Strategic Informatics

A blog about the strategic application of technology

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Apple World Wide Developer Conference 2013

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In less than 24 hours, the first Apple event in at least 6 months will be underway.  There are a lot of eyes on Apple given their incremental product releases.  Rumors abound about what will be unveiled however it seems a safe bet given the signs that are posted in the Moscone center that Apple will focus heavily on the OS X and iOS.  Apple has released the innovative MacBook Pro with Retina Display and manufacturers have yet to really catch up with the design or hardware specs of this product so it makes sense Apple innovates in the software in their portfolio.

Follow-me on Twitter @cary_brown for updates…

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User Interface Design using Silverlight Rich Internet Application (RIA) Technologies

March 16th will mark one year since we generated our first formal wireframe comp for what has now become a very robust enterprise application for physicians and their clinical staff.  This journey through building an initial prototype, development of a solid service oriented architecture,  building the project, analyst and development teams, generating a solid user experience, engaging our customers and more importantly engaging everyone in a new agile methodology has been nothing short of an amazing journey to which I’m very proud of what we have all accomplished.  As we approach formal implementation of a project kicked off just one year ago I would like to recognize some great vendors who helped us along our journey…  Xby2, Seamgen, and Cynergy Systems and especially my development staff at WellMed who kicked us off in this new agile development effort.

My recent visit to HIMSS ’11 in Orlando, FL validated what I already knew…that our user interface, which sits atop the underpinnings of a service oriented architecture, is far and away more usable and interactive than anything else on the market today.  The tool our customers use does not need to get in the way of doing business…  Cynergy Systems has created a showcase video highlighting their approach to User Interface design with our product and shows how good UX design can go a long way in helping ease complex tasks.  Below is the showcase video they produced and demo’ed at the Health Information Management System Society (HIMSS) meeting last month.

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Designing an Electronic Medical Record

Some big ideas come from asking pretty simple questions…

As it turns out the inspiration and vision for the development of an innovative Care Delivery Platform at WellMed was born out of necessity.  A necessity to accurately and efficiently deliver timely information about patients health status to caregivers at the point of care and document in a way that did not inhibit the caregivers ability to deliver quality care to seniors.

Many physicians are burdened with a mass of paperwork detailing patient activity.  The simple idea of putting relevant and timely information in the hands of a physician when it is most important to help manage risk and provide adequate decision support at the point of care is a goal many EMR vendors have tried to achieve by simply aggregating and archiving data.  There are several decision support tools available for physicians that manifest themselves in different ways such as ePrescribing applications, Reference Material, Patient Education Handouts, Risk Adjusted Payment Attestations, Document Management Repositories, Clinical Protocol sheets, etc… some within a single application, many others completely disconnected and disjointed requiring the user to log into multiple applications to perform seemingly simple functions.

When you think about it clinicians and many tertiary healthcare providers live and work in an environment where the vast majority of documents sent and received are in paper form and it is still growing.  When you add electronic information in the form of e-mail, document management systems, and patient data to the mix it becomes inefficient and cumbersome for providers to effectively manage.

We’re two decades into the internet revolution, and despite many efforts to create an all electronic clinic, paper is still the predominant method of healthcare communication in this country.  It’s 2010 and many providers get their documents more or less the same way we did 200 years ago!!!

That’s absurd…

While we can’t change an entire industry we can start by looking at ourselves and how we deliver healthcare to seniors.  When I started with WellMed 2 years ago I was inspired by our CEO’s vision and approach to wanting to leverage technology to gain efficiencies and better manage risk for our patients to keep them healthy and out of the hospital.  At the same time I saw his frustration with current solutions that did not allow us to progress to the next level of patient care.  The truth is we will never completely get rid of paper, this is a common misnomer, but we can manage it more effectively and make it more accessible to clinicians.  What the our clinics needed was a new, complementary approach for managing patient information.

So here is the simple questions that led to the creation of the Care Coordination Platform:

What would it take to deliver quality information to physicians at the point of care?

What would empower physicians to help deliver quality care for seniors and help improve outcomes?

After much thought and effort we think we’ve got an approach that nails these things.  It brings efficiency, new benefits for both business and physicians and more importantly our seniors.  So far the feedback and the demand for a solution have been terrific.

As we get ready to bring the solution we started developing a year ago to physicians we will continue to evolve the platform to include many other data elements in the patients continuum of care.  We have not been sitting idle and have solicited feedback from many providers and will continue to be engaged with all users of this new system.  Initial feedback has been great and we’ve got lots more work ahead, but we are off to a great start.

When we introduce the EMR Preview in 1Q 2011, it will have exceeded our current EMR functionality in many ways and plan on quickly following with quarterly releases of additional functionality including ePrescribing, and document management integration in subsequent iterations.  I’m very proud of what our team has created in such a short amount of time and will continue to develop as we forge new ground and develop new integrations with other custom and vendor solutions.  I would love to show you more than just a teaser image as the user interface takes full advantage of rich internet application (RIA) functionality.   I truly believe what we have designed will empower our providers to delivery quality care to seniors.  Until such time we make our internal development efforts widely available to contracted providers I will instead focus future posts on our approach to architecture, user interface, SOA, and agile development.

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What makes a successful mobile device?

I typically don’t title my posts with a question but it begs to be answered with the imminent release of Apple’s iPad.  Frankly… I’m frustrated with all the media fanfare around how tablet based computing is “now” going to revolutionize the industry.  Tablet PC’s have been around for for 10-15 years.  It’s not the hardware in as much as it is the software running on these devices that have been the problem with adoption.  Software also being inclusive of the operating systems that power the devices.  Initial incarnations of the slate based devices tried to take a desktop OS like Windows, and with the help of some task bar utilities (and who doesn’t love more of those cluttering your interface) would create a platform for mobile professionals.  The result was that year over year software vendors continued to make their mouse and keyboard driven desktop applications function in the confines of a cumbersome keyboard and mouse driven OS by pecking at a temperamental resistive touch screen display on a mobile device.  And we wonder why software solution have a hard time getting used by providers and clinicians.

What was needed was a truly mobile and touch driven OS and SDK like Apple provided in their iPhone to help developers conform to building applications that did not rely on technologies that didn’t exist on the hardware like a mouse.  This was needed because no one had stepped up to the challenge in a market dominated almost exclusively by Microsoft.  Linux was in its infancy in the mobile space back then but today the Android OS has certainly stepped up to the challenge the iPhone has presented in the mobile device space and is providing a competitive platform against which Apple may have a hard time competing if the innovations in the open source world continue to leapfrog apple.

My issues with mobile computing in healthcare revolve around technologies that get in the way of providers and clinicians doing their core job which is attending to patients and not fumbling through hundreds of check boxes and interfaces designed to be used on a desktop.  Vendors need to realize just because you can run your application on a tablet PC doesn’t mean you should.  Let me repeat….Just because you CAN run your application on a tablet based device DOESN’T mean you should.  If an application is architected properly then there should always be a layer of abstraction between the interface and the underlying core enterprise services that drive that interface.  I’m not hating on Microsoft for providing Windows Tablet OS as I think they have considerably innovated in this area to help vendors use their legacy applications on mobile slate and convertible based platforms.  Multiple modalities for inputting data such as handwriting, voice, and predictive text recognition are all very good tools.  I think they were smart to merge these functions into the standard Windows 7 build and not offer a separate OS as they have in the past.

More interesting is the total rewrite of their mobile platform with Windows Mobile 7.  This ground-up initiative from Redmond is akin to becoming more like iPhone and Android operating systems but paves the way for more svelte hardware with mobile chip sets that can extend battery life without sacrificing performance.  Microsoft is bringing XAML to the mobile platform and leveraging their gaming SDK for development which eliminates any backward compatibility with pre-Windows Mobile 7 apps but I don’t view this as a bad thing.  New platform new apps…  Microsoft has long since reached the breaking point at which they need to support legacy applications and this new direction and outlook toward supporting the mobile user should be a refreshing change for developers.  A lot of our new development revolves around innovating in the user interface with Rich Internet Application (RIA) technologies such as Silverlight.  It makes us think differently about how applications are used and more importantly how it enables our users (physicians and clinical staff)  to do their job more effectively not insert yet another technology that gets in their way.

It has been a while since I posted an entry but my entire team and I have been hard at work maintaining existing applications and plugging away at UI and WCF service development.   Stay tuned…as we plug through our iterations and get ready to deploy our app I’ll share with you some of what WellMed is doing to “change the face of healthcare for seniors…”

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iPhone Development

Curiosity got the best of me this evening so I signed up for the iPhone Developer Program.  Being a person who has lived through several horrible user interfaces, Apples approach is refreshingly simple and with many more capabilities in the 3.0 release of the iPhone firmware I think there are many more unique applicaitons to be built.  I have more than an idle curiousity with developing an application utilizing some of the  initiatives we currently have going on at work but time will tell what direction our mobile strategy moves in.  In the mean time I’ll test the waters to see what new API’s Apple has released with their new 3.0 SDK.  Bluetooth communications, dock connector API’s, all have some interesting possiblities.

 

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Conversation with Bill Crounse, M.D.

I had a great discussion with Dr. Bill Crounse, Director of Worldwide Health at Microsoft about their direction and focus on healthcare initiatives.  I’ve followed Bill’s blog for about a year and his insight into the ways Microsoft is innovating in healthcare is insightful.  He mentioned working with Robert Scoble, Microsoft’s former blogger extrodionare, and the need to show the world outside of Microsoft the innter workings of their relative verticals (e.g. healthcare, development, and R&D)  and how they have taken a core approach to technical interoperability and how it addresses business needs.  I do think they are strategicially looking at healthcare and not trying to blanketly push their technologies into this space without clear end-goals.  While this conference has been very tech heavy, it has thankfuly addressed several issues we deal with in our discussions with clients on a regular basis such as content management, business processes, user processes, and workflow tools.  Dr. Crounse has traveled abroad several times and offers his perspective on implementations Microsoft has done in other coutries such as China and Spain.   Especially insightful is his conceptual applications for technologies coming out of Microsoft’s R&D department.  While I’m quite doubtful for touch technology in their latest table implementation there is some value as you will see in the video I posted yesterday about it’s “Minority Report” style display tehnologys for interacting with the vasts amounts of data patients accumulate throughout their continuum of care via different multitouch displays.  Take a look at his healthcare  blog at Microsoft and his past entries for some perpective and technologies in place in other organizations.

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Google’s Android Innovates

Apple is very innovative with the iPhone but that gap won’t last long with features like this taking hold in mobile devices and an army of open source developers providing the catalyst for new and interesting features.

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SDK downloaded

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Of all people to convince me to download an SDK my wonderful wife thought it would be cool to develop an application for the iPhone. Now perhaps she got caught up in all the activity surrounding Steve Job’s keynote at WWDC ’08 this year but I figured why not download the SDK and try my hand at things. I’ve never developed in objective C before but there is a first time for everything right? I’ll put some thoughts into what types of applications you would want to carry around with you and keep everyone posted. My wife already has some interesting ideas!

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I just received my e-mail confirmation from Apple so I’ll probably dig into the SDK this evening after I finish my client work this afternoon.

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Programming Itch


I’ve got the programming itch again… For years I’ve done development on and off mostly for personal use. I created my first official application for an academic medical center in Houston a couple of years ago. It cleaned up a pharmacy database inside the EMR and updated the entries with a third party catalog of pharmacies purchased from a marketing department in California. After doing this manually by hand I though there has got to be a better way to accomplish the same thing I was using Excel, Access, and Text files to do by hand so the first Pharmacy app was created. It imported Excel documents provided by the EMR database administrator and provided a cleaned up version for import back into the EMR. After speaking with the DBA he requested the application also export a SQL text file that he could simply update the Oracle database with. So with that my first point release was born! Version 1.1 made the DBA very happy and saved about another hour of his already busy day.

So I’m tasked with how I should scratch this programming itch I have and improve my programming skillsets. With so many options like VB, C#, C++, Ruby on Rails, Java, where is a lowly programmer to start? I have become in recent years an avid Linux user and have found good use for desktop and servers in my home, and as a result have adoped and been attracted to several open source software solutions so I thought I would look in this direction first.

My requirements would be something I could easily adopt to the web as well as something powerful enough to run scripts locally and be a cross platform. So I’ve settled on PHP. My content management system web sites (Joomla, WordPress) have all been PHP based and my wife’s upcoming e-commerce site Princess and the Peas is based on a PHP e-commerce platform so I thought if I were to create any enhancements this would be a good place to start developing. I may be using this site as a testing ground so I’ll be sure to post my progress.


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Web development tree grows another branch

Apple’s iPhone certainly has one of the best mobile web browsing experience on the market today.  What does having a mobile version of Safari in your pocket mean to web developers?  Despite Apple’s best efforts in providing an uncompromising solution for mobile web browsing it means having yet another development platform to deal with.   Much to the chagrin of developers we are seeing websites developed specifically for the iPhone.  As an end user and someone who as you have probably gathered already thinks most user interfaces need a lot of work I don’t think this is necessarily a bad thing.  The extra effort in developing a platform specific version of your site can yield a completely different experience for the user.  It doesn’t hurt that Apple is gaining market share in the smart phone market either.

If a website is effectively designed there will exist a layer of abstraction between the database, business logic, and the user interface allowing flexibility to modify any specific layer.  I’ve seen this happen with back-end database systems, front end web servers and client application

I thought I would mention some websites that have effectively made already useful sites more effective with a mobile version version of Safari:

Digg – http://www.digg.com/iphone

Alltop – http://alltop.com/m/

American Airlines – http://mobile.aa.com

TripIt – http:/m.tripit.com/

Amazon – http://www.amazon.com/ (yes it redirects to the iPhone beta site)

Revision3 – http://m.revision3.com

Strategic Informatics – http://www.strategicinformatics.com/ (Also automatically redirects)

ParseAll – http://iphone.parseall.com

FlightStats – http://m.flightstats.com

Flickr – http://i.m.yahoo.com/a/flickr