Poland will implement a comprehensive web-based electronic patient
record (EPR) project which is in its beginning phase and a comprehensive introduction will be available starting in 2014. Read more about this project from this link (this link will open in a new tab in your current browser). This press release from CompuGroup Medical AG, Poland was received via email courtesy of Arunasalam P., Malaysia.
Image credit : CHIP Malaysia
I fist read about – from reading the September issue of CHIP Malaysia, an IT magazine I purchase from time to time, a move to streamline medical records into a centralised system utilising virtualisation technology supplied by VMware, the market leader in virtualisation at the University of Malaya Specialist Centre (UMSC). This article was too short and hard for me to understand about ‘virtualisation’. I decided to find out more, prepare a post on this blog, and here is what I like to share with you readers. In this post I shall focus a little on virtualisation techonlogy – hoping you and I can understand it better, and how UMSC hopes to decentralise medical records, and its benefits.
The UMSC is a private medical centre within a publicly funded, 1,300-bed teaching hospital called the University of Malaya Medical Centre (UMMC), both operated by the University of Malaya. UMSC provides the public access to world-class specialist clinical services with the support from about 200 clinicians and another 250 nursing and support staff.
Image credit : http://sprouti.com/
The VMware website explains that virtualisation is about how “today’s x86 computer hardware was designed to run a single operating system and a single application, leaving most machines vastly underutilized. Virtualization lets you running multiple virtual machines on a single physical machine, with each virtual machine sharing the resources of that one physical computer across multiple environments. Different virtual machines can run different operating systems and multiple applications on the same physical computer. “
You can watch this video and learn how virtualisation works.
Source of the video above : http://www.vmware.com/virtualization/
I am sure many of you readers out there will feel intimidated watching and understanding all the IT jargon in this video.
Allow me to describe a little about virtualisation, and tell you how servers we know about can be transformed into virtual machines, which is what basically virtualisation is all about.
Most of you will know and surely heard of servers and networks. A server is a physical computer dedicated to running one or more services to serve the needs of the users of other computers on the network, the “clients”. Servers usually run a single operating system and a single application. You would have heard the IT guy talking about a database server, file server, mail server, print server, web server, gaming server. Each of these kind of named serves run a single operating system and a single application, depending on the computing service that each of these servers offer. This is the traditional way servers are managed, in a simple way of understanding You would have noticed several servers (computers) all located in a server room. Since servers are designed to run a single operating system and a single application, these leaves most of such computers (machines) vastly underutilised. This is when the virtualisation technology steps in.
Virtualisation converts any one server which is a single physical machine, into mutliple virtual machines inside it, with each virtual machine sharing the resources – including the CPU, RAM, hard disk and network controller of that one physical computer across multiple environments. Different virtual machines inside any one server can run different operating systems including Windows, Linux and more and multiple applications, for example Oracle, Exchange, SQL Server, Sharepoint and SAP, on the same physical computer. Thus, the old “one server, one application” model is eliminated. This frees IT admins from spending so much time managing servers.
Healthcare IT infrastructure in healthcare settings in many places as it was at UMSC, is a very traditional environment of complex, device-centric computing made up of autonomous content factories or “silos” with inherently incompatible technologies, product-specific workflows, uncoordinated content development, efforts resulting in overlapping content, linear workflows to produce multiple deliverables from each product’s content.
Medical records in most hospitals in Malaysia are still not centralised, scattered across departments often keeping their own documents making it diffiucult to collate them. This often leads to long delays in patients getting treatment.
In the pursuit of a new strategy for content ubiquity (that is to say the state or capacity of the contents of medical records being everywhere, especially at the same time), UMSC seeked solutions to change its fragmented, legacy IT systems of a decentralised medical records system into cost-effective, agile computing infrastructure environments. UMSC wanted to concentrate the data and make it readily available for their medical personnel to access.
According to Leon Jackson, Head of IT, UMSC, in the past doctors could end up using as many as three terminals simultaneously to access the necessary information to treat a patient. Jackson was hired in 2009 to help develop UMSC’s IT system for its new premises in 2016. He started the hospital on a journey which would see the digitisation of existing workflow and adopting virtualisation to drive efficiency and making a move toward a unified virtualised IT environment. Jackson believes this is one of the easiest ways to gain a competitive edge in the medical industry.
The solution process faced a specialised set of infrastructure and end-user requirements to support the digitisation of biomedical imaging and other medical information, to enable/ease basic clinical processes via electronic workflows, and to provide personal desktop environments that could be accessed on mobile devices, and via terminals throughout UMSC including in sterile and electronically sensitive areas such as operating theaters which allow for more “sterile” equipment through the deployment of thin-client touchscreens with washable mice and keyboard.
UMSC wanted to deliver a more user-centric (that is to say in which the needs, wants, and limitations of end users of a product are given extensive attention) connected care computing infrastructure environment to boost the availability of systems needed to treat patients effectively, the encouragement of clinicians to embrace digitisation, and meet demand for new medical services applications.
After evaluating options, UMSC decided on VMware. VMware claims that VMware virtualisation solutions have been chosen by over 250,000 customers, including 100% of the Fortune 100.
VMware’s solution to UMSC was for a more user-centric computing infrastructure environment which enables higher quality on-demand experience which allows new ways for clinicians to collaborate across applications and data from any device, where and when they need. In this way, more clinicians and healthcare consumers were expected to leverage hybrid cloud resources, while maintaining a managed, secure environment to use their applications and services, through which healthcare providers will be able to deliver better services at lower costs.
We know for a fact that patient care happens everywhere – bedsides, remote offices, homes, labs and these days in the cloud. These varied locations require providers to manage a variety of unique desktop environments, ranging from workstations on wheels to high-traffic nursing stations to inpatient room computers.
UMSC hopes to benefit from this automated and efficient ubiquitous IT system in the following ways:
For your information, UMSC is currently running about 100 VMware View desktops, and expects to increase this over the following year to 300 concurrent users. Jackson revealed that to support this migration, UMSC had invested up to 4 percent of its revenue each year for the last three years on IT.
Also on the pipeline by the end of Q3 2012, is when all clinicans will use iPads to access a virtual Windows 7 desktop incorporating legacy thick-client (thick-client meaning, “intelligent” regular Windows applications installed on the local machine i.e the client machine, capable to processing more data locally on the client) applications together with new mobile applications for its hospital information systems.
References:
Avanti, K 2012, How VMware is helping to ‘free’ Malaysian healthcare, Computerworld Malaysia, viewed 22 September 2012, <http://www.computerworld.com.my/resource/applications/how-vmware-is-helping-to-free-malaysian-healthcare/>
CHIP Malaysia, Making Sense of Medicine, September 2012, Online Dynamics (M) Sdn. Bhd., Petaling Jaya, Selangor Malaysia
Farhan, G 2012, 01/08/2012, Cloud medicine at UMSC, PC.com Malaysia, viewed 25 September 2012, < https://www.liveatpc.com/cloud-medicine-at-umsc>
Ryan, H 2012, M’sia hospital prescribes virtualization for healthcare sector, ZDNet, viewed 25 September 2012, <http://www.zdnet.com/my/msia-hospital-prescribes-virtualization-for-healthcare-sector-7000002976/>
VMware, viewed 22 September 2012, <http://www.vmware.com/>
VMware Customer Case Study, Medical Center’s Virtualization Journey Boosts Patient Care and Transforms Medical Systems, VMware, viewed 26 September 2012,<http://www.vmware.com/files/pdf/customers/
VMware_University_Malaya_Specialist_Centre_12Q2_EN_Case_Study.pdf>
Diabetes mellitus is a common disease causing significant mortality and morbidity. It is a serious debilitating and deadly disease, but you can control it and you can learn to live with it as once you are a diabetic, it’s very difficult to reverse it.
In Malaysia, the First National Health and Morbidity Survey (NHMS I) conducted in 1986 reported a prevalence of diabetes of 6.3% and in the Second National Health and Morbidity Survey (NHMS II) in 1996, this had risen to 8.3%. The third National Health and Morbidity Survey (NHMS III) was conducted between April to July 2006 and showed a dramatic increase in the prevalence of diabetes for adults aged 30 years and above to 14.9% – an increase of 80% over a period of just 10 years (8.3% in NHMS II vs 14.9% in NHMS III ) representing an average 8% rise per year.
Can electronic health records (EHRs) serve to help patients manage their health and to provide treatment to patients with chronic diseases, such as diabetics?
EHR systems widely implemented in Wisconsin, USA are improving coordination and making health care more efficient, lowering costs and identifying and treating at-risk patients to improve their health.
Image credit : JSOnline, Milwaukee, Wisconsin, USA.
Eida Berrios, a registered nurse and certified diabetes educator, leads a discussion in early July during a class for patients with insulin pumps at the Sixteenth Street Community Health Center in Milwaukee.
Here is how it works in diabetes management using EHRs for patients at the Sixteenth Street Community Health Centers in Milwaukee, Wisconsin as reported from the July 16, 2012 JSOnline, the online version of The Milwaukee Journal Sentinel – the primary newspaper and the largest newspaper in Milwaukee :
This is one good example how EHRs serve as a platform to manage health education, to help patients manage their health and to provide treatment.
Abridged by R. Vijayan, from the original article “Diabetes management using electronic medical records” by By Aisha Qidwae of the Journal Sentinel, July 16, 2012.
It’s late sunday afternoon, I was reading news feeds. One feed struck me as worthy of sharing on this blog this instance. I hope you like the Photoshop graphics I swiftly assembled to prepare along for this post.
A Bloomberg report, citing a privacy blog Dissent Doe reported that hackers were able to access electronic medical records and emails belonging to the Surgeons of Lake County, a medical practice in Libertyville, Illinois, USA.
The hackers holding the data for ransom, demanded the practice to pay ransom money for a password to access the encrypted.The blog reported the practice declined to pay, it shut down the server and notified authorities but was clueless whether the practice was eventually able to access its Electronic Health Records (EHRs), or if it did, how did they do it.
This disturbing new trend emerging serves as a warning that unpredictable things can happen to data once it’s digitized when hackers (criminals) try to exploit the healthcare industry’s shift to digital healthcare information.
Also from this article, it quoted Bloomberg which reported two cases involving pharmaceutical prescription systems in 2009 and 2008, and also several cases prior to 2008 related to outsourcing practices.
In 2009, the Virginia Prescription Monitoring Program was hacked and hackers demanded $10 million from the state of Virginia (USA) after he or she claimed to have stolen and encrypted personal and prescription drugs for 8.3 million patients. Another hacker in 2008 demonstrated he or she had personal information on a few dozen members of the prescription-drug benefits manager Express Scripts and demanded ransom money, but never got the ransom demanded from this company. Four years earlier to 2008, several California hospitals were blackmailed after outsourcing their medical transcriptions overseas.
The Obama Administration is aggressively expanding the use of EHRs that it strongly believes is fundamental to reforming the U.S health care system. Billions of dollars worth of grants have been announced to help hospitals and health care providers implement and use EHRs. Many hospitals around the world have also moved the EHR way.
Criminal activities I am now quoting from this article, may seem one small event or events in an isolated area far away in the U.S and may not seem especially noteworthy, but it may offer the first tangible warning of a larger problem developing as the shift to digital medical records begins in U.S in a big way and even here on Malaysian shores as our hospitals begin to move the EHR way. I think hackers holding healthcare data for ransom may be described as a canary in a coal mine for the future of EHRs.
Abridged by R. Vijayan from the orginal article “Hackers Hold Health Data Hostage” by John Pulley for Nextgov, August 11, 2012
I am sure many Health Information Management (HIM) practitioners in the U.S. and HIM practitioners from the U.S. who are following this blog already know about an innovative tool for charting their promotional pathways. I had kept away this article after reading a news feed about it a few days ago, and wanted to toy around with this interactive tool before I could blog about it today.
In the U.S., the U.S. Bureau of Labor Statistics expects employment in the medical record and Health information Management (HIM) field to increase 21 percent by 2020.
With this expected growing demand for qualified HIM professionals high and for both HIM students and professionals seeking to chart their career course in the rapidly changing field of HIM, the American Health Information Management Association (AHIMA) representing more than 64,000 specially educated Health Information Management professionals in the United States and around the world has unveiled Health Information Management (HIM) Career Map©.
This HIM Career Map© is a one-stop place to learn about HIM careers, where the field is now and where it is heading. Claimed as the first career map of its kind in the healthcare profession, it was made possible by working in a partnership between the AHIMA Foundation and the Center for Adult and Experiential Learning (CAEL) and in part by philanthropic contributions from Career Step – “a leading online school with almost 20 years of experience providing career education specifically designed to help students gain the knowledge and skills needed to quickly transition to a successful career after graduation.” (Career Step 2012).
The HIM Career Map© is an interactive and visual representation of 53 current HIM job titles and roles that compose the scope of the field and 14 emerging roles in HIM arranged in a grid with six broad job families on the top row and four skill levels on the left side of the grid.
Any white dot in any square of the grid represents each HIM job title while a yellow diamond in any square of the grid represents an emerging HIM job title. Clicking on a white dot displays a rounded rectangle box pointing to the chosen HIM job title white dot. This box shows a description and details on the skills required, job responsibilities, education and work experience needed for success, and promotional pathways. More detailed description on this HIM job title can be viewed by clicking on the yellow box labeled ‘FULL DESCRIPTION’ at the bottom of the rounded rectangle box. Simultaneously, line(s) radiate from this white dot to other white dots or yellow diamonds representing promotional HIM job title(s) in neihbouring squares of the grid .
The following screenshots show three (3) views of this map. A larger view of each screen shot opens in a new tab of your current browser window.
introduction screen
Grid showing skill levels on the left, broad job families on top row,white dots for existing HIM titles and yellow diamonds for emerging HIM titles
HIM job title box and radiating lines to adjacent HIM job titles
The HIM Career Map© also indicates alternate titles for some positions due to the different terminology used in the industry. The map is driven by data from AHIMA subject matter experts, staff and an AHIMA member survey.
For full details of the HIM Career Map©, visit http://hicareers.com/CareerMap/ (this link will open in a new tab of your current window).
AHIMA hopes that the map will help students, recent graduates and HIM professionals looking for new opportunities to plan a path to success through the promotional and transitional career paths associated with them.
AHIMA plans to add emerging roles to the map as needed to reflect the current reality of HIM roles, pathways between the roles and connections to the direction in which the profession is moving.
I think this tool is simple yet a clever plan to graphically display HIM job titles and career pathways in a grid, and qualifies as a one-stop quick resource center and reference portal to check on HIM opportunities in the U.S.
References:
Career Step, viewed 5 July 2012 <http://www.careerstep.com/about-us>
Health Information Careers – Career Mapping, viewed 5 July 2012 <http://hicareers.com/CareerMap/>
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