Stephen Z. Fadem, M. D.

How to avoid making mistakes

Purchasing an information system for a medical office is a major undertaking. If it is not done with careful planning, it can be a disaster. Yet, a successfully implemented health system can save time, increase productivity and efficiency, and improve the quality of care by making requested information readily available for patient care as well as for strategic planning. Here are a few items to consider when determining what system to purchase. There are several online resources -

Start with http://links.nephron.com (There are special sites for administrators and for physicians, and as well there is an entire practice management section).

1. RFI (Request for Information) Determine all the facts about available systems. Interview other clients from provided lists. Below are a series of questions to ask them.
2. RFP (Request for Proposal) This discipline will help you understand your needs, the specifics of your project, expectations and budget. It will also set a straight course regarding setup, training, service, support, responsibilities and upgrades from invididual vendors
3. NPV (It is important to know what your discounted cash inflow and outflow are going to be, and if the outflow is higher than inflow (NPV is negative), you must understand that your investment is not financially sound. Here you and your team should brainstorm to determine all of the ways that the computer will help cut expenses - time, supplies, labor, increase productivity, meet regulatory demands, increase retrievable funds, more accurately show you financial information and clinical information. Also, you must include all costs - capital expense, hardware purchases, network installation, set up, configuration, and software purchases, set up, training of administrator, training of end user, support costs, upgrade costs, supplies costs and computer depreciation (yes, they wear out!!)
4. Survey - It is important after you system is installed and operational that you document carefully how well the vendors met your expectations.
Were setups done in a timely manner?
Was training helpful?
Was training attempted during setup?
Did the vendor train your staff properly on system administration?
Did the vendor attempt to deflect innovation or promote it?
Were they willing to listen to new ideas and enhancements?
How serious was the problem of fingerpointing?
Did the vendors seem to understand hardware, networking and software issues?
Did the program perform as you expected?
Is the program user friendly and easy to use?
Are there obvious bugs?

1. History - where we have been with information -
Use health care as an example
“The doctor said” to “index Medicus” to BRS
Tie in advances in information technology
Add advances in medical and science tech - keeping up
Consequence: Patients are more informed
Guidelines - clinical trials - v research - anectdotes - v nothing (develop in future chapter)

2. Business example - The Peach
Faires, Guilds,
Sears Roebuck catelog
Train - travel - highways - 1920s
Refrigeration - meat
Television (develop in future chapter)
Direct marketing (develop in future chapter)
Infomercial
Online
e-commerce
3. Advertising - The Media - Daniel Boorstin - The Image
Making news - press releases for new products
Larry King Live and the Talk Circuit
4. Branding and awareness
5. Creating a web product for professionals
6. Creating a web product for e-commerce
7. Creating a web product for patients and consumers
8. Making sure information is authentic -
9. Development - Why Zope
10. Using the product - Why Transparent - levels of use - adminstrator to end user
11. Where do we go from here?

1. desktop.google.com
2. define= (google)
3. hubmed - reference managers
4. MDRD GFR
5. ez capture - images
6. Mozilla - tabs
7. Yahoo - spyware and popup blocker
8. Yahoo - beeper reminders
9. Airport - quick connect wireless
10. 3M mousepad
11. colorpic
12. ppt-wav-gif exporter
13. autofilter
14. ppt viewer
15. thumb drive
16. scintila and textpad
17. pdf - digital signature
18. verisign - digital signature
19. background images
20. shortcuts - toolbar
21. keyhole.com (NASA)
22. JPEG2000 - freeware
23. Touchgraph
24. Webdevelopment tools - Mozilla

… by Brian Rosenthal

I implemented an “archive” method, which can be called from any DTML Document (or any other object, for that matter, but not for a method).
Let’s say we want to archive the DTML Document “news_dtml”
We call “(Link:http://links.nephron.com/news_dtml/archive)http://links.nephron.com/news_dtml/archive", which does the
following:
A. CREATE A FOLDER “news_dtml_archive” if it does not already exist.
B. CREATE A METHOD inside the folder called “index_html” which lists
all Documents inside the folder.
C. CREATE A DOCUMENT “2004_11_01″ titled “TITLE - 2004-11-01″ (or
equivalent) which contains in its body the result of calling the method.
n that way, any time you call the “archive” method on an object, it
will create a folder to manage the archives and start populating it.
Now, you have to actually hit that page
“(Link: http://links.nephron.com/news_dtml/archive)http://links.nephron.com/news_dtml/archive” to get this to work. It doesn’t make sense to call “archive” from within the document because you wouldn’t know whether the document was finished (not to mention the
loop: document calls archive, which calls document, which calls archive…).
Therefore, to get the archive script to be called regularly, we have to schedule a task to hit the page
“(Link: http://links.nephron.com/news_dtml/archive)http://links.nephron.com/news_dtml/archive” (or whatever you want to archive) on regular basis (probably at 10 PM at night).
Zope does not to my knowledge have a scheduling infrastructure, so we will use the “crontab” infrastructure on the UNIX machine (same as the
auto-execute).
I have set it to auto-execute every evening at 10 PM California Time (midnight CST) for news_dtml and I can add as many as you’d like to that
file.Alternatively, you can take a look at the script that runs. It is located here: /home/brosenth/crontab/nd_nightly.sh

Setting up e-mail online to minimize spam
Making your computer run faster
Adding spice to Powerpoint
Photo finish
Newsdesk
Keeping track of information
Using visio to create guidelines
Publishing and storing on the web
Paperless office
Wireless world
History and physicals without pencils

szf.com is a development page where new technologies for the web are being developed and tested.

Current projects:

Touchmed
Newsdesk
Photos online
links.nephron.com
Kidney Associates File Server

for any questions
contact Stephen Z. Fadem, M.D.
fadem@nephron.com

Hi, My name is Steve Fadem. I will be holding some instructional classes during the NKF CM.04 meeting exhibits in the cyberNephrology section.

I am interested in what you would like me to talk about. I will answer any questions you are having regarding
Powerpoint
Visio
MS Word
MS Excel
The Web
TouchMed
Newsdesk
MDRD calculators
Powerpoint quizzes
Google
Blogs

Please let me know specifically about what you want.