Structured Analysis/Design Methodologies & HIPAA

Here is one of the first articles I’ve seen that explores the approach of applying structured analysis methodologies such as Unified Modeling Language (UML), definition here, to the HIPAA challenge.

Though I’m an advocate of both conventional (Gane/Sarson) and more current UML methodologies with respect to system/software development and business process re-engineering, ten years of professional practice as a business systems analyst has demonstrated that the majority of organizations will not pay for the professionals and the Computer Aided Software Engineering (CASE) tools needed to support modern-day structured analysis and development.

Those organizations that do fund a structured approach like UML have a tough-time suffering the time frames needed to gather requirements, analyze needs and document the results, before beginning to develop and implement a new design. This is true even for executives and managers who understand the long-term benefits of this approach over conventional analysis and development methodologies.

Extreme programming/data modeling, and even a condensed UML approach (Extreme UML) are in the works by some advocates, in an attempt to shorten the lifecycle of a structured analysis and design project. If these efforts are successful, one expected result would be that more organizations would adopt and fund a structured analysis and development approach, as opposed to hacking away endlessly trying to bring an organization into compliance with HIPAA.

it-costs-too-much-compared-to-what

Medscape (free login required) has a conference report on how technology is changing medical education, particularly via PDA’s. What is notably missing is actual patient records at the point of care. ‘…Currently…most medical students do not use their PDAs for patient-encounter information. Deleshia Kinney, a first-year medical student from Southern Illinois University, noted, “Right now I use my PDA for references, PBL questions, and research. I know that they will be useful for clinical encounters and annotation, once the issues of confidentiality, security, and ease of updating software have been addressed.”

ZDNet: Insurer Considers Microsoft NT High-Risk

ZDNet is reporting that: ‘…J.S. Wurzler Underwriting Managers, one of the first companies to offer hacker insurance, has begun charging its clients 5 percent to 15 percent more if they use Microsoft’s Windows NT software in their Internet operations. Although several larger insurers said they won’t increase their NT-related premiums, Wurzler’s announcement indicates growing frustration with the ongoing discoveries of vulnerabilities in Microsoft’s products…”We saw that our NT-based clients were having more downtime” due to hacking, says John Wurzler, founder and CEO of the Michigan company, which has been selling hacker insurance since 1998…’

September 2001 OSHCA Meeting Draft Agenda Released

The Open Source Healthcare Alliance (OSHCA) has a draft agenda for their September 6-7 meeting at The Forte Posthouse Kensington in London with a number of luminaries: Glyn Moody, author of ‘Rebel Code’, Bob Mayes of the US Center for Disease Control, Dr. David Chan, author of the OSCAR (Open Source Computerized Ambulatory Records) family practice software and others are slated to attend. The SPIRIT project will also hold a workshop. Others such as the keynote speaker are to be announced.

Algorithms in Africa

Thanks to Karsten for this link: Algorithms in Africa is a thoughtful look at some of the ethical issues of computerization in 3rd world countries with emphasis on sustainability after 1st world installers have gone home. ‘…The center, located in a rural village of southern Uganda, provides food, medical care and education to about 600 children, most of whom have been orphaned by AIDS. The conditions are austere: one book for ten children, a tiny blackboard and a roof with holes. Bram found that his skills could help at Kibaale, his help made a difference. After a year spent working with the Centre, he wanted to find ways he could continue helping the project while also letting other people know of its existence. That’s when Bram hit on the idea of “charityware” for Vim. The license for Vim says simply: “Vim is Charityware. You can use and copy it as much as you like, but you are encouraged to make a donation to orphans in Uganda. Please read the file doc/uganda.txt for details.”…’

Review: Linux vs. Windows 98 Scanning

Updated 5/24/01: Read in the comments section on sharpening algorithms. I finally broke down and shelled out some dollars for a scanner, an Epson Perfection 1240U Photo in order to add a few pics to LinuxMedNews.com. Having plunked down my money I thought I might as well do a side by side test of the scanner on Linux and Windows. I was prepared to be disappointed in Linux due to previous experience with sound card and video configuration. Read on to see what happened.

The Epson Perfection 1240U Photo I bought was $217 from Computers4Sure. It is a USB device which includes a transparency adapter for scanning negatives and other films. The scans were done on the same machine dual-booted to Windows 98SE and RedHat Linux 7.1 using the defaults for all software.

Installation for both Linux and Windows receive a B+. It came down to two issues: both had annoying installation problems but Windows was somewhat easier to install. This was negated by the bundled manufacturers software NOT being as good as Linux! Xsane (“Scanner Access Now Easy”, the Linux scanner graphic user interface program) was more cleanly laid out and better suited to its purpose than the manufacturers bundled scanning software. Xsane supported every feature of the scanner, including the transparency unit. Along with GIMP, the combination was quite powerful. What’s more, I didn’t have to install it as RedHat 7.1 already had placed it on my machine. A major minus is that I had to surf the web to find out that xsane was the scanning software for Linux and I had to find and enter some magic incantations and edit /etc/sane.d/epson.conf to get it to work. Moreover, I found the included Adobe(TM) PhotoDeluxe(tm) software bundled on Windows to be clumsy, non-standard and had an excessive number of screen changes to get tasks done. It seemed like more of an advertisement than ‘serious’ software and it became intrusive. The FilmFactory photo organizing crippleware, er, software was also a disappointment.

After paying $217 for the scanner and bundled software, I found that you had to fork over $40 more to use the full version of FilmFactory which was virtually unusable in its ‘free’ bundled form. Not good. While one of its GNOME counterparts gAlbum looks somewhat deserted on Sourceforge it provided a fair amount of functionality without the absurd limits that the out-of-the-box FilmFactory had: 5 ‘roll’ limit, and file format export limited to GIF and BMP. That is unless you wished to shell out $40 for the full version.

I did not notice any appreciable difference between scanner speed on Windows and Linux. The scanned in photos both became blocky with greater than 200% Zoom of a picture. However, picture colors were more accurate with Linux.

This picture was scanned using the Epson bundled scanner software on Windows, while this one was scanned using the xsane 0.62 software on RedHat Linux 7.1 at identical 200 dpi originally TIF file format, but converted to JPEG for display on the web. I’ve put them in a large size so that a close comparison can be done and I used default settings on all software for an out-of-box experience. The flesh tones and colors are less vibrant on the Linux scanned picture, however, the Linux scan is much closer to what the actual photograph looks like. The blue chair is too blue and the flesh tone is more colorful than the actual photo in the Windows scan. Update 5/24/01: a reader has found that the Windows scan has been put through a ‘sharpening’ algorithm that is present in GIMP, but not default. Sharpening with GIMP results in a sharper scan on Linux which you can see here.

In conclusion, which is better? I call it a tie. Once the hardware was installed, scanning software on Linux was better than Windows. Linux lost a few points for having to figure out which software did scanning, and having to edit a configuration file. But, it gained it back with the ‘bundled’ xsane software for Linux which was more suited to task than its equivalents on Windows. Scanned picture colors were more accurate on Linux than Windows. Finally, you don’t have to put up with company logo’s and splash screens at every turn with the bundled Windows software which seemed to compromise the user interface.

DigitalCoast: What’s Next for Epocrates?

DigitalCoast has an extensive article on the origins of ePocrates, the successful free prescription drug database for Palm. ePocrates is getting into other follow-on applications like e-prescriptions but surprise, surprise, they may not be free: ‘…In February, ePocrates began a small rollout of its own electronic prescription writing application. Working in conjunction with PBM Advance PCS, it has developed software that allows doctors to electronically renew prescriptions via their handheld devices. Each time a prescription is renewed, ePocrates will collect a transaction fee ranging from 25 cents to $1. Snyder said the product should be available on a larger scale by the year’s end…’ Seems kind of steep to me, but they are in a position to exploit their market position. The article is a good read for those interested in how they made the original ePocrates successful.

FreeMed: ‘Stable Enough for Production’

The FreeMed project is announcing that: ‘Version 0.2.1.2 (Thelonious/CVS) is now available on sourceforge and http://www.freemed.org/. It features a lot of bugfixes from last time, but also has Lucid’s nice calendar application integrated in by way of loadable calendar modules, thanks to Chris at Lucid. This is the second in a series of CVS releases of FreeMED. Even though it is a CVS release, several locations are using this version, and it should be stable enough for a production environment.

Digital Signature Debate Enters the Mainstream

Peter Waegemann,CEO of the Medical Records Institute is interviewed by the NY Times about digital signatures and the lack of a DS requirement in the HIPPA regulations: ‘…Mr. Waegemann, a businessman who is also chairman of an industry standards group, is pressing for the use of so-called electronic signatures that would add an authentication code to each document. His concern stems from a federal law that by October 2002 will require health care providers and insurers, as well as government programs like Medicare and Medicaid, to start conducting their administrative transactions electronically…’

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