muglestonpaige

Fun with Punxsutawney Phil

2012-02-02T14:39:00.000-08:00

Below are some interactive sites, printables, videos, and treats
to help you celebrate Groundhog Day with your students this week!

Groundhog Day Sites:

A great talking storybook by Mighty Books here.

Groundhog Day Story by Starfall

Whack a Groundhog Game

Official Website of the Punxsutawney Groundhog Club

Groundhog Day Games

Online Groundhog Day quiz here.

Groundhog Day Songs here and here.

Groundhog day Smart Notebook files to download here and here.

Groundhog Day Printables:

From ABCTeach here.
Groundhog Day Quiz from Education World here.
TONS from Enchanted Learning here including: puppets, masks, follow the instructions worksheet, spelling worksheets, word hunts, alphabetical order, word search, analogies, poems, quiz, code, fractions, books and MANY more!

Groundhog Day Videos:

There is a great Groundhog Day slide show from the New York Times here.

Here are some fun YouTube Groundhog Videos:

Groundhog Day Treats:

There are also some SUPER cute little groundhog day treats I found recently on Pinterest.

How cute is this one from Sweetology?

Kitchen Fun with My 3 Sons has several cute groundhog day treats here.

Family Fun has these adorable groundhog cupcakes! So fun!

Jeff's List of his favorite FOSS Applications

2012-02-02T14:05:00.000-08:00

People like stuff that is free. People like lists of things. Today I am going to put these two things together with the following list of my favourite FOSS (free open source software) applications.

Web Browser: Firefox

Platforms: Linux, Windows and OSX

I know Chrome/Chromium have gained a lot of popularity in the past year, but I still like Firefox most as my primary web browser. My two pmain reasons for this are the fact that it generally renders text "nicer" than most webkit-based browsers and the fact that it integrates with most Linux desktops more fully than Chromium does.

IRC Client: Xchat

Platforms: Linux and Windows

Xchat is a fairly straight forward GTK IRC client. It supports a variety of features, but also is clean enough to simply let me get right into the chat room I want without much configuration.

Instant Messenger: Pidgin

Platform: Linux, Windows and OSX

When it was first created it was known as "gaim", but today many know the popular GTK instant messenger client as "Pidgin". Supporting a number of messenger types including AIM, Yahoo, Google Talk, MSN and many others - Pidgin is a very versatile messaging client.

Torrent Client: Transmission

Platforms: Linux and OSX

Transmission is fairly light bit torrent client that has both GTK and QT interfaces. It is stable and fairly feature rich while staying out of the user's way. It supports many commonly used torrent features such as setting download/upload speed limits and prioritising downloads.

FTP Client: Filezilla

Platforms: Linux, Windows and OSX

The swiss army knife of FTP clients Filezilla supports many common transfer protocols including FTP, SFTP, FTPS, and FTPES.

PDF Viewer: ePDFViewer

Platform: Linux

ePDFViewer is a very simple and light weight PDF viewer that utilises the GTK and poppler libraries.

Office Suite: Libre Office

Platforms: Linux, Windows and OSX

Libre Office is a full featured office suite that provides a word processor, spreadsheet editor, presentation creator and much more. It is written in C++/Java and was forked from OpenOffice.org a little over a year ago.

Video Editor: Openshot

Platform: Linux

Easily one of the best open source projects to be started in the last couple of years. Openshot is a non-linear video editor that is written in mostly in python and GTK. The interface is clean and generally makes finding whatever function you are looking for fairly easy.

Video Ripping: Handbrake

Platforms: Linux, Windows and OSX

Ever have a video DVD you purchased and wanted to backup in case you lose or scratch the disc? Handbrake is the perfect tool for this task. It will simultaneously rip and encode a variety of media formats to a variety of other different media formats.

Disc Burning: XFBurn

Platform: Linux

Part of the XFCE software collection XFBurn is a to the point disc burning software based on libburnia. In case you hadn't noticed by now I am a fan of "simple and clean" software and XFBurn is no exception to this rule.

Media Player: VLC

Platforms: Linux, Windows and OSX

VLC is a multi-media player that is written in QT. It's most valuable asset is the fact that all of it's many multi-media codecs are self contained - meaning it can play nearly any media format right after installation without the need for installing system wide codecs packages.

Now, take note that I mention these are my favorite applications - not that they are always the best application for every possible task. Odds are there are others that are just as good (or better) in some situations than the ones I listed. One of the best things about FOSS is the ability to choose what you want to use. So try lots of different software and find which applications work best for you.

~Jeff Hoogland

Heart Writing Fun

2012-02-02T12:25:00.000-08:00

I love Valentine's Day and love doing some heart related things with my kiddos.
Below are some fun heart related ways for your students to practice writing and spelling!

This fun site allows you to type in your own words (poem, story, etc) and then it turns it into a heart shaped page! Here's one I did using part of I Corinthians 13.

This Word Hearts site allows you to change the color of font, the font, the background color, and use your own words to populate a heart. This would be fun to use for spelling word practice!

Make your own customized candy heart here

or here

which would be so fun for spelling word practice!

Make your own heart maze here.

Read Write Think has a fabulous shape poem interactive that allows student to create and print a poem (or short story) in the shape of a heart.

Arguments for a Universal Health Record – Part II

2012-02-02T11:00:00.000-08:00

All animals can exchange information when in proximity to each other. Humans advanced this useful exchange to occur when the interacting parties are far apart, which makes the human animal quite unique. First came human couriers carrying verbal information, followed by human couriers carrying written missives, then came technology. Technology in the form of transportation vehicles, and technology in the form of unmanned transport of sounds and symbolic characters, changed the world. Telephones and computers on the Internet rendered the travel time of information from any point on the globe to any other point to milliseconds or less, but did not change the age old paradigm of information physically moving from one place to another. Until now.

This is the age of social media. Those of us who remember licking envelopes and stamps are often tempted to dismiss social media as a superficial waste of time better suited to perpetually distracted kids than any serious endeavor. When you think about Facebook, Twitter, Google+, Farmville and such, it is hard to believe otherwise. Ignoring the actual activities currently occurring on social media platforms, and looking exclusively at the mode of communication, one is forced to acknowledge that a change in paradigm has occurred, and we are reverting to exchanging information when we are in close proximity to each other, only this time around proximity is virtual, not physical. Information ceased to travel virtually, and instead, we do.

When we “go to” Google+ and engage in a lengthy discussion regarding Universal Health Records, we are creating and consuming content which resides in one virtual location – Google’s network of servers. If you want to participate in such conversation, you have to “come to” Google+, just like you had to come to Town Hall in days gone by, if you wanted to debate matters of importance. Unlike exchanging information by horse, train, telegraph or email, this communication paradigm is once again social, but flexible enough to occur in real time or at a time of your own choosing.

Back to medical records. Today most medical records are stored in physical format (paper) at various physical locations (brick and mortar facilities). Health information exchange is occurring mostly through courier, whether manned (patient, snail mail) or unmanned (fax). Those who advocate for electronic medical records desire to change the format of the record from physical to virtual, leaving the storage of virtual records pretty much as it is today. Once the content is computerized, it can also be exchanged by computer couriers, such as email and Electronic Data Interchange (EDI). This is supposed to make medical records “liquid” and the data can then flow from one computer to the other in a network of rivers and rivulets spanning the entire nation. Since such a complex system of waterways can be useful only if 100% clean water is allowed to flow through, as opposed to a mixture of seawater, oils, spirits, and other beverages, much care must be exercised at every medical records repository to transform whatever is released out into the public system to clean water. As discussed in part one of this series, ensuring water purity and building canals, dams and other infrastructure is expensive, fraught with peril, and assuming such system can be built, it is also obsolete right out of the box.

What problem are we attempting to solve by computerizing medical records? The customary answer to this question is that medical care has become extremely complex, it requires scores of professionals working together and, to foster better outcomes, they should all have the most accurate pertinent information at their disposal. Now, if we could bring all these professionals into one room filled with books and journals, and sit them down around one table, we would be just fine with old fashioned verbal information exchange. Since this type of physical proximity is becoming less and less likely, we find ourselves in need of a solution to allow disparate teams to collaborate on one project. We can do this the old way, and arrange for virtual information to flow electronically between team members, or we can do this the social media way, and arrange for team members to meet in one virtual space and work in virtual proximity. But wait, there is more... In health care, our projects are longitudinal. Each episode of care builds on all previous ones and also informs all episodes to come. This in a nutshell is why the entire medical record must be an open and shared resource.

Given the realities of our health system of systems, I am being told that such selfless collaboration at the data level is very unlikely, and given the real and manufactured concerns with privacy and government oversight, having a universal comprehensive data store is politically impossible in health care. Nobody objdcted to the technical soundness of the proposed solution. Granted, health care is much more complex than Google+ or Google Docs, and we will need more data, more definition and a much bigger and more sophisticated transactional database structure. As much as I would like to, we cannot flip a switch and begin accumulating universal health records overnight. So how would we go about starting to move in this direction?

One very promising idea comes from Dr. David Kibbe and the Collaborative Health Consortium. The notion of a health care collaboration platform, or clinical groupware, could do for health care what Google+ and Facebook did for virtual social interaction, but it stops short of providing a longitudinal and open medical record. If you were an avid Facebook user and recently tried to switch to Google+, you probably already encountered the big tall wall surrounding that particular platform. While this may be a minor nuisance when it comes to social media, and fully understandable from a software, or platform, vendor business perspective, it is not so minor when it comes to medical records, as every doctor who tried to switch EMRs can tell you. Every business should have the right to erect walls around its platform, its innovation and its intellectual property. No business should have the right to monopolize patient data, even if it was created by services and tools of a proprietary platform. The data layer must be separated from the service platform layer, because the data layer belongs to individuals and, in aggregate, it is a public good.

Another suggestion was that initiating standardized information exchange may lead to the eventual creation of local and later regional data stores. Perhaps the various State HIE organizations would grow into such data repositories. Perhaps the ever expanding integrated health systems would accomplish something similar. Eventually, we may be able to connect all these repositories into a federated model of national health records. All this is possible of course, but this rudderless experiment strikes me as a major waste of time and resources. So here is a small suggestion. There are several billions of dollars appropriated for a VA/DoD joint EHR which is supposed to be open source. Presumably, such effort will yield a database schema sooner rather later. Let’s use that. Let’s define a minimum set of data, not much different than what is required to be exchanged for Meaningful Use, and begin populating a national database. It will take time before this becomes the authoritative version, but it will happen. Initially, we can mandate certified EHRs to use the national database to retrieve and update this modest dataset in real time. This should not be a very difficult task for EHR vendors. At the same time, we should allow new products to be developed against this new and open schema. What would be the cost of building a simple user interface to the Universal Health Record to display an accurate list of problems, meds, allergies, immunizations and lab results? Hint: very close to zero. What value would physicians, and patients, derive from the ability to access such definitive lists for any patient, any time, from any browser, on any device? You decide.

Health Information Exchange is an outdated paradigm. It is based on understanding the Internet to be an improved version of the Pony Express system. The Internet has evolved into something completely different and unless we evolve with it, we are doomed to be arming heavily for a war that has concluded and it will never be fought again.

Introducing E17's Notification Module

2012-02-02T10:07:00.000-08:00

The Enlightenment developers are busily hacking away as always. There are so many SVN commits to the E repository that it is easy to over look new features if you aren't looking for them. A nifty little module recently made its way into the core of Enlightenment though - its called "Notification". Notification is a native E alternative to other notification daemons such as notify osd.

If you have a recent Enlightenment build you will find Notification under the core E modules:

Simply loading the module is enough for it to start working. However as is the case with most of the E17 desktop, the Notification module is fairly configurable:

The notifications themselves are sleek, simple and stay out of your way:

The Notification module should work with all applications that work with other notification daemons such as notify osd.

~Jeff Hoogland

Confused about iPads in Education

2012-02-01T13:30:00.000-08:00

It's been nearly two years since I got my first Asus convertible tablet/netbook, loaded it up with Linux and started kicking it around with my every day to classes. In general I have found it to be an extremely useful tool.

I need to type notes or prepare a presentation? Not a problem - it is a netbook after all and can perform all the same functions as a laptop. I need to take hand written notes? I don't have to keep track of notebook paper that I always inevitably lose. I simply fire up Xournal and can use any stylus (or even a pen with a cap over the tip) to take notes on the computer just as if I was writing on a notebook.

My netbook convertible does what any good piece of technology should - it makes my life easier.

You want to know what doesn't seem tn make anyone's life easier during class? Those iPad's I've seen piles of people caring around campus with them this last year. In fact, I've never once seen an iPad used productively to take notes in a classroom. You can't type notes effectively on the dang thing - at least I've yet to find anyone that can match my 90+ WPM using a touch screen keyboard. You also can't take hand written notes effectively due to the poor quality of basically every capacitive stylus in existence.

One useful thing the iPad can do is function as a calculator. Another thing I've heard proposed is replacing text books with ebooks on the iPad. You know what else has all the functions of a calculator and can read ebooks and pdfs? You guessed it - my netbook.

The biggest joke at the end of all of it? Even the "16GB" version of the iPad costs more than the highest end Asus T101MT.

Maybe I'm just not "hip" enough to see the need for them, but it seems to me if we want to revolutionize how our students learn using technology they would be better served if that technology came in the form of something other than an "iPad" or capacitive tablet of any sort. Whats your take on it?

~Jeff Hoogland

100 Day Posters

2012-02-01T08:51:00.000-08:00

I have a big blank wall in my room that is waiting for some computers to be delivered {woo hoo!}.

While we wait I've been using it as a giant bulletin board which I love.

Since Thursday is the 100th day of school, this week I put up some posters for my kids

to add to with our goal being 100 items per poster.

For them to add something it has to be unique and it's been super fun to see the neat things they add!

Here are the posters we have up:

100 Things We Love to Eat
100 Things We Hate to Eat
100 Different Animals
100 Different Things That Are Round{ish}
100 Different Books We Love
100 Things That Make Us Angry
100 Things That Make Us Excited
100 Things That Make Us Sad
100 Things That Make Us Scared
100 Things That Make Us Happy

Here are some of my favorites:

{Love Fat Albert}

{the bookroom was written by a teacher :}

Here are the headers if anyone would like them!

100 Different

Before you Facebook, TXT, Tweet, or Blog.... THINK

2012-01-24T18:11:00.000-08:00

I started thinking today after getting a comment on my

Before You Speak: THINK posters that our kids today

{and many adults too}

really need to heed that same advice before posting

things on Facebook or texting or Tweeting or blogging.

I big puffy heart technology but the immediacy of it can truly be a serious danger.

It's so easy to pop off and say something without thinking when
upset or angry or excited without pausing to consider if it's wise or hurtful.

So I made a new sign just to remind us all!
{myself included}

Before You Fb Txt Tw or Blog

On the Topics of Software, Average Users and User Friendliness

2012-01-24T12:02:00.000-08:00

The term "average user" is something you hear thrown around a lot with regards to software. Pro-Linux, on the desktop, people often make claims on why it Linux ready for this "average user" (shoot even I've done it on occasion). There are also those who feel Linux should be pigeon-holed into a server room and on to mobile devices, they will make the exact opposite claim. They say Linux on the desktop isn't ready for this "average user".

My question to you all is:

Who is this "Average User"?

I've often been told I am not one of these "average users" because I create and distribute software. Who is then? Is my brother the level designer an "average user"? Is my fiancée the accountant an "average user"? Is my mother the tutor an "average user"? What exactly is the criteria to be in the group of people so many seem to be trying so desperately to make software for?

Often hand-in-hand with this idea of an "average user" is the concept of "user friendliness". In fact a drive to make our user interfaces even more "user friendly" is what has caused the radical changes in the Gnome desktop (and of course the creation of Unity).

What is "User Friendly"?

From what I can gather, something is only "user friendly" if an "average user" can sit down in front of it and do exactly what they want with zero direction.

Where on earth did this idea come from?

When you first learned algebra - was it expected to be something you could just "figure out" with no guidance? How about learning a language? Science? History?

Why is the standard different for learning software?

Actually, I take that last question back. There are lots of classes for learning about software. I've seen classes for learning how to use Windows, Photoshop, Microsoft Office... the list goes on! Are these pieces of software considered "user friendly" and ready for the "average user" even though we offer classes to learn how to use them? Yep.

Why is the standard different for Linux then?

Some food of thought. Please give me some input on any/all of my questions by dropping a comment below.

~Jeff Hoogland

iPad Apps for Lawyers: iJury for Voir Dire

2012-01-24T09:28:00.000-08:00

iJury

After alengthy trial and engaging voir dire without computer assistance, Orlando,Fla.-based attorney Lawrence Williamson teamed up with computer technician SeanHam (who assisted Williamson with trial logistics and document management) tocome up with iJury, an affordable iPadapp that would enable attorneys to "concentrate on the art of voir direand move away from the excessive note taking and paper shuffling."

Digitalconvergence is an admirable charge for any app and fits well with the iPadvision. I've reviewed several apps designed for jury selection (voir dire) andmonitoring and, although they all appear to be helpful, the fiercest competitorto iPad apps remains the venerable Post-it® Notes.

Some thingsjust seem to work better the old-fashioned way. Perhaps one reason is thatentering data on the iPad, although it can be comprehensive, takes most of uslonger than scribbling on sticky notes. While it is likely just a simple matterof adjusting your work flow to input data on the iPad, I still see more peopleusing the familiar little yellow squares than apps such as iJuror, JuryTracker, JuryDuty,or even full-feature software applications such as JuryBox.

One thingsticky notes can't do is perform data analysis, but that is true of most iPadapps for voir dire. Most apps do a decent job of storing and retrieving jurorinformation, but don't do much in the way of looking at the big picture. iJuryis different. Once you've entered personal information on each juror, you'reable to view the bigger picture, literally, in a series of dynamic charts.These bar charts indicate trends in your jury pool, including overallindications of positive, negative or neutral scores for your case, as well as adesktop view of a jury's gender and racial balance and socioeconomic status.

Figure 1

Figure 1shows a high-altitude view of iJury that can help flag potential issues withyour currently seated panel of jurors. Additionally, a sample set of commonvoir dire questions is included, which may be scored positively or negativelyfor each juror according to their responses -- and you have the option to addyour own questions.

Figure 2

LaunchingiJury the first time brings up a nice tutorial video, which you may also viewonline. I thought this was a nice touch, allowing you to get a quick feel ofwhat the app is all about and how to handle each task. The video can also beaccessed again later by tapping the "Info" icon in the Case browser.

Figure 3

Incomparison to other apps for jury selection, iJury requires a similar amount ofinput for each potential juror, and focuses only on the currently seated panelvis-a-vis the entire jury pool. When using the iPad in this manner you wouldcertainly want to enter all of your juror information ahead of time from theirresponses to your questionnaire.

Figure 4

Overall,iJury appears to be a nice alternative for iPad-wielding attorneys and trialconsultants looking to clean up the counsel table and keep it free from stickynotes during voir dire. And at only $14.99, it won't break the bank.

::::PRODUCT INFORMATION ::::

Manufacturer: Dynamis Law
Product: iJury for iPad
Price: $14.99

Arguments for a Universal Health Record

2012-01-22T15:14:00.000-08:00

We passed the one thousand mark on products certified as EHR technologies for ambulatory care and the five hundred mark for inpatient care, and there is no relief in sight. In addition, there are multiple other software products that are routinely used in health care, such as standalone practice management and billing systems, claim processing software, pharmacy programs, lab, imaging and other diagnostics software, personal health records products, and more recently a veritable explosion in mobile applications ranging from monitoring your heart to evaluating your happiness. I don’t know of any other industry where so many disparate software packages are able to communicate and cooperate with each other seamlessly, and yet this is the goal of the gargantuan effort of those who develop interoperability standards in health care. If you’ve ever been involved in software systems integration, you probably know all too well that the weakest and most unstable link is always at the interface between products, even those built by the same vendor, regardless of the agreed upon standard. When it comes to seamless operations and cost effectiveness, nothing beats true database level integration.

For those who read this and have an irresistible kneejerk reaction tempting them to cite examples such as ATM networks, telephone networks, Google or email, please understand that this is an apples to unicorns comparison. Assuming that our ultimate goal is to have all health records for all people available at all geographic locations at all times, is weaving a web of rickety interfaces between thousands of products, really the best option? It is, if you sell existing, or enabling, technology for this arrangement, and it is not, if you intend to use, or pay for, the end solution.

The usual arguments against a Universal Health Record, and its scary database in the sky, are that we must build on existing infrastructure; that rip-and-replace is cost prohibitive; that a free market should provide as many choices as possible; and that privacy is best served by keeping data close to home, and certainly out of the hands of Big Government. Sounds pretty reasonable. What if we dig a bit below the surface though?

Medical Records

Assumption: At any given moment in time there can be only one correct version of a complete medical record for any one person
Fact: Currently, various parts of the medical record are stored at various locations, by various organizations, in various formats
Fact: Most organizations possess unique content, but also content overlapping with what others store, containing multiple discrepancies and various errors
Observation: Using partial medical records for provision of care could be desirable, inconsequential, dangerous or lethal, depending on which parts are missing
Observation: There is conceptually no reliable way to know whether parts of the medical record are missing at the point of care, let alone ascertain the criticality of missing parts

Health Information Exchange (HIE), as its name indicates, is intended to shuffle fragments of the medical record from one organization to another just in time to inform the provision of care. The government and various other organizations are diligently working on standardizing the contents, the format and the means by which medical records data is communicated. Since the thousands of software programs deployed in health care all store data in different formats, using different data dictionaries, different storage systems and different terminology, it is envisioned that each system will have some sort of transformer at its edge that will translate the inner workings of the system before sending information out, and execute the reverse procedure before letting outside information in. Once the standards are finalized, all technology vendors will be building (or buying) such “transformers” and everybody will be communicating seamlessly. Could it really be that simple?

Reconciliation

Unlike banking, where managing a checking account at your local bank does not require immediate information on your Cayman Islands holdings, medical care operates on a single record set of data elements. Since this record set is being altered at various care facilities, health information exchange must continuously reconcile the data elements. So for example, let’s say that you visit your primary care doctor complaining of chest pain and he diagnoses gastrointestinal disease and prescribes antacids, but you are still concerned and decide to see a cardiologist in the city, who diagnoses angina. Shortly after visiting the cardiologist office you get hit by a bus and end up in the local ER. Was your cardiologist aware that you have been complaining of chest pain for the last 20 years, angina was repeatedly ruled out in spite of your concerns that Aunt Mary also has angina, and antacids always worked for you? Is the ER aware that you just got diagnosed with angina and have a shiny NitroMist sample in the backseat of your car? Is your primary care doc going to be appraised of your adventures? In a world of perfect information exchange the answer is yes to all questions.

However, perfect information exchange in this case requires that your primary care physician pushed your medical records out to the cardiologist, including your fixation with angina and Big Macs, or that the cardiologist was able to locate your primary care records and pull the information in. It also requires that the ER was able to obtain your primary care records from back home, any other medical records from other providers and also the very recent cardiologist records and combine all those data points in one authoritative record set. This reconciliation process would occur every time you seek care and every time you, or other diagnostic facilities and eventually devices, update your records in any fashion. And these transactions will have to execute without a unique patient identifier just for you, and while processing and propagating privacy rules which may differ between various care providers and exchange intermediaries.

Now imagine millions of people with similar needs, and you have many millions of transactions flying around back and forth between thousands of software programs executing in hundreds of thousands of locations, from industrial strength data centers to the lonely Dell server under the printer in a doctor’s office. Yes, the contents will be standardized by those edge transformers, but every relay, every handshake, every acknowledgement and every translation back and forth to the native software program constitutes a point of possible failure, and every reconciliation of multiple messages from disparate sources is an error waiting to happen. In computer land errors don’t usually wait for too long before they happen, and this has nothing to do with lack of standards. Sending applications lose connectivity intermittently and go into a peculiar state of limbo. Receiving applications often get stuck on one bad message, creating huge processing queues on the other end. Messages mysteriously disappear only to be found in a log file or another patient’s chart. Every new release is always an adventure. This is how things are today, with only a fraction of the envisioned number of transactions in the brave new world of a seamlessly connected health care system.

The Power of One

The alternative to having a flimsy system with a multitude of moving parts is to have one unified database system, with one architecture and one schema definition. This does not necessarily mean one EHR. We could of course have a single EHR built on top of this database system, but for those concerned with innovation, free markets and with the problematic one size fits all approach, by all means, let’s build thousands of EHRs with user interfaces and functionality to fit every individual preference, all accessing the same exact database, containing the same exact records. This Universal Health Record will be, by definition, complete and correct at all times, since all health care applications will be built on top of this database, much like browsers are built on top of the World Wide Web. Switching EHRs should be as simple and straightforward as changing from Firefox to Chrome, not to mention how happy the folks advocating substitutable applications instead of walled gardens would be. Oh, and the sum total of investment in a homogeneous data infrastructure is dwarfed by the various other public and private initiatives, all ultimately funded by tax payers.

The 800 pounds gorilla in the room is of course privacy and to a much lesser extent security. A medical database system of this magnitude would have to be built and administered by the Federal Government. Patients would have to be uniquely identified in the system. Granted such Universal Health Record would accessorize well with a universal health care system, but let’s face it, if you are on Medicare or Medicaid, the government already has your medical records. Private payers have mega databases chockfull of medical records and so do EHR companies and pharmacies. Your data is being constantly de-identified, sold, re-identified and exploited for financial profit. Once the planned information exchange network kicks in, a host of State and private agencies will also begin building their own repositories of medical records. The privacy horse has left the barn, and the best we can do now is regulate the use of what was once private. At a minimum, the Universal Health Records database will ensure that you can see everything everybody else is seeing and have some say in its accuracy and utilization, which is orders of magnitudes better that the alternative.

Before you Speak: THINK {again}

2012-01-22T06:28:00.000-08:00

I'm pretty sure the Before You Speak: Think
poster is the most printed one I've ever made.

It's pretty bright- which isn't everyone's cup of tea-

so this morning I decided to do one in black/gray
for anyone who finds that one just a tad too much.

I also made one in my typical primary colors for those that like that better.

Such wise words we all need to remember.....at home, at school, at work- always!

If you have any trouble downloading these, just right click on the image,

save it, and print it as a JPG!

Before You Speak Think-3 Before You Speak Think2

Consider the Source

2012-01-21T18:31:00.000-08:00

If I had a dollar for each time I said the words "Consider the source"

I'd be able to take my family on a super snazzy vacation.

I say it often to my students, to my sweet daughter, and to my friends.

I found myself saying it often on Friday to a sweet friend who

was very upset by something someone had said to her.

In our conversation I kept reminding her that this person who said the hurtful things

was someone who was known for causing trouble-

who in fact seemed to actually enjoy upsetting people.

I decided I'd like to have this hanging in my classroom as a reminder

to me and to my students that before we assign value to something someone has said

we need to consider who it is doing the speaking.

Here it is in case you also need the reminder!

Consider the Source

Bloathi Linux

2012-01-18T10:24:00.000-08:00

Bodhi Linux is mainly built around two things - the Enlightenment desktop and a minimalistic approach to software. Even with these goals stated we still have users (and review writers) that complain about the lack of pre-installed software Bodhi comes with by default.

With this in mind one of the Bodhi forum members, Timmy, has put together a remaster of the latest Bodhi ISO image that he has cleverly called

"Bloathi Linux"

Bloathi is simply the latest Bodhi release with a slew of pre-installed software setup on it. By default it comes with:

Envision
GEdit (Replaces Leafpad)
Jockey-GTK (Maybe better known as "Hardware Drivers")
LXKeyMap (Keyboard Layout Switcher)
LXRandr (Monitor Settings)
XScreensaver
Sun Java 6 (JRE and plugin)
Gnome System Monitor
Gnome System Manager
Qalculate
Inkscape
LibreOffice
Pinta
Simple Scan
Firefox
Pidgin
Thunderbird
Transmission
DeaDBeeF
VLC
Xfburn
Adobe Acrobat Reader
ubuntu-restricted-extras
adobe-flashplugin
bodhi-filesharing
bodhi-printing

You can find the ISO (and md5sum) for the disc hosted on source forge here. If you'd like to make suggestions for Timmy, you can find a forum thread he has posted here.

~Jeff Hoogland

Bodhi Linux ARM Beta Release for Genesi Smartbook

2012-01-17T21:36:00.000-08:00

Much to my fiancée's dismay my little Genesi Smartbook has been occupying much of my time of the late. In fact, just six days ago I posted about how to get an early build of a Bodhi ARM file system for the Smartbook.

Today I am happy to announce a more functional release for the Genesi. Audio now works and permissions have been sorted out so the normal user can shutdown the system. Beyond these bug fixes this release (and future releases) are coming in an easier install media. We will now be providing two different .img files for the Smartbook, you can find them for download here.

One of the images is a live image. Use this one if you want to simply run Bodhi from your SD card. The second is an installer image. Simply boot it up, follow the on screen prompts and Bodhi will be installed to the internal SSD of the Smartbook. IMG files allow for simply loading these images onto an SD card with a single command:

sudo dd if=myfile.img of=/path/to/sdcard bs=1M

You can also load the image onto your card via a GUI if you are into that sort of thing. Please note this command may take five minutes or longer to complete. Once you get the system online the user name is "bodhi" with password of "bodhi". Sudo is setup for this user by default.

Next on my ARM todo list is to get our App Center working and putting together a formal tutorial for getting Bodhi running on the HP Touchpad.

Finally, if you run into any issues please let us know in the Genesi section of our forums.

~Jeff Hoogland

The 100th Day of School

2012-01-17T12:36:00.000-08:00

The 100th day of school is quickly approaching.
How is that possible? Didn't we just start school the other day?

Below are some fun sites to use with your kiddos that
I posted about last year as well as a few

new ones to help you celebrate this special and fun day!

100 Owl Grid is a fun interactive game from ABCya.com.
Children must help the Owl to find his friends. The Owl will tell you a number that represents where his friend is hiding in the number grid. Click on the correct square.
Be careful...you only have two chances or you will lose his friend!

100 Snowballs is a fun interactive from ABCya.com. Simply touch and drag the snowballs to create your own image, as long as you use 100 snowballs. If your class is reading 100 books, add a snowball as a way keep up with how many books the class has read throughout the day.

Give the Dog a Bone is a fun game that works great on the Smart Board. The object is to find 10 hidden bones on the 1-100 number square in less than a minute. A fun challenge for the 100th day!

Starfall has a cute 100th day of school book that would

be great to show to your class on your Smart Board.

Mathwire's 100 Days of School activity page is full of fabulous math activities. One of my favorites includes the 100 ways to represent 100 activity.

This fabulous People in Order video includes 100 different people

who are arranged according to their age, starting from age 1.

{wouldn't it be fun to make your own?}

Count Along to 100

Splat Square

Below are some 100th Day of School Printables

From ABCTeach

Printable Book from Enchanted Learning

100th Day of School Book

100 Animals book

100th Day Poem

From Starfall

From Scholastic

100th Day of School Songs

Books to read on the 100th Day of School

Find tons of great links to 100th Day of School boards on Pinterest here!

Review: ExhibitView for iPad

2012-01-16T18:34:00.000-08:00

Author’s Note: I’veadded some additional screen shots and info to this blog version.

I’ve had many people ask, “When will TrialDirector have an iPad app?” The last time I discussed itwith InData, they had looked into the idea but felt that it may not be worththe investment to develop an iPad app. They were, however, exploring remotecontrol possibilities, using an app such as LogMeIn Ignition to control thefull-featured PC version of TrialDirector over a Wi-Fi network.

William Roach, developer of PC-based ExhibitView software,decided it was worth his time to develop an iPad app for ExhibitView. By addingExhibitView iPad to their productline, the company has become the first trial presentation software company tooffer a software application for both the PC and the iPad. Roach says, “Specificallywe wanted to be in the iPad space because of all the excitement. We reallythought about how we could enhance the value of our PC brand and not circumventits sales. With the majority of law firms still having PC’s and everyonegetting iPads, we felt it was a very deliberate strategic move.”

ExhibitView is alsodeveloping a version of its trial presentation software for the Google Androidand Apple Mac operating system. This aggressive development strategy is encouraging to gadget-mindedlitigators. Although I don’t have an Android tablet, I would love to compare ExhibitViewon Android with the iPad version once itis released. For now, I will settle on a standalone review of the ExhibitViewon the iPad.

After several years of battling for market-share with thelikes of TrialDirector and Sanction, ExhibitView iPad joins the ranks of TrialPad,Evidence, and ExhibitA in the iPad apps for trial presentation space. For the purpose of thisarticle, I will not review the PC version of ExhibitView, although I will saythat users of the software will find themselves at home with ExhibitView iPad, whichhas a similar look and feel to the PCapplication. In fact, the PC version of ExhibitView has just added a newfeature, “Save as iPad,” which exports an entire case in ExhibitView on the PC toa file that can be imported without modification into the iPad app.

At the current introductory price of $29.99 (regularly$69.00, or free with purchase of ExhbitView PC version), ExhibitView falls in the mid-range for trialpresentation apps. In the “Wild West” iPad app development game, price does notnecessarily indicate value. It seems that setting a price point for an app is (orat least was) something of an experiment, which Roach and ExhibitViewbenefitted from by coming to the table, or iPad, late.

Opening ExhibitView iPad brings up a screen which features aDropbox link icon. One of the first things you’ll need to do is set up a Dropbox account, because that is theonly way to get exhibits and files onto the iPad and into the app. But don’tfret, Dropbox still has free accounts with a maximum of 2 gigabytes of diskspace allocation. Once you establish an account and link it to the app, you’llhave full access to all of your exhibits stored in Dropbox.

From Dropbox, you may choose individual files or entirefolders to download to the iPad. This can make it very quick and easy to importan entire case file into the app, which you’ve assembled on your PC (or via theSave as iPad feature in ExhibitView). Although file transfer via iTunes is notsupported, connecting via cable to your laptop every time you need to updateexhibits in a case is not a very practical method during a trial.

Another nice feature on the home screen is the Help button.The help file does a nice job at covering the basics, although you couldprobably just jump right in and start using the app by creating a new case,adding exhibits, and trying out all of the tools and features.

Although ExhbitView iPad works in either landscape orportrait mode, which allows for 360 degree iPad rotation, I would recommendusing landscape mode because of the added real estate available to see andselect files listed on the left-hand side of the iPad.

The app handles several file types, but I encourage you towork with PDF files. I tested PDF, Microsoft Word, and PowerPoint files; JPEG and PNG images; and MP4 video. Other than graphic layersgetting a bit whacked in PowerPoint (I’ve seen formatting issues in other apps,and would generally recommend converting exhibits to PDF anyway), it all workednicely, including the Word document. I did, however, notice an issue indisplaying the proper (full screen) image with native PowerPoint and Word. Although.pptx and text files showed up in the file list, they are not supported, anddid not display. In a trial presentation app, it would certainly be helpful tohandle a text file, with options to work with transcripts.

A nice feature I like about ExhibitView’s “database” view isthat there are tabs which will automatically filter and sort exhibits by filetype for you: Documents, Images, A/V Media, and All (to show everything in yourevidence collection).

Connecting the external monitor when the app is runningautomatically connects the iPad, displaying the ExhibitView logo, howeveryou’ll still need to hit the “On-Off” button to begin sending images. Note thatthis button indicates the current state: not what will happen when you tap it.In other words, if you tap the red “Off” button, it turns the presentation on,and then the button turns green, and reads “On.” Maybe it’s just me, but thisseemed a bit counter-intuitive for what appears to be an active buttonsoliciting a state change. Once I tapped “On,” the screen goes to a blank (no logo) dark graycolor, ready to display an exhibit.

The presentation features are nice and the app handles thetwo most important features nicely – Callout Zoom and Highlight, with highlightsappearing a natural, transparent yellow. Although you can only have one activecallout, you can move the callout around and even leave it in place when youscroll to another page of your exhibit.

You can use a pinch-zoom gesture to zoom in on an exhibit andadd a Callout on top of the pinch-zoom, and even highlight the Callout. You canrotate the image (probably should have done that ahead of time anyway) and use astraight-line or free-drawing pen, which you may set to a desired color andthickness. I noticed that the free-draw pen formed a series of short, straightlines (rather than actual curved lines) when attempting to draw a circle. Thereare Undo and Redo annotations buttons, an Eraser to remove part of anannotation, and a Print (Adobe AirPrint) button.

There is also a nice “Screen Lock” feature, which disablesall of the file access options and allows you to hand the iPad to a witness to use like a “John Madden” Telestratordevice (yup, just realized, there’s an app for that, football fans). When your witness is donemarking up the document, you can use the snapshot button to capture the imagein .png format. The flexibility of the iPad would permit you to do this “live”in front of the jury, by keeping it plugged into the system, or you couldeasily disconnect, save the work, and then reconnect to show the completedwork. This could even be a valuable feature when used in conjunction with othertrial presentation software. At least (in my opinion), it beats the heck out ofthose clunky touch-screen monitors.

In addition to all of the annotation and presentationfeatures, you can display two exhibits side-by-side, and annotate or zoom in oneach one.

Many of the differences between ExhibitView PC andExhibitView iPad are actually a result of the limited functionality of the iPaditself. You simply cannot build and manage a complex database on an iPad – atleast not in a practical manner. Also, you’ll enjoy a far greater degree ofspeed and accuracy when using a mouse and keyboard (compared to a finger, oreven a stylus), as well as the ability to handle most common file types, asopposed to just a few. I’ll always agree that doing almost anything on an iPadlooks cool, but that’s really not all that important in most trials.

I would be comfortable using the ExhibitView app in asmaller matter, but only after thoroughly testing and checking it with all ofmy exhibits. I would look forward to the opportunity to have a witness use theExhibitView iPad app to mark up an exhibit. This could also be a nice tool touse in depositions. I feel that ExhibitView is a real contender in the trialpresentation app space, and if you’re interested now would be the time to getit for just $30. I will close by stating that phenomenalsuccess stories notwithstanding, I still prefer to use my laptops insteadof an iPad for trial presentation.

ExhbitView iPadWebsite

ExhibitViewiPad on iTunes

Kid Resolutions

2012-01-16T15:36:00.000-08:00

Last week in each of my classes we discussed resolutions.

It was a fun discussion where we talked about how resolutions were basically a goal-

something people wanted to do {like exercising more}

or wanted to stop doing {like biting their nails}.

After a long discussion about realistic goals,

each of my students chose a goal for 2012.

Below are a few of my favorites:

I'm going to not blame my sister.

To not hit my brother.

Get ripped.

{A 4th grader getting ripped? So funny!}

Not get annoyed by Brandon.

{I don't know Brandon but this cracked me up!}

I would like to stop messing with my mom while she's working.

This is my favorite!

My resolution is to sometimes follow all the rules at home.

I love my kids!

Relationships

2012-01-16T05:55:00.000-08:00

I was recently contacted by a sweet blog reader who is a principal {Hi Kathy!}

and is writing a book and wanted to include some of my quote posters.

{How cool is that? Seriously.....like bucket list cool!}

I've been working this weekend on a few additional quotes for her book

about relationships and thought I'd share them.

If there is one thing I've learned in my 20 years of teaching is that

building relationships with your students is key!

No Significant Learning

Relationship Are All

Update: ExhibitView for iPad, BlackBerry's Doom, Android Tablets

2012-01-09T13:43:00.000-08:00

I would tell you that I’ve just finished reviewing ExhibitView iPad, but then I’d haveto tell you that you’re going to have to wait to read it until it getspublished on LawTechnology News. I’ll let you know once it’s up there (follow me on Twitterif you want the quickest and latest updates: http://twitter.com/litigationtech).Without spoiling, I can tell you that I was impressed, and look forward toseeing other developments from them.
Update: The review has been published and is now live on Law Technology News.

Speaking of Law Tech News, I’ve been quoted in a fewarticles there recently. One was an interesting piece by Brendan McKenna, LTN'snews editor, entitled “2011'sTech Folly of the Year”. That “folly” was none other than the once-ubiquitousBlackBerry, so addictive it was even referred to as the “CrackBerry.” Read theentire article for some additional insight, but here’s my prediction of doom.

In May, our own TedBrooks announced his defection from BlackBerry here in the pagesof LTN, saying,"BlackBerry has been losing market-share in a big way recently, and Isuspect I am a classic defector. Although I've been a BlackBerry user fornearly 15 years, I am weary of screen-envy, and since the next version ofBlackBerry OS for the latest BlackBerry device won't support my current device,I'm done with it." He adds that he feels no desire to purchase thePlayBook, for the reasons cited above. In August, Brooks again suggested that RIM's days were numbered: "Eventhough Research In Motion has owned the legal market for many years, unlessthey once innovate instead of renovate, the BlackBerry's days arenumbered." While not necessarily indicative of a trend, Brooks is knownthroughout the legal technology community for his Court Technology andTrial Presentation blog, so when he defects in such a public manner,it may be right to presume that RIM has one foot in the grave.

Just last week, Evan Koblentz, a reporter for Law TechnologyNews shared his thoughts on the iPad versus Android tablets, in “iPadMania Aside, Tablets Are Inefficient Work Devices for Lawyers.” Aftertesting the Samsung Galaxy Tab 8.9, Koblentz finds that “For tech-minded lawyers, Android is worth considering because of themany customization options, various screen sizes, and hybrid laptops, such asthe Asus Transformer series. But for most lawyers, it makes a lot more sense tofollow the herd into Appleville, as LawTechnology News columnist TedBrooks noted recently.”

Also, I’ve just downloaded and started my review of a newapp which claims to be an aid in jury selection, called iJury. Staytuned, and I hope the New Year has been good to you thus far!

Snow FUN!

2012-01-08T07:03:00.000-08:00

In addition to the virtual snowman builders I posted last week,
here are some fun snow online activities for your students!
Snow much fun!!

Snowdays- this site allows students to create their own snowflakes. Kids (and adults) absolutely love this site! Once they have created some snowflakes, they can search for their own flakes in the search box at the bottom of the page. If you want to see some really fabulous snowflakes, search for Flake Fan. Snowflakes can also be printed out!

Snowflake Workshop- this is another cool snowflake maker called Snowflake Workshop that works great on the SMART Board. Just click on the pencil and draw the cutting lines. Then click on the scissors and watch your snowflake generate.

10 Little Snowmen Interactive Story

Snowstorm Game

Snowflake Symphony Game- Make beautiful snowy music with Snowflake Symphony. Move your mouse over the snowflakes, click on them and you'll hear a musical, magical snowflake symphony!

Build Your Own Snowman.....even in Texas!

2012-01-05T06:45:00.000-08:00

Here in Texas snow isn't something we see often, if ever.

So winter activities like building a snow man are something our kids don't get to do.

Lucky for them, there is an easy and fun solution!

Here are a few fun virtual snowman building sites

so you students can practice building a snowman even when it's warm!

Build a Snowman

Make a Snowman

Snowman Dress Up Game

Build a Snowman

Highlights Build a Snowman

Virtual Snowman

Snowman Maker

Snowman Family Builder

Commedia dell'Arte

2012-01-03T08:03:00.000-08:00

"Accountability is something that is left when responsibility has been subtracted."
-- Pasi Sahlberg

This was the year when America turned on its doctors, and on itself. Not the 300 million citizens who are busy with other existential threats, but the elite 1% that effectively runs America, and the cadres of intellectuals who provide grant funded scientific cover to our leaders no matter how misguided they seem to be. Health care is a fiscal mess and someone, other than policy makers, must be held accountable. The greedy little doctors who are over treating us to enrich themselves are a good target and so are all of us greedy little people who refuse to go peacefully and expediently into the night. The same strategy is being applied to education, with the pathetic self-serving teachers obsessed with their benefits and the misfit children who ought to be cleaning toilets instead of learning, identified as the culprits for our educational fiasco. Mind you, the elite 1% is not experiencing either education failures for their children, or health care difficulties for their families. For them, this is not personal, it’s business, and they are about to make us an offer we can’t refuse.

A hundred years ago, give or take a couple of decades, America delegated the responsibility for taking care of the sick to the medical profession, and as science advanced by leaps and bounds, people were greatly rewarded with better health and longer life, and doctors were rewarded with prestige and financial prosperity. Some say too much prosperity, some say too little, but all in all, fewer than 10 cents of each health care dollar go to physicians. Professional responsibility for sick-care does not require one to be a saint and it is not necessarily incompatible with seeking higher remunerations for one’s services. However, something went very wrong along the way. Ever so gradually doctors have lost control of their profession to the rising corporate and public interests in health care who acquired complete jurisdiction over physicians’ reimbursements. Doctors became the servants of two masters, responsible for one and accountable to the other.

This obviously unworkable situation caused enormous problems during Managed Care I (the HMO). On the eve of Managed Care II (the ACO), our leaders are proposing, on behalf of the people, to release the medical profession from the moral and ethical responsibility which formed the foundation of the patient-doctor relationship and replace it with uniformly measurable accountability to public and private payers. Patients are advised to reject the old ways of paternalistic physician managed care, in favor of the empowerment afforded by payer, health system or employer managed care, which is certain to bring about better health care at lower costs everywhere except in Connecticut. Physicians, who enter apprenticeship as teenagers and graduate somewhere in their thirties, are having difficulty letting go of the historic burden of responsibility. Patients seem not to have read the official memo, and most are still expecting doctors to uphold their end of the ancient bargain. There are of course well publicized and well marketed exceptions.

While responsibility is entrusted, accountability must be managed, monitored and acted upon. From a patient’s perspective, the locus of trust must shift from the doctor to monitoring organizations. While the old trust was based on long term relationships, word of mouth or gut feelings, introducing much variability in outcomes, the new trust is based on facts, calculations and objective data, hence the controversial importance of Electronic Health Records (EHR), which are increasingly fitted to facilitate the transition from old to new. EHRs too are the servants of two masters, used by one and governed by the other.

Early EHRs were built and sold to doctors as tools to enhance practice revenue and personal income. Interestingly enough, very few physicians found that proposition enticing, and EHRs did not sell very well. Today’s EHRs are prescriptive data collection tools, with budding capabilities for reporting and exchanging information, and largely promissory abilities to deliver relevant evidence based protocols at the point of care. As the Meaningful Use incentives program enters its second year, physicians are increasingly purchasing and using EHRs. A minority is truly excited about a digital future, but the majority of EHR users, and practically all those still sitting on the sidelines seem to be asking the same question: how does this help with patient care? Well, it does, and it doesn’t, depending on what one means by patient care.

Most physicians are looking at EHRs as tools to help them do a better job. These doctors are still under the impression that they are at the center of health care delivery and EHRs are tools to assist them discharge their responsibilities to their patients. They are looking to computers to help search a medical record in intelligent ways, abstract all pertinent information and no more, manage repetitive tasks on their behalf, deliver timely reminders, provide advice upon request and become invisible when not needed - in short, the perfect butler. This is about hands-on patient care, one patient at a time.

Those who govern EHRs are continuously harmonizing them, through the Meaningful Use regulatory system, to promote accountability of EHR users. They need data. They need boxes to be clicked, numeric values to be captured and buttons to be pushed, and they need everything compiled and transported out to analytics engines to assess performance or lack thereof. They don’t need to know about Mary’s Lasix trouble, but they do need to calculate the p value from paired t-tests for the average change in percentages between baseline and subsequent years across patients qualifying for the measures. This is about standardized patient care at the population level.

Today’s EHRs have some features serving their users, but most development is geared to serve the governors and as a result, EHRs are not able to please either one of their masters. As Managed Care II blooms and the doctors for the 99% transition to accountability regimens, minding their p-values and t-tests, EHRs will become fabulous engines for enterprise data collection and processing. When the powers to be come to the realization that government intervention based on the assumption that people are irresponsible, greedy, dimwitted and largely inconsequential is doomed to fail, and Managed Care II joins its predecessor in the annals of failed policy, EHRs will finally become slick, intelligent and nonintrusive servants to both responsible doctors and their patients, helping deliver better health care at lower costs, one patient at a time, and by definition across the sum total of the people, because technology is not the limiting factor. Responsibility is.

eLearning Learning Adds Personalized Subscriptions

2012-01-02T15:23:00.000-08:00

Aggregage, the platform that powers eLearning Learning has added a powerful personalization engine. That means that eLearning Learning now allows users to sign-up and have their content personalized based on their interests.

You can sign-up via the "Personalize Your Content" button on the right side of the interface shown to the right of the red arrow below. Or put another way, just above and right of the picture of Justin Bieber.

By the way, I should point out that the four top articles on the site when I took the screen shot were all great:

It's what I love about the site. It always has great, fresh content from a wide variety of industry professionals. Every time I visit it, I find something that I missed that was really good content.

Now with personalization it's even better. The picture below gives a sense of what's happening:

Curators handle finding the best sources of content. The system then uses social signals such as those coming from Facebook, twitter, LinkedIn, delicious as well as clicks and views. These are compared to averages for the source and also looks at who is providing the signal, how often they signal things, how often they signal for that particular source, etc. Those aspects existed before and it does a good job of finding great content. You can read a bit more about these aspects in eLearning Learning Launches New Features.

What's new now is that the site allows you to sign up and provide your Twitter and LinkedIn information. The site will look at your activity on these sites and the content of what you share. It will use that to find interests as well as to cluster you with other users who are like you based on interests and sharing. You can partially control your interests via the Subscription page as shown below:

This will change over time based on your LinkedIn and twitter activity. You can always visit and manually select interests as well. You can read a bit more here: Personalization Explained.

The system then can combine three pieces of information to figure out what will be most interesting to you:

Social signal score – are people in the audience finding it interesting
Topic match – does it match up with your interests
Like sharing – are individuals who are like you sharing this

The system uses these to both rank things on the site and to generate Daily and Weekly newsletters.

The reason that I'm most exited about this is that I partly use eLearning Learning to make sure I don't miss things that is good content that is relevant to me. Now with personalization, it is even less likely that something will sneak by.

I also personally like the format of the new newsletter.

Give it a try and let me know what you think.

Ted’s Top Ten from 2011

2011-12-29T08:47:00.000-08:00

Here are a few of my most popular and favorite articles fromthe past year. Thanks for reading and sharing this blog!

Applesto Apples: Two iPad Apps for Trial Presentation - TrialPad v. Evidence

JANUARY 12, 2011 – This article offered the firsthead-to-head comparison of the first two trial presentation apps for iPad, andquickly found itself at the top position for all-time most popular articles,where it remains today. There are now others, including ExhibitA and ExhibitView for iPad, which I will be reviewing very soon.

iPadApps for Lawyers: iJuror, JuryTracker, Jury Duty, WordPerfect Viewer

JANUARY 24, 2011 – What is it about those iPad app reviews?Readership on this blog increased exponentially in 2011, largely attributed to themany iPad app reviews I’ve written. This article explores several apps for juryselection and monitoring, and is comfortably in the second position forall-time most popular articles.

JudiciaryOpinions on Technology in Trial

MAY 3, 2011 – Often, litigators make certain assumptionsabout the Judge and jury, which are not always on the mark. One such assumptionis that Judges don’t care for the use of technology in court. Here are a fewnoteworthy quotes for the doubters.

SamsungNexus S: BlackBerry Replacement or iPhone Alternative?

MAY 18, 2011 – I’ve never really used a device just becauseit’s the cool thing to do. I do love my iPad, but I don’t believe it is a truelaptop replacement – regardless of what others might say. Same goes for myphone. I did my homework, and found that the Google phone would be a bettertool than the iPhone, and on a better network (Sprint) that still features anunlimited data plan. This particular article was also very popular in thenon-legal tech channels.

CaseyAnthony Verdict: Was it Wrong?

JULY 5, 2011 – It’s hard to believe this happen this pastyear – it already seems so long ago. Our justice system was put to the test, aswas our perception of trial coverage by the media. Whether you agree or not,the verdict stands. This article wasvery popular in both the legal and non-legal audience.

TryingYour Case in 3 Hours: California’s Expedited Civil Jury Trials Act

SEPTEMBER 6, 2011 – Written for CAOC Forum Magazine, thisarticle was mentioned as one of the most-read posts on LinkedIn. While thebasics of trial preparation are similar, you’d better have everything ready togo in an abbreviated trial.

I AmTroy Davis

SEPTEMBER 21, 2011 – This was perhaps the saddest article I’veever written. Regardless of your position on capital punishment, we must notallow our judicial system to be manipulated in the interest of convenience orto satisfy public rage.

Ten Questions to Ask Your “Hot Seat” Provider

NOVEMBER 7, 2011 – Due diligence should go beyond thestorefront. Make sure the person who will actually be working with you isqualified. Don’t just accept the sales pitch.

TenQualities of Top Trial Presentation Professionals

NOVEMBER 20, 2011 – Hmm, looks like I was on a roll here. Ifyou are considering bringing in an outside vendor to assist with your nexttrial, this article offers another check-list of qualifications you should belooking for.

12Top Legal Sites You Should Check Out

DECEMBER 4, 2011 – You can’t accuse me of tooting my ownhorn with this one. In fact, I’ve listed several of my favorite sources oflegal and technology information. In less than a month, it has found a home onmy all-time most popular articles, at number 3. Readers have added several oftheir own suggestions. Feel free to add yours.

The F Words of Health Care

2011-12-24T10:52:00.000-08:00

Vassily Kandinsky, 1923

Fragmentation, Fee-for-service and Futile care are the trifecta of what is supposedly ailing our health care system, or non-system, as it is fashionably described nowadays. Modern health care has reached its crisis point not due to hordes of people keeling over and dying in the streets, as they did during historical health care crises brought on by plagues and famine, but due to exploding costs of delivering decent care to all people. Since the issue now is mostly financial, health care as a discipline is attracting the interests of those who practice the dismal science of Economics. Over the last two centuries, economists have successfully addressed the F words in other industries with spectacular results in developed countries, so why not apply lessons learned to health care?

The obvious reason to treat economists with suspicion in health care is the quintessential argument that people are not widgets, but there is another problem. Most tried-and-true solutions for increasing availability and quality while lowering costs of products are not accounting for the other explosion occurring as we speak – the Internet. How can this assertion be true when we are in the midst of a government sponsored spending spree to computerize medical records and adopt Health Information Technology (HIT)? Apparently, even those who lead and define the HIT revolution are reluctant (or unable) to grasp its full implication, thus they are consistently underestimating the power of the Internet to serve the individual, and as a result are hedging their bets on technology with classic industrial models from days gone by.

In a 2008 Health Affairs article, Dr. Donald Berwick has defined what has become the official goal of policy making for the Secretary of Health and Human Services. Better known as the Triple Aim, the goals are to create better health, provide better care and lower costs of care. If you look at health care as just another industry, the Triple Aim translates into a better product with a better process at a lower cost. Well, when put this way, the solution is pretty obvious and it has been obvious for over two centuries. We must address the F words: eliminate Fragmentation by aggregating independent artisans in one physical location, stop paying Fee-for-service (piecework) and pay salaries instead, and most important, eliminate Futile work by standardizing the process. In short, apply the industrial revolution to health care and realize the economies of scale that brought prosperity and happiness to the developed world. Except that for some strange reason, this solution doesn’t quite work in health care.

Case in point: Federally Qualified Health Centers (FQHC). FQHCs started out in the early 1960s as community run clinics to provide medical care to the poor. By the mid-nineties, and with the best of intentions, the Federal government and the Centers for Medicare & Medicaid Services (CMS), created funding grants and reimbursement methods to support these clinics. Today there are thousands of FQHCs of different types, operating in health care shortage areas and providing team-based comprehensive care including preventative care, basic primary care, behavioral care, dental care, lab and pharmacy services, mostly to Medicaid beneficiaries and the uninsured, but also to small numbers of Medicare and privately insured patients. FQHCs must use mid-levels to provide and coordinate care and must report on quality measures. In return, FQHCs receive millions of dollars in grants for building and improvements, have access to cost effective workforce, can obtain free malpractice protection, are tax exempt and are paid more than double what a private practice is paid for Medicaid services. By all accounts, FQHC are addressing the triple Fs of health care rather well, but how are they doing against the Triple Aim objectives?

Studies are mixed regarding quality of care provided by FQHCs, and patients cared for by FQHC are largely sicker than those seen in private practice. Interestingly enough, neither Medicare, nor privately insured patients are flocking to FQHCs, in spite of the financial advantages offered, particularly to Medicare patients, and in spite of the spiffy state of the art facilities. This may, or may not be, an indicator for perceived quality of care. How about lowering costs? Do FQHCs provide care at a lower cost than, say, an independent solo private practice? Adding direct reimbursement rates, grants, tax breaks and other benefits, FQHCs visits cost more than twice the amount paid by Medicaid to private practices, which cannot compete with FQHCs and all but disappeared from areas where FQHCs operate. What would have been the results if twenty years ago CMS would have decided to increase Medicaid fees and pay for uninsured visits to independent practices, instead of exclusively backing the creation and operations of a separate but equal clinic system for the poor? We may never know for sure.

FQHCs are only a small example* of why economies of scale are not easily achieved in health care. Large hospital organizations and even fully integrated health systems, which may be providing better care (or not) seem equally incapable of reducing costs in spite of attacking all three Fs, or seeming to do so, and there are two reasons for this failure: a) larger health care facilities have disproportionately larger overhead costs and b) large systems are better equipped to charge more for services, which renders their efficiency efforts less urgent. And this is not a matter of opinion. CMS acknowledges this built-in inefficiency as evident in the physician fee schedule which pays an additional “facility fee” for services provided in hospital owned outpatient clinics, presumably to cover the extra overhead. Surprisingly, CMS is consistently creating incentives and regulations to accelerate provider consolidation into these big inefficient and expensive systems. The only possible explanation would be that CMS is betting that elimination of the last two Fs (Fee-for-service and Futile care) will be easier in a consolidated environment and the gains will ultimately exceed the losses from doing away with independent practice (Fragmentation). What about information technology? Well, it is supposed to help with process standardization, data collection and performance measurements, similar to what computers do in every other industry.

We have all seen the infomercials for high-tech hospitals, where a bunch of doctors are seated around a conference room table, each holding a laptop or tablet, presumably discussing patients in a team environment. There is something very wrong with these pictures. First, it costs us a fortune to have all these physicians in one room. Second, there is almost no added utility for them to be using computers instead of passing around a piece of paper, and computers are expensive. Third, there is no patient in the room. Now let’s imagine a different picture: a primary care physician sitting in his office, with a patient next to him, both interacting with a computer on which a Skype conference is taking place with an oncologist sitting in his own office thirty miles away, a surgeon in a hospital lounge in the city and perhaps a radiologist half a continent away. Everybody on the call has access to the same electronic medical record, appointments can be made in real time, literature can be consulted and shared, prescriptions can be changed and a common care plan agreed upon by all and understood by all can be created and by using intelligent predictive analytics tools various options can be explored. Perhaps a family member in a different country is conferenced in and perhaps the patient is at home or in a break room at work. Perhaps there’s an electronic sign-up sheet for the oncologist, if the patient wants to ask something else later and have a physician friend in New Zealand listen in. And with one click on a PayPal button all doctors are paid for their time.

In this Internet age, manufacturing style physical consolidation is not only unnecessary, it is cost prohibitive. Modern lifestyles and modern medicine have created a need for doctors and patients to collaborate and the Internet is providing the means to accomplish such collaboration without having to physically gather everybody under one expensive roof. There is no need to obliterate the operational efficiencies of private practice and replace it with the bloated bureaucracy of large institutions, and there is no need to dispense with long lasting doctor-patient relationships in favor of computerized care coordination, and there is absolutely no need to substitute a bunch of numbers in a computer for a real patient. The Internet is decentralizing and individualizing everything from politics to manufacturing. Health care is, and always has been, decentralized, individualized and based on the local patient-doctor dyad. The resemblance is striking. We either embrace the fully aligned collaborative nature of the Internet to achieve better health, better care at lower costs, or engage in a doomed effort to impose an unnatural centralized command and control structure in health care just because it worked well for nineteen century steel manufacturing and because policy makers don’t truly understand the magnitude of the connectivity revolution.

* According to the Kaiser Family Foundation FQHCs had about $12.7 Billion in revenues in 2010, 75% of which came from Federal and State agencies. They served almost 19.5 million patients with over 77 million encounters. Simple math yields a cost of approximately $165 per encounter.

Three New Computer Labs Open Thanks to Timothy Smith Network Donation

2011-12-23T10:43:00.000-08:00

Thanks to a generous donation by the Timothy Smith Network, the Hale, Trotter and Blackstone schools have all opened brand new computer labs this year. The Timothy Smith Network donated $25,000 to each of the schools to purchase the new computer equipment. The Nathan Hale school installed a new lab that features a SMARTBoard with integrated projector and 17 new iMac desktop computers. The Blackstone School purchased thin-client multi-seat computers to completely renew two computer labs. They were also able to establish a "mini-lab" of six computers in their Parent Center, which allows parents access to technology for Parent University and Parent ESOL classes that are held at the school. Director of Accelerated Improvement at the Blackstone, Lisa Lineweaver, said "We are very appreciative of this generous donation from the Timothy Smith Foundation and excited about the boost to learning and student engagement that is sparking at the Blackstone."

The Trotter Elementary school used the donation to purchase 25 brand new PC's for their computer lab. They are very excited to use the new machines for research, developing podcasts, presentations and utilizing intervention programs such as First in Math and Reading Counts. They are also confident that the new lab will help to increase participation in their Technology Goes Home program which is a city-wide program that provides families with 15 hours of technology skills training. At the end of the training graduates can purchase a netbook at an incredibly low price as well as qualify for discounted internet access. The computers that were in the Trotter lab before the donation were older had become unreliable, costing the students valuable learning time.

A fourth school, the Higginson-Lewis school, also received a Timothy Smith Grant. They purchased a number of different interactive technologies for their classrooms, including Mobi mobile interactive whiteboards, document cameras and iPads.

The Boston Public Schools would like to thank the Timothy Smith Network and their executive director, Susan O'Connor, for their continued support of our students, families and schools.

Rudolph the Red Nosed Reindeer

2011-12-14T11:47:00.000-08:00

We are in the home stretch.........only a few more days!

Here are some super fun reindeer sites to use with your

kiddos during these last few days before the holiday break!

This is one of the cutest sites out there to use during the Christmas season!

The Rain Deer Orchestra is a site where students touch the nose (or type the number on their shirt) of a reindeer to play different musical notes. There are three song choices to choose from- Jingle Bells, We Wish You a Merry Christmas, and Deck the Halls- or you can free play and play and make up your own song.

This is a fabulous site to use with students on your Smart Board-with a different student in charge of a different number or one student in charge of the entire orchestra. Students could also do this at individual student computers-which would be a fabulous way to practice number recognition and mouse skills.

Oh no! It's Christmas Eve and Rudolph the Red Nosed Reindeer is missing!

Rudolph is Missing! is an online story that asks inference questions as the story goes along.

It's up to you to find out where Rudolph has gone!

Where's Rudolph? and Christmas will be ruined if he isn't found!

Click on the picture to find the hidden reindeer. Rudolph hides in a different place in every new game!

Here's a fun online reindeer coloring page!

There are many online sites where students can listen to Christmas stories.

This is one of my favorites because it gives visitors the option to read the story themselves or have it read to you.

The Reindeer Barn is a part of the NorthPole.com site. Raymond is a reindeer that lives in the reindeer barn with all the other reindeer and hopes to be the newest member of Santa’s reindeer team. Students find the places in the barn that take them to Raymond’s stories about his adventures.

Sparklebox has some great reindeer printables including these

reindeer with numbers 1-50 on them

Sharing, Collaborating, and Working with Colleagues - 21st Century Leadership Cadres

2011-12-12T12:32:00.000-08:00

Teams ofteachers and administrators in 15 schools and 2 central Academic Departmentscame together this week to share best practices related to learning withtechnology via the 21st CenturyLeadership Cadres Professional Development. Highlights of the day includeduse of QR codes for workflow in the classroom and “above the line” teachingpractices related to 21st Century Learning. The goal of our leadership cadre isbuild a core group of educational technology leaders in each school. Thisyear’s program pilots the use of iPads for instruction. It also provides timeto “share, collaborate, and work with colleagues” which are key needs that teachers shared atthe Superintendent’s Teach + Sharethis week.

The 21st Century Leadership Cadres isa yearlong professional development opportunity sponsored by the Office ofInstructional and Information Technology (OIIT) and Apple ProfessionalDevelopment, that aims to develop cadres of leaders and teachers embedding 21stCentury Skills into teaching and learning. Eachcadre is made up of school teams that include one Principal/Headmaster and twoteachers who participate in face to face learning sessions and onlinecollaborations. This is the third year that the BPS has offered the 21st Century Leadership Cadres.

Mobile Living: Life on the Road

2011-12-12T07:26:00.000-08:00

No, I’m not talking about hitting the road in an RV. I’mtalking about the out-of-town trial, and a few things you might not otherwisethink about until you need them – which would then be too late. I’ll offer afew thoughts here, and feel free to add yours at the end of the article.

Internet Connection– Honestly, I can’t imagine being without a decent connection these days, whenonly a few years ago, it was a pure luxury. In most courthouses in majorcities, you can get a decent cell-phone signal. If you can do that, and if youhave a smart phone that doubles as a Wi-Fi Hotspot, you’re set for providingaccess to several laptops, iPads, or other devices. There are also servicessuch as Courtroom Connect in many courtrooms, in addition to a free publicservice in some (usually intended for jurors). All due cautions apply to each.

Printing, Scanning,Copying – These common, simple daily functions must not be overlooked, andideally, you will be able to do a decent job of each in both the war room andthe court room. While the war room should have equipment available to handlethe expected volume, you should also be able to scan or print something in thecourtroom, if necessary. There are a number of portable scanners and printerson the market, and mine fit into my carry-on bag which I take to court with meeach day. I’d rather not print 10 copies of 12 different exhibits in a bighurry, but I can handle the occasional (or frequent) emergency.

With that, you might also consider using 3-hole pre-drilledpaper if you’re putting everything into binders, so you don’t have to worryabout punching the pages. One more tip is to bring along a high-capacitystapler, since many exhibits are too thick for a standard staple (over about 20pages). You should also check out local resources for vendors.

Redundancy – You shouldalways have a current backup of your trial database available. When you’re athome, this may be simple, but when you’re on the road, although dealing with the“blue screen of death” is no longer a routine issue, problems still occur. Irecommend have a second laptop of the same make, model and configuration, inaddition to a full copy on an external hard drive, which may be used totransfer from one to the other (leaving a third copy on the drive itself). I’mnot a big fan of data sync software either, and I have seen it fail. There’snothing quite like the feeling you get when you realize something has gonewrong. At least if you’re handling it manually, you will know what you did, andlikely have a quick recovery available. Also, over-writing database files doesn’talways go as expected, so I will first delete the old set, and then copy over theupdated set. Thumb drives and cloud services such as Dropboxcan also be helpful.

Other Devices –iPads, Tablets and other devices can also help to make your life a bit morecomfortable. If you have one, you know what I mean. If you don’t, you probablywon’t understand until you get one. Although there are even apps for trialpresentation which I’ve reviewed here, such as TrialPad,ExhibitA, Evidence,and now ExhibitView (currently onsale for $29.99, which I’ll be reviewing soon), most of the cases I handle arefar too complex for the capabilities of the iPad. On smaller matters, however,using the iPad in trial could be fun. I have successfully used mine in severalCLE presentations.

Use Caution With RoomServices – If you’re looking for an easy way of upsetting an otherwisehappy client, go ahead and turn in your expense report with a long list of topmovies, fine dining, cocktails, and sending out all of your suits you’ve beenmeaning to get dry-cleaned. Just because you’re living in a hotel doesn’t meanyou’re on vacation. Although your extravagant indulgences may be strategically distributedthroughout the duration of your stay, think of how it’s going to look on paper –one right after another.

Okay, off to court. Have a great day!

Senior staff members from the Department of Homeland Security visit students from John D. O’Bryant School of Mathematics and Science

2011-12-06T20:13:00.000-08:00

Students from Mr. Henry’s AP Computer Science class and member of O’Bryant’sNavy ROTC gathered in the Science Auditorium on Thursday, November 17, 2011,for a presentation from senior staffers from the Department of HomelandSecurity. Paul Mesterhazy, DeputyDirector of the National Cyber Security Division, and Kristina Dorville,Director of Cybersecurity Awareness Programs were invited to the school as partof Cybersecurity week in Boston (Nov 14 – 18). Paul and Kristina discussed topics relevant to nationalcybersecurity and informed students that there are many jobs in the field ofcybersecurity that require talented students with math, science and programmingskills. Paul and Kristinaresponded to thoughtful questions posed by O’Bryant students. Paul and Kristina also met with BPS CIOMelissa Dodd and TechBoston director Felicia Vargas who shared informationabout the BPS Cyber Safety Campaign. Our guests were impressed with the Internet safety materials developedby BPS students and took samples of the materials to share with otherDepartment of Homeland Security administrators in Washington, DC.

The Pin Factory EHR

2011-12-05T16:12:00.000-08:00

In 1776 Adam Smith explained to posterity how specialization increases productivity using the now famous example of a pin factory. While one master pin maker could turn out anywhere between 1 and 20 pins each day, going through all the steps involved in making pins all by himself, a specialized army of laborers, each fulfilling one step in the pin making process, could increase productivity more than two hundred fold and turn out almost 5000 pins per person per day. This would have the triple benefit of enriching the factory owner, creating jobs and making pins both affordable and widely available for consumers. What happened to the master pin maker, who used to make a very nice living when pins were expensive and hard to come by? He would most likely be employed in the factory to supervise the smooth flow and quality of the new pin mass production system. He would make sure that each laborer works at a speed appropriate for feeding the next laborer in line and he would probably sample a few pins here and there to make sure they are as sharp and sturdy as the ones he used to make in the olden days. When the master pin maker passes away a new supervisor would be hired, most likely one that has never made an entire pin before, but instead has a much better understanding of the production process. The profession of pin coordinator has been born.

Although Adam Smith put forward the notion of specialized labor, Henry Ford is customarily credited with the invention of the modern assembly line. Interestingly, Ford is attributing his invention to the observation of Chicago’s meat packing industry. It seems that while no two cows are identical, the butchering of animal life lends itself rather well to disassembly line methodology. Today, manufacturing assembly lines use human labor where it is cheap and in abundant supply, and are staffed with robotic machinery where human labor is expensive and/or scarce. In all cases the process is orchestrated and controlled by sophisticated computer software. This is why we are all able to purchase a car, chat on our cell phones and enjoy perpetually fresh slices of white bread in plastic bags, amongst many other wonderful things, which were once only available to the wealthy few.

Modern medical care is increasingly out of reach of most people. It is expensive, and adequate resources are scarce in many areas. Medical care also varies widely in quality, and the costs of production are anybody’s best guess, depending on geography, time of year and even workers vacation and education schedules. This is very much the same as making pins in the eighteen century. In all fairness, some specialization of labor has already occurred in medicine, but there is no coherent method of placing each worker in his/her station of the continuum of care, and there is no standard process by which workers hand off work from station to station. According to experts, this lack of orderly processing, along with the absence of quality control, is creating a terrible waste of resources and a flurry of defects in the finished products. If the advanced methodologies of modern day manufacturing are working so well for everything from cars to pins to cows, wouldn’t it make sense that we should at least try them in medicine?

Fortunately, we already have several pieces of the puzzle in the works. As mentioned above, we do have a certain degree of specialization in medical practice. We also have hospitals, which could function very much like factories, but as Clayton Christensen observes, most have no well-defined assembly lines. And then, of course, we still have the independent small shops that take piece-work home and operate without any standardized quality control. We also have the beginnings of computerized control systems in the form of Electronic Health Records (EHRs), which, according to John Halamka, are quickly moving from just bookkeeping software to dynamic coordination of processes, complete with encyclopedic knowledge of medicine and a good measure of artificial intelligence to devise and “enforce automated care plans”.

The only thing left to do is to lay out proper assembly lines, and we don’t really need to think outside the box too much, because manufacturing has solutions for this dilemma as well. In modern industry, there are practically no factories that start out with raw materials and end up with a finished product. Instead, some factories concentrate on producing parts and others are built to receive parts and assemble them into useful products. Exact specifications for each part, to be followed by production lines and relied upon by assembly lines, make this geographically dispersed process possible. In health care, the primary care homes will serve as production centers, where people are constantly measured, tracked, tested and evaluated, so when they are finally shipped to a hospital for a procedure, the hospital knows immediately which assembly line to place them on and the omniscient EHR will control the most minute detail in the process, from medication dosing to incision size and implantable device brand and model, thus reducing both errors and costs. Once the hospital’s work is done, patients are released back to evaluation and management in production centers, and here is where the cyclical nature of health care differs from a typical manufacturing process, and this is why it is extremely important that EHRs be interconnected and preferably Cloud based to achieve a high degree of omnipresence.

Yes, there are many more details to be worked out, like emergencies, accidents and the exact specifications that an EHR should contain on each type of person. We will have to establish quality feedback loops between hospitals and primary care centers to continuously refine processes for both entity types, so basically the EHR will need to be able to adapt to, and learn from, new information, in a manner similar to IBM’s Watson software. Since people are not pins or even cars, the tolerance levels (allowed deviation from specs) will be high initially, so line workers will need to be highly skilled as well. In all likelihood physicians will be working those lines for the foreseeable future. As the learning control system improves, portions of work would be offloaded to less skilled resources and eventually to machines, and more significantly, entire tasks could be packaged into deterministic protocols and pushed out from expensive hospitals to the less skilled primary care production centers, which will further push the most trivial tasks to consumer owned devices.

Obviously, EHRs will prove to be the heart, brain and circulatory system, of the health care industry. As we speak, EHRs are increasingly being tasked with care coordination activities (not to be confused with continuity of care, or longitudinal care), which are the precursor to the industrial line controller. Folks wondering why they should use EHRs that are not ready for prime time, should understand that we have to have an EHR in every practice, so that the system can have visibility into current processes to learn, adapt, grow and devise new methods of providing care. After all, you cannot control that which you cannot see.

If you think this is all farfetched and disastrous, please find a senior citizen that lived through the Great Depression and ask her what she thinks about dinner being prepared moths in advance in computer controlled industrial vats, thousands of miles away from home, pumped full of preserving chemicals, freeze dried, shrink wrapped and delivered by airplane to a football field size department store, with minimal human intervention, ending up in a small irradiation chamber in your home before it hits your dining table (or couch). Yet we all buy the stuff and feed it to our kids with no apologies, because it is cheaper, faster and more convenient than tenderly preparing beef stroganoff and baking pot pie at home, after work, every day. And neither grandma nor you can even fathom the handcrafting of pins by master artisans. Is health care really that much different?

12 Top Legal Sites You Should Check Out

2011-12-04T20:19:00.000-08:00

Many of us have our own short-list of web sites we checkfrequently to keep current on topics of interest. Whether you found your way tothis site through a web search, clicked on a Twitter, Facebook or LinkedIn link,I appreciate that you’re reading the Court Technology and TrialPresentation Blawg. Of course, I also greatly appreciate those who sharethis site with others. Web traffic and readership are pure motivation tobloggers, as are comments and compliments.

I am going to share a few of my favorite blogs which I enjoyreading regularly. I hope you’ll enjoy my list, which will focus on legaltechnology, jury selection, graphics and trial presentation. Feel free to addsome of your favorites in the comments area.

1. Law Technology News-- The mother of all legal technology sites, this site is a Law.com publication,headed up by Monica Bay, a household name in legal technology. Articles areoriginal, fresh and timely, and they also have a print publication available. Authorsinclude a staff of excellent writers, and LTN features many familiar names inthe profession.

2. The RedWell -- This site features a directory and preview links to currentarticles provided by a select group of bloggers. Topics include Jury Selection,Litigation Graphics, Trial Presentation, and Communication for Lawyers.

3. The JuryExpert -- This site is not actually a blog, but rather a veryhighly-regarded monthly collection of articles, provided by members of theAmerican Society of Trial Consultants. Authors vary monthly.

4. LinkedInTrial Technology -- With nearly 2000 members, this is the largest online groupfocusing on the intersection of law, technology, and visual communication.

5. LawyerTech Review -- This site features a bi-lingual (English and Spanish) collectionof articles covering all the latest tech-toys a lawyer could want. A favoriteis the App Friday series, where legal luminaries are asked about the apps theyuse. Attorney Geri Dreiling is the Editor, with Enrique Serrano providing theSpanish version of the site.

6. BowTie Law -- Attorney Josh Gilland explores legal technology and itsapplication in case law, and covers e-discovery frequently.

7. Deliberations -- The “official”blog of the American Society of Trial Consultants features articles by JuryConsultant Matt McCusker.

8. CogentLegal Blog -- Morgan Smith and company offer a great deal of insight on howto communicate visually, using graphics and animations. Smith, an attorney, isthe primary author, with contributions from others.

9. TheLitigation Consulting Report -- Ken Lopez features helpful topics focusingon using graphics to speak to jurors. Some great ideas.

10. igetlit.comInformation Graphics & Litigation -- Jason Barnes offers great insight on visualcommunication techniques based on his years of experience in the profession.

11. LitigationPostScript -- Dr. Ken Broda-Bahm provides perspectives of a Jury Consultant.Lots of great “how-to” info on jury selection and analysis.

12. Litigation SupportTechnology & News -- Joseph Bartolo and Frank Canterino scour the netfor you to offer a collection of summaries of current articles found on manypopular blogs.

I’dgladly recommend any or all of these sites to those who are interested in themodern practice of law. Of course, there are many more, and feel free to addyour own in the comments section, and use the Twitter, Facebook, Google+ andother social media buttons to share this collection. As a disclaimer, I willmention that I have contributed to numbers 1, 2, 3, 4, 5 and 12 listed above.

2011 EHR Adoption Rates

2011-12-01T09:16:00.000-08:00

On Wednesday, November 30, the Centers for Disease Control and Prevention (CDC) released the results of its yearly survey on Electronic Health Records (EHR) adoption for office-based physicians. No surprises. Generally speaking, the majority of physicians in ambulatory practice are now using an EHR, and over half of surveyed doctors say that they intend to seek Meaningful Use incentives. The report is also presenting results broken down by State, so you can learn what folks are doing in your immediate vicinity. The more instructive exercise is to compare last year’s survey results [Fig. 1] to this year’s estimated EHR adoption numbers [Fig. 2].

Figure 1: Percentage of office-based based physicians with EHR - 2010

Figure 2: Percentage of office-based physicians with EHR - 2011

The most immediate observation is that 6.2% of physicians have adopted an EHR in 2011, thus returning to EHR growth rates preceding the 2009 -2010 slowdown, which was largely due to the confusion created by Meaningful Use regulations. The next observation is that the percentage of docs that have at least a basic EHR has gone up by 8.9% in 2011. A basic EHR is one that has “patient history and demographics, patient problem list, physician clinical notes, comprehensive list of patient's medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically”. Although the survey instrument in 2011 did ask about more advanced functionality, and is practically identical to the 2010 instrument, the CDC did not publish a separate number for those with fully functional systems in 2011. Although I cannot be certain, I would assume that most of the growth in 2011 was fueled by Certified EHRs, which by definition should be fully functional. So if I had to guess, and I hope CDC will release the numbers so I don’t have to, I would estimate that in 2011 we have at least 20% of physicians using fully functional systems, which is roughly double what we had in 2010.

Another interesting trend that has been holding since around 2007 is that about a quarter of office-based doctors have some type of bare bones software in their office and they are not upgrading to even a basic EHR. Considering that over half of those surveyed intend to apply for Meaningful Use incentives, this trend is bound to change in 2012. Some of these folks may have purchased a fully featured EHR, but chose to either not turn features on or chose not to keep up with upgrades to newer versions. For ambulatory EHR vendors these numbers translate into a market opportunity ranging from 50% of the market to a full 80% of ambulatory physicians.

It would be very beneficial if CDC released the complete data set from this survey (anonymised, of course), so we could gain a better understanding of EHR adoption patterns by practice type, size and location. Although it is widely acknowledged that larger practices and employed physicians are further along the curve, the rich details provided by the survey instrument should help both vendors and various organizations engaged in efforts to spur technology adoption, better target their work, and it could also illuminate any disparities which may affect quality of care for vulnerable populations and physicians who serve them.

In summary, the new CDC survey is showing a stable growth in technology use by office-based physicians, modestly improved by government initiatives over the last two years, and well positioned to further improve in 2012 and beyond.

Winter Break Programming Class for BPS Students

2011-11-29T06:15:00.000-08:00

The Boston Public Schools Office of Instructional and Information Technology is offering a free two-day training for students during vacation week. OIIT's TechBoston Unit in conjunction with Machine Science are hosting the two-day Scratch programming workshop. Students will learn how to design and write their own computer program or animation using Scratch, a graphical programming language developed at MIT.

During the training students will also:

Learn how to make programs in Scratch
Learn basic Scratch control structures
Experiment with motion, sensing, looks, and sound
Learn about using variables and operators
Make drawing programs with the pen function
Create original games and animations
Share projects on the Scratch web site
Download and “remix” projects from the web site

The free two-day workshop will be held on Tuesday, December 27 and Wednesday, December 28 from 8:30am-3:00pm at Madison Park High School. This opportunity is open to any BPS students in Grades 6-12. There are a limited number of seats, so sign up early!

For more information please visit http://bpsengineering.wordpress.com/student-resources/december-2011-bootcamp/. Online registration is required: http://tinyurl.com/december2011camp.

For further questions about the training, please contact:
Haruna Hosokawa
hhosokawa@techboston.org

To learn more about the Scratch programming language, please visit http://scratch.mit.edu/.

Thanksgiving in Health Care

2011-11-20T19:03:00.000-08:00

Thanksgiving is almost here and between shopping for yams and turkeys and waiting for the cranberries to pop in the saucepan, there is ample time for reflection. Most folks evaluate the past year and make predictions for the next somewhere around Christmas, but since little serious business is conducted after Thanksgiving, and I’d rather leave predictions to professional gamblers, this is the week where I sift through this year’s events and try very hard to elicit personal feelings of gratitude. Since this is a health care blog, here are some health care related things I am very thankful for, and since like most social media aficionados, I too have a very short attention span, most are rather recent events.

First and foremost I would like to thank the Supreme Court of the United States for agreeing to hear arguments from the States, the Federal Government and small businesses backed by large businesses, on the Patient Protection and Affordable Care Act (PPACA) (a.k.a. Obamacare). Although having PPACA end up in front of the Supreme Court was a foregone conclusion since before the ink was dry on the President’s signature, and perhaps long before that, I am particularly grateful for the Supreme Court’s chosen timing for making a decision on this matter. The Court will hear arguments early in the spring of 2012, and if all goes according to plan it will either uphold or obliterate President Obama’s most important policy achievement just in time to inform my decision on who to vote for in the Presidential elections. It means a lot to me, and I am sure to many other conflicted voters, to have the advice of the wisest nine men and women in the land, and it is much more elegant and efficient to mentor us now instead of having to fix the issue after the elections take place.
Second, I would like to express my gratitude to Walmart who is finally volunteering to extend its unparalleled efficiencies in supply chain management to health care. Like most Americans, I have seen my health insurance premium go up by almost 20% recently and my deductible has too many zeros to fit in that little box on a standard check. It is reassuring to know that very soon Walmart will do for health care what it did for tee-shirts and accessories. Obviously, any organization that can put a plastic Luis Vuitton handbag in the hands of the humblest day laborer can surely be relied upon to bring PSA testing and chronic disease management to every hamlet and every housing project in the land. And even though I have no plans to start shopping at Walmart, particularly for health care, I am looking forward to the proven Walmart effect on prices of medical products and wages, which should make all health care, affordable for all of us.
On a more technical, and more work related note, I need to thank the FDA for unequivocally excluding Electronic Health Records (EHR) from its proposed regulation of mobile medical applications. The mobile health (mHealth) field is in its infancy and chock full of bright eyed and bushy tailed young entrepreneurs who can obviously benefit from FDA guidance just like their brethren in the perpetually sizzling bio-tech and device industry already do, with more innovation than any investor can handle percolating up all day every day. On the other hand, the frail and elderly EHR field, led by billion dollar technology and insurance companies, is in no position to withstand the rigors of FDA regulatory activities, which may inadvertently interfere with the massive life supporting cash infusion from government initiatives.
For a closely related effort, I am also grateful to the Institute of Medicine (IOM) for its recent report supporting the FDA position on EHR regulation. While acknowledging the inherent patient safety issues posed by use of EHR devices, the IOM is proposing a tangled web of voluntary and non-regulatory boards and organizations to be created for the purpose of observing and guiding EHR product use and development. The IOM does recognize that the system it proposes may very well fail to address the issue at hand, in which case it recommends that the FDA comes in to the rescue as a last resort. Hopefully by then EHR companies will have had every chance to absorb the Federal flow of cash to the industry in its entirety.
A few days ago we observed Veterans Day and we all expressed our heartfelt thanks for the sacrifices made by our men and women in the armed services. I would also like to thank Congress and its Super Committees for going above and beyond gratitude, and actively trying to provide our Veterans, even those who are too old, too depressed or otherwise incapacitated, with one more chance to serve our country. As we sink deeper and deeper in debt, there is a great opportunity for millions of heroes to forgo a little bit of health care services, or pay a bit more for each, so the greatest nation on earth can save a whopping $11 billion each year. Compared to putting oneself in harm’s way, this is easy stuff and while it is true that one large corporation, like GE for example, could single handedly create those savings just by paying their taxes for the year, it is much more meaningful that the glory should go to our Veterans. It is the right thing to do and I am so proud of our honorable members of Congress.
Finally, I would like to thank Congress one more time for perhaps the most extraordinary achievement in its history, and that is transforming pizza into a vegetable. Granted the Supreme Court of 1893 paved the way by declaring the tomato fruit to be a vegetable, but combining white flour and globs of animal fat into the texture of this new vegetable is nothing short of miraculous. Although Congress accomplished this in the context of ensuring that our children eat healthy food in school cafeterias, I am certain that many adults and most children will incorporate more of this wonderfully healthy vegetable in their diets outside of school lunch, and I for one, will try very hard to find a creative way to add this Congressional vegetable to our Thanksgiving table this year.

Now that I thanked all I could think of, and before I return to my bubbling cranberry sauce, I would like to ask for one little thing. Bypassing the Congressional middlemen, and going straight to the top, I would like to ask Hershey and Nestlé and all other multi-national decision makers, if it would be possible to make chocolate a vegetable too. Since cocoa beans grow on trees, chocolate is practically a fruit as it is, so making it a vegetable should be trivial in view of the various precedents quoted above, and it would mean so much to me and to countless other women and children trying hard to take personal responsibility for their own health and health care.
Happy Thanksgiving everybody!

Ten Qualities of Top Trial Presentation Professionals

2011-11-20T14:50:00.000-08:00

Dr. Conrad Murray, Michael Jackson Trial (see video below)

Back in the day, when I was the firm-wide in-house TrialConsultant for Brobeck, trial presentation software and technology wereactually quite similar to what we use today – at least with respect to the waythe exhibits are organized and presented in trial. Sure, computers and softwarehave come a long way, but the biggest difference is the fact that more lawyersare using it. So, what are a few of the key qualities that seem to be a commonthread among the nation’s leaders in trial presentation? I think you’ll findthat many of these are also the traits shared by successful litigators.

1. TrialExperience
There is a reason this profession is often referred to as the “hot-seat.” There is nowhere to turn, or nobody else toblame when (not if) something goeswrong, and only experience can help develop the knowledge of how toimmediately correct most any issue, and in such a manner than nobody else evenrealizes there was a problem.

2. Confidence
This comes naturally with actual trial experience, as noted in #1 above. Ifthere is a lack of experience, there will also be a lack of confidence.Typically, a lack of confidence is easy to spot, and often, the reasons forthis shortcoming become apparent in trial. A truly confident trial presentationprofessional will appear cool and calm, even when they’re under a great deal ofpressure.

3. Obsessiveness
In addition to trial experience, there is nothing like preparation to bringpeace of mind to the trial team. During trial prep and the trial itself, thereare no adequate excuses for not getting something ready in time. If this meansworking 16+ hour days, and not going to sleep until everything is ready for thenext day, then so be it.

4. Makes itLook Easy
Maybe you’ve seen at attorney working with a trial professional, and notedhow it appeared as if every step was rehearsed – almost as if they both knewexactly what to do, and when. On the other hand, perhaps you’ve witnessed (orbeen part of) of a trial presentation meltdown, where exhibits weren’t presentedin a timely manner, and frustration was apparent on the part of the attorneyand trial presenter – not to mention the Judge and jury. The best trialpresentation professionals are able to anticipate where the next callout orhighlight should be, and will just make it happen.

5. Above-averageWork Ethic
One thing I have learned in my years working with some truly greatattorneys is that you must be willing to work harder than opposing counsel.While hard work won’t turn a bad case into a good one and win, laziness can makeyou lose. Great attorneys are relentless. So are their trial teams. GerrySchwartzbach once told me quite simply, “We will out-work them.” David Boiesonce asked his weary trial team, “Do you want to sleep, or do you want to win?”

6. DataManagement Expert
One problem with those who find that trial presentation software isactually pretty easy to learn (at least the basics), is that it doesn’t makeyou a file management expert. Unless you are capable of organizing tens ofthousands of pages, you shouldn’t attempt to do so. One of the most commoncauses for problems in trial presentation is poor data management.

7. Computerand Software Expert
While nobody can know everything, an experienced trial presentationprofessional will be familiar with most programs used by law firms, including litigationsupport applications. They will also be able to assist with computer problems,spreadsheets, and graphics. They will certainly be intimately familiar withtheir trial presentation software, and will know how to make the most of allfeatures. Paralegal skills and experience can also be a plus.

8. Resources
One life-lesson I learned many years ago was that the smartest people arenot necessarily those who have all of the answers – but rather, those who knowwhere to find the answers. Whether that means knowing where and how to searchthe Internet, or having a list of fellow professionals handy, there shouldrarely be a situation that cannot be resolved. It can also mean finding a wayto get 3 copies of 20 exhibits scanned and printed at 2:00 AM.

9. IT Expert
One quality that is often overlooked is the ability to simply “make thingswork.” This can mean installing and wiring an entire courtroom, setting up theremote war room, or getting everyone connected to the network. When working outof town in a remote war room, chances are you didn’t bring along your ITdepartment with you. There is far more to this business than putting exhibits upon a screen.

10. Top Firms and Cases
Never hesitate to check the background of your provider. If you’ve neverheard of them, and/or if they don’t have an impressive list of clients and cases,chance are they don’t have the experience necessary to support your trial. Unless you’re willing to provide trainingwheels, don’t waste your time with someone who is just getting into thisbusiness.

Here’s an example of a total FAIL in the recent MichaelJackson trial of Dr. Conrad Murray, as described in #4 above, courtesy of ChrisBallard, of Video and the Law.

A Day in Trial

2011-11-15T09:51:00.000-08:00

There is an increasing interest in using trial presentationsoftware to help persuade jurors in litigation of all types. Once considered the domain of themega-firms with their billion-dollar clients, trial presentation technology hasnow trickled down to the point that it can be used in most any matter. Thedecision is no longer whether or not to use it, but how to get the most out ofit, while staying within the budget. There are a few common options.

You may want to have an attorney handle it. At first glance,this appears to be a perfect match. Another attorney billing on the case, andthey are already familiar with the exhibits and the case. From a client’sperspective, however, the billing rate is likely quite a bit higher than thatof a trial technician, but even more importantly, it takes a great deal of timeto manage the database, prepare exhibits and deposition clips, and present theevidence. If the assigned attorney has little else to do, it could work. Ifthere are other “normal” trial responsibilities, adding a menu of tasks thatrequire constant attention and maintenance may not be a good fit.

Another way to staff your trial presentation is to pull aparalegal and have them do it. However, as in the example above, chances areyou’ve already assigned a full day’s workload on your paralegals, and unlessyou’re able to relieve them of all of their other chores during trial, burnoutmay be on the near horizon. It is notrealistic to expect anyone to work two full-time jobs, and that is about whatit amounts to.

Other considerations are familiarity with the software,protocols, and the case itself. Trial presentation software is not unlike manyother specialized programs that unless you use them regularly, you are notreally comfortable or familiar with the features. In trial, you don’t have time to search the Help Menu for solutions,or call for support when you have a problem. It’s all on you, and if youcannot make it work in a matter of seconds, you may find yourself using the hardcopy exhibits.

Whether in-house oroutsourced, a full-time trial presentation technician or consultant isgenerally going to be the best option available. Someone whose solefunction is to ensure that every exhibit is accessible, and presented to thejury as needed. The more experience they have in this role, the better thingswill flow, and the trial presentation database should be their primaryfunction. All other tasks should take secondary roles, as it often requires14-16 hours per day or more during trial to keep everything rolling smoothly. Oncecounsel is finished preparing for the next day’s witnesses and retires for theevening, the trial tech goes to work, getting all exhibits and testimony readyto go, backing up the database, and adding new documents. They will also befamiliar with the courtroom presentation equipment, and how to deal with theCourt staff.

Although it may seemcounter-intuitive to bring in someone who isn’t already familiar with yourcase, this can actually be one of the greatest assets of a consultant. Itis true that they don’t know the case, or how you view things. Neither willyour jurors, and if you have someone willing to share an objective “outsider’s”perspective, that’s the closest you can get to the mind of your jurors. Don’texpect (or ask) them to see it your way, and don’t attempt to convince them. Youdon’t need another pat on the back or a “yes-man.” Just ask for their feedback,and take advantage of any insight they have to offer.

Target & Heart of America Transform the Hennigan School Library

2011-11-13T13:00:00.000-08:00

On November 2nd, the Hennigan School unveiled a new library, thanks to the phenomenal partnership of Target and Heart of America, a non-profit literacy-focused foundation. For the third year in a row, Target and Heart of America have selected a Boston school to make over as part of Target's School Library Makeover Program. Complete with 2,000 new books, a state-of-the-art technology center, and eco-friendly design elements, the new library is bright and inspirational, just like the Hennigan Students. At the unveiling, students also took seven books for their home libraries.

Target incorporated its Meals for Minds program as part of this year's makeover, partnering with the Greater Boston Food Bank to establish a monthly food pantry site at the school's community center. The pantry will provide fresh fruits and vegetables, among other healthy food choices, to Hennigan families.

For more on the library makeover, as well as photos, visit The Boston Globe article at: http://www.boston.com/yourtown/boston/jamaicaplain/gallery/new_hennigan_school_library/

BPS Technology & Special Education Offices Launch iPad Collaboration to Support Students with Autism

2011-11-13T12:09:00.000-08:00

OIIT is partnering with the Office of Special Education and Student Services on an iPad project for special education teachers and strand specialists within the Highly Specialized Strands for students with autism. The use of iPads as an instructional support is proving to be instrumental in teaching students challenged with autism.

Approximately 60 teachers in 15 schools will began the project this past week with a two-hour training which will include basic operations and settings, overview of apps, use of a blog and wiki and BPS Connect devoted to this project, and small group discussion on how to use the iPad and applications in the classroom.

Each participating teacher will receive a 16 GB iPad 2 with wifi, which will be preloaded with over thirty applications, for student use in their classrooms. Applications will include basic Augmentative and Alternative Communication apps, speech-to-text apps, and literacy and numeracy activities.

For more information on iTouch technologies & OIIT’s app recommendations, visit our iTouch Technology Resources site.

The IOM Report on Health IT Safety

2011-11-09T10:48:00.000-08:00

A recent report from the Institute of Medicine (IOM), “Health IT and Patient Safety: Building Safer Systems for Better Care”, introduces a new health care related term, "Health IT-assisted care", defined as "health care and services that incorporate and take advantage of health information technologies and health information exchange for the purpose of improving the processes and outcomes of health care services. Health IT–assisted care includes care supported by and involving EHRs, clinical decision support, computerized provider order entry, health information exchange, patient engagement technologies, and other health information technology used in clinical care”. And the IOM report, as its title implies, is recommending strategies to ensure that health IT-assisted care is safe for patients.

The IOM report presents a comprehensive literature review regarding the status of health IT as it pertains to patient safety from every conceivable angle, starting with the manufacturing process and drilling down into product selection, implementation processes, training, and actual use of EHRs and other health IT products. As most folks who follow the health IT industry know all too well, the report concludes that data concerning the effects of health IT on patient safety is currently scarce and inconclusive. Nevertheless, the scarcity of data and the “sparse evidence pertaining to the volume and types of patient safety risks related to health IT” did not prevent the committee from acquiring “the sense that potentially harmful situations and adverse events caused by IT were often not recognized and, even when they were recognized, usually not reported”. That maybe so and again it may be that what we see is all there is to see. Either way, “[t]he committee believes the current state of safety and health IT is not acceptable; specificactions[sic] are required to improve the safety of health IT”. To that end, the report presents 10 recommendations to the Secretary of Health and Human Services (HHS).

HHS should create and publish an action plan in the next 12 months to assess the risk of health IT for patient safety and begin mitigation through education, research, standardization and the testing and accreditation of health IT products. Suggested organizations for funding and carrying out these activities are ONC, AHRQ and NLM.
HHS should insure that health IT vendors freely exchange information regarding issues as they pertain to patient safety. This is where the infamous gag clauses in EHR contracts should be addressed.
ONC should work with public and private sectors to make user reports of patient safety issues publicly available. NCQA and JCAHO are amongst the suggested implementers.
HHS should fund the creation of a new Health IT Safety Council to evaluate criteria for measuring safety of health IT.
ONC should require all health IT vendors to publicly register with the agency.
HHS should define mandatory quality management processes for health IT vendors. ONC, FDA and certification bodies are suggested organizations for administering a compliance process.
HHS should establish a mechanism for reporting adverse events which is mandatory for vendors and voluntary for users. Reports should be collected analyzed and acted upon.
Congress should create an independent federal entity, similar to the National Transportation Safety Board (NTSB), to investigate the reports collected in item 7 above.
HHS should monitor progress and if found lacking, should direct the FDA to exercise its full authority to regulate health IT. The FDA should immediately begin preparing the infrastructure for this eventuality.
HHS should support cross disciplinary research of safety aspects of health IT, such as user centered design, safe implementation methods, sociotechnical systems, and effects of policy decisions on health IT.

This is a very impressive and very well-reasoned list of tactical and strategic initiatives, but it also presents some difficulties. First, reporting adverse events is a prerequisite to almost all activities recommended by the committee. It is not clear how such reporting is to be implemented when malpractice suits are a consideration. The report suggests that reports should be kept private, even anonymised, and that users should be protected from punitive actions. Does this protection extend to legal action? If the report-collection agency becomes aware that a patient died due to preventable error, should the patient’s family be notified? Should malpractice attorneys be allowed to review this public information and subpoena the identifiable data? Second, all ten recommendations made by IOM require significant funding and it is not clear where the monies should come from at the moment. The recommendation in item 9 above, that the FDA readies itself for full regulation of health IT as a contingency plan if all else fails, seems duplicative and particularly wasteful. Somehow the committee seems to believe that FDA regulation, unlike regulation by multiple disjointed organizations, would negatively affect anticipated innovation in health IT.

Speaking of the FDA, the immediate question, of course, is why do we need a 137 page report from the IOM to figure out how and who should oversee patient safety? The Food and Drug Administration (FDA) is currently overseeing patient safety issues arising from surgery-assisted care, radiology-assisted care, pharmaceutical-assisted care, implantable device-assisted care and all sorts of other types of assisted care. Most recently the FDA published its proposal to oversee mobile device-assisted care (phones, tablets and laptops). How and why is health IT-assisted care different? How is a medication dosing calculator on an iPhone different than the same calculator in an EHR? How is an iPhone connected to a blood pressure cuff different than an EHR connected to a blood pressure cuff?

To my immeasurable delight, the IOM report contains the answer in the Dissent Statement of Dr. Richard Cook. While the IOM report is recommending that health IT be regulated and monitored by a smorgasbord of existing or yet to be created organizations, none of which have the required expertise to tackle the task, and all of which will need to be heavily funded for this endeavor, with the FDA as a last resort measure, Dr. Cook proposes to allow the FDA to do its job in the first place. Dr. Cook’s simple and straightforward recommendation is to have HHS “direct the FDA to exercise its authority to regulate health IT, including all EHRs and associated components, and health information exchanges, as Class III medical devices”. While possessing all salient characteristics of a Class III device, “health IT is on track to be a medical device used for every person in the United States” [italics in the original], which makes it both urgent and imperative to have health IT regulated and monitored properly and Dr. Cook's conclusion succinctly sums it all up: "health IT is a medical device. It should be regulated as a medical device now and should have been regulated as a medical device in the past".

Ten Questions to Ask Your “Hot Seat” Provider

2011-11-07T07:59:00.000-08:00

First, I’ll define the term “Hot Seat.” In litigation, thisis used to describe the role of the trial presentation technician or consultant– the one responsible for managing and presenting the evidence to Judge andJury. Any delay in presenting the requested exhibit can seem like an eternity. One miscue on their part, such as bringingup the wrong exhibit, can immediately result in a mistrial – hence the term, “hotseat.”

1. How much will it cost?

Make sure to get the “real numbers” in any estimates you receive, and see ifthere are hidden extras, such as overtime, travel, equipment, weekend orholiday charges, project management fees, etc.

2. How much do you personally make?

Cost does not always equal value, and hourly rates do not necessarily indicatethe level of competency of the individual actually providing the services. Thismay be a very personal question, but if the hourly rate is $250, and yourhot-seat tech is making $25 of that, there’s a problem.

3. How many actual court trials have you personallyhandled the “hot seat” in?

This should be a realistic number, and is not the same question as, “How manycases have you worked on in any capacity?”

4. Have you ever been involved in a trial similarto this?

Your “hot seat” person will be comfortable, and thus more effective, infamiliar surroundings. Although it would be unrealistic to expect experiencewith the exact case type, things like the size and value of the matter, venuetype, data formats, and general type of litigation are all helpful qualities.

5. What extra value do you have to offer the trialteam?

In some cases, the answer may be zero, and that is fine. In others, similarcase experience, case feedback, jury monitoring, or other extras may help makethe decision whether or not to hire.

6. May I see your bio?

Don’t expect to see a résumé, as you’re not hiring an employee. However, youhave every right to request a bio of the person(s) who will be assigned to yourcase. Make sure you’re getting what you pay for.

7. How long have you been doing this type of work?

A few years can be a reasonable amount of time to master most of this. Unless you’re knowingly hiring a trainee(can you spell m-a-l-p-r-a-c-t-i-c-e?), make sure they’re not learning on yourdime, and at the expense of your case.

8. Can you assist with Opening Statement andClosing Arguments?

Depending on the case, it can often be helpful to have another set of eyes lookingat things, and offering ideas on how to tell the story visually. This may ormay not be something you need or are willing to pay for in your case.

9. Are you capable of producing on-site graphics?

Any hot-seat technician should be able to make at least minor changes on thefly as needed. There’s simply not always time to engage the “graphics team,” regardlessof wherever they may be located.

10. What sets you apart from your competitors?

This can apply both to the company, and the individual(s) assigned. However, hiringa well-known company does not necessarily mean that the person they will assignis the best for you. Make sure it’s a good fit from top to bottom.

EHR Adoption is Like Treating Cancer

2011-10-30T21:34:00.000-07:00

EHRs are not ready for prime time. EHR benefits are questionable and there are documented instances where patients’ deaths were directly attributed to an EHR. EHRs are cumbersome and slow. They are unnecessarily complex and built on very old technology. The people who build EHRs have no concern for the end user and therefore EHR usability is pretty abysmal. And EHRs are expensive to buy and expensive to maintain, not to mention that they can completely derail your practice through loss of productivity. The fact that some users seem to do well with their EHRs, and even derive some joy from using them, is not a valid counter argument since most users are not so fortunate and through no fault of their own. There really is no excuse for such failure in this day and age. Just look at the iPad and the iPhone. You can walk into any Apple store and 5 minutes later walk out with a fully functional product with a delightful, intuitive interface, loaded with hundreds of interchangeable apps that even a three year old can use right out of the box. All for a few hundred bucks.

If you happen to be diagnosed with cancer, you will most likely be subjected to years of unpleasant treatments. You will be injected with poison and irradiated with more poison. You will lose your hair, suffer bouts of vomiting and diarrhea and be physically debilitated to the point where you cannot leave your bed. You will most likely have to go through painful surgeries, take all sorts of medications that were shown to kill thousands of rodents and never recover your old self again. And this entire ordeal will cost you a medium size fortune. The fact that some lucky patients go on to win the Tour de France is not really an acceptable rebuttal. Most do not. And there really is no excuse for such incompetence in this day and age when one little pill can cure you of an yeast infection in 24 hours and a $4 course of antibiotics will render you as good as new if you happen to develop a sinus infection. Not to mention the innumerable vaccines that will miraculously prevent you from contracting the plague.

Yes, this is a farfetched analogy, but replacing paper charts with an EHR is not like playing Angry Birds, and if you want a fair chance at survival, you have to tolerate the side effects imposed by the current state of technology. Just like you cannot postpone your cancer treatment until the doctor from Star Trek figures it all out, you cannot postpone transition to EHR until EHRs are “ready for prime time”. And make no mistake, in today’s reality, paper charts are as big a threat to the survival of an independent medical practice, as any garden variety cancer is to a human body. Paper charts will gradually and irreversibly deprive your practice from the nutrients and oxygen needed for survival, i.e. reimbursement, until it shrivels and dies, or it gets absorbed into a larger organism. The common wisdom seems to favor these outcomes. I do not. If you are one of the fewer and fewer physicians who has no desire to either shrivel or practice Wal-Mart medicine, here is one way to think about your current EHR predicament. [Note: Considering the gravity of the situation, you would be well advised to seek a second opinion.]

Diagnosis – Look around you. EHRs are slowly gaining ground. You would be hard pressed to find a medical group of significant size that does not have one. Data collection is not as voluntary as it is being portrayed, unless of course you think that you are overpaid and can easily absorb cuts in reimbursement. You can choose to make believe that this too shall pass and once Obama is no longer calling the White House home, all will be as it was. Alas, computerization of medical records has bipartisan support, and it always did, due to a rare alignment of powerful financial interests and progressive ideology. If you want to continue the practice of medicine, you will need to use the tools of the trade. For better or worse, both the trade and its tools are being redefined. Barring a global disaster, the chances of spontaneous remission are nil.

Staging – How bad is it doc? Well, it won’t kill you tomorrow, but the longer you wait, the harder and more expensive it will become, the fewer the choices and the lower the chances of a good outcome. Both public and private payers are experimenting with new reimbursement methods. These pilots, or projects, are cropping up everywhere, supported by grants and all sorts of tax payer monies. The goals may be different and the rules of engagement are certainly different, but these arrangements have one thing in common. They all prefer that you generate and consume large amounts of clinical data in electronic format. You will need an EHR for that.

Treatment – A physician-centered approach to the problem suggests that you should be informed of your options and allowed to make a decision based on your personal and cultural preferences. Since medical practices are not people, you may choose to euthanize your practice. This may make perfect sense if your practice had a long and productive life and your medical career is in its twilight years anyway. A less terminal option would be to allow your practice to be hooked up to the machinery available in large health systems. You will still have to use an EHR, but your new employer will undertake the mitigation of most side effects. There is a slim chance that someday you may be able to remove the tubes and resume private practice, but while your medical career can survive indefinitely, your practice as you know it now is not likely to recover. Or you could make a stand and fight for your independence.

Prognosis – By definition there could be no blinded trials for EHR utilization, and by omission there are no randomized control trial results to learn from. The anecdotal evidence suggests that many thousands of physicians in independent practice are surviving just fine after EHR implementation. Some would say that they are doing better than ever now, and others have resigned to the new ways of doing business. For most, the life threatening problem has been transformed into a manageable chronic condition. It must be noted however, that a significant number of physicians is currently in need of life-support from health systems and hospitals, and many of these are post EHR implementation. We cannot be certain, since there is almost no literature on the subject, but it is highly probable that practices suffering from a relapse have had multiple comorbidities to start with and/or developed other life threatening conditions since. There are no guarantees of course, but if you have an otherwise healthy practice, a positive outlook and a supportive environment, chances are good that transition to EHR now will enable your independent practice to survive and thrive for many years to come. And the opposite is also true.

New Student Information System Focuses on Using Data to Improve Instruction

2011-10-30T07:58:00.000-07:00

On October 31st, teachers in all BPS schools will begin entering attendance online in Aspen, our new Student Information System. Over the next twelve months, additional modules will be rolled out as we provide training and support to ensure that schools are poised to leverage the power of this exciting technology to strengthen instruction and accelerate student learning.

Strengthening teaching and school leadership, a key strategy of our Acceleration Agenda, calls for providing schools with timely information to enable them to measure student progress on an ongoing basis and respond with appropriate interventions. The launch of our new student information system ushers in the district's renewed focus on using data to inform instruction in every school, for every student.

Our new SIS is a web-based solution that integrates many critical tools within one cohesive portal. The SIS will allow BPS teachers and staff to report on and access the most up-to-date information about the students in front of them, including student attendance, grades, behavior, assessment and demographic information. And next school year, families and students will be able to log in to monitor progress and communicate with principals and teachers.

As the needs of Boston's students evolve, so too must our strategies and systems to meet them. From the classroom to the district office, data need to be collected, analyzed, and used for consistent and intentional inquiry to inform our collective practice of ensuring that all students are ready for college and career success. Our new student information system is a milestone for our focused effort on using data to transform education.

To log on to the SIS, go to: http://sis.mybps.org. For questions and support, please contact our Office of Instructional & Information Technology (OIIT) at 617-635-9200.

Media Literacy Conference Saturday!

2011-10-21T18:30:00.000-07:00

Media Literacy Conference, a Focus on Youth

Saturday, October 22, 8am-4pm, MIT

HOME, Inc., in partnership with MIT & Barr Foundation, invites educational decision makers, curriculum developers, after-school program coordinators, superintendents, instructors and community leaders are all welcome to attend and participate in relevant panel discussions and breakout sessions. The conference is the fourth to be held on a biennial schedule and will feature today’s most topical 21st Century educational challenges.

The conference will feature leaders in the field including Arnie Packer, the father of 21st Century skills and project based learning; and other prominent educators, filmmakers, public health workers and representatives from organizations dedicated to developing programs that promote and generate awareness and a deeper understanding of media literacy.

The keynote address will be delivered by Scot Osterweil, Creative Director of the MIT Education Arcade and a research director in the MIT Comparative Media Studies Program. He is a designer of award-winning educational games, working in both academic and commercial environments, and his work has focused on what is authentically playful in challenging academic subjects.

To learn more, visit: http://www.prweb.com/releases/mlc/2011/prweb8809383.htm

To register: http://www.mlc2011.ezregister.com

Code-a-thon Saturday: Help Make Boston Better

2011-10-21T18:23:00.000-07:00

Looking for something to do tomorrow? Check out the Boston New Urban Mechanics/CfA Code-a-thon.

Boston is one of the most livable cities in the United States. People come from all over the world to experience Boston’s walkable neighborhoods and lively local culture. However, Mayor Thomas M. Menino knows that there is still much that should be done to innovate in how we deliver services and provide information to the public about the City.

To this end, the Mayor Menino’s innovation team, the Office of New Urban Mechanics, is partnering with Code for America to host a code-a-thon that encourages hackers and makers of all types to come together to build tools, visualizations, and apps that enable more people to experience more of the City. Come help us build Boston.

The Challenge for the day will be to create tools that enable people from a wide variety of backgrounds in terms of ethnicity, physical ability, age, etc to access the diverse opportunities that the City affords.

When: October 22, 2011, 9am - 9pm
Where: Boston University, School of Management, 4th floor, Room 424

To register, visit: http://buildingboston.eventbrite.com/

Read what CfA is saying: Code-a-thon Saturday: Help Make Boston Better | Code for America

EHR Bargains Review – Practice Fusion

2011-10-16T18:50:00.000-07:00

(Survival Tips for Small Practices)

If you subscribe to Prof. Clayton Christensen’s theories of innovation, Practice Fusion is to the EHR industry what Southwest Airlines was to the air travel industry, ad extremis, with no thrills, no frills and no peanuts. Practice Fusion is completely and truly free to users, and it will take you from point A to point B in a straight and short line, with point A being paper charts and point B being a Meaningful Use incentive check.

The Model

Practice Fusion is a web-based EHR and it is free to use no matter who you are. The company website has a self-provisioning button where any visitor can sign up for a free account and immediately start using the software. All you need is a valid email address. The company prides itself in taking users live on the EHR in 5 minutes. It actually takes much less than 5 minutes to get to a point where you can begin charting, but it takes a week or more to hook up to electronic prescribing and lab interfaces, and this is very much in line with industry practice. Practice Fusion offers free connectivity to national reference labs and a handful of regional ones as well. Just like there are no charges for electronic prescribing, there are no interface fees for the currently available lab connections and no mention of “custom” interfaces built for a fee. You get only what you see.

Since we all know that there is no free lunch, how is it possible to get a free EHR, including significant interoperability? The standard answer to this is that Practice Fusion is ad supported. Just like you get free email services from Google in return for agreeing to see ads on every email page, when you sign up for Practice Fusion, you are agreeing to see ads on every EHR page. To my pleasant surprise, the ads are mostly limited to about one inch of space at the bottom of the screen, and are not at all intrusive in the workflow. I actually don’t quite see how these ads support anything, since with the exception of one Dell advertisement they all seem to be Practice Fusion self-promotions. Furthermore, the fairly new Patient Fusion portal displays no ads at all. Similar to most other EHRs, the Practice Fusion end user agreement reserves the right for the vendor to aggregate and monetize EHR data, and perhaps this is a possible explanation for this free lunch.

Functionality

The best description for Practice Fusion’s functionality is bare-bones. There is no fluff, no bells and no whistles to be found in the very simple, very clean user interface. After muddling through a variety of top-shelf EHRs with double and triple menu-bars and icon studded task-bars on every page, the Spartan look & feel of Practice Fusion is quite refreshing. Although there are multiple training aids in the system, if you are an average computer user (e.g. email, Word), you should not need much coaching to become productive at very short notice. This of course eliminates another hefty expense associated with EHR adoption: training.

Whatever free-form stuff you are now doing on paper, you can do in Practice Fusion, pretty much the same way. It comes with a simple set of SOAP templates consisting mostly of questions where you get to type in the free text response. You can also type directly into the note and probably use Dragon as well. You can create your own sets of questions, or add to existing ones. You can order meds, labs and imaging and print those, or send electronically if connected. Scanned documents can be uploaded to any particular chart. There is no clinical content available for decision support, at this time. Registry functions are in their infancy and the handful of available reports is very simplistic. Disappointingly, the Meaningful Use report does not automatically calculate numerators and denominators for core and menu items, but clinical quality reporting is automated. There is very little customization possible and none is required.

For patients, there is Patient Fusion, a simple web-based portal that allows patients to see appointments, meds, allergies, immunizations and labs. It also provides some links to medical content on the web. It seems that the portal is very much a work in progress, but just like the EHR, its user interface is clean, simple and appealing. Unlike the EHR, which is Flash based and therefore unavailable for use on Apple mobile devices, the portal is accessible from an iPhone or an iPad. Practice Fusion did announce recently that a native version of its EHR for the iPhone is due to be released soon.

Viability

Practice Fusion is privately owned and has been around since 2005, but started taking off in earnest around 2009. Its recent growth coincides with the HITECH act and the advent of Meaningful Use. Although it is possible that it will follow a trajectory similar to Southwest Airlines and blossom into a major EHR vendor, it is also possible that it would make a rather attractive acquisition target for one of the much bigger fish circling health care IT right now. Will it remain free to end users? There seems to be no current intent to charge customers for software usage, but Practice Fusion received over $36 million in venture capital, which usually comes with expectations of short term spectacular returns. Time will tell.

Bottom Line

Practice Fusion is currently certified for Meaningful use as a Complete EHR, which means that you don’t have to buy additional software in order to achieve Meaningful Use requirements. As is the case with all web-based EHRs, you will have to buy desktop (or mobile) hardware, internet services and networking hardware. You will still need to pay for a Practice Management system and billing, and unless you choose to utilize the sole Practice Fusion partner for these activities, you will need to budget staff time for double data entry. You will not need to pay for the EHR, its server and its maintenance. If you are interested in Meaningful Use incentives, and if you practice in a small group, and if the cost of EHR seems prohibitive (or a waste of good money), and if you have no use for bdlls and whistles above and beyond a paper chart, then by all means, go ahead and try it out. It’s free.

Occupy Health Care

2011-10-14T12:36:00.000-07:00

Earlier this year, in the midst of the civil unrest in Egypt, Michael Millenson pondered about the passive attitude of those lacking health care insurance and their failure to organize and “take to the streets”. Well, unless you are living under a rock, or are really busy seeing patients, you know that we have quite a few people “taking to the streets” nowadays. They call themselves the 99% and they are set to Occupy Wall Street along with a bunch of other cities across the country. They have been called everything from “the rise of a popular movement” to “anti-American”. Are these Michael Millenson’s uninsured finally standing up for themselves? Judging from the stories they write on the placards covering their faces, which look eerily similar to what you see at busy urban intersections (e.g. “Lost home and job, will work for food”), lack of health insurance is often cited as a source of misery, but so are student loans, lost savings and inability to find work. Although this peaceful movement of folks camping out in parks and marching down streets has no coherent message, their grievances are casting a large net directed at the destructive influence of Wall Street, big corporations and consumerism in general. Michael Millenson should be satisfied, since health care is most definitely included in this all-encompassing indictment of an unjust society, and here is why.

But first a little detour into terminology. The word “care” originates from the Old English caru, cearu "sorrow, anxidty, grief," also "serious mental attention" for the noun, and carian, cearian "be anxious, grieve; to feel concern or interest" for the verb. When it comes to one’s health, with the exception of patients, their loved ones and increasingly fewer and fewer doctors, nobody in the medical complex experiences any feelings of anxiety, grief or even true interest or concern for the sick, although they may experience all of the above for the cash flow associated with treating sick people. The term health care is an anachronism from a bygone era and it needs to be changed. Health Services seems a much better fit with the prevailing consumer philosophy, which brings us to the next point.

Ever so gradually and insidiously, the term consumer is replacing the term patient in health services contexts, just like it replaced the term people in larger contexts. The etymology for the word consumer dates back to the early 15th century as "one who squanders or wastes", and in economic sense, "one who uses up goods or articles (opposite of producer) from 1745”. Interestingly enough those who presumably advocate for poor and vulnerable populations and even our own government are enthusiastically standing up for their constituencies of squanderers and wasters. Sometimes terminology describes existing realities and sometimes carefully chosen terminology shapes reality. We are witnessing the latter. The big corporations being targeted by those who Occupy Wall Street, have a long, and productive, history of manipulating the 99% into using up as many goods and articles as possible, and then some (i.e. debt), while extracting both profit and power from an increasingly impoverished society. Squandering and wasting is the secret sauce for a consumerist world order, and the medical complex is no different. According to Forbes, in the midst of a recession, CEO pay has increased in 2011 by 28% compared to 2010. The highest paid CEO in America, at $131 million per year (twice as much as the second CEO on the list), is running a health services company. Makes perfect sense. After all health services are quickly approaching 20% of a successful wasting and squandering economy. $131 million is peanuts by comparison.

But here the big corporations are encountering a big problem. The U.S. government, that is supporting a large portion of the waste and squander in the health services sector, is running out of money, and the squanderers themselves seem unwilling to waste their own money on health services. They much rather debt finance homes, cars and iPhones than, say, colonoscopies and designer drugs. The solution to this quandary is a brilliant one-two punch. First we use the bought and paid for government to educate consumers that in a world of finite resources, after skimming the $131 million type “compensations” from the top, only those who have their own resources (i.e. cash) should expect to continue wasting and squandering health services. Second, to compensate for lost revenue from government’s support of health services consumption, we employ two, time tested, strategies. We convert non-consumers to consumers by giving them free small things to lure them into buying more expensive items. For example, we give out free cholesterol screenings so we can create a recurring revenue stream from statins and hopefully more expensive interventions down the road. After all there is a huge untapped market of 50% of Americans who barely use any health services. Then we increase the prices of everything from health insurance to direct services, by eliminate those obnoxious small businesses floundering in this space and fragmenting our ability to negotiate higher prices. The government is of course expected to help with the necessary laws and regulations, and so far, keep your fingers crossed, it’s going rather well. With a little bit of luck, smart consumers will soon realize that it is in their best interest to spend money they don’t have on the medical complex rather than the real estate market, which has gotten more than its share already, or the high tech gadget market which is booming, or the automotive market which is dead anyway (except for Audi who is selling cars for a crumbling infrastructure littered with trash). It’s all about reallocating extortion revenue and nobody is in a better position to do that than the medical complex. Brilliant indeed.

As the ancient prophet said “What has been will be again, what has been done will be done again; there is nothing new under the sun” [Ecclesiastes 1:9], all of the above has been tried before, in this case by the legendary Mullah Nasreddin, and we know how it ends:

One winter Nasreddin had very little money. His crops had been very bad that year, and he had to live very cheaply. He gave his donkey less food, and when after two days the donkey looked just the same, he said to himself, "The donkey was used to eating a lot. Now he is quickly getting used to eating less; and soon he will get used to living on almost nothing."
Each day Nasreddin gave the donkey a little less food, until it was hardly eating anything. Then one day, when the donkey was going to market with a loan[sic] of wood on its back, it suddenly died. "How unlucky I am," said Nasreddin. "Just when my donkey had got used to eating hardly anything, it came to the end of its days in this world."

To the 99% of us donkeys out there: Occupy Health Care Now!

October Proclaimed National Cybersecurity Awareness Month

2011-10-13T08:10:00.000-07:00

Recently, PresidentBarack Obama issued a proclamationthat October is National Cybersecurity Awareness month, calling our digital infrastructure“a strategic national asset” and its security “our shared responsibility”. Thisis a great opportunity to integrate cybersafety skills with your students andfamilies. Cybersecurity is an important topic to teach to our students andfamilies who live in a digital world where so much of their personal data andfinancial information is online. It is imperative that everyone learnstrategies to stay safe online and keep their personal data safe. Inconjunction with President Obama’s proclamation, the Federal Trade Commissionlaunched a redesigned cybersafety website called OnGuardOnline.gov. StaySafe Online is also promotingOctober as CyberSecurity awareness month and contains numerous resourcesfor the classroom andthe home. The site alsocontains a section of handytip sheets in pdf format that can be printed out and given to your studentsand their families.

Whether the topic is cyberbullying,cybersecurity, or online personal safety, any information you can share withyour students and families is important. Don’t forget to check out the BostonPublic School’s CyberSafety website,which also contains many helpful classroom resources and downloads.

The Rise of Big Data

2011-10-09T16:20:00.000-07:00

Health care is in the process of getting itself computerized. Fashionably late to the party, health care is making a big entrance into the information age, because health care is well positioned to become a big player in the ongoing Big Data game. In case you haven’t noticed computerized health care, which used to be the realm of obscure and mostly small companies, is now attracting interest from household names such as IBM, Google, AT&T, Verizon and Microsoft, just to name a few. The amount and quality of Big Data that health care can bring to the table is tremendous and it complements the business activities of many large technology players. We all know about paper charts currently being transformed via electronic medical records to computerized data, but what exactly is Big Data? Is it lots and lots of data? Yes, but that’s not all it is.

Americans live for approximately 78 years. They see a doctor about 4 times per year and spend on average 0.6 days each year in a hospital. To keep a life time record of blood pressure readings for all Americans, including metadata (date/time of reading, who recorded the measure and where, etc.) takes approximately 6 TB (terabytes) of storage space, or about 12 laptops with standard 600 GB hard drives. Not too big. What if we start using mobile wearable devices to quantify ourselves, as some folks already do, and we record blood pressure, say, every hour? We will require 1460 TB of storage, or almost 3000 laptops, or the equivalent of 6 times the digitized contents of the Library of Congress, and this is for blood pressure monitoring only. Adding in the remaining 99.9% of the medical record, including large imaging files, hospital monitoring devices, pharmacy data, insurer data, telehealth sessions and other personal health sensors, and keeping in mind that all these data are meant to be exchanged freely over the Internet, we are approaching a data tsunami of biblical proportions. And we are not done just yet. Once health care’s Big Data is released into the mainstream Internet, it will initiate secondary and tertiary waves of new data created by consumers addressing their newly found health care data on social media venues, specialty forums, blogs and commercial sites offering services for health data. Big Data is the fluid combination of the ever increasing real-time data streams created by everything from government to businesses to Facebook, Twitter, Geo-locators, mobile devices and connected sensors everywhere. Big Data is as much about size as it is about cross pollination of data from disparate sources.

A fascinating June 2011, McKinsey report predicts that Big Data is the “next frontier for innovation, competition, and productivity” and that Big Data will become equal to labor and capital in its importance to production. For U.S. health care, the report is predicting $300 billion per year in savings due to utilization of Big Data to drive the execution of strategies proposed by health care experts. In the area of clinical operations, the report lists projected savings from Comparative Effectiveness Research (CER) when tied to insurance coverage, Clinical Decision Support (CDS) savings derived from delegating work to lower paid resources and from reductions in adverse events, transparency for consumers in the form of quality reports for physicians and hospitals, home monitoring devices including pills that report back when they are ingested, and profiling patients for managed care interventions. Administrative savings are projected from automated systems to detect and reduce fraud and from shifting to outcomes based reimbursement for providers and, interestingly, for drug manufacturers through collective bargaining by insurers. Most savings listed under research and development opportunities from Big Data seem to accrue to pharmaceutical and device manufacturers. There is nothing to suggest that Big Data will somehow reduce unit prices of products or services.

To be honest, I don’t quite understand where the $300 billion in savings come from as there are no actual itemized numbers to support this prediction. In addition to stated reliance on individual studies and expert interviews, there are many structural assumptions regarding massive provider consolidation, proliferation of Accountable Care Organizations, technology adoption rates of 90% across the industry and data sharing amongst all stakeholders, at which point Big Data will come in and do its thing. The costs for generating, storing and analyzing Big Data which include emerging data storage technologies and analytical expertise are factored in, with the costs of national deployment of EHRs alone “estimated at around $20 billion a year, after initial deployment (estimated at up to $200 billion)”.

Most people, including doctors, will probably agree that pertinent data, big or small, can be transformed into pertinent information, and pertinent information is vital to good decision making. But is Big Data pertinent? Are all those petabytes of minute details about everything and everybody really useful, or are we just mixing a little wheat with a lot of chaff? There are various opinions on this, but the prevailing wisdom seems to be that the more data you have, the more likely you are to be able to extract something useful out of it. By observing patterns and correlations in this ocean of information you may discover answers to questions you wouldn’t have known to ask in the first place. There is much power in Big Data, but there is also danger. As big as Big Data may be, it does not guarantee that it is complete or accurate, which may lead to equally incomplete and inaccurate observations. Big Data is not available to all and is not created by all in equal amounts, which may lead to undue power for Big Data holders and misrepresentation of interests for those who do not generate enough Big Data. Collection and analysis of Big Data has obvious implications to privacy and human rights. But the biggest danger of all, in my opinion, is the forthcoming relaxations in the rigors of accepted scientific methods, and none seems bigger than the temptation to infer causality from correlation.

We’ve been there before. When humanity dwelt in caves and villages, correlation was enough to establish causality. We’ve come a long way since, but the global village we are creating today seems tempted to go back to observation as the main way of gaining understanding. Just like the historic villagers, we are now convinced that we can see everything there is to be seen; therefore the answers to all our questions must be found in the Big Data mirror we placed in front of us. All we have to do is stare at it long enough and the patterns will emerge. The sheer size and variety of Big Data will make it much easier to reject the null hypothesis and see patterns where none exist. On the other hand, if we keep staring at our digital selves in the eye for long enough, perhaps we will achieve the most coveted observation of all: a glimpse through the windows to our digitized soul.

Who Should Pay for EHRs?

2011-10-02T11:58:00.000-07:00

During the 2008 Presidential campaign, Candidate Obama promised an EHR for every American by 2014. The goal was to improve quality of care, reduce disparities and contain costs of health care. When the HITECH act became law in 2009, physicians found themselves under increased pressure to purchase an EHR. Many took action, went out and bought an EHR for their practice, and these are now well positioned to collect the financial incentives put forward by the HITECH act. Many more did not. EHRs are by and large a complex and expensive proposition and the HITECH incentives are not covering the average cost of purchasing and maintaining an EHR. In survey after survey, physicians consistently rank cost associated with EHRs as their top concern when considering transition from paper charts to electronic medical records. This is a bit disconcerting, since physicians have no problem buying other expensive tools and paying for human resources in their practices. How are EHRs any different?

Non physicians usually attribute this reluctance to computerize medical records to technophobia or a perverse need to keep patients uninformed in order to maintain power and perhaps even financial advantages. Physicians on the other hand, mostly argue that EHRs do not benefit them directly and therefore they should not be expected to use them, let alone pay for them. Since there is no evidence of physician technophobia in any other areas of medicine (or private life) and since there is no measurable benefit to doctors in keeping their patients in a subservient position, the question then becomes: who is benefiting from EHRs?

There are three primary stakeholders in health care: those who receive care, those who provide care and those who manage the financial aspects of health care, and no, we are not getting into the quintessential argument of whether there should be only two primary stakeholders. There are several secondary stakeholders as well: those who manufacture medical goods, those who provide ancillary services and those engaged in medical research.

Historically, an EHR has been defined as a software tool, used by health care providers to collect, analyze, display and exchange clinical information with others. The content collected in an EHR was exclusively generated by health care providers or by traditional ancillary service providers (e.g. labs, imaging, etc.). There is however a new type of ancillary service providers aiming to provide services directly to patients, mostly through mobile devices, who are clamoring for the right to become an accepted partner to the EHR clinical information exchange network. And of course patients, whether through these new ancillary service providers or directly, are also increasingly voicing a desire to be included in clinical information exchange. These developments are altering the classic definition of an EHR and changing the focus from tools to provide care to broad content management, which is more in line with Candidate Obama’s vision. In reality all these functions are still in their infancy, but the direction is fairly cldar, and it is worth noting that unless all functions are optimally performed, there is not much benefit accruing to any stakeholder. Various constituencies may derive more value from one particular function rather than the others, but as long as that value exceeds what is made available by a paper system, someone should be willing to pay for it. Let’s examine our stakeholders, and their willingness to pay, from the bottom up.

Secondary Stakeholders – Here we find the drug and device manufacturers and the bewildering array of diagnostic facilities. Most of these companies are largely indifferent to what EHRs do and some stand to lose revenue when EHRs shine bright lights on spending patterns. They are not likely to consider paying anything for widespread EHR adoption. On the other hand, the mushrooming mobile health and personal health application providers, who base their entire existence on the availability and successful use of EHRs, show no willingness to share in the cost of computerizing medical records. Needless to say that medical research centers which have been habituated to mostly free access to data sources, may be willing to pay data aggregators, but would never consider participation in infrastructure investments.

Health Insurance Providers – The largest health insurance provider in this country is the Federal Government through the Centers for Medicare and Medicaid Services (CMS), and CMS is proposing to bear a rather hefty portion of the costs of EHR deployments. Obviously CMS is expecting to see great financial rewards from a fully functional EHR network. Whether CMS is placing onerous or misguided requirements on the technology is a completely different question and one has to keep in mind that CMS is primarily a payer and its primary concern must be proper stewardship of tax payer funds. To do that, CMS needs data, and lots of it. You don’t usually pay a mechanic to take a look at your car – you pay him to fix it. CMS is now paying health care providers to treat people and it would much rather pay them to fix people and keep them under warranty, and it would also prefer that this is done via a fixed price contract, instead of the current time & materials model. EHRs are the tools by which quality assurance is performed and deliverables are accounted for and measured.

What’s good for the goose should be good for the gander, and private insurers figured out that paying for EHRs may not be such a bad idea after all. I am not 100% certain, but I would suspect that financing EHRs for physicians in order to improve quality of care falls under the medical expenditures rubric and can be deducted from the federally imposed Medical Loss Ratios (MLR). Since private insurers have historically ran much tighter ships than CMS, I would expect that in return for their Stark exempt contribution to EHR expenses, private insurers will ask for at least as much data as CMS and probably a lot more.

Health Care Providers – These folks are as diverse as the patients they serve, but their interests in EHR are most closely correlated to their size, which ranges from the solo doc in a micro practice to integrated delivery networks serving millions of patients. For large providers who operate multiple and varied facilities of care, EHRs are a tool to effectively manage their business. They were always willing to pay for them and they are continuing to do so now, in spite of the constant rumbling about CMS regulations. At the other end of the spectrum, the small providers, mainly physicians in private practice, who are more financially strapped than ever, see no good reason to take on debt and pay for tools with no demonstrated ability to provide tangible returns. Keep in mind that using paper-based tools to manage a few hundred customers who purchase one of a handful of services between 9 and 5 four days a week, is not nearly as onerous as managing millions of customers purchasing thousands of different services around the clock all day every day. Nevertheless, even these small providers are starting to buy EHRs. As EHR software gets better, some manage to find efficiencies never before contemplated and others are just trying to keep up with the Joneses and survive. Reluctantly and grudgingly, with lots of hard feelings building up, they too are willing to pay.

Patients – All stated goals of EHR adoption ultimately benefit patients. Some may stand to benefit more than others, but in aggregate we will all benefit from improved quality, reduction in disparities and cost containment of medical services. Whether directly or indirectly, through taxation, premiums, wage reduction, increased prices of goods and plain old cash, patients pay for the entire enormity we call health care costs, which includes cost of actual care delivery, overhead and profit margins for all other stakeholders. EHR software is part of that overhead and so are the costs of analyzing, displaying and exchanging information collected by EHR software. When CMS and private insurers and even health care providers write checks for EHR software vendors, somewhere down the line this translates into a little bit less health care for each patient and/or a little more money needed to obtain care. So although we pay for all EHR expenses, we as patients, find ourselves in the perplexing situation where we are forced to lobby, argue, advocate and practically beg for access to the work product of EHR software. And that work product is our life story. It is the record of our birth, the narrative of our childhood successes and mishaps, a document of our education, sexual activity, fears, hopes, marriages, new children, career choices, residence, divorce, widowhood, disease, death and everything in between. In other words: Data. We are paying for this data to be collected, exchanged and analyzed. We are paying for people to decide if we should have a right to opt-in or opt-out of such activities. We are paying for media campaigns to convince us that what we are already paying for is worthwhile.

So here is one suggestion: instead of paying for EHRs indirectly, while allowing all stakeholders to complain about the expenses as if the fees came out of their own pockets, how about patients paying for EHRs directly? There is no difference in aggregate and we are not talking about a lot of money for each individual patient. A yearly fee of something between $5 and $10 per patient, per facility, should suffice. Call it EHR fee, or EHR subscription. Once we explicitly pay for it, we own it; not the software, not the hardware, but the Data itself. And this is how it should be.

New Technologies Helping Austistic Children in the BPS

2011-09-30T04:50:00.000-07:00

Check out Channel 5's segment on how Boston Green Academy is using iPads and assistive technology apps to support students on the autism spectrum. Boston plans to pilot iPads in autistic strand classrooms around the city as we seek new and innovative ways to support the learning, and success, of all students.

http://www.thebostonchannel.com/video/29335939/detail.html

Road Trip to Meaningful Use Land

2011-09-25T09:30:00.000-07:00

The voice on the phone seemed genuinely amused, “Let me see, the GPS can’t find our location, right?” Right. One U-turn by the burnt barn, a right after the Conoco station, another right at the end of the road, a left across the John Deere and two and a half hours from the city on highway W, brought me to a small and very white store front, housing a nail salon and a busy family physician practice. If I stretched out both arms, I could put one hand on the front desk, and place the other hand on the back of a waiting room chair. There were six chairs separated by small tables adorned with yellow silk flowers. A texting young man in jeans and baseball cap and a middle aged woman clad in floral attire and a big green purse, occupied two of those chairs. And then Bessie walked out the doctor’s office behind the usual and customary tennis ball footed aluminum walker which was almost as tall as her, and helped by the front desk lady made a slow trek to the one chair with arms on both sides. They were calling Joe to come pick her up. Joe was going to be there in ten, fifteen minutes, tops. It was 4 PM and they were running behind.

Looks can be deceiving though. This practice is an anomaly in the rural health continuum. There are computers in every room and not even a trace of paper charts. They’ve been on a top of the line Cadillac EMR since 2005, paying a small fortune every year for the privilege and for IT guys to support it. They kept up with all the upgrades and are on the latest and greatest certified version and would very much like to get the Meaningful Use incentive that will cover about three quarters of what they spent on EMR maintenance this year. The doctor would even like to try the patient portal. He thinks it could make him more efficient. They were all ready to go on October 1st, but then something happened. They started getting solicitation emails from their EHR vendor informing the doctor that there are several accessories that he must purchase in addition to his fully certified EHR, if he wants to qualify for Meaningful Use incentives, and of course, the Cadillac vendor has a special sale on accessories this month. Confusion and frustration were palpable around the huge, and completely out of place, formal pedestal dining table in the break room.

I’ve been to this movie before, and I never had any luck convincing this particular vendor that a certified complete EHR should allow the user to achieve Meaningful Use with no need for other bits and pieces that were not mentioned anywhere during the certification process. Unfortunately, those who certify EHRs and those who supervise the certifiers are turning a blind eye and a deaf ear to what is essentially a regulatory issue. In the break room the confusion and frustration were slowly changing to anger and the big plastic QT cups of pink lemonade that were brought in by someone didn’t help much. The conversation shifted to the various Meaningful Use measures and by now I wasn’t surprised to hear that they are doing rather well on most, from electronically prescribing everything to recording race and ethnicity and generating beautiful CCD clinical summaries. They weren’t sure how to give folks electronic copies of their medical records, but nobody ever asked for that and it’s highly unlikely that anyone will in the next three months. That should be good enough.

“Am I also good on immunizations? I don’t do many of those either… maybe a few HPV and some flu shots for elderly patients to save them a trip to the pharmacy. I shouldn’t have to report anything, right?” Eh… wrong, doc. Even if you only do one immunization in the next three months, you would have to test an immunization interface with the State registry, and your Cadillac EHR can’t generate the test file at this time although it is fully certified for Meaningful Use. I’ve been trying to get an answer from this vendor for months. I’ve asked CMS for a solution over a month and a half ago. I have written a blog post that got more page visits than anything I ever wrote before, and came up empty on all fronts. But the doctor seemed to be working his way to an innovative solution all by himself.

“So if I don’t give any shots after October 1st, I should be OK…. We have one bottle of HPV left anyway and Marcie needs her shot… I have a week to do that… They pay peanuts for shots, you know…. They’ll just have to go to the pharmacy…. It’s not that far…. I really don’t give many shots anyway… Yep. It should work… “. October is flu season, and I was wondering if Joe picked up Bessie by now and if the pharmacy is on their way home. I wanted to know if the pharmacy had a chair with arms for Bessie and if the pharmacy folks would also call Joe to pick her up after waiting in line for her flu shot. But instead, I just found myself mumbling that this wasn’t really the intent, but yeah, this should work.

A couple of months ago, I heard a story about a geriatrician who chose to stop giving courtesy flu shots to his patients because of Meaningful Use. I found it hard to believe then. Needless to say, I believe it now. I am certain this was not the intent at CMS and I am pretty sure this was not on the Meaningful Use roadmap at ONC. I am not in the habit of pleading and begging the powers to be to do the right thing, but I will make an exception this once. This unremarkable little practice in the middle of nowhere could have been the poster child for successful EHR adoption. Can somebody at HHS, CMS or ONC help these small practices stand up to the greedy whims of a powerful EHR vendor? And above all, can we do something to help Bessie keep her “I” in Health IT, please?

Disclaimer: In order to protect their priv`cy, the names of all people and locations mentioned in this post have been changed, as have certain physical characteristics, quotations and other descriptive details.

The Power of Empowerment

2011-09-18T11:27:00.000-07:00

Grant Wood, American Gothic (1930)

Housing is expensive if you want to live in a Tudor style mansion on a half-acre wooded lot. Housing is a lot cheaper if you choose to rent a two-bedroom apartment on the fourth floor of a square building with no elevator, 45 minutes away from your workplace. And it won’t kill you to rent. Food is also very expensive if you want a varied, fresh and gourmet diet, but food can be cheap, and it won’t kill you to cook your own food and stick to a diet of mashed potatoes and boiled cabbage, with an occasional bit of tripe. Health insurance is very expensive if you insist on having all your medical needs covered by an insurance policy. Health insurance can be a lot cheaper if you pay for most of your medical care yourself and if you only buy limited coverage for the eventuality of falling off your dressage horse, and cheaper still if you promise to drop dead shortly thereafter. Health care itself is very expensive if you insist on receiving medical care from highly trained professionals, using cutting edge technology in state of the art facilities. Health care can be a lot cheaper if you find a way to take care of your health without involving doctors and hospitals and their overpriced opinions, chemicals, machines and unnecessary procedures. It’s all about consumers empowered to freely make their own choices: mansion or rented apartment, steak or tripe, Cadillac or catastrophic health insurance, ICU or alcohol rub…..

The Consumer Empowerment terminology originated in the health insurance industry to mark the transition from having insurers pay for every cut, bruise and sniffle, to the more responsible way of paying for much of your health care directly out of your own pocket leaving the insurer responsible for rarely incurred catastrophic expenditures. The newly empowered consumers discovered that health insurance is now much more affordable, and perhaps even unnecessary, while health insurers discovered that magically, their profits are also improving, probably because empowered consumers seem to generate significantly less reimbursement claims, than the irresponsible and unempowered crowd served by public entitlements.

Although empowering consumers to pay for their own health care proved to be a stroke of genius, we have a long way to go before the overall cost of health care is contained. The problem here is that over the years Americans figured out that staying healthy doesn’t really pay off and quite the opposite is true, because once you get really sick there are all sorts of freebies made available to you, from amputations to chemotherapy to mastectomy to castration - a veritable smorgasbord to choose from, and the temptation is huge since the monetary value of these free goodies can add up to more than many people make in a lifetime of hard work. Not to mention the fatherly physician figures busy offering you helping after helping of a carefully selected array of the most expensive fare available. And then an innovative idea was put forward by selfless luminaries, and is catching on like brushfire after a long global warming induced drought. If health care insurers were able to cut costs and increase profit by empowering consumers to insure themselves, could health care providers achieve the same spectacular success by empowering consumers to care for themselves?

Empowering consumers to engage in their own health care may rank up there with cold fusion and perpetuum mobile in its transformational potential for humanity. Empowering millions of people to actively manage their medical care, by making their own medical decisions, breaking free of the old-fashioned paternalistic directives of financially conflicted physicians, and restoring the nineteenth century self-reliant approach to health care, will slash costs, improve quality and eliminate disparities in health and health care in one patient-centered fell swoop. And how do we accomplish such monumental task? We harness the unlimited power of the Internet. This is the Information age, and just like the Industrial age brought a car and a television set to every home, the Internet puts the entire world’s knowledge at the fingertips of all humanity with astounding effects already visible in the education attainment of our children. But the world’s knowledge is missing a vital piece of information pertinent to our goals in health care.

Enter Health Information Technology (HIT). HIT will pry loose the last piece of the puzzle – the secretive documentation amassed and jealously guarded by doctors in their offices. Information kept in detailed color coded charts and recorded in strange cult-like symbols that prevent anybody but doctors from understanding the contents. Once that information is made available to computers and the thousands of new high tech tools chomping at the bit to translate, analyze and recommend what you should buy to treat any ailment ever recorded, the Internet will bring this knowledge to every hamlet and fuel a renaissance of rugged Americanism where every man woman and child will be empowered to manage his or her own health care. The amount of money spent on health care will decrease sharply since the time people spend researching, diagnosing and treating themselves at home, and the cost of technology tools and over the counter remedies to facilitate these activities are not considered health care expenses. The quality of such care will be exponentially improved by harnessing the knowledge and insights of millions, instead of just one medical school graduate. And by definition, the Internet eliminates all disparities, as evidenced by the blossoming democracy in Egypt.

So much empowerment may seem a bit daunting to some who grew accustomed to getting advice from doctors. No need to worry though because this will be a gradual and gentle process. It’s not like you will have to perform an appendectomy on yourself come Monday morning, although it wouldn’t hurt to start practicing simple things like freezing warts at home and researching minor chest pain on Internet boards. When you finally keel over in pain, or are otherwise ready to confront a doctor, you must prepare yourself mentally to act as empowered as possible. While the civic minded insurers have been happy to empower people and let them spend their own money any way they saw fit, doctors find it much harder to relinquish control of their patients. You need to come in with all your symptoms researched, a tentative diagnosis formulated and most important, a preferred course of treatment that fits your cultural values and preferences. You need to resist your doctor’s efforts to tempt you into partaking in the smorgasbord of free tests and procedures, some of which will be harmful to you and others will be very unpleasant for your friendly insurer. If you concur with your doctor’s opinion and have some tests done, make sure you understand WBCs and RBCs, units and normal ranges for the lab you are going to use after shopping around for a good price, and be sure to validate whether you need a differential count or not. The Internet is your friend and all this information is available online. But whatever you do, don’t leave your doctor’s office without an electronic copy of your medical records in a computable format, because any day now, there will be a free app for all these decisions and iWatson will empower you to care for yourself and your loved ones in ways that the log-cabin pioneers couldn’t even dream about. Better, faster and infinitely cheaper.

Community Plan-IT Begins September 15th, Have Your Voice Heard!

2011-09-14T08:29:00.000-07:00

From September 15 - October 20, Community PlanIT will serve as a platform for the district's first "virtual town hall meeting" - engaging BPS staff, parents, students and other members of the community on how we should rate our schools' performance and the opportunities they offer. The exercise will culminate with a real face-to-face town hall meeting for all oparticipants on October 20th at The English High School.

Go to http:communityplanit.org and click on the Boston Public Schools link on the left pane to begin! Over 500 people are already registered, and groups of students across the district will play a more active role - producing video content and posting "challenges" to participants in the conversation. To get your students, parents, staff or partners engaged, contact Carl Allen in the Office of Accountability or send them straight to http://communityplanit.org.

Community PlanIt Introduction from Evan Leek on Vimeo.

New L4L Sessions Posted for Next Week

2011-09-14T08:10:00.000-07:00

Four new Laptops 4 Learning sessions have been posted to My Learning Plan and are ready for enrollment. If you are a newly eligible teacher, or still have your version one laptop, you can go to www.mylearningplan.com to sign up. In order to find the the laptop orientations, sign in with your username and password, click on the district catalog and then do a search for L4L. There are sessions on Monday, September 19 through Thursday, September 22. All sessions are held from 4pm to 6pm at Madison Park High School. If you have questions or are having trouble getting into My Learning Plan, please call the OIIT Service Desk at 635-9200 between the hours of 7:00am and 4:00pm. Please remember, all eligible participants must come to the training session with a valid picture id and their BPS username and password.

BPS CIO talks technology on WCVB's CityLine

2011-09-05T17:58:00.000-07:00

A few weeks back, I had the unique opportunity to speak with Karen Holmes Ward, host of CityLine, Channel 5's award-winning urban news and feature magazine program, about technology in the BPS as we embark on a new school year.

In Boston, technology plays an increasingly central role as a driver of educational innovation to prepare students for college and career success. We aim to provide students and educators with access to state-of-the-art technology tools and support to eliminate access and achievement gaps, personalize instruction, and engage students in meaningful, relevant ways to realize the goals set forth in the district's Acceleration Agenda.

Thank you to the Honorable Thomas M. Menino, Mayor of Boston, the Boston School Committee, and Dr. Carol Johnson, Superintendent of Schools, for their commitment to education and technology.

Check out the short video segment to learn about some of the ways in which we're using technology in the district to strengthen teaching and learning:

CityLine Segment 3 - Technology in the BPS Video - WCVB Boston