Saturday, February 27, 2010

Life as a Healthcare CIO: The Interim Final Rule on Standards

I come across blog "Life as a healthcare CIO " by John D. Halamka MD . His point on Health Informatics standard very interesting and i want to share with other reader.

Yesterday at 4:15pm, HHS/ONC released the Interim Final Rule (IFR) - Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology.

Pages 79-81 contain the content and vocabulary standards

Page 85 contains the privacy standards.

Let's examine the major recommendations.
The standards selected leverage the hard work done by HITSP, Consolidated Health Informatics, Federal Health Architecture, NCVHS, and government agency efforts . The IFR notes that unless marked with the following superscripts, all of the adopted standards are from the ONC process that took place prior to the enactment of the HITECH Act or are required by other HHS regulations.

A number sign “#” indicates that the HIT Standards Committee recommended this standard to the National Coordinator but it was not part of the prior ONC process.

An asterisk “*” indicates that the standard was neither recommended by the HIT Standards Committee nor part of the prior ONC process.

A plus sign “+” as mentioned above indicates a standard that is not a voluntary consensus standard.

The content and vocabulary standards selected includes Adopted Standard(s) to Support Meaningful Use Stage 1 (2011) and Candidate Standard(s) to Support Meaningful Use Stage 2 (2013).

1. Patient Summary Record
The adopted content standard is HL7 CDA R2 CCD Level 2 or ASTM CCR. The candidate content standard is the hope that this will be converged to a single standard based on HIT Standards Committee recommendations. As I said in my Genius of the AND blog, I truly believe that CCD and CCR is the most parsimonious set of content standards for the summary record in 2009. I'm hopeful that HL7 and ASTM will continue their work together, simplifying the XML of CCD so that CCD and CCR can converge into a single approach which makes implementation easier for all.

Of interest, page 66 of the IFR notes that CCR must be parsed by all EHRs even if CCD is used. Per the IFR - "A final example would be, if an eligible professional uses Certified EHR Technology that has implemented the continuity of care document (CCD) standard for the exchange of a patient summary record and receives a patient summary record formatted in the continuity of care record (CCR) standard, their Certified EHR Technology must be capable of interpreting the information within the CCR message and displaying it in human readable format. We do not expressly state how this should be accomplished or in what format human readable information should be displayed (e.g., information in a CCR message could be converted to a text file or PDF). We only require that Certified EHR Technology must be capable of performing this function. We believe this requirement is critical and have included it to allow flexibility in the marketplace during meaningful use Stage 1 and to prevent good faith efforts to exchange information from going to waste (i.e., information is exchanged, but is unreadable to both Certified EHR Technology (machine readable) and humans)."

The adopted vocabulary standards for problem lists are the applicable HIPAA code set required by law (i.e.,ICD-9-CM) or SNOMED CT. The candidate standards are the applicable HIPAA code set required by law (e.g.,ICD-10-CM) or SNOMED CT. My hope is that SNOMED CT adoption is accelerated and that ICD-10's role will be limited to a back office function. Widespread implementation of ICD-10 will be costly and brings little added value to clinicians, while SNOMED CT captures clinical observations very well, enabling decision support and better quality measurement.

The adopted vocabulary standards for medications are any code set from an RxNorm drug data source provider that is identified by the United States National Library of Medicine as being a complete data set integrated within RxNorm+ (note the + indicating RxNorm is not a consensus standard from an SDO, it's a product of the National Library of Medicine). For a complete list of the allowable vocabularies, see the NLM list which includes:

GS - 10/01/2009 (Gold Standard Alchemy); MDDB - 10/07/2009 (Master Drug Data Base. Medi-Span, a division of Wolters Kluwer Health); MMSL - 10/01/2009 (Multum MediSource Lexicon); MMX - 09/28/2009 (Micromedex DRUGDEX); MSH - 08/17/2009 (Medical Subject Headings (MeSH)); MTHFDA - 8/28/2009 (FDA National Drug Code Directory); MTHSPL - 10/28/2009 (FDA Structured Product Labels); NDDF - 10/02/2009 (First DataBank NDDF Plus Source Vocabulary); SNOMED CT - 07/31/2009 (SNOMED Clinical Terms (drug information) SNOMED International); VANDF - 10/07/2009 (Veterans Health Administration National Drug File). Also, FDA Unique Ingredient Identifiers (UNII) are a component of RxNorm.

The candidate vocabulary standard is RxNorm. I believe that the EHRs will continue to use proprietary standards internally for many years to come, but will need to map to RxNorm for all data exchanged.

The adopted vocabulary standard for allergies is not specified at this time i.e. free text or local vocabularies are fine. The candidate vocabulary standard is the Unique Ingredient Identifier (UNII). This makes great sense, since it will take vendors and self built system operators several years to implement controlled allergy vocabularies throughout their products.

The adopted vocabulary standards for procedures are the applicable HIPAA code set required by law (i.e.,ICD-9-CM) or CPT-4. The candidate standards are the applicable HIPAA code set required by law (e.g.,ICD-10-CM) or CPT-4. Of all the vocabulary standards mentioned in the Interim Final Rule, only one, CPT-4, requires payment for its use. I hope that HHS licenses CPT-4 for general use just as it has licensed SNOMED-CT. This will significantly reduce the implementation burden.

The adopted vocabulary standard for Vital signs is not specified at this time i.e. free text or local vocabularies are fine. The candidate vocabulary is a CDA template. This makes sense. I'm a fan of CDA templates to make CDA easier to implement.

The adopted vocabulary standard for units of measure is not specified at this time i.e. free text or local vocabularies are fine. The candidate vocabulary is UCUM. This is a very reasonable approach, giving commercial and hospital labs the time they need to implement a controlled unit of measure vocabulary standard.

2. Drug Formulary Check
The adopted content standard for Drug Formulary Check is the Applicable Part D standard required by law (i.e., NCPDP Formulary & Benefits Standard 1.0). The candidate vocabulary standard will also be whatever is required by Part D. This standard is widely deployed and there are no credible alternatives.

3. e-Prescribing
The adopted content standard for e-Prescribing is NCPDP script 8.1 or NCPDP script 10.6. The candidate standard is NCPDP Script 10.6. We debated this at the HIT Standards Committee, hoping that NCPDP 10.6 could be accelerated, but it is a reasonable compromise to offer some transition time. The adopted vocabulary standards are the same as for the Patient Summary Record above.

4. Administrative Transactions
The adopted and candidate standards for Administrative Transactions are those required by HIPAA i.e. 4010 now and 5010 in 2013. This is expected.

5. Quality Reporting
The adopted content standard for quality reporting is the CMS PQRI 2008 Registry XML Specification#,+ (note that this means it was suggested by the HIT Standards Committee and not by HITSP, it's not an SDO product but was produced by CMS). The candidate standards are those to be suggested by the HIT Standards Committee. We debated this at the HIT Standards Committee because QRDA is an emerging standard for quality reporting but not a widely implemented one. This glide path is reasonable, but does require implementers to change course - implementing PQRI XML now and possibly QRDA or other standards later. It will be interesting to follow the comments on this one - maybe PQRI and QRDA should be allowed now to prevent this rework.

6. Submission of Lab Results to Public Health Agencies
The adopted content standard for lab reporting is HL7 2.5.1. The candidate standards are potential newer versions to be recommended by the HIT Standards Committee such as CDA documents. This is very reasonable given that all lab transactions in the country currently use HL7 2.x approaches.

The adopted vocabulary standard is LOINC when LOINC codes have been received from a laboratory. The candidate vocabulary standards are LOINC, UCUM, and SNOMED CT or Applicable Public Health Agency Requirements.

What does this mean? Per the IFR "We do not require Certified EHR Technology to be capable of mapping all laboratory orders or tests to LOINC codes. Rather, we require that Certified EHR Technology be capable of using LOINC codes that are received and retained to populate a patient summary record. Moreover, having LOINC codes used internally for meaningful use Stage 1 will prepare Certified EHR Technology for any future potential meaningful use Stage 2 requirements. We believe the use of LOINC, Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), and other vocabulary standards will accelerate the adoption and use of clinical decision support. Requiring LOINC as a vocabulary standard that Certified EHR Technology must have the capability to support for meaningful use Stage 1 provides an incremental approach to achieving these future goals." This is a very reasonable glide path to accelerating adoption of LOINC.

7. Submission to Public Health Agencies for Surveillance
The adopted content standards are HL7 2.3.1 or HL7 2.5.1. The candidate content standards are potentially newer version(s) or standards based on HIT Standards Committee Input, such as CDA documents. Of interest, Geocoded Interoperable Population Summary Exchange (GIPSE), a summary format for surveillance data submission, is listed as a vocabulary standard. I believe it should be moved to the candidate content standards area, as it is a great way to report summary surveillance data content.

The adopted vocabulary standard is listed as According to Applicable Public Health Agency Requirements. The candidate vocabulary standard is listed as GIPSE or According to Applicable Public Health Agency Requirements.

8. Submission to Immunization Registries
The adopted content standards are HL7 2.3.1 or HL7 2.5.1. The candidate content standards are potentially newer version(s) of standards based on HIT Standards Committee Recommendations such as CDA documents. The HIT Standards Committee discussed this, since HL7 2.3.1 is the currently accepted standard for immunization exchange, but HL7 2.5.1 is now ready. Allowing both for now makes sense.

The adopted vocabulary standard is CVX*,+, the CDC's National Center of Immunization and Respiratory Diseases (NCIRD) maintained HL7 code set. Note that this recommendation is marked as not made by either HITSP or the HIT Standards Committee, but actually it was made by both via the HITSP Interoperability Specification for Public Health Case Reporting
The Privacy and Security adopted standards represent the simplest set of technologies and policies that protect confidentiality and ensure data integrity. They are:

1. General Encryption and Decryption of Electronic Health Information - A symmetric 128 bit fixed-block cipher algorithm capable of using a 128, 192, or 256 bit encryption key must be used (e.g., FIPS 197 Advanced Encryption Standard, (AES), Nov 2001).+. This was recommended by the HIT Standards Committee.

2. Encryption and Decryption of Electronic Health Information for Exchange - An encrypted and integrity protected link must be implemented (e.g., TLS, IPv6, IPv4 with IPsec).+ This is a very reasonable recommendation that represents the best thinking of the HIT Standards Committee, HITSP and industry experts. We all recognize that TLS is great for point to point connections, while IPv6 and IPv4 with IPSec are better for organization to organization secure connections. It's a very wise approach.

3. Record Actions Related to Electronic Health Information (i.e., audit log) - The date, time, patient identification (name or number), and user identification (name or number) must be recorded when electronic health information is created, modified, deleted, or printed. An indication of which action(s) occurred must also be recorded (e.g., modification).+ Rather than require ATNA or CT profiles, this recommendation leaves the audit trail to policy - what data to record. This is a reasonable compromise distilled from many hours of expert testimony.

4. Verification that Electronic Health Information has not been Altered in Transit - A secure hashing algorithm must be used to verify that electronic health information has not been altered in transit. The secure hash algorithm used must be SHA- 1 or higher (e.g., Federal Information Processing Standards (FIPS) Publication (PUB) Secure Hash Standard (SHS) FIPS PUB 180-3).+ This was recommended by the HIT Standards Committee.

5. Cross-Enterprise Authentication - Use of a cross-enterprise secure transaction that contains sufficient identity information such that the receiver can make access control decisions and produce detailed and accurate security audit trails (e.g., IHE Cross Enterprise User Assertion (XUA) with SAML identity assertions).+ Just as with auditing, this is left to policy and does not require a single specific standard/profile such as XUA. The use of SAML approaches does make great sense and will be widely adopted in healthcare, since it is already widely used in other industries.

6. Record Treatment, Payment, and Health Care Operations Disclosures - The date, time, patient identification (name or number), user identification (name or number), and a description of the disclosure must be recorded.+ This too is left to policy, which is a great choice, since the industry has yet to figure out how disclosures will be tracked operationally.

These recommendations are consistent with the work of thousands of experts over the past decade. They do not include all the detailed recommendations from HITSP or implementation profile writers such as IHE but they do include all the highly mature constructs that are deployable in 2011 without over burdening the industry. From what I know about standards harmonization, the state of standards adoption, and the unresolved controversies/debates, the rule is the right mixture of harmonization and compromise. Not every stakeholder will be happy with it, but it is good enough. It moves us all forward toward the goal of less optionality, more constraints, and vocabulary controlled semantic interoperability.

Well done!

(Source - Life as a Healthcare CIO: The Interim Final Rule on Standards)

Health Informatics Journals - Health Informatics Forum

Here's a list of Health Informatics journals.

Artificial Intelligence in Medicine
Bioinformation Journal
BioMed Central Health Geo-informatics Journal
British Journal of Healthcare Computing and Information Management:...
Cancer Informatics
Clinical Informatics and Telemedicine Journal of the Ukrainian Asso...
Computer Methods and Programs in Biomedicine
Computers in Biology and Medicine
electronic Journal of Health Informatics
Health Data Management
Health Informatics Journal
Health Information Management
Healthcare Informatics
Informatics in Primary Care
Informatics Review
International Journal of Medical Informatics
ITIN Official journal of the British Computer Society Nursing Speci...
JAMIA: The Journal of the American Medical Informatics Association
JBI - Journal of Biomedical Informatics
JHIDC Journal of Health Informatics in Developing Countries
Journal of Medical Internet Research
Medical Informatics and the Internet in Medicine
Medical Technology Business Europe developments in electronic medic...
Methods of Information in Medicine
Online Journal of Nursing Informatics (OJNI)
Perspectives In Health Information Management
Printernet a German Nursing Sciences/Informatics journal
Telemedicine Today

Sources: HIWW, HI Europe, Informatics Review
Health Informatics Journals - Health Informatics Forum

Friday, February 26, 2010

Cisco UCS testing shows throughput constraints, one lab says

Cisco's Unified Computing System (UCS) architecture has severe bandwidth constraints that limit throughput to a fraction of what is promoted by the company, according to a testing lab. The lab also claims that UCS actually works against the necessary automation for a virtualized environment.

An anonymous Cisco competitor commissioned Tolly Group to perform the Cisco UCS testing. Tolly claims that while Cisco promotes UCS blades as having 40 Gbps of capacity, actual throughput enabled during testing was as low as 27 Gbps.

"In recent weeks, we have been asked by one of Cisco's former blade server partners to benchmark the network throughput of Cisco's UCS for an upcoming comparative report. The limitations of Cisco's external switch-based UCS architecture were eye-opening to say the least," Tolly Group founder Kevin Tolly wrote. The full report is scheduled for release Friday.

Analysts and engineers familiar with UCS agree that Cisco's Unified Computing architecture – which includes blades, chassis, fabric interconnect and extender, management software, and network adapters -- constrains bandwidth in ways that technology from competitors may not, but they say the throughput enabled is perfectly suitable to support today's applications. They also say that competitors' products have other drawbacks.

"This is not a real-world instance [for testing]," said one engineer, who runs a Cisco shop but hasn't yet implemented UCS. "No one is pumping out 10 gigabits per second." The engineer's own shop is 85% virtualized, runs on a 4 gigabit uplink backbone and has never had a bottleneck problem, he said.

Cisco UCS testing: Where bandwidth constraints may be found

The Tolly test points to a number of throughput trouble spots in the unified computing architecture, starting with the idea that there are more servers than active uplinks in a chassis and that there is dependence on a clumsy external switch.

A single UCS chassis holds eight servers, each of which has its own 10 GbE converged network adapter, but the chassis' fabric interconnect has only four active uplinks to the top-of-rack switch.

"Even though the blades have a theoretical aggregate capacity of 80 Gbps, they all have to communicate to the top-of-rack UCS 6120 XP Fabric Interconnect switch via the maximum of four 10 GbE uplink ports of the UCS 2104 Fabric Extender," Tolly wrote. "The UCS chassis can accept a second fabric extender, but Cisco documentation makes it clear that this second unit is for failover only and cannot be used to provide 80 Gbps of uplink connectivity."

Is Cisco unified computing architecture static?

Once the throughput is essentially cut in half by "eight servers vying for four available uplinks," the system does not then automatically aggregate the 40 Gbps of bandwidth across the servers as needed, Tolly said in his report.

"Cisco documentation informs us that a given server is 'pinned' to a given uplink port. 'Pinned' as in static, can't move, can't change, maxed out," he wrote.

Having thumbed deeply through Cisco's UCS user guide, Tolly found the following quote halfway through: "The pinning determines which server traffic goes to which server port on the fabric interconnect. This pinning is fixed. You cannot modify it. As a result, you must consider the server location when you determine the appropriate allocation of bandwidth for a chassis."

Not only does the idea of "pinning" go against the very idea of automated virtual machine migration, according to Tolly, it causes further bandwidth limitation.

Tolly first benchmarked the throughput between two physical servers "pinned" to different uplinks with positive results. Out of the maximum of 20 Gbps bi-directional, he measured 16.7 Gbps of application throughput, not counting lower-layer protocols.

But when the same test was conducted between two physical servers that were tied to the same uplink, there was contention between the two servers as traffic transited the top-of-rack switch.

"The aggregate throughput dropped to 9.10 Gbps out of a possible 20 Gbps," Tolly wrote. "Further tests, and common sense, showed that the best throughput would be achieved when two pairs of servers pinned to the four different links communicated 1 to 2, and 3 to 4. That got us about 36 Gbps. That's great, but what about your other four servers?"

When Tolly added two more real servers and requested additional bandwidth, there was significant degradation resulting from the contention.

"By the time we reached the limits of our test requesting an additional 20 Gbps of bandwidth, Cisco's total system throughput had dropped to just 27 Gbps," he wrote.

Will Cisco UCS bandwidth constraints become a real problem?

When Cisco first set out to design UCS, developers didn't anticipate the speed of virtualization uptake and its bandwidth requirements, said Joe Skorupa, research vice president at Gartner. For now, Cisco's UCS far exceeds the needs of most shops.

"As virtualization proceeds over the next 18 months, the bandwidth requirements will increase," he said, adding that eventually Cisco will have to address the problem.

The company would have done better to design around the problem from the start just to avoid these types of claims, Skorupa said. After all, the networking giant is the "new kid on the block," with a battle against competitors that will be exhausting. But he said it's likely that Cisco's next iteration of equipment will address the problem.

Cisco didn't respond to Tolly's testing results, saying: "Cisco did not authorize or actively participate in the Tolly Group test, therefore we cannot accept or validate its conclusions. Further, Cisco cannot comment on test reports that have been paid for by another vendor."

Tolly contacted Cisco for participation in the course of testing, but Cisco declinedCisco UCS testing shows throughput constraints, one lab says

Problem With Network In Fakulti Perubatan Sg. Buluh CTC,IMMB and RC - Internet very slow ! can u fix it ASAP!

One of the challenges of being a ICT Project Manager for this project is the "internet is slow, can you fix it" phone call. Generally, the network is blamed first, but there are many layers that all need to be examined - desktop, network, server, storage, database, active directory, internet service provider etc. For example, a complaint about email slowness can be caused by a lot of factors.

After do some research and analysis on the network configuration i found out 2 factors contribute to the problem "internet is slow, can you fix it". (a) The network configuration configure by CCNP from datacraft configured without proper planning (b) The juniper router configure by Mesiniaga configured without understanding over all scenario of UiTMNet environment.

Since this project still under defect liability period so I'll conduct special meeting to revolve this problems as soon as possible.

The general approach i will used cover three domains. Begin by identifying and defining the problems from a user perspective. This helped to identify issues related to system performance versus non-technical issues that amplified the technical issues and affected user perception of performance, e.g. training, improper usage of the application.

I'll used multiple subject matter experts to focus on the different domains to ensure they had the in-depth knowledge to evaluate each of them.

The three investigation domains and key focus areas within each domain is:

End User Observation & Interviews
Client device performance analysis
Device configuration & Log review
Device specification analysis per application vendor recommendations

WAN link utilization
Device performance analysis
Device configuration & Log review
Packet Loss & Latency analysis
Traffic Analysis

Server and Storage performance analysis
Device configuration & Log review
Service and Process performance analysis
Device specification analysis per application vendor recommendations

The findings from the assessment did not identify a "magic bullet" issue that caused performance issues, but instead identified multiple smaller issues that combined to impact system performance.

In my experience of troubleshooting complex IT systems, I've found that the comprehensive approach outlined above works very well. Hope to see the result soon...

Thursday, February 25, 2010

The Ultimate Guide to Taking Control of Your Health Records | NOEDb

Managing your personal health records has become the latest buzz. By utilizing an online service, you can record, store, update, and share all your information. Having all of your information in one place promises to provide better treatment for routine medical care, and in cases of chronic illness or emergencies, having the most up-to-date information on your health can make the difference between life and death. The following resources will help you learn about managing your health records, tell you where to go for the best services to help you, and offers a peek into what medical providers can implement.

Gathering Information about Electronic Health Records (EHR)

Before you start managing your health records, it's best to get the facts relating to how and why it's done. The following resources will help you find out the basics about EHR.

  • The International Council on Medical & Care Compunetics. This international site posts articles, studies, and more to help inform or raise discussion questions about EHR. Read articles that touch on topics such as the security of Google and Microsoft for medical records to social networking and patient portals. Because this site is international, not all articles are in English.
  • HIPAA. Health Insurance Portability and Accountability Act was established in 1996 to set rules for electronic medical records. Visit this site to learn all the latest on health information, background information, regulations and standards, and compliance and enforcement.
  • This personal health record resource is sponsored by the American Health Information Management Association, a non-profit devoted to managing health records. At this site, you will learn why it's important to manage your records and how to go about doing so by accessing their resource library. You can also research various types of record management systems that are on paper, software-based, or on the Internet, ranging from free services to those with cost.
  • emrupdate. Get the latest news, read blogs, and join in forums all discussing the EMR issue. This site is an unbiased site, but it does allow Google ads, which will flash names of various EMR providers across the top of the page.
  • Personal Health Record (PHR) Systems: An Evolving Challenge to EHR Systems. Read about PHRs and learn speculation on how they may evolve over the next several years in this helpful primer.
  • RPMS EHR Website. While designed for health care management of American Indians and Alaska Natives, this website offers an informative view of electronic health record management in action through articles, presentations, training, and a forum.

Free Services and Tools

All of these resources are free of charge and will help you set up a personal health record management system. Many of these services work in conjunction with the first two--Google Health and Microsoft HealthVault.

  • Google Health. With Google Health, you can organize all your health records in one place. Once you sign up, you can import medical records, choose conditions about which you would like to receive more information, and find out how your medications might interact. You can even search for doctors by specialty or location and receive a Google Map with each result.
  • Microsoft HealthVault. Collect, store, and share your health information with this free service. It also connects to a variety of sites, programs, and devices that utilize your information to enhance your health record management.
  • iHealthRecord. Now merged with Google Health, this free service is easy to use, secure, and used on over 100,000 physician websites. You can sign up for a free account, link it to your information in Google Health, and be able to manage everything from one spot. You can even print a handy wallet card to carry important health information with you always.
  • MediKeeper. Create your own health page with this service that works in collaboration with Microsoft HealthVault. You can track your health risks, get personalized alerts, and receive health news.
  • myHealthfolio. Manage your health records with this service that includes health calendars, health cost management, medication management, health education, and more. This service works along with Microsoft HealthVault.
  • Based in the U.K., this service provides support and information on conditions ranging from asthma to diabetes to stroke and their treatments.
  • Dr. I-Net. Manage your medical records, lab results, and medical billing with this resource. You also have access to a wide range of information on a variety of health topics.
  • Health Butler. This preventative health website helps you manage your care and records through such preventative measures as cancer screening, immunizations, and more. You can even receive email reminders for your personal preventative healthcare tasks.
  • TouchNetworks. Patients can store their health information, make it available to their physicians, and communicate with their physicians through this free service.
  • WorldMedcard. Store your health information here, then print out a card that you carry in your wallet. Any time you need medical attention, whether routine or emergency, your information card allows access to your full, up-to-date medical records. With participating providers in over 36 countries, you can feel comfortable that no matter where you are, your medical provider will be able to help you with a more personalized treatment.
  • ZebraHealth. Manage your health history, medications, allergies, physicians, and more with this service. You also have access to a physician locater, health forums, and health news updates.
  • WebMD Health Manager. Use this service to manage your health records, get health assessments and a personalized health plan, and more. You can even share your information with your health care provider with this service.

Services and Tools Available for a Fee

While there are many services you can get for free, others cost a bit of money. It might be worth it to you if you feel the security is better or the services far outweigh what you can get for free. Some services are highly specialized and charge a fee because of their tight focus.

  • HealthRecords Online. Manage your emergency contact information, medical records, obstetric records, get newsletters and health reminders, and have your physician notes all in one place with this service out of Canada. This service requires a paid subscription, and is directly connected with participating physicians around the world for a seamless medical record management system.
  • ActivePHR. Receive 90 days free before signing up for a subscription with this service that stores health information, tracks test results and health goals, and makes information available to physicians, family members, and emergency personnel. This service works with Microsoft HealthVault.
  • icePHR. Working in conjunction with Microsoft HealthVault, you can organize and track up to ten family members' health profiles with this service. Some of the information you can manage includes personal contact information, allergies, conditions, emergency contacts, immunizations, and medical devices.
  • GeneMedRX. Manage both prescription and non-prescription drugs through this service to reduce the risk of an adverse drug reaction. There is an annual fee for this service, and additional family members can sign up for a reduced fee.
  • PureWellness. With health risk assessments, diet and exercise tools, incentive tracking, online coaching and mentoring, and a resource library, this service will help keep you healthy.
  • MyVitalData. Keep all your most important information here. You choose what you want to share, making it available to hospitals, first responders, and disaster response teams. There is a fee to maintain this service, but the cost is very low.
  • This service takes information from your health profile, your available workout resources, and the music on your MP3 player to create a customized fitness program designed by top fitness trainers. You will end up working out to your favorite songs without needing to buy any additional equipment and know that your exercise program is custom tailored for you.
  • TrainingPeaks. If you are in training, this service will help you manage your fitness with a virtual coach and training plans, help you make healthy food choices, and allow you to analyze your performance. There is an annual fee for this service, but it is probably less expensive than that gym membership and a lot more personalized.
  • MySelfHelp. Help yourself with this behavior-management service that will assist you in making positive changes in areas such as depression, stress, insomnia, eating disorders, grief, guilt, low self-esteem, and compulsive shopping. This service is available for a monthly fee.
  • Store your health records, print a personalized emergency card, track prescriptions, and communicate with your physician with this Swiss-based company. Children under five are free with adult memberships.
  • FullCircle Registry. Manage your living will and emergency contact information with this service. In case of a health emergency, medical staff will know your wishes and your family members will be contacted right away. There is a fee associated with this service, but the annual cost is low.
  • ElderIssues. Elder care can require many different medical needs. Whether you are currently caring for a parent, planning to care for a parent soon, or are planning for your own care, you can manage all the necessary medical records here for a small monthly fee.
  • Keep your entire family's records together with this service. You can even print out the records or have a basic version sent to select physicians prior to your appointment. These services are free of charge, but for a fee, you can upgrade to a better subscription, which includes a service that uploads your information and sends it to your physician on the forms used at that specific office.

Services and Tools for Specialized Groups

From veterans to those with chronic illness to the parents, the following resources are all designed for a niche market. Whether you are looking for a fitness program or a way to monitor your weight, you are sure to find something useful among this list.

  • VistA. Veterans Administration health care system is one of the largest integrated systems in the world. Patients have access to Personal Health Journals through MyHealheVet in this system.
  • Heart Profilers. Sponsored by the American Heart Association, you can manage your heart health care with this free service that works with Microsoft HealthVault.
  • DPS Weight Management. A part of Microsoft HealthVault, this service helps you make healthy lifestyle choices with behavior planning and tracking as well as weekly lessons to help you manage your weight.
  • MSN Route Tracker. Manage your exercise goals with this creative service. Select your destination, then log and track your exercise progress as you learn about where your virtual hike is taking you. Your fitness goal will take on a whole new life.
  • LifeMasters. Managing care for patients with chronic disorders, this service connects physicians, patients, and payors to ensure the best treatment and reduced financial costs through better management of the patient's health care. They offer support on a wide range of disorders such as asthma, cancer, congestive heart failure, and low back pain management.
  • MiVIA. Originally launched as a personal health record resource for migrant and seasonal workers in California, this service is now available for many populations with special needs such as those living with chronic illnesses or the uninsured. MiVIA is used by many clinics, mobile clinics, and rural hospitals.
  • SugarStats. For people managing diabetes, this free service will come in handy. Track and monitor your blood sugar levels and even share them with your family or physician. This service is free, but they do offer a premium service with more enhanced features for a fee.
  • Trixie Tracker. Parents who want to keep a record of their baby's daily patterns can do so with this service. Track your baby's sleep, diaper changes, bottles or breastfeeding, medicine doses, and more; then share with family and friends if you want. There is a monthly fee for this service, but buying in bulk saves you money.

Services for Medical Professionals

Whether you are a physician who wants information on setting up an electronic records system or a patient who wants to find out more about what is out there and what institutions are using to manage your records, the following list covers different types of systems available as well as information such as how and why to implement a system and an assessment of some of the open source systems available.

  • Indivio. This personally controlled health record allows patients to have full copies of their medical records in a secure format. Because this technology is open source, it is available to all developers at no cost to implement.
  • Centricity EMR. This GE product promises a virtually paperless office with their system. Subscribers to this service receive free webinars, case studies, and white papers as a part of the service.
  • e-MDs. Using Microsoft technology, this system is designed to be easy to use and implement. It also offers handwriting recognition and automatic ICD-9 coding for medical professionals using the system.
  • CapMed. Having been around for over ten years, this company is the "leading provider of interactive personal health management solutions for the healthcare and pharmaceutical industries." Find all you need about setting up this system that provides quality and security for its clients and their patients.
  • Open-Source EHR Systems for Ambulatory Care: A Market Assessment. Find out what these researchers have to say about several open source systems and whether or not they are suitable for professional use.
  • HiMSS Electronic Health Record. Find out why you should implement an EHR system, get legislation, the latest news, tools, and more from this informative site that lets the medical professional become an informed user of EHRs.
  • Eclipsys Sunrise Patient Portal. Provide important medical information to your patients about their health care via this portal. Patients can connect with their Microsoft HealthVault account.
  • CureMD. Both an electronic medical record management and practice management system, physicians can get connected with this service. Among the features are browser-based medical records, front office management, patient portal, mobile access, and more.

The Ultimate Guide to Taking Control of Your Health Records | NOEDb

Salam Maulidul Rasul - Bermulanya Sebuah Kepimpinan Melalui Teladan

"Perjuagan kearah satu akidah, satu kepercayaan, satu Tuhan, satu perjuangan, satu pemikiran, satu tindakan dan satu iman.."

Sekadar Merehatkan Mata

Jury finds mother guilty of murder in girl’s drug death - The Boston Globe

A South Shore mother was found guilty yesterday of second-degree murder in the death of her 4-year-old daughter, Rebecca, who went to sleep one night after being given toxic levels of psychotropic drugs and never woke up. Carolyn Riley, 35, showed no visible emotion when the 12-member jury returned the verdict after 19 hours of deliberations in Plymouth Superior Court. Riley, her upper chest displaying a “Rebecca 12-13-06’’ tattoo that reflected her daughter’s date of death, was handcuffed as soon as the word guilty was uttered by the jury forewoman.

Before sentencing, Judge Charles Hely permitted the reading of a letter from Ashley Davidson, 17, Riley’s first biological daughter, who as a toddler was removed from her mother’s care, placed in a foster home, and eventually adopted. The teenager condemned her mother for the cruel fate she delivered Rebecca, as well as the tormenting memories left for her and Rebecca’s two other siblings, ages 14 and 9, now both in foster homes. “When I think that you are my biological mother, I sometimes wonder if it is in my blood. Will I grow up to be a mother like you?’’ said the letter, read by her adoptive father, Bob Davidson.

Riley, who has an additional tattoo on her arm with the name Ashley, listened and stared at the floor.

The judge sentenced her to life imprisonment, with the possibility of parole after 15 years, the mandatory punishment for a second-degree murder conviction. It was one of the lesser offenses that the jury of eight women and four men was allowed to consider in this first-degree murder case.

As officers led Riley out of the courtroom, she looked at her mother, Valerie Berio, a constant presence in the 3 1/2-week trial who was sobbing among the spectators. Riley quietly wept as she was taken our to be transported to MCI-Framingham.

While Plymouth District Attorney Timothy J. Cruz praised the verdict as “a small measure of justice for Rebecca,’’ the mother’s defense lawyer, Michael Bourbeau, said the decision, which he plans to appeal, reflects the jury’s judgment of “what kind of a mother she was,’’ as opposed to the evidence in the case.

He had argued to jurors that medical evidence showed that Rebecca died of fast-acting pneumonia, not drugs, and that the mother gave medications based on the sometimes-flexible instructions of her child’s psychiatrist.

Riley’s husband - Michael Riley, 37 - will be tried separately on the same charges, and his case is scheduled to go to trial next month unless yesterday’s result leads to a plea bargain.

Rebecca’s case attracted national attention to the expanding use and potential abuse of giving psychotropic drugs to very young children. When Rebecca died, she and her two older siblings, Gerard and Kaitlynne Riley, were each on three potent psychiatric medications for bipolar and hyperactivity disorders. Each of them went on the drugs at age 2.

Prosecutors say Carolyn and Michael Riley, Weymouth High School graduates who had been living briefly in Hull when Rebecca died, deliberately sought the psychiatric drugs for their three children to scam their local Social Security office into approving disability benefits.

But behind the twists of the case is the all-too-familiar tale of a deeply troubled, financially strapped couple whose capacity to harm their children became catastrophically evident - to their many doctors, psychiatrists, teachers, and social workers - only when it was too late.

The prosecutors, Frank J. Middleton Jr. and Heather Bradley, depicted Carolyn Riley as an unusual form of child abuser, a woman who used three sedating medications, including Depakote, Seroquel, and clonidine, to control her energetic toddlers and induce sleep.

Remarkably, prosecutors said, Carolyn Riley managed to obtain the drugs routinely through prescriptions from Dr. Kayoko Kifuji, a Tufts Medical Center psychiatrist who faces a medical malpractice lawsuit in the death and agreed to testify only after being granted immunity from prosecution.

On the night Rebecca received her fatal overdose, her father, who had been prone to violent outbursts, became irate about the child’s pleas to be with her mother. Rebecca had been battling a respiratory illness for days, and that night, according to housemates, Rebecca kept trying to enter her parents’ bedroom, moaning, “Mommy, Mommy.’’

Prosecutors said that the mother, whom they portrayed as routinely putting her husband’s needs above her children’s, went to the pill dispensers in their Hull home. That night, the state said, Carolyn Riley gave the coughing and feverish child as much as twice the girl’s daily dosages of clonidine at once, the equivalent of seven tablets of .1 milligram each.

Rebecca’s lifeless body, clad only in a pull-up diaper with a teddy bear beneath her head, was discovered by her mother around 6 a.m. on Dec. 13, 2006, next to her parents’ bed.

Her defense lawyers, however, portrayed Carolyn Riley as an overwhelmed mother deserving of sympathy, a former foster child who was doing her best to raise a family in which the adults and children all had mental health problems.

If the mother had some lapses, her lawyers said, they had to be viewed in light of the difficult choices of a woman struggling with poverty and a domineering husband.

In the year before Rebecca died, Michael Riley saw the children sporadically. He was barred from living with the family in a Weymouth housing development because he had been charged with trying to sexually assault and show pornographic pictures to Ashley during one of her visits with the family.

The father, who was convicted of only the pornography charge and served a 2 1/2-year prison term that ended this year, remains behind bars awaiting his trial in the death of Rebecca.

The attachment of Carolyn Riley to her husband was a recurring theme in the lengthy trial. As the mother waited over three days for a verdict, sitting on a bench reading a romance novel and playing games on her cellphone, she responded readily to reporters’ questions.

When asked about the prosecutor’s argument that she and her husband wanted only to maximize their disability benefits, the mother, who speaks with a soft, girlish voice, disputed that point. She said that Social Security awards more money in total to a couple who file as unmarried singles.

But, she said that she and Michael, together for more than 15 years, chose to remain true to their status as a wedded couple.

“We would have gotten more money if we weren’t married,’’ she said.

Jury finds mother guilty of murder in girl’s drug death - The Boston Globe

Wednesday, February 24, 2010

The Top 100 Open Source Software Tools for Medical Professionals

Open source software benefits professionals in all industries: government, Internet, business, education, and even health care. Expensive software and subscriptions for anti virus systems, supporting electronic medical records and even phone or e-mail communications can put on a strain on small clinics as well as larger hospitals. Open source tools are free, highly customizable, and secure enough to handle the sensitive data that medical professionals often work with. Read below for our list of the top 100 open source software tools that benefit health care professionals.

Medical Billing and Electronic Medical Records

These open software tools will help you manage your medical practice, from organizing EMRs to billing.

1. FreeMED
The FreeMED project is a “system for medical providers that runs in any web browser in multiple languages.” FreeMED will keep your EMRs safe and organized.

2. OpenEMR
Take paperless billing to the next level by transitioning to an open source format. OpenEMR features appointment scheduling, patient registration, payment tracking and more.

3. OpenEMR Current
OpenEMR Current is another electronic medical records software system.

4. OpenEMR Virtual Appliance
This version of OpenEMR open source software runs with the FreeVMware Player and features the FreeB billing application.

5. FreeB
This GPL medical billing program can be used with any EHR system and “tracks basic demographics, procedure codes and diagnosis codes.”

6. SmartCare
This software develops EMR programs that can be used in disadvantaged countries, particularly Zambia.

7. XChart
XChart is a project by the Open Healthcare Group that promotes EMR, based in XML.

8. OpenMRS
This medical record system is a Web-based open source program that is designed for medical professionals working in developing countries.

9. Open Dental Software
This set of tools is designed just for dental offices. Doctors and staff can manage inventory, appointments and more.

10. ClearHealth
ClearHealth is powered by open source software and “covers the five major areas of practice operations including scheduling, billing, EMR, HIPAA Security and accounts receivable.”

Antivirus, Security and Privacy

From protecting and saving your research data to keeping patient information private, these open source security tools are vital for any medical professional.

11. PeerGuardian 2
PeerGuardian is an IP blocker for Windows operating systems.

12. Eraser
This free software program lets users remove private files from their hard drive through an advanced overwriting technique.

13. Clam Win
Perfect for health care professionals on a budget, this antivirus software is completely free. It also features high detection rates for spyware, a scanning scheduler, and an app that searches Outlook for virus-infected attachments.

14. PktFilter
Certain Windows users can utilize this security tool which configures IPv4 filtering devices.

15. The Open Anti Virus Project
Access a free anti virus system here.

16. SuperShredder
This file-shredding software makes sure sensitive data is completely destroyed.


17. Zimbra
Zimbra’s e-mail solution is used in government offices, education institutes and other business environments. Medical professionals will benefit from its fast backup and recovery of mailboxes, anti-spam and anti-virus protection, BlackBerry and other mobile device support, and flexible applications.

18. Thunderbird 2
Organize your inbox with the help of Thunderbird 2, a tool that “allows you to customize your e-mail to suit your needs.”

19. phpBB
Set up a forum on your medical blog or website with this popular program.

20. Mirth
This solution supports HL7 messaging, letting healthcare professionals manage and customize data interfaces.

21. Asterisk
This “complete telecommunications platform” features telephony actions like voicemail set up and call conferencing, so you can cut down on phone bills.

22. hMailServer
Cut down on costs with this free e-mail server for Windows.

23. Pidgin
This tool is especially useful for medical professionals who travel or are in private practice. Consolidate all of your IM accounts with this tool, which allows you to communicate with patients, family and vendors from AIM, Google Talk and other IM clients.

24. aMSN
If you’re addicted to your MSN chat service but need to communicate with contacts who use other clients, use aMSN to chat with users from any network. aMSN also features webcam support, offline messaging and chat logs.

25. MailArchiva
Organize your inbox with this open source tool that will help you archive incoming and outgoing e-mails.

26. OpenMoko
Learn about the project to “free your phone” and customize your mobile experience here.

27. Podcast Generator
Design and publish your own podcast with this open source software program. It comes with multi-language support, Web mp3 streaming and the ability to support any media file type, including mp3s, oggs, and mixed audio/video podcasts.

Graphics and Imaging

Use these graphics and imaging tools to view brain images, 3D images and more.

28. Eviewbox DICOM
This Java tool is a portable digital light box that lets medical professionals view all kinds of images, including DICOM images.

29. Gallery
Share photos with patients and office staff by using this open source tool. You can upload pictures onto your website and organize online photo albums.

30. Medical Image Viewer
This free program reads DICOM, raster and Analyze/Nifti images. Doctors can upload and manipulate medical images including an x-ray on their computers with this program.

31. Medical Imaging Interaction Toolkit
Also known as MITK, this tool features plane rotation modes, 2D and 3D views, RAW image import and data storage.

32. BrainVisa
This interactive software shows different images of the brain.

33. ParaView
ParaView is used “for parallel, interactive, scientific visualization,” according to Wikipedia.

34. ClearCanvas Workstation
ClearCanvas’ Workstation 1.0 is a DICOM PACS viewer for medical professionals.

35. Endrov
Endrove is a plugin that acts as a database, library and imaging program. Users can create their own editing tools, and the program can support XYZ, time and channel dimensions.

36. 3D Slicer
This multi-platform visual and image computing software system features manual editing capabilities, fusion and data co-registering, “visualization of tracking information for image-guided procedures” and interactive options.

37. MedINRIA
This medical image and processing tool displays high-quality algorithms.

This tool is “a competely free tool for viewing, analyzing, and registering volumetric medical imaging data sets.” AMIDE runs on Macs, PCs, Linux machines and more.

39. Tempo
Tempo displays brain electrical activity on your computer in a 3D format. Features include animated topographic maps, a 3D rotating head model and a free download.

Content Management Tools

Manage your medical blog or website with these user-friendly open source tools, which allow you to reach a wider audience and share your advice.

40. Joomla
Joomla supports “cutting edge content management” that stores images, presentations, and documents. It also has a simple installer, features an image manager and more.

Manage your web content with XOOPS, whether you’re setting up a forum on your site or just want to work on your blog.

42. Drupal
Drupal is flexible enough to support personal blogs and large interactive sites. Features include easy searching capabilities, indexing, customization accessories, online help and more.

43. WebGUI
WebGUI is “web done right.” It currently runs 10,000 websites, and allows users to sell and advertise products, maintain subscription services, beef up site security, publish articles, upload photos and more. It works whether you want to start your own healthcare business or simply dispense advice and attract new patients.

44. Caisis
This program tracks and manages data relating to cancer patients.

Research and Reference

For quick assistance for your research studies, take advantage of these open source reference items.

45. XTerm Medical Dictionary
This medical dictionary and database is updated twice a month, so you’re always current.

46. OpenClinica
This open source project is a “web-based electronic data capture system for clinical research.” The tool lets users manage data, submit new information, extract data, manage accounts and more.

47. PubMed
The U.S. National Library of Medicine sponsors this search tool that includes life science journals and other references.

48. caGrid 1.1
In an effort to connect scientists, tools and the medical community, this project makes cancer research data more accessible.

Medline is a free web-based database that holds journals, articles and other references for scientists and medical researchers.

50. MIX
MIX is a meta-analysis tool that’s free and open source. It works with Microsoft Excel and “can be used to reproduce the meta-analytical calculations and graphical data explorations of virtually all” meta-analysis data sets.

This free and open database is designed to “facilitate the exchange and pooling of results…for clinical care, outcomes management, and research.” LOINC stands for Logical Observation Identifiers Names and Codes.

52. The National Drug Code Directory
Look up drug products and information in this government directory.


For open source software to make the most of your audio, visual and mobile files, look to these free tools.

53. Krut Computer Recorder
Save and record audio and video from your computer screen with the Krut Computer Recorder.

54. Juice
If you’re in surgery while your favorite medical podcast or Internet program runs, you can use Juice to “create your own custom online audio anytime.”

55. National Heart Lung and Blood Institute Interactive Tools and Resources
Access applications and reference tools from the NHLBI for your Palm OS or PocketPC device.

56. WFDB Software Package
WFDB, or WaveForm DataBase, Software Package is a toolkit “for viewing, analyzing and creating recordings of physiologic signals. It comes with a WFDB library, a set of user-friendly applications and more.

57. Sispread
Sispread allows medical professionals to simulate the effects and tracking of the spreading of infectious diseases.

58. Miro
With Miro, you can “turn your computer into an Internet TV.” Look up medical stories on the Discovery channel, catch up on the news during your break in the office, or upload your own YouTube tutorial to help others learn more about their health problems.

59. Audacity
Record patient interviews or your own notes using Audacity, a free, cross-platform sound editor that works with Mac OS X, Windows, GNU/Linux and other systems.

60. Moosic
De-stress in your office or in the operating room with this computer jukebox for Unix systems.

61. HandBrake
This version of HandBrake can translate audio and DVD files, as well as access Apple audio support, letting users watch video on their iPhones in a seamless format.

62. puka
puka is a software program from Physionet that is designed “for detection of breaths in strain gauge recordings.” The system is written in Java, and can read and write data from MySQL databases.

63. PeerCast
This p2p broadcasting tool lets medical professionals watch and listen to relevant tutorials, lectures and podcasts online. PeerCast also “lets anyone become a broadcaster without the costs of traditional streaming.”

64. MediaPortal
Since you spend so much time at work anyway, why not turn your PC into a media center to help you de-stress, catch up on the news, or even listen to music while you operate?

Storing Patient Information

Keep track of patient records with tools these open source office suites, address books and more.

65. Open Office
Open Office is the open source solution to the office suite. Create word processing documents, spreadsheets, and databases to stay organized. It’s also compliant with all other office suites.

66. The Address Book
Simply known as The Address Book, this tool can hold a “virtually unlimited” amount of contact info.

67. Rubrica
Rubrica is an address book for GNOME desktop users. It stores data based on XML but can export information to HTML and text formats too.

68. PostgreSQL
This program claims to be “the world’s most advanced open source database.” It can read foreign keys, works on many different operating systems and supports features like a point-in-time recovery system, online backups and more.

69. Freemed YiRC
Often abbreviated as FMYiRC, this tool is designed for child care agencies and youth in residential care organizations that need help setting up case management and information systems.

70. Bots
Share patient information and records by taking advantage of Bots’ “any-to-any-format” data conversions, secure communications and other features.

71. Chiapas
Chiapas is an HIPAA data translation solution that lets users supplement their SQL databases and patient information.

72. Future SQL
Administrators can manage, configure, and set up records and files on their MySQL database with this tool, which includes a data dictionary, customizable templates and more.

73. SugarCRM
Visit the SugarCRM site for open source tools that help you manage vendor information, patient contacts and more.

General Tools that Work for Everyone

Below is a list of general open source tools that prove useful to medical professionals too.

74. Firefox
This popular open source browser is fast and extremely customizable. From reference dictionaries to search engine add-ons, you can easily access research material and client information from your Firefox toolbar.

75. Feedreader
Feedreader is a tool that brings you the news you want quickly and easily. A user-friendly format means that you won’t have to waste time clicking through pages or figuring out the next step.

76. BitPim
BitPim “allows you to view and manipulate data on many CDMA phones from LG, Samsung, Sanyo and other manufacturers,” so that you don’t have to put up with annoying ring tones or sloppy display formats.

77. DBDesigner 4
Design your own database using DBDesigner 4.

78. Sunbird
Use this desktop calendar to keep you on schedule and up to date on appointments, presentations and more.

79. K-Meleon
Make your Internet search even faster when you use this highly customizable, “light” Internet browser.

80. FreeMind
FreeMind is a free mind mapping software tool that will help you brainstorm, make decisions and prioritize.

81. Bluefish
Medical professionals who are also web savvy can edit websites, write scripts and develop programming codes for their sites and blogs with Bluefish.

82. Time Stamp
This tool helps freelance and private practice healthcare professionals keep track of their billable hours.

Collaboration Tools

Collaborate with other medical professionals by networking online, inviting them to work on your desktop or taking advantage of remote access applications.

This version of the GNOME desktop features a remote desktop, simplified keyboard settings, networked filesystems, DVD and Digital TV capabilities and more.

84. Portable Apps
Medical professionals who use Windows can take all of their computer’s applications with them wherever they go with this nifty tool.

85. MirrorMed
MirrorMed is a web-based, open source EHR and practice management system that “is capable of running a healthcare practice.”

86. MedMapper
Download this “medical decision-making algorithm tool” here. Medical professionals can create visual algorithms to explain processes and collaborate on projects.

87. MyDrugRef
Find out what other healthcare professionals think about drugs and prescription medicines on this online forum and networking site.

Storing, Sharing and Managing Files

Manage and share files with these two open source tools, which are free and customizable.

88. Filezilla
This FTP solution is free, easy to use and multilingual. The system runs on Windows, Linux and Mac, and can transfer files larger than 4GB.

89. eMule
eMule is a peer-to-peer file sharing client that lets you download all types of files from the Internet, making it useful for research and preparing presentations.

For Patients

From public health to patient diaries, these open source programs are highly beneficial for medical professionals who work on cases large and small.

90. Diets in Details
Help your patients lose weight by introducing them to this free software program. It includes a database with over 50,000 food names and info., a calorie counter and a diary.

91. HippoDiary
This spreadsheet-like medical diary gives patients the tools they need to document their health and keep a health diary. It includes an XY-chart, customizable fields, and the ability to do mathematical calculations.

92. BMI Calculator
Quickly calculate your BMI or a patient’s BMR with this simple tool.

93. Food Additives
Nutritionists will enjoy this program that lists the food additives to avoid and checks the food you just bought to see how many harmful additives it contains.

94. AcreSoft Health Stars
For patients who have trouble staying on schedule and remembering to take their pills, introduce them to this free program that tracks blood sugar, miles walked, steps walked, doctor’s visits and more.

95. NetEPI
This public health and epidemiology project includes several different open source tools that feature a web-based outbreak database tool and more.

96. InfluSim
This tool lets medical professionals witness the simulated effects of an influenza pandemic.

97. Tapeworm
GNOME desktop users can use Tapeworm to track calorie, fat, protein and carb intake, as well as exercise efforts, weight gain or loss and more.


Find more miscellaneous tools here, from health information systems to free operating systems.

98. Care2X
This open source project includes a central data server, health exchange protocol, practice management and hospital/healthservice information system.

99. Open Health Services
This program “allow[s] for a wide variety of safe, secure reports and services to be delivered to consumers, leveraging the power of their electronic medical records.” Patients can access personal health records, manage sleeping and dietary habits, and more.

100. Debian
Debian isn’t just one open source software tool: it’s a free operating system based on Linux.

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(Source : http://www.ondd.or)

myMetro | TMpoint bergerak

TELEKOM Malaysia Berhad (TM) terus komited menawarkan lebih banyak kemudahan kepada orang ramai terutama pelanggan apabila memperkenalkan TMpoint on Wheels (TMOW) iaitu unit TMpoint bergerak yang menyediakan pelbagai perkhidmatan ditawarkan syarikat telekomunikasi itu. Ketua Pegawai Eksekutif Kumpulannya, Datuk Zamzamzairani Mohd Isa, berkata 15 unit TMOW disediakan dengan peruntukan kira-kira RM2.4 juta.

Beliau berkata, TMOW akan bergerak di seluruh negara termasuk Sabah dan Sarawak terutama di kawasan baru dan membangun yang tidak mempunyai premis TMpoint.

“Setiap TMOW menyediakan jualan produk dan perkhidmatan TM termasuk pembayaran bil, malah ia mempunyai ciri unik di mana TMOW turut mempunyai Klinik Jalur Lebar (Broadband Clinic) iaitu sudut khas untuk pelanggan mendapatkan khidmat nasihat mengenai Internet mereka.

“Selain itu, individu yang berada dalam lingkungan 50 meter dari TMOW juga akan dapat menikmati perkhidmatan WiFi percuma dan unit bergerak ini juga akan beroperasi pada hujung minggu,” katanya pada majlis pelancaran TMOW di Kuala Lumpur, semalam.

Majlis pelancaran disempurnakan Menteri Penerangan, Komunikasi dan Kebudayaan, Datuk Seri Utama Dr Rais Yatim dan Pengerusi Suruhanjaya Komunikasi dan Multimedia Malaysia (SKMM), Tan Sri Khalid Ramli. Zamzamzairani berkata, pihaknya yakin TMOW dapat mendekatkan TM dengan pelanggan, sekali gus menyediakan ruang untuk berinteraksi serta memenuhi keperluan masyarakat dan mewujudkan kesedaran mengenai teknologi komunikasi dan maklumat (ICT).

Antara perkhidmatan yang boleh didapati di TMOW termasuk perkhidmatan telefon untuk kediaman dan perniagaan (TM Homeline dan Businessline), perkhidmatan Internet (Streamyx), penjualan kelengkapan (set telefon, peralatan suara dan Internet), penjualan kad prabayar i-Talk, kutipan pembayaran bil TM dan khidmat pelanggan (aduan, pertanyaan dan khidmat nasihat).

Pelanggan juga boleh menjelaskan bil lain seperti Celcom, Astro, Tenaga Nasional Berhad (TNB) dan Syabas serta bil penguasa tempatan (cukai pintu) dan menambah nilai Touch n Go. Sejumlah 15 unit trak TMOW akan ditempatkan di semua negeri dan beroperasi setiap hari dari jam 10 pagi hingga jam 7 malam. Sebarang maklumat boleh melayari

Recent thoughts on IT in health care

"The proposed economic stimulus package provides billions over the next several years…the risks of misspending this money and having subpar results are real."

Health Affairs 2009

"Successful IT strategies result in revenue enhancement, cost optimization, improved patient safety, quality of care, physician productivity, and staff satisfaction."

Value of Healthcare IT White Paper, INTEL Corp. 2007

"Leadership survey findings show commitment to health care IT. EMR and CPOE cited as top issues."

– March 2009,

"It was found that less than 2% of hospitals had comprehensive and enterprise-wide EHR systems installed and in full usage."

– In recent surveys by the Harvard School of Public Health

(Source - Center for Continuing Professional Education)

EHR Overview - The Prospect of New Business

In 2007, 85% of small physician practices and 75% of medium and large physician practices in the United States still use paper medical records. Over the next few years, the wide-spread adoption of Electronic Health Records across all physician practices, regardless of size, will increasingly improve as EHRs become a necessity.

Physicians need to be more aggressive about improving both the efficiency and the effectiveness of their practices. It is imperative to use appropriate process improvement techniques and technology tools. Automating a bad process only makes things worse. Technology tools by themselves will not sufficiently improve the care setting.

The best approach for a physician practice is to first improve processes, where necessary, and then install a system that would create an Integrated Electronic Practice that addresses both the clinical and business needs of the practice in as seamless a fashion as possible. Most vendors have products to do both. EHR software addresses the clinical side and Practice Management software provides tools for the business needs of billing and collections, scheduling (patient, provider, equipment), and productivity and revenue analysis.

The vision for the Integrated Electronic Physician Practice is to have seamless interoperation between all offices of the physician practice and with the systems at the practice's affiliated hospitals, clinics, laboratories, etc. This holistic environment produces an up-to-date, accurate, and complete clinical picture of the patient that enables the best quality care to be provided regardless of where the patient is treated. It also allows the business side of the practice to run in a more effective and profitable manner.

(Source - EHR Overview Home)

Tuesday, February 23, 2010

BERNAMA - Kabinet Akan Putuskan Tarif Baru Elektrik Pada Rabu

KUALA LUMPUR, 23 Feb (Bernama) -- Kabinet akan memutuskan mengenai tarif baru elektrik pada Rabu, kata Menteri Tenaga, Teknologi Hijau dan Air Datuk Seri Peter Chin Fah Kui.

Beliau berkata kementeriannya telah mengemukakan kertas cadangan mengenai semakan tarif tenaga kepada Unit Perancang Ekonomi di Jabatan Perdana Menteri.

"Sekiranya Kabinet meluluskannya, akan terdapat kenaikan, tidak mungkin penurunan," kata beliau kepada pemberita pada majlis Tahun Baru Cina Tenaga Nasional Bhd di sini. Mengenai peratusan kenaikan, Chin berkata: "Saya tidak boleh beritahu kerana mungkin esok Kabinet membuat keputusan lain."


BERNAMA - Kabinet Akan Putuskan Tarif Baru Elektrik Pada Rabu

BERNAMA - Kerajaan Cari Jalan Kurangkan Kos Pembinaan Hospital

KUALA LUMPUR, 23 Feb (Bernama) -- Kerajaan mahu mengurangkan kos pembinaan hospital di negara ini sehingga satu pertiga tanpa mengabaikan kualiti dan kemudahan yang disediakan, kata Menteri di Jabatan Perdana Menteri Tan Sri Dr Koh Tsu Koon. Sebagai contoh, kata beliau, Perdana Menteri Datuk Seri Najib Tun Razak telah mengarahkan agar penanda aras bagi setiap katil harus diletakkan pada RM500,000 berbanding RM1.5 juta sekarang.

Kos setiap katil itu dikira berdasarkan jumlah kos keseluruhan pembinaan hospital dan dibahagikan dengan jumlah katil yang disediakan, katanya kepada pemberita selepas melancarkan persidangan antarabangsa 'Continuing Professional Development' bertema "Ke Arah Kejururawatan Bertaraf Dunia", di sini Selasa.

"Jika kos setiap katil sangat tinggi maka anda terpaksa mengenakan bayaran yang tinggi juga atau mengalami kerugian...dan dalam kes hospital kerajaan akan melibatkan duit pembayar cukai," katanya.

Bagaimanapun beliau enggan mendedahkan jumlah sebenar yang terpaksa ditanggung kerajaan apabila membina hospital baru sambil berkata soalan tersebut wajar diaju kepada Menteri Kesihatan Datuk Seri Liow Tiong Lai.

Koh berkata penyedia perkhidmatan kesihatan wajar mengutamakan nilai wang, mengurangkan kos dan mengurangkan kemewahan yang tidak perlu selaras dengan konsep 1Malaysia yang diperkenalkan kerajaan.

"Penekanan kedua adalah pembangunan manusia...bermakna adalah lebih baik (bagi penyedia perkhidmatan kesihatan) untuk berbelanja ke atas kepakaran tenaga kerja berbanding 'batu bata'," katanya.

Beliau berkata kerajaan sekarang memberi penekanan terhadap nilai bagi wang yang dibelanja dan kualiti sumber manusia dalam perkhidmatan kesihatan.

Koh juga berkata Malaysia masih perlu mengeluarkan lebih ramai jururawat dan paramedik pada pelbagai peringkat, terutamanya untuk memenuhi keperluan Klinik 1Malaysia.

"Jika dibuat perbandingan, kita mempunyai sekitar 150,000 petugas dalam perkhidmatan kesihatan kerajaan iaitu dengan nisbah lima bagi setiap 1,000 penduduk berbanding 1.5 juta di United Kingdom dengan nisbah 24 bagi setiap 1,000 orang," katanya.

Koh berkata walaupun begitu Malaysia berjaya muncul sebagai antara pembekal utama jururawat untuk negara-negara lain.

Justeru beliau mengalu-alukan inisiatif kolej kejururawatan International College of Health Sciences (ICHS) di Malaysia untuk meluaskan program dengan membina sebuah kampus baru di negara ini dan memperkenalkan ijazah dalam bidang kejururawatan.

Persidangan sulung selama tiga hari itu diadakan bagi menyediakan wahana untuk warga perkhidmatan kesihatan meningkatkan kemahiran dan kepakaran mereka dalam usaha mengangkat standard profesyen jururawat di negara ini. Persidangan itu dihadiri oleh lebih 200 petugas profesional dari hospital kerajaan dan swasta serta institusi perkhidmatan kesihatan.

BERNAMA - Kerajaan Cari Jalan Kurangkan Kos Pembinaan Hospital

Monday, February 22, 2010

1M'sia Clinics should be manned by docs: MMA | Daily Express Newspaper Online, Sabah, Malaysia.

Kuala Lumpur: The Malaysian Medical Association (MMA), the country's premier organisation representing doctors, lauds the Government's move in setting up 1Malaysia clinics for the urban poor, saying it is in line with the caring concept.

Its President, Dr David K L Quek, said while the MMA supported better, affordable and more accessible healthcare facilities for the public, the announcement that the 1Malaysia clinics were manned by medical assistants and nurses took many doctors by surprise.

Writing in his President's Column in the latest MMA bulletin, he said initially his personal opinion was that just 50 clinics around the country would have very little impact on any doctor's rice bowl but he was wrong as the Government's move had caused much anxiety and confusion among general practitioners.

"I have received, literally, hundreds of angry and condemning SMSs, and faxes and email demanding that the MMA address the issue which they felt had unfairly impacted their services. Almost every doctor who had complained believed this approach of using clinics to be run by medical assistants and nurses was wrong in law," he said.

He emphasised that the MMA strongly felt that all the 1Malaysia clinics should be manned by doctors, in line with the Medical Act, which dictates that all medical and health clinics be run only by registered doctors.

So far, the Government has set up 50 1Malaysia clinics in the urban areas to provide basic services like treating minor ailments and monitoring of diabetes and hypertension.

These clinics are manned by hospital assistants and nurses and periodically supervised by doctors.

Latest field reports indicate that these clinics are well received by the people and are becoming popular.

On the shortage of doctors, Dr Quek said the MMA believed that there was no real shortage but just a "misdistribution of resources".

He said the MMA understood that logistical problems resulting from the reluctance of doctors to be relocated to a more rural or remote location despite improved perks remained a challenge for the Ministry of Health.

Nevertheless, he added, it believed that a proper and fair deployment policy should be initiated to overcome the problem.

He said if the 1Malaysia clinics were now part of the expanded public healthcare system, then the MMA believed that even more public sector doctors would be willing to be deployed on rotation or as part of a training initiative for an enhanced family practice or general practice vocation.- Bernama

1M'sia Clinics should be manned by docs: MMA | Daily Express Newspaper Online, Sabah, Malaysia.

About ISO/TC215

Since 1998, ISO/TC215 Health Informatics has developed standards within the following scope:
  • Standardization in the field of information for health, and Health Information and Communications Technology (ICT) to achieve compatibility and interoperability between independent systems.
  • Ensures compatibility of data for comparative statistical purposes, (i.e. classifications) to reduce duplication of effort and redundancies.

The above diagram illustrates the current structure of the ISO/TC215, and its nine working groups.

ISO/TC215's current work program comprises over 130 items, which comprehensively cover the contemporary health information standards spectrum.


  • Hosts over 25 active participating (P-member) countries, including Canada, and a similar number of observing (O-member) countries.
  • Maintains an extensive array of liaisons through its standards efforts, including but not limited to: HL7, the International Health Terminology Standards Development Organization (IHTSDO), the European Committee for Standardization (CEN)/TC251 – Health Informatics, and Digital Imaging and Communications in Medicine Standards Committee (DICOM).
  • Provides leadership to the Joint Initiative on SDO Global Health Informatics Standardization, including the Joint Initiative Council (JIC).
    • The JIC consists of leaders from participating SDOs, including ISO/TC215, HL7, CEN, Clinical Data Interchange Standards Consortium (CDISC) and IHTSDO.
    • The JIC operates as a council of equals, and as liaison group under ISO/TC215.

ISO/TC215 and its working groups typically meet twice per year to develop standards and related guidance documents. This includes a Plenary Meeting in the spring and a Joint Working Group Meeting in the autumn. Additional out-of-cycle meetings are held as required; ad hoc meetings, in conjunction with ISO/TC215’s principal liaison SDO partners, HL7 and CEN/TC251, are also frequent.

For more information on the technical committee, ISO/TC215 – Health Informatics, please visit the ISO website.