Nexus S 4g Leaves iPhone Playing Catch Up

Author: Mehdi Rais, M.D.

I recently upgraded my phone to a Nexus S 4g.  I was a little hesitant to write a review without really diving into the inner workings and capabilities of this phone.  Among the points that really attracted me to this phone included:

• 4g speeds on one of the fastest operating Android phones (1GHz Hummingbird processor with 16gb internal memory.)
• The ability to pair Sprint and my Google Voice accounts.
• A phone that is rated as the fastest on the market to receive updates in Android OS and one of the few phones that currently runs on the latest Android offering preloaded: Gingerbread 2.3 
• The Voice Actions platform allows me to do everything I need on the phone without a keyboard, but rather voice commands.
• And finally the least advertised but most anticipated function on my end: the phone is one of the first mobile devices to incorporate Near Field Communication (NFC) into the OS. 

Here are my initial thoughts:

1. The 4g speeds while spotty are extremely functional.  I know Sprint has one of the largest 4g networks in the country.  When I am either grinding away at my office or at home (90% of the places I normally am physically located), I flip on the WiFi and it works like a dream.  This does come at a price with battery life, which I am still trying to balance.

The speed of the phone is an enormous leap ahead of the iPhone 3gs.  I did not have the iPhone 4 to put through all the tests, but in a series of short tests with a friend's phone we both found the Nexus S is appreciably 'snappier' than the iPhone 4. We took a quick comparison in boot up times, app navigation, and program start up.

2. Sprint + Google Voice is a fantastic idea in theory.  I love the ability to get all my voice messages transcribed and e-mailed or text to me, have different voicemails for different groups of people, be able to check and respond to any text messages or voice messages while online anywhere in the world, and the ability to filter out advertisers or spam callers much like I would filter my e-mail with spam messages.

While this is all awesome in theory, there is a lot of work to be done on this product by my friends at Google and Sprint.  I found calls often didn’t get routed my way and went straight to voicemail.  Text messages took hours to days to receive and send.  Having said this, I am confident Google does have the resources to make this work and am confident that the bugs will get worked out.  As with any new technology, I have become accustomed to expect these sort of bugs.  I will utilize this service only when placing international calls (much cheaper rates through Google Voice than my service provider) or when I am located outside of the country for the time being.

If you haven't heard of Google Voice and Sprint connection, check the following video:

3. As of this writing only three phones have Android 2.3: Nexus S (the first to receive the OS), Sony Ericsson Xperia Neo, and Samsung Galaxy S2 (a phone that I am absoluting salivating to get my hands on.)  Because the Nexus phone line is so intimately built under the watchful eye of Google and is one of the only Android phones without the bloat ware that comes standard with cell phone providers, it makes logical sense that the Nexus S will continue to get updated first.

4. Voice Actions is nothing short of AWESOME. It is a simple and elegant way to speak certain specific commands to get all the functionality out of your phone that you would have to do previously by typing. This is a massive leap ahead of anything Blackberry or iPhone currently offers.

• “Navigate to Post Office” brings up the navigation software and guidance to the nearest post office. 
• “Text (or e-mail or call) Joe Kim” brings up my messaging application and the ability to speak that message rather than type it and send it.
• ”Google MedicineandTechnology.com”  brings up my web browser and my favorite site in the search results. 

I have found the speech recognition software to be remarkably accurate despite being in noisy environments.  It is ideal for people on the go or those just tired of typing in on a cell phone keyboard.

5. While I have not tested Near Field Communication capabilities (NFC tags are on order through Ebay), the possibilities really make my head spin.  For a given tag, I can set parameters on my phone to start or stop working.  For example, I plan on putting a tag in my car and forcing my phone into “car mode” where the keyboard is disabled and all use is done through voice actions.  When entering my home or work office, I will automate turning on WiFi.  All of this occurs without any significant power resources as NFC does not require an immense powerload and automatically.   Here is a simple instructional on setting up and using NFC for any phone device.

NFC appears to take center stage in the coming months and years in phone functionality.  Just today, Google announced a new payment platform utilizing Near Field Communication coined Google Wallet.  Google believes this app will make your phone your wallet through using NFC capabilities.  After linking your Google Wallet to a Citi Mastercard or Google Prepaid Card, you simply tap your phone near the NFC tag at a given register and you will have automatically paid for the item(s) or service(s).  I will speak more about Google Wallet soon, but for now I am giddy in anticipation of this product.

Overall, despite the shortcomings of several of its “futuristic” offerings, the phone is solid in the hand, incredibly fluid user interface, and a pleasure to deal with.  I encourage you to head over to a Sprint store to give it a try.

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed at his blog. Look for him on Twitter @DrMedBlog.

Not All Informatics are Created Equal

Author: Mehdi Rais, M.D.

The term Biomedical Informatics is so widely and loosely used that it is easy to forget that there are levels of specialization within the discipline. A simple job search in the field of Informatics will only amplify the confusion as often the terminologies within separate sub-specialties overlap.  

One of the first white papers written on the Informatics discipline and specialization subtypes was offered by the American College of Medical Informatics and published in 2004 in JAMA. In the article, the field of Biomedical Informatics had been organized around the applications of Informatics into four specific areas of specialization:

1. Clinical Informatics: utilizes biomedical informatics to address the patient care domain.
2. Bioinformatics: studies how data is represented and transmitted within a given biological system and often begins at its most molecular level.
3. Imaging Informatics: concerns all processes of image use and include the techniques to acquire and/or convert images into digital form, analyze and manipulate this data, and use the images in a variety of ways in their digital form.
4. Public Health Informatics: utilizes data of biomedical informatics and applying these processes to address problems that may arise in the public health domain.

The field of Clinical Informatics is further broken down into sub-specialties that include: Health Informatics, Medical Informatics, Nursing Informatics, Dentistry Informatics and Pharmacy Informatics.  Additionally if there is a focus on healthy individuals as the user, this is defined as Consumer Health Informatics.

As you can see, there are several specific degrees of specialization under the umbrella of Informatics.  Which area do you fall under?

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed at his blog. Look for him on Twitter @DrMedBlog.

Increase Your Net Value by Understanding PDSA

Author: Mehdi Rais, M.D.

Business Process Improvement (BPI) is a systematic approach to help any organization increase their efficiencies to achieve greater desired outcomes.  Whether you are working in clinical medicine, pharmacovigilance, EMR implementation, health informatics, clinical marketing, or involved in any other group, BPI is a compelling way to demonstrate value to an organization or a potential suitor, and  ultimately prevent redundancy of your position.  As you look to add value in your career or next position, demonstrating how you would increase efficiencies is one of the top ways to bring value and set you apart from the rest of the pack. 

There are quite a few theories on achieving BPI that are available by simple search, but I would like to focus on just one that has had wide adoption from the American Heart Association to the U.S. Military to many organizations in between: Plan-Do-Study-Act (PDSA).  In this four-step repeating cycle, the testers establish an objective and the processes to achieve this objective through "plan"; this plan is then activated through "do"; a built in self-checking mechanism permits for measurement and analysis against specific desireable outcomes in "study"; and finally the result of this analysis leads to implmenting necessary changes through "act."

This business/engineering theory seems like a natural principle for clinically inclined individuals to grasp. For all intents and purposes, it is a permutation of the scientific method that was hammered into aspiring clinicians brains during our undergraduate years.  But without knowing the lingo, we would never be able to make the association.

The following is an 8-minute presentation on PDSA and offers a great glimpse into it's background and potential uses.

How will you incorporate PDSA?

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed on Twitter @DrMedBlog.

Japanese Philosophy and EMR Implementation Work Hand-in-Hand

With thoughts and prayers headed towards our friends in Japan, I thought it would be a good time to focus on their contributions towards work flow and process analysis, the cornerstones of health care consulting and EMR implementation.  

As many of you know, EMR implementation is more than buying a software package and a few machines and hitting the ‘on' button.  Prior to any of these investments, there are processes and efficiencies that must be identified and implemented such that an office, group or hospital can maximize the use of EMR to improve patient outcomes.  Several organizational methodologies exist to conduct such analysis and implementation: Sigma 6, Lean Thinking, Deming Cycle, etc.  One specific Japanese philosophy, 5S,has received a lot of attention of late as we transition towards complete EMR implementation.

5S represents a philosophy built around the principles of building an efficient workplace with standardized work procedures.  The tenets of 5S involve simplifying, reducing waste and non-value activity while improving quality efficiency and safety.   There are five words that this philosophy is built around.  They include:

1. Sort (Seiri): elimination of wasteful items around the workplace.  To do so, a process called red tagging is completed in which a red tag is placed to identify any item that is wasteful around an office.  All red tagged items are then removed and put into a central area where they can be evaluated.  Such items that are unneeded are discarded while those with occasional use are moved and organized.  This process allows for valuable work space to be freed up and clutter to be removed.
2. Set in Order (Seiton): focuses on efficient and effective storage methods.  For any given item, one must ask him or herself: What do I need to do my job? Where should I locate this item? How many of this item do I need? All shared items should have a place where employees can find it (e.g. mop, stapler, etc.) Everything has a place.
3. Shine (Seiso): Having rid yourself of waste and set in order the remaining goods in the office space, cleaning those areas thoroughly shall be the next focus.  A daily scheduled follow-up cleaning will help with sustaining such improvements while ensuring the remaining goods are looked after and kept in their best order.
4. Standardize (Seiketsu): creating a system of standardized practices is the next part of the 5S philosophy.  All employees doing the same job should be able to switch to any station with the same function and reproduce the work task.  Involving employees to participate in the process will only help make them feel invested and increase compliance with new standards.  
5. Sustain (Shitsuke): literally means implement and achieve.   While humans are quite resistant to such change, this process can and will prove to be one of the most difficult to complete.  The tendency always is to revert back to “old ways.”  Employees should always be thinking about ways to improve the work place and processes; in the event that some sort of issue arises where an improvement can be made, one must review the first 4 S’s and how they relate to the new process prior to making the appropriate change.

While sticking to the 5S principles won’t guarantee the smoothest implementation, there are some great reminders of what it takes to make a system work.  As you continue to consider EMR implementation or a career as an Implementation Clinician, Informatics Specialist, and/or Clinical Consultant, understanding work flow, process analysis and process implementation should be your highest priority.  With your solid clinical background and this framework to help guide health care facilities to more efficient results, you will begin to understand what it takes to take on such a job.  

ONC's HITECH Certificate Program: The Rewards Add Up

I have written about my many motivations to acquire a Health IT certification through the Office of the National Coordinator's HITECH program.  The advantages are numerous: a top notch education designed by industry and academic leaders, the opportunity to network with individuals in the field, tuition entirely reimbursed upon successful completion within the six months, etc.

One more advantage was announced in the last week: the American Health Information Management Association (AHIMA)  is now offering HITECH students membership at a special rate of only $50 --  a $115 discount for up to two years.  As you may know, AHIMA membership provides a world of resources, including access to more than 61,000  other health information, informatics, and technology professionals committed to advancing the industry.    

Among the advantages of membership as highlighted by AHIMA.org include:

• Access to the AHIMA Body of Knowledge online library
• Network on the Communities of Practice
• Exciting annual convention and many other events held throughout the year
• Career Assist job-search site
• Practice briefs provide professional insight
• Opportunity to grow your professional skills through online and in-person training.
• Receive AHIMA’s award-winning Journal—Available in both print and digital format
• Career-enhancing credentials
• Discounts on professional resources for career growth.

This partnership not only promotes AHIMA, but it tells me that the HITECH certificate program is headed in the right direction as far as industry adoption goes.  As of this publishing, I could not find any other Health IT certificate program that has established such a bond with AHIMA.

Click here for more information.

Android's Google Reader App Gets More Muscle

Author: Mehdi Rais, M.D.

Last week, Android’s Google Reader app received some dynamic updates that bring the app closer inline with the online experience, and in some ways now exceeds the web version.  I lean on this app to keep up with over 225 news feeds a day ranging from Health IT to technology to emerging clinical best practices to a myriad of other topics.  Among the updates to the Android version of Google Reader include:

• Unread Count Widget: any feed can be chosen within your Google Reader (labels, person, specific feeds, or all items.)  You’ll have a pulse on developments in your reader inbox as they happen.  Clicking on such feeds will send you to the respective feed.

• News Ticker Widget: any feed within Google reader can cycle through those headlines and stream on the homescreen. Much like the previous widget, clicking on a given article will take you to the article.

• Mark previous as read: this feature isn't available in the online version; currently you can only mark a time period (last day, week, etc.) as read, not everything prior.  In your reading list view, you can simply press “Mark previous as read” to mark feed listings above the screen as read.

These developments are right in line with the spirit of Google Reader's aim to streamline your online browsing experience.  Have you made the leap yet to Google Reader?

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed at his blog here. Look for him on Twitter @DrMedBlog.

EMR = MSQ (A Massive Security Quagmire)

With the emergence of electronic medical records, the amount of intimate data being stored on any given patient is enormous.  This begins with identifying information such as age, race, sex, social security information, billing information, etc.  Such data is invaluable to identity thieves and marketers alike. Last week it was reported that a group of hackers broke into the Emory Health Care System and stole the records of at least 77 patients at an orthopedic clinic.  

Alarmingly, the hospital IT department did not detect nor identify any security problems.  The security breach was picked up by an ongoing case being pursued by the FBI.  In a statement by a hospital spokesperson for the Emory Health Care System, the intentions of the thieves were revealed, ”According to the IRS this information appears to have been subsequently used for the filing of fraudulent federal tax returns with the intent of collecting associated tax returns."

Despite the perception of being a secure network, I find it amazing that such security breaches could occur without any clue of its occurrence by the IT department. This event speaks volumes as to the distance we have to go to prevent the compromise of highly sensitive patient data.  

As I continue through my HITECH program, I learn every day about a new creative way hackers have accessed such sensitive data.  Creating a secure system truly is a monumental task requiring both education of health care workers, increased hardware and software resources, and a better trained more prepared IT team. Along with creating a unified language as being one of our nation's largest hurdles for system-wide EMR implementation and adoption,  top-rated health IT security will prove to have an equally immense resource cost.