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dhtobey Tobey

Evidence-based medicine - Wikipedia, the free encyclopedia - 1 views

  • The systematic review of published research studies is a major method used for evaluating particular treatments. The Cochrane Collaboration is one of the best-known, respected examples of systematic reviews. Like other collections of systematic reviews, it requires authors to provide a detailed and repeatable plan of their literature search and evaluations of the evidence. Once all the best evidence is assessed, treatment is categoried as "likely to be beneficial", "likely to be harmful", or "evidence did not support either benefit or harm".
    • dhtobey Tobey
       
      We need to find access to the Cochrane Collaboration -- this is obviously a large, extant community socializing the vetting of clinical evidence.  We should find out more about their methodology and supporting technology, if any.
  • Evidence-based medicine categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions is provided by systematic review of randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports, and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, difficulties in ascertaining who is an expert, and more.
    • dhtobey Tobey
       
      Is this ranking an emergent process supported by some type of knowledge exchange platform? What about consensus/dissensus analysis? Seems ripe for groupthink and manipulation or paradigm traps.
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  • This process can be very human-centered, as in a journal club, or highly technical, using computer programs and information techniques such as data mining.
  • Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
    • dhtobey Tobey
       
      Need for LivingSurvey, LivingPapers, and LivingAnalysis.
  • Despite the differences between systems, the purposes are the same: to guide users of clinical research information about which studies are likely to be most valid. However, the individual studies still require careful critical appraisal.
    • dhtobey Tobey
       
      In other words, there are wide differences of opinion (dissensus) that must be managed and used to inform decision-making.
  • The U.S. Preventive Services Task Force uses:[9] Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweighs the potential risks. Clinicians should discuss the service with eligible patients. Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients. Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations. Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients. Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.
    • dhtobey Tobey
       
      Relates well to Scott's idea of common problem being one of risk management.
  • AUC-ROC The area under the receiver operating characteristic curve (AUC-ROC) reflects the relationship between sensitivity and specificity for a given test. High-quality tests will have an AUC-ROC approaching 1, and high-quality publications about clinical tests will provide information about the AUC-ROC. Cutoff values for positive and negative tests can influence specificity and sensitivity, but they do not affect AUC-ROC.
    • dhtobey Tobey
       
      ROC curves are similar to PPT, though addressing a different and less impactful issue of system sensitivity and specificity, rather than reliability (consistency) as determined by PPT.
dhtobey Tobey

Amazon Stealing the Cloud « SmoothSpan Blog - 2 views

  • A survey of 600 developers by Mashery reported that 69% of respondents said Amazon, Google, and Twitter were the most popular API’s they were using.
  • Amazon and Netflix jointly published a great case study and announced Netflix would move more infrastructure into Amazon’s Cloud.
  • A wonderful post on CNet talks about Goldman Sachs’ findings for the Cloud.  There were a ton of them including:           – A ranked list of apps moving into the Cloud.  Web Conferencing and Salesforce Automation were #1 and #2. 
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  • The majority of SMB’s now have a “SaaS first” policy, they prefer it. 
  • Amazon.com is used by 67 percent of the survey respondents. It is clearly the out-in-front leader, despite being a “newcomer” to enterprise IT. For internal clouds, VMware’s leadership remains pronounced, with 83 percent of respondents using its virtualization technology.  Platform-as-a-service layers are gaining momentum, dominated by Amazon’s Elastic Compute Cloud, or EC2, service, with 77 percent of respondents choosing EC2 as a preferred partner, well ahead of Google.  These share numbers are why the title of this post is that Amazon is stealing the Cloud.  They represent remarkable share and momentum.
  • UK firm Netcraft finds that the Amazon Cloud hosts 365,000 web sites.  Evidently a number of firms have discovered that web hosting is a great commodity use for the Cloud. -  PC World asks why Amazon doesn’t charge more for its service.  They conclude that AWS is looking to build economies of scale and set low prices that act as a barrier to entry for new competitors.  Like I said, Amazon isn’t afraid of being commoditized for they are the commoditizers.
  • And they’re building barriers to entry of several kinds: -  Nobody but Amazon has the experience of running a Cloud service on this scale.  They can’t help but be learning important things about how to do it well that potential competitors have yet to discover. -  There is a growing community of developers whose Cloud education is all about Amazon. 
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.
Steve King

Intuit Press Release - Intuit and Microsoft Join Forces to Deliver Web Applications to ... - 0 views

  • MOUNTAIN VIEW, Calif. and REDMOND, Wash. – Jan. 20, 2010 – Intuit Inc. (Nasdaq: INTU) and Microsoft Corp. (Nasdaq: MSFT) plan to create new opportunities for software developers to deliver and market Web applications to small business customers through the Intuit App Center. The two companies plan to integrate the capabilities of their cloud services platforms ­– the Intuit Partner Platform and Microsoft Windows® Azure platform™ – to enable developers and channel partners to deliver solutions to the millions of employees within businesses that use QuickBooks® financial software. In addition, the two companies will provide small businesses with Microsoft’s cloud-based productivity applications via the Intuit App Center.
  • s two leading technology platform providers to small businesses, Intuit and Microsoft are creating a vast ecosystem of more than 750,000 development firms and channel partners to create more new innovative applications and services that will reach the market more quickly.
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

.:: iSec Consulting ::. - 0 views

shared by Steve King on 04 Jul 10 - Cached
  • Complex Event Processing (CEP) is a technology which has been used for many years in the Aerospace and Defence Industry for Situational Awareness and Data Fusion modules in Command, Control, Communications, Computing and Intelligence Systems (aka C4I).   Currently CEP is being rediscovered as a foundation for new class of extremely effective Business Intelligence, Security and System/Network/SCADA Monitoring solutions in industries like Financial Services, Telecommunications, Oil and Gas, Manufacturing, Logistics etc.
Steve King

AchillesINSIDE™ - 0 views

  • By leveraging the proprietary data in Delphi™, the world’s largest database of industrial system vulnerabilities, Wurldtech has created a solution specifically designed to help reduce the cost and complexity of mitigation activities for process control networks by integrating specific vulnerability intelligence into common security enforcement devices such as firewalls and intrusion detections systems. This allows common IT infrastructure to be tailored for industrial network environments and continuously updated with specific rule-sets and signatures, protecting control systems immediately, substantially reducing the frequency of patching activities and reducing overall costs. This update and support service is called AchillesINSIDE™.
Steve King

UC Berkeley, Management of Technology (MOT) Program Course: Human and Organizational Fa... - 0 views

  • This course advances the concept that humans and their organizations are an integral part of the engineering paradigm and that it is up to engineering to learn how to better integrate considerations of people into engineering systems of all types. This course focuses this concept on the assessment and management of the risks associated with engineered systems during their life-cycle (concept development through decommissioning). Risks (likelihoods and consequences) are addressed in the contexts of the desired quality from an engineered system including serviceability (fitness for purpose), safety (freedom from undue exposure to harm), compatibility (on time, on budget, with happy customers including the environment), and durability (freedom from unexpected degradations in the other quality characteristics). Reliability is introduced to enable assessment of the wide variety of hazards, uncertainties, and variabilities that are present during the life-cycle of an engineered system. Proactive (get ahead of the challenges), Reactive (learn the lessons from successes and failures), and Interactive (realtime assessment and management of unknown knowables and unknown unknowables) strategies are advanced and illustrated to assist engineers in the assessment and management of risks.
Steve King

Process Improvement consulting services from Shaw Resources - 0 views

  • A methodical approach exists based on the Shaw patented method - Customer-Inspired Process Deployment®. The methodology starts with how an external customer experiences your organization and creates the structure of your organization as an assemblage of processes. This approach will most likely look quite different than your traditional organization chart. In fact, the organization chart really has little to do with how work gets done, in most cases. 
dhtobey Tobey

GroupMind Express - Collaboration Software and Consulting for Decision Support - 2 views

  • We provide web-based tools and consulting services to support organizations and consultants. Our purpose is to help teams make decisions based on shared data, resulting in increased alignment and faster implementation.. Here are several standard organization needs, and how we can add value to your work   Your need Our value-add Surveys Shared results lead to group learning. Identify your areas of strength and weakness. Meetings Interactive meetings provide opportunities for buy-in and for gathering the group's intelligence. Hear from everyone.   Brainstorm or Delphi process Create better solutions and build improvement by using fast-cycle brainstorming to increase group understanding.
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    Steve and I looked at this platform this evening in prep for tomorrow's walk-thru and after reviewing the KE capabilities and customization limitations, this may be a better option. We should therefore postpone tomorrow's walk-through and see about getting a trial version of GroupMind to try out for Raytheon.
Steve King

BS 25999 Business continuity - 1 views

  • S 25999On June 15, 2010 the DHS Secretary Janet Napolitano announced the adoption of BS 25999 for the PS-Prep program.  BS 25999 (which comes in two parts) is one of three standards for use in the Voluntary Private Sector Preparedness Accreditation and Certification Program (PS-Prep). PS-Prep is directed by Title IX of the Implementing the Recommendations of the 9/11 Commission Act of 2007.
dhtobey Tobey

DynaMed - 1 views

  • The American Academy of Family Physicians (AAFP) has determined that DynaMed may be of assistance to family physicians in answering clinical questions with high-quality evidence.
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    This could be a potential partner or competitor to an EBM community desktop. They have been endorsed by AAFP which is probably closer to the equivalent of NERC on the practitioner side with perhaps C-PATH being the equivalent on the pharma side.
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.
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.
Scott Edelman

Certification Partners - 0 views

  • Certification Partners delivers industry-leading IT certifications and training courses through high schools, online universities, training companies, industry associations and companies. We have more than 140,000 alumni globally who have succeeded with our three proprietary credentials in the IT and telephony markets: CIW, CTP and CCNT. Through our Select Partners® program, we deliver industry-leading training for our name-brand partners in IT and Finance credentialing organizations, and professional associations. We help students become professionals and we help professionals develop the skills to strengthen their careers.
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    Potential channel partner to sell LivingMethods.
dhtobey Tobey

US NSF - Dear Colleague Letter: Small Business Innovation Research and Small Business T... - 1 views

  • The Directorate for Engineering’s Division of Industrial Innovation and Partnerships’ Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) programs invites all active SBIR/STTR Phase I grantees to participate in the Phase IB supplemental funding opportunity. Phase IB supplements to Phase I grantees are intended to foster partnerships between strategic partners and investors and the SBIR/STTR companies.
  • Through this supplemental program, small businesses will be able to effectively leverage funding and investment from interested outside parties on the technology funded in Phase I that could lead to successful commercial products and processes and at the same time provide some of the gap funding required to carry the grantees' effort from Phase I to Phase II.
  • The objective of the Phase IB option is to extend the R&D efforts beyond the current grant to meet the product/process/software requirements of a third party investor to accelerate the Phase I project to the commercialization stage and enhance the overall strength of the commercial potential of the subsequent Phase II project. The Phase IB option extends the Phase I grant for six months, and the combined Phase I and IB project will typically not exceed one year in duration for the SBIR grant and one and one half years for the STTR grant.
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    SBIR Phase 1B awards in conjunction with venture firms targeting this space might be prime prospects for the DTSE Methodology and commercialization services. I wonder if there is an easy way to get a list of currently active SBIR Phase I projects?
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    I think is what Bob mentioned as a good thing for the grants he is working on? .. . maybe he has list.. he seems focused on grants these days
dhtobey Tobey

Computer-Based Testing Provider for Certification and Licensure Exams: Pearson VUE - 0 views

  • Pearson VUE provides a full suite of services from test development to data management, and delivers exams through the world’s most comprehensive and secure network of test centers in 165 countries. Pearson VUE is a business of Pearson (NYSE: PSO; LSE: PSON), the international education and information company, whose businesses include the Financial Times Group, Pearson Education and the Penguin Group.
dhtobey Tobey

cloudHQ for SugarSync - Basecamp, SugarSync and Google Docs - 0 views

    • dhtobey Tobey
       
      This is an interesting example of an integrated but very limited "social desktop" for cloud-based collaboration. We should start to keep a running list and matrix of this type of service to explain and compare VivoWorks' offerings.
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