issues could clear itself out. But they are not defined nor explained and this "quasi" standard will not resolve the issue at hand.

Let's talk about Adaptive Diaster Recovery

Coming into Thursday, I had a full load of appointments to run some updates and upgrades. Then the dreaded emergency call.. The 7:48am call and voicemail that abruptly woke my wife and I up.... Checking out, the call was from one of my clients in Albany (2.3-3.5 hour drive).

Add Murphy's Law with my Internet being down, it seems like today is not going to be a good day.. Luckily, the disaster was not as much of a disaster after executing an actual disaster recovery plan..

Though the disaster recovery took 3 hours (most of my recovery go from 15 mins to 5 hours depending upon the type of back up solution, type of disaster, and amount of data that needs to be restored), we had a partial recovery... Well, it was more like 99.999% because the software corrupted one data file and the last time stamp on CDP backup was on 11:00am (so we lost all the data changes on that file from 11:00am to 4:00pm).. Talk about griefs of all the data entry changes that was lost for that file (it is one of the most heavily used files). Secondly, why was there no other updates or changes?

So we went back to our DRP plan (though this was not a drill, they have experienced and tested it out)... And here we get to the article and additional notes to consider the disaster plan:

Do You have a Disaster Recovery Plan (DRP)?
http://netsecurity.about.com/od/disasterrecovery/a/Do-You-Have-A-Disaster-Recovery-Plan-DRP.htm

Like my previous post, the article hits the same detail with a little more in depth of defining the critical files, how to backup, your plans, downtime, etc. For some, it might be enough. But even with a decent thought out plan, there some things you can't control..

What was the problem was the application software actually generated a corrupted the file but was still accessible and "functional". But due to the corruption, it was not write-able on the backup at 6pm (though I am trying to figure how it was read, access, and modified).

Like GIGO (garbage in, garbage out), the corrupt could be updated into your data set and you have a problem (depending upon type of backup). Also, since the application did not warn of any problem, the error on the file could potential crash the software at any time....

As the article points:
"Whichever method you choose, make sure you set a schedule to backup all your files at least once weekly, with incremental backups each night if possible. Additionally, you should periodically make a copy of your backup and store it off-site in a fire safe, safe deposit box, or somewhere other than where your computers reside. Off-site backups are important because your backup is useless if it's burned up in the same fire that just torched your computer."

Even with the setup, we would have to go back to the last "complete" backup (which would have been the day prior). But all the entry on the other aspect of the software is lost... So you see the issue at hand... What would you do?

The amazing thing that is forgotten in all disaster plan is Know your tools at hand.. The software has an amazing audit trail of all entries (update/delete) and since that file did not get damaged.. You could "duplicate the error". Could we go back 1 day prior? Yes, with just one file, it was not worth going back 1 whole day. It was best to back half-day and "rebuild and data enter" the data set to the current.

As the article states:

• Support phone numbers (for ISP, PC manufacturer, network administrators, tech support)"

Additionally, there was a contingency plan to consider how the office will function without data. Luckily, they are keeping some form of hard copy and they have electronic journal in the software. Both would have worked and they were able to back track the information.

Lastly, they had accounting tools at hand from the day prior, and the audit trail verified the numbers and was no issue. The software support added the last tools to ensure the data is not corrupted in other aspect and the team confirmed the entries were correct. Though a lot of mental and time-consuming validation. They were up in 3 hours!!!!! Added this involved multiple stakeholders.

What impressed me was that the CDP provided all increments and differential on the file (except the time of corruption). They do not back up every second but they update 1-2 hours or no activity.

Though I was not back for my whole day appointment til 9:00am (yes, I had a 24 hours work day schedule), I am glad that the office had a disaster, respond to the disaster, and execute their plan flawlessly... Lastly, any out of control matter... We just managed it and develop a solution with some thought and executed it... That is adaptive and creative thinking..