Tag Archives: organization

Thoughts

Changed all site URLs

I pushed through some major changes to site URLs tonight. Every single site URL has now changed as a result, but the change is good, and all old URLs should still work just fine, seamlessly redirecting visitors to the new URLs. Just in case though, please let me know if you find a non-working URL.

The changes have to do with how post, category and tag URLs appear. WordPress, my site’s platform, allows me to change URL rewrite rules (the way a certain URL is generated when you visit a page on my site). I’ve wanted to make this change for a long time, and finally bit the bullet after first trying it out on one of my other sites, Dignoscentia.

Here’s what this means for you:

These changes may not be important to some, but they are to me. Once I get something like this in my head, something that I think will help me organize my content a little better and make the URLs a little shorter and easier to type, I have to go through with it.

I have some more changes planned for the actual categories themselves, such as re-organizing my content into more logical categories. I also need to finish tagging all my posts (currently 1242 posts and counting).

This is all part of my long-term efforts to properly curate my content. You may want to have a look at the site news tag to see what other changes I’ve made to the site over time. It’s been an interesting journey with quite a bit of work behind the scenes, but I like doing this sort of stuff a lot.

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Reviews

Google Health is a good thing

When it launched a few weeks ago, Google Health received fairly lackluster reviews. Privacy issues and lack of features were the main complaints. Well, I’m here to tell you those initial views are wrong.

Even if you’re a long-time reader of my site, you may not know what qualifies me to make that statement, so let me tell you a bit about myself.

My background

A few years ago, I was Director of Health Information Systems at a South Florida hospital, where I implemented an electronic medical records system. My job was fairly unique, because I not only wrote the policies and procedures for the system and oversaw its implementation, but I also rolled up my sleeves and built the various screens and forms that made it up. I, along with my staff, also built and maintained the servers and databases that housed it.

As far as my education is concerned, I hold a Master’s Degree in Health Services Administration (basically, hospital administration). I was also admitted to two medical schools. I ended up attending one for almost a year until I realized being a doctor wasn’t for me, and withdrew.

For plenty of years, I’ve been a patient of various doctors and hospitals, as have most, if not all of you, for one reason or another.

Furthermore, my father is a doctor: a psychiatrist. He has a private practice, and also holds a staff job at a hospital. My mother handles his records and files his claims with the insurance companies, using an electronic medical records system. I get to hear plenty of stories about insurance companies, billing ordeals, hospitals and the like.

So you see, I’ve seen what’s involved with medical records and access to said records from pretty much all sides of the equation. Again, I say to you, Google Health is a good thing, and I hope you now find me qualified to make that statement.

The benefit of aggregation

Just why is it such a good thing? Because I wish I could show you your medical records — or rather, their various pieces — but I can’t. That’s because they exist in fragments, on paper and inside computer hard drives, spread around in locked medical records facilities or in your doctors’ offices, all over the place. If you endeavored to assemble your complete medical history, from birth until the present time, I dare say you’d have a very difficult time getting together all of the pieces of paper that make it up — and it might not even be possible. That’s not to mention the cost involved in putting it together.

A few of the problems with healthcare data sharing

Do you know what my doctor’s office charges me per page? 65 cents, plus a 15 cent service fee. For a 32 year old male (that’s me) it would take a lot of pages (provided I could get a hold of all of them) and a lot of money to put my medical record together.

The sad part is that this is MY medical information we’re talking about. It’s information that health services workers obtained from MY body. It’s MY life and MY record, yet I can’t have access to it unless I fill in a special form at every doctor’s office I’ve ever visited, and pay for the privilege. Is that fair? NO. Can something be done about it? YES, and so far, Google Health is the only service I’ve seen that is trying to pull together all of the various pieces that make up my medical record, for my benefit and no one else’s. Sure, the system is in its infancy, and there’s a lot of work to be done to get it up to speed, but that’s not Google’s fault.

I’ve been inside the healthcare system, remember? I know how things work. I know how slowly they work, to put it mildly. I know how much resistance to change is inherent in the system. Just to get medical staff to use an electronic medical records system is still a huge deal. The idea of giving the patient access to the records, even if it involves no effort on the part of the medical staff (but it does, as you’ll see shortly) is yet another big leap.

Let’s also not forget to consider that medical records systems are monsters. Each is built in its own way. There are certain lax standards in place. Certain pieces of information need to be collected on specific forms. The documentation needs to meet certain coding standards as well, or the hospitals or doctors’ offices or pharmacies won’t get reimbursed. There are also certain standards for data sharing between systems, and the newer systems are designed a little better than older ones.

Yet the innards of most medical health systems are ugly, nasty places. If you took the time to look at the tables and field names and views and other such “glamorous” bits inside the databases that store the data, you’d not only find huge variations, but you’d also find that some systems still use archaic, legacy databases that need special software called middleware just so you can take a peek inside them, or form basic data links between them and newer systems. It’s a bewildering patchwork of data, and somehow it all needs to work together to achieve this goal of data sharing.

The government is sort of, kind of, pushing for data sharing. There’s NHIN and the RHIOs. There are people out there who want to see this happen and are working toward it. Unfortunately, they’re bumping up against financial and other barriers every day. Not only are they poorly funded, but most healthcare organizations either do not want or cannot assign more money to either getting good record systems or improving their existing ones to allow data sharing.

Add to this gloriously optimistic mix the lack of educated data management decisions made in various places — you know the kind of decisions that bring in crappy systems that cost lots of money, so now people have to use them just because they were bought — and you have a true mess.

Oh, let’s also not forget HIPAA, the acronym that no one can properly spell out: Health Insurance Portability and Accountability Act. The significant words here are Insurance and Accountability. That’s government-speak for “CYA, health organizations, or else!” There’s not much Portability involved with HIPAA. In most places, HIPAA compliance is reduced to signing a small sticker assigned to a medical records folder, then promptly forgetting that you did so. Your records will still be unavailable to you unless you pay to get them. Portability my foot…

Benefits trump privacy concerns

Alright, so if you haven’t fallen asleep by now, I think you’ve gotten a good overview of what’s out there, and of what’s involved when you want to put together a system like Google Health, whose aim is to pull together all the disparate bits of information that you want to pull together about yourself. Personally, I do not have privacy concerns when it comes to Google Health. There are more interesting things you could find about me by rummaging through my email archives than you could if you went through my health records. If I’m going to trust them with my email, then I have no problems trusting them with my health information, especially if they’re going to help me keep it all together.

Not sure if you’ve used Google Analytics (it’s a stats tool for websites). Not only is it incredibly detailed, but it’s also free, and it makes it incredibly easy to share that information with others — should you want to do it. You simply type in someone’s email address in there, and you grant them reader or admin privileges to your stats accounts. Instantly, they can examine your stats. Should you prefer not to do that, you can quickly export your stats data in PDF or spreadsheet format, so you can attach it to an email or print it out, and share the information that way.

I envision Google Health working the same way. Once you’ve got your information together, you can quickly grant a new doctor access to your record, so they can look at all your medical history or lab results. You’ll be able to easily print out immunization records for your children, or just email them to their school so they can enroll in classes. A system like this is priceless in my opinion, because it’ll make it easy to keep track of one’s health information. Remember, it’s YOUR information, and it should NOT stay locked away in some hospital’s records room somewhere. You should have ready access to it at any time.

Notice I said “whose aim is to pull together all the disparate bits of information you WANT to pull together” a couple of paragraphs above. That’s because you can readily delete any conditions, medications or procedures you’d rather keep completely private from Google Health. Should you import certain things into it that you don’t feel safe storing online, just delete that specific thing, and keep only the information you’d be comfortable sharing with others. It’s easy; try it and see.

Lots of work has already been done

Another concern voiced by others is that there isn’t much to do with Google Health at the moment — there isn’t much functionality, they say. I disagree with this as well. Knowing how hard it is to get health systems talking to each others, and knowing how hard it is to forge the partnerships that allow data sharing to occur, I appreciate the significant efforts that went on behind the scenes at Google Health to bring about the ability to import medical data from the current 8 systems (Beth Israel Deaconess, Cleveland Clinic, Longs, Medco, CVS MinuteClinic, Quest, RxAmerica and Walgreens).

What’s important to consider is that Google needed to have the infrastructure in place (servers, databases) ready to receive all of the data from these systems. That means Google Health is ready to grow as more partnerships are forged with more health systems.

In order to illustrate how hard it is to get other companies to share data with Google Health, and why it’s important to get their staff on board with this new development in medical records maintenance, I want to tell you about my experience linking Quest Diagnostics with Google Health.

Quest is one of the companies listed at Google Health as having the ability to export/share their data with my Google Health account. What’s needed is a PIN, a last name and a date of birth. The latter two are easy. The PIN is the hard part. While the Quest Diagnostics websites has a page dedicated to Google Health, where they describe the various benefits and how to get started, they ask people to contact their doctors in order to obtain a PIN. I tried doing that. My doctor knew nothing about it. Apparently it’s not the same PIN given to me when I had my blood drawn — by the way, that one didn’t work on Quest’s own phone system when I wanted to check my lab results that way…

Quest Diagnostics lists various phone numbers on their site, including a number for the local office where I went to get my bloodwork done, but all of the phone numbers lead to automated phone systems that have no human contact whatsoever. So Quest makes it nearly impossible to get in touch with a human employee and get the PIN. Several days later, in spite of the fact that I’ve written to them using a web form they provided, I still don’t have my PIN and can’t import my Quest Diagnostics lab results into my Google Health account.

➡ Updated 5/27/08: Make sure to read Jack’s comment below, where he explains why things have to work this way with Quest — for now at least.

That is just one example of how maddening it is to try and interact with healthcare organizations, so let me tell you, it’s a real feat that Google managed to get eight of them to sign up for data sharing with Google Health. It’s also a real computer engineering feat to write the code needed to interact with all those various systems. I’m sure Google is working on more data sharing alliances as I write this, so Google Health will soon prove itself even more useful.

More work lies ahead

I do hope that Google is in it for the long run though, because they’ll need to lead data sharing advocacy efforts for the next decade or so in order to truly get the word out to patients, healthcare organizations and providers about the benefits of data sharing and Google Health.

For now, Google Health is a great starting point, with the infrastructure already in place and ready to receive more data. I’m sure that as the system grows, Google will build more reporting and data export capabilities from Google Health to various formats like PDF, as mentioned several paragraphs above, and then the system will really begin to shine. I can’t stress enough what a good thing this is, because just like with web search, it puts our own medical information at our fingertips, and that’s an invaluable benefit for all.

Join me for a short screencast where I show you Google Health. You can download it below.

➡ Download Google Health Screencast

(6 min 28 sec, 720p HD, MOV, 39.8MB)

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Thoughts

Winnowing my photos

I seldom keep more than 50-60% of the photos I take. There’s no reason to waste my disk space with digital trash. It’s funny, the more photos I shoot, the less of them I keep. Lately, only about 10-20% of my photos manage to survive deletion. It’s an inversely proportional relationship.

When I decided to share my photos online, I whittled down my collection of over 18,000 photos (already winnowed) to about 7,000 that I wanted to upload. Over the past few weeks, I’ve been winnowing even those photos. I was a little too enthusiastic at first, and uploaded some photos that should have stayed on my computer or gone straight to the trash bin because they missed my initial winnowing. It’s been a painful process, and it’s very bruising to the ego, but it’s got to be done. It’s really hard to delete a photo when it’s had 10, 20, 30, even 50 or 60 views, but if it’s inferior, there’s no reason to let it stay.

I’ve reached a point now where I’m sharing thousands of photos (over 3,500 are public, with a total number of over 5,800), so there’s no reason not to winnow. If someone’s going to take the time to go through my photos, I don’t want them to see chaff, I want them to see substance. I know I’m sick of chaff. With time, my eye has gotten better at spotting good photos. And it’s also gotten more sensitive and easily disgusted with crappy snapshots that don’t deserve to waste disk space. I see so many of those when I hunt for good photos, that I can’t stand to see any in my own collection.

If you’ve been looking at my photos, and wondering how it’s possible that the total number of photos stays constant and even goes down while I upload new photos every day, now you have your answer. If you’re an experienced photographer, and you’ve seen some photos in my collection that you think are terrible, let me know. I’ll have a look and gladly delete any inferior photograph.

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Reviews

Cannot edit EXIF data in iPhoto

Those of us using iPhoto (up to version 6) are probably pretty disappointed to find out that we can’t edit a photo’s EXIF data. What’s more, whatever data we add to the photo (changing title, date, description, rating) also doesn’t get stored to a photo’s EXIF fields. Instead, it gets put in some other associated file, and gets lost entirely when the photo is exported out of iPhoto — for example, uploaded to Flickr.

This may not be so bad for photos that we take with our digital cameras, because they’ve already got a good amount of EXIF data stored in them, but it absolutely stinks for photos that we’ve scanned in. I’ve got all of my family’s photos in iPhoto, organized and rated and dated. A good chunk of those photos — over 60% of some 17,000 odd photos — are scanned in. That means that when I email those photos or import them into a program like Picasa on my PC, or upload them to Zooomr, all of the date information and other data that shows up in iPhoto is lost, by design (and a poor one at that). Isn’t this ridiculous? It makes all of that time spent working with the photos in iPhoto useless. They pass through the program like a duck through water. All of that “water” drips right off when the photo’s out of the app. It’s just not right.

If I can crop and adjust a photo’s color, brightness, contrast, exposure, sharpness and other parameters in iPhoto, and have those changes be preserved when I drag that photo into an email, it stands to reason that any other changes made to the photo (date, title, description, rating) should also be preserved. Otherwise, iPhoto is really not a full-fledged photo management app.

Now, I understand there are apps like Aperture, Lightroom, and of course, Photoshop, for editing photos and getting at more of a photo’s EXIF data. But not everyone wants or needs those applications. They’re meant for users who do a lot more with photos. To me, even though I have Photoshop, it seems silly to open it up just to edit the EXIF data of a photo. And I’m not going to get Aperture just to edit EXIF data. Aperture is meant for professional photographers and I’m still just an amateur photographer. This is such a basic function that it should be integrated directly into iPhoto. If the EXIF data from a photo can be viewed in iPhoto, it should also be editable, and that same data should be preserved inside the photo when it is exported to the web or for use in other applications.

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Thoughts

13 arguments for telecommuting

I thought I’d put together this list of arguments you could use to make the case for telecommuting at your workplace. No, there’s nothing special about the number 13. That’s how many reasons I came up with. If you know of more, please let me know and I’ll be glad to publish them here.

First, I should say I’m all for telecommuting, and I think it’s unfair to make people come into work when most jobs — in particular tech jobs — can be readily converted (with little or no effort) to allow employees to work from their homes.

Reduced office space

Leased office space can be less (significantly less) when employees are allowed to telecommute, since most people won’t need dedicated offices at company headquarters. All that’s needed are offices for the employees that need to be there: phone operators, receptionists, facilities, help desk, and meeting rooms. You’ll need the latter because employees will probably need to come in for meetings or other tasks that need to be performed on-site once a week or every two weeks. In addition, sales folks may need to come in to meet with clients, etc. An unexpected benefit will be that you’ll actually be using the conference rooms a lot more than before. Management will be happy, since the space they’re paying for will be well utilized.

Reduced business utilities

Utilities and other bills, like communications, will be much, much less. With most of the workforce staying at home, and much less office space, electricity usage will be slashed. None of those things that really rack up the bills, like A/C, computers and lights will be anywhere near their previous figures. People will use IM and video conferencing tools (like Skype) to communicate with each other, and will use home phones when needed. You’ll be able to ditch expensive phone system, or scale them down significantly.

Less crowding during rush hour

Businesses that allow their employees to telecommute are doing a greater good. They’re directly contributing to solving today’s serious traffic problems. When employees don’t need to come into work, they stay home and their cars stay in the garage, not on the streets, clogging up avenues and highways, causing traffic delays and accidents. Let’s not also forget the added benefits of burning up less fossil fuels.

Less pollution

When cars stay in the garage, there’s less pollution. I’m not just talking about greenhouse gases, I’m talking about traffic noise as well. Those of you who live near busy streets know this.

Contribute to national security efforts

Businesses that allow employees to telecommute are indirectly contributing to the safety of our country, by reducing our dependence on foreign oil. The less gas employees burn driving to work, the less gas that we’ll need to purchase from countries that finance terrorism. That’s always a good thing. And police and fire trucks will have an easier time driving on our streets during rush hour with less cars on the roads.

Less stress for everyone

I don’t know about you but traffic is very stressful. Sitting in traffic, knowing you can’t go anywhere and you’re stuck there, sandwiched in between other cars, puts one in a very helpless mood. Don’t even get me started on how much time is wasted on commutes, because that’s completely ridiculous and unnecessary. And let’s not forget the people who are actually trying to go shopping or must make it to an event during rush hour. They’re stuck in there too, and they’re not going to work.

Higher job satisfaction

Wasted time makes productive people unhappy. Time and energy gets wasted in traffic. Hence, allowing employees to work from home makes them happy. It’s logical, isn’t it? Besides, I don’t need to analyze things to know that if I could sit at my computer in the morning, right after having breakfast, and get right to work, instead of having to find clothes, get in the car, waste my time on the road, get out of the car and settle in my office, I’d be a lot happier. Why go through all that when I’ve got everything I need right at home?

Less expenses for employees

What do we spend on gas every month? C’mon, add it up! I spend about $100, but I’m one of the luckier ones, because I only have a 25 mile round-trip commute. I’m sure other people spend more. And we’re not even counting the wear and tear on our cars. And how would we value the time we waste in traffic, time that could be spent working productively? I suppose we could calculate our hourly rate, then come up with a total for the time wasted on the road.

Less expenses per employee (business-wise)

Managers, count up the costs to get an employee in a chair at your place. Add in furniture, supplies and equipment (and make sure to include the computer as well). Well, now slash all those costs by about 70%. Happier? An employee that works from home won’t need an office, won’t need a phone, won’t need a desk or a chair or a bookcase or a filing cabinet or even a computer. Okay, there might be some leeway with the computer. You could let them sign out company equipment if you desire, or sponsor the whole or part of the cost of a computer, considering that they’ll use it for work now in addition to their home chores. And you might need to supply them with work-related software as well. But think about it, all of the other costs will go away. When employees come in, they can use terminals set up in the conference rooms, or bring their own laptops. And they’ll use common desks set up near conference rooms to do work that needs to be done at work, not dedicated offices.

Improved management practices

When employees telecommute, work becomes objective and goal-oriented for everyone. It has to, in order for telecommuting to work. Employees get treated as adults instead of babies that need to be micromanaged. Clear monthly and weekly objectives get set, and employees produce status reports or track their objectives online. When tracking is enabled, it’s easy to see who performs and who doesn’t perform. Non-performers can be let go. This is efficient management. Employees are enabled to do what they need to do, and the good ones will go out there and do it.

More family time

Those of you who are married or have significant others, let me ask you this: if you had two hours a day, extra, would you spend them in traffic, or would you spend them with the person you love? That’s an easy answer, right? So okay, you don’t have a spouse. Wouldn’t you rather pursue a hobby or read a book rather than waste your time in traffic?

Safety, safety, safety

People without time constraints are more laid back when they drive. When you work from home, you don’t need to rush into work. This means we’ll have less aggressive drivers on the streets, and our lifestyles will be more relaxed on the whole. Businesses who allow their employees to telecommute are indirectly decreasing the number of accidents and costly traffic tickets.

No more workplace annoyances

This may be more of a pet peeve of mine than anyone else’s, but I’d rather use the bathroom at home than the one at work. I don’t want to go to the bathroom and see (or smell) someone else in there. Why? Because people are disgusting. I want to be able to relax, at home, in my own bathroom, where I’m not in danger of contracting other people’s germs or be subjected to other people’s gross bathroom habits. I’m sure there are plenty of things that annoy you about your own workplace or co-workers, so we probably don’t need to get started down that path. Well, wouldn’t you be happier if you could see less of those annoying people, and only deal with them through email, from time to time? I thought so.

Hope this helps you make the case for telecommuting at your own workplace. Or, that it helps business managers realize the value of this wonderful practice, which is a fantastic way to attract motivated and valuable employees to one’s organization.

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