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dhtobey Tobey

Varying Your Practice Moves May Help Improve Skills - 0 views

  • Varying the types of skills you work on in practice sessions engages a different part of the brain than the one you use when focusing on a single task, researchers say. The finding explains why variable practice improves the brain's memory of most skills better than working on just one type of task, according to the research team from the University of Southern California and the University of California, Los Angeles.In their study, published online recently in Nature Neuroscience, the investigators divided 59 volunteers into different groups. Some were asked to practice a challenging arm movement, while others did the arm movement and related tasks in a variable practice structure.The participants in the variable practice group learned the arm movement better than those who practiced only the arm movement, the study authors found.Among those in the variable practice group, the process of consolidating memory of the skill engaged a part of the brain called the prefrontal cortex, which is associated with higher level planning. Among those who practiced only the arm movement, the engaged part of the brain was the primary motor cortex, which is associated with simple motor learning, the authors explained."In the variable practice structure condition, you're basically solving the motor problem anew each time. If I'm just repeating the same thing over and over again as in the constant practice condition, I don't have to process it very deeply," study senior author Carolee Winstein, a professor of biokinesiology and physical therapy at the University of Southern California, said in a university news release.
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    Study with many implications for skill-based training, such as the National Security Academy.
Steve King

NEJM -- What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice - 0 views

  • Primary care practices typically measure productivity according to the number of visits, which also drives payment.
    • dhtobey Tobey
       
      This study is directly related to the TrustNetMD mission, but could also be useful for other EBM-related and OBM-related community desktop solutions.
  • Several studies have estimated the amount of time that primary care physicians devote to nonvisit work.1,2 To provide a more detailed description, my colleagues and I used our electronic health record to count units of primary care work during the course of a year.
  • Greenhouse Internists is a community-based internal medicine practice employing five physicians in Philadelphia. In 2008, we had an active caseload of 8440 patients between 15 and 99 years of age.
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  • Our payer mix included 7.2% of payments from Medicaid (exclusively through Medicaid health maintenance organizations), 21.5% from Medicare (of which 14.0% were fee-for-service and 7.5% capitated), 64.7% from commercial insurers (34.5% fee-for-service and 30.2% capitated), and 6.5% from pay-for-performance programs.
    • dhtobey Tobey
       
      I wonder how this breakdown compares with national/urban averages? Also how are these trending? Is the pay-for-performance increasing dramatically? I would think so based on what we are hearing.
  • Throughout 2008, our physicians provided 118.5 scheduled visit-hours per week, ranging from 15 to 31 weekly hours each. We regard this schedule as equivalent to the work of four full-time physicians, with physicians typically working 50 to 60 hours per week. Our staff included four medical assistants, five front-desk staff, one business manager, one billing manager, one health educator (hired midyear), and two full-time clerical staff. Our staffing ratio was approximately 3.5 full-time support staff per full-time physician. We had no nurses or midlevel practitioners.
    • dhtobey Tobey
       
      From the little I know this is a typical primary care scenario - very poor leverage of professional staff, meaning no use of nurses or midlevel practitioners to leverage physician time and expertise.
  • We use an electronic health record, which we adopted in July 20043 and use exclusively to store, retrieve, and manage clinical information. Our electronic system came with 24 "document types" that function like tabs in a paper chart to organize documents, dividing clinical information into categories such as "office visit," "phone note," "lab report," and "imaging." Since all data about patients is stored in the electronic record (either as structured data or as scanned PDFs) and each document is signed electronically by a physician, we are able to measure accurately the volume of documents, which serve as proxies for clinical activities, in a given time period.
    • dhtobey Tobey
       
      Each of these document types could become a "LivingPaper" creating a "LivingRecord" vs. the current EHR... Steve have you discussed something like this with TNMD?
  • The volume and types of documents that we receive, process, and create are listed in Table 1
  • Telephone calls that were determined to be of sufficient clinical import to engage a physician averaged 23.7 per physician per day, with 79.7% of such calls handled directly by physicians.
    • dhtobey Tobey
       
      Wow! I never would have guessed that telephone calls were such a significant part of the physician day. Does the EHR provide a CRM for call-logging?
  • Of these calls, 35.7% were for an acute problem, 26.0% were for administrative purposes
  • Physicians averaged 16.8 e-mails per day. Of these electronic communications, 59.3% were for the interpretation of test results, 21.7% were for response to patients (either initiated by patients through the practice's interactive Web site or as part of an e-mail dialogue with patients), 9.3% were for administrative problems, 5.0% were for acute problems, 2.8% were for proactive outreach to patients, and 1.9% were for discussions with consultants.
    • dhtobey Tobey
       
      60% for interpretation of test results!!! Opinion management ranks as the highest use of electronic communications. THIS IS OUR SWEET SPOT! We need to find this type of data for research scientists.
    • Steve King
       
      this is a a perfect source document for HC CD
  • Each physician reviewed 19.5 laboratory reports per day, including those ordered through our office (which are delivered to us through an electronic interface and are automatically posted to the database of the electronic health record as numerical values) and those ordered outside our office (which enter our chart as scanned PDFs and are not posted as numerical values). The work cycle of responding to a laboratory result includes interpretation by telephone, letter, or e-mail. (Our office sent 12,541 letters communicating test results, about a third of which were sent by e-mail.) For noninterfaced laboratories, we must decide which values need to be entered manually into the electronic health record by a staff person; the values of scanned results cannot be graphed or searched without this step. Laboratory results frequently trigger a review or adjustment of a medication, which requires access to accurate, current medication lists with doses.
    • dhtobey Tobey
       
      How difficult would it be to integrate LivingPaper with existing EHRs and/or lab systems. Since EHRs are still in the "early adopter" phase, perhaps we can address some of the most critical needs making EHR use unnecessary, or perhaps this is a HUGE joint opportunity with Microsoft's healthcare division.
  • Each physician reviewed 11.1 imaging reports per day, which usually required communication with patients for interpretation. Such review may require updating problem lists (e.g., a new diagnosis of a pulmonary nodule) or further referral (e.g., fine-needle aspiration for a cold thyroid nodule), which generates additional work, since results and recommendations are communicated to patients and consultants.
  • Each physician reviewed 13.9 consultation reports per day. Such reports from specialists may require adjustments to a medication list (if a specialist added or changed a medication), changes to a problem list, or a call or e-mail to a patient to explain or reinforce a specialist's recommendation. Some consultation or diagnostic reports relate to standard quality metrics (e.g., eye examinations for patients with diabetes) and need to be recorded in a different manner to support ongoing quality reporting and improvement.5
  • Before our practice had an electronic health record, we employed a registered nurse. After the implementation of the electronic health record system, much of the work that the nurse performed could be done by staff who did not have nursing skills, and by 2008, we no longer employed a registered nurse. However, on the basis of the analysis described here, we have hired a registered nurse to do "information triage" of incoming laboratory reports, telephone calls, and consultation notes — a completely different job description than what we had before.
    • dhtobey Tobey
       
      Most interesting! This is the conclusion we came to and presented to TNMD as a business plan concept -- become the triage service through outsourcing/insourcing RNs supported by the community desktop system.
  • Our practice is participating in a multipayer Patient Centered Medical Home demonstration project7 (which allowed us to hire our health educator). This project is overseen by the Pennsylvania governor's office and funded by the three largest commercial insurers and all three Medicaid insurers in our region
    • dhtobey Tobey
       
      Monetization is with the insurers -- just as we expected.
dhtobey Tobey

Google Prediction API - Google Code - 0 views

  • The Prediction API enables access to Google's machine learning algorithms to analyze your historic data and predict likely future outcomes. Upload your data to Google Storage for Developers, then use the Prediction API to make real-time decisions in your applications
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    Potential analytic toolkit for analyzing behavior trends in best practices
Scott Edelman

OverDrive - Global distributor of digital eBooks, audiobooks, music & video for library... - 1 views

  • Steven Potash is President and CEO of OverDrive, Inc., a digital media company he founded in 1986. Under his leadership, OverDrive has become a leading digital media distributor and Digital Rights Management (DRM) clearinghouse for hundreds of leading publishers, studios, and media producers in the US and abroad. OverDrive distributes over 100,000 premium eBook, audiobook, music, and video titles to a network of over 6,000 libraries and online retail websites.
  • Mr. Potash has led OverDrive into strategic relationships with Microsoft Corporation, Adobe Systems, Inc., and hundreds of leading media companies and retailers. During the 90's, OverDrive began offering print-to-digital conversion services to publishers, and eCommerce solutions for retailers in the trade, academic, and consumer markets. Since 2000, Mr. Potash launched Content Reserve, which has grown to become the world's leading distribution network for eBooks and digital media with over 100,000 products from 500 publishers. During 2002 OverDrive expanded its digital content services to public, academic, and corporate libraries with the launch of Digital Library Reserve. Mr. Potash has served as President and as a Board member for the International Digital Publishing Forum (www.idpf.org), an international standards body and trade association for digital book applications.
  • Prior to OverDrive, Mr. Potash was active in the practice of law, served as Special Counsel to the Ohio Attorney General, served as an acting Municipal Judge, and authored technology columns for the American Bar Association Journal. A native of Cleveland, Ohio, he earned a B.A. in Journalism from Ohio State and his J.D. from the Cleveland Marshall College of Law. He is currently licensed to practice law in Ohio and federal courts. He lives in Cleveland with his wife Loree.
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    Steven Potash looks like an ideal board of advisor candidate. He understands both law and digital publishing... and he's from Cleveland, so must be a cool guy :o)
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    when I see that mountain of digital books and pubs.. I can't help but thinking about all the LivingPaper knowledge sharing sessions that could be layered on top of that content.. ie, content rules.. but social content is even better.
Steve King

The Dynamics of Sensemaking, Knowledge, and Expertise in Collaborative, Boundary-Spanni... - 0 views

  • This ethnographic study investigates how a project group deals with the contradiction between distributed knowledge in boundary-spanning collaborative processes and the expectation that software systems will provide unified, codified knowledge. Group and individual activities were observed over a period of 18 months, to examine the ways knowledge was presented, recognized, shared, or otherwise managed during joint design of business process and IT systems change. The study explores how knowledge and expertise were translated across organizational boundaries, and identifies four stages in the development of group understanding of how to manage sensemaking and expertise across knowledge boundaries: focus on defining shared goals; acknowledging and sharing tacit knowledge about organizational practice; identifying external influences; and explicit knowledge generation.
Steve King

ProModel - Healthcare Solutions - 0 views

  • New Technology Evaluation and Implementation Hospitals and healthcare systems are under greater pressure than ever to improve patient care, increase staff satisfaction, control or reduce costs, and meet insurance and government regulations and live up to industry watchdog best practices. To help meet these demands, providers must continue to implement new technology as part of the solutions or risk obsolescence.
dhtobey Tobey

MedHomeInfo - Your Resource for Becoming a Medicare Medical Home - 0 views

  • Welcome to MedHomeInfo, the resource for physicians and practices that want to participate in the Medicare Medical Home Demonstration (MMHD)
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    Community Desktop prospect for Patient-Centered Medical Home
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    We should add this .org as a prospect for a VivoWorks communiity desktop.
dhtobey Tobey

Cybersecurity panel: Federal CISOs must focus on worker training - FierceGovernmentIT - 0 views

  • Only 12 percent of federal CISOs worry about poorly trained users. According to an April 2010 study by the Ponemon Institute, 40 percent of all data breaches in the United States are the result of negligence, however a comparable statistic for the federal space is unavailable.
  • The Computer Security Act of 1987 requires federal agencies to "provide for the mandatory periodic training in computer security awareness and accepted computer security practices of all persons who are involved with the management, use, or operation of each Federal computer system within or under the supervision of that agency." At the NIST event, Hord Tipton, executive director of (ISC)², estimated that most federal employees only get an hour of training per year, under FISMA requirements.
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    This points to a significant opportunity for deployment of the Critical Intelligence cybersecurity course, but also other eLearning systems that fulfill the requirements of the Computer Security Act.
Steve King

The next wave of change for US health care payments - McKinsey Quarterly - Health Care ... - 0 views

  • We estimate that by 2012, about 80 percent of the projected eight billion core US health care transactions will be in electronic formats,
  • The complexity of clinical data should not be underestimated—a typical patient-level clinical data set can include more than 800 discrete fields, compared with only about 20 to 30 for a financial transaction.
  • Resulting in part from this systemwide complexity, industry administrative costs will grow by about 10 percent annually over the coming years
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  • Cross-industry collaboration could finally spur the creation of payment utilities such as full-cycle-payment automation (described in our 2007 article). As noted there, we believe in the potential for cross-industry collaboration to create an at-scale payment-settlement utility that knits together health care transaction processing through clearinghouses, the automated clearinghouse payment network, and card network payments for retail payments.
  • By applying CBO data, we estimate that 55 percent of hospitals and 85 percent of physician practices will reach the basic stages of meaningful use by 2014.
Steve King

The Microsoft Connected Health Framework - 0 views

  • The Microsoft Connected Health FrameworkArchitecture and Design BlueprintThe Connected Health Framework - Architecture and Design Blueprint represents a vendor-agnostic set of best practices and approach based on Services Oriented Architecture (SOA), for architecting e-Health solutions for health information networks ranging from within health organizations to across multiple government agencies.
Steve King

Microsoft EMR: It's Not Just a Matter of When, It's a Matter of Who - 0 views

  • Microsoft Dynamics is largely present in just about every software market but medical. And they’re missing out big time. The United States healthcare IT market is growing at about 13% per year and is expected to reach $35 billion in 20111. The biggest opportunity for growth in the industry is among ambulatory care physician practices, partly due to the Stimulus Bill requiring the use of electronic health records (EHR) systems by 2015.
Scott Edelman

Entertainment Law | Lewis and Hand, LLP | New York Law Firm - 0 views

  • Lewis & Hand, LLP lawyers represent authors, publishers and distributors and advise clients on all aspects of traditional, electronic and digital publishing. We review, draft, and negotiate all types of publishing related agreements, including: Author Agreements Option and Purchase Agreements Publishing Agreements Agent Agreements
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    Potential advisory board member or alliance partner
Scott Edelman

Sheppard Mullin Richter & Hampton LLP: Entertainment, Media and Technology - 0 views

  • The Entertainment, Media and Technology Industry Team at Sheppard Mullin is a full-service multi-disciplinary group representing the major motion picture studios, television networks and other domestic and international entertainment, media and communications companies in all areas, including: motion picture and television development finance, production and distribution advertising/sweepstakes branded entertainment games intellectual property licensing and merchandising mergers, corporate finance, acquisitions and other strategic corporate transactions music First Amendment convergence, online/technology publishing sports
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    Potential legal alliance partner for methodology publishing.
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