Monday, October 31, 2011

Random Thoughts on the Cocktail Party

Watching our special teams play was like watching a teenage cutter holding a box of Wusthofs. It was sad and gross to watch, yet the plot line would make a pretty decent Lifetime Movie with Meredith Baxter playing the role of Coach Richt. It was enough to make me miss Jon Fabris...a little.

But we won. And that's all that matters. After 17 trips to Jacksonville, I can tell you I've seen us play way smarter and lose.

And why did we win? Because the defense, which was a rolling shipment of fail last year, simply got dramatically better. The result -- If you have a few minutes to enjoy a cold beer and warm schadenfreude, read these Gator recaps from Orson Swindle and Run Home Jack over at EDSBS:
"You could give Charlie Weis a Garmin, fifteen Sherpas, a moving walkway made up of arrows saying "MARZIPAN FACTORY THIS WAY FREE SAMPLES" and the ball on the eight yard line and that piece of shit still couldn't find the end zone." - RHJ

"But don't say this is all necessary. It's not. Meyer's struggles in his first year got him to nine wins. [NAME REDACTED] learned and unlearned basic arithmetic on the job and still won seven games. This team will lose to Vanderbilt. This team will lose to South Carolina. This team will lose to Florida State, and they will miss a bowl game for the first time since the pre-Spurrier era. That is not good coaching. That's failure, and boring, depressing failure at that. At least fight James Franklin at the fifty when you're done losing to Vandy, Will, and thus give us something to cheer about." - OS
Honestly, I don't expect Weis to be back in Gainesville next year. Muschamp really can't fire the guy, but Weis has the career competence to look around and see that his QB situation isn't going to get much better (he's sampled the goods already). This is just a bad fit. The bad news...the Gators will be better off without him.

However, without Charlie's offensive reputation, there's the cold reality that the Gators' head coach is just a loudmouth ex-UGA player who is now 0-5 in Jacksonville.

And by the way ... going for it on 4th and 19 is an absolutely, positively stupid call. It doesn't matter that it worked. It's still such a galactically stupid call as to bring your entire thought process into question. Assuming there was a thought process to begin with.

See Also:
-- "If Weis is a Genius, then Addazzio was a Mastermind." - Orlando Sentinel


Auburn at Georgia Game Time

CBS is are using the six day option to decide on the kickoffs for the Nov 12th games.

The games up for that day:

Alabama at Mississippi State
Tennessee at Arkansas
Auburn at Georgia (likely two top 20 teams)
Florida at South Carolina.

LSU and Mississippi play Western Kentucky and Louisiana Tech, respectively with kickoff times in the evening.  Kentucky at Vandy is already set for a 12:15 kickoff on the SECNetwork.

Presumably they are waiting for the Arky/SC and Bama/LSU outcomes, although it is hard to see why.  I guess you could see them picking Florida at a top 10 South Carolina for the spectacle of Spurrier possibly losing ground in the SEC East race to his old school.  I don't see what they would want from the Tennessee at Arky game.  As for waiting for 'Bama, having the team of the Century of the Year playing is worth something.  

The TV slots remaining are 12:00, 3:30, 6:00 and 7:45.  Apparently the selection order for those games is the 3:30 slot, then 7:45, then 6:00 and then 12:00 (although by the contract, CBS would have a first pick for both of their games).  I think we'll end up at 3:30 if South Carolina loses this week, since it'll be for the SEC East.  While CBS would love to have 'Bama, the compellingtude of two top 20 teams, the South's Oldest Rivalry, and the division title on the line wins out, in my mind.  If SC wins, it is still a toss up.

Predicted times:

Noon CBS: Florida at South Carolina
12:21 SECNetwork: Kentucky at Vandy
3:30 CBS: Auburn at Georgia (70%) or Alabama at Mississippi State (30%)
6 ESPN2 Tennessee at Arkansas
7:45 ESPN Alabama at Mississippi State (70%) or Auburn at Georgia (30%)

Either way, I don't see us kicking before 3:30, and we could get a night game (remember, set your clocks back on November 5th) at 6pm or 7:45pm.  The only way we are noon is if we lose to New Mexico State and Auburn loses to Open, OR CBS is picking the Noon game before ESPN picks, which makes it even murkier.  Or someone requests a noon kickoff. Whichever.


PS. If you have anything more definite on the selection order that I couldn't find, please share that in the comments.

3 Questions Answered: Florida

On to the questions.

  1. Will decided schematic advantage matter? No.  Hell, no.  I mean Jarvis basically called BS on it.  Grantham's adjustments in the second half were awesome.  For that matter the adjustments after the second drive were dead on (Florida had 152 yards at 7:34 in the 1Q; they had less than 70 the rest of the way).  Bobo's play calling was strong, again.  The two TDs on 4th down were exactly the right calls and to the right spots.  That sound you heard was Richt's cojones clanking together.  We showed up more prepared and with a better game plan.  When it the last time that has happened?
  2. Can Aaron live down last year?  He had a serviceable game. There were some throws that were off, either because he or the receiver missed the route.  However, he never had the one WTF throw. I'll take it.
  3. Will the defense handle the running game well?  Dude.  Just. Dude.  If you had told me we'd hold them to -19 yards rushing, I'd have bet my house on the game.  Outside of one Rainey run of 17 yards (that ended in a forced fumble), they had nothing.  The one bubble screen was the only time we seriously over pursued on a misdirection.  Very strong performance all around. 
I'll get to the special special team's play, which nearly cost us another game (hello, South Carolina), later.  Beyond that, we did what we needed to do.  It was very 2002, but we were on the other side of the score.

Sunday, October 30, 2011

EHR Adoption is Like Treating Cancer

EHRs are not ready for prime time. EHR benefits are questionable and there are documented instances where patients’ deaths were directly attributed to an EHR. EHRs are cumbersome and slow. They are unnecessarily complex and built on very old technology. The people who build EHRs have no concern for the end user and therefore EHR usability is pretty abysmal. And EHRs are expensive to buy and expensive to maintain, not to mention that they can completely derail your practice through loss of productivity. The fact that some users seem to do well with their EHRs, and even derive some joy from using them, is not a valid counter argument since most users are not so fortunate and through no fault of their own. There really is no excuse for such failure in this day and age. Just look at the iPad and the iPhone. You can walk into any Apple store and 5 minutes later walk out with a fully functional product with a delightful, intuitive interface, loaded with hundreds of interchangeable apps that even a three year old can use right out of the box. All for a few hundred bucks.

If you happen to be diagnosed with cancer, you will most likely be subjected to years of unpleasant treatments. You will be injected with poison and irradiated with more poison. You will lose your hair, suffer bouts of vomiting and diarrhea and be physically debilitated to the point where you cannot leave your bed. You will most likely have to go through painful surgeries, take all sorts of medications that were shown to kill thousands of rodents and never recover your old self again. And this entire ordeal will cost you a medium size fortune. The fact that some lucky patients go on to win the Tour de France is not really an acceptable rebuttal. Most do not. And there really is no excuse for such incompetence in this day and age when one little pill can cure you of an yeast infection in 24 hours and a $4 course of antibiotics will render you as good as new if you happen to develop a sinus infection. Not to mention the innumerable vaccines that will miraculously prevent you from contracting the plague.

Yes, this is a farfetched analogy, but replacing paper charts with an EHR is not like playing Angry Birds, and if you want a fair chance at survival, you have to tolerate the side effects imposed by the current state of technology. Just like you cannot postpone your cancer treatment until the doctor from Star Trek figures it all out, you cannot postpone transition to EHR until EHRs are “ready for prime time”.  And make no mistake, in today’s reality, paper charts are as big a threat to the survival of an independent medical practice, as any garden variety cancer is to a human body. Paper charts will gradually and irreversibly deprive your practice from the nutrients and oxygen needed for survival, i.e. reimbursement, until it shrivels and dies, or it gets absorbed into a larger organism. The common wisdom seems to favor these outcomes. I do not. If you are one of the fewer and fewer physicians who has no desire to either shrivel or practice Wal-Mart medicine, here is one way to think about your current EHR predicament. [Note: Considering the gravity of the situation, you would be well advised to seek a second opinion.]

Diagnosis – Look around you. EHRs are slowly gaining ground. You would be hard pressed to find a medical group of significant size that does not have one. Data collection is not as voluntary as it is being portrayed, unless of course you think that you are overpaid and can easily absorb cuts in reimbursement. You can choose to make believe that this too shall pass and once Obama is no longer calling the White House home, all will be as it was. Alas, computerization of medical records has bipartisan support, and it always did, due to a rare alignment of powerful financial interests and progressive ideology. If you want to continue the practice of medicine, you will need to use the tools of the trade. For better or worse, both the trade and its tools are being redefined. Barring a global disaster, the chances of spontaneous remission are nil.

Staging – How bad is it doc? Well, it won’t kill you tomorrow, but the longer you wait, the harder and more expensive it will become, the fewer the choices and the lower the chances of a good outcome. Both public and private payers are experimenting with new reimbursement methods. These pilots, or projects, are cropping up everywhere, supported by grants and all sorts of tax payer monies. The goals may be different and the rules of engagement are certainly different, but these arrangements have one thing in common. They all prefer that you generate and consume large amounts of clinical data in electronic format. You will need an EHR for that.

Treatment – A physician-centered approach to the problem suggests that you should be informed of your options and allowed to make a decision based on your personal and cultural preferences. Since medical practices are not people, you may choose to euthanize your practice. This may make perfect sense if your practice had a long and productive life and your medical career is in its twilight years anyway. A less terminal option would be to allow your practice to be hooked up to the machinery available in large health systems. You will still have to use an EHR, but your new employer will undertake the mitigation of most side effects. There is a slim chance that someday you may be able to remove the tubes and resume private practice, but while your medical career can survive indefinitely, your practice as you know it now is not likely to recover. Or you could make a stand and fight for your independence.

Prognosis – By definition there could be no blinded trials for EHR utilization, and by omission there are no randomized control trial results to learn from. The anecdotal evidence suggests that many thousands of physicians in independent practice are surviving just fine after EHR implementation. Some would say that they are doing better than ever now, and others have resigned to the new ways of doing business. For most, the life threatening problem has been transformed into a manageable chronic condition. It must be noted however, that a significant number of physicians is currently in need of life-support from health systems and hospitals, and many of these are post EHR implementation. We cannot be certain, since there is almost no literature on the subject, but it is highly probable that practices suffering from a relapse have had multiple comorbidities to start with and/or developed other life threatening conditions since. There are no guarantees of course, but if you have an otherwise healthy practice, a positive outlook and a supportive environment, chances are good that transition to EHR now will enable your independent practice to survive and thrive for many years to come. And the opposite is also true.

Friday, October 28, 2011

CBZ Round Table on Georgia Florida

Kevin asks, I answer:

In what area do you see Georgia as having a specific advantage over the Gators? Passing offense vs passing defense.  The Gators have really struggled with Brantley out.  They weren't exactly world beaters, passing wise, with him in.  Murray has had his issues, but he is quite good when he is given a few seconds to make his reads.  I expect the Gators to come after him.  I also expect us to be able to exploit that with the TEs, RBs and quick routes like last week against Vandy.  Tyler Bray did a good job until Tennessee's lack of running game allowed the Gators to sit back and dare them to pass without Justin Hunter in the game.  We have more competent receivers than Tennessee and more plays designed to leverage that.

In what area do you see Georgia as being at a specific dis-advantage to the Gators? Individual big play threats on offense.  Hey, we've got very good play makers, especially Mitchell.  He will be individually as good as Rainey or Demps in a year.  At any given time, on any given play, at any given spot on the field, either of those guys can hurt you running or catching the ball.  We don't have that.

Give us one Georgia player that needs to play his best game of the season for Georgia to win this ball game (and why). Murray. The smart money would be on someone on defense, but I feel ok about them.  If Murray gets rolling, completes 60% of his passes and has one int. or less, I feel very good about our chances.  If he tops 325 yards, completes 65% of his passes, has 3+TDs/0ints and throws around 30 times, we win big.

Many thanks to Kevin at College Football Zealots for putting this together.


Thursday, October 27, 2011

3 Questions: Florida

This is a bit speculative, since I am writing it nearly a week early (due to being on a cruise during the whole week of Georgia-Florida).

  1. Will decided schematic advantage matter?  Ignoring all evidence to the contrary, I don't believe in the Jacksonville curse.  I do believe Florida has consistently showed up more ready to play for the past 20 years.  Now, we come into a game where we have been doing a good job preparing and look to be a better team than Florida. Will that matter? We have to be able to run the ball, which is the Florida defense's 'weakness.'  Do that and we will be ok.
  2. Can Aaron live down last year?  The 2010 Florida game was his worst.  Can he come out and play sound offense, deliver the ball well, and make good decisions?  
  3. Will the defense handle the running game well?  Vandy has me nervous. Up until then, I'd have been very content with our game preparation and take our chances with Rainey, Demps, and Burton.  Now, I think it remains to be seen if we can correct the issues we have with misdirection and delay hand offs.  I feel good about slowing down Florida's pass offense, which you have to figure they will still try to establish.  I feel decidedly less so about playing soundly against their potent rushing threats.  Despite what we have seen the past few weeks from Florida, they aren't nearly as bad as they have looked.

Monday, October 24, 2011

Growing Demand for Mobile Enterprise Application Services

More capable smartphones and media tablets are now joining a variety of highly portable netbook computers that have already invaded the workplace. Many are being combined with mobile apps that tap into cloud-based productivity solutions.

According to the latest market study by ABI Research, healthcare is one of the most dynamic sectors for mobile technologies, and manufacturing is now the largest sector for mobile enterprise applications worldwide.

By 2016, manufacturing will generate approximately 23 percent of the nearly $5 billion in mobile enterprise application service revenues.

Mobile enterprise applications, also called mobile B2E applications, include dashboard apps, work flow approval apps, and line-of-business applications for both the smartphone and tablet.

ABI's mobile services practice director, Dan Shey, says, "Manufacturing beats healthcare for B2E app adoption and revenues because of its large employment worldwide and the breadth of occupations that can benefit from mobile apps."

China is also one of the biggest drivers for manufacturing B2E mobile app adoption.

Manufacturing is the second largest employer worldwide. Manufacturing also employs a wide range of occupations using B2E apps, including shipping or receiving workers, delivery drivers, management and supervisory personnel, sales, and installation and repair workers.

Moreover, China is the world’s manufacturing hub, which drives B2E app needs -- not only for Chinese manufacturers but also for companies visiting their Chinese subcontractors.

Healthcare is the top sector in B2E mobile app adoption when viewing the data at the regional level. Healthcare leads in Western Europe, the Middle East, and especially North America, where healthcare B2E adoption outpaces manufacturing by nearly five to one.

Dawgs vs. New Mexico State Kickoff Time Set

Dawgs to play New Mexico State at 12:30 on CSS.  At least we'll all be home in plenty of time to see the game of the century of the year. 


College Pickem Results

Congrats to Aladawg for the only perfect ballot this week.

Richtflair extends his lead in the overall standings. I'll be on a boat (I've got a nautical themed pashmina!) the rest of the week, so posting will be sporatic. If you are cruising out of JAX this morning, we'll be the loud ones in red all week.

Go Dawgs.



Warning: The following video isn't safe for those with any sense of decency due to the wide use white rap beats, bad fade haircuts, over-sized muffintops, men in body socks, flip flops with socks and the use of the color orange. Viewer discretion is demanded.


Friday, October 21, 2011

College Football Zealots Mid-season Round-table

College Football Zealots has convened another round-table, this time in two parts.  The first questions are below.

At the mid-way point what makes you the most excited about this Georgia football team?  The upside.  While the simple answer is the defense, since it has been at least seven years since I didn't have a foreboding sense of abject dread every time we had to punt, the complete answer is the upside.  Georgia hasn't played a quality opponent with a fully put together game yet.  We've had good defensive performances.  We've had good passing performances. We've had good rushing performances.  We have had games where we didn't crap ourselves on special teams.  I realize it is a big 'if', but if we ever put it all together and keep it together, we will be a dangerous football team.

Which player has been the biggest surprise on defense (and why)?   Bacarri Rambo.  I was on him all last season and during the off season for his lapses in 2010.  He has stepped up big time and is a big part of why we are in the top 10 in total defense in the nation. Take away the two trick play TDs (Ole Miss and Vandy) and it is hard to remember anyone throwing a big pass against him.  This time last year, the mention of 'wheel route' would elicit a Pavlovian response of cursing about Bacarri from most Georgia fans.  Now, offenses have to trick play to get him off his coverage.  He plays pass coverage like a corner and running plays like a linebacker, and rarely makes mistakes on either.

What needs to happen for Georgia to run the table in the rest of their games?  1) Get better at recognizing misdirection and delays on defense; 2) Find a way to get the curse of Fabris off the special teams; 3) Have Murray finally get his timing on long pass plays down pat; 4) Get complete games from Crowell.  Special bonus answer in the event we play in the SECCG: Have all the pieces come together and hope Trent Richardson is suspended.

Part two is coming next week.  Many thanks to Kevin at CFZ for putting this together.


Thursday, October 20, 2011

Mid Season Questions

The folks at College Football Zealots have asked me to do another round table, this time in two parts.  I'll have my answers tomorrow, but I am curious about your thoughts.

At the mid-way point what makes you the most excited about this Georgia football team?

Which player has been the biggest surprise on defense (and why)?

What needs to happen for Georgia to run the table in the rest of their games? 


Wednesday, October 19, 2011

Life Calls

We are taking advantage of the bye week for non-blog related work. If the posting or comment moderation is less frequent. That's why.

Life calls.

PWD and TD

Geathers and Williams suspended.


Tuesday, October 18, 2011

Stand by Your Man

Putting aside Clay Travis' histrionics interesting take (go find your own link) over what Coach Richt 'might have said' during the exchange, I do have a bone to pick with Richt.  Dude.  Stand by your man.

Hey, I get you are trying to diffuse a situation.  I get that Franklin is Jim Schwartz a whiny titttybaby for getting so up in arms over anyone saying anything after all of the shenanigans his team pulled during the game.  I also get you need to man up and apologize for things getting out of control.  I am sure commiserating with the crying child is not the right way to go.

Not the best moment for Coach.


Ok, I've had an hour to mull over the video (and to watch it again several times).  After doing so, I have calmed down and also removed the hittroll's link above.  If you want to read Clay Travis, you can find it on your own.

As for my further thoughts, my problem with Richt remains his giving Franklin a passie to calm him down.  Thinking about the heat of the moment, Richt was just trying to get off the field when Franklin starts his soliloquy on respect.  He just said whatever to get him to quiet down.  The harsh 20/20 of hindsight says he should have smiled, said nice game, sorry about the confrontation...or 'WHAT IS YOUR DEAL?!?'...either would have been fine...and gotten his team to the locker room.

I'm still not happy about the comment, but I believe Richt wasn't intentionally taking Franklin's side over Grantham's.  No way he could have since he could have had any of the facts outside of the few that are sprinkled into JFrankies fit.

College Pick'em - Week 6 Standings

RichtFlair continues to lead the way.  Another multiple perfect week deal, with dawgy45 edging Mass Dawg on the tiebreaker.

Standings for Week 7
Rank Selection Edit W-L Pts Tie
Mich - MSU
14 - 28
1 dawgy45's picks 12-0 78 27-34 (*)
1 Mass Dawg 12-0 78 35-31
3 R.I.P. Jonathan 11-1 77 27-31
4 expansionpalooza 10-2 75 21-28
5 SparkleCity Dawg's picks 11-1 73 23-27
5 melj_go_dawgs's picks 10-2 73 17-21
5 BallGroundBulldog 11-1 73 28-35
5 ga_dawg_in_ut's picks 11-1 73 13-16
5 SullyDawg's picks 11-1 73 27-21
10 bsellers's picks 11-1 72 24-30
10 underdawgma's picks 11-1 72 20-31
10 Tankdawg's picks 10-2 72 24-31
10 ugafan's picks 11-1 72 21-24
10 TXDawgs1's picks1 11-1 72 34-35
10 Cstrickland's picks 11-1 72 14-17
10 Updyke Tree Service's picks 11-1 72 31-28
10 Dawg Nuts 9-3 72 34-28
10 DawgRocker's picks 10-2 72 35-27
10 ppostlmayr's picks 10-2 72 27-24

Overall Standings Through Week 7
Rank Selection W-L Pts
1 Richt Flair's picks 65-16 442
2 aueagle's picks 65-16 437
3 Hobnail_Boot 62-19 434
4 papadoc19's picks 64-17 431
5 jud92's picks 64-17 430
6 HunkerDownDawg's picks 62-19 429
6 ugafan's picks 61-20 429
8 ecdawg's picks 62-19 428
9 andyweaver's picks1 62-19 427
9 Updyke Tree Service's picks 61-20 427

Remember we will have selection due this week, even though Georgia is off.


Monday, October 17, 2011

Vanderbilt Review

The Good:
  • Pass offense. Vandy came into the game only allowing ~200 yards per game.  Murray had 326.  We are still plagued by the missed connections on the down field plays, including one off the hands of one receiver and another catch out of bounds that should have been in bounds.  
  • Pass blocking. I didn't give the line enough credit.  Murray had plenty of time to throw nearly the whole game.  It showed.
  • Pass defense.  Vandy wasn't going to light it up by going down field, but we held them to season lows in completions and QB rating, against season highs in attempts and interceptions.  All of that with the punter and RB a combined 2 for 2 and 78 of their 149 passing yards.
  • Abry Jones, where passes go to die.
  • Jarvis Jones. He only creates havoc and gets held.  Nothing less.
The Bad:
  • Misdirection and delay recognition on defense.  I wondered when this game was going to happen.  One of the downsides with an aggressive, but young, defensive squad is that they can get caught out of position on QB runs.  We saw that happen time and again on Saturday.  I have confidence in Coach Grantham to work this out, but the problem is the need to do so quickly, since we'll face at least two QBs and offenses that dream about these kinds of defenses before we are done.
  • Run defense in general.  Zac Stacy was lonesome on some of his runs.  I mean he wasn't even looked at until he had five yards.  
  • False starts on the wildcat.  Dudes, stop screwing up our trick plays.
The Ugly:
  • The spirit of Fabris.
The day after Drew Butler's eligibility runs out, Coach Richt should by him a gold watch.  Drew might have literally have saved his job with that tackle on the blocked punt.  

Also, you will note I didn't include the personal fouls and such in here.  I am not saying we should ever commit those types of penalties. I am saying, after watching the replay, I can't find grave fault with the players for committing them.  There was a crew of folks out who didn't perform their job very well that could have nipped a lot of this in the bud early, but didn't.  That John Jenkins got warned for his tackling is a good sign of what that crew was looking for.

Finally, and clearly, we aren't at the level I thought we were.  Vandy exposed our run defense.  I'd hate to be on the defense this next week two weeks with the way they played.  Can't think Grantham is going to be a pleasant person to be around.



(H/t Senator Blutarsky)

Like the goatee? I grew it on the way over. (Image:ABH)
I love that the State Patrolmen look like they are nervous.  That'll tell you all you need to know about what Coach Richt had to say.


Sunday, October 16, 2011

EHR Bargains Review – Practice Fusion

(Survival Tips for Small Practices)

If you subscribe to Prof. Clayton Christensen’s theories of innovation, Practice Fusion is to the EHR industry what Southwest Airlines was to the air travel industry, ad extremis, with no thrills, no frills and no peanuts. Practice Fusion is completely and truly free to users, and it will take you from point A to point B in a straight and short line, with point A being paper charts and point B being a Meaningful Use incentive check.

The Model

Practice Fusion is a web-based EHR and it is free to use no matter who you are. The company website has a self-provisioning button where any visitor can sign up for a free account and immediately start using the software. All you need is a valid email address. The company prides itself in taking users live on the EHR in 5 minutes. It actually takes much less than 5 minutes to get to a point where you can begin charting, but it takes a week or more to hook up to electronic prescribing and lab interfaces, and this is very much in line with industry practice. Practice Fusion offers free connectivity to national reference labs and a handful of regional ones as well. Just like there are no charges for electronic prescribing, there are no interface fees for the currently available lab connections and no mention of “custom” interfaces built for a fee. You get only what you see.

Since we all know that there is no free lunch, how is it possible to get a free EHR, including significant interoperability? The standard answer to this is that Practice Fusion is ad supported. Just like you get free email services from Google in return for agreeing to see ads on every email page, when you sign up for Practice Fusion, you are agreeing to see ads on every EHR page. To my pleasant surprise, the ads are mostly limited to about one inch of space at the bottom of the screen, and are not at all intrusive in the workflow. I actually don’t quite see how these ads support anything, since with the exception of one Dell advertisement they all seem to be Practice Fusion self-promotions. Furthermore, the fairly new Patient Fusion portal displays no ads at all. Similar to most other EHRs, the Practice Fusion end user agreement reserves the right for the vendor to aggregate and monetize EHR data, and perhaps this is a possible explanation for this free lunch.


The best description for Practice Fusion’s functionality is bare-bones. There is no fluff, no bells and no whistles to be found in the very simple, very clean user interface. After muddling through a variety of top-shelf EHRs with double and triple menu-bars and icon studded task-bars on every page, the Spartan look & feel of Practice Fusion is quite refreshing. Although there are multiple training aids in the system, if you are an average computer user (e.g. email, Word), you should not need much coaching to become productive at very short notice. This of course eliminates another hefty expense associated with EHR adoption: training.

Whatever free-form stuff you are now doing on paper, you can do in Practice Fusion, pretty much the same way. It comes with a simple set of SOAP templates consisting mostly of questions where you get to type in the free text response. You can also type directly into the note and probably use Dragon as well. You can create your own sets of questions, or add to existing ones. You can order meds, labs and imaging and print those, or send electronically if connected. Scanned documents can be uploaded to any particular chart. There is no clinical content available for decision support, at this time. Registry functions are in their infancy and the handful of available reports is very simplistic. Disappointingly, the Meaningful Use report does not automatically calculate numerators and denominators for core and menu items, but clinical quality reporting is automated. There is very little customization possible and none is required.

For patients, there is Patient Fusion, a simple web-based portal that allows patients to see appointments, meds, allergies, immunizations and labs. It also provides some links to medical content on the web. It seems that the portal is very much a work in progress, but just like the EHR, its user interface is clean, simple and appealing. Unlike the EHR, which is Flash based and therefore unavailable for use on Apple mobile devices, the portal is accessible from an iPhone or an iPad. Practice Fusion did announce recently that a native version of its EHR for the iPhone is due to be released soon. 


Practice Fusion is privately owned and has been around since 2005, but started taking off in earnest around 2009. Its recent growth coincides with the HITECH act and the advent of Meaningful Use. Although it is possible that it will follow a trajectory similar to Southwest Airlines and blossom into a major EHR vendor, it is also possible that it would make a rather attractive acquisition target for one of the much bigger fish circling health care IT right now. Will it remain free to end users? There seems to be no current intent to charge customers for software usage, but Practice Fusion received over $36 million in venture capital, which usually comes with expectations of short term spectacular returns. Time will tell.

Bottom Line

Practice Fusion is currently certified for Meaningful use as a Complete EHR, which means that you don’t have to buy additional software in order to achieve Meaningful Use requirements. As is the case with all web-based EHRs, you will have to buy desktop (or mobile) hardware, internet services and networking hardware. You will still need to pay for a Practice Management system and billing, and unless you choose to utilize the sole Practice Fusion partner for these activities, you will need to budget staff time for double data entry. You will not need to pay for the EHR, its server and its maintenance. If you are interested in Meaningful Use incentives, and if you practice in a small group, and if the cost of EHR seems prohibitive (or a waste of good money), and if you have no use for bells and whistles above and beyond a paper chart, then by all means, go ahead and try it out. It’s free.

Venerate or Denigrate? My Thoughts on Grantham

Wait, let me title this 'My thoughts on Franklin.'  Lost in all of this, due to the choke sign last year, is that Franklin is way more than complicit in what happened.  As what happened in the game, the second guy is the one that always gets caught.  His condescending statements about the situation merely show that:
“We just had a tough, emotional game and some things were said that I didn’t think were appropriate. I went to find Coach Richt and didn’t find him, so I found one of his assistant coaches and it didn’t go well. We’re not going to sit back and take it from anyone.”
Now, I'm not going to say Grantham is blameless here.  Clearly he has a temper and that temper got the best of him.  But is Grantham supposed to 'take it' when the other guy gives it out?  If the story that Franklin was chastising a Georgia player on the field is true, then the whole situation sits on Franklin's shoulders.  That is a way bigger issue than the choke sign last year.

Of course, there are people willing to lay all the blame on Grantham for everything due to something he did a year ago without even worrying about how it went down, or why.  Grantham is a very passionate coach.  We need that.  From my seat, Grantham didn't do anything other than stand up for his guys.  We, as Georgia fans, deserve whatever we get if we are willing to cast him aside for that.

If I am proven wrong, I'll say so.  Until then, I believe there were at least two men involved that could have handled their business differently.  Regretfully, only one is getting the blame.


3 Questions Answered: Vandy

After the finish in Nashville last night, I'm sure I'll screw this up somehow...
  1. Will Georgia be up for the game? No.  Not sure why Crowell is out, but if you want to blame Coach Richt, well, just blame him. The defense looked stout at time and less so at times.  The offense, without the more open running with Crowell, and more missed opportunities in the passing game, looked pedestrianer than normal. I was worried this would be the case, and it was.
  2. Will we see a more open playbook in the second half if we have a 2+ score lead? See above.
  3. Can the defense keep up the intensity? At times, yes.  At other, more important times, no.  Much will be made about Grantham's actions, probably rightfully.  However, if Coach Franklin made comments to a Georgia player about their play, especially after the entire game of uncalled chop blocks and such, well, I fully support him.  As for his unit, I would sure hate to have to wait two weeks to get Grantham off my back, because the next two weeks will not be hugs and cuddles.
I am relieved we won.  I think we've all expected a game like this, one were we don't play very well again. We won on the road.  Move on.  I guess.

Friday, October 14, 2011

Occupy Health Care

Earlier this year, in the midst of the civil unrest in Egypt, Michael Millenson pondered about the passive attitude of those lacking health care insurance and their failure to organize and “take to the streets”. Well, unless you are living under a rock, or are really busy seeing patients, you know that we have quite a few people “taking to the streets” nowadays. They call themselves the 99% and they are set to Occupy Wall Street along with a bunch of other cities across the country. They have been called everything from “the rise of a popular movement” to “anti-American”. Are these Michael Millenson’s uninsured finally standing up for themselves? Judging from the stories they write on the placards covering their faces, which look eerily similar to what you see at busy urban intersections (e.g. “Lost home and job, will work for food”), lack of health insurance is often cited as a source of misery, but so are student loans, lost savings and inability to find work. Although this peaceful movement of folks camping out in parks and marching down streets has no coherent message, their grievances are casting a large net directed at the destructive influence of Wall Street, big corporations and consumerism in general. Michael Millenson should be satisfied, since health care is most definitely included in this all-encompassing indictment of an unjust society, and here is why.

But first a little detour into terminology. The word “care” originates from the Old English caru, cearu "sorrow, anxiety, grief," also "serious mental attention" for the noun, and carian, cearian "be anxious, grieve; to feel concern or interest" for the verb. When it comes to one’s health, with the exception of patients, their loved ones and increasingly fewer and fewer doctors, nobody in the medical complex experiences any feelings of anxiety, grief or even true interest or concern for the sick, although they may experience all of the above for the cash flow associated with treating sick people. The term health care is an anachronism from a bygone era and it needs to be changed. Health Services seems a much better fit with the prevailing consumer philosophy, which brings us to the next point.

Ever so gradually and insidiously, the term consumer is replacing the term patient in health services contexts, just like it replaced the term people in larger contexts. The etymology for the word consumer dates back to the early 15th century as "one who squanders or wastes", and in economic sense, "one who uses up goods or articles (opposite of producer) from 1745”. Interestingly enough those who presumably advocate for poor and vulnerable populations and even our own government are enthusiastically standing up for their constituencies of squanderers and wasters. Sometimes terminology describes existing realities and sometimes carefully chosen terminology shapes reality. We are witnessing the latter. The big corporations being targeted by those who Occupy Wall Street, have a long, and productive, history of manipulating the 99% into using up as many goods and articles as possible, and then some (i.e. debt), while extracting both profit and power from an increasingly impoverished society. Squandering and wasting is the secret sauce for a consumerist world order, and the medical complex is no different. According to Forbes, in the midst of a recession, CEO pay has increased in 2011 by 28% compared to 2010. The highest paid CEO in America, at $131 million per year (twice as much as the second CEO on the list), is running a health services company. Makes perfect sense. After all health services are quickly approaching 20% of a successful wasting and squandering economy. $131 million is peanuts by comparison.

But here the big corporations are encountering a big problem. The U.S. government, that is supporting a large portion of the waste and squander in the health services sector, is running out of money, and the squanderers themselves seem unwilling to waste their own money on health services. They much rather debt finance homes, cars and iPhones than, say, colonoscopies and designer drugs. The solution to this quandary is a brilliant one-two punch. First we use the bought and paid for government to educate consumers that in a world of finite resources, after skimming the $131 million type “compensations” from the top, only those who have their own resources (i.e. cash) should expect to continue wasting and squandering health services. Second, to compensate for lost revenue from government’s support of health services consumption, we employ two, time tested, strategies. We convert non-consumers to consumers by giving them free small things to lure them into buying more expensive items. For example, we give out free cholesterol screenings so we can create a recurring revenue stream from statins and hopefully more expensive interventions down the road. After all there is a huge untapped market of 50% of Americans who barely use any health services.  Then we increase the prices of everything from health insurance to direct services, by eliminate those obnoxious small businesses floundering in this space and fragmenting our ability to negotiate higher prices. The government is of course expected to help with the necessary laws and regulations, and so far, keep your fingers crossed, it’s going rather well. With a little bit of luck, smart consumers will soon realize that it is in their best interest to spend money they don’t have on the medical complex rather than the real estate market, which has gotten more than its share already, or the high tech gadget market which is booming, or the automotive market which is dead anyway (except for Audi who is selling cars for a crumbling infrastructure littered with trash). It’s all about reallocating extortion revenue and nobody is in a better position to do that than the medical complex. Brilliant indeed.

As the ancient prophet said “What has been will be again, what has been done will be done again; there is nothing new under the sun” [Ecclesiastes 1:9], all of the above has been tried before, in this case by the legendary Mullah Nasreddin, and we know how it ends:

One winter Nasreddin had very little money. His crops had been very bad that year, and he had to live very cheaply. He gave his donkey less food, and when after two days the donkey looked just the same, he said to himself, "The donkey was used to eating a lot. Now he is quickly getting used to eating less; and soon he will get used to living on almost nothing."
Each day Nasreddin gave the donkey a little less food, until it was hardly eating anything. Then one day, when the donkey was going to market with a loan
[sic] of wood on its back, it suddenly died. "How unlucky I am," said Nasreddin. "Just when my donkey had got used to eating hardly anything, it came to the end of its days in this world."

To the 99% of us donkeys out there: Occupy Health Care Now!

Half Way Home - Mid-Season College Football Review

I'll take a look at Georgia later this week or early next week, but I wanted to look around the college football landscape and see what has surprised me.
  • Expansion. Well, I'm not surprised, but it has been a story.  I've thought for a while TCU was headed some place other than football hell the Big East.  I guess Missouri's handling of trying to get out of the Big12 is a bit of a surprise.
  • Southern Cal's lack of defense.  I think Arizona State's improved play has everyone not in Tempe scratching their heads.  On the other hand, Monte Kiffin has looked like Monte Hall coaching this bunch.  
  • Hot seat talk about Dooley.  Hey, I'm not taking up for the guy.  I hate orange as much as the next guy.  However, any Tennessee fan that thinks fter 18 games, six of which are being played with essentially an all-star high school team, that Dooley isn't getting it done is an idiot.  He might not be the long term answer, but clamoring for a new coach now gets you a Mike Locksley type hire.  Not an improvement.
  • Oklahoma State's offense. Dude. They look like UNLV basketball in the 80's.
  • Texas A&M's first half play.  Wow, they are among the best teams out of the gates I have seen in a long time.
  • Texas A&M's second half play.  Wow, they suck.
  • Wisconsin's march through the B1G.  The Badgers called the Houston Nutt QB Transfer Clearinghouse and ended up with Russell Wilson from NCState.   Dude is 83 of 111 for 1391 yards and 13 TDs.  The Badgers have the easiest road to the BCS championship game at this point, with only road games against Michigan State and (snicker) Illinois between them and a rematch with Nebraska at Lucas Oil Stadium for the B1G championship.  Oh, and their defense is the tits.
  • Decided schematic advantages.
  • Georgia Tech throwing the football. Paul Johnson hates that newfangled shit, but it sure works.
  • Clemson at 6-0. Wins over Auburn, Florida State, and Virginia Tech? A coach named Dabo? Nah, no worries, man. Just living the upstate dream.
  • Auburn's defense.  They've made amends a bit with their strong performance against South Carolina, but they won early on mirrors and camera angles. Ted Roof has looked every bit the former head coach at Duke with the way his unit has tackled.
What about the season to this point has surprised you?

Thursday, October 13, 2011

3 Questions: Vanderbilt

Playing in Nashville always worries me.  Normally, it isn't that much of a game, but we always struggle early there.  Vandy's D is much better than in years past.  Vandy's offense is Vandy's offense.
  1. Will Georgia be up for the game? Having an off week before Florida is a double edged sword.  Getting an extra week to heal and prep is huge. With the way our defense is playing, I hate for them to have a week off. That ldads me to the concern I have about Vandy and the team not being focused on Saturday night.  The Commodores are strong defensively, especially on the run. 'Bama exposed their weakness on the short passing game, so look for us to leverage Orson's size and the running backs' receiving abilities early. Talent wise, this is a 24+ point win.  If we show up and play the same defense we've been playing, it could end up being that much or more.
  2. Will we see a more open playbook in the second half if we have a 2+ score lead?  Richt gigged Bobo's play calling a bit about us getting ultra conservative on the last drives in Knoxville.  I don't expect us to take multiple down field shots if we have that kind of lead.  I hope we will do more than a 23 dive on 3rd and 8 on back to back to back to back drives. 
  3. Can the defense keep up the intensity?  Many commentators have made mention of how weak Georgia's schedule is in pointing out how strong the defense has looked.  What they haven't mentioned is how they looked vis a vis the 'really good' defenses in the conference.  For example, Mississippi State gained 193 yards (3.3 yards per play average) against LSU and scored two offensive FGs.  Against Georgia, Mississippi State had 213 yards (3.2 ypp average) and scored one offensive FG.  If the Dawgs do close to Vandy what Alabama did (190 yards, 4.4 ypp, 0 points), that is one more indication where the defense is.
As a bonus, will we finally get the long run back from Smith or Boykin we've been waiting on?

Wednesday, October 12, 2011

You mean...other than their confessions?

My favorite part of the news that Auburn has been cleared of any wrong doing is the part where the NCAA says the allegations against Auburn didn't meet "the burden of proof."

To clarify...that means a confession isn't enough enough proof.
More allegations surfaced in March when the four former Auburn players raised additional claims of wrongdoing in the program.

Raven Gray, Stanley McClover, Chaz Ramsey and Troy Reddick told HBO's "Real Sports with Bryant Gumbel" that they received thousands of dollars while being recruited by or playing for the Tigers.

They said the cash was delivered in book bags, envelopes and even handshakes. Ramsey played at Auburn most recently, in the 2007 season

And by confession...I mean four confessions.

Auburn is running circles around the NCAA. We are truly in the Golden Age of NCAA Rule Violations. Bear Bryant tips his cap to the Aubies. We all stand in awe.


Spurrier: Master of Deflection

Look, coaches and the media long have had a love-hate relationship.  We saw what happens when mamma's rile gets up last week.  This week, we saw Spurrier at his finest.  Spurrier spent all of 1994 ignoring a writer for the Orlando Sentinel, something that is incredibly hard to imagine now.  Now, on a bitchiness scale, I rate this up there with St. Urban's "You're a bad guy" rant.  This is a two days before Aunt Dot gets to town, and you ate the last of the chocolate chocolate chip Häagen-Dazs, you asshole, bitchrant.

As a PR move, it is glorious.  He fires Garcia earlier in the day.  His allin bet on Garcia staying off High Life and reefer long enough to finish his senior season is called down.  Spurrier put winning above doing the right thing, probably the best thing, pure and simple.  How to keep the story away from the truck of fail that was the decision to let Garcia off the mat at least four more times?  Make counter accusations!

Awesome move, Coach.  When you are done, I think Exxon could use some advice on blaming those pesky seals for all the cuteness and shit they leave on rocks, which makes it harder to clean up spilled oil.


Ed Note: In the spirit of blogeristic integrity, it should be noted that Quinton did a 5 questions with Ron Morris before the 07 game.

Tuesday, October 11, 2011

Garcia Kicked off South Carolina's Team

Really.  They mean it this time.


SEC Bowl Projections

As we've hit the half way point of the season, here are some thoughts on SEC and BCS bowl projections.

National Title: Alabama vs. Oklahoma
Rose: Wisconsin vs. Stanford
Fiesta: Oklahoma State vs. Michigan/Nebraska
Sugar: LSU vs. Boise State
Orange: Georgia Tech vs. West Virginia

Comments: I have Bama over LSU simply by virtue of the home field advantage on Nov. 5th. I have Georgia Tech winning the ACC because they are tough to defend with only a week to prepare, and the weak ACC is begging them to win it.  Although, GT could slip out of that spot if Virgina Tech beats them.  Remember, VT has a bye week before facing the Yellow Jackets, and Paul Johnson's track record when a BCS team has more than 7 days to prepare can generously be described as "poor."  If the winner of Nebraska at Michigan has two losses or less, they'll get the Fiesta Bowl at large spot. A Big 12 flashback of OkSU and Nebraska would make great TV.

CapitalOne: Arkansas vs. Michigan/Nebraska
Outback: UGA vs. Penn State
Cotton: Auburn vs. Texas A&M
Chick-Fil-A: South Carolina vs. Virgina Tech
Gator: Florida vs. Michigan State
Music City:  Tennessee vs. Florida State
Liberty: Mississippi State vs. Houston
The Bowl in B'ham Nobody Watches: No SEC Team Eligible

Comments: In my projection, I have Georgia beating UF or AU, but not both. I have South Carolina making the SEC title game, but losing to Arkansas, Clemson and Alabama which might knock them down a slot in the bowl pecking order.  I think Tennessee and Miss State will both end up bowl eligible.  Vandy would need to beat Georgia, Tennessee or Wake Forest to have a shot at bowl eligibility.  That's not impossible, but it's not likely either.  As for Texas A&M in the Cotton Bowl...I just don't have the stomach for putting Kansas State in that spot.


College Pick'em - Week 6

Another week with three perfect picks.  DinDawg predicting a big Oklahoma win on the tiebreaker.  Great job by kdsdawgs and brad1165, too.  For the season, Richt Flair is a limousine ridin', jet flyin', kiss stealin', wheelin' dealin' son of a gun WOOOO!! leader half way through the season.

Standings for Week 6
Rank Selection Edit W-L Pts Tie
1 DinDawg Fan's picks 12-0 78 35-21 (*)
1 kdsdawg's picks1 12-0 78 27-21
1 brad1165's picks 12-0 78 17-10
4 jathebirdyboy's picks 11-1 77 32-28
4 Polarshark 11-1 77 31-21
4 macdaddy's picks 11-1 77 31-24
4 snoopdawg's picks 11-1 77 21-14
8 RobertKBurnham's picks 11-1 76 42-34
8 marks31's picks 11-1 76 30-21
10 Mass Dawg 11-1 75 35-17
10 LM 11-1 75 35-24
10 Annapolis Dawg's picks 11-1 75 27-20
10 Dawgirl's picks 11-1 75 24-21

Overall Standings:

Overall Standings Through Week 6
Rank Selection W-L Pts
1 Richt Flair's picks 54-15 373
2 aueagle's picks 55-14 368
3 jondeal's picks 55-14 367
4 Hobnail_Boot 52-17 366
5 contrarian's picks 53-16 365
6 ecdawg's picks 53-16 363
6 blaked04's picks 55-14 363
8 jud92's picks 54-15 361
9 HunkerDownDawg's picks 52-17 360
9 papadoc19's picks 54-15 360

Monday, October 10, 2011

Isaiah Crowell Stats

So far, Isaiah Crowell has been just about everything Georgia fans could've hoped for in a freshman tailback who lacked super powers or the first name Herschel.

Over a 13 game season, he's on pace for over 1200 yards rushing and about 9 TDs.  Those are pretty realistic and potentially conservative numbers given that Vandy, New Mexico State, Kentucky and likely a tier 2 Big Ten team represent four of the remaining seven opponents.

His statistical splits against ranked teams and SEC opponents are solid so he's rising to the level of the opponent for the most part.  He's also playing banged up.

Obviously, the one area where he can improve dramatically is his conditioning.  His average yards per carry per quarter are:
-- First Quarter = 6.2 yards/carry
-- Second Quarter = 5.6 yards/carry
-- Third Quarter = 3.4 yards/carry
-- Fourth Quarter = 3.7 yards/carry

If you prefer a look by half, it's 5.9 yards per carry in the first half and 3.5 yds/carry in the second half. 

In fairness, he probably didn't see the fourth quarter of very many high school games as dominating as his team was.  But still...UGA and Crowell must find a way to get him ready for more work.

The flip side of this equation...if you're an elite high school running back recruit like Keith Marshall (RB from Raleigh, NC), you can realistically look at the success of Crowell and still see tremendous playing time.  Crowell would likely be happy to have you take some of his snaps. (Weirdest sentence I've written in a while)

I'm pleased for him as he's having a great freshman season.  The coaches just have to find a a way to get more quality carries from him in the fourth quarter of games.


Gilliard and Walsh Named SEC Players of the Week

Gilliard for his 12 tackles (a sack and 2.5 tackles for loss), strip and pass break up.  I was remiss in not mentioning his play earlier.  Walsh for his two FGs.


Tennessee Review

Despite what some pundits think (no links, you can feed their troll habits without my help), I'm remain happy with the team's play. Fourth strong defensive effort in a row.  Strong play calling when we needed it.  Strong running from Crowell later in the game.  A win in Knoxville.  I'll take it.
The Good:
  • Coaching adjustments.  If I'm going to call out the lack of coaching acumen, it is only appropriate that I laud it when it goes well.  The half time adjustments were good.  The second half play calling was very good.  
  • Special props to the call on Crowell's second TD run.  In the second half, almost every run was to the left side of the line, presumably to protect against him losing the ball out of his sprained right wrist.  We went back to the play that we ran at Mississippi from inside our own 5 that gained 25+ to the right side.  It was as well blocked and well executed Saturday night.  As a bonus, Tennessee's defense was completely expecting him to cut left when he cut right.
  • Energy.  Loved going for it twice on 4th down on the first drive. Crowell kept answering the bell. The defense kept hitting hard.  It was a nice change after the last two trips to Knoxville.
  • -20 yards allowed rushing.  I've seen some people pointing to this being a product of how bad the Vols rushing offense is.  To that, I'd answer that those guys didn't just fall down behind the line on their own.  
  • Keeping Bray off kilter enough that he never got into a rhythm. 
  • Walsh getting his mojo back.
  • The defense not falling into super prevent on the last drive.  Yes, they only had :18 seconds, but we still came after them very hard.
The Bad:
  • 4th and 56.  Damn.  I know you could call a hold on nearly every play (and the first one against Aron White was particularly tictac), but damn.  Although you could make a case that you'd rather get all of your holds for one game out of the way in one drive.  
  • An 8 minute, 12 play, 28 yard drive.  I am not sure how you do that.  Wait, you end up 4th and 56.
  • Not getting that last first down.  The game is on the line.  Finish them.
  • Murray's long passes.  Give Bobo credit, he kept giving Murray chances to work it out (which he did with the long Mitchell pass), but they were there all night and he just isn't in sync on the long ball right now.
  • I miss Orson Charles in our passing game.
  • The long 3rd and 4th down conversions allowed in the first half.  I started having flashbacks.
The Ugly:
  • The first half.
One last observation.  When it was 3rd and 56, why not throw it long?  At that point, armpunt isn't the worst option, right?  In all a strong game.  Still areas to improve in, but strong.


3 Questions Answered: Tennessee

I had questions.  Now I have answers.

  1. Will we slow down their passing offense enough? Yes.  We held Bray to a season low in passing yards.  He only had one game with fewer than the 18 completions, and he only threw 24 times in that game (compared to the 33 times he threw Saturday).  Rogers had a couple of big catches on their one TD drive, but was largely silent, especially in the first half.  We didn't him him as much as I thought we would need to, but we kept his rhythm off enough to make it a long night.
  2. Can we score enough points to win? Wow.  If you'd told me we'd win with 20, I'd have counted on rain or something else.  Give Tennessee credit.  They played really strong defense in the first half.  We only had the ball three times in the first half.  The Vols bowed up when they needed to.  I have to give Bobo credit with the play calling in the second half.  He kept going to the long ball because it was open, and despite Murray consistently missing those open guys.  He mixed run and pass very well on both TD drives.  
  3. Which team will make the biggest special teams screw up? It ended up not mattering.  We blocked an extra point that would have made it interesting.  They missed a FG early, but I don't think that mattered either.
Hey, a road win in Knoxville is a road win in Knoxville.  Our defense held Tennessee to -20 yards rushing.  Taking sacks and tackles for losses out they still only had 41 yards rushing.  I'll take that all year.

Sunday, October 9, 2011

The Rise of Big Data

Health care is in the process of getting itself computerized. Fashionably late to the party, health care is making a big entrance into the information age, because health care is well positioned to become a big player in the ongoing Big Data game. In case you haven’t noticed computerized health care, which used to be the realm of obscure and mostly small companies, is now attracting interest from household names such as IBM, Google, AT&T, Verizon and Microsoft, just to name a few. The amount and quality of Big Data that health care can bring to the table is tremendous and it complements the business activities of many large technology players. We all know about paper charts currently being transformed via electronic medical records to computerized data, but what exactly is Big Data? Is it lots and lots of data? Yes, but that’s not all it is.

Americans live for approximately 78 years. They see a doctor about 4 times per year and spend on average 0.6 days each year in a hospital. To keep a life time record of blood pressure readings for all Americans, including metadata (date/time of reading, who recorded the measure and where, etc.) takes approximately 6 TB (terabytes) of storage space, or about 12 laptops with standard 600 GB hard drives. Not too big. What if we start using mobile wearable devices to quantify ourselves, as some folks already do, and we record blood pressure, say, every hour? We will require 1460 TB of storage, or almost 3000 laptops, or the equivalent of 6 times the digitized contents of the Library of Congress, and this is for blood pressure monitoring only. Adding in the remaining 99.9% of the medical record, including large imaging files, hospital monitoring devices, pharmacy data, insurer data, telehealth sessions and other personal health sensors, and keeping in mind that all these data are meant to be exchanged freely over the Internet, we are approaching a data tsunami of biblical proportions. And we are not done just yet. Once health care’s Big Data is released into the mainstream Internet, it will initiate secondary and tertiary waves of new data created by consumers addressing their newly found health care data on social media venues, specialty forums, blogs and commercial sites offering services for health data. Big Data is the fluid combination of the ever increasing real-time data streams created by everything from government to businesses to Facebook, Twitter, Geo-locators, mobile devices and connected sensors everywhere. Big Data is as much about size as it is about cross pollination of data from disparate sources.

A fascinating June 2011, McKinsey report predicts that Big Data is the “next frontier for innovation, competition, and productivity” and that Big Data will become equal to labor and capital in its importance to production. For U.S. health care, the report is predicting $300 billion per year in savings due to utilization of Big Data to drive the execution of strategies proposed by health care experts. In the area of clinical operations, the report lists projected savings from Comparative Effectiveness Research (CER) when tied to insurance coverage, Clinical Decision Support (CDS) savings derived from delegating work to lower paid resources and from reductions in adverse events, transparency for consumers in the form of quality reports for physicians and hospitals, home monitoring devices including pills that report back when they are ingested, and profiling patients for managed care interventions. Administrative savings are projected from automated systems to detect and reduce fraud and from shifting to outcomes based reimbursement for providers and, interestingly, for drug manufacturers through collective bargaining by insurers. Most savings listed under research and development opportunities from Big Data seem to accrue to pharmaceutical and device manufacturers. There is nothing to suggest that Big Data will somehow reduce unit prices of products or services.

To be honest, I don’t quite understand where the $300 billion in savings come from as there are no actual itemized numbers to support this prediction. In addition to stated reliance on individual studies and expert interviews, there are many structural assumptions regarding massive provider consolidation, proliferation of Accountable Care Organizations, technology adoption rates of 90% across the industry and data sharing amongst all stakeholders, at which point Big Data will come in and do its thing. The costs for generating, storing and analyzing Big Data which include emerging data storage technologies and analytical expertise are factored in, with the costs of national deployment of EHRs alone “estimated at around $20 billion a year, after initial deployment (estimated at up to $200 billion)”.

Most people, including doctors, will probably agree that pertinent data, big or small, can be transformed into pertinent information, and pertinent information is vital to good decision making. But is Big Data pertinent? Are all those petabytes of minute details about everything and everybody really useful, or are we just mixing a little wheat with a lot of chaff? There are various opinions on this, but the prevailing wisdom seems to be that the more data you have, the more likely you are to be able to extract something useful out of it. By observing patterns and correlations in this ocean of information you may discover answers to questions you wouldn’t have known to ask in the first place. There is much power in Big Data, but there is also danger. As big as Big Data may be, it does not guarantee that it is complete or accurate, which may lead to equally incomplete and inaccurate observations. Big Data is not available to all and is not created by all in equal amounts, which may lead to undue power for Big Data holders and misrepresentation of interests for those who do not generate enough Big Data. Collection and analysis of Big Data has obvious implications to privacy and human rights. But the biggest danger of all, in my opinion, is the forthcoming relaxations in the rigors of accepted scientific methods, and none seems bigger than the temptation to infer causality from correlation.

We’ve been there before. When humanity dwelt in caves and villages, correlation was enough to establish causality. We’ve come a long way since, but the global village we are creating today seems tempted to go back to observation as the main way of gaining understanding. Just like the historic villagers, we are now convinced that we can see everything there is to be seen; therefore the answers to all our questions must be found in the Big Data mirror we placed in front of us. All we have to do is stare at it long enough and the patterns will emerge. The sheer size and variety of Big Data will make it much easier to reject the null hypothesis and see patterns where none exist. On the other hand, if we keep staring at our digital selves in the eye for long enough, perhaps we will achieve the most coveted observation of all: a glimpse through the windows to our digitized soul.