There is only one 192.168.1.1

My parents' laptop was marooned in one room of their house, chained by a wired connection to the DSL modem. I decided that adding a wireless router (Linksys WRT160N in this case) would be great to untether the machine. I expected the installation to be limited to daisy-chaining the new router between the DSL modem and the laptop, setting up a few things (admin password, SSID, wireless security and band options) and enjoying wireless connection in 5 minutes. And to do it all from 400 miles away. Piece of cake!

This could be a long blog post because my projected 5 minutes rapidly expanded into 5 hours, but I'll keep it short. Trouble manifested itself when after several failed attempts we reverted to old wired setup (new router not connected) and I noticed the laptop reporting being connected to a gateway at 192.168.1.1 - weird! Did I mention that the laptop runs Vista and I wanted to mock around with it as little as possible? So why would a DSL modem be at 192.168.1.1??? As usual, an extended Googling session brought clarity to this murky issue. Verizon's DSL modem - Westell 6100F in our case - turns out to be a router/modem combo! This box was acting as a router and the modem, and when new Linksys entered the picture, we had two devices - both routers! - competing for 192.168.1.1 address. No wonder things weren't working right.

I found excellent instructions on how to turn Westell's router functionality off, placing it in "bridged" mode, and effectively making it into dumb modem. Scary thoughts crossed my mind; "bridging" sounded eerily similar to "bricking," and being 400 miles away, last thing I wanted was a bricked Verizon's box! Nonetheless, after some deep breathing, we carried out the instructions. A few tense moments ensued when Westell in its new bridged mode was not connecting to the Internet. Turns out my parents particular flavor of Verizon's DSL uses PPPoE and newly dumbed-down Westell was no longer providing the necessary authentication information. Luckily, at this point configuration of Linksys proceeded smoothly and it was all too happy to take over the necessary PPPoE duties and we were online in no time.

Moral of the story? There can be only one 192.168.1.1! One for each private network, that is.

Raw Burgers and Future of Clinical Decision Making: A Ramble

The inspiration for this post was the final episode of "The Next Iron Chef". I was definitely psyched to see Jose Garces win. There was a moment in the show when the other finalist, Chef Mehta, served the judges a dish featuring a pork burger, and they commented that the pork was undercooked or even raw. This got me thinking - here are highly trained professionals, experienced practitioners of the art of cooking, and they are making such basic mistakes? In this day and age of advanced technologies, can't we come up with some gizmo to stick inside that burger patty, take its temperature and figure out - definitively - its state of doneness? Why rely on these rules of thumb (or rather the thenar eminence) - pun intended - by touching the meat to gauge whether it will still moo when I cut into it? Why am I talking about this? Well, think intravenous lines placement by highly trained professionals, experienced practitioners of the art of medicine. How are these lines placed? Essentially, by blindly poking around until you find the right blood vessel! Why not use the fancy technology? There are portable ultrasound thingies that help to visualize the needle and the vessel. Yes, they are far from perfect, but nothing new will be developed unless there is a demand for it, and there will be no demand until we stop thinking that relying on technology somehow makes doctors less cool.

Of course, same goes for information technologies. In his blog entry "Health IT: What’s the Future?" Steve Downs of Robert Wood Johnson Foundation recaps themes from a recent "Discovery and Innovation in Health IT" workshop. One presenter focused "on the need for cognitive support, showing a hockey stick graph of the number of facts that will be relevant to a given clinical decision over time (this theme reappeared several times over the two days). The number is expected to reach 1000 by 2020, while the number of facts that a human can contemplate while making a decision remains stuck at um, five." Healthcare practitioners need clinical decision support (CDS). I am surprised that such a statement could still be considered controversial...

Just like those ultrasound vein visualizing gizmos, CDS technologies are far from perfect. Thus far the CDS efforts are targeted at individual systems. The challenges are to figure out how to get/represent/manage/update/share clinical care guidelines logic that drives CDS recommendations, how to surface these recommendations to clinicians at the right place and time in a workflow-aware fashion so that they do not dismiss them outright, how to make these recommendations "actionable" to facilitate carrying out an order should a clinician decide to follow a recommendation. Necessarily, these efforts are hard - if not impossible - to generalize. These systems tend to be tightly bound to their initial implementation environments and are therefore non-interoperable in any meaningful way.

Ken Mandl and Zak Kohane proposed an idea of a plugin-friendly platform instead of a typical monolithic EHR. For this to work, the underlying clinical data must be handled in a way that abstracts it from individual applications. Alternatively, leave your monolithic applications alone and pool your data into a near-real-time repository that is application-agnostic. Ether way, if data can be separated from applications (how's that for a radical idea?), there is hope for the kind of interoperability that would result in scalable CDS. Automated processes are needed to abstract and represent domain knowledge encoded in clinical guidelines so that it can be machine-processable (consider baby-steps like HQMF); and it will probably take a miracle to figure out how to deliver CDS recommendations to practicing clinicians in such a way that they are useful. But despite these challenges, if the right incentives are in place to ensure a healthy demand for CDS technologies, we will see progress. The end-goal is the realization of the potential of healthcare IT - safe, appropriate, timely, high-quality care.

Newton MessagePad 2100 is back

Apple Newton MessagePad 2100
Originally uploaded by matveyp

No, Apple is not resurrecting the Newton, but my very own Newton MessagePad 2100 is making a comeback. It is running an NPDS webserver software and is available online! Come visit and leave a note on my Whiteboard if you'd like.

I owned this Newton since 1997 and early in its life it served as my primary computer - I did my wordprocessing, printing, e-mail, Telnet, etc. on this machine and it was fantastic. Since about 2002 I tried on and off to keep it up and running as a webserver. You can learn more about its setup when you visit. In short, the Newton is connected to my home network via Ethernet by way of a PCMCIA card.

What is different this time around? First, I did not want to rely on pre-MacOS X operating system (namely System 9) to connect to the Newton for synchronization, software uploads and backups. But I ran into a catch-22: Newton connection tools (NCX) available for MacOS X require a piece of software to be installed on the Newton. My solution was to fire up Classic mode on my old and trusty PowerBook G4, download and install original Apple's Newton Connection Utility, and use that to install the required package on the Newton. That worked flawlessly. And now I can connect to my Newton right from my MacBook Pro!

I also needed to take care of what is known as the Y2010 bug - read more about it here.

Lastly, I wanted to make sure that Newton's clock is accurate. For that I ended up using NewtSync.

There is a community of Newton enthusiasts who continue to use this incredible machine to do wonderful things. For example, this tracker shows which Newtons are online at any given moment. I am grateful to folks who continue to work on maintaining existing capabilities and developing new ones. I hope that by keeping my Newton online I am participating in some small measure in ensuring that innovations represented by this platform are recognized and appreciated.

Image files to PowerPoint slides Automatically

Imagine that you (a Mac user, of course) have a bunch of image files (say, screenshots) that you need to get into a PowerPoint presentation. How do you do it? Well, in PowerPoint you would create a new slide, go under Insert menu, pick "Picture…", in the subsequent dialog box navigate to where your image files are, pick one, hit "Insert" and then repeat the process as many times are there images to include. The question is - aren't computers supposed to make your life easier??? I encounter this scenario quite frequently, and so I figured that investing a bit of time into trying to figure out how to do this right was worth it. The solution is based on Apple Automator and uses Snow Leopard revamped Services (if you are not using Snow Leopard, this is still imminently doable with Automator). Here we go.

Launch Automator and choose "Service" on initial prompt

Set the selectors in the upper right gray bar as shown on below

Find the poorly named but highly useful "Create PowerPoint Picture Slide Shows" action and drag it in:

File > Save

I named my service "Add to PowerPoint Presentation"

You're done!

To test, select some image files in Finder, then go Finder > Services > Add to PowerPoint Presentation. Viola!

Next time you find yourself with a heap of images that need to go into PowerPoint (or any other repetitive kind of task), right when your mind starts to get numb just imagining what you are about to start doing, ask yourself - won't it be better to have my computer do this for me? Then take a little time, figure out a cool solution, and write about it so I can find it!

Paste unformatted text in Word 2008 for Mac via keyboard shortcut

I often need to paste text into Word 2008 for Mac but frequently need to make sure the formatting does not clash with existing document. The only way Word lets you do it is to go Edit > Paste Special… then manually select Unformatted Text and hit OK. Way, way too many steps and keyboard/mouse switches for a simple and frequently used action. Ideally I want to accomplish this with a keyboard shortcut. Older versions of MS Office for Mac supported VB scripting, and there was an easy native solution; as you know, Office 2008 dropped that support. So people who know turned to Apple Script. And I turned to Google to find those people… The solution:

In AppleScript Editor, open a new document and paste this in:

try
set theClip to Unicode text of (the clipboard as record)
tell application 'Microsoft Word' to tell selection to type text text theClip
end try

Save as Script; name it "Paste Plain Text\omV.scpt" and place it into ~/Documents/Microsoft User Data/Word Script Menu Items

Now, when you need to paste unformatted text, hit Option+Command+V and - viola! - magic happens.

Enjoy!

Minute Clinic

Minute Clinic at CVS rules! I went in today for a flu shot and was very pleasantly surprised. Actually, it reminded me of my visit to another Minute Clinic location 2 years ago - I also went in for a flu shot and also walked out smiling and surprised at how nice and effortless and well thought-out the entire process was. It's an experience that is entirely different from all other healthcare-related interactions you would typically deal with. Little to no wait. Smiling, likable, nice personnel. In-and-out - exactly how I like my interactions with healthcare system to be, if I must interact with it. Also, on the geeky side - their IT is very impressively done. You register at a kiosk outside - touch-screen PC with good (not excellent, but good) interface walks you through a few screens of demographics and typical questionnaire about your allergies, etc. Quick and painless. There's a question about whether you like to get access to your records and you need to provide your e-mail address if that is what you want. One I got home, there was an e-mail waiting with instructions to click on a link to verify my identity. Another nice touch - I had to enter a code found on my paper visit receipt which I was given upon leaving the clinic - this way the system was able to not only verify my ownership of the e-mail, but also verify my identify, but in a completely unobtrusive and seamless way! Once I completed the simple registration process online, I saw the records from both of my visits to Minute Clinic - complete with all information, even including vaccine lot numbers! In addition, there were two buttons - one for exporting my records into Google Health and another for Microsoft HealthVault. As easy as clicking a button - literally! Pleasant, simple, transparent - overall two thumbs up. If only they had H1N1 vaccine there...

Russification of Macintosh

My venerable Russification of Macintosh site has not been updated in a while, mostly due to the fact that the free hosting provider has been ignoring my pleas to restore access to the files. There've been some recent developments and I wanted to make sure that my fellow Russian-speaking computer users have uninterrupted access to the wisdom and goodness that is the Russian phonetic keyboard layout. Hence this update in my blog.

If you are a Mac user, things have gotten substantially easier since I originally started providing information about getting your Mac to "type" in Russian. Macs come with all the necessary pieces in place - fonts, keyboard layouts, applications that are ready to deal with Cyrillic alphabets right out of the box. One crucial thing is still missing, however - if you are not familiar with key layout in a standard Russian typewriter, you will find it difficult to use Apple-supplied Russian keyboard layouts. This is where my phonetic keyboard layout comes in - it makes it to super-easy to type in Russian because majority of letters are arranged in such a way as to correspond phonetically with latin keys on your keyboard. Here's what my keyboard layout looks like:

There are two things that prompted me to make this update in my blog - first, keyboard layout files are no longer available for download from the original website; and second - MacOS X 10.6 "Snow Leopard" finally did away with old way of specifying keyboard layouts in favor of newfangled XML-based files. I made a quick version of my layout in the new format and have been testing it for a while; it is now ready for wider audience.

Dear users, please enjoy!

Keyboard Layout for MacOS X 10.6 "Snow Leopard" and above

Download this file: ruskbd106.zip

Unzip it by double-clicking on it

Place contents into either /Library/Keyboard Layouts or ~/Library/Keyboards folder

Go to System Preferences -> Language & Text -> Input Sources tab and enable the new layout - it is called "Russification"

Log out and log back in

Switch to this layout to type in Russian; switch back to your default layout when you're done

Option key accesses certain letters not present in regular layout

Apostrophe is in the upper left instead of "~" (tilde) key - this feature is unique in Snow Leopard version

If you use this layout, consider making a donation to support availability and continued development!

Keyboard Layout for MacOS X 10.2 "Jaguar" to 10.5 "Leopard"

Download this file: ruskbdx2.zip

Unzip it by double-clicking on it

Place contents into either /Library/Keyboard Layouts or ~/Library/Keyboards folder

Log out and log back in

Go to System Preferences -> International -> Input Menu tab and enable the new layouts (you truly need only one - "Русская - AppleStd")

CapsLock toggles between Latin and Cyrillic layout:

• CapsLock up -> Latin
• CapsLock down -> Cyrillic

Shift key functions normally in both configurations, producing capital letters.

Option key accesses certain letters not present in regular layout

If you use this layout, consider making a donation to support availability and continued development!

Keyboard Layout for Windows

Now you can have the same easy-to-use phonetic keyboard layout you came to trust on your Mac when using Windows. I understand that you would rather be using your Mac, but sometimes we simply have no control over these things. So while you have to put up with Windows, at least you do not have to put up with a typewriter-style keyboard layout!

Should be compatible with Windows 2000 and XP (limited testing performed on XP only)

Instructions

Download this file: RU-MBP.zip

Unzip

Double-click "RU-MBP" to install

Configure XP

Start->Settings->Control Panel->Regional and Language

Languages Tab, in "Text services and input languages," click

"Details..."

Under "Installed services," click "Add..."

Under "Input language:" select Russian

Check "Keyboard layout/IME:"

Choose "Russian Phonetic Student Keyboard Layout," click "OK"

There are now 2 Russian keyboard layouts; remove the one named "Russian"

One the same window under "Preferences" click "Language Bar..."

Check "Show the Language bar on the desktop" and click "OK"

A few more "OK" to dismiss the remaining windows

Now, use Left Alt + Shift to activate the new layout you just installed!

If you use this layout, consider making a donation to support availability and continued development!

What's the difference between a "disc" and a "disk?"

Did you ever wonder about the difference between a "disc" and a "disk?" Find out by reading a recent Apple's KnowledgeBase article.

Create custom keyboard layouts with Ukelele | MacFixIt - CNET Reviews

MacFixIt has a writeup on using Ukelele utility to create your own keyboard layouts for the Mac: Create custom keyboard layouts with Ukelele | MacFixIt - CNET Reviews

Configure built-in VPN client in Snow Leopard

MacOS X 10.6 Snow Leopard comes with built-in VPN client. Snow Leopard did break my Cisco VPN client, so learning how to set up the native client makes me very happy. Steps are:

• System Preferences > Network
• Click "+" and pick "VPN" under Interface
• Choose "Cisco IPSec" as VPN Type
• Enter a name of your choosing as Service Name
• Click "Create"
• Server Address - value of Host from your .pcf file
• Account name - your user name
• Password - leave blank and you will be prompted upon establishing a connection
• click Authentication Settings
• Shared Secret - either value of GroupPwd from .pcf file; if blank, take value of enc_GroupPwd and decrypt it at http://www.unix-ag.uni-kl.de/~massar/bin/cisco-decode
• Group Name - value of GroupName from .pcf file

Upgrading to Snow Leopard

Despite the warning of incompatibilities with software I use at work (see below), I went ahead with Snow Leopard upgrade. Picked up the install disk at Harvard Technology Services, hoping to save on sales tax. No such luck, but even at a bit over $30, I was a happy camper and looking forward to playing with the new OS.

The install went very smoothly and took under 1 hour. I recommend looking under "Customize" and at the very least choosing to add Rosetta - I understand Apple's desire to forget the PowerPC legacy as soon as possible, but chances are, you still have some old apps that require Rosetta. If you don't install it, you can always add it later.

First order of business - Juniper's VPN over SSL issues. As others described, I did the following:

sudo chmod 755 /usr/local/juniper/nc/[version number]/

sudo mkdir /Applications/Network\ Connect.app/Contents/Frameworks

and that did the trick - my VPN over SSL is functional and I can connect to a PC in my office using RDC any time I want.

Growl - as expected, not compatible. Got the beta - it is indispensable. Of course, it still does not work with Mail (so I am back to my AppleScript-based hack) nor does it work with growliChat (replaced that with Chax alpha). Growl's system-wide notifications are brilliant and once you start using them, you'll be hooked.

iStat menus failed to load - turned out I had an old version. I love how tasteful and unobtrusive theythose menus are, and came to rely on CPU load and temperature and network load indicators. New version is compatible and runs great.

Highly anticipated feature - automatic text replacement. I type "THanks" and it magically converts to "Thanks" - in my opinion, that is what computers are for!!! I know that Microsoft products already do that, and there are commercial programs, but having such feature be a part of the OS makes all the sense in the world. So add your desired replacements in System Preferences > Language and Text > Text and then go to Mail (or other apps, I guess), right-click in the body of a new message and choose Substitutions > Text Replacement. You are good to go!

Major issue of the day - freezing Address Book and Mail applications. Very disturbing, as you can imagine. Lots of Force Quits, restarts, etc. to no avail. More Googling and - bingo! - the problem is with a Smart Group I had in my Address Book which used a negation in one antecedents. Solution was inspired by this post - sort your /Users/user_name/Library/Application Support/AddressBook/Metadata folder by Kind and look for "Smart" something or other. I then used QuickLook to figure out which Smart Group the file was for and trashed the offending ones. Problem was solved!!! Belatedly, saw a mention of it in more visible places... Apple definitely needs to fix this one soon.

And now - the pièce de résistance - enabling Exchange 2007 integration. I was very pleasantly surprised by how easy it was - even easier then iPhone! I put in my e-mail address and a password and my Mac figured that it was an Exchange account, set up Mail and downloaded all my mail, set up iCal and populated a new calendar, and set up Address Book. Everything happened extremely fast and with no hiccups. I immediately proceeded to drag Entourage off my Dock and hope not to have to use it ever again. Looking forward to trying Mail/iCal/Address Book combo as the only destination for all my "personal information managment" needs.

To wrap up, Snow Leopard looks good and my Mac feels pretty snappy running it. Clearly not without issues, but worth the upgrade anyway, in my opinion.

Is your network fast enough? | Business Center | Working Mac | Macworld

This is something I am certainly going to try: Is your network fast enough?

My Photo in Schmap Boston Guide

A picture I took with my iPhone and uploaded to Flickr was chosen to be included in a 2009 edition of "Schmap Boston Guide." The picture was taken in Boston Common and shows the gilded dome of the state capitol - the Massachusetts State House - over the green foliage of the park. Here it is on the pages of the Schmap Guide: Boston - Historical Background.

Acton is great

Acton, MA is #16 on Money Magazine's "Best Places to Live" in 2009:

http://money.cnn.com/magazines/moneymag/bplive/2009/snapshots/CS2500380.html

http://www.wickedlocal.com/acton/news/x540127961/Acton-16th-in-country-on-Best-Places-to-Live-list

Cool!

Safari Microformats plugin | Download

New version of Safari Microformats plugin is compatible with latest release of Safari version 4.

Growl Beta

Growl Beta 1.1.5 b1 is available and it fixes the Mail.app + Safari 4 beta crash

Front Row plugin launches Boxee

So you have your Mac hooked up to your TV and you have Boxee installed. How do you launch it - with a keyboard or a mouse? That is so old-school! Install this - Front Row Boxee - and wielding your Apple remote go to Front Row. Behold - launch Boxee from Front Row - no getting from sofa required!

Social networking meets home appliances

I am a fan of "This Old House" and on a recent show they were talking about the latest trend in hot water heaters - tankless water heater. They are apparently very popular in Europe and are making inroads here. The idea is that instead of heating water and storing it in a tank, you install a high-capacity heater "inline" and it runs on-demand only. Supposedly, you can have 3 showers running at the same time and it will meet the demand. Sounds very cool. But that's not all - and this gets even more fascinating. When you open the faucet, the heater senses the pressure change and comes on, but you have to wait until all the cold water that is sitting between the heater and your faucet runs out before you get the hot water. No big deal, the same thing happens in system with tanks. But with this system, it can be addressed! Imagine installing a recirculating pump between the tankless heater and the faucets. It can draw that cold water and pre-heat it. he question is - when do you turn on the recirc pump? Why, put a motion detector in the bathroom, of course!!! It sees you come in, assumes (rightly so in most cases) that you will be needing some hot water, and turns on the recirc pump. That, in turn, gets the water heater going and when you open a faucet in a little while - viola! - hot water.

Why am I so excited about it besides the fact that it is simply cool? Well, a few years back I would say that it is an example of a context-aware system. It can perform a function based on an generic input (no motion detector or demand from a faucet without an associated sensor), but it can also perform that function based on some specific information - a person walked into a restroom. Obviously, the range of contextual information can increase and so can the usefulness and efficiency of the system.

These days, this invokes a social networking analogy. Imagine that the motion sensor is Tweeting about your presence. Or better yet, imagine that this sensor is just one element in a larger network of devices that are gathering the stream of information you generate as you interact with your real as well as virtual environment! And this information can be consumed as a feed by your friends, by various devices around you, and processed to find interesting related streams generated by others, and so on...

The cool tankless water heater plus a recirc pump setup is a good illustration of an entire ecosystem of "social" interactions, real and virtual.

Safari 4 beta

Update: Safari 4 compatible microformats plugin is now available

---

Safari 4 beta came out with a stunning new feature - Top Sites. I went from relying on a personal "hotlist" of frequently visited sites back when tabbed browsing was not invented yet to keeping multiple tabs open via Safari's ability to launch an entire folder of bookmarks at once. Top Sites is a much improved - and visually appealing - of achieving the same goal. I am definitely a fan. And I am not even talking about significantly improved performance, especially when it comes to JavaScript.

This beta did break a few things - in my case, microformats plugin is not working and Mail.app + Growl was causing crashing - went back to AppleScript solution which was used prior to Growl 1.1.4

One thing the new beta omitted is a loading indicator progress bar. Here's a way to bring it back: macosxhints.com - View a pie-chart-style progress indicator in Safari 4 Beta

ICD-10 by 2013

HHS today approved a final rule specifying that ICD-10 is to adopted in the USA by October 1, 2013.

ICD-9 in use currently was published by WHO in 1977. The work on ICD-10 was completed in 1992 and it was quickly adopted by many countries around the world. By the time ICD-10 is adopted in the States (no surprises if it will be delayed, I am sure), the new version will be out (draft of ICD-11 is expected in 2010).

Transition to ICD-10 will be a major challenge for entire healthcare establishment in this country.

Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions

National Research Council, part of our National Academies of Science, released the report of a committee chaired by Bill Stead of Vanderbilt University. The report addresses healthcare IT from the policy perspective. Below is the author's summary of the report:

Two key statements:

• page S-2: “current efforts aimed at the nationwide deployment of HCIT will not be sufficient to achieve the vision of 21^st century health care, and may even set back the cause…”
• page S-8:  “… government institutions—especially the federal government—should explicitly embrace measurable health care quality improvement as the driving rationale for its health care IT adoption efforts, and should shun programs that focus on promoting adoption of specific clinical applications.” 

 

Observations & reasoning behind the statements:

• page 1-5:   “Many health care institutions, especially large ones, do spend considerable money on IT, but the IT is implemented in ways that make even small improvements hard to introduce.  Even across the systems within an institution, interoperability is often awkward and slow.  Information exchange with the information systems of other institutions is rare.” 
• page S-3:  “IT applications appear designed largely to automate tasks or business processes.  They are often designed in ways that simply mimic existing paper-based forms and provide little support for the cognitive tasks of clinicians or the workflow of the people who must actually use the system.  Moreover, these applications do not take advantage of human-computer interaction principles, leading to poor designs that can increase the chance of error, add to rather than reduce work, and compound the frustrations of doing required tasks. …”
• page S-4:  “Health care IT was rarely used to provide clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research.  Health care IT rarely provided an integrative view of patient data.”
• page 3-2:  “Care providers spent a great deal of time in electronically documenting what they did for patients, but these providers often said they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care.”
• page S-2:  “Success … will require greater emphasis on providing cognitive support for health care providers and for patients/family caregivers … which refers to computer-based tools and systems that offer clinicians and patients assistance for thinking about and solving problems related to specific instances of health care.”
• page 3-3:  “The majority of today’s health care IT is designed to support automation, with some investment in supporting connectivity, and little in support of decision support or data mining.   Yet the IOM’s vision for 21^st century health care expects health care IT capable of supporting cognitive activities and a learning health care system.  These activities are much more about connectivity, decision support and data mining than they are about automation.  The health care IT investment portfolio must be re-balanced to address this mismatch.”
• page S-8:  “In focusing on the goal to be achieved, namely better and/or less expensive health care, clinicians and other providers will appropriately be drawn to IT only if, where, and when it can be shown to enable them to do their jobs more effectively. Blanket promotion of IT adoption where benefits are not clear or are over-sold—especially in a non-infrastructure context—will only waste resources and sour clinicians on the true potential of health care IT.”

 

What health care needs from IT that today’s systems rarely provide (pages S-3 to S-4):

• “Comprehensive data on patients’ conditions, treatments and outcomes;
• Cognitive support for health care professionals and patients to help integrate patient-specific data where possible and account for any uncertainties that remain;
• Cognitive support for health care professionals to help integrate evidence-based practice guidelines and research results into daily practice;
• Instruments and tools that allow clinicians to manage a portfolio of patients and to highlight problems as they arise both for an individual patient and within populations;
• Rapid integration of new instrumentation, biological knowledge, treatment modalities, and so on into a “learning” health care system that encourages early adoption of promising methods but also analyzes all patient experience as experimental data;
• Accommodation of growing heterogeneity of locales for provision of care, including home instrumentation for monitoring and treatment, lifestyle integration, and remote assistance; and
• Empowerment of patients and their families in effective management of health care decisions and their implementation, including personal health records, education about the individual’s conditions and options, and support of timely and focused communication with professional health care providers.”

 

Making progress in the near term:

Page S-5: “Principles for evolutionary change:

• Focus on improvements in care - technology is secondary.
• Seek incremental gain from incremental effort.
• Record available data so that today’s biomedical knowledge can be used to interpret the data to drive care, process improvement, and research. 
• Design for human and organizational factors so that social and institutional processes will not pose barriers to appropriately taking advantage of technology.
• Support the cognitive functions of all caregivers, including health professionals, patients, and their families.”

 

While preparing for the long term:

Page S5:  “Principles for radical change:

• Architect information and workflow systems to accommodate disruptive change.
• Archive data for subsequent re-interpretation, that is, in anticipation of future advances in biomedical knowledge that may change today’s interpretation of data and advances in computer science that may provide new ways extracting meaningful and useful knowledge from existing data stores.
• Seek and develop technologies that identify and eliminate ineffective work processes.
• Seek and develop technologies that clarify the context of data.”

 

And (page S-9) “Encourage interdisciplinary research in three critical areas: (a) organizational systems-level research into the design of health care systems processes and workflow; (b) computable knowledge structures and models for medicine needed to make sense of available patient data including preferences, health behaviors, and so on;  and (c) human-computer interaction in a clinical context.”