Home » Readers Write » Currently Reading:

Readers Write 6/24/09

June 24, 2009 Readers Write 14 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

What Interesting, Light, and Cheap Technologies Are We Using?
By EncoreDiva


We don’t have a single server of our own.  We use hosted solutions for e-mail and SharePoint. 

We have a Web-based accounting system, timekeeping system, and expense reporting application.

We’re experimenting with Yammer to encourage collaboration within a virtual organization (and to cut down on e-mail), we have a page on Facebook, we utilize the status feature on LinkedIn to update our network on what’s new with the company and we utilize Skype for IM and quick calls. 

We use www.freeconference.com for internal conference calls and www.dimdim.com for internal webcasts. We utilize Administaff for our payroll and benefits and they administer (securely) all employee information. Our recruiting system is Web-based and open source (www.catsone.com) and it’s easily accessible from an iPhone. From a desktop perspective, we’re playing with OneNote and so far I’m LOVING it!

Meaningful Use: A Brief History
By Dr. J

13,000 BC: Prehistoric humans decorate their caves with images of herbal remedies used for their medicinal purposes. Unfortunately, these primitive clinical information systems are not CCHIT certified and reimbursement for shamanism drops dramatically. Neanderthals go extinct.

2600 BC: The Egyptian Imhotep describes the diagnosis and treatment of 200 diseases. ICD-10 soon expands this list by nearly three orders of magnitude.

460 BC: Hippocrates, the “father of modern medicine,” writes the first draft of his famous oath. After an extensive public comment period, Hippocrates tones down his commandment to “first, do no harm by taking an extensive medical history, including prior medications, allergies, and surgeries and accounting for the patient’s renal and hepatic function” out of concern that this tough requirement may hamper widespread adoption.

150 AD: Galen of Pergamum, pioneering Roman surgeon, insists on using only papyrus. He refuses to implement parchment in his practice because he finds it so disruptive to his workflow.

1231: Theodoric, Barber of York, proposes standardized terminology for various forms of bloodletting, primarily so he can “upcode” to get increased reimbursement for using leeches.

1427: As the Black Plague sweeps through Europe, self-flagellation is lauded as a pioneering effort for health information exchange. Whole communities get into the act by burning sufferers alive, using the fiery glow as a novel public health reporting tool.

1601: James Lancaster proves that consumption of citrus fruits prevents scurvy in British sailors in the world’s first controlled clinical trial. Unfortunately, in a world without quality metrics for scurvy prevention, Lancaster fails to achieve his pay-for-performance bonus for the year.

1795: After a mere 194 years (and 1 million scurvy deaths), the British navy mandates lemon and lime juice as standard sailor’s rations. Next up, EHR adoption.

1816: Rene Laennec invents the stethoscope, which is subsequently rated “Best in KLAS” over the objections of the Open Source community.

1845: Surgical anesthesia is pioneered at Massachusetts General Hospital. The Federal government sets up “Regional Anesthesia Extension Centers” to assist in anesthesia implementations nationwide.

1854: Florence Nightingale begins a medication bar-coding initiative during the Crimean War, but then realizes it would be preferable to save lives by cleaning the army hospital’s sewage system.

1884: Robert Koch establishes his famous postulates to identify microorganisms responsible for various diseases. Privacy advocates successfully sue Koch, forcing him to go back and de-identify the pathogens.

1889: Sir William Osler creates the medical residency but completely fails to anticipate the headaches his other creation, the co-signature, will cause in 120 years.

1895: X-rays are discovered by Wilhelm Röngten, without the assistance of a PACS. Nevertheless, for years Röngten would claim that his images conform to DICOM standards.

1928: Alexander Fleming extracts penicillin from mold growing on a tablet PC he had forgotten to plug in for several days. He tries to e-prescribe the antibiotic for a patient, but the antibiotic is not in his “favorites” list, so he handwrites the prescription and gets the dosage wrong.

1967: Christiaan Barnard performs the first human heart transplant. No one ever hears about it because Twitter has not yet been invented.

2003: The human genome is completely sequenced. Instead of the expected ACTGs, the genome is apparently filled with strange acronyms like LOINC, CCD, CCR, and HL7.

2008: CCHIT is involuntarily dissolved for the first time.

2009: David Blumenthal, the National Coordinator for Healthcare Information Technology, delivers the government’s definition of “meaningful use” to an immense crowd of jubilant healthcare providers from the steps of the Lincoln Memorial, after an opening concert by U2. Healthcare in the US is saved! The rest of the industrialized world yawns while besting us on nearly every relevant quality measure for the tenth straight year.

The PACS Designer’s Review of Cloud Acronyms
By The PACS Designer

Illustration: Youseff, UCSB

The number of acronyms applied to cloud computing is growing, and even TPD is confused about what they really mean when it comes to providing users solutions for expanding the computing universe of an institution.

Even IBM has gotten into the marketing hype by calling their cloud offering Computing as a Service with their introduction of their Blue Cloud.

So let us look at what the Wikipedia has to say about the types of service renderings related to cloud computing solutions.

The most common term heard is Software as a Service (SaaS).  The Wikipedia definition is:

"Software as a Service (SaaS, typically pronounced ‘sass’) is a model of software deployment whereby a provider licenses an application to customers for use as a service on demand. SaaS software vendors may host the application on their own web servers or download the application to the consumer device, disabling it after use or after the on-demand contract expires. The on-demand function may be handled internally to share licenses within a firm or by a third-party application service provider (ASP) sharing licenses between firms."

Another cloud computing term is Platform as a Service (PaaS) which is defined as:

"Platform as a service (PaaS) is the delivery of a computing platform and solution stack as a service. It facilitates deployment of applications without the cost and complexity of buying and managing the underlying hardware and software layers(1), providing all of the facilities required to support the complete life cycle of building and delivering web applications and services entirely available from the Internet(2)—with no software downloads or installation for developers, IT managers or end-users. It’s also known as (cloudware).  PaaS offerings include workflow facilities for application design, application development, testing, deployment and hosting as well as application services such as team collaboration, web service integration and marshalling, database integration, security, scalability, storage, persistence, state management, application versioning, application instrumentation and developer community facilitation. These services are provisioned as an integrated solution over the web."

The next cloud computing term is fairly new, and is Infrastructure as a Service (IaaS) and is defined as:

"Infrastructure as a Service (IaaS) is the delivery of computer infrastructure (typically a platform virtualization environment) as a service. These virtual infrastructure stacks(3) are an example of the everything as a service trend and shares many of the common characteristics. Rather than purchasing servers, software, data center space or network equipment, clients instead buy those resources as a fully outsourced service. The service is typically billed on a utility computing basis and amount of resources consumed (and therefore the cost) will typically reflect the level of activity. It is an evolution of web hosting and virtual private server offerings."

Lastly, IBM’s term of Computing as a Service will most likely be used as a marketing tactic only as their already is a CaaS which stands for Communications as a Service!

Hopefully posting all of these terms in this entry will help users understand solution offerings by vendors, and be a guide to everyone contemplating using cloud computing structures as solutions.

(1) Google angles for business users with ‘platform as a service’
(2) Comparing Amazon’s and Google’s Platform-as-a-Service (PaaS) Offerings | Enterprise Web 2.0 | ZDNet.com
(3) IT as a Service is a model ripe for adoption

View/Print Text Only View/Print Text Only

HIStalk Featured Sponsors


Currently there are "14 comments" on this Article:

  1. Interesting cloud acronyms article. It was so long I couldn’t finish it during my Food-as-a-service, so I had to continue reading it during my Car-as-a-service ride on the way to the plane-as-a-service. At least the last fad of adding an “i” or “e” prefix onto everything meant less typing….

  2. Dr. J nails a three pointer from waaaaaaay beyond the arc! Swoosh…nothing but net. Beautiful, Dr. J!

  3. “What Interesting, Light, and Cheap Technologies Are We Using? ”

    I’m thinking about getting rid of all hardware and software in our IT shop and NOT implementing a virtual solution.

    Not only do I save the organization a ton of money but my work load goes way, way down! 🙂

  4. Dr. J,
    BRAVO, BRAVO, BRAVO! You are the Mel Brooks of the EHR world. Mark Leavitt needs to stop acting as Ceasar with the director of HHS bringing him grapes on a platter. Lilly Von Schtupp needs to call Mark Leavitt and tell him “We are so tired. Tired of playing za game. Everything C-ZHIT is Kaput”! (Blazing Saddles)

  5. The history of the “meaningful use” was great! I’m a “hybrid” man, as I see the paper record as lasting forever… unless there’s a fire, of course! Sometimes I wonder if this is an old chart- http://www.earlham.edu/~seidti/iam/papyrus_66a.gif . Heck, the handwriting is very similar to mine!

    BTW, CCHIT was dissolved twice- in 2006 I found that the CCHIT incorporation papers stated as plain as day that their profits were to be split among its founders at the end of the year, then on 8/2006 their monthly minutes notes mentioned that they were going to have a $1 million dollar profit. Of course, I posted this tidbit throughout the ‘net as it confirmed my beliefs that CCHIT was a scam. From 9/2006 thru 11/2006 their monthly minute notes suddenly disappeared, only to reappear by December. In December CCHIT was dissolved and reincorporated.

    The original articles of incorporation and 8/2006 minutes can be downloaded from here- http://msofficeemrproject.com/Page3.htm (see the PDF1 and PDF2 at the bottom).


  6. Today’s HIStalk has got to be one of the best. Every entry is great.

    EncoreDiva… I am amazed and impressed by your company’s complete outsourcing. With the right technologies and assurances around security and reliability, I can see where this could become a sweeping business trend, even for hospitals. Maybe I’ll quick buy some Yammer and DimDim stock.

  7. FOSS software? check out egroupware. I took an old box out of the closet, installed ubuntu server, and egroupware, and had the whole thing up and running <1hr (30 min. of which I was under the influence of zopiclone.

    no fuss, no muss.

  8. BlueDogSpirit, “Meaninngful Use: A Brief History” is more like a Monty Python. Very Funny!! When you brought up Mel Brooks, the movie that came to mind was “Young Frankenstein”. H. Stephen Lieber can play Gene Wilder’s character, Dr. Fronkensteen, and Mark Leavitt can play Mary Feldman’s character, Igor. Scratch that, Lieber is not a M.D., a clinician or a technician.

  9. Dr. Borges,
    Thank you for the link to your PDFs. You have done a lot of work to document CCHIT from the beginning. CCHIT was set up as a for-profit all along, with HIMSS CEO as the CCHIT Fiduciary Chair who would receive his equal share of the profit. Not bad for all three “tax exempt organizations” who provided $50,000 seed money! Surely HHS must have seen these PDFs. Question: how can tax exempt organizations operate as a for profit, and still receive funding from the government? Why wasn’t a freeze in funding implemented from HHS until a thorough investigation could be completed? Why has HHS continued to reward CCHIT & HIMSS? CCHIT paid lawyers and consultants to set up the org. Did they overlook setting up ADP payroll for CCHIT employees? Why did Lieber allow the “loan” for Leavitt’s (Igor’s) salary, and what other perks do we not know about? I have so many questions. It is going to take a grass-root effort from the entire HIT, EHR community to demand transparency and accountability from HIMSS & CCHIT. In my opinion, HHS has been derelict in its responsibility.

  10. The Service as a Service moniker – how is that any different from a mainframe with dumb terminals?? So we go from centralized to decentralized to centralized to decentralized……..

  11. Hi BlueDog:

    >>> HHS has been derelict in its responsibility.

    I guess 2 things are in play- 1) “the end justifies the means”- if they can get CCHIT to somehow get physicians to buy into EMR then bending the rules can be ignored, and 2) as usual, someone got paid off big time.

    Unfortunately, it’s very hard to prove the payoffs, especially during Bush’s time when PACs ruled. During Obama’s tenure you can track down payments done by the Cerners, the Allsripts, the GEs… very easily done. Occasionally I can hit paydirt when, for example, last week we had the issue of the NJ Rep Conaway who put forth an HIT bill prohibiting the sale of non-CCHIT EMR softwares. His financial disclosure sheet for 2007 did mention HIMSS among other HIT companies. Misteriously, for 2008, when he put out the first version of the bill, he stopped disclosing HIMSS as a lobbyist… I doubt very much that they suddenly stopped padding his pockets.

    One of the things that is lauded is CCHIT’s “transparency”. What they don’t tell you is that there are several levels of transparency. THe 8/2006 minutes sheet is detailed to what seems to be every topic discussed. After the brief hiatus, the 12/2006 minutes suddenly became simple overview synopsis of the topics discussed… almost a “We came. We talked. We left.” format.

    Today I heard that Obama wants to cut the incomes of physicians who take Medicare by 21%. How are they going to pay for EHR? They’re not, and if they don’t then CCHIT is dead. May it RIP.


Subscribe to Updates



Text Ads

Report News and Rumors

No title

Anonymous online form
Rumor line: 801.HIT.NEWS



Founding Sponsors


Platinum Sponsors





























































Gold Sponsors
















Reader Comments

  • Sam Lawrence: Except in this case, coding = medical billing, not development. Though the same warning may be true...
  • BeenThere: Partners will find the savings from their cuts of coders as fools gold. There are a lot of hidden costs running an outs...
  • JC: If there is not there can be. VistA has a reference lab interface that can create the manifests/labeling and such as we...
  • Tom Cornwell: Great stuff from Dr. Jayne as usual. One small typo, last sentence of second-to-last paragraph: should be 'who's' not 'w...
  • HIT Observer: What I find most interesting here, is people defending their common practices rather than truly taking this as invaluabl...
  • Bob: There's no incentive for the provider to spend time doing a price comparison for the patient. Nor is it a good use of th...
  • Peppermint Patty: Veteran - can you clarify what was "fake "? Was something made up (definition of fake) or did you disagree with Vapo...
  • Pat Wolfram: Such a refreshing article. Thanks -- there really can be a simpler version of an acute HIT implementation. But I do ...
  • Woodstock Generation: Bravo to HIStalk's Weekender recaps and other news/opinions. I read it first thing on Monday mornings..................
  • Veteran: #fakenews...

Sponsor Quick Links