WSJ - Vendors Curb Cloud Adoption in Health Care, CIO Says

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• December 19, 2013, 6:10 PM ET

Vendors Curb Cloud Adoption in Health Care, CIO Says

There’s a consensus that health care providers are slower than most other industries to adopt cloud technology. The presumption has been that health care CIOs are fearful of the cloud, but that’s not the case, according to Steve Hess, CIO of the University of Colorado Health.

According to Mr. Hess, the problem is that many cloud vendors won’t sign agreements indemnifying their customers in the event of data breaches or other violations of very strict government regulations concerning patient data, such as the Health Insurance Portability and Accountability Act . They’re “unwilling to sign the HIPAA agreements and unwilling to live up to service levels,” he said. He said these vendors typically include large companies that built a health care business as an ancillary service, as well as startups that built custom solutions for specific health care organizations but haven’t developed a market strategy.

Likewise, Darren Dworkin, CIO of Cedars-Sinai Medical Center, said that vendors — particularly those new to health care — refuse to sign those sorts of agreements because they don’t yet fully grasp the health care business. “They don’t know what it is, so they’re afraid of it,” said Mr. Dworkin.

Judy Hanover, an IDC analyst who covers health care IT, said vendors offering generic cloud software, such as infrastructure services, or collaboration and productivity applications, are more likely to shy away from signing HIPAA contracts than a provider that targets the health care industry. Vendors offering more generic services don’t grasp the complex contractual nuances, or don’t want to incur new risk, she said.

Mr. Hess, who is moving several services to the cloud as part of an IT consolidation effort, said he recently migrated to Microsoft Corp.'s Office 365 software, which is HIPAA-compliant, to replace on-premise email software for 17,000 employees. He estimates this will allow the hospital to shave roughly $14 million in costs, and helps him offload email administration to a company that is better suited to provide it – and one he said was “very willing to sign that… [compliance] agreement.”

Forbes - Cedars-Sinai Taps iPhone For Enterprise Mobility

Dan Munro, Contributor

I write about the intersection of healthcare innovation and policy.

PHARMA & HEALTHCARE

 

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11/20/2013 @ 10:37PM |7,707 views

Cedars-Sinai Taps iPhone For Enterprise Mobility

Earlier this year I wrote about the ROI of an iPad inside a hospital. The story highlighted one healthcare CIO who estimated that the ROI for an iPad in his hospital was 9 days (here). It was a singular but compelling argument in favor of newer mobile devices like the iPad in a large clinical setting. But is the iPad the best initial mobile device in this demanding, often chaotic environment?

Cedars-Sinai Medical Center – a 958-bed non-profit hospital in Los Angeles – elected a different starting point for their mobile strategy. Instead of focusing initially on the doctors, Cedars-Sinai saw a more strategic fit with another core hospital resource – nurses. Inside any given hospital (which collectively represents about 30% of all U.S. healthcare spending), nurses remain the backbone of patient care.

Nursing stations themselves are a form of controlled chaos. Shift changes, nursing rotations, patient charting, actual care delivery, meal breaks – all need to be orchestrated to maximize efficiency. Healthcare is largely a patient services business. As with every business, efficient and effective communication is mission critical.

Historically, nurses have often been relegated to using antiquated technology like pagers, personal devices (like cell phones), push-to-talk services, fax – or simply POTS (plain old telephone service). Hospitals, like airports, often rely on paging systems to broadcast messages to every category of staff – including nurses. Communication itself becomes part of the ambient – and noisy background.

Newer mobile technologies in this demanding environment have additional requirements as well – especially when it intersects so directly with patient and hospital workflow. Two of the largest criteria initially are:

1) Easy and rapid adoption
2) Reluctance to revert

As a consumer device, Apple hardware is best-of-class and world renown. As an enterprise device – it has some very unique challenges that have made it a difficult choice for enterprise solutions of any kind – let alone healthcare.

1) Battery life: Reasonable for consumer use – but challenging for enterprise applications
2) Battery swap: Geek doable – but not very “user” friendly
3) YAOS (yet-another-OS): iOS – in fact any Apple OS – is not native to most core enterprise applications (like EHR’s)
4) Consumer purchasing model: At least initially, not very purchase-order friendly

For Cedars-Sinai, easy and rapid adoption trumped an enterprise feature set. It’s a bold bet because it argues heavily in favor of workflow over technology.

“They say culture eats strategy for lunch. In healthcare, we would say workflow eats technology for breakfast. The vision of a single device as a pocket computer to replace the tool belt or computer in the patient room has been around for a while. The iPhone, while a consumer device, has been the first real platform on which we could see our core vendors like Epic and an eco system of new vendors, like Voalte coming together to deliver the workflow that our nurses and doctors deserve.” Darren Dworkin, CIO – Cedars-Sinai Medical Center

The iPhone itself was first released in June of 2007. In October of that year, Time Magazine named it the “Invention of the Year.” About five months later (March of 2008) Apple released the iPhone Software Developers Kit (SDK). That paved the way for early stage ventures to build enterprise solutions around the revolutionary form factor.

One such company is Sarasota Florida based Voalte, Inc. Founded in October 2008 by Trey Lauderdale, the company was among the first to jump on Apple’s SDK with enterprise healthcare as a primary focus.

“We created Voalte One to take advantage of the latest mobile devices and provide improved experiences for hospital caregivers. As forward-thinking hospitals such as Cedars-Sinai embrace smartphone technology, we’re seeing huge potential for healthcare applications that not only improve caregiver communication but also tie in with Meaningful Use initiatives such as electronic health records and bar-code medication administration.” Trey Lauderdale, Founder & President – Voalte, Inc.

Inside Cedars-Sinai, the iPhone itself is industrialized with a 3rd party add-on battery (“sled”) that dramatically extends the usable hours on a single charge. Devices are re-charged in Voalte-customized cabinets located at the individual nursing stations.

This also makes the device shareable (via a secure sign-in function) among staff. The Voalte One app is designed specifically for enterprise healthcare use – and includes a rich set of core communication features:

* HIPAA compliant and unified communications (integrated voice, alarm, alerts and text messaging)
* No cell plan required (Voice-Over IP using hospital Wi-Fi that can also integrate with PBX)
* Call Rescue (plays “music-on-hold” until Wi-Fi connection is re-established)
* Message delivery notifications and “read receipts”
* Pre-defined (or user definable) messages
* Flexible integration with access to other iOS apps

The roll-out at Cedars-Sinai was piloted and then staged over the course of about 3 years – a timeline that’s fairly typical for large enterprise solutions. Today, Cedars-Sinai has over 2,300 registered users for the Voalte One solution and averages about 200,000 text messages a month. More broadly, Voalte now handles about 3.6 million text messages per month across 30 different hospitals.

All of which makes for a compelling and foundational solution. From this vantage point – other resources (like doctors) and core clinical applications (like EHR) can be added as they become available. In the case of Epic (Cedar-Sinai’s EHR platform), that happened earlier this year with the release of Epic Rover (now available in the iTunes Store here).

“The elegance and simplicity of Apple iOS devices combined with both Voalte and Epic software for communications and patient care create a wonderful opportunity to save nurses significant time and empower them to quickly communicate in the context of a patient, directly from the chart. We were very excited to work with industry leaders like Cedars and Voalte to provide an open integration improving communication, collaboration and ultimately the care of patients.” Carl Dvorak, President – Epic Systems Corporation

Cedars-Sinai’s selection of the iPhone in combination with Voalte’s communication platform required very little end-user training. The reluctance to revert to the old system was also rapid – often within a single shift. One interesting by-product of the solution is simply the ambient workstation and corridor noise. It doesn’t disappear – but the “new quiet” is definitely noticeable and much appreciated.

That’s one recipe – and one trajectory – for real ROI using mobile solutions in healthcare. It will be different for each organization, of course, but Cedars-Sinai with Voalte is a great example of how a consumer device can be leveraged to deliver a compelling enterprise workflow solution in healthcare.

WSJ - Healthcare.gov Getting Fresh Dose of 'Agile' Treatment

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• November 8, 2013, 4:51 PM ET

HealthCare.gov Getting Fresh Dose of ‘Agile’ Treatment

The HealthCare.gov contractor hired to fix the troubled online marketplace is assigning programming teams to release multiple software releases each week to fix specific portions of the site, according to the Obama administration. Experts say that focused fixes, conducted by contractor QSSI, could end up doing greater harm to the website if programmers fail to bring a holistic view to the project.

During a Friday media briefing Jeffrey Zients, the White House insider tapped to fix HealthCare.gov, admitted that more fixes could expose new HealthCare.gov performance issues in storage, capacity and software. On Monday, as contractors added more servers and upgraded software, HealthCare.gov went offline for 90 minutes. “The system was slow and sporadic for many users for significant periods of time during the week,” Mr. Zients said.  He added that system performance “remains a long way from where it needs to be,” and that outages will continue to occur as CMS improves the site.

HealthCare.gov, the $500 million online insurance market, hasn’t worked properly since its Oct. 1 launch. In recent weeks, the Centers for Medicare and Medicaid Services, the federal government’s lead agency for the site, allocated more servers, software, and engineers. Although these efforts have enabled more consumers to register, the new traffic is making HealthCare.gov sluggish for users trying to access sections located deeper in the site.

Scott Lundstrom, an IDC analyst who covers healthcare IT, said the fact that users are getting stuck farther down in the application suggest CMS has some significant software development ahead of it. “It’s like they finally got the front door unlocked, they stepped into the foyer, and realized they have to re-develop the rest of the house,” he said.

The QSSI “performance teams” will issue multiple software releases each week, targeted at the eligibility, enrollment, and plan comparison sections of the online health exchange. Ideally, the approach  will mitigate new bugs that pop up as shoppers try to enroll in insurance plans, and allow CMS to more quickly address its “punch list” of problems.

QSSI’s programmers may be dipping into agile development, a common tech industry practice of rapid, iterative programming where features and functionality are added incrementally. On Thursday Goldman Sachs Group tech leader Don Duet told CIO Journal that HealthCare.gov’s problems could be blamed on not using agile in the first place, although some experts suggest CMS used agile development in the initial build.

Last month CMS announced that it had hired Greg Gershman, an expert in government IT projects with a specialty in agile development. The creation of dedicated teams and rapid software releases suggests Mr. Gershman is exerting his influence on HealthCare.gov.  Reached via phone on Friday, a CMS spokesperson declined to comment on Mr. Gershman’s work.

Experts warn that there is such a thing as taking it too fast.

Lev Lesokhin, executive vice president at software analysis company Cast, compared CMS’ process to a “medical triage process you’d put in place in the battlefield.” He cautioned that while assigning fix teams by functional area can lead to faster fixes, they risk making changes that break the complex, integrated system. “If the escalation teams are not also looking at the holistic view… they will run a high rate of defects introduced with the fixes being put in place.”

Darren Dworkin, the CIO of Cedars-Sinai Medical Center, believes it will take more than agile development to save HealthCare.gov. “Healthcare like all industries needs software that is designed to accommodate the natural workflow of how people would think to approach a task,” said Mr. Dworkin. He said programmers and business people with experience enrolling people in health plans must work together.

WSJ - CIOs, Medical Device Makers Must Collaborate to Innovate

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• September 24, 2013, 6:31 PM ET

CIOs, Medical Device Makers Must Collaborate to Innovate

Hospitals and manufacturers need to work together to ensure that networked and wireless medical devices used on patients are safe from malware and other cyber-threats. Failure to do so will not only put patients at risk, they say, but invite additional federal oversight that may crimp innovation in a growing field.

Since issuing new draft guidance around medical device security in June, the Food and Drug Administration has been pushing manufacturers of heart monitors, ventilators and other medical devices to be more vigilant about securing their products before they market them. Networked and wireless medical devices hospitals rely on to support patients are susceptible to malware and other cybersecurity threats. For instance, Department of Veterans Affairs records show that since 2009, malware infected at least 327 devices at VA hospitals. More than 40 viruses hit devices including X-ray machines and lab equipment made by companies such as General Electric Co., Philips N.V. and Siemens AG.

Such vulnerability is scary, but too much federal oversight comes with its own negatives, says Darren Dworkin, CIO of Cedars-Sinai Medical Center.  ”I think the FDA has an important role to play in reporting, but it needs to be balanced,” Mr. Dworkin said. “You don’t want to go so far [in regulation] that you’re stifling innovation,” He suggested manufacturers solicit feedback from four or five health organizations before bringing the first version of their product to market – a practice that doesn’t happen often.

Nader Mherabi, CIO of New York University’s Langone Medical Center, said security should become more important for all stakeholders, as hospitals seek to connect medical devices with electronic health care records for information exchange. To ensure everyone shares the same understanding of security requirements, NYU Langone’s IT staff and clinical engineering group evaluates medical devices together. He said he is currently testing a pilot that would allow medication pumps and electronic health records to share information, which would save clinicians from manual data entry and paper records.

The FDA must also support stakeholders’ security efforts, said Russell L. Jones, a Deloitte & Touche LLP partner and author of a report, released Monday, on medical device security. He said the FDA and the National Health Information Sharing and Analysis Center, which works to improve the security of critical infrastructure, should build an outreach program to make hospitals feel comfortable sharing information about medical device vulnerabilities they discover. This could include webinars and a national summit bringing together provider and device manufacturer executives. “It’s not going to be easy but it is worth exploring,” said Mr. Jones.

He said CIOs can help their hospitals by familiarizing themselves with the FDA guidance on medical device security and create a risk management framework for their medical equipment. CIOs should also work with manufacturers to identify vulnerabilities and risks, create safety measures to mitigate damage, and set up a schedule to receive software patches that plug vulnerabilities, Mr. Jones said.

WSJ - Dell LBO Has CIOs Looking for a Speedy Resolution

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• July 24, 2013, 12:13 PM ET

Dell LBO Has CIOs Looking for a Speedy Resolution

Whatever happens as a result of Dell Inc.'s shareholder meeting next week, some CIOs want the computing company to quickly resolve its effort to go private so it can focus on innovating and serving customers.

On Wednesday, Dell Founder and CEO Michael Dell and private equity firm Silver Lake Partners sweetenedtheir bid to buy out the company by 10 cents, to $13.75 a share. The offer counters the latest overture fromCarl Icahn, the investor whose current offer is to buy out 72 percent of shares at $14 a share. The opposing sides have tusseled over the company almost since Mr. Dell and Silver Lake announced their intentions to take the embattled vendor private in a leveraged buyout in February.

Some CIOs who rely on Dell don’t care which party wins. Judy Snyder, CIO of Kelly Services Inc., said that while she wished Dell would stay public because it would be more transparent, she wants the matter to be settled — one way or the other. Ms. Snyder, who spends millions of dollars on Dell desktops, laptops and servers each year, said the “vote has to go through so they can stabilize so that we don’t have interruption in service.”

Darren Dworkin, CIO of Cedars-Sinai Health System, said via email that while Dell on seems to be conducting itself well despite the buyout uncertainty, he believes these “prolonged discussions are a major distraction for the executive team that would be better focused on driving new innovations.” Mr. Dworkin, who buys Dell desktops, laptops and help desk services, said that he hasn’t noticed a change in Dell’s products and services since the LBO battle began. But he said it’s clear Dell “needs some new innovation in the pipeline.”

Mr. Dell and Silver Lake have argued that going private will help the company focus on its evolution from a PC maker to a provider of cloud services, managed services and consulting services for businesses. Research firms Gartner Inc. and IDC said earlier this month that global PC shipments fell by about 11% in the second quarter.

Vince Kellen, senior vice provost and CIO of the University of Kentucky, said in a phone interview that he likes Dell’s current trajectory to go private and provide more cloud services. “That’s obviously where the growth is going to be,” Mr. Kellen said. Mr. Kellen said he spends over $1 million a year on Dell hardware, including servers and storage to support a high-performance computing cluster.

Dell spokesperson David Frink said the company’s relationship with customers remains unchanged. “We continue to focus on providing them a superior experience and the products and solutions they need to make their IT more efficient and productive,” Mr. Frink said.

Patent US 20130173309 A1

WSJ - New RIM Software Blocks Personal Content from Blackberry 10 Phones

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• May 14, 2013, 5:56 PM ET

New RIM Software Blocks Personal Content from BlackBerry 10 Phones

Research in Motion Ltd. Tuesday introduced new server software that blocks personal content from corporate BlackBerry 10 smartphones. The software, BlackBerry Enterprise Service 10 version 10.1, is designed to help CIOs satisfy the stringent security rules required by government offices and regulated industries.

RIM CEO Thorsten Heins revealed the software at the BlackBerry Live developer event in Orlando, Fla. The Canadian company is trying to reverse four years of smartphone market share losses, spurred by the heavy adoption of the iPhone and Android smartphones in the workplace, a domain RIM once dominated. Gartner Inc. Tuesday said Android and iOS accounted for nearly 93% of smartphones sold worldwide in the first quarter, compared to 3% for BlackBerry.

Reasserting its dominance in the corporate arena is a key strategy for RIM. Version 10.1 of BES 10 allows corporations to secure data on BlackBerry smartphones through encryption, in which data is encoded so that it can only be read by authorized parties. Some financial services firms and government agencies, bound by law to control information their employees share, prevent employees from accessing their personal content from corporate devices. BES 10 now allows IT administrators to prevent users from downloading or accessing personal applications on their BlackBerry10 smartphones, said Jeff Holleran, senior director of enterprise product management, at RIM. CIOs can elect to block employees from accessing personal email, instant messaging, Twitter Inc. or Facebook Inc. applications – even the phone’s camera. If CIOs deem any of those apps useful for employees, they may also permit access to those applications. “The enterprise has complete and total control as to which services it allows on the device,” Mr. Holleran said.

Darren Dworkin, CIO of Cedar-Sinai Medical Center, said blocking personal content can make sense. “Given the niche that they have in governments that require high security, that’s probably useful,” said Mr. Dworkin. But Mr. Dworkin, who allows employees to use their own smartphones for work, said he implemented IT and employee processes for protecting data, rather than focusing on locking down devices. He said he would support BlackBerry 10 smartphones if employees chose to use them at work.

RIM is also looking to regain relevance by supporting the platforms that usurped its corporate market share. The company this summer will update BES 10 to separate work and personal applications on iOS and Android devices. It will also make its popular BlackBerry Messenger instant messaging app available on iOS and Android.

BES 10 version 10.1 is available as a free download, though it will cost businesses $59 per year for each device they wish to connect to the server software. BES 5 customers may trade their current licenses for BES 10 at no additional charge.

RIM currently has two phones – the all-touch BlackBerry Z10 and the keyboard-equipped Q10 — running its BlackBerry 10 software. RIM will release a third phone, the BlackBerry Q5, this summer. Although BlackBerry 10 phones have been slow to catch on, the Department of Defense earlier this month approved the use of BlackBerry 10 smartphones on its networks. The DOD’s approval is a critical blessing for RIM, especially with the Air Force and other military branches now supporting iOS and Android devices.

RIM’s software plans are resonating with some analysts. Peter Misek, a financial analyst with Jefferies LLC, said Tuesday that he expects the DOD will use BES 10 to manage its employees’ BlackBerry 10,  iOS and Android devices. “We think BlackBerry’s software will gain traction throughout this year and see a significant ramp in revenues next year,” Mr. Misek said in a research note.