Wednesday, February 23, 2011

Electronic tablets break down educational barriers in R.I. schools

By Linda Borg

[caption id="" align="alignnone" width="380" caption="Jalixa Ramirez, a seventh grader at the Trinity Academy for the Performing Arts in Providence, uses an iPad to read her essay. The charter school’s 34 students use iPads to write essays, edit videos, practice math skills and e-mail homework. "][/caption]

PROVIDENCE, R.I. — Step into the Trinity Academy for the Performing Arts in South Providence and this is what you see: seventh graders using iPads to write essays, edit videos, practice their multiplication tables and e-mail their homework to teachers.

The iPad and other electronic tablets are quietly revolutionizing the way a handful of Rhode Island schools provide instruction, communicate with students and parents, and evaluate teacher performance.

West Warwick is about to pilot a Windows-based tablet program in two of its elementary schools.

Woonsocket offers dozens of online courses in everything from Mandarin Chinese to bioethics.

Providence is using the iPad to evaluate what teachers are doing in the classroom.

And the Rhode Island Association of School Principals is training educators from 15 public school districts on how to use the iPad in the classroom, in the central office and in special-education settings.

Because Trinity, a first-year middle school charter, only has 34 students and 6 teachers, it can afford to give an iPad to every student. At $500 from the school’s operating budget, the iPad is cheaper than a typical laptop, more portable, and, with its touch screen technology, easy to use.

[caption id="" align="alignnone" width="380" caption="Delaney Jimenez, a seventh-grade student at Trinity Academy for the Performing Arts in Providence, discusses her idea that she illustrated on her iPad as she is timed by fellow student Preston Powell with his iPad. "][/caption]

At Trinity, the iPad has nearly eliminated the need for paperback novels. The school buys one book for $6 and downloads 34 copies. And there are many books in the public domain, such as the entire works of William Shakespeare, available free of charge. The potential for cost savings is considerable.

“When teachers say, ‘Get out your worksheet,’ I’m like, ‘OK,’ ” says 12-year-old Teri Thompson. “When they say, ‘Get out your iPad,’ I’m like, ‘Yes! The iPad!’ ”

“It’s not boring like when you have pen and paper,” says Jalixa Ramirez, another seventh grader. “Plus, it’s much easier to organize your work. You can save everything to a file.”

Sharon Hussey, the executive director of the Rhode Island Network for Educational Technology, calls the iPad a “transformational device” because of the way it allows students and staff to interact with a host of applications, from math games to streaming video.

“Students today are constantly around technology,” says Jennifer Patten, a seventh-grade history teacher. “That’s how they engage. The iPad heightens that engagement. It gives them access to a wealth of information that goes beyond the textbook and it allows them to be critical of what’s out there.”

Last week, students watched the Egyptian revolution develop in real time by watching live blogs and broadcasts from CNN and other media sources. “Students were able to see history unfold in front of them,” says Elizabeth Richards, the artistic director of Trinity, which is dedicated to the performing arts. “And this was a revolution which arguably began online.”

Trinity uses the iPad to foster a constant dialogue between students and teachers. A child can submit a homework assignment and get almost instant feedback. An essay can be revised several times with teacher input before it is submitted for a grade. If a student forgets his homework assignment, he can e-mail his teacher from home.

“It gives students safe, secure, unprecedented access to us,” Richards says.

Trinity has also created a math portal that allows parents to review their child’s homework assignments via the iPad or a personal computer.

Of course, with greater freedom comes greater responsibility.

That’s why Trinity has developed a detailed policy, signed by student and parent, which explains how the iPad can be used. For example, the use of social networking sites is prohibited. Students may only access the Internet through a specific application that filters out inappropriate material. And the iPad must never be left unattended.

“It’s like my baby,” Ramirez says. “I don’t let anyone take it from me.”

“So far,” Richards says, “we have had zero problems with broken iPads, zero problems with stolen iPads and zero problems with serious violations. The kids are rising to that level of responsibility. That’s what we as a school are about.”

Trinity also understands that the new technology is also about having fun. For Christmas, the school bought several game applications, including the wildly popular Angry Birds, for students.

And Trinity is constantly discovering unexpected ways in which technology enriches learning. Richards says that a student e-mailed her about a friend who was in a potentially unsafe situation at home. The school was able to address it immediately.

“The iPad doesn’t make or break what goes on in the classroom,” she says. “You still need dedicated teachers and a quality curriculum. But it’s a huge asset to increase the diversity of content in the classroom. And it puts at students’ fingertips some of the technology that is changing the way the world works.”

Although technology is expensive on any large scale, there is little doubt that school districts large and small are beginning to embrace it.

According to a recent study by Education Week, a national teachers’ magazine, 46 percent of public school districts offer distance learning over the Internet or through video conferencing and 53 percent use online curricula.

But there continues to be a gap between what teachers want and what they get. Although more than 80 percent of teachers surveyed said they would like to use technology in the classroom, 47 percent said that funding for such technology is inadequate.

In the meantime, some districts are harnessing the technology they already have.

In Woonsocket, high school students use videoconferencing to bring authors into the classroom, communicate with other schools, and share data. One day, students piled into the library to watch a surgery performed in real time.

But it is the district’s distance-learning program that has generated the most buzz.

Located in the Woonsocket Area Career & Technical Center, the E-Learning Academy offers 200 electives and 13 advanced-placement courses that students can take on school computers without sitting in class.

What began six years ago as a credit-recovery program has since morphed into a virtual high school that enrolls more than 500 students.

It has saved more than a few students from certain failure, says coordinator Michael Ferry. Last year, a sophomore walked into Ferry’s office and said, “I quit.” After talking with the young man, Ferry realized the student’s biggest problem was getting to school on time.

“Can you make it here for 10 a.m.?” Ferry said. The student said yes.

The student showed up every day and took two courses at a time. He went to summer school.

He kept asking, “Am I a junior yet?” and Ferry kept saying, “Keep taking courses.”

Last spring, he asked the same question. This time, Ferry said, “I’ve got some bad news. You’re not a junior. You’re a senior.”

The young man graduated in June.

“I call them my angels,” Ferry says. “There are 500 stories like this one.”

Not every student is cut out for the traditional high school. Distance learning is perfect for the young mother, the student who is struggling with English or the student who has to work to support his or her family. It also works for the teenager who is “school-phobic,” who can’t deal with 2,000 students and all of the attendant drama.

“Technology offers flexibility in scheduling and the ability to work anytime,” Ferry said. “We would never be able to service these kids face-to-face.”

Working with a company called Nova Net, the high school took the company’s online courses and aligned them with its own curricula. Ferry said that the students taking the online courses receive the same content as those taking the face-to-face classes. The beauty is they can work at their own pace.

Students use this program to make up credits, and Ferry says that 56 students graduated last year thanks to the opportunity. Students can also access the curricula from home.

In Providence, iPads provide a fresh take on the classic “learning walk.” In the past, principals have observed teachers and then scribbled their observations on a long worksheet. The iPad not only makes it much easier to complete the evaluations, it aggregates the data and helps schools identify strengths and weaknesses in each subject.

The observations are not a “gotcha” exercise, however. Rather, they are an attempt to collect feedback from individual classroom visits, collate the data, and spot trends. Are students engaged? Are teachers mixing up different styles of instruction? Does the student know what is being taught and why? Ultimately, the information will be used to give teachers feedback on how to refine instruction.

“It’s important that we look at what we’re doing,” says Lenora Goodwin, an AP environmental-science teacher at Central High School. “I have good days and bad days, but I know that in the end I’m moving my kids along.”

This article was originally posted at

Tuesday, February 22, 2011

Interview with HIMSS CEO Steve Lieber: Mobile is the future

LieberHealth IT is very much in a transition phase right now. The “meaningful use” incentive program for electronic health records is underway, though in its early phases. National health IT coordinator Dr. David Blumenthal is departing government service in April, even as federal officials work to develop regulations for Stage 2 and Stage 3 of meaningful use.

And right at the nexus of all the change is mobile healthcare, according to H. Stephen Lieber, president and CEO of the Healthcare Information and Management Systems Society (HIMSS).

“The laptop is almost becoming a bit outdated as we move to smartphones and tablets,” Lieber said last week in a wide-ranging interview ahead of the organization’s annual conference, now underway in Orlando, Fla. Mobile is the next evolution in information technology, and we’re right on the cusp of the mobile era.

“It’s where we’re headed. It’s the future,” Lieber said. “The ability to deliver care from somewhere else [while] the patient is in still a different place, that very much is where we are headed.”

Lieber did acknowledge that some people are already there. “It’s certainly current for many. It’s the future for all,” he said.

In many ways, HIMSS conference is a new venue for mobile technology. While Sprint CEO Dan Hesse keynoted at HIMSS10 in Atlanta and more than 200 of the 900-plus vendors at HIMSS11 claim to offer mobile applications, mobile is struggling to find the spotlight in this massive event.

As we reported last week, a good portion of the mobile-related content at HIMSS is taking place outside of the regular conference.  Sunday featured a pre-conference RFID symposium, and mobile is central to HIT X.0: Beyond the Edge, a series of sessions on emerging healthcare technologies—including mobile, wireless and social media—that HIMSS really is running as a separate conference with an additional registration fee.

“The objective here is to bring into the HIMSS conference those things that you typically didn’t find prominently,” Lieber said of the X.0 programming. They’ve been there, but might have been hard to find. “You almost had to go looking for them,” he added.

“We want to be bringing into the conference what’s coming or what’s here but hasn’t necessarily been embraced on a widespread basis, as other technologies might,” Lieber explained. “It attracts a very different kind of audience.”

How much so? Of the approximately 900 people who signed up for HIT X.0, more than half had never attended HIMSS before, according to Lieber, likely because they didn’t see enough value in the main conference  to make it worth their while.

“We were successful in reaching out to a different audience, focusing on a different subject and structuring it in such a way that the audience recognizes that this is not typical for HIMSS,” Lieber said.

Lieber did caution against falling victim to unreasonable expectations some may have set for mobile health. “We see it all the time, in terms of hype cycles and booms,” he said.

“People need to be careful as they’re looking at applications and they’re looking at hardware, making sure that it’s designed for the environment,” Lieber cautioned. “The iPad wasn’t really designed for a linoleum floor,” for example. Nor was it designed for hospital-grade sanitizers.

“There’s a lot that happens in the early days [of a technology]—people coming into the field who come from a different sector and think they can just transplant their product or learning to healthcare, and it doesn’t work quite that way,” Lieber added.

One area prone to hype is remote and home monitoring, but Lieber is optimistic about its future. “Home care, that’s an area that still is in its infancy—if it’s even barely in infancy—that’s going to be another transition that we’ll see over the coming years.”

Of course, lack of reimbursement has held back wider adoption of wireless monitoring technologies. HIMSS is not actively lobbying insurers to pay for telehealth services, but the organization historically has been slow in getting into financial and reimbursement issues. “It’s related to what we do, but we’re much closer to the technology, the hardware and software issues,” according to Lieber.

But the time is coming. “What we are starting to see is a recognition by the payers that it’s in their best interest to find the ways to provide the right kind of reimbursement and incentives that help move care to the lower-cost—and oftentimes more-effective—setting,” Lieber said.

Insurers must make sure that they aren’t just paying for a service on top of regular care, though, Lieber said. “They’ve got to figure out how [to] bring that reimbursement scheme in that provides the right incentives that shifts it from a higher per-unit cost to a lower per-unit cost.”

This article was originally posted at

New sensor tags promise to improve compliance, operations

Three new wireless temperature and humidity sensor tags from Ekahau could help with regulatory compliance and improve operations across a number of industries, including healthcare. The Wi-Fi-based RTLS vendor says its new tags deliver an automated way to measure, monitor and manage areas where changes in the environment could be harmful.

Wireless and battery powered, the tags are designed to be easily configured and can be deployed in various environments without having to run cabling for power and connectivity. The tags boast a three-year battery life (when set at a 15-minute reporting interval), and are capable of sampling temperature and/or humidity every 15 seconds. On-board heuristics enable the tag to immediately report anomalies if they occur between reporting intervals, according to a company statement.

Two of the tags—the TS1 and TS2—have extended cable probes that can be installed inside the environment where temperature is being measured, such as a freezer or refrigerator. The TS1 tag has a single probe; the TS2 is a dual-probe tag.

The third—a humidity sensor tag called the HS1—includes on-board sensors that measure relative humidity (RH) ranging up to 100 percent, and temperature ranges of -40 degrees to +85 degrees Celsius (-40 degrees to +185 degrees Fahrenheit).

All three include audible and visual alarm indicators on the tags themselves and allow for programmable alarm limits and local data logging. The upside of continuous data logging is that the measurement data will not be lost even in the event of a network outage.

All of the new sensor tags also incorporate the ability to receive acknowledgments from the Ekahau servers and a smart re-try capability, in case of data transmission failures.

This article was originally posted at

Wednesday, February 16, 2011

Mobile solutions, new tech to play key roles at HIMSS Read more: Mobile solutions, new tech to play key roles at HIMSS

Along with interoperability, mobile solutions and new digital technologies will be among the biggest foci of the upcoming HIMSS conference (Feb. 20-24) in Orlando, Fla. We'll be hosting an executive breakfast on Tuesday, Feb. 22 at the Wyndham Orlando Resort on mHealth's ever evolving role in achieving Meaningful Use. And the health IT fair will showcase new mobile products from RIM, Sprint Nextel, and Siemens, which is teaming up with Enterasys.

NaviNet, which specializes in online communications between physician practices and health plans, will unveil its first set of mobile products since acquiring Prematics last fall. Prematics, which started with e-prescribing software subsidized by health plans, now offers clinical messaging and care management platforms, as well. NaviNet has integrated these patient information capabilities with its own revenue cycle management solution and connections with health insurers.

Health plans will also be represented at HIMSS through recent acquisitions of health information exchange (HIE) vendors. Axolotl, which was purchased by United subsidiary Ingenix, and Medicity, now part of Aetna, both will have a presence. Ingenix also will be touting its acquisitions of Picis, A-Life Medical and Executive Healthcare Records.

Also of interest on the exhibition floor will be the emergence of the "digital pen" technology, which promises to make it easier for physicians to document visits in electronic health records. Shareable Ink, already being used in many emergency departments, is about to announce a deal with a major ambulatory EHR vendor. Anoto, another digital pen firm, describes outpatient EHR vendor NextGen as its partner.

To learn more:
- explore the conference agenda and exhibitor list at the HIMSS website
- read about the Navinet-Prematics solution
This article was originally posted at

Tuesday, February 15, 2011

Administering a Gross Anatomy Exam Using Mobile Technology

By Alireza Jalali, Daniel Trottier, Mariane Tremblay, and Maxwell Hincke

Mobile technology has infiltrated medical school education. Students now bring tablet PCs, rather than notebooks, into the classroom. They can access Web-based curriculum during lectures and add notes directly to their files. At the Faculty of Medicine University of Ottawa the curriculum for the first two years is online, and PDAs have largely replaced reference books for students in clerkship programs. And more telling, employees at Ottawa Hospital Medical have been encouraged to replace pen and paper notes with iPads. Thus, transitioning from written to digital examinations seemed to be a reasonable next step. To assess the benefits and drawbacks of this approach, we developed a mock anatomy examination using the Questionmark software and compared its administration and evaluation on two electronic devices.

At the Faculty of Medicine of the University of Ottawa, gross anatomy is taught during the first two years of medical school. The course is divided into four units: musculoskeletal anatomy; the thorax, head and neck; the abdominal and pelvic cavity; and neuroanatomy. Students attend anatomy lectures and laboratories almost every week. After each unit students take a final laboratory examination, they also take a timed midterm examination. During each examination, students rotate through 20 (midterm exam) or 40 (final exam) stations in the laboratory covering anatomy, pathology, radiology, and a few other disciplines. Students spend two minutes at each station and answer two to four multiple-choice questions (MCQs). MCQs are frequently used in medical schools because they are reliable and allow for rapid marking and prompt feedback to learners (Fowell and Bligh, 1998); also MCQs can be used to examine higher levels of learning (Collins, 2006).

Our goal was to eliminate these paper examinations and move to an online version. As instructors we use guidelines from the National Board of Medical Examiners and the Medical Council of Canada to aid us in constructing our examination questions (Case and Swanson, 2002; Touchie, 2005). Since the students are taught using cadaveric specimens, their examination should also include such specimens. However there are disadvantages: Voluminous amounts of paperwork need to be organized. In proctoring seven examinations a year to 150 students, we use approximately 35,000 pieces of paper. It takes time to prepare the printed examinations, organize the examination stations, and then to carry all of the papers to the laboratory before the examination. It is also time consuming to correct the examinations and communicate results. Besides the issue of sustainability, online evaluation would save administrative time and money in addition to helping us to provide faster feedback to students.

Experimental Procedures

To move from a paper-based examination to an online version, we researched available hardware and software. We decided to use a portable device, which would allow us to continue to use the timed examination, the students would also be able to move easily from one station to another. After a discussion with our medical technology team, we chose two tablets for this study that were light weight and had fast screen reaction time and long battery life: the Lenovo S10-3t running Windows 7 Enterprise and the Apple iPad Wi-Fi 64GB running the iPhone 3.2 OS.

With all the available options, we tested numerous learning applications. Students were already comfortable Questionmark Perception and it was compatible with existing technologies being used at the school. The tool allows the creation of a question bank in different languages, which is very useful for our bilingual university. Also the ability to create 12 types of reports was useful, specifically the coaching report. The student can see detailed information, including the answers and scores for each question, which is used to help coach individuals through their learning curves. Furthermore, Questionmark Perception makes it possible to return to and continue a previously started examination via an auto-save feature. This feature is not Wi-Fi dependent and, therefore, lends itself well to a potentially unstable Internet connection environment and provides confidence for use during a live examination. For all of these reasons, our university purchased a license for Questionmark; eventually all of our written examinations at Faculty of Medicine will be created using the software.

Our data collection method was straight forward; we set up a mock anatomy examination using four stations, each having two MCQs. A student, an IT staff member, and a faculty member, who were all familiar with the paper-based examination, completed the examination first using the iPad, and then using the Lenovo tablet. The volunteers had two minutes at each station. Afterward they were individually questioned about their general impressions of the online examination and their preferences regarding the devices used.


We identified numerous benefits and challenges related to the method. All of the participants liked the idea of an online anatomy examination to replace the paper version. Ease of use and immediate feedback were among the advantages they identified. The two main disadvantages identified were the stress related to not having an examination paper in hand and dependence on a potentially unreliable Internet connection. The participants found that an online examination added to the stress of taking the examination. The participants worried that their responses would not be recorded by the machines and that their answers might not be submitted.


Although the online examinations may help faculty administratively, it will present challenges. Students may be stressed by undergoing a new method of examination and will require suitable orientation. The choice of hardware and software also needs to be considered carefully, as the examination might render differently depending on the selected technology. During our study we discovered depending on the selected online examination tool, an online exam will render differently on the iPad compared with conventional laptops and tablet PCs. This is mostly do to the fact that iPad uses Safari as browser instead of the more widely used Internet Explorer. Consequently achieving the desired look and user experience required modifications to digital files; even our method for organizing the examination was affected. However our preliminary trials established that an iPad and the Questionmark software was a suitable combination to use for a timed, online anatomy examination. This recommendation is in line with the Ottawa Teaching Hospital's decision to use the iPad at the patient bedside for clinical purposes. Our hope is the transition from paper examinations to an online version will save faculty members time, but also improve the evaluation process for students. An electronic exam will also translate into cost savings for the university. Moreover the final licensing examination administered by the Medical Council of Canada is taken on a computer, adopting an online anatomy examination will offer students much needed practice and, it is hoped, better preparation for such professional examinations.


The authors appreciate the continued and enthusiastic support from the University of Ottawa's Faculty of Medicine and Bureau des Affaires Francophones (BAF) with this project.

About the Authors

Alireza Jalali, M.D., is a Francophone professor of anatomy at the Division of Clinical and Functional Anatomy, at the Faculty of Medicine, University of Ottawa, Ottawa, Canada. His research explores the use of technology and more particularly the Web 2.0 tools in medical education.

Daniel Trottier is the manager of the Web, multimedia, learning technologies and IT Systems at the Medical Technology Office at the Faculty of Medicine, University of Ottawa, Ottawa, Canada. His research interest includes the use of new technological tools in medicine.

Mariane Tremblay is a multimedia and learning technologies designer at the Medical Technology Office at the Faculty of Medicine, University of Ottawa, Ottawa, Canada. She is fascinated with the use of new technology in medical education.

Maxwell Hincke, Ph.D., is the Head of the Division of Clinical and Functional Anatomy at Faculty of Medicine, University of Ottawa, Ottawa, Canada. He is very interested in the use of novel technology for teaching anatomy in the medical curriculum.


Case, S.M. and Swanson, D.B. (2002). Constructing Written Test Questions for the Basic and Clinical Sciences. Third Ed. Philadelphia, PA. National Board of Medical Examiners,

Collins, J. (2006). Education techniques for lifelong learning: Writing multiple-choice questions for continuing medical education activities and self-assessment modules. Radiographics 26 (2): 543-551.

Fowell, S.L and Bligh, J.G. (1998). Recent developments in assessing medical students. Postgrad Medical Journal 74 (867):18-24.

Touchie, C. (2005). Guidelines for the Development of Multiple-Choice Questions. First Ed. The Medical Council of Canada, Ottawa, ON,

This article was originally posted at

Education Budget Makes Tough Choices to Allow for New Investments in Early Learning, Reform and Innovation, Teachers and Leaders, and College Completion

Deep cuts and efficiencies in several key education programs will help fund new education investments to keep American students competitive in the global economy under the proposed 2012 Obama administration education budget. The President released the budget at a Baltimore public school on Monday, February 14.

"We are cutting where we can to invest where we must," said Education Secretary Arne Duncan, who joined President Obama for the announcement. "These are challenging times, but we can't delay investments that will secure our future. We must educate our way to a better economy by investing responsibly, advancing reform and demanding results."

Areas for new investment run the spectrum from early learning to college completion, and include funding for formula and competitive K-12 programs, including a new district-level Race to the Top program with a rural set-aside and another round of Investing in Innovation grants. The budget also includes new and expanded programs that support teacher and principal effectiveness.

Not including Pell Grants, the administration's 2012 budget request for the Department of Education is $48.8 billion, an increase of $2 billion or 4.3% over the 2011 budget, which was not approved by Congress and is being funded through continuing resolutions.

The Department expects demand for Pell grants to reach 9.6 million students next year, up from 6 million in 2008. The President's budget protects recent increases in the maximum grant to $5,550 while ensuring that all eligible students continue to be served.

In order to sustain the program in a responsible way, the Administration proposes saving billions by eliminating subsidies for graduate students with loans and eliminating a provision that enables some students to receive two Pell grants in a single year.

"These are very tough choices but with rising demand, we have to stretch our dollars as far as possible and do more with less," Duncan said.

In addition to eliminating 13 programs that will save $147 million next year, the Administration will cut $265 million in career and technical education (CTE) grants. States will still receive $1 billion in CTE grants next year as well as $3.1 billion for Vocational Rehabilitation State Grants and $635 million for Adult Education grants.

"Career education is vitally important to America's future but we need to strengthen and reform our programs before expanding them," Duncan said.

Other highlights of the budget include:

  • $350 million for a new Early Learning Challenge Fund to boost quality or early learning programs.

  • $900 million for a district-level Race to the Top program with a rural set-aside.

  • $300 million for a new round of i3 (Investing in Innovation) grants.

  • $500 million more for Title I (for low-income students) and IDEA (for students with disabilities) formula programs.

  • $150 million for the Promise Neighborhoods program, which integrates educational and social services in targeted communities.

  • $100 million more for after school programs (21st Century Community Learning Centers) for a total of $1.27B.

  • $54 million more ($600 million total) to turn around low-performing schools

  • $4.3 billion for teacher and principal preparation programs. This includes formula grants to states, alternative certification programs, STEM teacher prep programs, funds to support a well-rounded education, minority teacher recruiting programs and scholarships for high-achieving students to work in high-need schools.

  • $175 million in competitive grants to boost college completion.

  • $90 million for a new education research and development program and $60 million more for research and evaluation programs at IES.

"These targeted funding increases reflect the administration's competitiveness agenda and our continuing commitment to protect students most at risk while supporting reform at the state and local level," Duncan said.

In addition to setting aside some new RTT funding for rural districts so they get a fair share of the dollars, Duncan said that the competition would, "Recognize districts leading the way in terms of increasing productivity and raising student achievement."

Additional information on the U.S. Department of Education's FY 2012 budget proposal is available at

This article was originally posted at

Saturday, February 12, 2011

Online learning is making education more efficient and more effective

In his State of the Union address, President Obama urged the United States to out-innovate the rest of the world in order to to remain competitive. And when it comes to innovation, there’s no better place to start than education.

Fortunately, we're already moving in the right direction. Online learning is already being integrated into American education, with more than 3 million K-12 students enrolled in an online course in 2009. And the phenomenon is no longer confined to distance learning. Most of its growth has occurred in blended-learning environments, in which students learn online with adult-supervision.

This trend will continue. The troubled budget picture, coupled with the demand for better results, is forcing school operators to rethink the structure and delivery of education. This, in turn, is accelerating adoption of the blended learning model.

Blended learning has the potential to upend today’s standardized, factory-model school system by enabling personalized learning approaches for all students. Many experts agree that targeting students’ different needs at different times will in turn result in higher achievement.

One example is Carpe Diem, which began as a traditional, state charter school serving 280 students in grades 6 to 12 in Yuma, Arizona. When it lost its building lease eight years ago, the school had to slash its budget and question every assumption about what a “school” should look like.

Today, students at Carpe Diem are using online learning as teachers roam, looking over shoulders and offering instant help whenever a student struggles. Students only progress to the next level or unit once they have demonstrated mastery of the unit on which they are working. The software provides frequent feedback.

Students also spend time in traditional classrooms where teachers re-teach concepts as needed, and enhance and apply the material introduced online.

So far, the personalized learning approach has created a far more productive and affordable school model. Its student population—60 percent of which is on free or reduced-price lunch and 48 percent of which are minorities—is excelling. In 2010, the school ranked first in its county in student performance in math and reading and among the top 10 percent of all Arizona charter schools.

What is keeping America back from having many more Carpe Diems? Mostly ourselves. A host of policies and funding streams dictate to schools their inputs and processes, thwarting creative and innovative arrangements for student learning in the process. Others either restrict the online courses students may access, or tie them to an arbitrary calendar year. These policies should be reformed, and students should advance based on mastery; not the amount of time spent in a classroom.

Other countries are already moving in this direction. America, with its abundant technological resources and entrepreneurs on hand, ought to lead rather than follow.

Michael Horn is Executive Director of Education at Innosight Institute, a nonprofit think tank focused on education and innovation, which released a January 2011 report titled “The rise of K-12 blended learning” in conjunction with the Charter School Growth Fund and Public Impact.

This article was originally posted at

To out-educate, we must out-innovate

In his State of the Union address, President Obama urged the country to out-innovate the rest of the world. If we want to bolster America’s competitiveness now and for the future, there’s no better place to start than education, where Obama also said we need to out-educate the rest of the world.

Fortunately, we are well on our way. Online learning is sweeping across America, as more than 3 million K-12 students took an online course in 2009. And it is no longer just a distance-learning phenomenon. Most of the growth in online learning is occurring in blended-learning environments, in which students learn online in an adult-supervised environment.

This trend will continue. The troubled budget picture, amidst the demand for better results, is accelerating the adoption of blended learning by forcing school operators to rethink the structure and delivery of education.

Blended learning has the potential to upend today’s factory-model school system, which standardizes the way it teaches and tests, and instead enable personalized learning approaches for all students. Many experts agree that targeting students’ different learning needs at different times will in turn result in higher achievement as each student can realize his or her full human potential.

A research report Innosight Institute released recently reveals several proof points. One is Carpe Diem, which began as a traditional, state charter school serving 280 students in grades 6 to 12 in Yuma, Ariz. But when it lost its building lease eight years ago, the school had to slash its budget and question every assumption about what a “school” should look like. It turned to blended learning.

The results are strong. Carpe Diem developed a far more productive and affordable school model that personalizes learning for each student. Its student population—60 percent of which is on free or reduced-price lunch and 48 percent of which are minorities—excels. In 2010, the school ranked first in its county in student performance in math and reading and ranked among the top 10 percent of all Arizona charter schools.

As students learn online at Carpe Diem, teachers roam around offering instant help whenever a student struggles. The software provides frequent feedback. And students only progress to the next level or unit once they have demonstrated mastery of the unit on which they are working.

Students also spend time in traditional classrooms where they work with a teacher who re-teaches concepts as needed and enhances and applies the material introduced online.

What is keeping America back from having many more Carpe Diems? Mostly ourselves. Policy barriers stand in the way of allowing blended learning to truly be transformational.

A host of policies and funding streams dictate to schools what their inputs and processes must be and look like. In other words, they make it difficult for schools to adopt creative and innovative arrangements for student learning. Others restrict the online courses students may access regardless of how high quality they might be. And still more tie students to an arbitrary calendar year.

Real transformation would allow students to progress based on mastery rather than the amount of time they sat in a classroom. Of course in exchange for this increased autonomy that escapes these input-focused rules, schools and programs must sign up for higher accountability measures around individual student outcomes so that we’re not merely adopting new arrangements and technologies for their own sake, but instead doing so to improve the lives of our students in measurable ways.

Other countries are already moving in this direction. With America’s abundant technological resources and entrepreneurs on hand, we ought to lead them there rather than follow.

A modified version of this post appeared originally at The Economist’s The Ideas Economy blog here.

This article was originally posted at

Friday, February 11, 2011

Dragon Medical is Compatible with Most EMR Systems Today

Customers call just about every day to see if Dragon Medical will work with the EMR purchase they are considering. That's pretty amazing.

Our experience has shown that medical providers want to ensure Dragon Medical will work before buying an EMR. This information is crucial, because doctors that have tried the latest Dragon Medical or spoken to other practices that have, know one thing to be true.

Speech-to-text; is the fastest way to capture the narrative sections within EMR systems.

Voice Automated has been working with Dragon Medical since the day it was first released. Our sales staff, trainers and integrators, know how to best utilize Dragon Medical with your EMR.

Just in case you wanted to know, Dragon Medical already works with the EMR systems listed below:

  • EMR

  • ABELMed EHR - EMR / PM

  • Abraxas EMR

  • Accel™

  • AdvantaChart™

  • Agastha Medical Records (EMR)

  • AllMeds EMR

  • Amazing Charts

  • ARIA™ Oncology Information System

  • BETTERHEALTH record™

  • Centricity®

  • ChartCare EMR

  • ChartEvolve

  • ChartLogic EMR

  • ChartMaker®

  • ChartWare®

  • Clinical Navigator

  • CureMD PRS®


  • DC Talk™

  • digiChart®

  • Doc-U-Chart ®

  • DoctorAssistant By

  • Doctors Choice EMR™ & Nurses Choice EMR™

  • DocuMed®

  • e-MDs Solution Series

  • e-Medsys™ Electronic Health Record

  • E-Record EMR

  • eClinicalWorks

  • EDIM

  • Electronic Patient Charts

  • eMedRec

  • EmpowER System™


  • emr4MD

  • EMRWorks™

  • EndoSoft®

  • EpicCare Ambulatory EMR

  • Epitomax®

  • Evolution EMR™

  • EyeDoc® EMR

  • EZChart™

  • FreeMED

  • gCare™

  • GlaceEMR™

  • gloEMR

  • Harmony e/Notes EMR

  • HealthPort EMR V9.0

  • Health Probe Professional

  • Horizon Ambulatory Care™

  • iAchieve EHR

  • iDocLocker

  • InSync

  • InteliDOX®

  • Intelligent Medical Software

  • IO Practiceware

  • Janus Health

  • Life Record™ EMR

  • MD-Journal

  • MD-Navigator Clinical®

  • MD Advantage™

  • MDAware® 2.2

  • MDLAND Electronic Health Record and Practice Management Systems 8.0

  • MED3000 InteGreat EHR

  • Medamation™ MD

  • MedAppz iSuite

  • Medflow EMR

  • Medi-EMR

  • Medical and Practice Management (MPM)


  • Medical Practice Solutions

  • MedicsDocAssistant™

  • Medios EHR

  • Medscribbler™

  • MicroMD® EMR

  • MindLinc

  • EHR

  • NetPractice EHR

  • Nightingale On-Demand

  • OfficeEMR™ 2008

  • OmniMD™ EMR

  • OncoEMR


  • Patient Chart Manager

  • PBOmd

  • PeakPractice™

  • PerfectMed™ EHR

  • Phoenix Ortho

  • Physician Practice Documentation (PPD)

  • Power Chart

  • PowerSoftMD

  • Practical Medical Record™

  • Practice 2009

  • PracticeOrders

  • Practice Partner®

  • PracticeStudio.NET®

  • Practice Today


  • PrimeSuite® 2008

  • PrognoCIS™

  • ProgNote/MobileLink

  • Pronto

  • PsychNotesEMR

  • Pulse Patient Relationship Management (Pulse PRM)

  • Quick Notes EMR

  • Raintree

  • Rosch EMR-Allergy

  • SamNotes2000

  • ScriptSure

  • SmartEMR

  • SOAPware®


  • Team Chart Concept

  • TexTalk Medical

  • The AMCIS Network By

  • The Chart!

  • Touch ED®

  • TransMed

  • Turbo-Doc EMR

  • Unifi-Med™

  • UroChart™ EMR

  • Valant EMR

  • VersaSuite 7.5

  • Visionary™ DREAM EHR 7.1

  • Waiting Room Solutions Practice Management System

  • WebChartEHR

  • Webchart EMR and MIE™ Minimally Invasive™ EMR

  • Wellsoft EDIS

  • workflowEHR™

  • WriteMD®

  • WritePad™ EMR Systems


This article was originally posted at

Tuesday, February 8, 2011

Alternative Reality Games (ARGs) as Mobile Learning

It was not that long ago that “game” was considered a four-letter word in corporate learning environments. But in recent years, the idea of using games as a way to enhance learning has started to become more widely accepted. Conferences such as the eLearning Guild’s DevLearn even have specific tracks dedicated to developing games specifically as a way of training and performance improvement. This month’s issue of the Float Mobile Learning newsletter focuses on a specific type of game that is well suited for learning on mobile devices, the Alternative Reality Game.

Overview of Alternate Reality Games

An alternate reality game, or ARG for short, (pronounced by saying the letters ‘A-R-G’, not by sounding like a pirate) is an interactive narrative that uses the real world as a stage for telling a story, playing out a scenario or creating a learning experience. ARGs make use of diverse media and game elements to help tell and impact the outcome of the story. In an ARG, participants are presented with clues in an effort to solve puzzles and make informed decisions in the game’s unfolding narrative. These clues can be located in different places from physical locations (such as a library, school, office building or grocery store) to media such as websites, recorded telephone messages, videos or images. In many ARGs the story evolves as the organizers stay one step ahead of the participants, changing the direction of the game based on the response and reaction of those playing. Because ARGs link a fictional story to real world object and places, mobile devices are a natural medium to involve in the gameplay. Oftentimes, mobile specific technologies are employed to enrich the experience and further blur the lines between the game environment and the real world, such as QR Codes, GeoLocation, and using the device’s camera to acquire evidence. The emergent technology Near Field Communication or NFC for short will likely also have great potential for ARGs in the future.


ARGs have been used in many areas for a number of different purposes. From a marketing perspective, a number of very successful ARGs have been written as a way to build product awareness. A very popular ARG called I Love Bees was produced to market the 2004 video game Halo 2. At its height, ilovebees received between two to three million unique visitors over the course of three months. In 2007, Nine Inch Nails released an ARG called Year Zero as a way to market their upcoming album by the same name. The game was well received and won a couple Webby awards as evidence of its overall success and well-constructed world depicting a crumbling society that echoed the state of the music industry. In perhaps one of the best known ARGs to date, fans of the TV show Lost could participate in an ARG called the Lost Experience. The following description comes from The Lost Experience website:

The LOST Experience takes LOST fans on an expansive, international easter egg hunt through websites, commercials, emails, phone numbers, and more, in search of pieces to a larger puzzle, a puzzle which, when solved, will enlighten LOST fans to some of the show’s deepest mysteries!”

ARGs have also been used to solve real world problems. An ARG called World Without Oil was created to obtain collective input from players about dealing with the world’s dependency on oil. World without Oil simulates the first 32 days of a global oil crisis and establishes a “citizen nerve center” to track events and share ideas. In October 2008 the British Red Cross created a serious ARG called Traces of Hope to promote their campaign about civilians caught up in conflict.

These more serious ARGs like World Without Oil and Traces of Hope are just the tip of the iceberg when it comes to using “serious games” to enforce learning objectives and help drive key takeaways home for the learners/gamers participating in them. These collective problem-solving efforts promote teamwork, creative problem solving, and responding and communicating effectively in a fluid and continuously evolving situation. Strong stuff, indeed!

The Applicability of ARGs in Organizational Learning

There are many reasons why ARGs are an excellent way to enhance or supplement an organization’s learning program. Let’s examine a few of them here:

ARGs are Immersive – The gaming nature of ARGs naturally has the ability to get people involved, require them to collaborate and solve problems and can be written to tap into people’s competitive spirit. And if the game is written properly, all of this can be done in a way that ensures learning is occurring and incented.

ARGs Can Ensure Baseline Knowledge – Oftentimes, organizations struggle with developing training that meets the needs of people with different levels of expertise and experience with a particular topic. ARGs can be used to help people build prerequisite knowledge necessary for the next level of learning. Those who have the background and experience can quickly solve the puzzles and challenges presented, and be rewarded accordingly, while those who need more background can spend the time and use available resources to build their knowledge base. This helps level the playing field going forward and reduces remediation.

ARGs Help Spice Up Dry Content – ARGs can be used as a part of employee on-boarding programs where much of the information presented is less than exciting, but nonetheless important and in some cases required by law. By sharing this information through a story and in a game format, the elements of a game, keeping score, competition, problem solving, etc. can be used to enhance content that otherwise may be presented in a presentation or written format. Envision an office park scavenger hunt and you may be on to something here.

ARGs are Helpful in Assessing Knowledge – Well-designed and scripted ARGs can be a powerful way to assess learner knowledge and retention. Because of the problem-solving nature of ARGs, observing how players react to various situations provides great insight to what they really know. In addition, those running the ARG can control events as gameplay occurs, allowing them to adjust the difficulty level real-time. Countless metrics could be occurring behind the scenes, from execution time to accuracy and much, much more.

ARGs are Cost-Effective – ARGs offer a significant amount of flexibility when it comes to their design and complexity. The writing and story are the basis for a good ARG, not the specific technology. Very elaborate ARGs can be written with the only tool needed to play is a mobile phone with text messaging. A simple bridge between a SMS gateway and an LMS or CMS is all you would need for tallying and record keeping.

Getting Started

ARGs may seem daunting from a design perspective. As with any form of learning development, success comes from first creating a good plan. First consider the audience, the message to be conveyed and the resulting behavior. Use these discoveries to inform your game framework, the writing, the media asset creation and the ongoing gameplay and measurement.

Audience - The audience will have a big impact on the design of the ARG. Is the audience tech savvy? Do they know each other well? Are they located where they can physically work together or will collaboration mean working remotely? Understanding the users personas will go a long way towards ensuring a solid design that works well for the players.

Messages - Determine the key messages to be communicated as a result of the game. Is the information to be presented high-level or subtle details of a situation? Is the subject matter easy to understand or complex? Approach these messages much like you would in creating the learning objectives for your courseware, or crafting the use cases for your mobile applications.

Behaviors – What behavioral outcomes should result from this experience? Maybe the purpose is motivational or team building, or maybe it is to emphasize a point or raise awareness. Whatever your desired conversion point, ensure you have created the interaction points to drive these concepts home and you have placed measurement tools at these critical junctures in order to measure effectiveness. Considering these elements up front are critical to making sure the storyline and the gameplay achieves the desired results.

Environmental Considerations – The next step in developing an ARG design doc is to plan for the setting and timeframe of the ARG. Will the game space be limited to a specific venue or will it encompass a wider area? The answer to this question can impact the technology that can and should be used. Will the game occur over a couple of hours or days, or will it happen over a period of months? Finally, how will the ARG integrate with other aspects of the training or learning environment? ARGs are most effective when they are integrated with a larger plan and not just something that is “piled on” as an extra. For example, if an ARG is being used to introduce and get people excited about an upcoming conference, then the ARG should have a direct tie-in to the themes and events of the conference. An ARG used at the corporate headquarters as part of the on-boarding process is going to be doomed to failure unless it is given consideration in the new employees’ schedule. Plan accordingly.

Writing the Story – The story surrounding the ARG should obviously be written to match the audience and environment, as well as meet the goals and objectives that have been established. However, there are a couple of other considerations to take in to account when designing and writing an ARG. The first consideration is the game lifespan and refresh cycle. Will the ARG be played once by a group of people with a specific end date or is the game intended to be ongoing with people starting at different times over a longer period? Will there be a reset at intermittent times in order to start again? Another important consideration is monitoring and controlling of the gameplay. Is the outcome fixed and the same for each participant, or will the game be allowed to evolve with no specific outcome identified ahead of time? These decisions will greatly influence how the story is written and the clues are developed.

Develop Your ARG – Obviously, playing a few ARGs is an important first step to being able to develop a successful game. There are a number of online resources to help get you started. Giant Mice has a nice resource page with many links on various ARG development topics. There are also resources on how to design and organize your ARG. There are so many ways to design and develop your ARG that explaining them all in this newsletter would easily double or triple its size. But there are many resources on the web that provide excellent information and numerous ideas. Tandem Learning has a number of great resources at their website as well. From a mobile development perspective there are many easily available tools and services such as SMS (text messaging) and open source and other free tools that can be adapted to serve as a framework for building your game.

Key Components of a Successful Learning ARG

Here are some other qualities you should keep in mind as you craft your masterpiece:

Verisimilitude – The story supporting the ARG, while often fictional in nature, still should have an element of reality and truthfulness. Because gameplay takes place in the real world in physical locations, the storyline should be informative, engaging, and believable.

Easy to Use – In many cases the players will not be deeply familiar with ARGs and in some cases will not even know what an ARG is. The technology used to play the ARG should not be the focus; the story should be the focus. Therefore successful ARGs use technology to enhance the experience by being easy to use. If players have to spend all their time trying to figure out the technology, they will be distracted from the real intent of the game. In other words, Know Thy Audience.

Importance – Consider the importance of the ARG to the overall learning experience. Again, thinking about the audience and their receptiveness to this type of experience, many ARGs are designed to be an optional supplement to the real training. In these cases people should be able to enter and leave the game at any time without real-life consequences. As an example, The Lost Experience written for the TV series Lost, was not required in order to understand the TV show or to follow the plot. But for those who were interested in increasing their engagement with the show, the ARG served to provide additional insights to the overall story and enhance the viewing experience. Likewise, other ARGs that we have played at conferences and events add to the experience of the event, but weren’t required in order to have a baseline experience at the event.


Mobile devices combined with a good story and an educational game can be a powerful way to increase engagement and activity level of your learners. ARGs offer an interesting way to bring your mobile technology along for the ride. ARGs are being successfully used in marketing and entertainment as well as to train and solve real world problems. Organizations that are looking for creative ways to engage in mobile learning should consider the benefits ARGs have to offer. By crafting a realistic, enjoyable experience, you’ll be reinforcing behavior that most companies are actively seeking in their employees: critical problem solving, inquisitiveness and creativity.

This article was originally posted at

Top 10 Benefits of Online Learning

Choosing Online Learning

Choosing to go to school for an online education is a personal choice. Weighing the decision involves learning the benefits and the drawbacks of the online learning environment. Here we cover the benefits of online learning to the student in his or her personal and professional life.

Top 10 Benefits to the Student in Online Learning

1. Flexibility- learning online can give flexibility to the non-traditional student, professional student or the rural student, caused by saved travel time. Students will not need to plan for rush hour traffic. Also, harsh travel conditions call for students who go to a traditional class to prepare for extra travel time. Learning online saves valuable time and allows more flexibility in the learner’s life.

2. Diversity- students learn alongside people from all over the country and even world. This diversity causes the student to see different views, broadening their experience. This will teach students to speak better in their professional lives.

3. Technology- Student confidence will grow when he or she has better computer skill. Online students will also bring this knowledge to the work environment.

4. Deadlines- students must meet deadlines for reading, writing, and meeting online at set times. Meeting a deadline will be vital to work place success.

5. Support- students in an online learning environment share the experience and critique one another. Critique is meant to help; hence, students get more peer-guidance than in a traditional course.

6. Professional Growth- professional students will see the value of their education at work and motivated to continue. Transfer of learning from the classroom to work life will improve the student’s understanding of the subject matter and set him or her apart among other professionals.

7. Reading, Writing, Listening and Speaking Skills- Working in an online course will cause a student to read and respond critically and articulate well and intelligibly. This is a great benefit to a future employer. Employees who speak well with other professionals form strong relations and respect in the work place.

8. Prioritizing- Students in online learning create a balance of other daily life activities. They must learn to arrange time as there are deadlines to meet. Coordinating activities and prioritizing tasks are vital skills in the professional environment.

9. Choice- This will give the online learner the freedom to decide when and where learning is right for him or her. The student can decide if he or she is a morning person or night owl. Students have the choice to decide if they like to study in a quiet room or where the family is.

10. Discipline- Students in an online learning environment will learn to take responsibility for their learning. They will learn to follow written directions, think and reply critically, and research online, all of which will improve professional abilities.

From Challenges to Benefits

In researching whether to go for an online education or not, one will become well aware that there are some problems to face when studying in an online environment. More research needs to be conducted so the schools offering online programs can improve the learning experience.

Also, online learning is not for everyone. Some students are incapable of handling the time restraints to meet the deadlines, finishing the independent work in the course, or overcoming the lack of face-to-face instruction and feedback. Yet, these challenges can be the same benefits of online learning if they cause the learner to grow personally and professionally.

This article was originally posted at

Monday, February 7, 2011

The secret to e-learning


Office workers are using online learning to develop skills and build knowledge. Photograph: Alamy

Your desk may overlook the desolate edge-of-town business park and the only lunch venue is the canteen, but look on the bright side: you could spend your meal break browsing a book from the New York public library, absorbing an Oxford University lecture on the fall of the Roman empire or taking a short course to enhance your mastery of Excel.

Immobilised office workers can nowadays roam the intellectual world courtesy of the internet and can foster passions or update skills in brief, instant gobbets when their in-tray allows, instead of committing themselves to a strict academic timetable. Now the economic downturn has forced firms to reduce staff training and the newly redundant have to rethink their skills to impress potential employers, online resources are likely to become crucial.
"This is the time when people are thinking about their skills sets, either because they want to get a better job or because they want to learn more about, say, Renaissance art,," says Adrian Beddow of Learndirect, which offers a range of downloadable e-courses covering corporate skills from IT to employment law. "Our courses get you to learn a concept or understand a technique and reflect on how to implement it at work and they're designed so that workers can dip in and out from their desks."

The business world has long since learned to harness the advantages of online tuition. However, according to Jane Hart, founder of the Centre for Learning and Performance Technologies, companies try to force courses to fit the traditional educational mould. "There is a heavy focus on designing formal content-rich courses, pushed down to end-users, and managed, tracked and monitored in command and control systems," she says.

Gradually, though, many firms are waking up to the advantages of informal training managed by individuals around their own timetables.

Some have developed their own e-learning systems from brief tutorials to four-hour programmes. Cable & Wireless, for instance, allows staff to access an online library, web-based seminars known as webinars and a personal development programme. "We provide time for colleagues to develop themselves," says C&W's learning technologies manager Mike Booth. "We map out an online career path so they can see what roles they might aspire to and what skills and attributes they'll need, then we point them to suitable training. It takes a third of the time of a classroom-based course do it online and the information is always on hand as a point of reference."

• Know what's out there. Many of the world's best universities upload free lectures on iTunes and YouTube, Open University offers free modules from beginner to postgraduate level on its OpenLearn site and at Learndirect, where courses in business and management start from £17.50, you can do tasters for free. You can also search YouTube for quick how-to demonstrations in specific skills.

• Share the pain. The problem with e-learning is that it can be a lonely journey without the physical presence of tutor and classmates. Booth suggests enlisting support from a sympathetic manager who can help set targets and timetables. You could recruit an informal group of colleagues to learn with you or tout for learning companions through social networking sites to help keep you motivated.

• Stay focused. "The most common trap people fall into is not giving themselves enough time," says Booth. "If you book a day course you clear a day in your calendar, but e-learning tends to be low priority." Beddow suggests organising frequent, short periods of learning. "Try 15 minutes when you get into work early, 15 minutes at lunch and perhaps 15 minutes in the evening," he says.

• Know your goals. "Understand why you are doing it and what benefits you hope to get out of it," says Beddow. "That way you're more likely to stay committed."

This article was originally posted at

Will Health Data on Mobile Devices, iPads, Be Private and Secure?

There have been many recent and public events involving security breaches of electronic medical records and other patient data in hospitals. The unfortunate event in Tucson, Arizona where a Congresswoman was shot, led to the firing of three curious clinical support staff members for improperly accessing EMRs at the University Medical Center where the Congresswoman was being treated. In Iowa, five total hospital employees were disciplined (three fired) for violating federal law by viewing the medical records of hospitalized University of Iowa Hawkeye football players.

Beyond curiosity, one would think that people want to access medical records information from newsworthy people and events to try and sell the stories to the media who obviously would pay large sums of money to be the first to break the story about something like Michael Jackson’smedical past. But, then I wonder why a Las Vegas man, would go through the trouble of organizing a patient records scheme where he used private hospital files to solicit business and clients for a personal injury attorney. He obviously has some decent planning skills and would be better off in Wall Street, where schemes such as this go largely unnoticed, and can go on for quite some time.
I began to think about the possible issues stemming from physicians rapidly adopting mHealth applications on tools such as iPads, Android devices, Blackberries, and others. I posed the question on a Center for Democracy and Technology forum about Health 2.0 and HIPAA, as I thought about physicians moving around a medical facility with a device in hand containing lots of private patient medical information.

Barry Chaiken, MD, former chair of HIMSS and chief medical officer for Imprivata, shared 5 Key Considerations for Hospitals to Ensure Mobile Device Security in Becker’s Hospital Review.

Here they are:

  1. Keep data in a cloud: Perhaps none of the data can be saved on the actual devices, because of their portability.

  2. Get creative with passwords: More sophisticated authentication is evolving, so its necessary to have a unique password.

  3. Limit how devices are utilized: Hospitals and medical centers should configure access so that the hospitals control what is seen and accessed through a cloud.

  4. The ultimate goal should be zero breaches: Hospitals are at risk for losing not only patients, but also lots of money in remedying security breaches.

  5. Keep up with trends in technology: Hospitals should stay updated on the latest trends in technology and security applications.

Outlining preventative steps such as Dr. Chaiken’s will help reduce the risk of security breaches as the mHealth market continues to grow, and physicians adopt mobile devices as a convenient way to help deliver efficient and accurate patient care.

This article was originally posted at

Mobile Healthcare (mHealth) News RoundupMobile

mHealth: FDA approves incredibly cost-effective mobile ultrasound

By combining the computing power of Microsoft smartphones with a reasonably small hardware add-on, Seattle-based Mobisante is releasing what is perhaps the cheapest ultrasound system in the world - and it has just been approved by the FDA. MobiUS is the name of the product. When you buy it, you get a TG01 Windows Mobile smartphone. It comes with an ultrasound probe attached, and MobiSante’s software on-board. The entire system will cost less than $10k – in an industry where the average ultrasound unit retails for between $20k and $100k.

Read the rest here

FDA clears first diagnostic radiology app, Mobile MIM

Mobile MIM was one of the very first medical applications to debut in Apple’s AppStore when it first launched in 2008, but the application also has the distinction of being the first medical application pulled from the store because of regulatory concerns. Today those concerns are over: The US Food and Drug Administration has officially granted the mobile radiology application a 510(k) clearance. The app enables clinicians to measure distance, intensity values, display measurement lines, annotations and regions of interest. The images are securely transferred to the app from a hospital or physician’s office through a secure network transfer facilitated by MIM.

Read the rest here

WebMD launches Medscape for iPad, Android

WebMD may be sewing up its dominance in the smartphone-enabled clinical education space, launching two new versions of its Medscape Mobile product for iPads and Android phones. This comes more than seven months after the company’s initial foray into the iPad market, and nearly a year and a half after Medscape launched its iPhone mobile service. That’s in addition to existing apps already working on iPhones and Blackberry devices. Total users so far: 700,000, a number WebMD indicates should skyrocket with the addition of iPad and Android platforms. The mobile version of Medscape already was named the “most downloaded” free medical app last year by Apple.

Read the rest here

Mobile Health Startup Massive Health Gains $2.25 Million

Massive Health, a Dogpatch Labs startup co-founded by former Firefox Creative lead Aza Raskin and Sutha Kamal, just announced $2.25 million in funding from Andreessen Horowitz, Charles River Ventures, Felicis VC, Greylock Discovery Fund and Mohr Davidow Ventures as well as unnamed angel investors. In the same mobile health space as apps like Nike + and Jane McGonigal’s Social Chocolate, Massive Health aims to bring “the kind of innovation we expect from the Internet world to healthcare.” The co-founders write on their blog that they aim to incorporate elements of crowd-sourcing, game mechanics and social networking into helping someone stay healthy, “We are talking about tight feedback loops and deep insight into the interface which is your body.”

Read the rest here

Five mobile security tips for hospitals

During a recent interview with Becker’s Hospital Review, Dr. Barry Chaiken, the former chair of HIMSS and now chief medical officer for Imprivata, shared five tips for hospitals still trying to formulate a security strategy for the mobile devices their physicians, nurses and other staff are increasingly using. If you’re not familiar, Imprivata is a security solutions provider. While these are very high-level strategies, Chaiken’s list should be heeded. Security issues are more often than not an under-discussed issue in mobile health, especially for healthcare professional users.

Read the five tips here

This article was originally posted at

Friday, February 4, 2011

Physician Executives Should Not Ignore How Smartphones Will Transform Healthcare

Bottles Physician executives who ignore smartphones and their healthcare applications will miss the most important disruptive technology trend in the next five years. Physician executives who understand how smartphones will transform the industry for providers, payers, patients, and employers will thrive in their careers.

Rajeev Kapoor, a former executive at Verizon, describes the smartphone-enabled transformation: “The paradigm of healthcare has changed. You used to bring the patient to the doctor. Now you take the doctor, hospital, and entire healthcare ecosystem to the patient.” ( Susannah Fox of the Pew Research Center’s Internet and American Life Project offers a specific example when she talks about the celiac disease patient who uses her smartphone to evaluate food products in the grocery store.

“You cannot call your gastroenterologist every time you buy a new product.” ( David Jacobson of Wellpoint notes that “The technology of telehealth is well ahead of the socialization of the telehealth idea and we are at a tipping point for utilization to begin taking off.” (

The Global mHealth Developer Survey found that today 78% of respondents said that smartphones offer “the best business opportunities for mobile healthcare” in 2011; by 2015, 82% said smartphones would dominate the industry. Cell phones, tablets, and PDAs trailed smartphones in popularity according to the survey. (

Smartphones run on a specific operating system and can download applications (apps) that run on the operating system. The most popular operating systems in the United States are iPhone, BlackBerry, Windows Mobile, Palm, Web, Symbian, and Android. ( We are just beginning to discover how to harness the smartphone’s computing power, cameras, audio, video, motion sensors, and GPS functions to better manage health and wellness. (

In contrast to the rather slow adoption rate for both health information technology and personal health records, smartphone use is skyrocketing. In October 2006 15% of Americans owned a smartphone; by December 2009 that number was 42%. Surprisingly, one report noted that the smartphone market was “unfazed by the recession.” ( In late January 2011 Apple reported that someone downloaded the 10 billionth app for the iPhone. ( That lucky smartphone user received a $10,000 gift card to the iTunes store.

Why are smartphones so popular? The ability to carry around a handheld computer that is user-friendly and that allows users to do things anywhere at any time is attractive. One research whitepaper coined the term “care anywhere” for smartphone-enabled health care. ( But it has to be more than just that when people routinely say they “love their iPhone.”

MIT’s Sherry Turkle in her book Evocative Objects: Things We Think With writes “We think with the objects we love, and we love the objects we think with.” She also emphasizes how important it is that we carry this “second self” with us at all times. Mark Rolston, chief creative officer of Frog Design, observes that people grieve when they lose a personal electronic device. “You are leaving your brain behind,” he says (

Joseph Kvedar, MD, director of the Center for Connected Health at Partners HealthCare in Boston, states that humans find it easy and natural to anthropomorphize pet rocks and tomagotchis, and that we are truly forming trusting relationships with our smartphones. ( In her new book, Alone Together: Why We Expect More from Technology and Less from Each Other, Turkle explores the positive and negative consequences of this love affair with smartphones and other forms of technology.

Demographics will also drive increased use of smartphones in health care. The first of the 78 million baby boomers will turn 65 in 2011 and as the sandwich generation who are concerned about the welfare of their children and their parents, they know the importance of health and wellness. Boomers also lead all generations in technology spending, and they will use smartphone technology to foster ongoing independence for themselves and to care for their relatives who live across the country. John Sherry, Director of User Experience Design for Intel, observes, “A number of economic, generational, and societal factors combine to make boomers likely early users of remote health monitoring and management products.” (

Smartphones will transform healthcare by offering solutions in four classes of activities: communication, transactions, knowledge, and integration of information. (


Communication between all players in the healthcare space will be changed by the use of smartphones. The most obvious arena to examine is the patient/doctor relationship. People who access scientifically sound advice through their smartphones wherever they find themselves can become more independent, empowered, self-managing patients as the above celiac example shows. Smartphones also make patients more likely to participate in online conversations with other patients on social media websites like PatientsLikeMe and DiabetesMine. Patients want to communicate with their physicians via email, but physicians have been slow to accommodate this desire. Although many consumers have not been able to use smartphones for communication with their provider, 85% of those that have connected with their doctor by means other than face-to-face were satisfied with their discussion. (

Physicians worry about patient compliance, and 88% would like their patients to be able to monitor their weight, blood sugars, and vital signs on their own. 66% of physicians said they would like to use email for administrative communications like appointment reminders, but only 23% of consumers preferred communication by email for such simple communications. ( Forty percent of physicians said 30 percent of office visits could be avoided with the use of remote monitoring, email or text messaging with patients. ( A Mayo Clinic two-year study found that e-visits could replace in-office visits in 40 percent of 2,531 cases. (

The Good Shepherd Health System developed their own iPhone app to help physicians access medical records, track vital signs, order medication, and coordinate care with other team members. Physicians from Duke, Harvard, and the John Theurer Cancer Center have worked with Zibbel, a health solutions technology company, to create a smartphone enabled virtual network for mobile cardiology and oncology consults between experts. (

Smartphone technology can also change and improve communication between consumers and their pharmaceutical companies, health plans, employer, and health system. Michael Mathias, Aetna’s chief technology officer comments, “The days of mass communication are over. We can now deliver customized communications through mobile apps, online, telephonically, or through mail based on our understanding of how each member wants to be communicated with.” (

Kaiser and Mayo are both developing smartphone apps to help patients managing chronic conditions and healthy consumers who want to stay fit. Scott Eising of Mayo Clinic says, “We’re a very content-oriented organization. In our research into the mobile health consumer, we found that people are looking for very action-oriented information.” Mayo Clinic has launched Mayo Clinic Meditation and Symptom Checker iPhone apps so that we can “take care of patients here and ‘there,’ whether at home or at work.” (

Qualcomm is creating “the clinic without walls” to take care of its 12,000 employees in the San Diego area. Using the Myca Health platform, Qualcomm’s health staff can consult remotely with mobile employees via smartphones. “People are so connected to phones, they’re an extension of themselves. You can’t have your doctor with you all the time but the phone can keep you on the right path toward health and wellness,” states Dr. Marion Zabinski. (

Merck Serono has developed a smart electronic injection device with two-way Bluetooth communication functions that track all injections made by the patient. When an injection is missed, nurses contact the patient to remind them to adhere to the treatment plan. (


The ability of consumers to use smartphones to book a flight or make a hotel reservation has revolutionized the travel industry, and many predict health care will soon follow suit.

The first area in healthcare that has utilized smartphones for transactions is e-prescribing. The most common prescription orders that a doctor uses can be automatically populated on their smartphone. Donald Burt, MD, chief medical officer of PatientKeeper, says their 25,000 physician users spend 20 percent of their time on their smartphone. Trusted nurses can post prescription order request on smartphones, and the physician can modify or approve the order no matter where they are located physically. A PricewaterhouseCoopers 2010 survey found that over 80 percent of both specialists and primary care doctors were interested in e-prescribing using their smartphones. (

Aetna has made transaction functions such as physician finder and claims check available on smartphones. CVS Caremark has iPhone apps for prescription drug information and patient management of drug refills as well as for retail location finder functions. (


Allowing physicians to have access to the latest evidence-based medicine knowledge at the point of care may be the most exciting and important application of smartphone technology. In a national survey, one third of physicians responded they make decisions based on incomplete information in nearly 70 percent of the patients they see. ( Lay people are also utilizing this technology to become wiser consumers of health care.

Epocrates is perhaps the best example of a mobile reference resource that physicians turn to in real time for information about the patients they are seeing right now. Epocrates’ drug reference app is the most popular free medical download for iPhones, and one study documented that 60 percent of Epocrates users avoided three or more medical errors a month. More than 125,000 doctors use Epocrates on iPhone and iPod touch devices. (

UpToDate is another evidence-based, peer-reviewed information resource available via smartphones. Over 400,000 providers use UpToDate for their synthesis of the medical literature, the latest studies, and treatment recommendations. (

Skyscape has put together the largest library of medical resources that is available for smartphones, and the Medical Encyclopedia from the University of Maryland was one of the top ten free apps in the iTunes Store in December 2009. FDA Recalls is a free app for iPhones that keeps clinicians on top of which products have recalled by the manufacturer. (

Diagnostic tools for clinicians are too numerous to catalog. Examples include Diagnosaurs for general diagnosis, ARUP Consult for laboratory, OsiriX for digital imaging, Instant ECG for ECG interpretation, Vigilance for Emergency room situations, AirStrip OB for obstetrics, and American Well for remote physician consultations. (

Consumers are also using smartphones apps to keep abreast of medical knowledge. The Evincii app matches symptoms to over the counter medications, and the Mayo Clinic Symptom Checker iPhone app became available in early 2010. ( Consumer interest has been highest in fitness and weight control apps (Tap & Track, iTreadmill, Walk It! And Pedometer-Widget), Diabetes Management (Glucose Buddy, Handylogs Sugar), High Blood Pressure Management (HeartWise, My Blood Pressure and Heart Rate), sleep hygiene (Sleep Cycle Alarm Clock, Smart Alarm Clock), Stress Reduction (Stress Free with Deepak Chopra, Rage Eraser), and First Aid (Pocket First Aid & CPR). (

Integration of Information from Diverse Sources

Perhaps the biggest challenge for both consumer and physician is how to integrate all of this information that is available via smartphones. It truly is like drinking from a fire hose, and the amount of information can be overwhelming.

Health systems have been focused on implementation of the electronic medical records, and the Patient Protection and Affordable Care Act has provided billions of dollars to support rapid adoption. Unfortunately both the hospital systems and the Office of National Coordinator have largely ignored the importance of integrating mobile health into other health information technology efforts. For example, two thirds of physicians in a national survey said they were using smartphones in their practice that are not connected to either their office or hospital HIT systems. Thirty percent of physicians said their health systems or medical group would not provide support for smartphones. (

Many physicians and hospital administrators, tired of wearing multiple devices on their belts, have wanted their IT Departments to consolidate all messaging functions to smartphones. Most hospitals already have invested in pagers, cell phones, Vocera badges, SpectraLink Wi-Fi phones, and two-way radios, and what works for maintenance staff may not work for ICU nurses. A research white paper reporting on the experience of smartphone early adopter hospitals recommends supporting a variety of devices at the present time, but it also warns against being too slow to adopt smartphones. It also points out that work processes have been designed around the currently employed technologies and replacement by smartphones will necessitate work process redesign which may result in cost-savings. (

Smartphones in health care will not live up to their full potential if integration is not successful. No matter how many readmissions for congestive heart failure remote weight monitoring at home could avoid, such programs will fail if the information does not appear in the office or hospital medical record.

Joseph Kevdar, MD, director of the Center for Connected Health at Partners HealthCare, stated that while “sensor technology may be rapidly becoming commoditized, integration with EMR and data aggregation systems is not something we have done well. We need to get better at gathering information, adding logistical software to get to the intersection of all the data and population health management.” (

There are technological advances that are promising, according to Kvedar. Emotional sensors predict the patient’s mood by analyzing their voice (Cogito) or by facial recognition (Affectiva). Bodytrace’s wireless weight scale, Telecare’s wireless glucometer, and Vitality’s GlowCaps device all can find mobile networks when the sensor is triggered and so transmission of clinical data does not require the patient to do anything. (


Smartphone technology is already transforming the healthcare industry, but many physician and hospital leaders have not thought through the implications of their widespread adoption by both consumers and physicians. By understanding the implications of smartphones for communication, transactions, knowledge, and integration, leaders can begin to map successful strategies and tactics during a time of delivery system and payment reform. As John Mattison, MD, of Kaiser Permanente states, “The new wellness delivery channel for ubiquitous care will be the smartphone, and it will happen sooner than you think.” (

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