November 30, 2008

Do Not Resist…

Engage with grace slide…talking about DNR status with family and friends during the holiday season, according to Engage With Grace: The One Slide Project. The project’s goal is to ignite public interest in this difficult discussion. Their marketing is e-perfect: the project was introduced at last month’s Health 2.0 Conference by software developer Alexandra Drane, who related her inspiring family story. Word-of-mouth publicity is generated through the project’s interactive Web site and a rally of blog postings. To spread the word beyond the Web, they ask every professional lecturer, whatever the topic of their presentation, to close their talk with a final slide (see left), which lists five end-of-life questions designed to engage reflection and thoughtful discussion. The mainstream newspaper The Boston Globe published a front page article on the project last Wednesday, Talking Turkey About Death which is freely available online.

January 31, 2008

The healing (multi)touch

Filed under: — mlazoff

Multitouch, the new input technology familiar to iPhone users and fans of the film Minority Report, allows for manipulation of graphic images by user gesturing with one or more fingers, usually on a screen but also a table top or laptop touchpad. An article in today’s Wall Street Journal by columnist Walter Mossberg provides WSJ subscribers with background information and a fun video demonstrating the technology. For non-subscribers, all of Mossberg’s articles are freely available online under the Personal Technology section of All Things Digital, a wonderful blog-type Web site sponsored by WSJ.

September 28, 2007

Public-Private Disconnect?

Filed under: — mlazoff

Yesterday’s Slate article, Where’s My Free Wi-Fi? Why municipal wireless networks have been such a flop, describes the failure of many free citywide Wi-Fi systems, particularly those based on private/public partnerships in cities like Philadelphia and San Francisco. “The result, as this summer has made clear, has been telecom’s Bay of Pigs—a project the government wanted to happen but left to underqualified private parties to deliver…The deeper problem is economics… Private municipal wireless networks have to compete against competitors with better infrastructure who paid off their capital investments years ago…Today, the limited success stories come from towns that have actually treated Wi-Fi as a public calling. St. Cloud, Fla., a town of 28,000, has an entirely free wireless network. The network has its problems, such as dead spots, but also claims a 77 percent use rate among its citizens. Cities like St. Cloud understand the concept of a public service: something that’s free, or near-free, like the local swimming pool.” Ignacio Valdes, MD, creator of the wonderful open access software news blog LinuxMedNews, noted in today’s entry that the failure of several citywide Wi-Fi projects “may shed some light on the failings of RHIOs.”  (For example, see Requiem for an HIE Dream in last month’s News&Views.)

August 7, 2007

Cyberchondriac, (don’t) heal thyself

Patients are looking increasingly to the Internet for health information, according to a recent telephone poll of 1,010 U.S. adults conducted in July by Harris Interactive, Inc. Currently, 71% of American adults are what Harris refers to as cyberchondriacs, defined as “anyone who has ever looked online for health information.” As reported in an August 1st article published online at PC World, “Poll Shows Growing Number of Cyberchondriacs,” their numbers have more than tripled since 1998 (the first year Harris conducted the poll) from 53 million to a current 160 million adult Americans. The increase is gaining exponentially too, with a 37% increase in just the past two years. Other key findings: cyberchondriacs “search the Internet about 5.7 times a month to get health information…88% are successful in finding the health information they wanted…about 58% discussed the health information they gathered online with their doctors at least once in the last year, and 55% said they searched for health information based on discussions with their doctors,” up 10% from last year.

According to its director, Harris pollsters coined the term cyberchondriac as a positive reference. ”They’re not second-guessing their doctors, but they’re using a tool that wasn’t available a few years ago. They can get more information and a second opinion.” Dr. Rick Kellerman, president of the American Academy of Family Physicians cautioned that while the searching online for health information can be beneficial to patients and physicians, people have to be careful of Internet sources. In the end, “it may even mean that the need for that personal physician is even more important today than in the past. The problem is there’s so much information overload and you need someone to help figure out what applies to you.”

July 31, 2007

Secret Search

Filed under: — mlazoff

Not specifically for physicians, and no real secrets revealed, but a nice list of Web resources useful in How to Vet an Expert (and anyone else, for that matter). From BullsEye, a newsletter distributed by the expert witness and litigation consultant firm IMS ExpertServices. 

July 25, 2007

No smiley face for rating systems

Filed under: — mlazoff

An article in today’s Washington Post, Doctors Rated but Can’t Get a Second Opinion: Inaccurate Data About Physicians’ Performance Can Harm Reputations, ”raises questions about the line between responsible oversight and outright meddling in the relationship between caregivers and their patients.”

The journalist discusses the benefits and problems with computerized rating systems, which are currently used by more than 100 insurance industry markets or regions across the country, including the entire state of  Massachusetts. “Physician profiling relies on the growing practice of creating electronic medical records. Once kept only on paper, records about patients, doctors, hospitals, pharmacies and other caregivers are increasingly aggregated in giant digital storehouses…Doctors are rated on standards of quality of care and cost efficiency. An internist, for example, gets higher ratings on quality if he puts his heart attack patients on beta blockers, a medicine that reduces the workload on the heart, or if diabetic patients are tested for blood-sugar control…The systems differ. A doctor who performs well might be awarded stars, a smiley face or a Tier 1 rating. An inferior doctor’s patients might receive higher co-payments, or the physician might be shut out of an insurer’s preferred network…Such data-driven surveillance offers the prospect of using incentives to steer patients to care that is both effective and sensibly priced.” 

Or “steer” patients to neither. The trend towards physician ratings based on performance on selected quality indicators, “which parallels a push by President Bush to promote consumer access to information about health-care quality and cost, has spurred a lawsuit in Seattle, a physician revolt in St. Louis and a demand by a state [New York] attorney general that one insurer halt its planned program.”


October 10, 2006

May The Force(d Upgrades) Be With You

Filed under: — mlazoff

According to Brian Kreb’s Security Fix column in today’s Washington Post, Microsoft [Will] Push Out [Internet Explorer version 7.0 browser] IE7 This Month, “…to Windows users who download security updates through Microsoft Update or Automatic Updates.” This “long overdue upgrade” to the current version IE6 will include tabbed browsing, built in RSS feeds, tools to help identify data-stealing phishing sites, and security improvements in ActiveX. However, one new security feacture—Protected Mode, ”a ’containment wall’ to prevent the browser from installing software or changing computer settings without the user’s consent”—will not work with current Microsoft operating systems, not even XP. It will require Microsoft’s next operating system update, Vista, due out in early 2007.

Microsoft IE’s main competitor, the open source browser Mozilla Firefox, is mentioned in the article. “It will be interesting to see whether this upgrade for Windows will further increase Microsoft’s market share in the ongoing browser wars. According to numbers released today by Amsterdam-based Web analytics firm, the total global usage share of IE increased 2.8 percent since July 2006, bringing Microsoft’s share of the browser market worldwide to nearly 86 percent. The company says Mozilla Firefox’s browsers have a total global usage share of 11.49 percent, a decrease of 1.44 percent since July 2006. In the United States, the IE/Firefox ratio is roughly 80 percent to 15 percent, according to OneStat.”

September 8, 2006

Google for everyone

Filed under: — mlazoff

For those who cannot see to read and navigate Web sites visually, Google recently unveiled a still work-in-progress Accessible search engine in its Google Labs section. According to its FAQ section, “Google Accessible Search looks at a number of signals by examining the HTML markup found on a web page.” Though not a true validator, “…[i]t tends to favor pages that degrade gracefully — pages with few visual distractions and pages that are likely to render well with images turned off…Accessible Search is a natural and important extension of Google’s overall mission to better organize the world’s information and make it universally accessible.”

September 5, 2006

Fear of OSSing?

Filed under: — mlazoff

Open source software (OSS) is an increasingly popular alternative to closed-source (usually) commercial products. When the source code is available to all, it is easier to ensure the program’s security and flexibility—although most recommend either employing or consulting with a technician very familiar with the product for installation, customization and maintenance. For an introduction on OSS for physicians see MCR’s Free and Open Source Software, freely available with registration (access on MCR’s home page, under the right navigation panel’s Administration)

According to “Do Small Businesses Fear Open Source?” an article posted on last week’s Information, “[m]any emerging enterprises run business-critical applications with open source software and wouldn’t have it any other way. But fully half of small and medium-sized businesses say they use little to no open source software, according to a survey conducted by InformationWeek and sister publication Network Computing of 441 companies with 100 to 5,000 employees. An additional 20% say they use it only for applications primarily used by IT.”

The article provides quotes describing “a profound wariness of products that don’t come with the assurances (warranted or not) of commercial software: stability, ease of use, on-demand technical support, and accountability.” Support is available from some open source programs such as Red Hat, but “…not all open source software boasts this level of assistance, and there’s a big difference between having an 800 number to call and posting a question on a community site and hoping for a response. Of course, if you’re using software with an active community there’s a chance you may get a useful response faster than from the 800 number…”

In this survey, saving money was a key motivator for businesses to use open source software. “Some 46% of respondents to the InformationWeek/Network Computing survey say “low or no cost” is the most important reason for deploying open source software. But a true assessment of cost must include implementation, training, and long-term maintenance over the software’s life. While open source software often has a low (or no) price tag, and you can run it on inexpensive hardware, that’s only part of the savings. Companies also can cut costs by avoiding software that requires expensive skill sets.”

If purchasing open source software is less expensive than its closed-source commercial counterparts, the cost of technical support may not be. “The staff to run your open source software likely will be a key cost factor. Open source experts will be harder to find than Windows administrators, which also means they’ll be more expensive. Another cost is maintenance. If you have a skilled open source expert on staff or you purchase support contracts from a third party, maintenance may be a snap. But if your staff has to dig through source code to uncover bugs or scour mailing lists, forums, and Web sites for key fixes, support costs will rise…The ease of adapting and upgrading open source was the second most-frequently cited reason that emerging enterprises deploy open source software in the InformationWeek/Network Computing survey, though at 13% it’s a distant second to low price. Because you have access to source code, you can adapt the software to suit your needs…You also can take advantage of add-ons and modifications created by the user community, which often acts as an ad hoc development group. On the downside, if you aren’t capable of building a particular feature for yourself, you have little recourse but to hope someone else in the community will develop it.”

The article concludes, “[l]ike all software, open source carries both risks and rewards. Technical support, lifetime ownership costs, and the ability to find qualified open source administrators are the key factors in evaluating whether you’re the open source type. Through careful evaluation, you can minimize the risks and maximize the rewards of open source.” So the fear of open source software in this article title is unwarranted; beyond providing marketing information, the fear is in drawing conclusions from surveying individuals who don’t understand which business environments favor the use of open source software, and which do not.

August 1, 2006

Totally Tubular, Man

Filed under: — mlazoff

WebtollYahoo picked up last week’s Reuters story on comedian Jon Stewart’s parody of U.S. Senate Commerce Committee Chairman Ted Stevens’s (R-Alaska) definition of the Internet, by way of explaining Net neutrality: “The Internet is not something that you just dump something on. It’s not a big truck. It’s, it’s a series of tubes.” Stewart, host of the popular basic cable The Daily Show, “questioned Stevens’ knowledge of the Internet, and quipped, ‘You’re just the guy in charge of regulation.’” The story goes on to imply Stevens’s willingness to appear on The Daily Show to respond, although he has not yet been invited. Perhaps not just to save face; according to the article, “One congressional aide said the show had explained the controversial Net neutrality issue ‘better than any corporate lobbyist or policymaker I know.’” (Graphic is Coming Soon: The Web Toll by Oliver Wolfson, Popular Science) 

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