Health in the Clouds

The current administration has set a goal of having the federal government to invest in electronic health records so that all medical records are digitized within 5 years. This marks the same timeframe goal that was set by the previous Bush administration to digitize health records by 2014. This is a hugely ambitious undertaking considering that there is currently no standard for health records nor is the technology tested and ready for this massive of a project.

This will be a real test of the "cloud computing" that we are hearing so much about. The data will all be stored so that it can be accessed by health care professionals across the country in short order.

The anticipated benefit will be reduced costs and fewer mistakes because of comprehensive accurate records, however, this is certainly not guaranteed. As I have discussed before in my garbage in garbage out blog, the data would be suspect and no physician would trust it and risk his malpractice on it. Additionally they think it would reduce duplicate testing and other lab work, however, like I said, how the data is maintained is the key to the reliability of the data.
It is a lofty goal, and someday the data will be accessible electronically in some format, but until the mechanics are worked out, there is no way to get the data gathered. If transcription is required from hand written notes to the electronic format then there will be transcription errors. Scanning will be a huge undertaking and there are too many open issues yet to proceed.

As the government considers national health care, then some of these records will be standardized and this system could start. I think it would be wiser to just start keeping electronic records and let time make the database more and more complete vice trying to import generations of medical history and knowledge. We should look to the UK and watch them try to implement a simliar multibillion dollar system which has produced mixed results. Mixed results are not what the health profession needs to improve health care in this country.

One thing that really could be of benefit to the millions of health records is that the data could be mined for a treasure trove of data which could be then used in tracking and treatment of illnesses. This data is not centralized now and only the CDC gets scattered reports to try and identify trends and other health related issues that could be picked up earlier and thus have a better cure rate.

InformationWeek KC Jones January 12, 2009

Chapter 12 Case Study Questions

What problems are hospitals and physicians encountering in diagnosing diseases and prescribing medications? What management, organization, and technology factors are responsible for these problems?

Physicians and hospitals are suffering the same problems that they have for years and years. Even though they have put in some computer systems, for the most part they are still ultimately responsible for the diagnosis and the treatment of the patients. Most of the time they do that from experience and do not rely on information technology to assist. Seems that most medical offices use IT systems for scheduling and for recordkeeping. I think most of the problems stem from the egos of the doctors in not wanting to be second guessed in their assessment of the diagnosis. Certainly there is an art to it and physical factors are only a part of a patient condition that needs to be incorporated into a diagnosis. Additionally, since doctors are not pressing for it, management is not pushing it because of the up front costs associated with the system. The intial setup and programming is not standardized yet thus each system is very customized which costs a considerable amount of money. Pharmacies are much more computerized and better at checking medications for adverse interactions between medications.

Are CPOE and DDS systems appropriate solutions? Why or why not? What management, technology, and organization issues are involved in the use of these systems?

I think that CPOE and DDS systems are a part of the solution but not entirely. The human aspect of healing will always be a necessary part of the process. Once they become more accessible and less intrusive and obvious to the patient, a doctor can use them to reinforce his memory. The main issues are the privacy issues of the patient. It will take effort from all the various parts of the health care industry to implement a total solution. The current administration has high hopes in this area, but there are some huge hurdles to overcome before they return benefits equal to the costs.

What obstacles prevent computers systems from improving the medical industry? How can these obstacles be removed?

Right now there are two huge obstacles. First obstacle is the doctors who typically have huge egos and don’t want to be seen as one who needs help from a computer in front of his patient. The other are patients typically older and still view the doctor as all knowing. They will follow the diagnosis without questioning it regardless if it makes sense or not. As they die off, and the younger generation starts to be more customers of the health profession, they will be more open to computer aided diagnosis. Time will solve many of these obsacles as software becomes more advanced and more of the computer generation moves into the professions the old ways will go by the wayside.

The Squeeze in Online Ads

Everyone knows that advertising revenues are down significantly over the past year. The noticeable impacts can be seen at the many newspapers that have gone out of business from lack of revenue. The reality is that it’s not just hitting the newspapers but even web advertising is down from businesses holding back due to the slow economy.

Google has made many fortunes with it’s Adsense program and because of the size and success of Google they dominate a significant portion of the advertising space available online, however this article in the March 2nd issue of Business Week talks about a niche market that is getting the attention of the big names. Seems like many companies are starting their own advertising networks which are focusing on web pages and websites that have less traffic where advertising may not be found. The audience that is reaching these websites are smaller, however the content of the webpage may be of better quality and thus a more targeted reader.

Advertising today is typically done on the pay per click model so the goal is to get the clicked by the person who is best targeted for your market. The order of the listing is typically headed by those willing to pay the most per click. These prices are constantly bid on and the best search terms are often very competitive and expensive. These smaller advertising networks might not advertise on the highest traffic sites, but they may offer a more targeted customer and the article talks about the price being much less than the same terms on Google.

The article talks about sites like Yahoo and Martha Stewart starting their own advertising networks. This strategy certainly makes sense to a seach engine like Yahoo who has the traffic to make some serious money, additionally, this advertising strategy makes sense to the e-retailer because he/she can get a targeted customer to the site for less money, and that reduces overhead leading to higher margin.

And HIGHER MARGINS, is what business is about.

Chapter 9 case study - Limited Brands Inc

2. Describe the supply chain management problems encountered by Limited Brands in this case. What was their business impact?
The supply chain management became unwieldy and ineffective due to lack of attention of the supply chain throughout the growth spurt. As a result, Limited Brands found themselves being pushed out of the locations by the discount retailers who were able to better compete for the prime locations. Ineffective supply chain management caused slower response to market changes that negatively impacted retail operations. For a trendy store like The Limited, this is delay is a significant issue and may force the store into chasing trends rather than setting them. Trendsetting is critical to a higher end retailer to keep margins higher.

3. What management, organization, and technology factors were responsible for these problems?

Limited brands had 2 major problems in their supply chain however both were caused by the fast rate of growth that the company had experienced. This problem was more complex because of the way that this growth occurred. The mixture of pure growth and strategic acquisitions made supply chain growth a challenge to manage. The first problem is that there was a lack of management attention and resources that were paid to the supply chain during this phase of rapid growth. It seemed the management was so focused on growth through acquisitions that they did not pay enough attention to the integration of the acquired companies into the Limited Brands family. This is what caused major problem number two. Trying to merge, marry, and manage multiple software and hardware configurations without resources or guidance from leadership a nightmare for the information technology infrastructure and employees as they tried to make it all work with limited resources and no corporate guidance.

4. How did Limited Brands solve these problems? What management, organization, and technology issues were addressed by the solution.

Limited Brands finally addressed this after a catastrophic day on the loading docks pointed out a significant weakness in their supply chain operations. Non-coordination between supply chain information resulted in 400 truck showing up trying to unload cargo at a facility that could only handle 38% of the trucks. Following this fiasco, Limited Brands management purchased consulting services to integrate the 60 or so varied supply management configurations that had accumulated over the years due to acquisitions. Not only was the consultant tasked with integrating these processes, they were tasked with creating scaleable software to allow integration and growth by both future organic growth and future acquisitions. In addition, Limited Brands formed a wholly owned subsidiary tasked with maintaining the logistics and supply chain management for the stores.