tag:blogger.com,1999:blog-43435770488962132642011-11-17T12:20:11.826-06:00The blog of Dale Sanders, CIO of the Cayman Islands National Health SystemDale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.comBlogger701100tag:blogger.com,1999:blog-4343577048896213264.post-42999573415604909192011-10-09T10:27:00.000-05:002011-10-09T10:27:42.990-05:00

This blog is mostly intended for the younger professionals whose careers are just beginning, but older geezers (like me) might also find it interesting, as they face the challenge of honoring their aging parents while maintaining their career. The key messages are: (1) Career paths and opportunities are three parts chance, one part planning and preparation; (2) The professionals that reverse

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-49489826192444105152011-09-07T23:27:00.003-05:002011-09-08T08:09:24.760-05:00

Data modeling is the single greatest cause of long term failure and under-performance in data warehousing and business intelligence systems, across all industries.  It is compounded as a problem in healthcare due to the complexity of the data and the analytic environment. Errors in data modeling strategy gestate slowly, usually emerging in 2-3 years after go-live when the demands for more

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-14962111226588977052011-08-29T18:06:00.001-05:002011-08-30T09:08:14.063-05:00

A few weeks ago, a noteworthy healthcare consulting firm asked for input that they could pass-on to vendors that would help those vendors understand the relationship imperatives that are critical to a healthcare CIO, right now, in today’s market.  After giving this topic a few days of background thought, I concluded two things:  (1)  At least 60% of the imperative relationship advice that I give

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-1393929665945563602011-08-24T17:10:00.003-05:002011-08-24T22:16:44.896-05:00

A new study from Johns Hopkins reveals the value of standard protocols (aka, clinical practice guidelines) on reduction of central line infections in the ICU--  $1.1M per year. If I were CEO of an insurance company or major employer paying for healthcare, my contracts would require my healthcare providers to show proof that they’ve implemented evidence based protocols to achieve the best patient

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-23175548561015987742011-08-16T12:18:00.001-05:002011-08-16T12:18:41.164-05:00

This recent JAMA article (link below) on ACOs is a very common sense, succinct summary of healthcare’s future challenges.  As recently described by Francis Crosson, senior fellow at the Kaiser Permanente Institute for Health Policy, and despite the justifiable criticisms of the Affordable Care Act, Accountable Care Organizations cannot fail.  They will, in some form, define the future of

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-90541374883145228832011-07-25T17:21:00.000-05:002011-07-25T17:21:10.097-05:00

In ancient Mesopotamian judicial systems, it was against the law to convict a suspect of a crime without a dissenting judge or juror.  In other words, the system recognized the imperfection of human judgement and ensured that every suspect and different point of view should have at least one advocate.  A 100% consensus judgement of guilty was not allowed. Every major business decision should

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-10188003851875274092011-07-25T08:36:00.000-05:002011-07-25T08:36:27.896-05:00

The Health Services Authority of the Cayman Islands is engaging in the selection of a core vendor to supply an Enterprise Healthcare Information System. HSA defines a “core vendor” as an extension of its senior leadership who shares the same vision and values to constantly evolve and improve clinical, financial, and administrative operations.  Qualified vendors are encouraged to respond with

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-63360347452717357352011-07-23T21:02:00.006-05:002011-07-23T21:42:37.114-05:00

Many friends and professional colleagues are taking advantage of the growth in healthcare IT spending to start their own companies, which I think is great.  Quite a number of them call me for a sympathetic ear to lament about their administrative burdens.  In the mid-1990s, I was a founder and partner in a very successful IT consulting and software development company... but the idea of doing it

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-77027989353819836582011-07-10T20:42:00.004-05:002011-07-10T20:48:17.475-05:00

Arguably, the only investment from the US federal stimulus money that might have a long term return on investment (ROI) is the money being invested in healthcare computerization which should eventually drive down costs and improve quality.  Unfortunately, that money-- the HITECH (Health Information Technology for Economic and Clinical Health) Program-- is being spent on mediocre but very

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-3963554460508476892011-07-03T05:46:00.001-05:002011-07-23T21:44:57.411-05:00

People, including the people you work with and especially kids, have an innate need to tell their stories…their yarns.  Don’t try to pick the stories apart.  Sometimes specific facts matter, and sometimes they don’t.   Be keen to the difference.  And definitely don’t just sit there, saying nothing.  Help them tell their story.  Help them weave their yarn.  Better yet, live life with them and

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-7369958831577775982011-05-08T20:52:00.000-05:002011-05-08T20:52:43.250-05:00

With the recent selection of CSC, Microsoft, and HealthUnity by the MetroChicago Health Information Exchange, I’m once again intrigued with the role that Microsoft might play in the HIT market. I suspect the MetroChicago project is more interested in HealthVault, but Amalga is the most interesting product in Microsoft’s struggling healthcare vertical. Amalga is a strange and potentially very

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-87804225293304426262011-03-26T07:45:00.009-05:002011-03-27T18:21:37.610-05:00

Before we go too far in assuming that you need an EHR in order to achieve what Intermountain has achieved in lowering costs and improving clinical outcomes, it’s worth drilling down a little further in the details.  It is Intermountain’s billing, registration, and case mix systems that enable much of what Intermountain achieves… and virtually every healthcare provider and system in the US

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-76444814679412176202011-03-17T22:46:00.006-05:002011-03-18T07:45:59.207-05:00

The European Union is going to put legal pressure on Facebook to ramp up their privacy disclosure and protection, including the Facebook Right to Be Forgotten.  I have a feeling that the same right will someday be extended to a patient's medical record, no matter what the content. Once upon a time at Northwestern University, I helped build the curriculum for an "Ethics in Medical Informatics"

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-13248265478713135082011-03-17T10:22:00.000-05:002011-03-17T10:22:51.397-05:00

Below is a link to an excellent article published by the New England Journal of Medicine on healthcare reform in Vermont. This feels like the closest thing to a role model system for the US that I've seen so far.  In particular, it balances the local vs. federal control issue that offends so many people in the US.  The losers are the private insurance companies, but I've always been a fan of

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-61902393995854363432011-03-13T18:03:00.002-05:002011-03-13T22:04:03.092-05:00

Big Myth: Academic medical centers-- that is, universities that have a medical school, teaching hospital,  faculty practice plan, and receive substantial research funding from the US government-- provide the best care at the lowest price.   Wrong.  They provide great unique care-- for example, treatment of rare diseases or complications-- and they provide reasonable care for common diseases but

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-34985634060653729212011-03-05T07:57:00.000-06:002011-03-05T07:57:30.154-06:00

We are implementing a new care delivery and economic model called “CayHealth” which, at a very high level, seeks to maximize the quality of care delivered while assuring an economically sustainable healthcare system for the Cayman Islands. CayHealth is very similar in nature to the emerging Accountable Care Organizations (ACO) in the United States. We expect HIT vendors involved in the Cayman

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-88459927011493340922011-03-03T10:26:00.001-06:002011-03-03T10:26:45.461-06:00

In negotiations with poorly performing vendors, debtors, and/or employees, remember this thought.  It will come in handy: "The unfortunate cause of your problems has my empathy, but does not in any way diminish my intolerance for the consequences nor lessen my insistence that the situation be resolved to my fair satisfaction." If given a window of opportunity, many people will use the excuse,

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-31446118569749571732011-02-25T11:48:00.005-06:002011-02-25T15:57:16.214-06:00

The Cayman Islands National Health System is soliciting vendor partners for participation in the Enterprise Healthcare Information Systems Project. At present, the core enterprise applications are provided by the Cerner Corporation. The contract for those services expires in June 2013. This RFI begins a re-compete process for the award of that contract. The intent is to evaluate other vendors and

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-58647762464622198552011-02-23T08:04:00.002-06:002011-02-23T22:25:35.867-06:00

The Cayman Islands are unique in many aspects, but among them is the size of the nation compared to the sophistication of the business and government processes.  With a population of only 50,000 people, they are roughly the same size as a rural community in the United States-- ranked 201st on the size of countries by population.  But the C.I. government's processes and business acumen are far

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-50358213305154539502011-02-19T22:16:00.003-06:002011-02-26T23:27:06.764-06:00

Serving other people and causes in a way that boosts their success, esteem and fulfillment in life is like playing baseball. About two-thirds of the time, maybe a little less, those same people and causes will forget or criticize you for what you didn't do for them, rather than remember or thank you for what you did. That's a fairly typical batting average for human nature. Anything above .300

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-54188573324242932462011-01-30T15:08:00.003-06:002011-02-26T23:30:38.909-06:00

Below are screen mock-ups based on Facebook's and Amazon's user interfaces.  Borrowing ideas from them is comfortable because they parallel healthcare processes quite nicely, but also because the user interfaces on today's EMRs are abominable, and adoption rates are terrible (without financial coercion) as a result.  People flock to Facebook and Amazon by the millions, without financial

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-23902497821859435292011-01-28T16:29:00.000-06:002011-01-28T16:29:10.480-06:00

This prediction-- that business and clinical units will absorb more IT functions and thus further the decentralization of IT-- was presented to me for reaction, based upon an on-line discussion forum on Tech Republic.  Below is an excerpt from the discussion. Prediction:  “The biggest trend of 2011 will be the continued decline of the traditional centralized IT department.”    Reaction: I only

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-576069204120463802010-11-09T09:42:00.000-06:002010-11-09T09:42:56.507-06:00

Your company, regardless of industry, is now controlled by software. People are still the underlying foundation of any company, but the best people can be no better than the software they use to perform their jobs.  You can only move and adapt as fast as your software can move and adapt.  Likewise, if you are building bricks and mortar facilities, they too must be adaptable to the changes in

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-10143751220924791262010-10-26T03:07:00.002-05:002010-10-26T03:16:29.495-05:00

This article underscores the importance of using disease registries for proactive management of chronic disease. These registries are not the same concept as traditional disease registries used for reporting to government and public health authorities. These are disease registries which are integral to the day-to-day workflow of patient care and functional use of the EMR. Registries such as

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-436502880317107862010-10-26T02:48:00.002-05:002010-10-26T02:51:02.410-05:00

I will trust that true healthcare reform has arrived, when doctors stop wearing stethoscopes like a policeman wears a pistol... At the ready, all the time, just in case a violent heartbeat breaks out or a congested lung tries to hold up a 7-11.That was a friendly jab at my physician friends...like they jab me for wearing a pocket protector.;-)

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-28813356221983038722010-08-24T12:52:00.001-05:002010-08-24T12:55:46.046-05:00

Cerner and the British Medical Journal (BMJ) have teamed to provide evidence-based medicine (EBM) embedded in the electronic medical record in a manner that is as exciting and encouraging a development in healthcare IT as anything I’ve ever seen — I repeat, as exciting as anything I’ve ever seen. Coming from a noted cynic and critic of healthcare IT, this flash of optimism is a significant change

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-21126752958282224152010-07-25T19:32:00.000-05:002010-07-25T19:33:26.977-05:00

In ITIL, we healthcare CIOs are acting in predictable fashion by following the “Most Popular Practice” as opposed to the “Best Practice.” Before we pull the trigger on yet another silver bullet savior of process, I urge all of us to look closely at the contribution of burdensome process in the woes of Toyota…and GE…and Motorola. Try though we may fix the problems of healthcare IT with rigorous

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-53595325920248295522010-07-25T18:48:00.003-05:002010-07-25T18:53:17.818-05:00

Building on a recent post about Peter Orszag's resignation, and stimulus funding for healthcare IT...As long as we're throwing money around by the billions...If I were Dr. Blumenthal, I’d dangle $500M in front of Amazon, Google, Nintendo, Facebook, salesforce, eBay– or any other capable body– and sponsor a shoot out: Build an inpatient/outpatient EMR and financial management system that will rock

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-6821662808989665902010-07-25T18:44:00.000-05:002010-07-25T18:48:41.941-05:00

Before I levy my criticisms on Orszag and the mess that his philosophies will leave behind for healthcare CIOs, you need to understand that I’m as politically liberal as they come. I voted for Obama and celebrated in Grant Park when he was elected. However, while I’m a spendthrift with my money, I’m a tightwad when it comes to spending other people’s money, and therein resides the problem that

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-14206236608096244552010-06-08T19:49:00.002-05:002010-06-08T19:52:34.996-05:00

There are three messages that I hope to leave behind in this article. They may seem unrelated, but stick to the story and you’ll see how they all interact.Career opportunities come from equal parts planning, preparation, and random events.Current Electronic Medical Records in the United States are a reflection of a dysfunctional healthcare system and thus are dysfunctional themselves.There are

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-88490696998951551172010-04-28T16:56:00.005-05:002010-04-28T17:07:34.896-05:00

This is a follow-on to my previous post regarding the safety issues of EHRs…. But first, one comment and point of emphasis before I dive into the Top Ten details: Tightly-integrated, monolithic EHR solutions that rely on a single data model are much less prone to safety risk scenarios than those associated with loosely integrated, best-of-breed HL7-based systems. That’s my personal observation-

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-32252363621662195052010-04-27T21:09:00.003-05:002010-04-27T21:18:57.893-05:00

A CIO colleague recently shared with me that her EHR team runs a routine that balances the clinical results that are sent out against those that are posted to the EHR. I gather from her message that the results of that reconciliation are used by her team to manage the environment, but not shared with clinicians in some sort of a data quality dashboard. In the rest of our lives, there are

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-49942676303079447332010-04-20T18:06:00.001-05:002010-04-20T18:20:08.097-05:00

Below is a discussion motivated by four sentinel events which were root-cause attributable to electronic health records (EHRs) for which my teams and I were personally responsible.Remember when safety belts in automobiles first became popular? They were simple lap belts, no shoulder strap. Did they aid passenger safety? Yes, in some ways… but they also introduced the danger of a whole new

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-88781901256984448142010-04-20T17:52:00.002-05:002010-04-20T18:06:24.018-05:00

I've seen at least a dozen different employee performance evaluation systems in my career--all well-intended-- but they generally do more harm than good. Many companies are eliminating them altogether. At least one company decided recently to change them to "Employee Appreciation Reviews"-- only positive comments allowed. My logic for their upheaval is, if you see yourself as a great leader

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-1949088708535436952010-03-24T13:06:00.001-05:002010-03-24T13:07:48.774-05:00

I’ve been here in the Caymans for six months now. We’ve got a nicely defined 2-3 year IT Roadmap and strategic plan and we are starting to chip away at it. A recent independent assessment—sort of a mini audit—rated 12 areas of our IT state of affairs. At my request, the assessment team rated the 12 areas on a scale of 1-10 according to generally accepted best practices, with 10 being the best. We

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-3844323253127867232010-02-02T08:17:00.002-06:002010-02-02T08:22:57.921-06:00

My very dear friend, Anthony Guerra, former editor of Healthcare Informatics magazine, started a new online publication. Honored to support him with an occasional editorial, I posted one last night. I'll eventually double post to this blogger.com site, too.http://healthsystemcio.com/

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-59377384804036324902009-07-07T23:47:00.003-05:002009-07-08T00:06:49.806-05:00

It's not good karma to take pot shots at someone after they pass away, but I started this blog several months ago and never finished it, so I find at least some relief in that. The core message in this post: Beware the leader too comfortable in the role, too adept at eluding the grasp of humility.Robert McNamara died last Monday. For those interested in studying and learning about leadership

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-8877546205473670752009-06-10T08:24:00.003-05:002009-06-10T08:36:33.000-05:00

After a recent guest lecture, one of the students approached me afterwards and asked me for advice about leadership and management. She was about to become a first-time manager and leader for a six-person team. Later, she emailed me about the same topic. Below is my reply to her."Simply because you care about these issues of true leadership and are willing to study, think, and put forth the

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-65751832596196603092009-04-23T15:02:00.007-05:002009-04-23T16:38:51.119-05:00

The point of this blog is: Purchasing and installing an EMR and hoping that you’ll realize a positive return-on-investment is not enough. You need to dedicate the time and resources to constantly iterate, refine and improve the utilization of that EMR over time, far beyond its installation and go-live. It’s a race without a finish line so you might as well train, budget and plan for that

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-37756204033213401692009-04-09T21:44:00.003-05:002009-04-09T21:52:34.203-05:00

Amazon.com announced today that it will develop a new Electronic Health Record based upon the same user interface experience and underlying information technology that it uses to support its global ecommerce business.Said Amazon braintrust, Jeff Bezos, “Our experience with user interfaces and high performance computing are ideally suited to help healthcare. We nudge people’s decision making and

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-57982722954899023572009-04-07T23:26:00.001-05:002009-04-07T23:28:30.128-05:00

Following the model of healthcare systems that have managed to optimize the cost of care with the quality of care—such as Kaiser, Intermountain, and Geisinger—Northwestern Medical announced the purchase of Blue Cross Blue Shield of Illinois today for $3.3B, making Northwestern the only medical center in the US with a fully-integrated delivery system with a University academic mission. In the

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-47523743841177554412009-04-01T12:41:00.002-05:002009-04-01T12:43:50.084-05:00

Several days ago, I passed around a survey to gauge people's concerns about protecting their private information. The survey is now closed and you can see the results and comments here: Survey Results. In summary, 92% of respondents were more concerned with “Protection of my personal identity and financial data” vs. 8% with “Protection of my electronic health record data.” I appreciate

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-45575105679567810542009-03-31T12:14:00.002-05:002009-03-31T12:15:43.884-05:00

I have this theory that we (healthcare) could learn from retail in terms of customer relationship management, in a variety of ways. For example, in retail, almost every store has a “Top Customers” report that lists their top customers over the past year, month, and week. They calculate “top” by total purchases and by the number of customer visits to the store or web site. In theory, retail

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-77905709630649463562009-03-27T18:21:00.002-05:002009-03-27T18:22:55.402-05:00

If you haven't read the March 27 JAMA commentary from Ross Koppel and David Kreda, you should track it down. In summary, they point out very appropriately, that there are patient safety issues associated with the use of EHRs, and that HIT vendors should not be allowed to contractually walk away from their safety obligations in the design and implementation of their products. I agree with the

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-26204655145190527622009-03-25T23:14:00.004-05:002009-03-25T23:38:24.956-05:00

I'm running a little experiment here to see how people feel about protecting their personal data. Mostly I'm motivated by curiosity, but also by the recent Federal interest in Red Flag events in healthcare. The Federal Trade Commission (FTC) issued a regulation in 2007 to address identity theft. Known as the "Red Flag Rule", it requires “covered accounts” to develop an identity theft prevention

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-35041364323506101892009-03-19T10:19:00.002-05:002009-03-19T10:24:56.618-05:00

Let me begin by saying that, in reality, I’m not worthy of honoring Al Pryor. Such honor is bestowed upon his family and friends who knew him much longer and deeper than I did. My fond appreciation and respect for him are all that I have to offer.Among his countless medical informatics achievements, T. Allan Pryor was one of the "inventors" of Intermountain Healthcare’s HELP electronic health

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-77689873502040950342009-03-02T12:10:00.003-06:002009-03-02T12:43:59.116-06:00

I'm concerned that the speeding bullet of genomic discovery is going to outpace our ability to keep up with the demand for tests and our ability to fold the results and knowledge back into the EHR for consumption at the point of care and the process of delivering care. In fact, we already know enough about the effects of genetics on certain healthcare-related conditions, such as warfarin

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-88643675866352677272009-01-29T23:55:00.001-06:002009-01-29T23:55:00.195-06:00

We need to squeeze the subjectivity out of healthcare and make it more measurable; more understandable from an algorithmic perspective. Data and math need to play a larger role in diagnosis and treatment. We're moving down this path, everywhere, so that's a good thing. A simple example is the widespread use of BMI (algorithm-based) as it relates to the diagnosis of "obesity." BMI is not perfect,

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-45147347617770760772009-01-20T22:43:00.005-06:002009-01-20T23:40:35.085-06:00

This is a fairly tech-ish blog entry, but given the rise of importance and number of projects related to data warehousing and business intelligence in healthcare-- which is a good thing-- I am concerned about the continued rate of costly and poorly informed decisions in the execution of those projects. A blog entry on the topic is probably worthwhile, even if a bit techie. The essence of this

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-56223056201255548062009-01-19T11:50:00.002-06:002009-01-19T12:04:38.993-06:00

Often times, we celebrate today as a day of tolerance for diversity, but tolerance is a frail description for what Martin Luther King envisioned. Tolerance for diversity is not enough. We are obliged to be grateful for it. We must be fascinated and humbled by it. In the sum of diversity in Mother Nature, we humans among that, we glimpse the sum of God's knowledge which connects us all.Today

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-89372976741531301662009-01-06T09:02:00.008-06:002009-01-08T13:33:08.648-06:00

As reported in a recent article in the Boston Globe, David Kibbe, a senior adviser to the American Academy of Family Physicians, and Bruce Klepper, a healthcare market analyst, sent an open letter to our new president-elect, urging caution in the rush to invest in healthcare IT. Describing current systems as "expensive, cumbersome to use, and cannot easily exchange information about patients'

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-57735902915746345812008-12-06T13:32:00.008-06:002008-12-16T01:08:05.258-06:00

We still struggle to define the value and return-on-investment of EHRs, often times naively attempting to justify the investment based upon improvements to physician workflow and patient volume. The real value resides in the systemic value of the data that's collected, the data that's analyzed, and the data that is presented (or not) back to the physician at the point of care, that has been

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-83468933907434473232008-12-04T21:14:00.006-06:002008-12-04T22:06:15.415-06:00

In past blogs, I've alluded to the development of our Enterprise Data Warehouse at Northwestern. The "enterprise" is currently inclusive of data content from Northwestern Memorial Hospital (NMH), the Northwestern University Biomedical Informatics Center, and the Northwestern Medical Faculty Foundation (NMFF). In the future, the enterprise will hopefully include Children's Memorial Hospital, the

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-65145743208472015842008-10-29T15:10:00.007-05:002008-10-29T16:50:33.632-05:00

Normally, I would not use a public forum like this blog to endorse vendors and products, so when it happens, I do so with a fair amount of deliberation and forethought. Such is the case with my opinions about Microsoft and the evolution of their Business Intelligence and Data Warehousing strategy. In short, they get it. I think it's important to share these thoughts at a time when health care

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-52835715902126923712008-09-25T06:40:00.002-05:002008-09-25T06:58:40.127-05:00

Thanks goes to several colleagues for their comments and in particular for pointing out that I was not the first to question the value of Six Sigma, including a person and thinker who I greatly respect, Tom Davenport. Among his many excellent and insightful publications, he wrote "Competing on Analytics", a book that should be required reading for every executive and manager in healthcare.http:/

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-87509521009908425492008-09-22T12:55:00.000-05:002008-09-22T12:55:00.674-05:00

As healthcare organizations rush towards process improvement, many are adopting or have adopted Six Sigma as their quality improvement process du jour. While at first this choice sounds great and makes for eye-grabbing headlines, the reality is, Six Sigma will soon squeeze every drop of agility out of these same organizations. It’s only a matter of when, not if. Also, many of these same

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-15746889818922163372008-07-26T15:59:00.004-05:002011-02-26T23:21:39.427-06:00

Several readers asked to comment about the pricing structure and Total Cost of Ownership (TCO) for Amalga (aka, Azyxxi). I am still in pricing negotiations with Microsoft and of course need to respect the confidentiality of those discussions, so can't go into any detail, but will offer a few general thoughts, all of which I have shared with Microsoft. Utility vs. Legacy Pricing Models:

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-41955022546355294802008-07-04T07:02:00.000-05:002008-07-04T07:05:31.443-05:00

First, I want to recommend a book--Nudge-- for everyone in health care, especially CIOs. There are several elegant themes in the book, but one of the most pertinent is: If you simply expose people to data about their behavior and within a relevant context, you can often times "nudge" them towards a desired new state of behavior, without the need for a complicated, onerous, process improvement

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-55157001321232236232008-07-01T22:33:00.003-05:002008-07-01T23:36:05.311-05:00

A reader commented: "In a future post, could you consider reflecting upon your reasoning for a "buy and develop" approach, the principles you use to govern this, and how you keep the vendor software/services/APIs and your own in-sync? Also, do you see this as a fundamental shift for all health care organizations, or only the largest?"Differentiating Through "Buy and Develop": Although the key

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-51059527749037167882008-07-01T00:39:00.006-05:002008-07-02T20:52:55.844-05:00

My colleagues at CHIME are sponsoring a series of lectures and education sessions to explore the changing responsibilities of the CIO in healthcare. One of those areas of change involves the way we recruit and retain great IT professionals in an increasingly competitive hiring market.CIO’s in healthcare must start seeing ourselves in a competitive hiring market which extends beyond the boundaries

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com1tag:blogger.com,1999:blog-4343577048896213264.post-12482678495675961432008-04-07T11:42:00.009-05:002011-02-26T23:16:26.728-06:00

The gracious folks from Washington Hospital Center and Microsoft recently hosted our Chief Medical Information Officer, Dr. David Liebovitz, and me for a deep dive session on Azyxxi, now known as Amalga. One of the most impressive things about Amalga is the attitude and principles under which the product was originally developed by Drs. Mark Smith and Craig Feied, and Fidrik Iskandar. In terms

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-87365525871071528142008-02-25T13:04:00.003-06:002008-07-01T11:02:56.196-05:00

They would develop an open source, freely available tool for probabilistically matching patient identities and managing patient record duplicates. If Plaxo can do it with my contact lists, why can’t Google do something incredible with patient identity? I’m pretty sure a patient is a person and sometimes vice versa, so the concepts for identity should cross over, right?I appreciate Google’s recent

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-34037096154803561342008-02-13T08:34:00.001-06:002008-02-13T08:36:50.184-06:00

One of the best novels ever written. I can't possibly do justice to the context of the story in this measly little blog, so if you don't know it, you need to read the book, but Tom Joad, the main character, is contemplating the unjust death of his friend Jim Casy, the preacher-turned-labor activist, whose initials, coincidentally, he shares with another religious social activist in his day,

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-76323840300731694592008-02-08T11:43:00.000-06:002008-02-08T11:52:39.187-06:00

For the past three years, we have been completely remodeling everything in Information Services and Informatics here at Northwestern. Like a home remodeling job, it has been brutally stressful and inconvenient at times, but now the remodeling is almost done and we are emerging-- from "Rennovation to Innovation." (Sorry for the cliche buzz phrase, but it works!)In addition to our specific 2008

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-17409959830604714762008-02-06T09:49:00.000-06:002008-02-06T10:42:54.882-06:00

For many years as a consultant, I was well-recognized as an expert in calculating IT projects and their ROI. Companies would pay me enormous sums of money to help justify-- or kill-- IT projects based upon their ROI. I took great pride in my tough, financially-driven mindset when it came to IT investments and prioritization... until one day I realized that it was all a bunch of crap, and I was

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-35383524200744512922008-02-05T00:17:00.002-06:002008-06-27T11:06:28.417-05:00

Denis Protti, a gift of lucky influence in my life, from the U of Victoria in British Columbia, prodded me to finally publish, with his wonderful participation, an article on the basics of data warehousing in healthcare. Here's the link to the paper-- look for the PDF file called datawareshousing-- http://drop.io/dsandersIt's the first in a three part series, the second of which is underway and

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-78226956427448150512008-01-31T20:59:00.001-06:002008-02-13T08:34:30.923-06:00

I participated on a panel at a conference in Canada last week that was thoroughly enjoyable on several levels, including skiing. :-) The conference was an international gathering, focusing on Canada's plans to deploy a national EHR and maximize the secondary use of clinical data for quality improvement and research. I found myself daydreaming, “If I had responsibility for leading the adoption of

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-49668029143595787352008-01-13T11:42:00.000-06:002008-01-13T12:34:55.037-06:00

Below are the lyrics to a poem/song by a band named “The Call.” The name of the song is “Let the Day Begin” and I think it came out in the late 80s or early 90s. I had heard the song many times before and appreciated the lyrics, but I never REALLY appreciated the words until I heard the song played in Denver during the Procession of Survivors at the Susan B. Komen Race for the Cure against breast

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com0tag:blogger.com,1999:blog-4343577048896213264.post-57421217152607665072008-01-02T09:04:00.000-06:002008-01-03T14:17:24.561-06:00

While I’m thrilled to see SOA momentum, my cynicism tells me that many of the headline grabbing initiatives in health care are poorly conceived, based upon what I’ve read and heard from those involved. I see a gold rush to SOA in health care, but many people still don’t “get it” when it comes to fully grasping SOA concepts. Ironically, we are over complicating the basic software engineering

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com1tag:blogger.com,1999:blog-4343577048896213264.post-76560603326174755942007-12-29T12:04:00.000-06:002007-12-29T12:58:36.852-06:00

Finding a pure motive in blogging-- a motive which will stand the test of time--has been elusive for me, but Mike Doyle, my Manager of Analytics and Integration Services Development, convinced me that there might be a pure motive needle in the blogging haystack of otherwise. My Manager of Business and Administrative Information Systems Development, Regina (Reggie) Nowacki, backed him up, so I

Dale Sandershttp://www.blogger.com/profile/04982909782090993322noreply@blogger.com1