Finding the perfect Christmas gift for that college student in your life can be tough. We here at Alliance Defending Freedom (ADF) want to help. We know college students and the unique challenges they face.
How unique? Well, at least in California's San Mateo Community College District, Santa Claus has been banned as too great an insurance risk (See page 29 – "Santa Claus" on list of "Excluded Vendor/Exhibitors." Presumably, it's the flying reindeer). So they can't exactly depend on Santa to bring their gifts. And that's where we can help.
The merry band of attorneys at the ADF Center for Academic Freedom spend our days representing these college students facing threats to their very right to speak on their own college campuses. So we did some thinking and came up with these Christmas gift ideas for that college student in your life.
If your college student is attempting to engage in free speech on a college campus, there is a chance that he will be arrested for doing something particularly bold – like daring to distribute copies of the U.S. Constitution. That happened to our clients at Michigan's Kellogg Community College, who were trying to start a Young Americans for Liberty chapter there. Michelle Gregoire spent an evening in the local jail because she was asking KCC students, "Do you like freedom and liberty?" while providing them a free copy of the document that guarantees her (and them) both. If you're going to be deprived of your inalienable right to liberty for exercising your First Amendment free-speech rights on campus, you're going to need a good way to while away the time. I like a good Sudoku puzzle, and this one should keep your student occupied until their friends and family can be notified and bail them out. (Pro tip: You may want to include a quarter so they can make the phone call).
If you have a student at Southern Illinois University-Edwardsville hoping to exercise his free speech rights, this is an absolute must. SIUE restricts student speech to an area within 20 feet of "The Rock" (not Dwayne Johnson, but an actual boulder). Of course, even then they'll need the school's permission to use that tiny speech zone, but if they are granted permission to speak, the tape measure is a necessity.
If your SIUE student already has a tape measure, you might also consider a planner. SIUE requires that students notify the school of any "controversial" events, "(Examples: political figures, religious gatherings)" ninety days in advance. So if you think you might want to invite a member of the state legislature to speak on campus in mid-November, prior to exams, you need to be sure to plan for that and notify the school in mid-August before the fall semester even starts. And unfortunately these kinds of advance notice or permission for speech policies are all too common on other campuses.
Gift cards are usually weak sauce. Sure. But for many conservative, pro-life, and Christian student groups, they may also be quite helpful. While these students must pay mandatory student fees that are supposed to be used to fund the activities of all student groups, they often don't see much or any of those funds. Take the Students for Life chapter at California State University – San Marcos for example. Students pay over a million dollars in student fees. But while $300,000 of those dollars goes to the advocacy of the LGBTQA and Gender Equity Centers, less than $40,000 is set aside for the other 100 student groups, who receive just $500 each. And when Students For Life sought funding to bring a pro-life speaker to campus, they were denied. That's more of a Venezuelan grocery store of ideas than a marketplace of ideas.
If you have a student at California State University – Los Angeles, and they want to attend an insightful presentation from their favorite conservative political commentator, he may have trouble getting into the auditorium. The last time Ben Shapiro spoke at their school, faculty and student protestors blockaded the entrances so those hoping to attend couldn't even enter the building. The YAF students that day had to find a back entrance and sneak people in to hear a talk on freedom of speech. These walkie talkies will help students quietly navigate around the opponents of free speech.
Shopping for a Georgia Gwinnett College student but trying to stay culturally relevant? We have just the thing for you! This Captain America Shield is perfect for any student, like our client Chike Uzuegbunam, whose discussion of the Bible with other students was deemed "fighting words" by the College. That designation was an attempt to justify its decision to limit him to a small speech zone, require him to ask for permission to speak, and then stop him from speaking, even with his permit, on the grounds that others were offended by the Gospel. While not as effective as the Shield of Faith, Captain America's shield will prepare your student for any fight he accidentally starts with words like, "Love thy neighbor," "You will find the baby lying in a manger," or, "For God so loved the world." Bonus: this shield can be used for his costume at the midnight premiere of Avengers: Infinity War.


Giveaways are open to US Residents, 18 and older. I will disclose how I have chosen the winner on the post when the winner is announced. Typically, this would be using Random.org. The winner will either need to contact me or I will contact them via the email they provided. This instruction will also be provided on the post where the winner is announced. The winner will have 48 hours to respond to the email, and from that point I will provide further information on how the prize is delivered.
The owner of this blog also uses affiliate marketing and is paid by those affiliate networks. Due to an upgrade in the site, many previous post may now have affiliate links and may not say that specifically on the post. These are post done previous of September 1st, 2011. All current post should also indicate when an affiliate link has been used.


Towing and hauling big loads is not an issue for the brand new Chevrolet Silverado 2500HD, offered in Champlain. Parker Chevrolet Inc. has an extensive inventory of Chevrolet Silverado 2500HDs. This vehicle packs a powerful V8 engine with six-speed automatic transmission. For safety, the Chevrolet Silverado 2500HD has airbags, daytime running lamps, and teen-driver mode. Feel free to call us if you want to know more!


text:
Q: Drupal 7 drill down menu with Checkboxes - Similar to Amazons left menu I'm new to drupal, so I'm looking for any suggestions as I am learning here.
I'm working on a site where I have a taxonomy setup like so:
Top Vocabulary:
Events
Sub Vocab that would have check boxes:
[] New Events
[] Past Events
Category of Events
[] Webinars
[] Conferences
[] Workshops
Topics of Events ()
[] Topic 1
[] Topic 2
[] Topic 3
When you check one of the checkboxes it just narrows down what shows in the content area.
Similar to Amazon's menu here:

After I setup the taxonomy, how do I create a menu like this?

A: I have found the term I am looking for here... it's called Faceted Search. There is a module for Drupal 7 here: http://drupal.org/project/facetapi
There is also a good writeup on best practices here: http://www.uxmatters.com/mt/archives/2009/09/best-practices-for-designing-faceted-search-filters.php
There is also another post here on StackOverflow: Does anyone know of a faceted search solution for Drupal 7?
A couple good resources I have found for Drupal 7 Faceted Search:

*

*http://envisioninteractive.com/drupal/drupal-7-views-with-faceted-filters-without-apachesolr/

*http://php.dzone.com/videos/video-walkthrough-faceted

*http://drupal.org/project/search_api/

*http://www.webbydude.com/posts/10-drupal-faceted-search-tutorial

*http://nickveenhof.be/blog/screencast-2-creating-facets-apache-solr-drupal-7
I hope this helps someone looking for such a thing as Faceted Search.

redpajama_set_name: RedPajamaStackExchange


SPEARMAN - Helen Ruth Kenney, 85, of Spearman died Saturday, Dec. 17, 2011.
Services were Friday in Albuquerque, N.M. Graveside services will be at 2 p.m. Tuesday in Hansford Cemetery. Arrangements are by Boxwell Brothers Funeral Home of Spearman.
Ms. Kenney was born in 1926 in Hansford County to Eldred and Verna Kenney. She was a long-time member of Unity Church.
Survivors include a sister, Maxine Johnston of Pampa, and a brother, Byron Kenney of Texline.


3000 sq ft. Industrial and modern. Space for up to 80. More info located here.
Space is available on a sliding price scale for nonprofits and community groups.
Outside food and non-alcoholic drinks are allowed. Custodial fees will apply.
Thank you for your interest in Villa del Sol! Someone will get back to you soon. If you have any immediate questions or concerns, contact Taylor Gauthier at tgauthier@nedahome.org or at 763-227-3617.
Check out our events page for community events at Villa del Sol and on the West Side!
All community members are welcome!!


St Joseph's Catholic Church of Big Bear on N. Shre Dr in Big Bear Lake, CA is in the Beach California section(s) Religious Organizations and Religious Organizations. The map of St Joseph's Catholic Church of Big Bear shows the approximate location in Big Bear Lake, but you should call them at phone number (909) 866-3030 to verify their address is 42242 North Shre Drive, Big Bear Lake, California 92315 and to get hours and driving directions. For more information on St Joseph's Catholic Church of Big Bear Big Bear Lake their website URL is www.stjosephbigbear.com.


text:
Domino's Pizza:
Domino's Pizza® Expands Carryout Special With Additional Day
By: Domino's Pizza | 24 Shares 102 Reads
Campaign shows how "crazy" Domino's is, taking a great deal and making it even better.
ANN ARBOR, Mich., Feb. 6, 2013 /PRNewswire via COMTEX/ - Has Domino's Pizza gone crazy? Yes, according to Scott Boyle, Domino's Pizza franchise owner and star of the company's latest commercial, promoting a campaign that will extend the fan-favorite Domino's carryout special an extra day, now available for customers from Monday through Thursday.
Domino's, (NYSE: DPZ), the recognized world leader in pizza delivery, had been offering the value-aggressive large, three-topping pizza for $7.99 on Monday – Wednesday, and will now tack on an extra day for customers to enjoy a great pizza at a great price. Patrick Doyle, Domino's Pizza chief executive officer and co-star of the campaign, explains why – prior to giving Boyle a hand by helping with the carryout rush at a Domino's store.
"We continue to focus on giving people what they want and, in this case, taking a great deal and making it even better," said Doyle. "While Scott and I light-heartedly argue during the ad, we certainly agree on the fact that customers deserve a lot of pizza at a terrific value – and that is what the carryout special is all about."
Now making up roughly one-third of orders in the U.S., carryout has become a bigger part of what customers are looking for – and has helped Domino's continue striving to make its stores a welcoming destination.
"All jokes with Patrick aside, the great thing about the carryout special is that it brings people into our stores, to see our terrific team members at work doing what they do best," said Boyle. "The new store design that Domino's has launched will only help people feel more welcome, and have a bit more fun, when they visit our locations, see our kitchens and take advantage of this great deal."
About Domino's Pizza®
Founded in 1960, Domino's Pizza is the recognized world leader in pizza delivery. As of the third quarter 2012, Domino's operated a network of 10,040 franchised and Company-owned stores in the U.S. and over 70 international markets. During the third quarter, Domino's had global retail sales of nearly $1.7 billion: nearly $800 million domestically and over $862 million internationally. Domino's had global retail sales of over $6.9 billion in 2011. In October 2012, Domino's debuted its Handmade Pan Pizza, touting the product's fresh, never-frozen dough and establishing itself as a player in the Pan Pizza market. In September 2012, Domino's opened its 10,000th store, becoming one of only eight restaurant chains in the world to reach that milestone. In May 2011, Pizza Today named Domino's its "Chain of the Year" for the second straight year – making the company a three-time overall winner, and the first pizza delivery company to receive the honor in back-to-back years. In 2011, Domino's was ranked #1 in Forbes Magazine's "Top 20 Franchises for the Money" list.
Order - www.dominos.com
Mobile – http://mobile.dominos.com
Info - www.dominosbiz.com
Twitter - http://twitter.com/dominos
Facebook - http://www.facebook.com/Dominos
SOURCE Domino's Pizza
Founded in 1960, Domino's Pizza is the recognized world leader in pizza delivery, with a significant business in carryout pizza.

redpajama_set_name: RedPajamaCommonCrawl


text:
Report from HIMSS 12: wrap-up of the largest health IT conference
This is a time of great promise in health care, yet an oppressive atmosphere hung over much of href="http://www.himssconference.org/">HIMSS. All the speakers--not least the government representatives who announced rules for the adoption of electronic health records--stressed commendable practices such as data exchange, providing the patient with information, and engaging with the patient. Many berated hospitals, doctors, and vendors for neglecting the elements that maintain health. But the thrust of most sessions was on such details as how to convert patient records to the latest classification of diseases (ICD-10).
Intelligent Hospital pavilion shows off tempting technology.
I have nothing against ICD-10 and I'm sure adopting it is a big headache that deserves attention at the conference. The reason I call the atmosphere oppressive is that I felt stuck among health care providers unable to think long-term or to embrace the systems approach that we'll need to cure people and cut costs. While some health care institutions took the ICD-10 change-over seriously and put resources into meeting the deadline, others pressured the Dept. of Health and Human services to delay implementation, and apparently won a major reprieve. The health IT community, including HIMSS, criticized the delay. But resistance to progress usually does not break out so overtly, and remains ingrained in day-to-day habits.
But ICD-10 is a sideline to the major issue of Stage 2 meaningful use. Why, as I reported on Wednesday, were so many of the 35,000 HIMSS attendees wrapped up in the next step being forced on them by the federal government? The scandal is that these meaningful use concepts (using data to drive care, giving care-givers information that other care-givers have collected about the patient) have to be forced on them. Indeed, institutions like Kaiser Permanente that integrated their electronic records years ago and concentrated on the whole patient had relatively little work to do to conform to Stage 1, and probably have the building blocks for Stage 2 in place. And of course these things are part of the landscape of health care in other countries. (The proposed regulations were finally posted last Thursday.)
Recipients of Regina Holliday jackets record patient involvement stories.
Haven't our providers heard that an ounce of prevention is worth a pound of cure? Don't well-educated and well-paid executives invest in quality measures with the expectation that they'll pay off in the long run? And aren't we all in the field for the good of the patients? What is that snickering I hear?
Actually, I don't accept the premise that providers are all in it for the money. If so many are newly incentivized to join the government's program for a mere $15,000 per doctor (plus avoiding some cuts in Medicare payments), which is a small fraction of the money they'll have to spend implementing the program, they must know that it's time to do the right thing. Meaningful use can be a good framework to concretize the idealistic goals of health care reform, but I just wish the vendors and doctors would keep their eyes more on the final goal.
Redwood MedNet in Northern California is an example of a health information exchange that adopted standards (CONNECT, before the Direct project was in place) to simplify data exchange between health providers. Will Ross of Redwood MedNet told me that qualifying for Stage 2 would be simple for them, "but you won't hear that from many vendors in this exhibit hall."
Annual surveys by Family Practice Management journal about their readers' satisfaction with EHRs, reviewed in one HIMSS session, showed widespread dissatisfaction that doesn't change from year to year. For instance, 39% were dissatisfied with support and training, although a few vendors rated quite high. Still, considering that doctors tend to veer away from open source solutions and pay big bucks for proprietary ones out of a hope of receiving better support and training, they deserve better. It's worth noting that the longer a practice uses its system, the more they're likely to express satisfaction. But only 38% of respondents would purchase the same systems now if they weren't already locked in.
That's the big, frustrating contradiction at HIMSS. The vendors have standards (HL7 and others), they've been setting up health information exchanges (under various other names) for years, they have a big, popular interoperability lab at each conference--and yet most patients still have to carry paper records and CDs with images from one doctor to another. (A survey of HIMSS members showed that one-quarter allowed access by patients to their data, which is an advance but still just a start.) The industry as a whole has failed to make a dent in the 90,000 to 100,000 needless deaths that occur in treatment facilities each year. And (according to one speaker) 20% of patients hospitalized under Medicare have to return to the hospital shortly after discharge.
Omens of change
Suffice it say that by my fourth day at HIMSS I was not happy. Advances come, but slowly. Examples of developments I can give a thumbs-up to at HIMSS were data sharing among physicians who use Practice Fusion, a popular example of a growing move to web services for electronic records, and a CardioEngagement Challenge funded by Novartis to encourage at-risk patients to take more interest in their health. The winner was a Sensei mobile app that acts as an automated coach. Sensei CEO Robert Schwarzberg, a cardiologist, told me had put together phone-in coaching services for heart patients during the years before mobile apps, and was frustrated that these coaches were available less than once a week when what patients needed was round-the-clock motivation. Sensei Wellness is one of the many mobile apps that make both patients and doctors more connected, and HIMSS quite properly devoted a whole section of the exhibit floor to them.
Talking about Sensei Wellness with Dr. Robert Schwarzberg.
I dropped by the IBM booth for the obligatory demo of Watson's medical application, and some background from Dr. Josko Silobrcic. I also filled in some of this report from an earlier conversation with tech staff.
Medical diagnosis involves more structured data than solving Jeopardy riddles, structure that appears mostly in the form of links between data sets. For instance, medicines are linked to diagnoses, to lab results, and to other medicines (for instance, some drugs are counter-indicated when the patient is taking other drugs). Watson follows these relationships.
But because Watson is a natural language processing application--based on UIMA, which IBM donated to the Apache Foundation--it doesn't try to do much reasoning to pick out the best diagnosis or treatment, both of which are sometimes requested of it. Instead, it dumps huge indexes of medical articles into its data stores on one side, and takes in the text about the patient's complaint and doctor's evaluation on the other. Matching them up is not so different from a Jeopardy question, after all. Any possible match is considered and kept live until the final round of weighing answers, even if the chance of matching is near zero.
Dr. Josko Silobrcic before Watson demonstration.
Also because of the NLP basis for matching, there is rarely a need to harmonize disparate data taken in from different journals or medical sources.
I assumed that any processing that uses such a large data set and works so fast must run on a huge server farm, but the staff assured me it's not as big as one would think. For production use, of course, they'll need to take into account the need to scale. The medical informatics equivalent of a Christmas rush on sales would be an epidemic where everybody in the region is urgently hitting Watson for critical diagnoses.
Healing came to me on my last day at HIMSS, at too related conferences off to the side of the main events: a meeting of Open Health Tools members and the eCollaboration forum, run by health activists who want to break down barriers to care. Both groups have partnerships with HIMSS.
Open Health Tools positions itself as an umbrella organization for projects making free software for a lot of different purposes in health care: recording, treatment, research and more. One illustrative project I got to hear about at their meeting was the Medical Imaging Network Transport (MINT), which Johns Hopkins is working on in coordination with other teams
MINT cuts down on the transfers of huge images by doing some processing in place and transferring only portions of the data. Switching to modern storage formats (XML and JSON) and better methods of data transfer also reduces waste. For instance, current DICOM vendors transmit images over TCP, which introduces more overhead than necessary when handling the packet losses engendered by transmitting files that are several gigabytes in size. MINT allows UDP and other protocols that are leaner than TCP.
Best of all, MINT DICOM images can be displayed through HTML5, which means any browser can view them in good resolution, there is no need to install a specialized viewer at each location where the doctor is checking the image, and dependence on proprietary software is reduced. (The same reliance on standard browsers is also claimed by eMix in a recent interview.
At the eCollaboration forum, E-patient Dave DeBronkart reported that being an engaged patient is still swimming upstream. It's hard to get one's records, hard to find out what treatments will cost, and hard to get taken seriously as an adult interested in monitoring one's own care. Meg McCabe of Aetna says that insurers need to offer more sophisticated guidance to patients trying to choose a health provider--simple lists of options are confusing and hard to choose from.
One speaker warned providers that if they try to open their data for collaborative care, they may find themselves hampered by contracts that maintain vendor ownership of EHR data. But speakers assured us vendors are not evil. The issue is what the providers ask for when they buy the EHR systems.
Here's the strange thing about the eCollaboration forum: they signed up enough people to fill the room ahead of time and left many potential attendees lamenting that they couldn't get in. Yet on the actual day of the event, there were about eight empty seats for every attendee. Maybe HIMSS attendees felt that had to devote all their time to the stage 2 regulations, previously mentioned. But I take the disappointing turn-out as a sign of the providers' and vendors' lack of commitment to change. Shown a dazzling roster of interesting talks about data exchange, open record sharing, and patient engagement, they're quick to sign up--but they don't show up when it counts.
As members of the general public, we can move the health care field forward by demanding more from our providers, at the point where we have some influence. Anyone looking for concrete guidance for increasing their influence as a patient can try e-Patients Live Longer: The Complete Guide to Managing Health Care Using Technology, by Nancy B. Finn.
Public attention and anger have been focused on insurers, who have certainly engaged in some unsavory practices to avoid paying for care--but nothing as destructive as the preventable errors and deaths caused by old-fashioned medical practices. And while economists complain about the 30 cents out of every dollar wasted in the American hodge-podge of payment systems, we know that unnecessary medical procedures or, conversely, preventative steps that were omitted, also suck up a lot of money. One speaker at the eCollaboration forum compared the sky-rocketing costs of health care and insurance to a financial bubble that can't last. Let's all take some responsibility for instituting better medical and reporting systems so the costs come down in a healthy manner.
Other articles about HIMSS were posted last Tuesday and Wednesday.
Tags: Gov 2.0 americanrecoveryandreinvestmentact arra ehrs electronichealthrecords healthcare healthit himss hitech meaningfuluse medical onc participatorymedicine patientcenteredmedicine stimuluspackage
Day one of the health care IT track at O'Reilly's Open Source convention
I think the collective awe of health care aficionados at the href="http://www.oscon.com/oscon2010">Open Source Convention came
to a focal point during our evening Birds of a Feather session, when
open source advocate Fred Trotter, informally stepping in as session
leader, pointed out that the leaders of key open source projects in
the health care field were in the room, including two VistA
implementors (Medsphere and href="http://www.worldvista.org/">WorldVistA), href="http://www.tolvenhealth.com/">Tolven, and href="http://wwwf.oemr.org/">openEMR--and not to forget two other
leading health care software initiatives from the U.S. government, href="http://www.connectopensource.org">CONNECT and href="http://nhindirect.org/">NHIN Direct.
This meeting, which drew about 40 doctors, project leaders,
programmers, activist patients, and others, was the culmination of a
full day of presentations in the first track on health care at an
O'Reilly conference. The day's sessions unveiled the potential of open
source in health care and how dedicated implementors were making it a
reality, starting with an scene-setting talk by Tim O'Reilly that
attracted over 75 people and continuing through the next seven hours
until a dwindling hard core delayed drinks and hors d'oeuvres for half
an hour to hear a final late talk by href="http://www.oscon.com/oscon2010/public/schedule/detail/13943">Melanie
Swan on DIYgenomics.
Nine talks representing the breadth of a vital programming area can't
be summarized in one sentence, but for me the theme of the day was
open source advocates reaching out to solve pressing problems that
proprietary vendors will not or cannot address.
Tim O'Reilly's talk laid out key elements of the health care
revolution: electronic records, the quantified self (measuring one's
bodily activities), and the Internet of things that allows one to track
behavior such as whether a patient has taken his medicine.
We were honored to have key leaders from Health and Human Services
speak at today's conferences about its chief open source projects. href="http://www.oscon.com/oscon2010/public/schedule/detail/13257">David
Riley and Brian Behlendorf (known best for his work on Apache)
came from the Office of the National Coordinator along with lead
contractor href="http://www.oscon.com/oscon2010/public/schedule/detail/15304">Arien
Malec to show us the current status and--most exciting--the future
plans for CONNECT and NHIN Direct, which are key pieces of the
Administration's health care policy because they allow different
health care providers to exchange patient information securely.
I have href="http://radar.oreilly.com/2010/07/health-and-human-services-fina.html">written
recently about "meaningful use" for health care records. Malec
provided a homespun and compelling vision of the problems with the
current health care system: in contrast to the old days where doctors
knew every patient personally, modern health care is delivered as
episodic interventions. As Fred Trotter said in his talk, we've
reached the limit of what we can achieve through clinical efforts.
Doctors can do miracles compared to former times, but the problems we
suffer from increasingly call for long-range plans. Malec said that
health care systems need to remember us. That's what
electronic health records can do, combined with the data exchange
protocols provided by NHIN.
Riley, in what is likely to be one of the most revisited talks of the
conference--yes, we recorded the sessions and will put them
online--rapidly laid out the architecture of CONNECT and what's
planned for upcoming releases. Requests between agencies for health
care data have gone from months to minutes with CONNECT. Currently
based on SOAP, it is being refactored so that in the future it can run
over REST, XMPP, and SMTP.
NHIN Direct, the newer and more lightweight protocol, is also based on
digital certificates and uses S/MIME with SMTP over TLS. Parties can
do key exchange themselves or work through a trusted third party. It
seems to me, therefore, that CONNECT and NHIN Direct will eventually
merge. It is as if the NHIN Direct project was started to take a big
step back from CONNECT, look at what it achieved for the government
agencies that produce or consume health care and how the same benefits
could be provided to health care providers all over the country, and
to formalize an architecture that would become the new CONNECT.
NHIN is an even more impressive case of open government and
collaborative development than CONNECT. The public was involved from
the earliest design stage. Some people complained that established
vendors bent the process to preserve their advantages, but they
probably had less success this way than if HHS followed normal
government procedures. NHIN already has reference implementations in
Java and C#. If you're inspired to help bring health records to the
public, you can read the wikis and attend some training and contribute
reference implementations in your language of choice.
In addition to supporting the NHIN Direct protocol, some of the
upcoming features in CONNECT include:
Identity management services. This will probably be based on a
voluntary patient identifier.
Support for meaningful use criteria.
Support for structured data, allowing the system to accept input in
standards such as the CCR or CCD and populate documents. One feature
enabled by this enhancement will be the ability to recognize sensitive
health data and remove it before sending a record. (CONNECT can be
used for all health-related data, not just personal medical records.)
Moving to the Spring Framework.
Riley has done some pretty rigorous cost analysis and determines that
careful management--which includes holding costs down and bringing
multiple agencies together to work on CONNECT--has reduced development
costs from over 200 million dollars to about 13 million dollars.
Recent code sprints drew heavily from community volunteers: 4 or 5
volunteers along with 12 contractors.
In an href="http://www.oscon.com/oscon2010/public/schedule/detail/15296">overview
talk, Deborah Bryant of OSU Open Source Lab raised the issue
continuity in relation to NHIN and CONNECT. Every open source project
has to figure out how to keep a community of volunteers interested so
that the project continues to evolve and adapt to changing
circumstances. Government-backed projects, she admitted, provide
funding over a sustained period of time, but this does not obviate the
need for community management.
In addition, CONNECT is run by a consulting firm with paid contractors
who have to learn how to accept community input and communicate with
outsiders. Behlendorf said that simple things like putting all code
in Subversion and all documentation on a wiki helps. Consultants are
also encouraged to request feedback on designs and to talk about the
goals of sprints as far as possible in advance.
IntraHealth International manages the basic health care resource: people
The problems of the developing world were represented most directly by
the open source human resource information system href="http://www.intrahealth.org/">IntraHealth International,
presented by href="http://www.oscon.com/oscon2010/public/schedule/detail/15268">
Carl Leitner. IntraHealth International helps many Sub-Saharan and
South Asian countries manage one of their most precious and dwindling
resources: health care professionals. The system, called iHRIS lets
individual hospitals as well as whole nations determine where their
most pressing staffing needs lie, break down staff by demographic
information such as age and gender (even language can be tracked), and
track their locations.
Training is one of the resources that must be managed carefully. If
you know there's a big gap between the professionals you need and ones
you have, you can direct scarce funding to training new ones. When
iHRIS records expenditures, what do countries often find? Some
administrator has splurged on sending himself to the same training
program over and over, just to get the per diem. Good information can
expose graft.
Open source is critical for a system like iHRIS, not just because
funds are scarce, but because localization is critical. Lots of
languages whose very existence is hidden from proprietary vendors need
to be supported. Each country also has different regulations and
conditions. IntraHealth International holds regular unconferences,
mentoring, and other forms of training in its target countries in the
hope of (in Leitner's words) putting themselves out of business. Of
course, trained IT staff tend to drift into higher-paying jobs, so the
organization tries to spread the training over many people.
OpenEMR and Tolven
The overarching challenge for any electronic health record system, if
its developers hope it to be taken seriously over the next couple
years in the United States, is support for meaningful use criteria.
Proprietary systems have, for several decades, met the needs of large
institutions with wads of cash to throw at them. And they will gain
certification to support meaningful use as well. But smaller providers
have been unable to afford these systems.
The need for an open source solution with meaningful use certification
is pressing, and two project leaders of OpenEMR devoted href="http://www.oscon.com/oscon2010/public/schedule/detail/14893">their
talk to their push to make their system ready. They estimate that
they have implemented about 80% of the required functionality, but
more slowly than expected. Extraordinary measures were required on
many fronts:
Medical experts had to read thousands of pages of specifications as
they came out, and follow comments and debates to determine which
requirements would likely be dropped or postponed, so as not to waste
development time.
Contractors were hired to speed up the coding. Interestingly, the
spike in productivity created by the contractors attracted a huge
number of new volunteers. At one point openEMR became number 37 on
SourceForge in terms of activity, and it is still up around 190. The
project leaders had to upgrade some of their infrastructure to handle
an increased number of commits. They also discovered that lack of
documentation was a hindrance. Like the CONNECT team, they found that
maintaining a community required--well, maintenance.
Project leaders had to go to Washington and argue with government
bureaucrats to change requirements that would have essentially made it
impossible for open source projects to meet the meaningful use
requirements. They succeeded in removing the offending clauses, and
believe they were also responsible for winning such accomplishments as
allowing sites to certify modules instead of entire stand-alone
systems. Nevertheless, some aspects of certification require
contracts with proprietary vendors, such as lab interface, which is
done through a proprietary company, and drug-to-drug and
drug-to-allergy interactions, which require interaction with expensive
databases.
Tony McCormick pointed out that the goal of meaningful use
certification provided a focus that most open source projects lack.
In addition, the government provided tests (called scripts) that
served as a QA plan.
Meaningful use, as much as it represents an advance over today's
health information silos, does not yet involve the patient. The
patient came to the fore in two other talks, one by href="http://www.oscon.com/oscon2010/public/schedule/detail/13943">Melanie
Swan on her company DIYgenomics and the other by href="http://www.oscon.com/oscon2010/public/schedule/detail/15051">Tom
Jones on Tolven.
Swan summarized the first two generations of DNA sequencing (which
went a bit above my head) and said we were on the verge of a third
generation that could bring full genome sequencing down to a cost that
consumers could afford. A part of the open science movement,
DIYgenomics helps patients combine with others to do research, a
process that is certainly less rigorous than controlled experiments
but can provide preliminary data that suggests future research. For
many rare conditions, the crowdsourced approach can fill a gap that
professional researchers won't fill.
In addition to providing access to studies and some other useful
apps--such as one that helps you evaluate your response to
drugs--DIYgenomics conducts its own longitudinal studies. One current
study checks for people who do not absorb vitamin B12 (folic acid)
properly, a condition to which up to half the population is
vulnerable. Another study, for which they are seeking 10,000
participants, covers aging.
Jones's talk centered on privacy, but spread its tent to include the
broader issues of patient-centered medicine. Tolven simultaneously
supports records held by the doctor (clinical health records) and by
the patient (personal health records).
In a system designed especially for the Netherlands--where privacy
laws are much stricter and better specified than in the United
States--Tolven stores medical records in large, centralized
repositories because it's easier to ensure security that way. However,
strict boundaries between doctors prevent them from viewing each
other's data. Even more significantly, data is encrypted during both
transmission and storage, and only the patient has the key to unlock
it. Audit trails add another layer of protection.
In this architecture, there are no release forms. Instead, the patient
explicitly approves every data transfer. (Patients can designate
special repositories to which their relatives have access, in case of
emergencies when they're not competent to make the transfer.)
That was one day of health care at OSCon--two more are coming up. We
started our evening BOF with introductions, but more and more people
kept coming in the room, and everyone was so interesting that the
introductions ended up taking the entire hour allocated for the BOF.
The sense that our health care system needs to change radically, and
the zeal expressed to take part in that change, brought energy into
the room. This was a great place to meet like-minded people.
Tags: americanrecoveryandreinvestmentact arra connect diygenomics ehrs electronichealthrecords freesoftware healthcare healthit hitech interoperability intrahealth meaningfuluse medical medsphere nhin opensource openemr oscon participatorymedicine patientcenteredmedicine stimuluspackage tolven vista worldvista
Report from HIMMS Health IT conference: building or bypassing infrastructure
Today the Healthcare Information and
Management Systems Society (HIMSS) conference wrapped up. In
previous blogs, I laid out the href="http://radar.oreilly.com/2010/03/report-from-himms-health-it-co.html">
benefits of risk-taking in health care IT followed by my main
theme, href="http://radar.oreilly.com/2010/03/report-from-himms-health-it-co-1.html">
interoperability and openness. This blog will cover a few topics
about a third important issue, infrastructure.
Why did I decide this topic was worth a blog? When physicians install
electronic systems, they find that they need all kinds of underlying
support. Backups and high availability, which might have been
optional or haphazard before, now have to be professional. Your
patient doesn't want to hear, "You need an antibiotic right away, but
we'll order it tomorrow when our IT guy comes in to reboot the
system." Your accounts manager would be almost as upset if you told
her that billing will be delayed for the same reason.
Network bandwidth
An old sales pitch in the computer field (which I first heard at
Apollo Computer in the 1980s) goes, "The network is the computer." In
the coming age of EHRs, the network is the clinic. My family
practitioner (in an office of five practitioners) had to install a T1
line when they installed an EHR. In eastern Massachusetts, whose soil
probably holds more T1 lines than maple tree roots, that was no big
deal. It's considerably more problematic in an isolated rural area
where the bandwidth is more comparable to what I got in my hotel room
during the conference (particularly after 10:30 at night, when I'm
guessing a kid in a nearby room joined an MMPG). One provider from the
mid-West told me that the incumbent changes $800 per month for a T1.
Luckily, he found a cheaper alternative.
So the FCC is href="http://www.fcc.gov/cgb/rural/rhcp.html">involved in health care
now. Bandwidth is perhaps their main focus at the moment, and
they're explicitly tasked with making sure rural providers are able to
get high-speed connections. This is not a totally new concern; the
landmark 1994 Telecom Act included rural health care providers in its
universal service provisions. I heard one economist deride the
provision, asking what was special about rural health care providers
that they should get government funding. Fifteen years later, I think
rising health care costs and deteriorating lifestyles have answered
that question.
Wireless hubs
The last meter is just as important as the rest of your network, and
hospitals with modern, technology-soaked staff are depending
increasingly on mobile devices. I chatted with the staff of a small
wireless company called Aerohive that aims its products at hospitals.
Its key features are:
Totally cable-free hubs
Not only do Aerohive's hubs communicate with your wireless endpoints,
they communicate with other hubs and switches wirelessly. They just
make the hub-to-endpoint traffic and hub-to-hub traffic share the
bandwidth in the available 2.4 and 5 GHz ranges. This allows you to
put them just about anywhere you want and move them easily.
Dynamic airtime scheduling
The normal 802.11 protocols share the bandwidth on a packet-by-packet
basis, so a slow device can cause all the faster devices to go slower
even when there is empty airtime. I was told that an 802.11n device
can go slower than a 802.11b device if it's remote and its signal has
to go around barriers. Aerohive just checks how fast packets are
coming in and allocates bandwidth on that ratio, like time-division
multiplexing. If your device is ten times faster than someone else's
and the bandwidth is available, you can use ten times as much
bandwidth.
Dynamic rerouting
Aerohive hubs use mesh networking and an algorithm somewhat like
Spanning Tree Protocol to reconfigure the network when a hub is added
or removed. Furthermore, when you authenticate with one hub, its
neighbors store your access information so they can pick up your
traffic without taking time to re-authenticate. This makes roaming
easy and allows you to continue a conversation without a hitch if a
hub goes down.
Security checking at the endpoint
Each hub has a built-in firewall so that no unauthorized device can
attach to the network. This should be of interest in an open, public
environment like a hospital where you have no idea who's coming in.
High bandwidth
The top-of-the-line hub has two MIMO radios, each with three
directional antennae.
Go virtual, part 1
VMware has href="http://www.vmware.com/solutions/industry/healthcare/case-studies.html">customers
in health care, as in other industries. In addition, they've
incorporated virtualization into several products from medical
equipment and service vendors,
Hospitals consider these critical devices. Virtualization here
supports high availability.
A transcription service could require ten servers. Virtualization can
consolidate them onto one or two pieces of hardware.
Roaming desktops
Nurses often move from station to station. Desktop virtualization
allows them to pull up the windows just as they were left on the
previous workstation.
Go virtual, squared
If all this talk of bandwidth and servers brings pain to your head as
well as to the bottom line, consider heading into the cloud. At one
talk I attended today on cost analysis, a hospital administrator
reported that about 20% of their costs went to server hosting. They
saved a lot of money by rigorously eliminating unneeded backups, and a
lot on air conditioning by arranging their servers more efficiently.
Although she didn't discuss Software as a Service, those are a couple
examples of costs that could go down if functions were outsourced.
Lots of traditional vendors are providing their services over the Web
so you don't have to install anything, and several companies at the
conference are entirely Software as a Service. I mentioned href="http://www.practicefusion.com/">Practice Fusion in my
previous blog. At the conference, I asked them three key questions
pertinent to Software as a Service.
This is the biggest question clients ask when using all kinds of cloud
services (although I think it's easier to solve than many other
architectural issues). Practice Fusion runs on HIPAA-compliant
Salesforce.com servers.
If you don't like your service, can you get your data out? Practice
Fusion hasn't had any customers ask for their data yet, but upon
request they will produce a DVD containing your data in CSV files, or
in other common formats, overnight.
Extendibility
As I explained in my previous blog, clients increasingly expect a
service to be open to enhancements and third-party programs. Practice
Fusion has an API in beta, and plans to offer a sandbox on their site
for people to develop and play with extensions--which I consider
really cool. One of the API's features is to enforce a notice to the
clinician before transferring sensitive data.
The big selling point that first attracts providers to Practice Fusion
is that it's cost-free. They support the service through ads, which
users tell them are unobtrusive and useful. But you can also pay to
turn off ads. The service now has 30,000 users and is adding about 100
Another SaaS company I mentioned in my previous blog is href="http://www.covisint.com/">Covisint. Their service is
broader than Practice Fusion, covering not only patient records but
billing, prescription ordering, etc. Operating also as an HIE, they
speed up access to data on patients by indexing all the data on each
patient in the extended network. The actual data, for security and
storage reasons, stays with the provider. But once you ask about a
patient, the system can instantly tell you what sorts of data are
available and hook you up with the providers for each data set.
Finally, I talked to the managers of a nimble new company called href="http://carecloud.com/">CareCloud, which will start serving
customers in early April. CareCloud, too, offers a range of services
in patient health records, practice management, and and revenue cycle
management. It was built entirely on open source software--Ruby on
Rails and a PostgreSQL database--while using Flex to build their
snazzy interface, which can run in any browser (including the iPhone,
thanks to Adobe's upcoming translation to native code).upcoming
translation to native code). Their strategy is based on improving
physicians' productivity and the overall patient experience through a
social networking platform. The interface has endearing Web 2.0 style
touches such as a news feed, SMS and email confirmations, and
integration with Google Maps.
And with that reference to Google Maps (which, in my first blog, I
complained about mislocating the address 285 International Blvd NW for
the Georgia World Congress Center--thanks to the Google Local staff
for getting in touch with me right after a tweet) I'll end my coverage
of this year's HIMSS.
Tags: 80211wirelessnetworks aerohive americanrecoveryandreinvestmentact arra bandwidth broadband carecloud covisint fcc healthcare himss hitech meaningfuluse medical practicefusion saas security softwareasaservice stimuluspackage virtualization vmware wirelessnetworks
Report from HIMMS Health IT conference: toward interoperability and openness
Yesterday and today I spent once again at the href="http://www.himss.org/">Healthcare Information and Management
Systems Society (HIMSS) conference in Atlanta, rushing from panel
session to vendor booth to interoperability demo and back (or
forward--I'm not sure which direction I've been going). All these
peregrinations involve a quest to find progress in the areas of
interoperability and openness.
The U.S. has a mobile population, bringing their aches and pains to a
plethora of institutions and small providers. That's why health care
needs interoperability. Furthermore, despite superb medical research,
we desperately need to share more information and crunch it in
creative new ways. That's why health care needs openness.
My href="http://radar.oreilly.com/2010/03/report-from-himms-health-it-co.html">blog
yesterday covered risk-taking; today I'll explore the reasons it's
so hard to create change.
The health care information exchange architecture
Some of the vendors I talked to boasted of being in the field for 20
years. This give them time to refine and build on their offerings,
but it tends to reinforce approaches to building and selling software
that were prominent in the 1980s. These guys certainly know what the
rest of the computer field is doing, such as the Web, and they reflect
the concerns for interoperability and openness in their own ways. I
just feel that what I'm seeing is a kind of hybrid--more marsupial
than mammal.
Information exchange in the health care field has evolved the
following architecture:
Electronic medical systems and electronic record systems
These do all the heavy labor that make health care IT work (or fail).
They can be divided into many categories, ranging from the simple
capturing of clinical observations to incredibly detailed templates
listing patient symptoms and treatments. Billing and routine workflow
(practice management) are other categories of electronic records that
don't strictly speaking fall into the category of health records.
Although each provider traditionally has had to buy computer systems
to support the software and deal with all the issues of hosting it,
Software as a Service has come along in solutions such as href="http://www.practicefusion.com/">Practice Fusion.
Services and value-added applications
As with any complex software problem, nimble development firms partner
with the big vendors or offer add-on tools to do what health care
providers find too difficult to do on their own.
Health information exchanges (HIEs)
Eventually a patient has to see a specialist or transfer records to a
hospital in another city--perhaps urgently. Partly due to a lack of
planning, and partly due to privacy concerns and other particular
issues caught up in health care, transfer is not as simple as querying
Amazon.com or Google. So record transfer is a whole industry of its
own. Some institutions can transfer records directly, while others
have to use repositories--paper or electronic--maintained by states or
other organizations in their geographic regions.
HIE software and Regional Health Information Organizations
(RHIOs)
The demands of record exchange create a new information need that's
filled by still more companies. States and public agencies have also
weighed in with rules and standards through organizations called
Regional Health Information Organizations.
Let's see how various companies and agencies fit into this complicated
landscape. My first item covered a huge range of products that
vendors don't like to have lumped together. Some vendors, such as the
Vocera company I mentioned in yesterday's blog and href="http://solutions.3m.com/wps/portal/3M/en_US/3M_Health_Information_Systems/HIS/">3M,
offer products that capture clinicians' notes, which can be a job in
itself, particularly through speech recognition. href="http://emdeon.com/">Emdeon covers billing, and adds validity
checking to increase the provider's chances of getting reimbursed the
first time they submit a bill. There are many activities in a doctor's
office, and some vendors try to cover more than others.
Having captured huge amounts of data--symptoms, diagnoses, tests
ordered, results of those tests, procedures performed, medicines
ordered and administered--these systems face their first data exchange
challenge: retrieving information about conditions and medicines that
may make a critical difference to care. For instance, I saw a cool
demo at the booth of Epic, one of
the leading health record companies." A doctor ordered a diuretic that
has the side-effect of lowering potassium levels. So Epic's screen
automatically brought up the patient's history of potassium levels
along with information about the diuretic.
Since no physician can keep all the side-effects and interactions
between drugs in his head, most subscribe to databases that keep track
of such things; the most popular company that provides this data is href="http://firstdatabank.com/">First DataBank. Health record
systems simply integrate the information into their user interfaces.
As I've heard repeatedly at this conference, the timing and delivery
of information is just as important as having the information; the
data is not of much value if a clinician or patient has to think about
it and go searching for it. And such support is central to the HITECH
act's meaningful use criteria, mentioned in yesterday's blog.
So I asked the Epic rep how this information got into the system. When
the physicians sign up for the databases, the data is sent in simple
CSV files or other text formats. Although different databases are
formatted in different ways, the health record vendor can easily read
it in and set up a system to handle updates.
Variations on this theme turn up with other vendors. For instance, href="http://www.nextgen.com/">NextGen Healthcare contracts
directly with First DataBank so they can integrate the data intimately
with NextGen's screens and database.
So where does First DataBank get this data? They employ about 40
doctors to study available literature, including drug manufacturers'
information and medical journals. This leads to a constantly updated,
independent, reliable source for doses, side-effects,
counterindications, etc.
This leads to an interesting case of data validity. Like any
researchers--myself writing this blog, for instance--First DataBank
could theoretically make a mistake. Their printed publications include
disclaimers, and they require the companies who licence the data to
reprint the disclaimers in their own literature. But of course, the
disclaimer does not pop up on every dialog box the doctor views while
using the product. Caveat emptor...
Still, decision support as a data import problem is fairly well
solved. When health record systems communicate with each other,
however, things are not so simple.
The challenges in health information exchange: identification
When a patient visits another provider who wants to see her records,
the first issue the system must face is identifying the patient at the
other provider. Many countries have universal IDs, and therefore
unique identifiers that can be used to retrieve information on a
person wherever she goes, but the United States public finds such
forms of control anathema (remember the push-back over Read ID?).
There are costs to restraining the information state: in this case,
the hospital you visit during a health crisis may have trouble
figuring out which patient at your other providers is really you.
HIEs solve the problem by matching information such as name, birth
date, age, gender, and even cell phone number. One proponent of the
federal government's Nationwide
Health Information Network told me it can look for up to 19 fields
of personal information to make a match. False positives are
effectively eliminated by strict matching rules, but legitimate
records may be missed.
Another issue HIEs face is obtaining authorization for health data,
which is the most sensitive data that usually concerns ordinary
people. When requesting data from another provider, the clinician has
to log in securely and then offer information not only about who he is
but why he needs the data. The sender, for many reasons, may say no:
Someone identified as a VIP, such as a movie star or high-ranking
politician, is automatically protected from requests for information.
Some types of medical information, such as HIV status, are considered
especially sensitive and treated with more care.
The state of California allows ordinary individuals to restrict the
distribution of information at the granularity of a single institution
or even a single clinician, and other states are likely to do the
Thus, each clinician needs to register with the HIE that transmits the
data, and accompany each request with a personal identifier as well as
the type of information requested and the purpose. One service I
talked to, Covisint, can query
the AMA if necessary to verify the unique number assigned to each
physician in the us, the Drug Enforcement Administration (DEA) number.
(This is not the intended use of a DEA number, of course; it was
created to control the spread of pharmaceuticals, not data.)
One of the positive impacts of all this identification is that some
systems can retrieve information about patients from a variety of
hospitals, labs, pharmacies, and clinics even if the requester doesn't
know where it is. It's still up to them to determine whether to send
the data to the requester. Currently, providers exchange a Data Use
and Reciprocal Support Agreement (DURSA) to promise that information
will be stored properly and used only for the agreed-on purpose.
Exchanging these documents is currently cumbersome, and I've been told
the government is looking for a way to standardize the agreement so
the providers don't need to directly communicate.
The challenges in health information exchange: format
Let's suppose we're at the point where the owner of the record has
decided to send it to the requester. Despite the reverence expressed
by vendors for HL7 and other
standards with which the health care field is rife, documents require
a good deal of translation before they can be incorporated into the
receiving system. Each vendor presents a slightly different challenge,
so to connect n different products a vendor has to implement
n2 different transformations.
Reasons for this interoperability lie at many levels:
Lack of adherence to standards
Many vendors created their initial offerings before applicable
standards existed, and haven't yet upgraded to the standards or still
offer new features not covered by standards. The meaningful use
criteria discussed in yesterday's blog will accelerate the move to
Fuzzy standards
Like many standards, the ones that are common in the medical field
leave details unspecified.
Problems that lie out of scope
The standards tend to cover the easiest aspect of data exchange, the
document's format. As an indication of the problem, the 7 in HL7
refers to the seventh (application) layer of the ISO model. Brian
Behlendorf of Apache fame, now consulting with the federal government
to implement the NHIN, offers the following analogy. "Suppose that we
created the Internet by standardizing HTML and CSS but saying nothing
about TCP/IP and DNS."
Complex standards
As in other fields, the standards that work best in health records are
simple ones. There is currently a debate, for instance, over whether
to use the CCR or CCD exchange format for patient data. The trade-off
seems to be that the newer CCD is richer and more flexible but a lot
harder to support.
As one example, the University of Pittsburgh Medical Center tried to
harmonize its problem lists and found that a huge number of
patients--including many men--were coded as smoking during pregnancy.
They should have been coded with a general tobacco disorder. As Dr.
William Hogan said, "People have an amazing ability to make a standard
do what it's not meant to do, even when it's highly specified and
constrained."
So many to choose from
Dell/Perot manager Jack Wankowski told me that even though other
countries have digitized their health records far more than the U.S.
has, they have a lot fewer published standards. It might seem logical
to share standards--given that people are people everywhere--but in
fact, that's hard to do because diagnosis and treatment are a lot
different in different cultures. Wankowski says, "Unlike other
industries such as manufacturing and financial services, where a lot
can be replicated, health care is very individual on a country by
country basis at the moment. Because of this, change is a lot slower."
The UPMC coded its problem lists in ICD-9-CM instead of SNOMED, even
through SNOMED was far superior in specificity and clarity. Along with
historical reasons, they avoided SNOMED because it was a licensed
product until 2003 whereas ICD-9-CM was free. As for ICD-9-CM, its
official standard is distributed as RTF documents, making correct
adoption difficult.
Here are a few examples of how vendors told me they handle
interoperability.
InterSystems is a major
player in health care. The basis of their offerings is Caché,
an object database written in the classic programming language for
medical information processing, MUMPS. (MUMPS was also standardized by
an ANSI committee under the name M.) Caché can be found in all
major hospitals. For data exchange, InterSystems provides an HIE
called HealthShare, which they claim can communicate with other
vendors' systems by supporting HL7 and other appropriate standards.
HealthShare is both communications software and an actual hub that can
create the connections for customers.
Medicity is another key
HIE vendor. Providers can set up their own hubs or contract with a
server set up by Medicity in their geographic area. Having a hub means
that a small practice can register just once with the hub and then
communicate with all other providers in that region.
Let's turn again to Epic. Two facilities that use it can exchange a
wide range of data, because some of its data is not covered by
standards. A facility that uses another product can exchange a
narrower set of data with an Epic system over href="http://www.epic.com/software-interoperability.php">Care
Everywhere, using the standards. The Epic rep said they will move
more and more fields into Care Everywhere as standards evolve.
What all this comes down to is an enormous redundant infrastructure
that adds no value to electronic records, but merely runs a Red
Queen's Race to provide the value that already exists in those
records. We've already seen that defining more standards has a
limited impact on the problem. But a lot of programmers at this point
will claim the solution lies in open source, so let's see what's
happening in that area.
The open source challengers
The previous sections, like acts of a play, laid out the character of
the vendors in the health care space as earnest, hard-working, and
sometimes brilliantly accomplished, but ultimately stumbling through a
plot whose bad turns overwhelm them. In the current act we turn to a
new character, one who is not so well known nor so well tested, one
who has shown promise on other stages but is still finding her footing
on our proscenium.
The best-known open source projects in health care are href="http://openmrs.org/">OpenMRS, the Veterans Administration's
VistA, and the href="http://www.connectopensource.org/">NHIN CONNECT Gateway. I
won't say anything more about OpenMRS because it has received high
praise but has made little inroads into American health care. I'll
devote a few paragraphs to the strengths and weaknesses of VistA and
Buzz in the medical world is that VistA beats commercial offerings for
usability and a general fit to the clinicians' needs. But it's
tailored to the Veterans Administration and--as a rep for the href="http://www.vxvista.org/">vxVistA called it--has to be
deveteranized for general use. This is what vxVistA does, but they are
not open source. They make changes to the core and contribute it back,
but their own products are proprietary. A community project called href="http://www.worldvista.org/">WorldVistA also works on a
version of VistA for the non-government sector.
One of the hurdles of adapting VistA is that one has to learn its
underlying language, MUMPS. Most people who dive in license a MUMPS
compiler. The vxVistA rep knows of no significant users of the free
software MUMPS compiler GT.M. VistA also runs on the Caché
database, mentioned earlier in this article. If you don't want to
license Caché from InterSystems, you need to find some other
database solution.
So while VistA is a bona fide open source project with a community,
it's ecosystem does not fit neatly with the habits of most free
software developers.
CONNECT is championed by the same Office of the National Coordinator
for Health Information Technology that is implementing the HITECH
recovery plan and meaningful use. A means for authenticating requests
and sending patient data between providers, CONNECT may well be
emerging as the HIE solution for our age. But it has some maturing to
do as well. It uses a SOAP-based protocol that requires knowledge of
typical SOA-based technologies such as SAML.
Two free software companies that have entered the field to make
installing CONNECT easier are href="http://www.axialexchange.com/">Axial Exchange, which creates
open source libraries and tools to work with the system, and the href="http://www.mirthcorp.com/">Mirth Corporation. Jon Teichrow
of Mirth told me how a typical CONNECT setup at a rural hospital took
just a week to complete, and can run for the cost of just a couple
hours of support time per week. The complexities of handling CONNECT
that make so many people tremulous, he said, were actually much easier
for Mirth than the more typical problem of interpreting the hospital's
idiosyncratic data formats.
Just last week, href="http://www.healthcareitnews.com/news/nhin-direct-launched-simpler-data-exchange">the
government announced a simpler interface to the NHIN called NHIN
Direct. Hopefully, this will bring in a new level of providers
who couldn't afford the costs of negotiating with CONNECT.
CONNECT has certainly built up an active community. href="http://agilex.com/">Agilex employee Scott E. Borst, who is
responsible for a good deal of the testing of CONNECT, tells me that
participation in development, testing, and online discussion is
intense, and that two people were recently approved as committers
without being associated with any company or government agency
officially affiliated with CONNECT.
The community is willing to stand up for itself, too. Borst says that
when CONNECT was made open source last year, it came with a Sun-based
development environment including such components as NetBeans and
GlassFish. Many community members wanted to work on CONNECT using
other popular free software tools. Accommodating them was tough at
first, but the project leaders listened to them and ended up with a
much more flexible environment where contributors could use
essentially any tools that struck their fancy.
Buried in href="http://www.healthcareitnews.com/news/blumenthal-unveils-proposed-certification-rule-himss10">a
major announcement yesterday about certification for meaningful
use was an endorsement by the Office of the National Coordinator
for open source. My colleague and fellow blogger Brian Ahier href="http://ahier.blogspot.com/2010/03/meaningful-certification.html">points
out that rule 4 for certification programs explicitly mentions
open source as well self-developed solutions. This will not magically
lead to more open source electronic health record systems like
OpenMRS, but it offers an optimistic assessment that they will emerge
and will reach maturity.
As I mentioned earlier, traditional vendors are moving more toward
openness in the form of APIs that offer their products as platforms.
InterSystems does this with a SOAP-based interface called Ensemble,
for instance. Eclipsys,
offering its own SOAP-based interface called Helios, claims that they
want an app store on top of their product--and that they will not kick
off applications that compete with their own.
Web-based Practice Fusion has an API in beta, and is also planning an
innovation that makes me really excited: a sandbox provided by their
web site where developers can work on extensions without having to
download and install software.
But to a long-time observer such as Dr. Adrian Gropper, founder of the
MedCommons storage service,
true open source is the only way forward for health care records. He
says we need to replace all those SOAP and WS-* standards with RESTful
interfaces, perform authentication over OpenID and OAuth, and use the
simplest possible formats. And only an enlightenment among the major
users--the health care providers--will bring about the revolution.
But at this point in the play, having explored the characters of
electronic record vendors and the open source community, we need to
round out the drama by introducing yet a third character: the patient.
Gropper's MedCommons is a patient-centered service, and thus part of a
movement that may bring us openness sooner than OpenMRS, VistA, or
Enter the patient
Most people are familiar with Microsoft's HealthVault and Google
Health. Both allow patients to enter data about their own health, and
provide APIs that individuals and companies alike are using to provide
services. A Journal of Participatory
Medicine has just been launched, reflecting the growth of interest
in patient-centered or participatory medicine. I saw a book on the
subject by HIMSS itself in the conference bookstore.
The promise of personal health records goes far beyond keeping track
of data. Like electronic records in clinicians' hands, the data will
just be fodder for services with incredible potential to improve
health. In a lively session given today by Patricia Brennan of href="http://www.projecthealthdesign.org/">Project HealthDesign,
she used the metaphors of "intelligent medicines" and "smart
Band-Aids" that reduce errors and help patients follow directions.
Project HealthDesign's research has injected a dose of realism into
our understanding of the doctor-patient relationship. For instance,
they learned that we can't expect patients to share everything with
their doctors. They get embarrassed when they lapse in their behavior,
and don't want to admit they take extra medications or do other things
not recommended by doctors. So patient-centered health should focus on
delivering information so patients can independently evaluate what
they're doing.
As critical patient data becomes distributed among a hundred million
individual records, instead of being concentrated in the hands of
providers, simple formats and frictionless data exchange will emerge
to handle them. Electronic record vendors will adapt or die. And a
whole generation of products--as well as users--will grow up with no
experience of anything but completely open, interoperable systems.
Tags: agilex americanrecoveryandreinvestmentact arra axialexchange connect eclipsys emdeon epic firstdatabank freesoftware healthcare himss hitech hl7 interoperability intersystems meaningfuluse medcommons medical medicity mirthcorporation mumps nextgen nhin opensource openmrs participatorymedicine patientcenteredmedicine practicefusion projecthealthdesign stimuluspackage vista vocera vxvista
Report from HIMMS Health IT conference: from Silicon Valley technology to Silicon Valley risk-taking
I'm in Atlanta for the biggest US conference in health care IT, run by
the Healthcare Information and
Management Systems Society (HIMSS). This organization, along with
the branch of the federal government responsible for dispersing funds
for a medical records overhaul, has to do a huge job in an extremely
short time. I'll report what I hear (and how I interpret it) over the
next few days, aiming both at people who care in general about the
future of health care at particularly at readers who are wondering
whether their next career move may be into health care.
Although many people have been saying that the medical field would
benefit from a Silicon Valley approach to technology, it's coming to
seem that even more important would be a Silicon Valley approach to
risk-taking. I'll look at the events that created this imperative.
Where the pressure comes from
Why are most doctors in the U.S., some thirty years after IT became
ubiquitous in American offices, still working with paper records? The
main reason is that they work in small offices instead of large
institutions, as I describe in href="http://radar.oreilly.com/2009/11/converting-to-electronic-healt.html">an
earlier blog about electronic health records. Most economically
advanced nations have centralized, government-administered health care
systems, and therefore electronic records. Large institutions in the
U.S. also have them--the Veterans Administration's VistA is a famous
example--and more hospitals have made the move than small physicians'
A crisis in costs and achievements provides a nice impetus for change
( href="http://www.nytimes.com/2010/02/28/weekinreview/28abelson.html">an
article in last Sunday's New York Times lays out the stakes), but
cold cash does even better. Few things can make an industry perk up as
much as a sudden infusion of twenty billion dollars. Thus the impact
of a provision in the federal stimulus bill (properly known as the
American Recovery and Reinvestment Act of 2009 or ARRA) that mandates
the adoption of electronic medical records.
The framers and implementers of the stimulus bill were both ambitious
and idealistic, but they weren't naive. They know that the adoption of
electronic health records, like any computer system, can be botched
and can turn out to miss the benefits that it's supposed to bring. So
in this part of the act, called Health Information Technology for
Economic and Clinical Health (HITECH), they lay out a demanding list
of practices that clinics and hospitals must carry out to qualify for
government money. In other words, HITECH is really about behavior and
workflow, not technology.
What does HITECH call for? Some requirements seem fairly easy to meet,
such as tracking key clinical conditions on patients. Others get quite
complex, even at Stage 1 of the implementation. For instance, doctors
are supposed to use their electronic systems to help check their
treatment plans for errors and suggest best practices, a field called
clinical decision support. Stages 2 and 3 require complex data
exchanges with other organizations, which in turn requires
interoperation among different systems from different vendors. I'll
return to interoperability in a later blog. Other rules include
evidence-based order sets (which bring up suggested treatment regimes
based on research) and reporting treatments and results to registries
to foster the further development of best practices.
All these requirements are put forward under the buzzword
meaningful use, an ironic choice given that the requirements
aren't even completely defined yet. Still, whether it's meaningful or
not, the term has instantly leapt to the forefront of discussion among
vendors and providers, because of the financial rewards attached to
In principle, the meaningful use criteria are good. The government bodies
creating the requirements got stakeholders involved early and often.
It's well understood that these things are needed to improve care and
reduce inefficiency. As in any major attempt at social change,
doom-sayers predict disaster. (I'm not necessarily saying they're
wrong; in this case they include href="http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=349DF6BB879446A1886B65F332AC487F&type=Blog&tier=7&id=B98FF5D2B2E34463A550B2407329FC6C">CIO
Anthony Guerra and href="http://blog.srssoft.com/2010/02/government-ehr-program-potentially-harmful-unintended-consequences/">IT
company CTO Evan Steele, both featured at the HIMSS conference.)
But for the most part, the health care industry is lined up behind
meaningful use--or at least behind the promise of the money that
health care providers will be paid to implement it. Grumbling among
vendors and practitioners focuses on the timetable for implementation,
not on the practices themselves.
If you've gotten the impression from this summary that Congress and
the Administration have bypassed all the political bickering around
health care reform bills and implemented it under the guise of a
financial recovery, I'd say you're right. HITECH doesn't directly
address the health care industry or other controversial issues such as
how to pay doctors. And those issues still need to be resolved. But
HITECH does try to reform the health care system around better
practices.
So the HIMSS conference is taking place at the height of a suspenseful
moment in U.S. health care history. The Administration has released
proposed final rules, but they're in the middle of a 60-day comment
period. Meanwhile, working from the drafts that have been released
all along, vendors are feverishly bringing their tools into
conformance and claiming (how could they not?) that the tools will be
ready soon for adoption.
The pressures extend to other players all throughout the health care
industry. A certification body called the Certification Commission
for Health Information Technology (CCHIT) is design certifications for
vendors' systems as well as the hospitals and individual providers who
adopt them, matching the meaningful use criteria "no more and no
less," as said today by the outgoing CCHIT chair, Dr. Mark Leavitt.
The pressure will then be on the providers--and here is where I'm
seeing the most resistance.
Suspicion and silos
Given that many clinicians never adopted electronic systems, and
others who did regretted doing so, we don't have to be surprised to
hear that some don't think it will work or don't believe that they can
make the change.
It would seem that heath care IT is hot right now. HIMSS is sprawled
across three buildings in the Georgia World Congress Center (whose
address completely confuses Google Local, by the way). Getting from
one place to another between sessions means forcing my way through
hundreds and hundreds of attendees. To walk from one corner of one
show floor to the other would take several minutes. I picked up half a
dozen magazines on health care IT.
But even here--among people who paid to attend a health care IT
conference--dissent can be felt. There's a lot of anger at electronic
systems and their vendors, complaints ranging from high costs and
inflexible templates to user interfaces that slow down busy staff and
problems with data exchange. A few observers claim that HIMSS and
CCHIT are just vendor-controlled consortia who want to milk providers
and walk away with government money. I must say, though, that debate
here ranges across many points of view. I was impressed to see an
HIMSS book on patient-centered records, which--if made the basis of
health care--would produce a bigger revolution than anything discussed
so far. (I'll explain why in another blog this week.)
Although attendees want to make the move to electronic records, many
talk about other people who won't. And a typical session on clinical
decision support was devoted, not to ways of using electronic medical
systems, but to persuading the attendees that electronic medical
systems would be worthwhile.
The timetable does seem like a forced march. Even though the systems
that meet the meaningful use criteria are still under development--and
so is the certification--providers will be rewarded as early as 2011
for installing them and using them heavily. (The records have to be
used for 80% of some practices in order to get the money.) And each
year that providers wait before meeting the meaningful use criteria,
they get less money. A stick also accompanies the carrot; providers
that accept Medicare and Medicaid will actually be penalized if they
don't demonstrate meaningful use.
Furthermore, implementing the rules will require the hiring of more IT
staff and telling clinical staff to take time to serve on committees.
These considerations contributed to a href="http://www.healthcareitnews.com/news/chime-airs-critical-concerns-about-ehr-incentive-program">declaration
by a consortium of Chief Medical Officers that the timetable was
too aggressive. Some Congressmen have recently href="http://www.himssconference.org/daily/tuesday.aspx#1">made the
same request, so you know someone has been talking to them.
But many others in the field--including the vendors, confident in
their ability to deliver, and some hospital managers in the forefront
of implementing electronic records--urge the government to stay the
course. Their attitude is that the need is great (because health care
costs are rising so precipitously), the schedule is demanding but
still feasible, and "if not now, when?"
I stated earlier that HITECH was more about behavior and workflow than
technology. The push to implement the meaningful use rules brings
this to the fore. Old silos between IT, doctors, and other staff won't
work; neither will silos between doctors, billing, labs, and other
departments.
Providers trying to achieve meaningful use must talk to their staff:
not just doctors, but also nurses, technicians, and anyone else who
touches a record. They have to examine their workflows and be willing
to admit when they don't conform to health care standards or are
inefficient. They have to make some of the same mistakes offices and
factories made when they computerized in the 1980s, and learn from
those mistakes. To some extent, implementing an electronic system is a
bottom-up activity.
That's why I say that a Silicon Valley approach to risk-taking is even
more important for this field than a Silicon Valley approach to
technology. I'm not so concerned with the famous Silicon Valley
tolerance for failure. Health care is not a social network, and
failure there has serious consequences. I'm more interested in a
Silicon Valley willingness to cross organizational boundaries and to
encourage people's opinions on things where other people are the
recognized experts.
Overall, I don't think the money offered by HITECH will really drive
the decision to change. I think providers will move as they hear of
others running awesome applications to make life easier--and save
lives. I've stopped using the phrase "killer app" in the health care
field for obvious reasons, but the standards, protocols, and storage
mechanisms won't have much impact until applications follow.
So I'll end with a nod toward a company for which I have a fond spot
because it happens to be the href="http://www.oreillynet.com/pub/wlg/3961">first health care
company I talked about in a blog, over six seven years ago. href="http://vocera.com/">Vocera is still going strong, providing
mobile devices with health care applications to over 600 sites.
Medical staff can issue orders, call for help, or scan medications
using these tiny clip-on devices.
Although Vocera doesn't work on the immensely popular iPhone, it does
have partnerships with the makers of several other handhelds,
including the Blackberry and one from Motorola. It collects scads of
statistics about things such as the number of contacts made and the
success of speech recognition software, to help sites judge its
effectiveness. I find it an example of the kind of product that will
drive electronic medical systems, because it will please not only a
Chief Medical Officer, regulator, or insurance claim processor, but
someone doing clinical work on the floor of the hospital.
Tags: americanrecoveryandreinvestmentact arra healthcare himss hitech meaningfuluse medical stimuluspackage vocera
Converting to Electronic Health Records: fits and starts
The people of the United States are finally pulling together around the
goals of reducing health care costs (by far the highest per capita in
the world) and improving outcomes (we have the worst health of any
developed country). Everyone seems to recognize the critical
importance of data and communications in these efforts. So several of
us at O'Reilly Media, having been involved with information
technologies for some time, are tracking the issues that come up in
deploying computer technology in health care--not just to streamline
payments, not just to facilitate access by doctors to records, but
actually to create new ways to deliver and track health care.
I recently attended a forum on how my state, Massachusetts, is
facilitating the move to Electronic Health Records, a prerequisite for
many things doctors, patients, and insurance companies can do to
improve health. It's notable that the chief sponsor of the event, the
Massachusetts Health Data Consortium,
was largely set up by insurance companies. Lots of invective has been
thrown at these companies recently, but the questions of technology
can pull together the insurers, providers, and patients in a common
quest.
My own understanding of the progress and frustrations in deploying
heath care technology was enhanced by the conversations I had that day
and the statistics bandied about.
Smallness is not nimble
Small doctors' offices went along with other industries and services
in the 1970s and 1980s by computerizing--but certain parts stayed in
the 1960s. So now, the big stumbling block that doctors face--adapting
their workflows to computerization--is reminiscent of the problems
other industries had in the 1970s and 1980s.
A typical scenario in those other industries was to use the waterfall
development model (or something even less structured) and setting
aside a requirements phase during which managers confidently told
application designers, "This is our workflow."
OK, requirements phase over and done with. The applications were
deployed, and it turned out that hundreds of little things the line
staff did every day were left out of the workflow. In other words, The
official workflow that the manager knew about was not rich and subtle
enough to encompass reality.
Doctors are more aware than those managers of how hard it is to
formalize their workflows, but the mismatch between current practice
and computer ideal is just as great. I can understand doctors'
reluctance to install electronic systems because in their work, more
than most, when one standardizes their data ands fit their
observations to the structure of the electronic record, lots can
easily get lost in translation. Not only is every patient and every
symptom a bit different, but every doctor is different in the manner
of observing patients and recording results.
It would seem, therefore, that the unique individuality of the
doctor--as well as the patient--would make digitization of records a
problem that was independent of the size of the provider's
organization. But still, some aspects of conversion are easily when
it's done on a large scale. Thus, speakers at the conference suggested
that the biggest barrier to adoption is the fragmentation of medical
According to the president of the Massachusetts eHealth Collaborative,
Micky Tripathi, 80% of US medical practices consist of just one or two
physicians, and small practices handle 90% of all outpatient visits.
Given the difficulties of electronic record conversion and the
reluctance of doctors to put in the effort, only 1% of these practices
currently use electronic health records.
I suppose that small practices may improve care the way small
restaurants cook more gourmet food, but the structure of medical
practices clearly reduces efficiency. But electronic records hold out
hope as well. Doctors can use computer technology to accommodate their
preference for small practices.
The division of the industry into tiny segments also increases the
risk of lost records (especially when they're on paper, but even
electronically). Forum speakers said the patient must ultimately be
the steward of his or her own records.
It's great when a new practitioner can start up an office tightly
oriented around electronic health records. Converting an existing
paper-based site is much harder. And I wonder whether EHR proponents
are willing face the cost (in time as much as money) of training.
Issues arise when large institutions adopt electronic records,
too. For instance, who gets control and the right to use the data, the
employer or the doctor who actually generates the data? As we'll see,
resolving questions about who benefits are critical to adoption.
Always somebody else's job
Tripathi made another impressive point: doctors don't see the benefit
to them in digitizing. In fact, they see it as benefiting everybody
else but them. I think this is because they don't know of any killer
app that would make the change not only desirable but indispensable.
This is the same reason Linux hasn't taken over on the desktop, even
though its applications and interfaces are quite easy to use and
highly functional. Linux can do everything Windows does--but for the
average computer user, it doesn't do anything more than
Windows does. After looking over the applications provided on a common
desktop distribution such as Ubuntu, one could well ask--why bother
switching?
In short, if a system just does the same thing as the one it's
replacing--even if it does that thing more efficiently and with fewer
errors--it won't generate enough excitement to drive adoption and make
adoption seem worth the pain.
The move to electronic records seems to have garnered support from the
leadership of all the important stakeholders: the medical profession
(as illustrated by the participation of the American College of
Physicians and Massachusetts Medical Society today), insurers,
governments, and patient advocates. But as I've mentioned, support in
the medical profession hasn't penetrated to the grassroots.
I wonder whether doctors could be swayed by stories of promising
apps--such as the one used by the Army's mCare Telehealth initiative
for Wounded Warriors suffering from Traumatic Brain Injury (TBI). As
described to me by Stuart Vaeth of Diversinet Corporation, which
created the mobile platform underlying the application, doctors can
use this little utility to remind soldiers to follow treatment plans.
Better health, fewer doctor visits, lower overhead--all in one small
Another expert I talked to claimed that wouldn't suffice. What doctors
need is to be offered an array of useful applications that are
guaranteed to work with the platforms they choose to install. This
suggests that standardization is even more important than is usually
thought, because it will create a platform for new applications. That
leads to my next point.
Government's role
Without speaking about current health care bills, I'll focus for a
moment on the medical part of the stimulus package, which suggest ways
government intervention can help fix health care.
First comes standard-setting. The most obvious role here is to promote
standards that ensure the different systems adopted by different
providers fit together. As reported by Ray Campbell, executive
director of the Massachusetts Health Data Consortium, the
Medicare/Medicaid part of the bill requires conformance to
requirements that will force conversion. God is still in the (yet to
be worked out) details concerning meaningful use.
Second comes actual investment. When up-front expenditures are high
and it takes years to recoup them, and especially when most sites are
small, somebody has to provide incentives. Campbell said the best
stimuli are actually up-front. In the case of the the American Recovery
and Reinvestment Act (ARRA) stimulus, the up-front stimuli aren't even
direct cash bonuses (which make up the bulk of the stimulus, but after
conversion is complete and judged to conform). Rather, the up-front
stimuli are research centers that provide expertise to sites that want
to digitize.
Although I am still holding back on commenting about the current
health care bills, I should reveal that I worked on grassroots efforts
to pass the 2006 Massachusetts health care bill that inspired
others to push for the current efforts by Obama, Pelosi, and Reid.
With all its problems, the Massachusetts bill put all of us on the
line in this state to work together to solve our health problems.
So instead of fearing a takeover of health care by government (it's
strange how Americans tend to view "government" as some homogeneous
monstrosity, like the mysterious obelisk in the movie 2001),
the public can view legislation as a way to stand together as a
The one thing of which I am convinced is that we need to replace the
current adversarial model of allocating health money with a
cooperative one. Only if providers and patients get lots of data, and
are willing to use it creatively, can we lower costs.
It worked with the energy utilities. Until recently, they operated
under a simple model where the more energy the sold, the more money
they made. Regulators and utilities worked together to find new models
that rewarded them more for conservation than for consumption. Health
care is a more complex problem--more levers and pulleys to the system,
and subjects who face a diversity of diagnoses--but with all that is
at stake, we should find a way forward.
Tags: americanrecoveryandreinvestmentact arra healthcare massachusettshealthdataconsortium medical stimuluspackage


text:
ARGENT early stage researchers engage in different types of outreach activities, promoting awareness in different countries.
The UK Parliament
ESR Sophie Grellet had the opportunity to meet several Members of Piarliament in London at the occasion of the Voice of the Future (VOF) event. The Royal Society of Biology, taking forward its Royal Charter duty 'to serve the public benefit', has worked with the House of Commons Science & Technology Committee and other science organisations, in order to organise this regular event.
Sophie asked the MPs about their ethical point of view on the use of nanotechnologies.
Genesis Care Medical Centre, Linford Wood, Milton Keynes, UK
ESR Sophie Grellet is currently working with Genesis Care Medical Centre at Linford Wood, Milton Keynes, UK. With the kind help of all the radiotherapy team, who made this work possible, she is able to use their facilities and irradiate different samples following a treatment plan similar to the one use for patients.
Within this collaboration, Sophie presented her work to a group of medical physicists which has been a good opportunity to interact and discuss with practitioners.
Leighton Bizzard Primary School, Peterborough, UK
Four ESRs visited Leighton Bizzard primary school to introduce the children to the world of research. It was a very good experience to discover that already at a very young age, you can have a lot of interests from these potential future researchers.
« Fête de la Science » at the Paris Sud University in Orsay, France
ESR Marta Bolsa Ferruz and ESR Vladimir Ivosev, represented ITN ARGENT at the 25th edition of "la Fête de la Science" (Science Festival) in France, from October 8th to 16th, 2016. Organized by the French Ministry of National Education, Higher Education and Research, this event regrouped over 3000 scientific manifestations all over France. A free of charge access to entertainment activities, expositions, debates and scientific initiatives was given to a wide public of all ages, with the aim of spreading and promoting the interest for science, make it more accessible and understandable.
ITN ARGENT researchers welcomed the visitors in one of their laboratories at ISMO (Orsay Institute of Molecular Science) and presented their research topic "Nanoparticles and Hadrontherapy", via two different presentations adapted to the age of the public.
"Science Uncovered", Ulster Museum, Belfast, UK
Within the framework of the European Researchers Nigh, ESR Soraia Rosa participated in the Science Uncovered event held in the Ulster Museum in Belfast. This event was directed towards the general public to promote science and cancer research, in particular. All these outreach activities allow the students to bring increased awareness of cancer research importance and to build a bridge between the different fields of research.
The EuroScience Open Forum, Manchester, UK
ITN ARGENT ESRs at the EuroScience Open Forum in Manchester in July 2016. The event is held every 2 years and this time ITN ARGENT took the opportunity to present the work being done within the network and interact with various stakeholders as well as the general public.
Presentations during an internal day of CNRS-Ismo
ESR 1 (Marta Bolsa) and ESR 2 (Vladimir Ivosev) made a presentation of their respective work in the project during an internal day of CNRS-Ismo lab dedicated to the PhD students.
Presentation at the COST MP1203 meeting in Amsterdam
ESR 1 (Marta Bolsa) participated in the COST MP1203 meeting in Amsterdam on April 11th and 12th: Theranostic, the integration of therapeutics and diagnostic. She made an oral presentation of 30 minutes "Nanoparticles: exquisite tools to improve radiation therapy" to promote her work and the project.
Seminar in University of Paris Sud
ESR 1 (Marta Bolsa) presented a seminar in University of Paris Sud on January 11th 2016 about her work in the project. Numerous researchers and students from several labs in the Paris area attended the presentation.
Abstracts for the day of doctoral school of University Paris Saclay
For the day of doctoral school of University Paris Saclay, Marta Bolsa (ESR 1) submitted an abstract named "Toxicity evaluation of nanoparticles on proteins using Synchrotron radiation circular dichroism". Vladimir Ivosev (ESR 2) will also present his poster related to the abstract "Uptake dynamics and intracellular localization of small gold nanoparticles in glioblastoma, cervical and prostate cancer cell lines".