Archive for March, 2008

A new book details the extent to which countries across the globe are increasingly censoring online information they find strategically, politically or culturally threatening.Access Denied: The Practice and Policy of Global Internet Filtering challenges the long-standing assumption that the internet is an unfettered space where citizens from around the world can freely communicate and mobilise. In fact, the book makes it clear that the scope, scale and sophistication of net censorship are growing.

“There’s been a conventional wisdom or myth that the internet was immune from state regulation,” says Ronald Deibert, one of the book’s editors.

“What we’re finding is that states that were taking a hands-off approach to the internet for many years are now finding ways to intervene at key internet choke points, and block access to information.”

Mr. Deibert heads The Citizen Lab at the University of Toronto. The Lab, along with Harvard Law School, the University of Cambridge, and Oxford University, has spent the last five years testing internet access in some 40 countries.

We are starting to see something more like the China Wide Web, the Pakistan Wide Web, and the Iran Wide Web
John Palfrey, director of Harvard Law School’s Berkman Center for Internet and Society

The book highlights Saudi Arabia, Iran and China as some of the most aggressive nations when it comes to net filtering. They use a variety of technical techniques to limit what their citizens can see online. But they reinforce that filtering with other methods, such as net surveillance.

“Surveillance is a huge deterrent,” says The Citizen Lab’s Nart Villeneuve. “If you talk to dissident groups in these countries, they’ll tell you that they’re under surveillance, that they’re concerned for their safety, and that it definitely influences their online behavior.”

And even as human rights and internet rights groups fight to raise awareness about internet censorship, countries such as China have responded by getting smarter in what they block, and when they block it.

‘Selectively blocking’

“We call it ‘just-in-time’ filtering,” Mr. Deibert says. “Countries are selectively blocking access to information around key events, such as demonstrations or elections. They are clamping down on the internet during times that it suits their strategic interests to do so.”

As an example of this kind of filtering, he points to China’s recent blocking of YouTube after videos of Tibetan protestors appeared on the video-sharing site.

Google protestor

Google has been criticised for working with Chinese authorities

Belarus, Cambodia and Burma have all engaged in this kind of selective censorship as well.

And then there is the case of Pakistan, which recently caused the entire YouTube service to go down worldwide for a couple of hours because of a government order to block material.

According to John Palfrey, director of Harvard Law School’s Berkman Center for Internet and Society, the Pakistan case points to certain weaknesses inherent in the very architecture of the internet.

“It was designed by a bunch of friends in essence – academics and military people – who were just creating a local network. Now, it has scaled globally.

‘Informal protocols’

“But it’s still based on some fairly informal protocols. It turns out that when one censor in one country messes around with something, he can bring down access to entire parts of the internet.”

Mr Palfrey points out that some countries are considering whether or not to bypass the World Wide Web all together by creating what amounts to their own local area networks. “We are starting to see something more like the China Wide Web, the Pakistan Wide Web, and the Iran Wide Web.”

But The Citzen Lab’s Ronald Deibert does not think the evidence points to a complete “balkanization” of the net by sovereign states.

“I don’t think it’s a stretch to say that a person in Iran experiences a much different Internet than a citizen in a country like Canada,” he says.

“But it’s not a simple equation with territorial boundaries. Maybe the best analogy is with the old Middle Ages, where you had multiple and overlapping layers of authority. I think that’s the future of the net.”

That future is being complicated by the increased use of mobile phones, PDAs and other devices to access information online. For citizens, these devices mean more ways to access the internet, and therefore more potential ways around government blocking.

But Jonathan Zittrain, chair in Internet Governance and Regulation at Oxford University, says that governments are already starting to realize the potential threats from mobile devices as tools to access and spread information.

“In fact, when it comes to mobile devices,” Zittrain says, “you may see common cause among China, the United States and Europe, all of whom would like another lever they can pull that will enhance their control over the net, whether they’re looking for terrorists, subversives or political dissidents.”

“I’d hate to think that the technological advances, say, in America, turn out to be exactly the advances, wrapped in a bow, the technologies China might use to squash dissidents.”


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By Jim Finkle

BOSTON (Reuters) – A new version of Mozilla’s popular Firefox Web browser is ready for download with improved security and memory use as the tiny company takes a stab at Microsoft Corp’s dominant Internet Explorer.

The program’s creators told Reuters on Thursday that the privately-held company’s trial version of Firefox 3 browser is ready for the masses to use after months of development.

Until now, the company has discouraged average Internet users from moving on from Firefox 2, which was launched in October 2006.

“In many ways it (Firefox 3) is much more stable than anything else out there,” Mozilla Corp Vice President of Engineering Mike Schroepfer said in an interview.

Key rivals to Firefox are market leader Microsoft’s Internet Explorer and Apple Inc’s Safari browser.

Engineers at Mozilla are still putting the finishing touches on the software and hope to release the final version of Firefox 3 by the end of June, Schroepfer said.

Mozilla is in a battle with Microsoft, which unveiled an experimental version of its Internet Explorer 8 in Las Vegas earlier this month and is looking to expand its presence on the Web through its bid to acquire Yahoo Inc.

Additions boost security and allow users to run Web sites when they are not connected to the Internet. Mozilla also says Firefox 3 uses less computer memory than Firefox 2.

Until now Mozilla has discouraged the typical computer user from exploring these new features. But its developers said on Thursday that the situation has changed and that they will be revising their Web site.

As of Thursday afternoon, the Web site still stated: “We do not recommend that anyone other than developers and testers download the Firefox 3 beta 4 milestone release. It is intended for testing purposes only.”

But they said that as they concluded their fourth round of tweaking their software, they determined it was ready for prime time.

A fifth round of changes, due to begin within the next few weeks, will involve “tuning the visual look and feel of the program” and further improving its stability,” Schroepfer said.

(Reporting by Jim Finkle; Editing by Brian Moss)

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Employees need to know their organization’s policies on E-mail and the Internet

It’s essential for some jobs, handy for most, but don’t be fooled—the personal computer can be a job ender. Even as you read this story, you should probably be asking yourself: Am I actually allowed to browse online and read news stories at the office?

The parameters for computer use at work (and even at home) are often confusing. We communicate, network, watch our TV shows, do our grocery shopping, and get our news on our computers. But it’s no free-for-all. Employees should know exactly what their employer’s policies are for E-mail and Internet usage, because workers are losing their jobs after computer-based missteps. Here are five ways to log on and lose your job:

Blog it up. Blogger Chez Pazienza worked as a producer at CNN’s American Morning until mid-February, when Pazienza says his boss informed him that the company discovered his name attached to blog posts written without CNN’s approval. Pazienza was fired soon after. Pazienza runs Deus Ex Malcontent, where he writes about Oprah and President Bush with equal abandon. He hadn’t identified himself as a CNN employee on the blog, but CNN spokeswoman Barbara Levin says company policy is that employees must first get permission to write for a non-CNN outlet. Levin didn’t elaborate, noting that the company does not comment on personnel matters.

There’s even a term for being fired because of a blog—it’s called being “dooced.” While some blogging advocates say a well-executed blog can boost your career by presenting your best side to the HR executives Googling you, there are limitations. Dooce.com founder Heather Armstrong writes on her site that she lost her job a year after beginning the blog for writing entries that involved colleagues. She now tells site visitors, “Be ye not so stupid” and offers parameters for safe blogging: “Never write about work on the Internet unless your boss knows and sanctions the fact that you are writing about work on the Internet.”

Play a way. Solitaire, that ever seductive way to while away the hours, is probably not a great choice for the workplace. New York City Mayor Michael Bloomberg caught sight of a solitaire game on a city employee’s computer screen in 2006 and fired him. “I expect all city workers, including myself, to work hard,” Bloomberg said then.

Richard Bayer, an economist and chief operating officer of the Five O’Clock Club, an outplacement and career coaching organization, says employees who use a company computer for personal matters on company time—whether playing solitaire or checking on their 401(k)’s—are essentially stealing from their employer. “It’s a new, 21st-century form of theft,” Bayer says, adding that a couple of personal E-mails each day are within reason.

Look at pics. Yes, those kind of pics. Think about this: Nearly one third of bosses have fired workers for misusing the Internet, according to a recent study by the American Management Association and the ePolicy Institute. Eighty-four percent of those employers said the reason was the viewing, downloading, or uploading of inappropriate or offensive content. The Washington, D.C., city government recommended the termination of nine employees in January for allegedly looking at pornography sites at work. The key here is privacy—as in, tell yourself you have none. The computer system belongs to the company, and courts have consistently sided with employers when it comes to computer-related terminations, says Nancy Flynn, executive director of the ePolicy Institute.

Post your pics. Social networking may quickly gain an air of formality. The mayor of tiny Arlington, Ore. (population nearly 500), grabbed headlines recently after she was recalled by voters. Among other issues, the residents were sharply divided over the propriety of photos of the mayor dressed in her underwear that were posted to her MySpace page.

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By Rory Cellan-Jones
Technology correspondent, BBC News
The creator of the web has said consumers need to be protected against systems which can track their activity on the internet.

Sir Tim Berners-Lee told BBC News he would change his internet provider if it introduced such a system.

Plans by leading internet providers to use Phorm, a company which tracks web activity to create personalised adverts, have sparked controversy.

Sir Tim said he did not want his ISP to track which websites he visited.

“I want to know if I look up a whole lot of books about some form of cancer that that’s not going to get to my insurance company and I’m going to find my insurance premium is going to go up by 5% because they’ve figured I’m looking at those books,” he said.

Sir Tim said his data and web history belonged to him.

I think consumers rights in this are very important – we haven’t seen the results of these systems being used
Sir Tim Berners-Lee

He said: “It’s mine – you can’t have it. If you want to use it for something, then you have to negotiate with me. I have to agree, I have to understand what I’m getting in return.”

Phorm has said its system offers security benefits which will warn users about potential phishing sites – websites which attempt to con users into handing over personal data.

The advertising system created by Phorm highlights a growing trend for online advertising tools – using personal data and web habits to target advertising.

Social network Facebook was widely criticised when it attempted to introduce an ad system, called Beacon, which leveraged people’s habits on and off the site in order to provide personal ads.

‘No strings’

The company was forced to give customers a universal opt out after negative coverage in the media.

Sir Tim added: “I myself feel that it is very important that my ISP supplies internet to my house like the water company supplies water to my house. It supplies connectivity with no strings attached. My ISP doesn’t control which websites I go to, it doesn’t monitor which websites I go to.”

Talk Talk has said its customers would have to opt in to use Phorm, while the two other companies which have signed up – BT and Virgin – are still considering both opt in or opt out options.

Sir Tim said he supported an opt-in system.

“I think consumers rights in this are very important. We haven’t seen the results of these systems being used.”

We should look out for snags in the future – things can change so fast on the internet
Sir Tim Berners-Lee

Privacy campaigners have questioned the legality of ISPs intercepting their customers’ web-surfing habits.

But the Home Office in the UK has drawn up guidance which suggests the ISPs will conform with the law if customers have given consent.

Sir Tim also said the spread of social networks like Facebook and MySpace was a good example of increasing involvement in the web. But he had a warning for young people about putting personal data on these sites.

“Imagine that everything you are typing is being read by the person you are applying to for your first job. Imagine that it’s all going to be seen by your parents and your grandparents and your grandchildren as well.”

But he said he had tried out several of the sites, and thought they might in the end be even more popular with the elderly than with young people.

Sir Tim was on a short visit to Britain from his base at MIT in Boston, during which he met government ministers, academics and major corporations, to promote a new subject, Web Science.

This is a multi-disciplinary effort to study the web and try to guide its future. Sir Tim explained that there were now more web pages than there are neurons in the human brain, yet the shape and growth of the web were still not properly understood.

“We should look out for snags in the future,” he said, pointing to the way email had been swamped by spam as an example of how things could go wrong. “Things can change so fast on the internet.”

But he promised that what web scientists would produce over the coming years “will blow our minds”

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Rory Cellan-Jones

In the august surroundings of the Royal Society of Arts and Sciences, in a lecture theatre decorated with 18th Century paintings, a crowd gathered on Tuesday morning to celebrate the birth of a new science.

It’s called Web Science, and is an attempt to start understanding and exploring the ever growing phenomenon of the world wide web. Who better, then, to be the main speaker at today’s event than Sir Tim Berners-Lee, the inventor of the web?

Sir Tim began with a vivid picture of the way his baby has grown: “There are more pages out there on the web than there are neurons in your brain.” He went on to explain that he hadn’t been sure about using the word “science” in this new discipline because web science needed to reach out and include sociologists, philosophers and artists as well as the technical community.

“When we build the web,” he explained, “we choose a lot of the answers to philosophical questions. We are constructing a whole new world and we are writing down the rules. And a huge amount of the design involves the psychology of the user.” As an example he described how e-mail had taken off because users trusted each other to send only valuable material – but was now under threat because of spam: “The social assumptions have changed – people no longer assume that messages they are getting are messages they need.”

Sir Tim Berners-LeeSir Tim is working with the Southampton University computing science department, which along with Boston’s MIT, is leading the Web Science Research Initiative.

Professor Wendy Hall from Southampton (you can see an interview with her above) explained. “The web is the elephant in the room – it has transformed our lives, but we never see it. We feel the time has come to study it – to see its benefits and understand its possible dis-benefits.”

Her colleague Professor Nigel Shadbolt sketched out some early projects to illustrate the areas the new science might investigate. He showed a map of the blogosphere – “it’s a butterfly shape” – which illustrated the way communities coalesce around certain blogs. He showed why research into Wikipedia needed a sociological angle – what drives the users to write entries? – As well as technical analysis of the patterns of its growth.

Professor Shadbolt also gave some insights into the semantic web – a project which Tim Berners-Lee and the Southampton University academics have been pursuing for some time, to a degree of scepticism from other parts of the web community. He described plans to give every fact on the internet its own web address, with the aim of building a “data web” where every connection was more clear and more searchable. “So you could ask questions like show me all the tennis players in Moscow,” he explained.

Of course, scientists have been examining the web for some time. Now, though, they are trying to work out how they can guide its future growth. Tim Berners-Lee puts it like this: “The web is basically a web of people. Because it’s something we created, we have a duty to make it better.”

But the web has grown and prospered without any real guiding hand, despite the attempts of governments and businesses to bend it to their will. So can the web scientists really do anything to shape its future?

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By JESSICA MINTZ, AP Technology Writer 

SEATTLE – Microsoft Corp. gave early testers their first glimpse of its next-generation Web browser Wednesday, and said Internet Explorer 8 will adhere to the same standards as competitors’ programs.

Microsoft‘s browsers, including the current Internet Explorer 7, gained notoriety among Web developers for handling Web page code differently than Mozilla Corp.’s Firefox, Apple Inc.‘s Safari, the now-defunct Netscape Navigator and others.

For the most part, major non-Microsoft browsers and outside developers who built Web pages worked with agreed-upon technical standards, while Microsoft was accused of adding proprietary code to those standards. The result: Web pages that looked good in Internet Explorer but broke on other browsers, or vice versa.

At a Web developer conference in Las Vegas Wednesday, Dean Hachamovitch, general manager for Microsoft’s Internet Explorer division, made light of Microsoft’s past spotty standards and pledged to do better.

Hachamovitch said that in early Internet Explorer 7 days, his kids would hear about broken Web sites and ask, “Daddy, did you guys break the Web?”

“And most of the time I could honestly say, ‘No.’ But, you know, Web developers might answer that question a little bit differently,” Hachamovitch said.

He elicited a laugh, but developers have sometimes had to build Web sites from scratch a second time to devise a version that worked with Microsoft’s browsers.

Microsoft said the new version of the browser, when complete, will support industry-standard versions of the code that tells browsers what Web pages should look like, including CSS 2.1, by default.

“That’s a big deal,” said Chris Swenson, a software industry analyst for the NPD Group.

While most Web surfers might not feel a huge impact, Swenson said it will bring “a sigh of relief” for developers, who will spend a lot less time tweaking Web pages to work with different browsers.

However, both Swenson and Microsoft note that Web standards continue to evolve, and that definitive tests to determine compliance don’t yet exist. Microsoft indicated Wednesday its intention to step up involvement with this process.

Microsoft’s decision might also help it fend off a new antitrust investigation in Europe.

Regulators there are looking into whether the software maker held other browsers back by not following open Internet standards. The probe was launched after Norwegian browser developer Opera Software ASA filed a complaint in late 2007.

Microsoft unveiled a few features in the new browser that may appeal more to average Web users. For example, right-clicking on a Web page will give people more “to-do” options than they’d see today. Users will be able to “Send to Facebook,” “Map with Live Search” or “Define with Dictionary.com” with a quick click.


On the Net:

Microsoft’s Internet Explorer 8 site:


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Hospitals are suffering from IT growing pains. “The reality,” says Vi Shaffer, research vice president for Gartner, “is that having more information more accessible changes the rules for everyone.” In the middle of it all are CIOs, who must bridge the old and the new, often learning their evolving role on the fly.

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Don’t call U.S. hospitals IT wannabes anymore. For years they suffered by comparison with digitally savvy industries like financial services and insurance, which typically spent almost 10 percent of operating budgets to automate both backroom and customer-facing systems. By contrast, the healthcare Latest News about healthcare industry’s budget commitments languished closer to 2 percent.

That’s changing. Hospitals now devote about 7 percent of their operating budgets to clinical, business and patient-outreach applications, according to technology researcher Gartner (NYSE: IT) Latest News about Gartner. “As we look at the adoption of evidence-based care, it almost demands that you have automation to support that,” says Ken Lawonn, senior vice president and chief information officer of Alegent Health, Omaha, Neb.

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Automation Angst

This infusion of cash and automation is heightening tensions around IT, though, and the strains are beginning to show:

  • In a handful of recent surveys, nurses say many benefits of technology are outweighed by clumsy user interfaces and time-draining sign-on procedures that are impractical in the crush of daily work.
  • Risk managers worry about the rush to automate without adequate planning and training. “One of things that concerns me is the speed at which we are trying to implement new technology and processes. Too often, a tech solution is slapped on top of a manual process without a thorough review of the process itself, and the impact it might have on related processes,” says Douglas J. Borg, director of insurance for the Duke University Latest News about Duke University Health System, Durham, N.C.
  • Hospital executives are scrambling to figure out the legal implications of relying on digital records as new “e-discovery” laws require hospitals to quickly deliver every electronic document requested for legal proceedings.
  • Government and private payers contribute their own challenges with pay-for-performance rules that pressure hospitals to spend money on statistical systems for analyzing outcomes and reimbursements.
  • In the middle of it all are CIOs, who must bridge the old and the new, often learning their evolving role on the fly. “[CIOs] are much more engaged in the fabric of the actual day-to-day operations,” Lawonn says. “We’re using IT at the point of care, and we’re interacting in real-time with nurses, physicians, physical therapists. Our interactions today are within the workflow of how you provide patient care.”

All of which leaves hospitals with IT growing pains. “The reality,” says Vi Shaffer, research vice president for Gartner, “is that having more information more accessible changes the rules for everyone.”

Fault Lines Appear

To many people’s surprise-and relief — healthcare is starting to outpace certain other industries when it comes to technology adoption. For example, while a study published in December 2007 by Diamond Management and Technology Consultants found only a third of CEOs across American industries championed technology and included CIOs in strategic planning, almost 70 percent of healthcare respondents say the senior business leader is an active IT proponent. By similar percentages, healthcare organizations say the CIO and the person in charge of business strategy were both “very involved” in the integration of business and IT.

However, a study by Spyglass Consulting Group found that 64 percent of nurses consider wireless infrastructure too unreliable to support point-of-care applications, a prime component in bedside documentation for EMRs. So-called wireless “dead zones” make network access impossible or drop established connections. As a result, most acute care nurses say they keep PC carts in hallways and out of patient rooms, instead preferring to use them like fixed-location terminals.

The Spyglass study also reported that point-of-care applications typically don’t integrate well with nurses’ work practices. For example, to use a bar-code reader prior to administering a medication, a nurse must find a mobile cart, wheel it into the room, log in to the system, find the patients record, and then finally scan the medication. “It just takes phenomenally longer than what nurses are used to doing,” says Gregg Malkary, Spyglass managing director.

So how do nurses respond? “In some organizations, nurses are cutting off all the patients’ wristbands and wanding them all at the nurses’ station. The idea is, ‘If I can do everything at once, I can save myself a lot of time and a lot of steps,'” Malkary says.

Other problems for nurses arise because clinical applications may not be able to share data even if each is designed to support industry-wide data standards, warns Jan Wilson, R.N., manager for nursing information systems at Lehigh Valley Hospital, in Allentown, Pa. For example, when a patient moves from the emergency department to the med-surg floor, nurses often need to consult two different applications for vital signs rather than seeing a combined summary. “So, nurses either have to learn multiple software programs or they defeat the purpose [of electronic systems] and print out reports so they can review information from another system. We have a long way to go before we’ll see data across the continuum.”

Hospitals are circumventing workarounds with almost obsessive up-front planning and lengthy rollout schedules. Methodist Hospital of Southern California in Arcadia has been planning for almost two years to fully turn its new electronic charting system into a full-blown EMR. Over the next year, nurses will electronically input only initial assessment data and the patients’ belongings list until the entire staff becomes comfortable with the technology.

“We’re taking baby steps and are going very slowly,” says Steve Owens, R.N., director of nursing administration and transitional services. “We overdid [the slow pace], but that was good. Its made us successful.”

Methodist also ran a 24-hour “command center” for seven days after the program’s go live to connect nurses with staff “super users,” a consultant, or the nurse informatics officer if problems arose.

A survey of nurses by healthcare researcher KLAS also points to other factors leading to uneasy relationships among clinicians and clinical IT. The frustrations aren’t caused by “a genetic trait of clinical people” prone to dismissing technology, stresses Kent Gale, KLAS president. On the contrary, nurses who regularly operate high-tech diagnostic equipment and CT scanners would readily accept clinical programs that enhance productivity Save up to $500 off top-selling HP printers. and patient care. KLAS found low adoption rates by nurses for applications designed to automate core activities like patient discharging because the programs were too cumbersome. “There’s a lot of redundancy — you have to enter things two or three different times in two or three different places,” Gale says. Nurses “basically say that the vendors stopped before they finished” perfecting the design of their software.

Ironically, CIOs and nurses find common ground in the battle against applications that don’t work as advertised. A decade ago, hospitals followed an IT-centric approach to clinical systems, Wilson says. “Now I don’t think an IT analyst makes any decisions without talking to clinical users. From the way systems are designed to how they’re upgraded, it’s a lot more clinically driven and much more collaborative,” she says.

In the KLAS survey, IT managers also complained that “the care and feeding [of some nursing applications] was more than they would like to see,” says Gale. “IT departments are saying, ‘Vendors need to do a better job testing their own software before they give it to us.’ ”

Increased Risks

The frustrations highlighted in these surveys don’t point only to personnel issues; they also have wide-ranging legal implications, CIOs and consultants say. When clinicians enter data multiple times in the same or different applications, they increase the chance for errors, Malkary says.

Dead zones in wireless networks may prompt a nurse to administer a bedside medication without the bar-code safety check, Gale cautions. System errors that result in lost or inadvertently altered medical data are another concern. “When we think about the reliance on technology for direct patient care, do we have the appropriate kinds of [liability] coverage for an event where we might have a system outage?” Alegen’s Lawonn asks. “We have been having conversations with the folks in risk management about new kinds of coverage that we may need, given the fact that we have these electronic media for capture, storage or retrieval.”

Rules for legal discovery — the request for relevant information from a hospital for research in litigation — were expanded in 2007 to more broadly cover electronic data.

The new regulations are causing hospitals to review their processes for the disclosure of information, as well as data retention and destruction policies, says Duke’s Borg. “It will be important for hospitals to work closely with their counsel to determine what policy additions and changes might be necessary. We’ve only [seen] the tip of the iceberg on this issue,” he says.

“Everything is discoverable now, including e-mails and [instant messages],” explains Tom Weakland, managing partner in Diamond Managemen’s healthcare practice. “Managing all that technology is much more complex, especially in a large organization where you have lots of physicians all communicating and collaborating together.”

A lot of companies discourage or even prohibit IM use, Weakland says, “because they haven’t figured out how to track it and make it discoverable. Others have pretty strict standards around what you can and can’t e-mail.”

Another potential risk comes because some core hospital systems still run on decades-old applications with outdated capabilities, such as the inability to create long, harder-to-hack passwords. CIOs know these programs don’t meet today’s best practices, but IT managers must accept them for the time being. “You just run up against a brick wall because you can’t do what you can’t do,” says Joel Wagner, vice president of global delivery at Eclipsys Corp., a health IT software vendor. In addition, more resources must now be spent for behind-the-scenes technologies designed to avoid downtime and data loss. “Business continuity used to be more of an option for a community-based hospital. Now it isn’t,” he adds.

For Alegent’s Lawonn, continuity and recovery strategies mean spending more for alternate power sources and system-wide redundancies. Still, the biggest availability threats remain regular maintenance downtime. “If you’ve got to make a change to the application you’ve got to bring it down,” he says. He works with vendors and systems integrators to keep the disruptions as short as possible by having revisions and patches ready for uploading. “And then we keep talking to our provider about zero downtime. We’ve just got to get there,” he says.

Borg says that all of these new potential risks hasn’t led Duke to expand its liability coverage, although other hospitals are considering so-called “cyber-liability” insurance to mitigate the loss or misuse of electronic data. Instead, Duke is opting for prudence based on careful front-end planning to examine and document new technology-based processes before they’re implemented. “We pilot everything to work out issues and problems before [an application] is released for broader usage,” he explains. “It takes a group with both clinical and technical skills to manage [the evaluation process] successfully.”

Increased Scrutiny

CIOs face pressures to add another genre of applications that isn’t directly related to patient care but one that’s increasingly vital to hospital operations — analytical software to address the rise in pay-for-performance plans.

First, hospitals need internal analyses to understand how well they’re meeting industry quality measures, such as the Joint Commission’s Core Measurement rankings. In addition to moving hospitals toward better patient outcomes, the analyses should tell organizations how profitable their procedures are for treating various illnesses. “Looking at how we treat pneumonia patients is an organizational question,” Gartner’s Shaffer says. “How do we treat them, how do we get paid for them, and are we going to make money on them?”

Second, hospitals need comprehensive outcome information to see how they’re complying with evolving reimbursement rules from federal agencies and private insurance companies. For example, the Centers for Medicare & Medicaid Services says it will change how it pays for healthcare-associated infections and clinical mistakes. The challenge for hospitals is how to collect data to show they are receiving all the money they’re due under those new rules, Shaffer says.

Fish Memorial’s Scorecards

To help with CMS core measures reporting, Florida Hospital Fish Memorial in Orange City added electronic scorecards to its operations to summarize clinical performance, such as whether patients diagnosed with pneumonia received the proper antibiotics within the four-hour timeline set by CMS. The hospital worked with its EMR vendor, Cerner, to develop the scorecard module and now sees some measurements within a minute of the activities.

“Based on this technology, we continuously adjust our processes,” says Evie Lowe, R.N., chief operating officer. “We have a team for evidence-based practice that looks at our current data and what we need to do to improve certain areas. The results are also rolled up to the corporate level where they review the system-wide results on a quarterly basis.”

Fish Memorial used the performance summaries to improve treatment of influenza and pneumonia patients. “We found we were right where we wanted to be, so we created a multidiscipline team to work out a process,” says Karl Jacob, R.N., quality manager. “We’ve had at least a 50 percent improvement in our results in one year.” Actions included programs to vaccinate more of the high-risk members of the community, he adds.

The answer could be a greater reliance on business intelligence applications, a category of software that will likely be one of the biggest growth areas in the next year, according to analysts. Diamond Management says data mining Latest News about data mining and analysis programs were cited by hospital executives most often as tools to transform the businesses. “They realize that not only are you strategically dependent upon technology to do your day’s business, but you are also starting to become more and more dependent upon technology’s ability to help you analyze all of the different information you have available to you as an organization,” Weakland says.

In addition, with the push for greater insights into internal operations, pay-for-performance programs will increase reliance on business intelligence for external reports, which will also require CIOs to develop new working relationships. “The CIO is having to both work more closely with the clinical staff and to better understand how information that comes out of IT is framing the way that the institution is perceived by the outside world,” says Jeff Luck, director at SG2, a healthcare consultant.

Lke other sophisticated technologies, a new business intelligence application may not immediately deliver on its full potential, says William Woodson, vice president at SG2.

“It’s proving to be quite cumbersome, even for places that have reasonably good EMR systems,” he says. The problem is that much of the data from ambulatory operations is still captured with pen and paper. Melding it with electronic information into an analytical program requires someone to manually pull data from charts and enter it into digital systems — a time-ccrisuming process.

“We expect to see more metrics coming into the world that are combined inpatient/outpatient [information],” Woodson says. “There’s going to be some heavy lifting for most of the industry for a while.”

New Job Descriptions

Pressures for greater clinical buy-in to technology, new legal risks, and a growing requirement for more detailed performance measurements are redefining what it means to be a CIO.

It puts some CIOs at a career crossroads. Some top IT managers must work to maintain their newfound influence by immersing themselves in the needs of clinicians and business managers, Shaffer says. “If CIOs devolve into saying, Those are other people’s problems — I keep phones working and the e-mail running,’ then they are essentially demoting themselves and relying on others to determine their fate,” she says.

© 2008 Hospitals & Health Networks. All rights reserved.
© 2008 ECT News Network. All rights reserved.

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