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Telehealth Virtual Addiction Treatment
September 23, 2020 | BY: Hazelden Betty Ford Foundation
Telehealth: Making Treatment a Virtual Reality for More People
Let's Talk Addiction & Recovery Podcast
Accelerated in part by the COVID-19 pandemic, online addiction treatment and recovery services have rapidly become more widely available. But how effective is virtual addiction care? Are patients showing up and staying connected? Are counselors seeing outcomes comparable to in-person care? Are health insurers covering online programs? Yes, yes and yes. Learn more as host William C. Moyers talks with Hazelden Betty Ford's Bob Poznanovich about promising new telehealth solutions for addiction.
Read the podcast transcript below or listen and subscribe on iTunes, Google Play or watch on YouTube.
0:00:13 William Moyers
Here we are another interview in our Let's Talk podcast series. Thanks for joining us. I'm your host, William C. Moyers. These podcasts feature experts on the gamut of issues that matter to Hazelden Betty Ford. The same issues that matter to you, our audience. From substance use prevention to cutting-edge research, treatment of addiction, and recovery from it. These conversations have become quite popular the past two years. And if you've tuned in previously for today you'll note that things look a little bit different around here. No wonder. We're recording in the midst of the pandemic that has affected all of us. Hazelden Betty Ford takes seriously the need to do everything possible to prevent the spread of coronavirus among our patients and our employees. Even here in the studio, we're following public health guidelines. As a result, I can take off my mask for the interview because the production crew, the Executive Producer, and yes, even my guest, Robert Poznanovich, are elsewhere in the building. The fundamentals of social distancing 101. It's a real treat to have Bob Poznanovich with me today because a long time ago, before he went to work at Hazelden, before he became the Vice President of Business Development for this organization, Bob and I met in the community of recovery in St. Paul. Bob, it was in about 1980—'95 when you and I would get in the car together and drive to Center City. Certainly a lot has happened in our lives personally and professionally. Just share with our audience today your personal connection to the organization.
0:01:45 Bob Poznanovich
Sure hi William. It was February 13th of 1995 when I had reached my bottom. When I was using cocaine, a really high amount, in Chicago. I had just lost my job as a senior executive in a technology company and kind of lost my relationships and kind of like everybody else I reached that point that I ran out of options and fortunately I found the Hazelden Foundation. I went to treatment like I said in February and stayed in Center City until March. And then I went to Fellowship Club where I met you and other members of the community. Some point at the end of March we started volunteering. And every Saturday a group of us would go to Center City and share our strength, experience, and hope with patients. And I think that became a big secret to, you know, my recovery is that volunteering and giving back. And having some fun and you know filling that void that the drugs and alcohol had that was now being filled with recovery. And then I think that's one of the promises. And one of the gifts. Is to have really true friendships like yourselves and others throughout the years. So it's nice to see you and it's nice to be here in the same capacity with you, being able to kind of carry—put a face on recovery and carry the message of hope.
Who'd have ever imagined it, right? Way back then? [Bob laughs heartily] You know you talk about how much you lost but we're so glad that you've gained so much. And we're so glad that you continue to hold onto really the expertise that has put you into the role now as the Vice President of Business Development for this organization. At really a critical time. Not only in our growth but as we, you know, address the pandemic of coronavirus. And you're in charge of a lot of that effort. Can you take us through the process of developing and launching Hazelden Betty Ford's telehealth strategy?
Sure. So because my background has always been in technology, I was looking ahead and trying to predict kind of where the industry was going to go as you're looking at technology and health care in general. I think it was pretty clear that technology utilization in behavioral health was really lagging and particularly even more so in substance use. I mean a lot of organizations didn't even have electronic medical records. And you looked at the industry, you started to look at the industry problems, patient problems and care delivery problems, back in 2018. When I happened to have seen a demo of some software that one of our Payer partners was developing. And it clicked on me that this technology could be used to deliver care differently. So it was in 2018 we started to talk about how could we use video, and live video between patients, not just in a one-on-one environment, which was kinda being done, you know, for telehealth for years. But how could it be done in a group environment? Because the problem we were looking to solve was access. And as we're working with a lot of our partners around the country and communities, academic health centers and other state organizations, you know, health care to rural patients is a real challenge. So, you know, could it help provide care and improve access to rural markets? Would the convenience of being able to get care wherever you're at improve engagement? You know, if you live in downtown L.A., Chicago, or New York, you know the catch mitt area is really small. Big cities 'cause people don't wanna fight the traffic after work to get to care. So could convenience improve engagement?
And the other was would stigma—could we help overcome some of the stigma by not making people physically have to show up in a building, kinda put a label on themselves, kinda come out much more in a public sense. And could we engage them earlier by having them feel it's safer as well as convenient to start that way. So we had started in 2018 down the path saying could we accomplish all kind of the goals of health care? Which is improve access, improve outcomes, improve patient satisfaction. And lower costs. In 2019, we started a pilot along with a couple Payer partners. One of the primary ones was Anthem. Out of California. And we ran groups where we took our patients with our counselors using a technology platform to deliver the same type of care we were doing virtually. And we piloted that for about nine months. During that nine-month period, we really worked on developing the right protocols for patient safety. For confidentiality. For workflows, for integration, tweaking clinical content, developing and understanding what counselor skills had to be developed. You know that bedside versus web-side manner is just something that we really are focusing on. And we learned a lot of that.
And our plan was to launch our virtual outpatient services at the end of March and then roll it out one state at a time—
Mmm-hmm.
—Throughout this year. And then because of the epidemic and because of our really number one focus which was to make our patients and staff safe, we transitioned all of our outpatient patients across seven states into virtual care services over a couple weeks. And we moved something like 1300 patients successfully.
Over that period of time. Between our intensive outpatient, outpatient, and day treatment programs. And those numbers are even higher today than they were—the number of patients we're treating today are even higher than they were when we transitioned the initial group out.
So you had the plan to roll it out in the spring of 2020, you never anticipated the pandemic, what is the pandemic of coronavirus as a relates to virtual care? What have you learned so far?
Number one that it appears to work, that virtual care seems to work. If you look at a couple of indicators. Staff satisfaction and confidence in the delivery system. If you think of—if the counselors don't think that the product and the service and the patient engagement is working, that would be a very—a big obstacle. The second one is the surveys that we've have from patient satisfaction.
You know some have said they would never think about going back to brick and mortar and that was not universal but it's a high percentage are very, very comfortable with that delivery vehicle. And we're looking at early data outcomes. On engagement. Meaning, that our patients today are averaging more sessions and have significantly less no-show rates. Which we believe, when you improve that level of engagement, and consistency, that we will improve outcomes. And we are starting to study, you know, the outcomes that we'll know in a few months. If outcomes are at least the same if not better using some virtual. [Moyers nods] In fact I think we'll know over time too as we do some stratification about which patients would fit better in a facility versus brick and mortar facility. And I think we'll know that over time as well as what skills counselors have to develop. And what are the outcomes by counselor and is there some skills that we could learn to create that better therapeutic alliance.
And those outcomes, the efficacy of virtual care is being gauged through the Butler Center for Research.
So Bob, so you disclosed at the beginning of our podcast here you know your own personal journey. You know as well as I do that addiction is an illness of isolation. And the antidote to it is community. Virtual does bring people together but is it—is it the best answer for what we used to experience when we're on the units, when we're sitting in a group of chairs in a circle down at St. Paul?
Yeah. I think it's gonna be different. I mean, at some point I think that there's gonna have to be that—that one-on-one contact. You know isolation is a concern. I think that that's one of the areas that we could measure, it's one of the apps and some of the things that we're looking at for future product developments is how do we measure and how do we intervene. On isolation. Because it is kind of the diagnosis of the disease or consequence of the disease. You know but today's day and age, we're gonna have to rely on some social separation. We're seeing really good participation and acceptance of virtual meetings. You know we've got the daily pledge.org which is our run site. Which is seeing record numbers of patients. Some of the online AA meetings. And NA meetings. And other Twelve Step meetings have seen record numbers of people. I know that there was a meeting in my old hometown which used to draw a hundred or so people physically, who had over a thousand people attend a speaker meeting virtually. [Moyers nods] You know I've been able to attend meetings with friends in Chicago that I never would have done—
Right. [nods]
—Pre you know COVID because I wouldn't have been in Chicago or I wouldn't have been in their area where they're going to meetings. So, I think it's gonna be a change. I think it—I think it can't completely replace the face-to-face, I think there'll still be some of that connection, maybe that connection with a sponsor. So that there is some additional accountability. But I think for those who have transitioned into recovery virtual will be able to complement it really well. And then we—but we've also looked at what we've got in our continuum of care, William, too.
So even though we started at Hazelden, you know, 2018 looking at virtual care, and then 2019 piloting it, we've really looked—if you think about telehealth is the overall big environment, which includes not only virtual services which means delivering care live via video. But it's also digital resources, digital health—
—Solutions, content that's driven just one way on demand as opposed to bidirectional through live access. So you know since '09, 2009, you know, we've been moving—we moved digital content you know from—from our books and other literature—
—To the web. That was kind of early on. And then we moved all that content into an application called MORE.
You know which is an evidence-based continuing care recovery management tool that provided telephonic support as well. You know and we moved and integrated all of that into our electronic health. So first to the web and then into a stand-alone product and then into our electronic health system. And then we complemented that with apps.
Mmm-hmm. [nods]
—That we did as 27 different mobile apps that are available on the android and IOS platforms to support people.
And then there's thousands of hours and pages of content that's available through books, our bookstores, and it's available to consumers and not to mention things like our daily mediation and all the other resources that we provide free on our website. [Moyers nods] So, if you think about the complete continuum of care for telehealth, you know it's—it was a lot of digital resources that were available to individuals and families and communities via our web. A lot of it was available to our patients via now their electronic health record and other services. Some of that was just digital some of it was digital and telephonic. And now we've expanded all of those under a product family called RecoveryGo which is our organization's product family for our telehealth which is digital and virtual product solutions. For families, individuals, and the communities that we serve. Or, to support the providers that we also support. As they provide solutions to their families. So, if you think about the complete continuum to complement the lack of that face-to-face environment, you know we are now expanding not only into virtual addiction treatment but we are launching virtual mental health. So people will be able to get individual and group mental health services in all of our states and that will follow the states that we expand to.
So, people could start if they needed to with mental health services to kind of figure out what's going on. That might be the beginning and the end of their road.
They might find that mental health transitions to a core issue which is substance use and they may transition into substance programs for, you know, virtually. They may transition back after substance use back into ongoing mental health support if that's needed. So we've got a complete continuum virtually for mental health before, during, and after treatment. And we're providing family support too now virtually. There is four or five groups a week that are offered free by Hazelden. In our Family Program to anybody in the community. Any community. Who wants to get education about the disease of addiction, how it impacts them, how it affects their loved ones, how they can support those recovering—
Mmm.
—And how they could also take care of themselves to make sure they get healthy. And that's been a great resource and that's another indication of success. Every week we are seeing record numbers of people attend those programs virtually. And far exceed the number of people that would have attended our brick and mortar programs.
Right. Right.
So I think we're able to help more people in more markets differently as a result.
And Bob what's been the Payer response? When I say Payer, I'm talking about the private insurance companies that people often times use their insurance to access our system of care. What's been the Payer response to virtual?
So early on, prior to the COVID, we had had Payer—some Payer acceptance and willingness early on. There were some that were hesitant. With COVID however, every one of our Payers has made policy changes that supported both intensive outpatient as well as partial hospitalization.
I would expect all of those to continue with that platform going forward for intensive outpatient. I think the other levels of care will be determined.
You know, we're in conversations with them. We just did a panel discussion a couple weeks ago. With our research analysts and some of our Payer partners to start talking about, you know, what does quality, legitimate, ethical care look like? And you know how—how do we bring the value-based conversation to virtual? 'Cause value-based really hasn't hit even outpatient, let alone virtual. I think we're gonna have the same opportunities here to show what good care looks like. And to help them define standards and measurements that'll continue to validate this. I also think that there's risk as we've seen in health care in general as well as the substance use industry for fraud and abuse.
And I know that the Medicaid, Medicare and others are already looking at how do we safeguard, how do we insure that we're getting legitimate care?
But we hope to be able to lead those conversations to kind of set a path. With the research that we're doing through the Butler Center of Research the relationships we have with our Payers. To continue to say this is what legitimate, high-quality, good outcome care looks like. How do we start building into discharge plans virtual as part of a continuing care plan post-COVID as well to say how do we continue to use the tools?
To continue to improve engagement. Which we know leads to better outcomes and I think we just have to show that. That it's working, patients like it, the outcomes at the same or better.
And I think we'll get Payer support. And I think we'll—the government support will also be interesting too. To see some of the restrictions that government has made both state and federal. To support this going forward. I know there's a lot of push right now to continue to make all of the concessions that were made permanent.
I think Congress is meeting this week to discuss what to do with it. I see the Governor of Idaho just identified that he's going, that they're going to continue indefinitely post-COVID all—removing all of the regulations that they had imposed. So we're hoping you know that that continues. I mean there's a tremendous upside—
—In this if they do.
We've got one minute. Last question. From your position as the Vice President of Business Development, the incredible work that you've done for a long time now to expand our mission into so many different markets, so many different audiences and demographics. From your position, since March of this year, and now we're into the end of June with the pandemic being what it is. What's been the biggest surprise in a positive way for you, you know from your perspective as the Vice President of Business Development?
I think there's two, William. It's a great question. Number one is how rapidly we were able to launch virtual services and how, you know, good we were at it. I think those previous months helped. But we really accelerated it and expanded what we had envisioned as a launch and how well our clinical teams did that. And how well that translated the patient engagement. And the fact that we've grown, consistently grown, our number of people that we're serving. We're ten percent higher, excuse me, twelve percent today.
Twelve percent more patients treated virtually in our outpatient programs than we had in our facility-based programs. I think that that's great. And the second one was the continued I think demand, value, of our brand for our residential programs. You know, we drew people from more states outside of the states that we're in, in May of 2020 than we did of April of 2019.
So I guess the point is even despite the fear of travel and all of the consequences and all of the complications, people were still desperate for care and people really wanted good care. And they were more willing than ever to come to us. I think that really just showed the value of our reputation, brand, and our brand promise. And the hope that we provide people. And I don't think that would have predicted.
Well we've have to have you back on in six months or so and see where we are with telehealth and with our virtual care. Robert Poznanovich, the Vice President of Business Development, thanks for being with us today.
And thanks to all of you for joining us. Be sure to tune in again for another edition of our regular podcasts, Let's Talk. On behalf of our Executive Producer, Lisa Stangl, and our podcast team from Blue Moon Productions in the Twin Cities, we wanna remind you to stay safe and stay healthy in these times and all the time.
Telehealth includes not only virtual services, which means delivering care live via video, but it's also digital resources and health solutions.
—Bob Poznanovich
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Archive for the 'fiction' Category
Interview With Writer Sarah Anne Johnson
In author interview, books, fiction, writing on November 26, 2014 at 11:06 am
Sarah Anne Johnson. Photo courtesy of the author.
An introduction to writer Sarah Anne Johnson, author of the new novel The Lightkeeper's Wife (Sourcebooks, 2014). Her previous books include The Very Telling, The Art of the Author Interview, and Conversations with American Women Writers. An experienced author interviewer, Johnson shared that, "By asking the writers anything I wanted to know, I filled my writer's toolbox so that the next time I sat down to write, I could address things that I didn't have a way to look at before."
Interview With Writer Veronica Rossi
In art, author interview, books, editors, fiction, writing, young adult (YA) on June 14, 2014 at 11:17 am
Veronica Rossi. Photo by Marissa Bell Toffoli (2014).
An introduction to Veronica Rossi, author of the YA trilogy Under the Never Sky, Through the Ever Night, and Into the Still Blue (HarperCollins, 2014). This interview was done with the Rakestraw Books PG-14 Teen Advisory Board, whose thoughtful and fun questions spoke to the heart of Rossi's work and delved into what life is like for a writer.
When asked about drawing from mythology or other stories and sources, Rossi made a great point about how things can be connected but still unique: "If you're really writing something that your heart is in, and you're working hard to be honest in your writing and not copying other ideas, then no one else can write that. It's okay to borrow ideas, but borrow them and make them your own." Read the rest of this entry »
Interview With Writer & Artist Nick Bantock
In art, author interview, books, fiction, nonfiction, writing on February 3, 2014 at 4:24 pm
Nick Bantock. Photo by Yukiko Onley.
An introduction to Nick Bantock, author of the Griffin and Sabine books and a new book on creativity, The Trickster's Hat (Perigree, 2014). In The Trickster's Hat, Bantock shares exercises for writers and artists that explore elements of creativity such as where to begin, working from dreams and archetypes, blurring the lines between reality and fantasy, silence, the unexpected, the mysterious, and more. Read the rest of this entry »
Interview With Writer Lucille Lang Day
In author interview, books, editors, fiction, memoir, poetry, writing on January 24, 2014 at 3:52 pm
Lucille Lang Day. Photo by Marissa Bell Toffoli (2013).
An introduction to writer and editor Lucille Lang Day. She is the author of eight poetry collections, a number of short stories and creative nonfiction pieces, and the children's book, Chain Letter. Her latest book, Married at Fourteen, won the 2013 PEN Oakland Josephine Miles Literary Award in the category of memoir. Day holds an MA in English, an MFA in Creative Writing, an MA in Zoology, and a PhD in Science/Mathematics Education. She's also the founder and director of a small press, Scarlet Tanager Books. Read the rest of this entry »
Interview With Writer Antoine Laurain
In author interview, books, fiction, journalism, writing on October 3, 2013 at 8:22 am
Antoine Laurain. Photo by Marissa Bell Toffoli (2013).
An introduction to Antoine Laurain, author of the novel The President's Hat (Gallic, 2013; originally Le Chapeau de Mitterrand). A fifth-generation Parisian, Laurain is a journalist, screenwriter, director, antiques collector, and novelist. His previous books include Ailleurs si j'y suis, Fume et tue, and Carrefour des Nostalgies. Talking with Laurain after he arrived in the US to begin his book tour, there was an air of excitement to the uncommonly sunny San Francisco day. A certain light shown through his personality befitting of the afternoon and the thoughtful playfulness behind The President's Hat. There was already a hint of the surreal in the atmosphere before Laurain shared a story about the cover for the French edition of the book. After, there was nothing to do but marvel at how fiction and reality mingle in unexpected ways: Read the rest of this entry »
Interview With Writer Duff Brenna
In author interview, books, fiction, memoir, nonfiction, short stories, writing on September 13, 2013 at 10:30 am
Duff Brenna. Photo courtesy of the author.
An introduction to Duff Brenna, author of nine books including The Book of Mamie, Minnesota Memoirs, and Murdering the Mom. He is a freelance writer and Professor Emeritus of English literature and creative writing at California State University, San Marcos. Brenna finds ideas for his own writing from reading, and also from talking to people: "I know how to listen when I'm with people. Stories often pop out of their mouths that I use to write my own version of what they were saying. I also use my own life." Read the rest of this entry »
Interview With Writer Deanne Stillman
In author interview, books, essays, fiction, journalism, nonfiction, writing on August 16, 2013 at 11:58 am
Deanne Stillman. Photo courtesy of the author.
An introduction to Deanne Stillman, author of Desert Reckoning: A Town Sheriff, A Mojave Hermit, and the Biggest Manhunt in Modern California History. Her previous books include Mustang and Twentynine Palms. Stillman is a member of the core faculty at the UC Riverside-Palm Desert Low Residency MFA Creative Writing Program. When asked how she balances content with form, Stillman shared, "Place drives everything; in my stories, the desert or the land shapes the story and the characters, and often is a character itself."
Interview With Writer Richard James Bentley
In books, fiction, writing on June 7, 2013 at 10:04 am
Richard James Bentley. Photo courtesy of the author.
An introduction to Richard James Bentley, author of the novel Greenbeard (Exterminating Angel Press, 2013). Before writing fiction, Bentley was a technical writer, so it isn't a surprise that he collects mechanical adding machines and dictionaries. When asked how his experience writing technical manuals influenced the way he approaches storytelling, he answered:
The written word has always been part of my environment, and the narrative always part of my internal landscape, which is to say that my head has always been filled with stories. In the end, I suspect, everything is defined by narratives. When I worked as a technical author, trying to pick engineers' brains for the information that I needed to do my job, one of the psychological tricks I used was to get the guys to reminisce about the history of the project. Then, instead of a grunted list of facts and a bundle of paperwork thrust at me, I would instead get a coherent account of how the project had come to be its current state. A narrative. A story.
Interview With Writer Jennie Shortridge
In books, fiction, writing on May 22, 2013 at 12:47 pm
Jennie Shortridge. Photo by Natalia Dotto.
An introduction to Jennie Shortridge, the author of Love Water Memory (Gallery Books, 2013). Her previous novels include When She Flew and Love and Biology at the Center of the Universe. The story unfolds in Love Water Memory as Lucie explores the mystery of her past, and gets to know herself as if for the first time while recovering from amnesia. When Erica Bauermeister interviewed her at Rakestraw Books, Shortridge explained that writing a mystery "became like a little dance—how much to reveal when." Shortridge also shared the fun fact that "all of the characters were named for someone's favorite grandparent." That started with Grady, named for Shortridge's grandfather, and as she talked with other friends about their grandparents, she started a quiet tribute by using their names for characters in the book. After Bauermeister and Shortridge discussed the writing process, and what it's like to work with agents, editors, and publishing companies, Shortridge brought it all together with a simple point: "We write because we love stories."
Interview With Writer Charles McLeod
In books, fiction, short stories, uncategorized, writing on May 15, 2013 at 12:52 pm
Charles McLeod. Photo courtesy of the author.
An introduction to Charles McLeod, author of the novel American Weather and a collection of stories called National Treasures (Outpost19/Random House UK). His fiction has appeared in publications including Conjunctions, DOSSIER, Eleven Eleven, The Gettysburg Review, Hayden's Ferry Review, The Iowa Review, The Pushcart Prize: Best of the Small Presses, and the Norton anthology Fakes. McLeod was born in Texas, grew up in the San Francisco Bay Area, California, and now lives in Colorado. Since 2000, he's held eleven addresses in eight states. Read the rest of this entry »
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Interview With Writer Peg Kingman

redpajama_set_name: RedPajamaCommonCrawl


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Q: Java: any way to get a ZipFile (or anything with a direct getEntry method) from a byte array? I have the contents of a zip file in a byte array.  The file contains a number of entries (typically about 12), but I only care about three of them.
I would like to somehow get this into a ZipFile object, so I can pull those specific three ZipEntrys out using ZipFile.getEntry.  I'm open to using something other than ZipFile that has a similar look-up-by-name method like getEntry.
My initial investigation suggests that I'm out of luck. ZipFile requires a real file in the file subsystem (which I cannot and do not want to access) and so I can't get there from here, and no means other than ZipFile exists that allows extracting particular entries by name; but I wanted to check.  In languages like C# and Python, this is pretty straightforward (in C# I go from byte array to MemoryStream to ZipArchive; in Python I just wrap it in StringIO and treat like a file), so I wanted to make sure I'm not missing something obvious.
My Plan B is to use ZipInputStream and repeated calls to getNextEntry to go through all dozen or so entries, and throw away all except the three I care about, but that just smells bad to me.

A: A ZipInputStream can be instantiated for any InputStream ... including a ByteArrayInputStream.
Apart from that you are out of luck ... if you stick with Java SE classes.
The root of the problem (from an API design perspective) is that ZipFile is a wrapper for functionality that is implemented in native code.  The native code opens the input stream for itself, and it uses a native filename / pathname.
The main reason for a native ZIP implementation that works that way is that the JVM needs to load code from ZIP files as part of the bootstrap procedures.  This happens before the native implementation has loaded classes such as InputStream.  Indeed, it has to.
There are a number of 3rd party libraries. Start by reading this Q&A - What is a good Java library to zip/unzip files?

redpajama_set_name: RedPajamaStackExchange


Security analysis and attack-defense modeling are effective methods to identify the vulnerabilities of information systems for proactive defense. The attack graph model reflects only attack actions and system state changes, without considering the perspective of the defenders. To assess the network information system and comprehensively show attack and defense strategies and their cost, a defense graph model is proposed. Compared with the attack graph, the model makes some improvements. The defense graph will be mapped to the attack and defense game model, in order to provide a basis for active defense policy decision. Moreover, a generation algorithm of defense graph is proposed. A representative example is provided to illustrate our models and demonstrate the high efficiency of the algorithm.


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Lodewijk VII van Hessen-Darmstadt (Darmstadt, 22 juni 1658 – Gotha, 31 augustus 1678) was in 1678 enkele maanden landgraaf van Hessen-Darmstadt. Hij behoorde tot het huis Hessen-Darmstadt.

Levensloop
Lodewijk VII was de tweede zoon van landgraaf Lodewijk VI van Hessen-Darmstadt en Maria Elisabeth van Sleeswijk-Holstein-Gottorp, dochter van hertog Frederik III van Sleeswijk-Holstein-Gottorp. In 1676 werd hij door hertog August van Saksen-Weißenfels opgenomen in het Vruchtdragende Gezelschap. Als gezelschapsnaam droeg hij de Gracieuze met als motto bijzonder vermakend

In april 1678 volgde hij zijn vader op als landgraaf van Hessen-Darmstadt. Hij regeerde amper vier maanden en stierf in augustus 1678 in Gotha aan dysenterie. Het was de bedoeling dat zich in Gotha zou verloven met Erdmuthe Dorothea (1661-1720), dochter van hertog Maurits van Saksen-Zeitz. Na zijn overlijden werd Lodewijk VII als landgraaf opgevolgd door zijn halfbroer Ernst Lodewijk.

Landgraaf van Hessen-Darmstadt
Huis Hessen-Darmstadt
Hessen, L

redpajama_set_name: RedPajamaWikipedia


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State and business in post-colonial societies: What lessons can South Africa draw from the contrasting experiences of India and South Korea?
Professor Vivek Chibber
University of Johannesburg, Bunting Road Campus, FADA Auditorium
The 5th Mapungubwe Annual Lecture, State and business in post-colonial societies: What lessons can South Africa draw from the contrasting experiences of India and South Korea? was delivered by Professor Vivek Chibber on the 16th March 2016 at the University of Johannesburg
Born in Delhi in India, Professor Chibber obtained his PhD through the University of Wisconsin in the United States, and currently holds tenure as a Professor at New York University. He has published widely, with his most recent book Postcolonial Theory and the Spectre of Capital sparking widespread debate on post-colonial theories and approaches.
His previous work Locked in Place: State Building and Late Industrialisation in India will be of particular interest to South Africa, with specific reference to the role of the state and the capacities required of it to provide leadership to national development, the imperatives of state transformation in post-colonial societies and the constraints that face small open economies such as South Africa
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Linder Auditorium, Graduate School of Development Policy and Practice (GSDPP), University of Cape Town


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Home > Analytics > 2020 Healthcare IT: Not All Doom and Gloom
2020 Healthcare IT: Not All Doom and Gloom
by John Moore | April 22, 2021
Despite a chaotic 2020, notable success stories are emerging.
Doom scrolling through the pandemic was easy to do, for doom was in abundance. Make no mistake, the pandemic wreaked havoc on society and American businesses of all sizes suffered. Healthcare is one sector that was particularly hard hit, as the Spring 2020 lockdown halted most elective surgeries, office visits and trips to the ER. Subsequently, many health IT companies (outside of telehealth) suffered as projects were shelved and the RFP pipeline shut-down so health systems could focus efforts on addressing the surge in COVID cases coming through their doors.
Most public health IT companies stopped providing forward guidance to Wall Street investors. Numerous smaller, private health IT companies saw significant reductions in revenue leading to staff lay-offs, being acquired or simply closing up shop.
But as always, there are exceptions to every rule. Two companies I recently spoke with broke from the ranks of others in having very successful results for 2020 – one a health IT stalwart and another, a more recent upstart.
MEDITECH Awakens
Despite the pandemic, in 2020 MEDITECH was firing on all cylinders. The company reported 12 new accounts in 2020 taking market share from its competitors.
For many years I have felt that MEDITECH was seemingly asleep at the wheel. Sure, they did what was needed to comply with meaningful use requirements, but the overall EHR itself was stuck in a time-warp. At times I thought maybe this was just what their customers – typically smaller community hospitals — wanted. Other times, I imagined they were just resting on their laurels and simply unwilling to make the investments necessary to keep pace with their competitors.
Fast forward to today and boy, what a turnaround they have made.
Despite the pandemic, in 2020 MEDITECH was firing on all cylinders. The company reported 12 new accounts in 2020 taking market share from its competitors, even winning a hospital from Epic, which is almost unheard of. In total, the company had 31 net new sites for their latest EHR, Expanse.
After years of development, the company finally released Expanse, a fully cloud-based, enterprise solution. Like its predecessors, Expanse offers the typical EHR/RCM functionality of most EHR vendors, but also includes ERP functionality as well. The company has greatly improved the user interface, also adding an integrated ambulatory solution, which is an area where they have struggled in the past. This is all provided at an attractive price point and is scalable well-beyond their typical targeted <250 bed hospital.
While all these features are important to operating a health system, there may be one other critical factor at play: the migration to subscription-based, SaaS pricing. The typical licensing model for enterprise software is a one-time, upfront cost — capital expenditure — and ongoing, annual maintenance fees. Such pricing can be difficult for health systems, especially smaller, rural systems, who continue to see a squeeze on margins, which were exacerbated by the pandemic.
SaaS pricing requires far less money upfront and can be claimed as an ongoing operating cost. This is a far better model for cash-strapped organizations. Secondarily, with a SaaS model, ongoing maintenance and upgrades are automatically delivered via the cloud, which may reduce internal support costs.
While there are some drawbacks to SaaS solutions, particularly reduced ability to customize the solution, MEDITECH customers seem to be perfectly willing to make that trade-off.
In my experience, the typical lifecycle of enterprise software in a given institution is roughly a decade. The healthcare sector is now entering that period, since the passage of the HITECH Act, which was largely responsible for EHR adoption nationwide. This bodes well for MEDITECH – their timing couldn't have been better – as health systems begin reassessing their previously chosen EHR solution and look out into the market as to what others may be offering.
REDOX: Enabling the Developer Community
The rapid rise in use of telehealth in 2020 by health systems…was jet fuel for the company, igniting a doubling of health systems they interface with. In January 2020, REDOX interfaced with just under 500 systems. By January 2021, REDOX more than doubled th[at number] to close to 1,200.
REDOX is a VC-backed, integration infrastructure vendor providing API-based tools for developers to build apps that interface with clinical systems. When the pandemic lock-down hit last March, REDOX saw its sales opportunities evaporate. The company took "right-sizing" measures to preserve cash-flow and hunkered down.
However, the rapid rise in use of telehealth in 2020 by health systems to virtually engage with patients was jet fuel for the company, igniting a doubling of health systems they interface with. REDOX also assisted health systems in enabling such closed loop processes as lab orders, results and public health reporting. In January 2020, REDOX interfaced with just under 500 systems. By January 2021, REDOX more than doubled the number of health systems to close to 1,200, handling some 12 million messages a day flowing through their network.
Key to REDOX's success is their two-sided network, wherein they provide app developers with the EHR integration tools they need to be enabled in clinical workflows. Large healthcare organizations are also using these tools to develop apps for internal use cases, as well as leveraging REDOX integration tools to interface with other systems outside their own. This dynamic will continue to fuel growth for REDOX due to the natural "network effect" of its solution and go-to market strategy.
These two profiled vendors are examples that even in a pandemic of epic proportions, there remains a need for proven IT solutions that address specific pain points within a given organization. These vendors' success stories also point to broader trends in the market.
First, the continuing migration to cloud-hosted solutions and subsequently moving enterprise software costs from CapX to OpX to preserve cash flow. Virtually all enterprise software vendors now offer, on will in near future, a cloud-hosted version of their solution.
Secondly, organizations of all sizes realize that their enterprise solutions will only take them so far. To enable a multitude of internal and external processes and functions, other apps will need to be adopted or developed. The slow but steady migration to open API standards, such as FHIR, will accelerate over the next several years, providing a critical layer of functionality (Systems of Engagement) over the System of Record, which in healthcare today is the EHR.
Posted in: Analytics , API , Care Management , Engagement , Interoperability , Life Science , Population Health Management , Provider-Payer Convergence , Telehealth Tagged with: Meditech, Redox


text:
Q: How to use Special characters in Python? this is my code
f = open('test.txt','w')

f.write("\N{Circled White Star}")
f.close

And I get this error
Traceback (most recent call last):
  File "f:/mc experiment/python/SkyblockSniper-main/df.py", line 3, in <module>
    f.write("\N{Circled White Star}")
  File "F:\programing\python\lib\encodings\cp1252.py", line 19, in encode
    return codecs.charmap_encode(input,self.errors,encoding_table)[0]
UnicodeEncodeError: 'charmap' codec can't encode character '\u272a' in position 0: character maps to <undefined>

What I expected
The test.txt file should have
✪

What i got
<nothing>

A: Try changing the encoding of the file you open. UTF-8 worked for my testing.
You should also open files using context managers instead of the way you did it.
star = "✪"
with open('test.txt', 'w', encoding="UTF-8") as f:
    f.write(f"\n{star}")

A: Without access to the original Circled White Star symbol, unicode may be useful
star = '\u272A'
with open('test.txt', 'w', encoding="UTF-8") as f:
    f.write(star)


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You need a box of scraps, any size scraps will do, I used pieces as small as 1in.
Take 2 pieces and sew the straight sides together. Choose the next pieces and chain sew them.
With a long scrap on the bottom, sew one scrap, then another until you run out of the bottom piece.
You don't have to sew squares pieces, just make sure the edges are straight.
Use any left-over pieced blocks you have, it adds interest.
When you've had enough sewing, cut the chain of pieces apart and press them.
Trim the pieces on both side, at this stage it does not have to be square, the different angles add interest.
Take the trimmed pieces and sew some to more scraps and some to each other.
When you've had enough of sewing, press and trim as before. Try not to trim right next to a seam, leaving it in your working piece, if this happens, take a little more off. This will make it easier to join and press the next piece. Repeat this 2 or 3 more times until the fabric pieces have grown to at least 6" on each side.
Square the pieces up to the nearest ¼", and sew together in pairs of the closest size.
Press and trim square. Repeat until the fabric piece is the size you want. If it's getting too big to handle, decide on a width of fabric you can deal with, for me it was 16", then cut all the pieces to this width. Any trimmings large enough to handle can be joined together again to make a piece this width. I then joined all the widths together in one long strip and cut into lengths to quilt.


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