Volunteerism used to be something you did over the weekend for the overall good of society; however, now there's a Web site dedicated to "microvolunteerism." It kind of reminds me of the microbrews I enjoy. Not like the big conglomerate breweries, but a smaller, handcrafted batch of volunteerism.

The goal is to facilitate effective distributed volunteer work, which I guess is kind of like the church I attend organizing Habitat for Humanity workdays, which I will be participating in the for the first time this weekend. Ever since former President Jimmy Carter and his wife Rosalynn worked on Habitat for Humanity projects in 1984, I have been interested in the work the organization does. Each year since, the Carters have given a week of their time to build homes and raise awareness about the need for affordable housing. Check back in the coming weeks for my blog about my experience in this volunteer effort.

The Microvolunteerism Project, according to its Web presence, aims to build communities of not-for-profit projects and volunteers who can mutually support one another.

The Project organizes regular meetings, both in physical spaces and on Skype. There are also several links on the Microvolunteerism.org Web site, including MediaMatic and bidnetwork.org

There's also a technology focus in one of the microvolunteerism opportunities, The RFID Guardian Project.

According to the RFID Guardian Project's wiki, as its name indicates, the RFID Guardian Project is a collaborative effort whose focus is to provide security and privacy to radio frequency identification (RFID) systems. The goals of the project are to:

• investigate the security and privacy threats faced by RFID systems;
• design and implement real solutions against these threats; and
• investigate the associated technological and legal issues.

The RFID Guardian is a mobile battery-powered device that offers personal RFID security and privacy management. One of the focuses of the project is to build an RFID Guardian prototype.

Not sure if this is true microvolunteerism, but I'll work with it. I'm not sure how it is helping one's neighbor in need like a soup kitchen volunteer, local food pantry volunteer, tutor to young people volunteer or building a house for someone in need volunteer, but I can see that it has its place in our society.

There's also another interesting microvolunteerism site, picnicnetwork.org, which brings together creative minds from all over the world, including a gathering planned for September in Amsterdam for the fourth edition of PICNIC. It's really a creative person's conference/festival.

PICNIC collaborates on ideas and knowledge from creators and innovators, through a conference, with ample participative sessions, interactive experience, matchmaking events wrapped in a festival experience. PICNIC 09's program includes three days of inspiration, fun and sensory stimulation in media, technology, entertainment, art and science.

Tell me about your volunteerism experiences from this summer and I will post them online over the summer. And, be sure to check back here later this summer for my report on my first experience with Habitat.

In a recent Green IT Report by Symantec Corp., a follow-up to its Green Data Center report released in 2007, senior-level IT executives report significant interest in green IT strategies and solutions, attributing their interest to cost reductions and environmental responsibility. (Editor's note: Be sure to read our "Going Green in IT," the top story in our July digital edition.

Symantec's data points to a shift from simply implementing "green" technologies primarily for cost-reduction purposes, to a more balanced awareness of improving the organization's environmental standing.

Ninety-seven percent of respondents said they are at least discussing a green IT strategy, while 45 percent have implemented green IT initiatives. CIOs are increasingly justifying green IT solutions by more than cost and IT efficiency benefits. Respondents cited things such as reducing electricity consumption (90 percent), reducing cooling costs (87 percent), and corporate pressure to be "green" (86 percent). Furthermore, 83 percent of respondents are now responsible or cross-charged for the electricity consumed in the data center -- bringing visibility and accountability to bear on the ultimate consumer of these resources.

"Over the past 12 months, IT has emerged as a new force in implementing green initiatives -- not only for energy savings benefits, but also as a result of widespread desire to implement environmentally responsible practices," said Jose Iglesias, vice president of global solutions at Symantec. "The pendulum has swung both ways and IT is now taking a balanced approach that is more integral to an organization's ‘green' strategy, proven by the fact that the vast majority of respondents are now responsible for the energy costs of their data center."

Senior IT executives report a significant increase in green IT budgets. Seventy-three percent expect an increase in green IT budgets over the next 12 months, while 19 percent expect increases of more than 10 percent. The typical respondent reported spending $21 to $27 million on data center electricity.

At the same time, IT is willing to pay a premium for energy-efficient products. Two-thirds of respondents said they would pay at least 10 percent more, while 41 percent are willing to pay at least 20 percent more. Additionally, 89 percent of respondents said IT product efficiency is either important or very important.

But there's more. As organizations continue to adopt programs and practices to drive environmental responsibility throughout their enterprises, IT is increasingly important to the broader enterprise "green" efforts. Perhaps the strongest indicator, 83 percent of IT departments report they are now responsible or cross-charged for electricity, providing a strong motivator for IT to reduce energy costs.

Furthermore, 89 percent think IT should play a significant role in "green" efforts and 82 percent have a corporate green advocate, with more than one-fifth focusing exclusively on IT initiatives.

Question: Has your hospital, health system or health plan implemented any "green" initiatives in the past few months? E-mail me at RMitchell@advanceweb.com with the details and I will publish them here in my blog.

Again, be sure to read our "Going Green in IT" July edition.

Most Seinfeld fans certainly remember "The Package" episode, involving a subplot in which Elaine Benes is unable to find a doctor willing to treat her troublesome rash. Branded a "difficult" patient by her primary care physician, Benes scours New York City doctors' offices in search of treatment, even plotting to steal her medical records with hopes of altering her doctor's comments. She eventually recruits fellow miscreant Cosmo Kramer -- posing as a physician from a fictitious clinic, no less -- to aid her in absconding with the file containing the damaging remark. Naturally, their efforts are thwarted, and the inept pair was sternly reprimanded for their attempted thievery.

This uniquely Seinfeld scenario was far flung, of course -- except perhaps by Seinfeld standards -- and a physician withholding a patient's medical records would be committing an egregious violation of the medical profession's code of ethics, not to mention breaking the law. Many states, including New York, require all health care practitioners and facilities to grant patients access to their own medical records upon request.

In reality, physicians may be compelled to share medical information with patients, but that doesn't mean that all doctors are eager to make their notes available to them. Many large hospitals with electronic health records (EHRs) allow patients to see their medical history, allergies and so on, but not notes made by their physician. Doctors commonly jot down comments after each patient's visit, which are read by other physicians treating these patients as well. Some doctors and health care facilities are hesitant to share those comments with patients, who may misinterpret medical jargon, take offense to a doctor's observation -- as in Ms. Benes' case -- or worry unnecessarily, for instance.

A group of researchers at Beth Israel Deaconess Medical Center in Boston is undertaking a project they hope will foster improved, clearer communication between physicians and their patients.

By the end of this year, thousands of patients at Beth Israel will have free and easy access to their physicians' notes as part of their online medical record, according to a recent Boston Globe article.  

The "open notes" project will involve about 100 physicians and between 25,000 and 35,000 patients at Beth Israel and two other medical sites, according to the Globe article.

The Robert Wood Johnson Foundation gave Tom Delbanco, MD, an internist at Beth Israel, and colleagues $1.5 million to fund the project, because physicians have "strong differences of opinion" on the usefulness of physicians' notes to patients, said Stephen Downs, an assistant vice president at the foundation, in the article. Dr. Delbanco and nurse Jan Walker are developing detailed surveys to give patients, including whether they read the notes and found them useful, and whether they discovered errors.

One question for doctors will be whether they kept private "shadow notes" that patients couldn't see. The ultimate measure of success will be whether doctors and patients want to keep sharing notes at the end of the study, the article noted.

As the move toward electronic health records continues, so too does the debate surrounding whether doctors' notes should be made available to patients online. According to Downs, Beth Israel is conducting the largest study yet on this issue, and we're curious if other facilities have considered similar projects. Has your hospital weighed the possibility of sharing doctors' notes with patients online? Is it a smart move to do so, and why or why not? Let us know what you think.

A bold statement for sure, and one that begs the question: How do I know the recession is over? Well, I looked into my crystal ball...er, paper bag, and it is definitely over.

What, you question the validity of this statement?

Come on now, I'm an honest guy.

It says it right here, in a report by the Associated Press (AP). The recession is over.

The economy has kicked it up a notch or two and people are spending money freely, again. But what, you ask, are they spending their new-found money on?

McDonald's.

Seriously, the golden arches saw a 2.8 percent increase in May in same-store sales in the United States. International same-store sales saw a whooper...oops, sorry about that, a whopping 5.1 percent increase.

The increase in the U.S. orders was filled by the classic menu staples, such as hamburgers, cheeseburgers, Quarter Pounders, large fries, shakes, Big Mac sales, and the new McCafe espresso coffees.

The AP said that in May 2008, McDonald's saw same-store sales in the U.S. rise 4.3 percent, with the help of a new menu item, the Southern Style Chicken Sandwich, and government stimulus checks that found their way to consumers' mailboxes and bank accounts.

The fried chicken sandwich was a favorite choice for the hungry consumer, boosting company sales in the U.S. for several months. Stimulus checks, meanwhile, helped expand sales at McDonald's chains as thrifty - and hungry -- consumers treated themselves to a few meals out of the house.

(Disclaimer: I don't eat at McDonald's.)

Analyst David Morris at Mintel said discounts at McDonald's competitors may have weighed down U.S. sales. Other fast-food chains and sit-down restaurants have heavily promoted their respective discounts to bring in the fast-food eating customers.

Consumers looking to save some cash have been turning over their dollar bills more readily for fast-food for the shear comfort, to take the place of costlier meals out, or as an alternative to the good, home-cooked meal.

But although McDonald's was able to increase its sales, or perhaps because of the economy, U.S. same-store sales were not as high as some Wall Street analysts had predicted. They're hungry, too.

A funny thing happened on the way to the reporter's pencil and notebook.

ADVANCE for Health Information Executives welcomed many IT executives' expertise to our pages over the years, and they ended up using that relationship to launch their own publishing "careers" and "experiences," leaving for other publications.

This came to mind as I paged through some older (and much thicker, I might add) issues of ADVANCE for Health Information Executives from our beginnings in 1997 and several issues from early 2000. Two people that had their beginnings on our pages and went on to other publications were Bryan Bergeron, MD, and Tim Dotson, RPh, MBA.

Bryan wrote for ADVANCE in 1997-2000, then went on to become an author of books and still serves on the advisory board of our competitor, Healthcare Informatics. And, Tim, who also wrote for us in 2003 and 2004 about his organization's experiences in deploying clinical information technologies, went on to work for another of our competitors, Inside Healthcare Computing, where he serves as executive editor. Tim now works for a trade journal publisher having health care industry experience as a pharmacy director, software analyst and IS director for two health systems.

So, practically speaking, those who have gotten their start in health IT publishing have had some involvement, initially, with our magazine. It's important to note as every trade publication's page counts drop, ADVANCE launched many a publishing experience, albeit, career.

I was having breakfast with a CIO on our editorial advisory board a few years ago and he mentioned how unique it was that a CIO could pick up the phone or drop an e-mail to one of our editors and get an article published. "That's a unique opportunity," a colleague of his outside health care had told him.

Places to write

And, speaking of people who work with ADVANCE, John Halamka, CIO, at CareGroup, has served as one of our distinguished editorial advisory board members for a number of years now. John has done some of his own writing -- extensively, I might add -- but it's not for one of competitors (phew, thankfully). Instead, he blogs about his experience as a health care CIO.

I read with interest John's recent blog post about his corporate and home work space (http://geekdoctor.blogspot.com/2009/04/my-work-spaces.html). John writes: "Home office -- At home, I do not have a separate office, but work from the family room. All of my blogs and articles are written in my Morris chair which I've used for the past 15 years. I also have a small writing desk, an incense burner, and a fragment of a tree that's hundreds of years old. While climbing, I found the tree at 13,000 feet and noticed something remarkable about it. As a seedling, the tree grew from under a rock, eventually surrounded the rock, and split the rock in half. To me, that's a great metaphor for perseverance. You'll find a cup of green tea but no papers, files or clutter in my home office space."

I read with special interest where John writes at home and how he writes with an incense burner nearby and maybe even a cup of green tea. I looked around my cluttered desk at work and here's what I found: a red water bottle that I fill from the water purifying system in our cafeteria two or three times a day. An empty coffee cup where I pour my freshly brewed Starbucks Breakfast Blend each morning sat next to my monitor. There's a stapler. What's that, you ask? Go and Google it. I bet John doesn't use a stapler because he has little or no paper.

I also have several file folders opened, with notes scribbled in pen on legal pad pages or steno notebook pages. There are pictures of my wife and two daughters, and a picture of me with my "hand on the throttle" when I drove a steam locomotive for fun.

I chuckled when I read John's blog about his sitting in a Morris chair with incense scent trailing toward the ceiling and sipping green tea.

I will probably always write from behind a computer screen. Besides, my eyes are so accustomed now to writing under bright fluorescent lighting that I probably wouldn't know what to do if the lighting were any different. Oh, sure, I do some of my creative writing from a comfortable reclining chair (Raymour & Flanagan variety) in my living room. Trains, sure it's about trains. Currently I'm writing a short story about a boy who gets locked in a model railroad club on a rainy Saturday and has the chance to run as many model locomotives as he can in a 16-hour span. And occasionally I sip my own favorite wine, too.

I knew a colleague here at Merion Publications who joined the editorial ranks thinking that writing was a glamorous profession, where we all sat around conjugating verbs and debating sentence structures.

Honestly, it's not like that. Most of the time you're writing against a hard deadline; you're trying to siphon blood from a stone and your head hurts beyond belief.

I remember seeing Steve Lopez, the author of the new novel, "The Soloist," which is now a movie, speak at a Mt. Airy Learning Tree event when he was a columnist at The Philadelphia Inquirer. Those attending the community event were peppering Lopez with questions, wanting to know the details on what it's like to work for a busy metropolitan newspaper. Lopez chided the questioners, wondering why they didn't want to talk about their "elected officials" -- he used the term loosely, I might add -- including Woodrow Wilson Goode, Philadelphia's mayor at the time, who literally burned down a city block while police confronted the group, MOVE. Lopez asked why those in attendance wouldn't rather discuss the corruption in City Hall and what could be done to get the politicians to address the public's concerns. They jumped at the opportunity and an interesting dialogue took place.

So, yes, blogs have certainly energized my writing and creativity, but for about 75 percent of my work, it's regular writing, following the journalistic style and skills I learned and honed over the years. It's about Who, What, When, Why and How in the lead of the story. And, it's done without the incense burner and green tea.

What makes the writing interesting, is catchy and interesting leads and the overall article that captures the reader's attention. This still holds true today.

Due to demand from contest entrants, the application deadline for ADVANCE's IT Project of the Year Award has been extended from May 15 to May 20.

Please click here for full details on how to enter.

The winning facility will be featured on the cover of our August 2009 print edition. This is a great opportunity to showcase your organization's IT prowess.

We hope to see your application in our inbox by the end of business on May 20. 

A recent survey by Fort Lauderdale, Fla.-based ProTech highlights some interesting insight onto what IT professionals are doing in these tough economic times. Eighty-nine percent of respondents surveyed said IT is playing a significant role in enhancing their company's competitive advantage in this tough economic climate.

The survey interviewed 11,000 IT professionals for ProTech's fifth annual Tech Talent survey and interviewed 525 IT executives for its seventh annual leadership survey. Twenty-four percent said they plan on increasing their IT staff this year and 61 percent of the same group -- compared to 42 percent last year -- said IT is a critical and valuable function within their organizations.

"In a down economy, IT is becoming more important as companies seek a competitive advantage," ProTech CEO Deborah Vazquez said. "Strategic use of IT can streamline operations, thereby reducing costs while increasing revenues and customer satisfaction. Companies must engage in these activities all the time, but especially right now."

Additional highlights from the survey...

Effects of economic downturn:

• Eighty-eight percent of respondents said the global financial crisis affected their businesses negatively.
• Thirty-eight percent of respondents said their organizations were hurt by a reduction in consumer spending and 33 percent said the credit crisis had a negative impact.

As for IT in Florida:

• Fifty-five percent of respondents said the commitment on behalf of Florida's local and state governments to developing the state's technology sector was weak.

IT budgets:

• Average IT budgets for companies in Florida in 2009 increased by 2 percent.

IT training:

• More than 50 percent of IT professionals said they would leave their company for less money if they received training that advanced their careers.

IT staffing:

• The three top reasons given by IT leaders for losing talented staff were: (1) compensation (30 percent); (2) lack of career path (26 percent); and (3) an employee moving to another location (19 percent).

Employee skills:

• Twenty-one percent of respondents said that skilled business analysts are the hardest IT professionals to recruit.

"Human resource directors need to focus on how to strengthen their IT teams so they can help their organizations succeed," Vazquez said. "The main priority for companies right now should be to recruit and retain talented technology professionals in order to not just survive, but to excel."

How's your area of IT working? Are you planning to expand your IS staff anytime soon? Please e-mail me at RMitchell@advanceweb.com

And the winner is...NIR Diagnostics

The Wharton School of Business at the University of Pennsylvania in Philadelphia awarded the student team from NIR Diagnostics, whose patented InfraVue device detects wound healing more accurately than current approaches, the $20,000 Michelson Grand Prize in this year's Wharton Business Plan Competition (WBPC) (http://bpc.wharton.upenn.edu/).

In its 11th year, the WBPC is among the most recognized and respected university-led business plan competitions.

This year, an audience of hundreds of attendees listened to presentations and then brief elevator pitches from the finalists and voted on the winner. NIR also received a $3,000 prize for the "People's Choice award," based on the attendees votes. NIR Diagnostics' advisors range from a 2001 WBPC grand prize winner to the chief of vascular surgery at Philadelphia's Drexel University's College of Medicine. Also, members of the NIR Diagnostics team include a past WBPC finalist who was also selected to the Wharton Venture Initiation program, Wharton's educational/business incubator.

This year's Venture Finalists included the following participants from the medical/health/life sciences fields: NIR Diagnostics; DocAsap, an online medical appointment scheduling service; RealisticEye, which develops an enhanced appearance prosthetic eye by making the static pupil appear to dilate; Remote Integrated Monitoring Solutions for remote monitoring of diabetics in their homes.

The other finalists: Cuddlebots, a robotic toy company; Myvideoport, an online platform and marketplace for professional movie creators and content providers; PayDivvy, a financial technology company that provides collective payment and finance services for roommates; and StealthRowing, which develops a convertible pair/double sectional rowing shell.

The 2009 BPC winners were:

• Michelson Grand Prize: $20,000 to NIR Diagnostics (developers of InfraVue wound assessment device)
• Second Prize: $10,000 to CuddleBots
• Third Prize: $5,000 to RealisticEye, which was the highest ranked team ever formed from Wharton's San Francisco Master of Business Administration for Executives program
• Gloeckner Undergraduate Award: $5,000 for the highest ranking Wharton undergraduate team for StealthRowing
• People's Choice award: $3,000 to NIR Diagnostics

Health care/medical semi-finalists included: Gaya Technologies, which uses established methods of telemedicine, digital data transmission, networking and videoconferencing to solve health care supply chain and demand mismatches in developing countries; MedVolution, a technology health care startup, launched last year and the 2008 Wharton Venture Award recipient. The company's software improves medical diagnostic accuracy through sophisticated algorithms to improve decision-making.

NeuroStim Technologies is an early stage medical therapy company focused on electrical stimulation to treat chronic pain. And, Neuroderma, which develops pharmaceutical therapies to address the unmet medical needs in neurology, dermatology and aesthetic medicine markets.

NIR Diagnostics looked to tap into a $1.1 billion global market for wound assessment with its InfraVue device. During the team's Venture Finals presentation, the students described current assessment techniques for complex wound healing; current assessments are accurate only about 50 percent of the time. Based on tissue optical properties, InfraVue can predict whether a wound is healing properly or requires further wound therapy. The device is in its beta prototype stage, and has completed animal tests. It will be available soon for human pilot studies. 

This year's Venture Finals, which were the culminating event of the year-long competition, attracted 300 venture capitalists, business leaders, faculty and students. The Venture Finals judges represented a broad range and depth of experinece:  David A. Cohen, president of Karlin Asset Management; William P. Egan, 1969 Wharton graduate, and founder and general partner at Alta Communications & Marion Equity Partners; Evan Jones, 1983 Wharton graduate and managing member at jVen Capital, LLC; David A. Piacquad, 1984 Wharton graduate and senior vice president of business development at Schering-Plough and Fred Wilson, 1987 Wharton graduate and a partner at Union Square Ventures.

Over the years, the BPC, which is open to any University of Pennsylvania student and managed by Wharton Entrepreneurial Programs, has seen student teams go on to become successful businesses, including PayMyBills.com, buySAFE, NetConversions, Integral Molecular, DealMaven, InfraScan, Verge Solutions, Embrace Pet Insurance, Petplan USA and MicroMRI.

Times are tough. And, while I'm not standing in a line for food, yet, I'm horribly saddened by the way the U.S. economy has headed south.

I blogged on ADVANCE for Health Information Executives' Web site in December 2007 about what I saw as the tea leaves that the economy was tanking after the sub-prime housing market meltdown. That blog entry was insightful about where things were headed.

Yes, the economy is tough, but it has led me to explore things I thought I'd never do.

More blog posts; an up-tick in Web site visits and activity, and more opportunities for me to step outside of my comfort zone. You see, I majored in journalism in college, and had only two courses on video editing, as part of my journalism education. That's all. The rest of my course load consisted of news writing courses. (Several news writing courses, in fact. The first day of a news writing course during my sophomore year started with the instructor, *** Conrad, an investigative reporter for the New Haven Register at the time, handing each of us a slip of paper with a street address written on it. We had to perform a title search on the property, visit the property, find its tax history, who had owned the property, talk with the homeowner/business owner, and write a news story about our findings.) My fellow classmates and I were perplexed. What did this have to do with journalism?

It has everything to do with journalism; what I learned applies to many of the tools and knowledge I use today; albeit in cyberspace.

So, what does this say about health IT trade journalism? Innovation and creativity will dominate our work, and those of us who will do our best work are the ones who have the training and experience to look beyond our notepad and pen, and will seek out new ways of telling the CIO's story. With the growth of multi-media opportunities, CIOs and other IT executives can now tell their stories live...err, well, almost live, with the benefit of video and or audio sound bytes. Who knows, maybe someday a CIO will be able to take our attentive and interested readers down the halls of their hospital or health system, and give live tours or demos of new technology that has been implemented. Wouldn't it be neat to be there - live -- when new technology "goes live"?

Yes, we're doing more with less, but we're also providing quality content, whether written, a standalone video, or video/audio that accompanies the written word. With these new opportunities we're finding that CIOs are coming to our Web site more frequently and staying much longer. They're watching videos, reading our articles and listening to our CIO podcasts. And as more CIOs read, view and listen to our online content, we'll engage a new group of interested subscribers; those who may not have read our print publication but are now visiting our Web site regularly.

A few years ago, the content on our Web site was not as strong as it is today. We had fewer CIOs writing for our site. However, today we have a nice mix of CIO-authored articles and articles written by health IT industry luminaries.

And, that, I must say, IS A GOOD THING!

Okay, let me say this as quietly as possible...IT'S OKAY ONCE AGAIN TO MAJOR IN COMPUTER PROGRAMMING!

Quiet enough?

According to a recent post on the Computing Research Association's (CRA) Web site, CRA's Taulbee Survey of PhD-granting computer science (CS) and computer engineering departments in North America colleges and universities have seen some growth. The survey, which has been conducted annually since 1974, and whose results of the 2007-2008 survey were released recently, measured CS bachelor's degree enrollments and production among PhD-granting departments in the United States since the late 1990s.

According to the Higher Education Research Institute, the percentage of incoming undergraduates among all degree-granting institutions who indicated they would major in CS declined by 70 percent between fall 2000 and 2005. The number of students who declared CS majors among the PhD-granting departments surveyed by CRA also fell. After five years of decline, the number of new CS majors in the fall 2005 was half of what it had been in the fall of 2000 (15,958 vs. 7,952). From 2005 to 2007, the number of new majors was flat, but in 2008 the number had increased to 8,734 students declaring CS majors.

Stabilization in the number of new majors over the past several years has stopped a decline in the total enrollment in CS. Enrollments declined from their peak in 2001-02 through 2006-07, but 2007-08 saw a slight uptick. If the number of new majors continues to rise, enrollment will follow.

New majors take anywhere from three to five years to complete their degree. CRA expects stabilization to occur and then be followed by an increase in new majors, which will take about three to five years to be seen in degree production. It's a positive sign nonetheless. The number of degrees granted fell again in 2007-08 to 7,406, a decline of about 8 percent from 2006-07, CRA said.

Well I had tried to post a blog entry on Tuesday, but didn't have a chance.

A couple of things to note was an interesting presentation on Wednesday morning by Alan Greespan. Greenspan noted the huge increases in medical expenses, 20 percent faster than the Gross Domestic Product.

Greenspan that earlier "high-tech" in health care was a doctor prescribing two aspirins and calling him in the morning. Greenspan noted a proliferation of problems in the United States economy, culminating with subprime mortgage crisis and a changing demographic of the baby boomer generation. With more people heading into retirement there is now actually less labor growth, coupled with further reductions in the workforce.

 HIMSS President/CEO H. Stephen Lieber asked Greenspan about the impact of the demographic shift, alternative energy, education -- a strong social agenda, and its impact on government spending and Social Security. Greenspan noted that health care reform will not be solved without overall funding, recognizing the unprecedented shift.

He said to avoid future difficulties is almost impossible, without "extreme clamps." He said that it's human nature to go between the feelings of fear when the markets fall and euphorea when they are doing well.

Other ways to avoid the crisis, Greenspan said, is to set collatoral standards. "You can't put a regulator in who knows when a crisis will occur. Sure, he or she will be right 55-60 percent of the time, but wrong 40 percent of time. In regulation you can't do that," he said.

 I also attended an informative educational session by Christopher Paidhrin, security compliance officer, HIPAA and IT Security Officer at Southwest Washington Medical Center in Vancouver, Wash. Paidhrin, who may be familar to regular readers of our magazine, and most recently was a source for a blog I wrote on cloud computing in health care. Paidhrin discussed what hospitals and health systems need to do to pass a HIPAA Audit.

 I hope you found the information that I reported on from HIMSS useful. Check my blog regularly for further stories that will be coming from my meetings at HIMSS. Feel free to contact me at RMitchell@advanceweb.com

This is Bob Mitchell, managing editor of ADVANCE for Health Information Executives reporting from the HIMSS conference in Chicago. It's cold, cloudy and it snowed a few inches Sunday evening.

 Here are some highlights from the first day of the conference:

 The McCormick Place is the setting for this year's conference, whose theme is Architects of Change. With images of "Tear Down these Proprietary Walls," "Interoperability," and the like, CIOs and IT executives heard first hand how they can be architects of change in today's health care environment.

 Chuck Christian, HIMSS chairman, CIO at Good Samaritan Hospital in Vincennes, Ind., and a member of the ADVANCE editorial advisory board welcomed conference attendees -- estimated at more than 28,000 -- to Chicago.

 Much of the focus here has been on the economic stimulus package and provisions of the American Recovery and Reinvestment Act of 2009. With two years to demonstrate "meaningful use" of electronic medical record technology, CIOs are hearing how they can leverage those IT investments they have already made and what work still needs to be done.

 Christian highlighted the investments that have already been made, and discussed that the budget of the National Coordinator of Health IT has increased from $60 million to $2 billion on the national health IT infrastructure.

Christian also highlighted the more than 900 exhibitors and more than 200 companies who are launching new products and services at HIMSS. He challenged HIMSS members to turn this week's conversations in Chicago into action when they return to their respective hospitals/health systems. But one was left wondering, "how do we do that?" A daunting task, indeed.

 During the opening keynote address, actor Dennis Quaid described the almost life-ending overdose of medication given to his twin children shortly after birth. Many speculated prior to the HIMSS conference, what Quaid could honestly say to health IT executives that wouldn't come across as chastising health care professionals for the medical errors that occurred. Quaid struck a balance, thanking IT executives, and specifically HIMSS members, for the work they are doing. He said that HIMSS members are on the cutting edge of health IT. "The technology is ready. We need your leadership to adopt the technology," Quaid said.

He expressed the need for set standards and interoperability.

At the conclusion of his keynote address, Christian presented a $10,000 check to the Quaid foundation from HIMSS.

 I also attended an educational presentation on the State Officials Legislative Forum. Because most of the work that is being done at the state level in establishing e-health initiatives, four state legislators presented on what their respective states are doing in terms of health IT. The presentors included Massachusetts State Senator Richard Moore, Indiana State Representative Peggy Walsh, New Jersey Assemblyman Dr. Herb Conaway and Iowa Representative Linda Upmeyer. Check my blog regularly when I return from Chicago for further updates on this and other educational sessions.

 Today, I'll be attending sessions on Lean, Strategies from the Ground Up and Hospital IT Consolidation. On Tuesday, I'll be attending The Paperless Hospital and The Smart Patient Room. Again, check back on my blog for further updates on these and other education sessions that I will be attending.

After weeks of downright horrible news on the economy, it's nice to see good news -- even if just a glimmer. A survey published this week by TNS Global, a global market information research firm, offers health care IT suppliers hope in these horrible economic times. TNS projects that health care IT will be relatively strong with more budget increases than reductions being made.

TNS Global's survey of IT managers found that about half have cut their 2009 budgets, while slightly more than one-third of IT managers are seeing flat budgets from 2008 to 2009, and 16 percent are projected to increase their spending this year.

As part of its ongoing technology leadership program, TNS surveyed 400 IT managers in the United States and Europe in February about the impact of the economy on their budgets. Reflecting a pullback in economic activity, a substantial percentage of organizations in every industry reported declining IT budgets. As expected, financial services and manufacturing saw the biggest reductions in their IT budgets. However, health care IT spending is projected by TNS to be relatively strong, with more increases in budgets and spending than cuts being made.

While budgets are generally down and no technology category emerged as a winner, some areas, such as storage hardware, are seeing less of an impact from economic conditions, and will likely grow. Strategic projects designed to improve business performance remain on the table for many organizations, TNS' survey found.

John Scott, vice president of technology at TNS, said, "Companies are adjusting to the economic crisis by prioritizing projects to maximize the dollar impact and stretch existing IT assets. However, budget allocations are not solely focused on the short term. As personnel and consulting budgets continue to shrink, the winning vendors will be those who offer solutions that are easy to implement and maintain with a compelling total cost of ownership -- not necessarily the lowest initial cost."

In addition to cost-cutting, the survey found that many organizations are reallocating their spending. Infrastructure spending, particularly in areas such as storage appear to be weathering the storm best, while consulting and professional services appear to be taking the most hits. "This underscores a trend we identified toward right-sizing," Scott said. "It's easier and faster to reduce variable costs than expenditures to support a fixed infrastructure."

Some other findings from the survey include:

• Relative to other technology areas, storage hardware spending will perform well in 2009 with 31 percent of respondents increasing their budgets and more than four in 10 holding their budgets flat as compared to 2008.
• While few of the respondents said they are increasing expenditures on end-user or enterprise applications, about half are holding budgets firm in these areas.
• Forty-three percent of respondents have cut desktop hardware budgets, likely extending the life of their existing hardware assets.
• Cuts in consulting and professional services are broad and deep. Fifty-six percent had cut their consulting and professional services budget, the respondents said. Among those who have made cuts, 65 percent indicated they were cutting 30 percent or more with nearly one-third of respondents cutting their budget by over 50 percent.
• Personnel budget cuts are mixed. Forty-three percent of respondents have cut their personnel budget but cuts are smaller than for products and services

Despite the budget crunch, many organizations are taking the long-term view in both costs and investment for business improvement.

• Instead of simply cutting costs, about four in 10 respondents are allocating budgets toward significant new IT projects that will support business growth.
• Thirty-seven percent are more focused on total cost of ownership as a result of the economic environment compared with only 24 percent who are now more focused on initial cost.

With your head in the cloud as you hear Kate Bush's ethereal voice singing Cloudbusting, her shrill voice is trailing off..."The sun's coming out..."

We were sitting in an editorial planning meeting awhile back and the topic of cloud computing came up.

"Cloud computing, what's that?" someone asked.

"What do clouds have to do with computing?" someone else asked.

I'm sure they were all wondering what I had smoked and which cloud I was on. What do clouds have to do with computing and health IT?

I set out to find out more about cloud computing. Is it a bunch of hype? Is it for real? Is it being used in health IT?

I called Christopher Paidhrin, information security officer at Southwest Washington Medical Center (SWMC) in Vancouver, Wash., who I had worked with in the past to get his perspective on cloud computing. I learned that Paidhrin and other information security officers have many concerns about computing in the clouds.

The mark of the cloud

"We have explored the concept of cloud computing and what kind of value it could add. We are looking at what our peers are doing, the evolution of the technology and Web 2.0, but realize the financial constraints and profit margins of financial organizations -- where cloud computing cut its teeth -- and what audience or client value cloud computing serves for our purposes in health care," he said. "Of course, with any system I look at it from a security perspective, and honestly, there is so much to consider with cloud computing that we are looking at it very deliberately and cautiously."

Security considerations include service providers being hacked, having Web sites defaced, denial-of-service attacks, internal workforce member control issues. "All it takes is for someone inside your organization to decrease a security level. And for us in health care, all access to information is confidential," Paidhrin said. "We work with highly confidential information that we then entrust a third party to protect when we are putting it into the hands of someone else, such as in the cloud. That level of trust has to be extremely high, based on the realization that a lot of applications or service delivery is moving from a standalone host to a redundant host for availability services, and then virtualization, which is also highly available," he said.

"Especially in the cloud, there's going to be virtualization of services. If there's no security on the servers and someone knocks through the front door, then the database and repositories are vulnerable," he said, citing a recent article in Dark Reading that said only 35 percent of respondents who had to comply with Payment Card Industry [PCI] Data Security Standard or Sarbanes Oxley [SOX] had security solutions in place. "Thirty-seven percent had no security for their virtualization environments. Those numbers scare me," he said.

Paidhrin said that a lot of industries are moving a variety of services to the cloud for reasons of availability, capacity, outsourcing of services, SaaS and SOA. And, when software licensing, internal maintenance and management costs rise and the ability to buy cost-effective hosted services gets cheaper, "these are extremely strong motivators to move to the cloud," he said. "But, as we know, health care is slow to adopt new technologies. And despite the exorbitant increases in health care costs, providers are operating with slim margins as it is. There are also returns on investment/total cost of ownership [TCO] challenges we face with moving to the cloud. The cost of migrating these services can often be a deterrent," he said. There needs to be demonstrated value of the existing systems before hospitals/health systems can begin moving to cloud-based systems.

"Many organizations would rather not be early adopters in cloud computing. We want to see other industries' proof of concept that could be applied to health care; we want that pain point to be as far from us as possible," Paidhrin noted.

There is also some resistance from application vendors in health care. "They prefer -- because it's profitable for them, and also because of legacy standards -- to have their systems tested on standalone systems. It's an old mentality -- we can control the asset, we control the revision, and we control our software -- and in health care, many vendors will not provide support for third-party systems or hosted services."

In health care, similar to the operating environment at SWMC, there are more hundreds of stand-alone applications. "At SWMC at least 150 of them are legacy applications, developed in COBOL, Visual basic, FORTRAN -- basically older programs that are not .Net, HTML or Web 2.0-friendly, for that matter. Vendors are slow to move toward portals or Web front-ends. They don't want to share the virtual space whether it's in a local server cluster or in the cloud. The legacy applications only work with one kind of database, and they may or may not work with a public or open source server or operating system," he said.

What's needed?

Paidhrin said that what's needed is an infrastructure, albeit, a health care cloud player, "...someone who has proven themselves in another industry and now demonstrates how it can be done in health care," he said.

But until that exists, and it's profitable, health care is going to be averse to moving to the cloud. "I think that health care would prefer open source because of the challenges we have had with vendor-specific applications. We don't like being trapped, and we're seen the virtue and value of open source, which has better licensing models, as opposed to desktop, per-seat licensing models of the past," he said.

Paidhrin said that moving information security to the cloud is a specific area that has potential. Cost incentives, because of security's broad reach, make cloud computing attainable in that environment. Because it takes anywhere from three to five people to maintain network and endpoint security, the TCO to leverage all services via the cloud for policy compliance makes it a serious consideration, he said.

"Security monitoring tools are highly available and highly trusted, and the CxOs get a report immediately which provides value for the work they are doing," he said. Newly available tools are rapidly achieving cloud-based security, but we're still a ways off in adopting universal security standards, like OASIS/SAML. Monitoring of mobile devices, such as laptops and other devices make cloud computing an important consideration. Cloud-based security would be beneficial for such things as laptop and mobile [encryption] security," he added.

Tell me your stories about cloud computing. Have you explored the cloud? Are you considering doing any work in the cloud? E-mail me at RMitchell@advanceweb.com.

I'll post your comments here.

Cynical comments about CIOs on a recent blog post caught my attention. Not only are CIOs the individuals who get the dirty jobs of having to reduce staff, cut dollars and hold everything together, now they have to be a punching bag, too.

I, honestly, don't understand where these people who write these things come from. They sound all important, as though they have lived in the CIO's shoes, or if they have been a director in an IT department, they think they know how to run the place.

They're quick to point out that they can right the ship that's been listing since the CIO took office, yet they're in the backseat screaming as the car teeters on the precipice. They're not, I repeat, not in the driver's seat. And, unless this person has been a CIO, he doesn't have a right, nor has he earned it, to chastise their work.

I laughed when I read this blog, toward the end, where the writer waxes on about: "How is the value of a CIO calculated today? Cost savings, return on investment, or some other fiscal metric. This is an easy way to measure success, but it's not the metric that matters most," he writes. But, my question is, who has asked the CIO to do this? The hospital/health system CEO? The board of directors? Not one CIO I know does work on their own in a silo. The silo came from the vendor, and all the CIOs that I know work at the pleasure of the hospital president or CEO (and board). When I started writing about health IT back in the 1990s, I heard stories of CIOs who were at odds with their hospital executive leaders because an implementation didn't go well or the system didn't meet the organization's needs or was implemented by IT when the organization didn't want the technology. The fallacy with this is why would a CIO and his staff implement technology that no one wanted? It's career suicide, I believe. 

The blogger continues that metrics for him are defined by the CIO reducing his e-mail traffic by 80 percent (sounds like he might be simmering against a former CIO who didn't do what he wanted!) and "deploy a mash-up tool that enables new analytic and customer delivery solutions" (though, again, he's driving his own agenda, here. The organization may not have asked for that tool yet, because most non-IT leaders and health system boards of directors will think this is a waste of the hospital's money and will not ask the CIO or IT department to implement such technology). The blogger also suggests that the CIO "deploy a prediction market that encourages the enterprise to look forward." (Okay, I'll give the blogger this one. It might be a good idea, but in practicality, who would use it? One person in the organization? Maybe the CFO?)

I also don't understand why people who blog love to lump everyone together. Yes, there may be CIOs who have more fiscal responsibility, but isn't the CFO the individual who handles the finances? The CIO probably manages two percent, okay maybe five percent of the purse strings. Since when is the person in charge of technology also in total control of the finances?  

Finally, he writes, "don't call yourself the chief information officer anymore. You are only the ‘chief' because you have (inappropriately) been given fiscal responsibilities. Being the gatekeeper should not be what makes you important." Again, two, maybe five percent of fiscal responsibility is only a short order compared to other areas.

"If you want to stay relevant, focus on business operations and the positive outcomes you can deliver with technical solutions." Amen to that, but all of the CIOs who I have spoken with over these past 10-plus years do this each day. They focus on the business operations (sometimes muddled by hospital/health system politics) and positive outcomes (until the wants and needs of the organization change - which can be monthly or annually).

"Your job is not about ‘information.' It's about relationships and connecting the silo functions of your business. (I would agree with the blogger's comments here, but this is really old news. We all know that the CIO's roles and organizational responsibilities are changing. How many CIOs have taken it upon themselves -- or been promoted -- to now have responsibility for other operations in the organization that are outside of IT?) Four CIOs I know immediately came to mind. They wouldn't be getting these promotions and additional job responsibilities if they did shoddy work; they'd instead be shown the door. (I've recently read some bloggers who argue that the CIOs have been given more responsibility outside of IT because their organizations want them out of IT altogether. To which I reply, "Give me a break!")

Finally, please don't preach unless you've lived the CIO life. I haven't lived the CIO life, nor will I ever purport to be a CIO. I worked for a small software vendor earlier in my career as a technical writer, so that's the closest I've come to IT. I may not have worked in an IT department, but I sure know how to keep my fingers still until I have something useful to blog or write about. I would never try and put myself above the dedicated men and women who work and lead IT initiatives at hospitals and health systems, just to steal a headline or two.