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The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care (as defined by NAHIT, the National Alliance for Health Information Technology.)

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The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care (as defined by NAHIT, the National Alliance for Health Information Technology.)

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Comparative Effectiveness

Comparative Effectiveness Research (CER) compares treatments and strategies to improve health. For CER, HITECH provides $300M for the Agency for Healthcare Research and Quality, $400M for the National Institutes of Health, and $400M for the Office of the Secretary of Health and Human Services.

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The Certification Commission for Health Information Technology is a private organization that certifies EMRs and EHRs based on 475 criteria spanning functionality, interoperability and security. CCHIT does not evaluate ease of use of products, financial viability of the company offering the software; or the quality of customer support offered by the software vendor. Whether or not CCHIT will be THE certifying organization to approve “qualified EMRs” will be announced at the end of the year. (Can be pronounced “SEA-CHIT” or each letter can be pronounced as in “C.C.H.I.T.”)

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American Recovery and Reinvestment Act of 2009, also called “The Stimulus Package” or “The Stimulus Bill.” Of the $850B in the bill, $51B is pegged for the health care industry and $19B of that will be used to incent medical practices to adopt EMRs/EHRs.

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Learn This: Digital vs. Analog and June 12, 2009

dreamstimefree_22608922It seems only yesterday we got along just fine using words like “photography” and “cable television” without the world “digital” in front of them.  They were “analog” technologies, but they didn’t need to be marketed as such, because there was no point – there was no marketing buzz on the term, and no alternative.  Nowadays the word “digital” is everywhere and is accompanied by a very positive connotation.  It seems if you are selling something “digital”, it is a superior, more technologically advanced product or service, and it probably lies on the cutting edge of its field.  Digital is an old buzzword, maybe even a little past its prime, but it is still used heavily to promote what are already standard, mainstream technologies.  If you Google the word “digital” the search engine returns around one billion web results.  Compare that to “health care” which gets only a tenth of that.

“…But, what does digital mean?…”

Good question!  Digital is a word I imagine few can give a succinct, straight definition for.  For all the triumphs and innovations of the “digital revolution”, I doubt that there are a lot of people who can define the term’s root-word.

Let’s talk about theory here for a while, in abstract terms.

Imagine a two clocks on the wall of your office. Both are set to the correct time, and are the same model, except for one small difference. The clock on the left is always moving. The second hand of the clock sweeps around the dial in one long stroke, as do the minute and hour hands, although much slower.

The clock on the right is not always moving. It jumps second to second in a “tic-toc” style, and when the minutes, and hours are finished those hands jump as well. Both clocks represent the same piece of information- what time it is- but they have two different ways of representing how the time changes from moment to moment.

The clock on the left is one constant motion, and so it never stops to tell you “exactly” what time it is, but does tell you when the time is between seconds (not very useful, but remember we’re being theoretical). The clock on the right is much more specific (you can tell exactly what time it is, to the second), but never reports time in the intervals between the seconds.

This distinction, between a continuous flow of information, and a constant drip-drip-drip of individual pieces of data is the difference between analog signals and digital signals.

The clock on the left is analog– it provides a continuous “signal” (flow of information)- what time it is. The clock on the right is digital– it provides a continuous series of “points” of information, with periods in between each point with no information being produced (the moment between each second’s “tic”)

Back to the real world

You remember music records, right? They were flat, circular pieces of vinyl that could be put into a primitive version of what looked like a large CD player. If you had electricity, you could plug this “record” player, or “turntable” into a power outlet, and attach it to a set of two speakers using pieces of wire. The player would turn the record at a constant speed, and then the listener would carefully place a delicate needle attached to a mechanical arm on the record player onto the surface of the vinyl and under optimum conditions, sound would be produced through the speakers. There were all manner of musical groups that made these records, and they could played at parties or by yourself for solo enjoyment. The whole affair was quite charming.

Record players work by having the needle run gently over the “grooves” of the record, which are imprinted on the vinyl in such a fashion that the vibrating needle will quietly reproduce the recorded sound. Then the record player electrifies and amplifies the sound, and boom- party time!

There are no “gaps” in the record when it is playing. Even while the record is silent, the needle is running over an empty groove that isn’t vibrating the needle. Even when the signal is blank, it is part of the entire record, and it’s continuous playback. Record players therefore, are an “analog” technology.

I grew up with compact discs. Compact discs are actually very similar to vinyl records in how they operate. A CD player spins the disc at a constant speed, but instead of a needle running over the grooves, a laser (Light Amplification by the Stimulated Emission of Radiation) is focused onto the grooves, and is reflected back onto one of two sensors, which then create a series of data points that are turned into music. But the key difference is in how that sound data is represented. Instead of a continuous flow of sound, a CD is comprised of billions and billions of these tiny data points. Every second of sound on a CD is 44,100 individual pieces of data that tell the CD player what sort of noise to make. Even though you don’t hear “skips” in between pieces of data, the sound is actually a series of noises that are 0.0000226 seconds long. CDs are digital technology then, because they rely on many individual pieces of data rather than one long stream of information.

Is digital better than analog?

Well, let’s stay with the record player vs. CD player discussion. Listening to the same recording on the two different players produces two distinct sonic experiences. If you’re not a huge music fan, but like to hear tunes from time to time you might not even notice it. But if you’re a music fanatic who takes his sound quality very, very seriously, then you probably notice a lot of differences. The analog record is going to have “signal noise” where electrical and environmental interference distorts and slightly interrupts the signal- the slight hiss you hear in the backgroud of a record, and the loss of audio quality as the signal fades in strength over time. Never mind the pops and scratches that come with the wear and tear of handling and playing the record. Purists insist however, that the analog signal provides a certain “warmth” and some talk about the presence of a “soul” to the music that can’t be found in digital.

Of course, this isn’t to say that CDs sound bad. In fact, without the signal loss and interference, many everyday listeners think CDs sound far superior to records. The digital signal means a “cleaner”, “brighter” sound that comes from listening to only the music, and not the noise in the background. However, something is lost with CDs, literally. Like the brief moments of time between the jumps of the second hand on the clock on the right in our earlier analogy, the tiny moments between each of the 44,100 tiny pieces of sound aren’t recorded or played back on CD. These microscopic little pieces of music that aren’t on the CD lead some audiophiles to call digital sound “cold” and slightly “empty”.

The bottom line is this however. Most music that is being made today is being sold on either CDs or MP3 downloads (learn how to start using MP3s in my earlier Learn This Now post here), and not vinyl records. Even disc jockeys that play in clubs rarely use real vinyl anymore. So even if you think CDs sound a little worse than vinyl, chances are you already use digital music almost exclusively, and will continue to do so.

What should I know going forward?

The truth is, there aren’t many traditional analog technologies still in use. Radio and television broadcasts are still analog, but with the rise of Satellite Radio services like Sirius and XM, and the coming American Digital Television transition, even those are on the way out.

The important thing to remember is that just because something says “digital” it isn’t necessarily a huge leap over an old technology, or even particularly new. But now that you know what digital and analog means, you are empowered to decipher any such attempts at newfangled tomfoolery. Stay tuned to for the resources you need to stay ahead of the curve. Cheers!

Note from Mary Pat: The change to digital technology has tremendous implications for healthcare.  Think about telemedicine, electronic health records, and sharing of all information digitally.  Expect some significant changes down the road in medical records between Obama’s stimulus plan and dollars for HIT and the transition to digital technology.

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Learn This: Twitter, Social Networking, and Micro-blogging








Twitter is a combination of two concepts, social networking and micro-blogging. When combined, they create a fascinating way for people to communicate and keep in touch.  Let’s explore social networking and micro-blogging individually first.


Social Networking


This is the Myspace, and Facebook you’ve heard so much about.  You already know what networking is – you create, build, and maintain personal and professional relationships to meet people, find opportunities, and learn new things.  Successful practice managers are constantly networking to be in the know and stay ahead of the curve.  Now add the social aspect of it to the equation.  Social networking means starting with people you already know, and using that as a jumping off point. Take your existing network of contacts and digitize them to build an on-line community.

Think about your contact list in your address book, email, phone, or Blackberry.  You have everyone in there: colleagues, friends, family.  What if you also had access to the contact lists of everyone in their contact lists?  There would be duplicate entries but there would also be a lot of people in this “friends of friends” list that you didn’t know before.  You would probably see a lot of new names and faces, some of whom you might want to talk to about your organization, their organization, your product, their service, their hobbies, even ask out on a date!

When you walk into a room and see a friend talking to someone you don’t know, you go and say hello to your friend, and introduce yourself to the stranger- you are building your network by social networking!

The differences between various social networking sites (see the MMP post on LinkedIn) will be explored in a later article, but all social networking sites have one thing in common – they are designed to help you meet new people through common friends, interests, pasts, and goals.




It’s blogging, but smaller.  But what’s blogging?  “Blog” is short for “web log”, and it is keeping an online journal of writings, pictures, and other multimedia, as well as news items and content found on the web.  Some blogs are just places where people write about their feelings and activities so other people can read them.  Some blogs are focused on a topic- like focuses on health care administration.  But all blogs are simply websites that are updated by their authors fairly frequently around some common theme.

How does blogging become “micro”?  By shrinking it down to its bare essence and relaying the heart of the message, communicating the necessary.  How could this be of use to you?  What if you set up a system where your kids received updates when you were going to be home later than usual from work, telling them they were allowed to have a soda with their homework before TV, and what would be for dinner when you arrived?  Or maybe your kids need to update you when their plans change.  What if all your colleagues were updating each other about the goings-on at a professional conference so they could decide on the fly which events to attend, and share their experiences, and decide where everyone would be meeting afterward.

Anything that could be helped by contacting an entire group of people quickly with short message could benefit from micro-blogging.


Twitter puts it all together


Twitter takes these two concepts, and merges the whole shebang with your mobile device.  Twitter lets you easily microblog to your social network over your mobile device. You don’t have to use a cell phone or a Blackberry to use Twitter- you can send and receive updates over the web, and through a variety of third party providers.

If you want to get started, go to the Twitter homepage at, and click the green button that says “JOIN THE CONVERSATION”.  You will create a username and password, and start adding contacts and you’ll soon be able to make your first micro-blog post (they call them “tweets”).

On Twitter, anyone you want to receive updates from is someone you are “following”, and anyone who is receiving your messages is one of your “followers”.  You can also send messages directly to just one user, or set up groups of people to receive certain updates – your co-workers don’t have to see your notes to your kids, and vice-versa. You can also do fun things, like upload a little picture of yourself to be your icon that people will see when they are on Twittera.


Now it’s time to supercharge your cell phone


But you don’t have to ever go to the site if you don’t want to!  The real power of Twitter is that it can let you do all these short internet communications (micro-blogging) right from your cell phone.  Basic text messages that you may already use on your cell phone (called “SMS messages“) can be used to send and receive messages from Twitter.   Just link your Twitter account to a mobile phone in your Twitter settings, and then you can send your updates as text messages to 40404.  Incoming Twitter messages from the users you follow will show up as incoming texts from Twitter, but with labels to show you which user the update is from.  You can also customize your mobile updates, so you only get messages from certain users. If you follow some people who are heavy updaters, you might get tired of constant alerts of new text messages.  Also be sure you understand your cell phone’s text messaging plan – Twitter is free to use, but if you don’t have unlimited messaging on your phone, it could be easy to run up a big bill.

Once you have your Twitter up and running on your mobile phone things get really interesting, as now you’ve basically turned your cell phone service into an internet chat room. And in terms of business, that gives you near constant connection.  Twitter users are often the first people to know the newest information, and love to post updates about it online.  It’s an interesting way to see what’s new in the world – finding out what people are talking about literally “right then”.  Plus it creates an interesting crowd of which to ask questions: What’s going on tonight?  Can anyone recommend good seafood on the north side of town?  Is anyone getting anything out of this conference?

The brilliance of Twitter is that it so easily connects people on all different types of computers and cell phone platforms.  Twitter can seamlessly create networks of people communicating for mutual benefit, and provide an interesting new way to keep on top and keep in touch.

To Recap:

  1. Social Networking = networking with your friends’ friends
  2. Micro-blogging = little missives without all the niceties and all the heart
  3. Twitter = #1 + #2 (little missives to your friends’ friends’ friends)
  4. How can you leverage this technology to make your practice more efficient and productive?

Note from Mary Pat: How can Twitter be used in a medical practice setting?  Here are a few ways – I’m sure you can think of others.  If your doctor is running late, use direct messages to Twitter patients to let them know right away that they can arrive later or reschedule their appointment.  Likewise, when an earlier opening is available, Twitter a patient to see if they could fill your appointment time.  Twitter your doc to let him/her know about schedule changes that would affect what s/he is doing right now.

And to get you started on Twitter, my Twitter name is “Mary_Pat_Whaley.”

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