Cool Technology of the Week

In many crime solving police procedural programs (NCIS, CSI, Criminal Minds etc), the perpetrator has used an untraceable, disposable cell phone.

But what is a disposable cell phone and where do you buy one? I've never seen one in my travels.

The answer - Walmart

The vendor - TracFone

The idea is that you buy an inexpensive phone (there are many options ranging from $15 to $50 dollars for Motorola and Samsung phones)

and then prepay for minutes - 60, 120, 200 without any contracts or bills.

The minutes are a single rate plan - national, international and roaming at local call rates.

The only hitch is that the minutes expire after 90 days or you can buy 400 minutes good for one year.

Since there are no contracts, you can use the phone as much or as little as you want, when you want. You just add minutes as needed.

The features of the service include

* A GSM phone

* A single Rate Plan - Call nationally, internationally or roam at local call rates

* Nationwide Network Coverage

* Features text messaging, voice mail, free caller ID, free call waiting

* Bluetooth Wireless Technology

* Hearing Aid Compatible (HAC) Rating: M3

* Battery life with up to 7.5 hours of talk time and up to 10 days of standby time - it is rechargeable, so you do not toss it when the battery runs out.

* TracFone Airtime Balance Display shows you how much airtime you've used and how much is left, so you control your costs

*Includes up to 20 minutes of starter airtime upon activation

A full featured cell phone without a contract for $15.00 That's cool!

Hiking Mt. Monadnock

It's Columbus Day weekend, which means it's the peak of Fall color in New Hampshire. Mount Monadnock provides a 3165 foot vantage point to see the changing leaves of New England and I hike it every Columbus Day.

You'll find a trail map online.

My thoughts on the trails:

Marlboro trail - a favorite of mine, since it is the road less traveled. The upper 1/3 is a bit steeper than most trails and challenging when wet/icy but the views are spectacular and the terrain is a great balance of forest, rock and mud.

Pumpelly trail - this longest trail up the mountain begins in Dublin, NH (near Yankee Magazine headquarters). My wife drops me off at the trail head and I walk the Pumpelly to the top, then Marlboro to the bottom, and run to East Hill Farm, where my family stays each Columbus Day weekend.

Birchtoft trail - a remarkable wooded trail that is a favorite of locals. It's often missing from guidebooks because it's the jewel of the mountain.

White Cross trail/White Dot trail - a well marked, well traveled trail. Good if you like hiking with a group.

Old Toll Road to White Arrow trail- the shortest, easiest trail. Good for families.

There are a few side trails I recommend

Cascade link - beautiful waterfalls and foliage

Marian trail to Great Pasture to Smith Summit - a largely untraveled wilderness path. I play my Japanese flute along these trails and have never seen another hiker

Amphitheater trail - access to a climbing area hidden near the top of the mountain

I've hiked the mountain hundreds of times in all weather conditions at all times of year. It's the 3rd most climbed mountain the world (after Mt. Fuji in Japan and Mount Tai in China) and definitely worth the trip.

My Privacy and Security lessons learned

The editor at Computerworld gave me permission to share my monthly column with you on my blog:

Privacy and security are foundational to health care reform. Patients will trust electronic health care records only if they believe their confidentiality is protected via good security.

As vice chairman of the federal Healthcare Information Technology Standards Committee, I have been on the front lines in the debate over the standards and implementation guidance needed to support the exchange of health care information. Over the past few months, I've learned a great deal from the committee's privacy and security workgroup. Here are my top five lessons:

1. Security is not just about using the right standards or purchasing products that implement those standards. It's also about the infrastructure on which those products run and the policies that define how they'll be used. A great software system that supports role-based security is not so useful if everyone is assigned the same role and its accompanying access permissions. Similarly, running great software on an open wireless network could compromise privacy.

2. Security is a process, not a product. Hackers are innovative, and security practices need to be constantly enhanced to protect confidentiality. Security is also a balance between ease of use and absolute protection. The most secure library in the world -- and the most useless -- would be one that never loaned out any books.

3. Security is an end-to-end process. The health care ecosystem is as vulnerable as its weakest link. Thus, each application, workstation, network and server within an enterprise must be secured to a reasonable extent. The exchange of health care information between enterprises cannot be secured if the enterprises themselves are not secure.

4. The U.S. does not have a single, unified health care privacy policy -- it has 50 of them. That means that products need to support multiple policies -- for example, those of a clinic that uses simple username/password authentication and those of a government agency that requires smart cards, biometrics or hardware tokens.

5. Security is a function of budget. Health care providers' budgets vary widely. New security requirements must take into account the implementation pace that the various stakeholders can afford. Imposing "nuclear secrets" security technology on a small doctor's office is not feasible. Thus, the privacy and security workgroup has developed a matrix of required minimum security standards to be implemented in 2011, 2013 and 2015, recognizing that some users will go beyond these minimums.

In debating how to enhance security for all stakeholders without creating a heavy implementation burden, the workgroup has come up with these ideas:

All data moving between organizations must be encrypted over the wire. Data moving in an organization's data center should be encrypted if open wireless networks could lead to the compromise of data as it is moved inside the organization. There is no need to encrypt the data twice -- if an organization implements appropriate secure wireless protocols such as WPA Enterprise, the data can be sent within the organization unencrypted.

All data at rest on mobile devices must be encrypted. Encrypting all databases and storage systems within an organization's data center would create a burden. But ensuring that devices such as laptops and USB drives, which can be stolen, encrypt patient-identified data makes sense and is part of new regulations such as Massachusetts' data protection law.

Such proposals strike a delicate balance, for while attaining the goal of care coordination through the exchange of health information depends on robust security technology, infrastructures and best practices, it can't succeed if safeguarding patients' privacy is unduly cumbersome.

Next Steps for Healthcare Information Exchange in Massachusetts

Tomorrow, I'm running a retreat of the New England Healthcare Exchange Network (NEHEN) Board of Managers and several invited stakeholders to discuss our 5 year plan for enhancing HIE functionality in the state. What are our guiding principles?

1. Create functionality that supports the workflow of our stakeholders

NEHEN's Board includes payers, providers, and patient advocates. As we think of the capabilities and functions supported by an HIE, we must meet the business needs of our stakeholders. Meaningful use is designed to foster healthcare information exchange and we want to facilitate meaningful use, but not at the expense of ignoring the needs of our stakeholders who have compliance, strategic, and customer driven needs.

2. Develop a framework of reusable functional components

In 2009, we've received 19 requests for new HIE projects. Each project is a "one off" with its own unique workflow and data exchange requirements. It is not scalable, sustainable or affordable to take on ad hoc projects that differ across each community. Ideally we'll be able to break down all our requests into a series of reusable capabilities that can be reassembled without significant IT effort to address the new project requests. Here's a list of candidate capabilities that we'll review:

Communicate Ambulatory Prescriptions

Communicate Structured Documents

Communicate Unstructured Documents

Communicate Clinical Referral Requests

Communicate Lab Results Messages

Communicate Lab Results Documents

Communicate Imaging Information

Communicate Quality Measures

Update Immunization Registry

Retrieve Immunization Registry Information

Communicate Emergency Alerts

Communicate Resource Utilization (hospital resource availability in a disaster or outbreak)

Communicate Benefits and Eligibility

Communicate Referral Authorization

Manage Consumer Preference and Consents

Access Control Service

Security Audit/Disclosure Service

Patient Identification Management Service

Knowledge and Vocabulary Service

Healthcare Document Management Service

Query for Existing Data Service

Administrative Transport to Health Plan Service

HL7 Messaging Service

Emergency Message Distribution Service

3. We need to prioritize these capabilities to guide our development efforts of over the next 5 years.

Given the business priorities of our stakeholders to achieve Medicare Part D incentives, Meaningful Use, ICD-10/5010 transition, and support Healthcare Reform, we'll develop a 5 year rollout plan for these services that will meet the greatest needs for the great number.

The outcome of this retreat will provide a foundation for the Massachusetts eHealth Institute's (our state government procurement organization for healthcare IT) ONC planning grant application.

I look forward to the retreat.

Of Bicycles and Printers

Bicycles and Printers? It's a parable, so humor me.

I ride a Trek 7.5 Fx Hybrid mountain bike. When I bought it in 2007, it cost $700 and it had Shimano Deore derailleurs, which are the lower end of Shimano's component sets. Although I have a great deal of experience adjusting bicycle components, I had many drivetrain problems - gears skipping, ghost shifting, low gears overshifted, high gears undershifted. No amount of adjustment left me a with stable, reliable ride.

Last weekend, I replaced the Deore components with Shimano XT, a higher end product. The difference between Deore and XT for my bike was about $100.00 or 15% of the cost of the bike. The new components worked perfectly and since I started using XT, I've not had a flawed shift or any adjustment problems. When I bought the bike, I would have happily paid 15% more to get a bike with a problem free drivetrain. The Deore components are now in the Wellesley Recycling Center and I'm a happy Shimano XT user.

And now, the analogy. At home, I've always used Inkjet printers such as the HP K550 and HP K5400 Pro. I spent very little buying these printers but filled them with expensive cartridges. HP printer drivers seem to have one purpose in life - to tell you to order new supplies. Each year the inkjet print heads fail and no amount of head cleaning/alignment can revive them. Since the cost of print head supplies exceeds the cost of the printer, I just replace the printer yearly. It seems that the lifecycle of a printer model is about a year, so I cannot even replace the printer with a similar model. Often that means that existing cartridges are no longer usable in the new model.

This weekend, I decided to get off the inkjet revolving door. I will never use an inkjet printer again because they are not eco-friendly, not cost effective, not easily maintainable, not reliable, and have poor life cycle management.

At BIDMC our printer lifecycle is 7 years with the following equipment

Color Laser

HP Color LJ4700N (Departmental)

HP Color LJ CP3525N (Work Group)

HP Color LJ CP1215 ((Single)

Black and White

HP LJ p4015N/TN (Departmental)

HP LJ p2055DN/X (Work Group)

HP LJ p2035N (Two-person)

I purchased an HP P2035N black and white laser printer at Staples and turned in my inkjet for recycling, getting $50 cash back. Yes, this printer costs a bit more up front, but it has the reliability, cost effectiveness, and life cycle management I need.

Just as with my bike, buying the right parts the first time to meet your requirements is the right thing to do.

I now have a small laser printer on my home network and not a single inkjet cartridge left in the house.

Cool Technology of the Week

Yesterday I was traveling through Newark to Princeton, New Jersey and I checked into my flight with my Blackberry.

That's right - I handed my Blackberry to the TSA and they let me pass.

I handed my Blackberry to the Gate folks and they let me enter the plane.

How is the possible? A little known option on the Continental Website called "PDA check in" that is completely paperless and is my cool technology of the week.

When you check in, Continental offers the option to send a 2D bar code to your smartphone/email device via a pre-registered email address (photo above). The bar code is invalid if printed. At airports with Continental gates, there is a special bar code reader at security that reads your PDA directly and validates the 2D bar code.

The gate uses the standard bar code reader that's used for all boarding passes.

Interestingly, I was the only one on the entire plane who used this feature.

I think folks are so paranoid about delays in security that they are reluctant to try new technologies at the airport.

Case in point - I wrote about Clear on April 11, 2008. In June of 2009, the company ceased operations.

However, I think the idea of using a PDA for boarding passes is simple, ecofriendly and works well. Whizzing through security with only my Blackberry - that's cool.

Japanese Artisans

This is another in my series of blogs about Kyoto. My August trip focused more on culture and people than on places and travel. Here's my mini-guide to the artisans of Kyoto.

First a bit about finding shops in Kyoto. In my quest for a lacquerware shop called Monju in the Gion (Geisha) region of eastern Kyoto, I needed to decode the address Hanami-koji Higashi-iru Minami-gawa, Shijo-dori, Higashiyama-ku.

Kyoto's addresses are purposely confusing. When Kyoto was the capital, addresses were designed to protect the emperor and his extended staff by obscuring the locations of buildings.

Here's a key:

Shi means city

Ku means ward within a city

Gun means municipality within a ward

Cho means town within a municipality

Mura means village

Dori means street

Kado means corner

Agaru means go to North

Sagaru means go to South

Higashi-iru means go to East

Nishi-iru means go to West

Kawa/gawa means river

Omotesando means shopping street

The system works by naming the intersection of two streets and then indicating if the address is north, south, east or west of the intersection. What this means is that a building can have more than one address depending on which intersection is chosen.

The official address to Kyoto Tower is Higashi-Shiokōji 721-1, Shimogyō-ku, Kyōto-shi, Kyōto-fu 600-8216

However, the informal address to Kyoto Tower, as given on its website is Karasuma-Shichijō-sagaru, Shimogyō-ku, Kyōto-shi, Kyōto-fu which means "south of the intersection of Karasuma and Shichijō streets.

So, the address of the Monju lacquerware shop means go to the corner of Hanamikoji and Shijo streets, then go East and wander around the block bounded by the former path of the Minami river (which now travels underground). I asked the local police station (Koban) and numerous shopkeepers. They had never heard of Monju and I did find an empty store front in a back alley off Shijo-dori. I presume it went out of business. I can recommend Urushi Art Lacquerware, manufacturer and wholesaler of Kyoto-style lacquer ware, which is located south of the Kyoto Imperial Palace at 637 Heinouchi-cho, Takakura Nishiiru, Takeyamachi-dori, Nakagyo-ku.

Other hints about finding your way around Kyoto :

The order of street names can be changed

Shijo dori Higashioji Nishi-iru

Higashioji dori Shijo Nishi-iru

The street names may be aliased

Shijodori Higashioji Nishi-iru

Shijodori Higashiyama Nishi-iru

Higashiyama dori is an alias of Higashioji dori

Compass directions can be combined

Higashi-iru agaru Kawaramachi dori Shijo dori

In fact, many shops are in alleyways or side streets and not on the main streets listed. When looking for an incense shop in Northwest Kyoto, my wife and I went to the general area and then followed the sweet smell of burning Aloeswood up a sidestreet for two blocks to find the shop.

Here are our favorite Japanese artisan shops:

Brooms - Americans may not think of brooms as a work of art. The Japanese weave natural materials into beautiful brooms that last for decades. The most amazing hand woven brooms in Kyoto are available at Naito on the west side of the Sanjo-dori bridge. We bought a broom and carried it back to the US. Carrying a broom around Japan definitely caused a few odd looks.

Fans - The Japanese make remarkable fans, decorated with finely detailed artwork. Although most people in Kyoto use free fans imprinted with advertisements, given away at train stations on the streets, the Geisha/Maiko and those wishing to experience Japanese traditional arts still purchase fans made by artisans. In Kyoto, I found a great fan shop, Miyawaki Baisen-an located at Tominokoji Nishi-iru, Rokkaku-dori, Nakagyo-ku.

Combs - In Japan, a woman's hair is considered one of the most important aspects of her appearance. Japanese women do no generally wear "bling" but they will add a finely crafted comb to their hair. Some of the most beautiful combs are available at Jusanya located at Otabi-cho, Shin-kyogoku Higashi-iru, Shijo-dori, Shimogyo-ku.

Washi paper - Japanese paper made from mulberry bark has great texture and natural character. The paper itself is a often a gift in itself. You'll find great washi paper at Morita Wagami located at Bukko-ji agaru, Higashi-no-toin-dori, Shimogyo-ku.

Chopsticks (Hashi) - Although Americans may think of chopsticks as simple throwaways, finely crafted chopsticks are a distinctive part of Japanense meal at fine restaurants and at home. When we travel, we carry our own folding chopsticks with us (saves trees) and at home we use beautiful handmade tiger bamboo chopsticks from Ichihara Heibei Shoten located at Sakai-machi, Shijo-sagaru, Shimogyo-ku.

Metalwork - Wonderful traditional and modern Japanese metalwork such as sake warming vessels are available at Seika-do located at Nijo-sagaru, Teramachi-dori, Nakagyo-ku. The owner, Mr. Yamanaka speaks English and is a wonderful teacher about Japanese metal artistry.

Ceramics - The Japanese make many styles of ceramics, often specific to the clays of a town or region. My favorite ceramics are the blue and white pottery sold by the shops in southeastern Kyoto near the Kiyomizu temple such as Asahi-do or Rakish-en.

Bamboo - Bamboo is an incredibly versatile material, used for fine Japanese flutes (such as the Shakuhachi I play), baskets for flowercraft (ikebana), and hundreds of household objects. The best store for bamboo craft is Kagoshin located at Shichi-ken-cho, Ohasi-higashi 4-chome, Sanjo-dori, Higashiyama-ku.

I hope you enjoy the journey to find these places at much as I did. Not only is it culturally enriching, it's good for you. I lost 5 pounds walking the streets of Kyoto and exploring its alleyways in search of the finest examples of Japanese traditional arts.