New site, new organization

I have not had much time to update this blog recently.  Work has been busy.  I have also been working on a new way of organizing my blogging entries.

One of the things I am doing is migrating off wordpress.com to a hosted wordpress.org instance.  There might be hitches and problems as I get going with this.  As of today, you can see the old postings on health IT or healthcare IT under http://svfruitstand.com/healthit. I hope to add more posts to it soon.

I also have not abandoned commenting on what’s new in IT and trends in social media and software.  Those blogs have been migrated over to http://svfruitstand.com/swblog.

Meaningful Use Challenges – software or process?

Responses continue to roll in after the Dec 30, 2009 final rule proposal from The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).  As expected, there are some positive and some critical comments.  From reading them, one cannot help but wonder what percentage of the challenges raised are due to poorly designed EMR (or EHR) software and what percentage are due to clinical processes that resist change.  I suspect a good portion the problems are due to software.

EMR and EHR software have been in the market for many years, though many have not  delivered on their promises.  In fact, a friend in the business once said the product he sold probably bankrupted a number of medical practices due to problems with the billing and other modules.   Those who have purchased these software and experiencing problems are rightfully concerned that they not only have to spend money to swap out their current EMR, but they may also lose out on the EHR incentive money.

However, from an objective observer and healthcare consumer’s point of view, I believe the Meaningful Use goals are worthy and necessary.  What needs to happen is for the software vendors to respond to the complaints of the purchasing doctors as well as Meaningful Use requirements.  This press release by research firm KLAS points out some of the feature gaps that need to be plugged.

There is indeed a market opportunity for EHR and Health 2.0 tools delivered as SaaS as The Health Care Blog says.  They are more flexible, more integration friendly and less costly to implement (at least from an infrastructure perspective).  Those who have already implemented a clunky and inflexible system, ironically these are probably hospitals and financially endowed practices, can be seen expressing concerns such as “unreasonable threshholds for some meaningful use criteria, including computerized prescription order entry, electronic claim submission and electronic insurance eligibility verification”.

This will continue to be a space to watch, whether you are a technologist or a medical professional.  There is hope yet EHR will learn from consumer web innovations that millions have been using for a number of years.

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Database as a Service – from Force.com to Amazon RDS and SQL Azure

These days, those who are building internet applications have many choices for database.  Traditionally (i.e. up to the last few years), you have the usual commercial and open source solutions such as Oracle, Microsoft SQL Server, MySQL, PostgresSQL to store user and application data.  Usually, these databases run in the company’s own data centers or a co-lo facility managed by AT&T, Verizon or the like.  However, offerings from Force.com (from Salesforce.com), Amazon Web Services and Windows Azure are changing this landscape.  In fact, in some cases, they start to converge despite their differences.

I started thinking about database as a service not because I was building one or looking for a DBaaS solution.  In fact, I was building a full stack internet application based on open source technology.  However, the offering from Force.com was rather intriguing as they claim to offer faster development time, easy to use language and secured infrastructure as this InformationWeek article indicates.

However, when you dig a little deeper, you will find that if you do not want your UI to look like the Salesforce.com form based interface and instead you want a rich interactive user experience, Force.com offers limited options.  The reason is because Force.com only offers a database driven form application UI or a heavy client written in Adobe AIR and Flex.  The former is reminiscent of web application from the late 1990s and the latter requires significant processing power on the client desktop.

Now you may say Force.com supports Java, Ruby and every other language under the sun.  That is indeed true though it is also where Force.com veers from a Platform as a Service provider into a Database as a Service provider.   If you want to use Java, Ruby, PHP or another language to build your application logic and client interface, you essentially have to host that code yourself.  You would be using the Force.com infrastructure for database and maybe stored procedures.  Sure you can host your application code at AWS or even Azure cloud but does it really make sense to have multiple vendors hosting different tiers of your technology stack?  It is tough enough to satisfy your SLA for applications that you run fully in-house.

In short, if you see a need to contract with multiple hosting vendors for the database, application and client technologies, you may well start looking at Force.com, Amazon RDS and SQL Azure as similar solutions.  Each has its strengths and drawbacks.  Here is an article comparing RDS and SQL Azure that you can start with.

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