People of my generation (the author is in the late afternoon of his twenties) don’t get it.  What we don’t get is how relatively new and modern personal computing technology is.  We don’t realize that we were one of the first generations to have computers in our classrooms when we started kindergarten, one of the first to have internet access in our libraries, and one of the first to have networked computer interaction as a fundamental part of our lives from a young age.  We don’t understand why other generations don’t find computing as intuitive as we do.

Learning to use computers effectively is a process of repetition, immersion, and is ideally started early in life, just like learning a new language.  I think there is both a challenge and an opportunity – for all generations – in the generational computing gap.  The younger folks who can find ways to tailor their products and services towards usability, approachability and friendliness can often make big strides in taking new technologies mainstream.  Boomers and older have tremendous opportunities to separate themselves from their peers and their competitors by balancing a willingness to be open minded about embracing technology with a keen eye towards results.

In this spirit I would like to talk about a basic computing concept: file extensions.  First, what is a computer file?
continue reading "Learn This Now: File Extensions and the Generation Gap"

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An excellent article on EHRs and CCHIT was pointed out to me recently and I thought I’d pass it along to my readers.  To answer the question “What is CCHIT?”, the site SoftwareAdvice says this:

CCHIT is a private, non-profit organization formed to certify EHRs against a minimum set of requirements for functionality, interoperability and security. It was founded in 2004 by three industry associations ( HIMSS, AHIMA and the Alliance). It was subsequently funded further by the California Healthcare Foundation and a group of payers (e.g. United HealthGroup), providers (e.g. HCA) and software vendors (e.g. McKesson). In 2005, CCHIT was granted a $2.7 million contract by the Department of Health and Human Services (HHS) to support its mission. A number of other medical associations have since supported CCHIT. Despite the HHS contract, CCHIT is not an extension of the federal government.

continue reading "What is CCHIT and Should My EMR/EHR Be Certified?"

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I wrote this article for the Physician Office Managers Association of America (POMAA) March/April 2009 Newletter.  If you don’t know POMAA, check out their website.

Each of us have areas of expertise based on our experience, our education and what we find interesting and fun.  IT knowledge and skills are no longer optional, however, and I suggest every medical practice manager learn as much as possible about the following five areas.  Your work life and the life of your practice may depend on it!

Skill 1: Email Etiquette and Management

Email can rule your work life if you don’t make good choices with your messages.  Managers need to know how to use the Rules Tool (Outlook) to automatically move messages into folders, and how to turn emails into Tasks and Appointments.  Work communication can succeed or fail if you don’t have the basics under your command.  Knowing how to archive your email will not only save you time when looking for important information, but will save you from the frustration of searching through hundreds of emails.  Here are the basics of email management:

1. Most organizational experts recommend looking at your email twice a day, and turning off the setting that notifies you immediately when you have new email.  Email can be very addictive, and can suck your time away from projects and other work.
2. Just like paper, try to only touch an email once.  Once you read the email, decide whether to delete it, answer/forward it and delete it, or do something else with it like dragging it to the task list or calendar.  Don’t get caught in the ugly cycle of reading it once, and going on to the next email without doing anything about it.  If you do that, you’ll end up with lots of emails that you have to read again…and maybe a third time.
3. Never put anything critical (of a criticizing nature) in an email.  If you need to have that type of conversation with a colleague, pick up the phone.  A critique to an employee is best done in person, with a follow-up email for the file.
4. Always check your outgoing email for tone.  The best tone for business email is professional. This means a greeting, a message, a “thank you” and footer with your full name, title, and contact information.  Some organizations are more formal, and some are less formal, but I would err on the side of being more professional.  You can always set your email signature to include the greeting and thank you and your name, so all you have to do is complete the middle.
5. For emails that do need to be saved for reference, make subfolders under your Inbox to place reference email. Even better, copy the email to a Word document, and delete the email.
6. Have high priority (your boss or bosses) and low priority (listservs, subscriptions) email automatically come into their own folders.  The low priority email can wait and the high priority email can be dealt with first.
7. Group emails with jokes, homespun wisdom, clever tests and unbelievable pictures are a waste of your time.  If you need a break from work, go for a walk, but get rid of the group emails.  They take personal and server email space and can border on or be outright offensive, causing a problem if you don’t nip it in the bud.  Remember that email is legally discoverable.
8. Be careful about answering emails off the top of your head, possibly when you’re angry, or rushed.  If you need to delay answering an email because of your mood, drag the email over to the task list and set the to-do for tomorrow.

Skill 2: Understanding Medical Office Software

Acronyms come and go, but the basic software that supports medical practices remains the same.  Practice Management Systems (PMS) typically include registration, scheduling, billing and reporting as one component.  Today’s systems are built around the billing function, with scheduling and registration supporting the ability to generate electronic claims and post payments back to the transactions.  Because billing is becoming more standardized, it is the reporting that can make or break a practice.

Electronic Medical Records (EMR) are sometimes referred to in a broader sense as EHR (Electronic Health Records) and range from the simplest of systems which act as a repository for the electronic chart to the most sophisticated systems which may include  digital imaging, e-prescribing, complex messaging, medication reconciliation, and test alerting, among others.  EMR and PMS can be totally integrated, or can interface with each other, populating the other uni-directionally or bi-directionally.  Those mangers with a deeper understanding of their own software systems will find it easier to implement pay for performance measures such as PQRI and e-prescribing, and will not have to rely on vendors to educate them.

PACS is Picture Archiving and Communication System and allows easy indexing and retrieval of images.  PACS exists primarily in radiology and surgical specialty offices, but as more hospitals extend EMR and PACS privileges to physician offices, managers will need to understand something about the technology.

Other systems that will interface to your system are transcription, outsourced billing systems, data warehouses, claims clearinghouse, electronic posting systems, and web services interfaces.  Get or make a graphic representation of your software and hardware system/network so you can talk knowledgeably about it and understand the effects of adding new servers, workstations or software modules.

Skill 3: Using Technology to Stay Current in Your Field

Magazines, newspapers and even television news is losing favor as people find the latest and most in-depth news on the Internet.  For physician office managers, news and important information is available through websites, newsletters, newsfeeds, webinars, podcasts, listservs and blogs. How does a manager sift through all these options and stay current with the demand of running a day-to-day practice?

One of the most important ways to consolidate this information is to subscribe to a feedreader or email from websites you like and have the news come to you (called “push technology”), instead of you checking the website every few days or whenever you remember (aka “pull technology”). These are the programs that will eventually do away with most, if not all, of your magazine subscriptions.  You know that guilty pile of professional magazines that you have in your office or at home that you have scanned but still plan to read in-depth?  Gone!

Most websites offer email or RSS options to their users.  An email option asks you to enter your email address and will email you when new information is available, typically offering the full content inside the email itself.  This is ideal for anyone who has these emails automatically placed into an email subfolder to read later.

RSS stand for Really Simple Syndication and is a way to push the content of many sites into a feedreader, which is an organizer of website feeds.  There are many feedreaders available at no cost and adding a new website feed to your personal feedreader is as simple as clicking on the orange RSS icon on the website page and identifying the feedreader you use.  The nice thing about using RSS is that you can group sites into categories you decide upon, it is easy to add new sites and drop sites that you find a waste of your time, and you do not clog up your email program with lots of emails.

Webinars and podcasts are another way to stay current. Many webinars are free and allow you to dip your toe into the pool of knowledge on a particular topic.  Webinars with a fee attached are usually longer and more in-depth, and can replace the traditional go-to conference which has become a budget breaker for many practices.

eBooks are quickly becoming the way to get just the information you want when you want it.  Most eBooks are reasonably priced (some are free) and can be stored or printed.

Skill 4: Online Patient Interactions and Web 2.0 Applications

Patient interactivity via practice websites is growing exponentially.  Many practices are using web functionality to communicate with their patients via secure messaging.  This allows bi-directional communication such as:

1.      Request an appointment (patient) or appointment reminders (practice)

2.      Send statements;  patients pay online with a credit card (practice & patient)

3.      Inform patients of test results (practice)

4.      Create personal health records (patient)

5.      Request a prescription refill (patient)

6.      Virtual office visits (practice & patient)

7.      Complete registration via fillable .pdf forms and download to practice management system (practice & patient)

8.      Request medical records; send an electronic copy of same (practice & patient)

9.      Complete a history of present illness prior to the on-site visit (patient)

10.  Ask & answer questions for the doctor, nurse, or staff (patient & practice)

If you’re not looking into ways to communicate with your patients electronically, start now.  Web 2.0 is now more typically referred to as social networking, social media or new media. What started out as a way for friends to communicate with each other is now an amazing, ever-expanding ability to connect/market to businesses, patients and referrers.  Very few medical practices are using social media, but they should, because it is the way of the future, and in many cases, very affordable.

Skill 5: Knowledge Management and Retention

Most medical offices try hard to document processes such as “How To Make An Appointment For Dr. Jones,” but find it difficult to keep up with documenting changes to those written protocols.  Documentation is crucial for operations in that it supports job performance and consistency, and is a basis for training new employees.  The traditional documentation method for most practices is use of Word documents, which can create an immediate usability logjam.  Due to cost, Microsoft Office is not installed on many workstations, and many office employees are not trained to use Word, so the onus for original creation of and changing of protocols falls to one person.  Changes in healthcare are happening so quickly that it is not reasonable for one person to be able to update all documentation, unless they are dedicated to it on a full-time basis.

Better and more affordable solutions are becoming available.  Speech recognition and office wikis are two possibilities for documenting office processes.  Speech recognition (you may already be using it for your transcription) is a very affordable solution, but it does take time to train the program to recognize your voice.  If you are not used to dictating, it may also be a learning curve, but it is one that will pay dividends down the road.  Doctors can use it to help you by dictating their preferences, such as appointments, patient intake, room set-up, procedure set-up, patient phone protocol and after-hours call contact protocol.

Private wikis are another good bargain in the marketplace, as many are available at no cost, and may be installed and managed on the web.  Wikis need at least one person to function as editor. Since you can have your entire staff work on documentation, the staff becomes very invested in the process of keeping the wiki fresh and up-to-date.

There are other free or low-cost project management web programs that can also be used to track changes and remind staff to document changes later.  The one area that is most important for tracking changes and managing knowledge in the practice is in billing.  Many practices are held hostage by their billers as their knowledge is so specific and proprietary that the manager feels s/he could not recoup it if they left.  No practice should be vulnerable based on knowledge any single employee has, including the manager.

I am very interested in technology that creates value in medical office practices.  If you are using something new and different in your practice, please email me and let me know.  Also, if you have any questions about the ideas I discuss in this article, I am glad to answer them: marypatwhaley@gmail.com.

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It seems only yesterday we got along just fine using words like “photography” and “cable television” without the world “digital” in front of them.  They were “analog” technologies, but they didn’t need to be marketed as such, because there was no point – there was no marketing buzz on the term, and no alternative.  Nowadays the word “digital” is everywhere and is accompanied by a very positive connotation.  It seems if you are selling something “digital”, it is a superior, more technologically advanced product or service, and it probably lies on the cutting edge of its field.  Digital is an old buzzword, maybe even a little past its prime, but it is still used heavily to promote what are already standard, mainstream technologies.  If you Google the word “digital” the search engine returns around one billion web results.  Compare that to “health care” which gets only a tenth of that.

“…But, what does digital mean?…”

Good question!  Digital is a word I imagine few can give a succinct, straight definition for.  For all the triumphs and innovations of the “digital revolution”, I doubt that there are a lot of people who can define the term’s root-word.

Let’s talk about theory here for a while, in abstract terms.

Imagine a two clocks on the wall of your office. Both are set to the correct time, and are the same model, except for one small difference. The clock on the left is always moving. The second hand of the clock sweeps around the dial in one long stroke, as do the minute and hour hands, although much slower.

The clock on the right is not always moving. It jumps second to second in a “tic-toc” style, and when the minutes, and hours are finished those hands jump as well. Both clocks represent the same piece of information- what time it is- but they have two different ways of representing how the time changes from moment to moment.

The clock on the left is one constant motion, and so it never stops to tell you “exactly” what time it is, but does tell you when the time is between seconds (not very useful, but remember we’re being theoretical). The clock on the right is much more specific (you can tell exactly what time it is, to the second), but never reports time in the intervals between the seconds.

This distinction, between a continuous flow of information, and a constant drip-drip-drip of individual pieces of data is the difference between analog signals and digital signals.

The clock on the left is analog- it provides a continuous “signal” (flow of information)- what time it is. The clock on the right is digital- it provides a continuous series of “points” of information, with periods in between each point with no information being produced (the moment between each second’s “tic”)

Back to the real world

You remember music records, right? They were flat, circular pieces of vinyl that could be put into a primitive version of what looked like a large CD player. If you had electricity, you could plug this “record” player, or “turntable” into a power outlet, and attach it to a set of two speakers using pieces of wire. The player would turn the record at a constant speed, and then the listener would carefully place a delicate needle attached to a mechanical arm on the record player onto the surface of the vinyl and under optimum conditions, sound would be produced through the speakers. There were all manner of musical groups that made these records, and they could played at parties or by yourself for solo enjoyment. The whole affair was quite charming.

Record players work by having the needle run gently over the “grooves” of the record, which are imprinted on the vinyl in such a fashion that the vibrating needle will quietly reproduce the recorded sound. Then the record player electrifies and amplifies the sound, and boom- party time!

There are no “gaps” in the record when it is playing. Even while the record is silent, the needle is running over an empty groove that isn’t vibrating the needle. Even when the signal is blank, it is part of the entire record, and it’s continuous playback. Record players therefore, are an “analog” technology.

I grew up with compact discs. Compact discs are actually very similar to vinyl records in how they operate. A CD player spins the disc at a constant speed, but instead of a needle running over the grooves, a laser (Light Amplification by the Stimulated Emission of Radiation) is focused onto the grooves, and is reflected back onto one of two sensors, which then create a series of data points that are turned into music. But the key difference is in how that sound data is represented. Instead of a continuous flow of sound, a CD is comprised of billions and billions of these tiny data points. Every second of sound on a CD is 44,100 individual pieces of data that tell the CD player what sort of noise to make. Even though you don’t hear “skips” in between pieces of data, the sound is actually a series of noises that are 0.0000226 seconds long. CDs are digital technology then, because they rely on many individual pieces of data rather than one long stream of information.

Is digital better than analog?

Well, let’s stay with the record player vs. CD player discussion. Listening to the same recording on the two different players produces two distinct sonic experiences. If you’re not a huge music fan, but like to hear tunes from time to time you might not even notice it. But if you’re a music fanatic who takes his sound quality very, very seriously, then you probably notice a lot of differences. The analog record is going to have “signal noise” where electrical and environmental interference distorts and slightly interrupts the signal- the slight hiss you hear in the backgroud of a record, and the loss of audio quality as the signal fades in strength over time. Never mind the pops and scratches that come with the wear and tear of handling and playing the record. Purists insist however, that the analog signal provides a certain “warmth” and some talk about the presence of a “soul” to the music that can’t be found in digital.

Of course, this isn’t to say that CDs sound bad. In fact, without the signal loss and interference, many everyday listeners think CDs sound far superior to records. The digital signal means a “cleaner”, “brighter” sound that comes from listening to only the music, and not the noise in the background. However, something is lost with CDs, literally. Like the brief moments of time between the jumps of the second hand on the clock on the right in our earlier analogy, the tiny moments between each of the 44,100 tiny pieces of sound aren’t recorded or played back on CD. These microscopic little pieces of music that aren’t on the CD lead some audiophiles to call digital sound “cold” and slightly “empty”.

The bottom line is this however. Most music that is being made today is being sold on either CDs or MP3 downloads (learn how to start using MP3s in my earlier Learn This Now post here), and not vinyl records. Even disc jockeys that play in clubs rarely use real vinyl anymore. So even if you think CDs sound a little worse than vinyl, chances are you already use digital music almost exclusively, and will continue to do so.

What should I know going forward?

The truth is, there aren’t many traditional analog technologies still in use. Radio and television broadcasts are still analog, but with the rise of Satellite Radio services like Sirius and XM, and the coming American Digital Television transition, even those are on the way out. By the way, you do know that all analog, “over-the-air” televisions are going to stop working on February 17, 2009 June 12th, 2009 right? If you use rabbit ears on an older television (cable and satellite users won’t be affected) to watch your favorite shows, you might want to look into getting a converter box, pronto. You can even get a free coupon from the Federal Government to help cover the cost.

The important thing to remember is that just because something says “digital” it isn’t necessarily a huge leap over an old technology, or even particularly new. But now that you know what digital and analog means, you are empowered to decipher any such attempts at newfangled tomfoolery. Stay tuned to ManageMyPractice.com for the resources you need to stay ahead of the curve. Cheers!

Note from Mary Pat: The change to digital technology has tremendous implications for healthcare.  Think about telemedicine, electronic health records, and sharing of all information digitally.  Expect some significant changes down the road in medical records between Obama’s stimulus plan and dollars for HIT and the transition to digital technology.

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One of the most valuable, if not THE most valuable, resource a healthcare executive has are colleagues and their collective experiences.  The issues that we confront daily are what we need and want to discuss with our comrades-in-arms.

The listserv is the most direct way of sharing information between colleagues.  I belong to a number of MGMA (Medical Group Management Association) listservs and to the AAOE (American Academy of Orthopedic Executives, formerly BONES) listserv.  These listservs are amazingly helpful and I have more often been the benefactor than the provider of information there.   But listservs have their limitations.

You have to be a member of these organizations to participate in their listservs.  This is not unreasonable, as the infrastructure and management of a listserv is not without cost.  As healthcare continues to get squeezed, however, managers will have to make harder choices about which resources and memberships they and their practices can afford.  Membership requirements also screen the participants, which may be important to some.  The screening, however, may limit the amount of participation and the diversity of participation.  Healthcare is becoming global, as any medical practice competing for the medical tourism dollar will tell you.

Listservs can also take time to read and delete or store.  I have not found an easy solution to arranging the information I want to retain, although there is always deleting the listserv emails and searching the archives later.

I am finding Twitter to be a no-cost solution to many of my needs not fulfilled by listservs.  I have access to thought leaders in and outside my field, and the conversations we have can be on or off the grid.  Although it was initially difficult to constrain myself, I now find the limitation to 140 characters to be very liberating.

Tweets are brief pointers to people, conversations, blogs, and resources across the world.  As Kenneth Yu says on his blog MindValley Labs:

…Twitter is currently the closest app on Earth that replicates the actual thought patterns of the human mind. You see, the human mind does not really think in blog and article form. It does not think in huge chunks of information.  Instead, it thinks in a stream of consciousness way, random disjointed thought layered upon random disjointed thought.

Twitter also has a number of applications designed to organize information, contacts and conversations in ways that make information easy to retrieve. To follow me on Twitter, use my Twitter name @mpwhaley.  To join a brand-new community of discussions around medical practice management, use the #medpractice hashtag to search and join the conversation.

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If you remember, MMP recently had a post about Twitter, and some ideas I had about the use of Twitter in a medical practice.  Since then, Twitter has exploded onto the healthcare scene.  Last Sunday I participated in an online Twitter online meetup discussing social media in healthcare.  The Twitterati (those who twitter) included medical students, physicians, payer representatives, consultants, patient advocates, patients and me.  The long and the short of the discussion was that the world of healthcare, full of traditionally slow technology adopters, has amazing potential for using social media to reduce waste, improve efficiency, allow staff and caretakers to give more time to patients, and possibly reduce healthcare costs.

Phil Bauman, “a Registered Nurse with a background in critical care, drug safety, accountancy, finance, treasury operations, and recruiting” wrote the following in his blog post of January 18, 2009:

HEALTH CARE SHOULD BE THE LEADER IN MICRO-SHARING

With 26 letters in the alphabet arranged within 140 characters, there are over 1.2 x 10^198 possible character combinations. Of course, the number of meaningful sentences is far less than that but a point stands out: there’s a virtually infinite number of short pulses of (meaningful) information that Twitter can facilitate.

With that kind of power, health care should be a leader in micro-sharing, not a lagger.

Phil put together a very impressive list of 140 Healthcare Uses for Twitter.  Here are a few of my favorites:

1. Disaster alerting and response
2. Maintaining a personal health diary
3. Emitting critical laboratory values to nurses and physicians
4. Issuing Amber alerts
5. Environmental alerts: pollen counts, pollution levels, heat waves, severe weather alerts
6. Updating patient family members during procedures

Click here to see the entire list, which is also available in an eBook, and in SlideShare.

Just in case you missed the first article, here is a recap on using Twitter:

• Go to www.twitter.com and sign up for FREE (choose a name and a password)
• You can use Twitter on the web or on your phone – you can look at it once a day (you don’t have to look at it and respond to it instantly.)
• Once you’re signed up, you can start “following” people and they can “follow” you.  I am following people who have interesting things to say about healthcare, and also people who are writing blogs like me.
• Start by following me (@mpwhaley) and I’ll be glad to follow you.
• For more info on Twitter, try this article on MSN

If you’d like to use Twitter and need some help, email me at marypatwhaley@gmail.com and I’ll be glad to talk you through it.

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“Have you seen that new website…?”

Chances are you have a lot of these conversations.  As the Internet becomes a  bigger part of the everyday lives of everyone from professionals to children to retirees, more and more people are talking about their online experiences during their face-to-face encounters.  This brings us to a very important vocabulary term that often follows next in the conversation:

 

 

“No…what’s the URL?”

The term “URL” (say it just like the name “Earl”) stands for “Uniform Resource Locator”, and is basically nothing more than a web address.  The URL for the blog you are now reading is “http://www.managemypractice.com”, and typing that into any web browser or Internet-ready device will take you to the MMP homepage.  As long as you can remember the name – ManageMyPractice- and the “dot com” at the end, you’ll get to where you want to be.

The “HTTP://” at the beginning stands for “Hyper-Text Transfer Protocol”, and tells the browser what sort of document you’re looking to retrieve and the “www” before the name tells the browser that you want to go to the webserver at ManageMyPractice.  Most servers will automatically point you to the webpage if you don’t specifiy the “www.”- so typing only “managemypractice.com” without the “http://www.” will still get you where you want to be.  The “.com” at the end means the website is a “COMmercial” page- not set up by a non-profit (.org) or government agency (.gov).

Email addresses are another example of an URL.

 

 

“Great! So what?”

Well let’s get back to your conversation.  If you’re talking about a popular, well-known URL – say Google.com or Amazon.com – you’re not going to have any problem getting people to understand you. Most people have heard of, and have used those popular websites before, so there should rarely be a problem.  What about a newly started website, or a little-known secret website like the energy saving Blackle.com or the political statistics blog fivethirtyeight.com?  These are sites that might not be huge destinations on the web, but notice their URLs…both are easy to say and hear, so if people talk about them to a friend in person, or over the phone, someone who has never been to one of the sites could easily get to them, because the URL is easily heard, spelled, and entered correctly into a computer.  This makes choosing an URL for your website extremely important- you want people to be able to hear the URL one time – the first time – and immediately know how to spell it, and therefore, how to access your page. This also makes domains very valuable properties: last April a gentleman from Maryland who bought “http://pizza.com” for $20.00 in 1994, sold the rights to the domain for $2,600,000.

Think about your practice website domain – is it easy to hear, spell and enter?

 

 

Getting URLs under control

Of course, not all URLs are so small.  For example, to check the current price of the Dow Jones Industrial Average on the New York Stock Exchange at the New York Times website, the address is

“http://markets.on.nytimes.com/research/markets/usmarkets/snapshot.asp?symbol=US%26DJI“.

Now, you probably aren’t going to tell someone over the phone to check out that site.  You’ll probably just say  ”click on the stock section on the front page.”

There are probably a lot of webpages that aren’t homepages that you go to frequently, and would like to tell other people about.  Or, if you use a micro-blogging service (like Twitter), maybe you only have 140 characters to write with, so you don’t want to use a lot of them to type out a long URL.  It would be very helpful if there was a way to represent a long URL like

“http://markets.on.nytimes.com/research/markets/usmarkets/snapshot.asp?symbol=US%26DJI“

with something smaller and more easily digestable…

 

Enter TinyURL.com

What you need is a TinyURL!  TinyURL.com is a free webpage that can convert a long address like

“http://markets.on.nytimes.com/research/markets/usmarkets/snapshot.asp?symbol=US%26DJI”

into a much shorter address like

“http://tinyurl.com/3nndbw” (try clicking on it!)

The first address is 85 characters, while the TinyURL is only 25 characters – a savings of more than 70%!  Once you create the TinyURL  by typing a long URL into the box at the top of the page, the site will create a permanent, small URL that is much easier to Email, Twitter, and even tell friends about!  The site is so useful that Twitter now automatically converts URLs to TinyURLs to save its users the time and hassle.

 

A word of caution

Some nefarious ne’erdowells have been able to put TinyURLs to underhanded uses.  They link innocent-looking TinyURLs to questionable websites to trick people into going to sites that are embarassing, or worse, dangerous and hope that the targets of these attempts don’t check what website they are actually going to before they click the link.  One way to ensure this doesn’t happen to is preview TinyURLs by going to the preview site

“http://preview.tinyurl.com/3nndbw“

by adding the word “preview.” before the beginning of the TinyURL, and there are third-party applications for doing similar security checks.  Of course, as always on the Internet, caution is the rule of the road.

Be careful, and Happy Clicking!

Note from Mary Pat: In case you’d like an option to tinyurl, there are many other url shortening offerings available. Here are a few recommended by the popular website ReadWriteWeb and writer Marshall Kirkpatrick.

Bit.ly is a new URL shortener with some awesome semantic web and geolocation data APIs on the back end. Using it will make the world a better place.

SnipURL offers many of the same stats that Bit.ly does but is friendlier to use. 

Cli.gs has analytics and a new “geotargeting” feature

 

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Twitter is a combination of two concepts, social networking and micro-blogging. When combined, they create a fascinating way for people to communicate and keep in touch.  Let’s explore social networking and micro-blogging individually first.

 

Social Networking

 

This is the Myspace, and Facebook you’ve heard so much about.  You already know what networking is – you create, build, and maintain personal and professional relationships to meet people, find opportunities, and learn new things.  Successful practice managers are constantly networking to be in the know and stay ahead of the curve.  Now add the social aspect of it to the equation.  Social networking means starting with people you already know, and using that as a jumping off point. Take your existing network of contacts and digitize them to build an on-line community.

Think about your contact list in your address book, email, phone, or Blackberry.  You have everyone in there: colleagues, friends, family.  What if you also had access to the contact lists of everyone in their contact lists?  There would be duplicate entries but there would also be a lot of people in this “friends of friends” list that you didn’t know before.  You would probably see a lot of new names and faces, some of whom you might want to talk to about your organization, their organization, your product, their service, their hobbies, even ask out on a date!

When you walk into a room and see a friend talking to someone you don’t know, you go and say hello to your friend, and introduce yourself to the stranger- you are building your network by social networking!

The differences between various social networking sites (see the MMP post on LinkedIn) will be explored in a later article, but all social networking sites have one thing in common – they are designed to help you meet new people through common friends, interests, pasts, and goals.

 

Micro-blogging

 

It’s blogging, but smaller.  But what’s blogging?  ”Blog” is short for “web log”, and it is keeping an online journal of writings, pictures, and other multimedia, as well as news items and content found on the web.  Some blogs are just places where people write about their feelings and activities so other people can read them.  Some blogs are focused on a topic- like ManageMyPractice.com focuses on health care administration.  But all blogs are simply websites that are updated by their authors fairly frequently, around some common theme.

How does blogging become “micro”?  By shrinking it down to its bare essence and relaying the heart of the message, communicating the necessary.  How could this be of use to you?  What if you set up a system where your kids received updates when you were going to be home later than usual from work, telling them they were allowed to have a soda with their homework before TV, and what would be for dinner when you arrived?  Or maybe your kids need to update you when their plans change.  What if all your colleagues were updating each other about the goings-on at a professional conference so they could decide on the fly which events to attend, and share their experiences, and decide where everyone would be meeting afterwards.

Anything that could be helped by contacting an entire group of people quickly with short message could benefit from micro-blogging.

 

Twitter puts it all together

 

Twitter takes these two concepts, and merges the whole shebang with your mobile device.  Twitter lets you easily microblog to your social network over your mobile device.  You don’t have to use a cell phone or a Blackberry to use Twitter- you can send and receive updates over the web, and through a variety of third party providers.

If you want to get started, go to the Twitter homepage at www.twitter.com, and click the green button that says “JOIN THE CONVERSATION”.  You will create a username and password, and get you started adding contacts and you’ll soon be able to make your first micro-blog post (they call them “tweets”).

On Twitter, anyone you want to receive updates from is someone you are “following”, and anyone who is receiving your messages is one of your “followers”.  You can also send messages directly to just one user, or set up groups of people to receive certain updates- your co-workers don’t have to see your notes to your kids, and vice-versa. You can also do fun things, like upload a little picture of yourself to be your icon that people wil see when they are on Twitter’s website.

 

Now it’s time to supercharge your cell phone

 

But you don’t have to ever go to the site if you don’t want to!  The real power of Twitter is that it can let you do all these short internet communications (micro-blogging) right from your cell phone.  Basic text messages that you may already use on your cell phone (called “SMS messages“) can be used to send and receive messages from Twitter.   Just link your Twitter account to a mobile phone in your Twitter settings, and then you can send your updates as text messages to 40404.  Incoming Twitter messages from the users you follow will show up as incoming texts from Twitter, but with labels to show you which user the update is from.  You can also customize your mobile updates, so you only get messages from certain users. If you follow some people who are heavy updaters, you might get tired of constant alerts of new text messages.  Also be sure you understand your cell phone’s text messaging plan – Twitter is free to use, but if you don’t have unlimited messaging on your phone, it could be easy to run up a big bill.

Once you have your Twitter up and running on your mobile phone things get really interesting, as now you’ve basically turned your cell phone service into an internet chat room. And in terms of business, that gives you near constant connection.  Twitter users are often the first people to know the newest information, and love to post updates about it online.  It’s an interesting way to see what’s new in the world – finding out what people are talking about literally “right then”.  Plus it creates an interesting crowd of which to ask questions: What’s going on tonight?  Can anyone recommend good seafood on the north side of town?  Is anyone getting anything out of this conference?

The brilliance of Twitter is that it so easily connects people on all different types of computers and cell phone platforms.  Twitter can seemlessly create networks of people communicating for mutual benefit, and provides an interesting new way to keep on top and keep in touch.

To Recap:

1. Social Networking = networking with your friends’ friends
2. Micro-blogging = little missives without all the niceties and all the heart
3. Twitter = #1 + #2 (little missives to your friends’ friends’ friends)
4. How can you leverage this technology to make your practice more efficient and productive?

Note from Mary Pat: How can Twitter be used in a medical practice setting?  Here are a few ways – I’m sure you can think of others.  If your doctor is running late, use direct messages to Twitter patients to let them know right away that they can arrive later or reschedule their appointment.  Likewise, when an earlier opening is available, Twitter a patient to see if they could fill your appointment time.  Twitter your doc to let him/her know about schedule changes that would affect what s/he is doing right now.

And to get you started on Twitter, my Twitter name is “mpwhaley.”

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Readers: how are you coping with the onslaught of information?  Emails, news stories, professional reading, listservs, blogs – it goes on and on. Here’s one technology you should take advantage of to ease the information load, whether you use it for your own knowledge, use it for your practice website to update patients, or use it to see what updates your competitors are making to their websites.  Abraham has written a great guide to RSS, what it is and how to get started using it.  If you have follow-up questions for Abe, please leave a comment by clicking at the end of this article.

By the way, if you’re wondering where the little orange square is on this site, it’s in the coffee cup in the upper-left hand side of the page!

RSS – Making the Web Work for You

In the past year, I have radically changed the way I surf my favorite web sites.  For my writing, information, and entertainment, I check for updates and new info on over 200 websites a day.  I like to stay informed, and that’s what it takes. Of course, I don’t read every word of every page – I could never get that done!  I skim, I browse, and most importantly, I get the web to do the work for me.

I never type in any of the sites’ addresses or click on a saved bookmark in my web browser.  In fact, I don’t even have to check if anything is new.  Any time one of my favorite websites adds an update, they notify me automatically, and I can read it, or ignore it and move on.  There is a huge volume of potentially valuable information on the Internet, but the savvy consumer has to be able to parse, filter, and mine this info for things that can actually benefit them.  I use a simple, free, and easy to use technology to do all of this – and I’m going to teach you to do the same.

The secret is called “RSS”, and these three letters can dramatically change how you use the web.  RSS stands for “Really Simple Syndication”, and like so many of our new technologies, it’s a powerful tool that’s harder to understand than it is to start using.  Once people start using RSS, they love it, but have a tough time telling other people what exactly it is. So here’s my best crack at it:

RSS software (or a RSS web application) is a technology that will notify you every time one of your favorite websites has an update, and will automatically deliver the update to you.

Since the website tells me what’s new every 15 minutes, I can very quickly get a grasp on what I do and don’t want, and don’t spend nearly as much time reading things I don’t care about.

 

What do I need?

 

You need a way to read RSS feeds.  There are several options with pros and cons, but they all work on the same principle, and they will all save you time, and make you better informed.

One of the simplest ways to use RSS is to just read the updates in your web browser.  In Firefox 3, when you click on a link to an RSS feed, you are given the option to subscribe to the feed using “Live Bookmarks”, and if you accept, a folder with the name of the RSS feed will go on your “Bookmark Toolbar”.  When you click this folder, a menu drops down displaying recent updates for the feed.  Microsoft Internet Explorer as has a similar system, where you pull open a separate sidebar to look at the feeds you subscribed to.  For users who simply have a few feeds they want to keep track of, these are great ways to start using RSS as soon as you finish reading ManageMyPractice.com.

For users wanting a more customizable and in-depth experience, you might want to try one of several web-based RSS services.  One of the biggest and most popular is Google Reader.  Google has a lot of practice in making things easy to use and understand on the web, and they do a good job with reading RSS feeds too.  It’s all web-based, so you read your feeds on the Google Reader website, and as long as you can remember your password, you can read them on any computer with an Internet connection.  Also, on the homepage for new Google Reader accounts, they have a great YouTube video about the service, and what it can do.

 

What feeds should I read?

 

You can read whatever you like!  See Part Two of this Monday Special for some feeds Mary Pat reads.  I like to group my feeds into categories, and read groups of them all at once!  I have a category for local news, with happenings and goings on around my city in it.  Another folder has national news from the New York Times and Washington Post. Another is for sports feeds, with ESPN, Sports Illustrated, and other sources for info. Another is just interesting feeds that often have thought-provoking stories and pictures…you get the idea.  If there’s a website about a topic, chances are great that there are RSS feeds about it as well.  Most web pages that have RSS feeds will say so somewhere on the site.  Also, newer web browsers will have features to tell you automatically if a web page offers an RSS feed.  In Firefox 3 for example, a little orange RSS icon shows up in the address bar when a feed is detected, and clicking on it will give you options to subscribe.  And in FeedDemon, you can just type in a site’s address, and it will give you a list of feeds the site offers.

It is becoming increasingly rare for almost any website or blog to not have an RSS feed, so if you read it, you can probably read its feed instead.

Get out there!

This should give you a great start to reading RSS feeds from your favorite website, and more quickly and efficiently digesting the daily Internet flood of info.  And remember, if you’re having a hard time explaining to your friends and family what this powerful technology can do, you know where to send them! 

 

To Recap:

 

1. Information can be overwhelming. 
2. RSS (Really Simple Syndication) is a way to aggregate or gather the sites you care about and have them “push” their updates to you, instead of you having to go pull the information from them.
3. Download news reader software.  See some suggestions above. 
4. Start looking for the orange RSS box on websites, click on the box, adding the site to your reader.
5. Don’t let your RSS feeds overwhelm you; delete feeds that don’t consistently meet your information and relevance criteria.
6. Let us know what feeds you find that you rate as high-quality. 

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This is the first of what I hope will be many posts from my talented technical consultant, Abraham Whaley.  I’ve asked Abe to demystify the technology that is intuitive if you’re under age 30, but Greek to those of us slightly over that age.  I can’t repeat enough that I think it’s important for managers to stay current on technology to stay fresh, stay marketable, and be able to translate world technology into technology for your practice.

Abraham welcomes your questions and comments.

Do you like good music?

How do you listen to it?

It seems every few years the electronics companies come up with a faster, cheaper, better-sounding something, and they begin anew the job of convincing us that it’s the ultimate in sonic enjoyment.

But seriously, what is all the MP3 fuss about?

MP3 is a file format. MP3 files have “.mp3″ at the end, so your favorite song looks like “yourfavoritesong.mp3″ on your computer. Just like “.doc” means a Microsoft Word document, and “.exe” is an executable program file, “.mp3″ is a sound file- i.e. music. MP3 files are a way to “compress” sound files. Compression is a common computer technique, where something is packed into a smaller space than in originally fit into in order to make it easier to use, and send to other people. Maybe you’ve downloaded or created “.zip” or “.rar” files for sending over the Internet. MP3 is just a way to make it easier and faster to send sounds to each other.

In order to make the sound file smaller, the programs that compress them find pieces of the sound data that people never hear, or can barely notice, and removes them. For the most part, this doesn’t affect the sound quality- although some sound mavens people heartily disagree!  And since most MP3 files tend to be between 5 and 10 megabytes, they’re pretty quick and easy to send in emails, download, and transfer from a computer to a music player.

 

What can I do with MP3s?

 

Listen to them! Any part of your life that would be enhanced with a little music can be enhanced with MP3s. First you’ll need something to play your MP3 files. That means either a piece of software that can turn the MP3 file into sound, or a hardware device with that software already on it (ie. an iPod).

The most popular choices for MP3 listening software are iTunes and Winamp.  iTunes is the Apple software that comes with the purchase of an iPod- but you can download it regardless and use it for free anyways. Since so many iPods have been sold (more than 150,000,000 as of this March, FYI), iTunes has become the standard in MP3 software for many people. If you’re thinking about buying an iPod, downloading and trying out iTunes is a great way to try the software before you buy the hardware that goes with it. iTunes also allows you easy access to the iTunes Store, where you can buy MP3s of music, audiobooks, and free, Internet radio shows that update and download automatically. Winamp has been around longer, and is a smaller, lighter program- but is still packed with a ton of features.

Also, both software programs allow you to “burn” CDs. Since every song is an individual .mp3 file, you can very easily make custom CDs that have only the songs you want, in the order you want. This was perhaps the most exciting development for me when I discovered MP3s- that I could make my own CDs to listen to in the car or at friends’ houses.

 

Where can I get MP3s?

 

First of all, you can make them! Both iTunes and Winamp allow you to (cool slang alert!) “rip” CDs to MP3. “Ripping” is just taking music on a CD and having the computer compress the sounds into MP3 files. Once this is done, the music stays on your computer and you can now play the music on your computer without the CD. You’ve probably just realized another pretty nice use for MP3 files- they can be used to back up your music collection. “Ripping” CDs is completely legal if you own the CD already, or are ripping music that is in the public domain.

Amazon has pricing comparable to the iTunes store, but made headlines by offering “DRM free” MP3 files. DRM (Digital Rights Management) is a way to stop people from sharing MP3s with each other by making them so they only play on certain devices, at certain times etc…But since Amazon offered files without the restrictions, their downloads can be a lot easier to use and enjoy. Apple does offer some, but not all downloads are DRM-free. Buying my first MP3 from Amazon was a delightfully quick experience. I didn’t even have an account with Amazon and in less than five minutes I was enjoying “Wily” by the British reggae band “Greyhound”. Amazon recommends you use their small download manager program, but once you download the program, it’s easy to keep track of the songs you downloaded.

Other services, like Rhapsody and the infamous, but now totally legal and legitimate Napster offer subscription-based programs. For a monthly fee, you can access and download music on your computer, on other people’s computers over the Internet, and onto some, but not all portable music players. The catch is that you aren’t buying the music, you’re paying for the right to access it. So if you decide to cancel your subscription, the music you downloaded doesn’t work anymore.

Additionally, many websites offer free, legal MP3s to download. iTunes usually has a free MP3 of the week, and websites like CNET’s Music.Download.com have plenty of free music that aspiring artists and hopeful record labels have released to get you excited about new songs and albums.

 

What if I want to take my music wherever I go?

 

So, you’ve downloaded an MP3 software program, ripped a few CDs (making sure to use the word “rip” to impress your kids), and even found some free MP3s online that you really like. Maybe you even organized some songs you like to regularly listen to into a “playlist” so you can hear your James Brown in the morning to get going and your Jackson Browne in the afternoon to relax. Sadly, you can’t take your laptop on a nice jog and shouldn’t browse the web while driving to work.

It’s time we liberated those MP3s from your computer! This is where a portable, hardware MP3 player comes in. There are a lot of choices to be made for those in the market, so here’s how to cut through the mumbo-jumbo.

First, the numbers. The two main things that a portable MP3 has that set it apart are its storage capacity and its extra features. Most everything else is negligible. Storage capacity is just that- how much music and sound you can store on the player.  Storage on players is measured in gigabytes. Now, if we assume for simplicity that most MP3 files are about 5mb (megabytes), we can get a picture of how much storage you need. A gigabyte of storage is roughly 200 songs. So, how many songs do you think you’ll put on a portable player? Are you going to listen to the same music over and over? Probably not. If you have 20 albums that you like to hear, and that’s it, a few gigabytes will be just fine. But if you are always on the hunt for new sounds, you’re going to want a lot more storage. Also keep in mind what else will be on the player- if you want to download movies, then those are much larger files. How about keeping photos on your player? Do you subscribe to any podcasts? The best way to figure out how much storage you need in a player is to start downloading and listening to MP3s so you can get a feel for how you’ll use one, and what you need.

Then there are the extra features. MP3 players are almost like digital pocketknives these days, and you should know ahead of time which tools you want if you’re looking to buy. For example, Apple now makes an iPod that is also a cellular phone (the ubiquitous iPhone), as well as an iPod that can surf the web, and send email but isn’t a cellphone (the iPod Touch). Microsoft’s entry into the market is called the Zune. The Zune has a larger screen, with a more detailed user interface, and some interesting features like the ability to share MP3s between Zune users. If you have a song on your Zune, you can “beam” it to another Zune close by so they can play it too. This feature has a major drawback though- beamed Zune songs are only good for three plays over three days. My neighbor has a Zune, and he loves it. Also, some MP3 players are really more like portable televisions that can also play albums. Examples of these are the Archos 5, and the Cowan O2.

Lastly, if you’re a little overwhelmed by all these choices, I would suggest CNET’s MP3 Player Finder. CNET’s site will ask you some questions, and make some suggestions as to what might suit your needs.

 

There’s more out there than MP3s!

 

Don’t limit yourself to just MP3 downloads either. There are a ton of ways to listen to music online, and a ton of different startups trying to “solve” online music. Although I own an iPod, and love finding new MP3s, I also regularly listen to custom radio stations on Pandora, search for songs on Songza and Seeqpod, and I’ve heard great things about MOG, Imeem, and Last.FM.  Plus, almost every new college-rock band and aspiring singer has a Myspace page, usually with music to listen to.

On a cautionary note: beware of getting something for nothing. One doesn’t have to look very hard to find illegal MP3s for download. The ethics of copyright law in the digital age entail more discussion than this column has room for, but suffice it to say, the laws regarding copyright are quite real. Do you know anyone whom has had the FBI knock on their door for stealing music? I do. It wasn’t fun for him.

Also, many of the websites that offer these illegal MP3s also offer other things – viruses, spyware, and things your mother wouldn’t approve of on a healthy computer. Be careful, use common sense, and if something seems too good to be true, it probably is. Except of course, the goodies at ManageMyPractice.com =).

To Recap:

1. Music is good.
2. Download free MP3 software.
3. Download free or not-free MP3s or load your own CDs onto your computer using the software.
4. Make your own CDs or playlists with your favorite songs. (Great holiday gifts!)
5. To take it with you, purchase a MP3 player after assessing your style and your needs, and load your music onto the player. 1 gig storage = 200 songs.
6. Don’t steal.  Your Mama would know.

Have fun out there!

- ACW

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