CHRIS PELUSO

Work. Travel. Technology. Food. Wine. All Things San Francisco.

Routine Visit to the Family Physician

The electronic medical record or electronic health record (EHR) has been around for several years in healthcare organizations and practices but only until last year has it been allowed to become reimbursable by the federal government. Back in the day, when someone went to the doctor for an appointment, all of their information was stored in a file with pieces of paper along with other file folders in a file cabinet. Then eventually, maybe the office started to electronically convert these pieces of paper into soft copy forms and filed them on their desktop PC while also keeping the hard copy files for back-up. Once the patient left the doctor's office and went to the lab or the pharmacy, they would have to take a piece of paper with necessary instructions from their doctor and then show the lab or the pharmacy their piece of paper to trigger whatever happened next. As one can imagine, being able to store a patient's records electronically and having it accessible to both the patient and their clinicians would be a positive step in the right direction for improved quality of care. Not to mention, the simplicity of reading medical notes in a universal font on the computer rather than the handwriting on a pad of paper could lead to a reduction of errors. In broad terms, EHR makes sense but let's take it to an isolated situation, namely one that I recently experienced.

Just recently, I decided to switch my primary care physician. Her bedside manner was lacking as I consistently felt rushed during my visits. She was fine taking my blood pressure, checking the different bodily systems (heart, lungs, etc.), but your PCP is also supposed to be your connection to other clinicians within the healthcare system and she wasn't good at ensuring that this network was in place for me. Even if a physician has their own private practice, they should have a network built within the medical community. So, I went to someone else.

Now what happened during my visit to the new doctor some people would find irritating, but because I have been in HealthCare IT for several years now, I actually found it comical. My new doc had a third entity in the room, the computer. I'm used to this. I've had other PCP's who routinely used the PC while they were performing my check-up. When I went to get Lasik, my optometrist and surgeon also used the PC while I was in the room and after answering their questions they would type notes in, replacing the old notepad with the click click of the keyboard. But during this last visit, my doc started to have issues with the computer. She thought it might be her lotion on her fingertips and the touchpad mouse on the laptop wasn't registering. She washed her hands and continued filling out the form on the laptop - still wasn't registering. She sat the laptop down on the counter and continued with my check-up and I couldn't help looking at the program she was using. Here I was getting my physical done, but trying to figure out why her computer wasn't working. I then started to troubleshoot, telling her "Well, the cursor is blinking so that doesn't mean it's frozen. But then I don't know this program so I'm not sure..." She said "This is so weird. I've been using this program for a while now and this is the first time that it's done this." I say "Eh, it figures. Since I'm in the industry of course it's not going to work for me!" I started to laugh. She said "Well, don't worry; I'm going to input all your info later in case it didn't save." I also found it interesting that when the computer stopped registering, she went to her clipboard but the original paper form wasn't there anymore because the computer program had worked so well they had stopped making copies. I'm not sure how she would have gotten my information in the computer without having to re-interview me.

Some might say that this type of incident seriously degraded the quality of my doctor's appointment, but I would disagree. I could see how good of a doctor she was as she adapted to the situation and honed in on the most important thing, my physical exam. She continued with the physical instead of lingering with the computer problems. By the end of the appointment, we talked about my health, what I should focus on, if I had any questions, and thoroughly went through what I needed to do next.

Will each physician be savvy enough to balance an exam, diagnoses, bedside manner and technology within your 15-20 minute check-up? What if this weren't a routine check-up, but a more serious type of visit? Does the introduction of a computer into the exam room make patients feel uncomfortable? With time, more health organizations are going to be implementing this type of technology into their practice (if they haven't already). There are organizations that have already invested millions into healthcare technology and now they also have the opportunity to get reimbursed by the government if they can prove that these electronic records have been used meaningfully and provided benefits to patients.

Filed under  //   doctor   ehr   healthcare   physician  

Really Necessary? Desktop Bare-Metal Hypervisors from VMware and Citrix @PCWBizCenter

See this article at PC World: http://www.pcworld.com/businesscenter/article/192411/vmware_citrix_struggle_w...

I think bare-metal hypervisors for servers makes tremendous sense, but for desktops? Come on... "Let's run our personal and work operating systems on the same machine!" Why do this? The existing model for running a virtual OS within the primary OS works on the desktop. On my Mac, I run VMware Fusion with Windows 7. This accommodates all the situations I've heard of on the desktop where you might need to have 2+ operating systems on the same machine.

In regards to restoring images to new hardware? Those benefits seem marginal at best. Virtualization is not required to easily deploy standardized disk images.

Apple has had Boot Camp for several years now, and in my opinion, it was primarily a marketing tool to give Windows users a level of comfort for buying into Apple's hardware. I don't know many people who actually run it, unless they truly want to run Windows as their primary OS and want Apple hardware. We actually have some people that do this at work, but the traditional VM players have been a much better option for switching between operating systems on the fly.

In the server world, running multiple virtual machines directly on the hardware has several benefits such as hardware cost savings, server performance efficiency, remote management, and power savings.. My company (Kerio Technologies) has been promoting the virtualization model for our firewall and mail server for a couple years now, and it finally seems to be catching on. This is the future for on-premise deployments as hardware performance increases have outpaced software requirements, allowing for multiple solutions to tackle the resources available on a single server.

Filed under  //   Apple   Citrix   Kerio   Tech   Virtualization   VMware  

Apple MacBook Pro hardware complaints

I switched from a Thinkpad to a MacBook Pro about 3 years ago. Even though the IBM (now Lenovo) laptop was a solid piece of hardware and never let me down, I couldn't pass up the chance to check out something new. Now that my Apple Honeymoon is over, I can fess-up what's been bothering me about Cupertino's latest concoction.

Now, don't get me wrong, Apple's MacBook Pro is a wonderfully powerful and slick looking laptop, but I do have some legitimate complaints that get me really frustrated and make the MBP sometimes difficult to enjoy.

USB ports are too close
Not all USB devices are ideally created to fit within the physical size of a USB port. Take my Verizon Wireless card for instance. As you can see, it takes up it's respective port and more, crossing over the second USB port. Since I use this wireless card for a good portion of the day, this pretty much makes the MBP a single USB port laptop. The previous generation MBP's at least had one on the other side of the laptop, making it usable regardless of the width of the device's connector.

Sharp edges
MacBook Pros look sharp! And that's because they are sharp... REALLY sharp. Again, great to look at, but difficult to enjoy. Case in point.. Oftentimes, my MBP sits on an elevated surface, such as a dining table, desk, or coffee bar. When it sits this high, my forearms are at an angle, and my wrists push against the front edge (seen in picture). This gets uncomfortable very quickly (I even get welts from this!!) and reduces the amount of time I can really use it. Either I have to stop using it, or I have to remove it from the elevated surface and put it on my lap, which brings me to my last complaint...

Hot, Hot, Hot!
While I cannot say the current MacBook Pros get as hot as their predecessors, they still get quite toasty. I don't have kids yet, but I would like to one day, and this little lap-warmer isn't helping. I now have a very specific position for my legs to be in to handle the heat the MBP gives off. My knees (from kneecap center to kneecap center) must be the width of the laptop, leaving half of each leg under the laptop. And the MBP itself must sit far enough away so the screen is slightly past my knees. This gives plenty of room for the heat to vent out without warming my midsection too much.

So, other than those three problems, I think Apple has a true winner with it's latest laptop hardware. If they can "fix" these problems, however, I believe the hardware would equal or best everything else out there.

       
Click here to download:
Apple_MacBook_Pro_hardware_com.zip (125 KB)

Filed under  //   Apple   Review   Tech  

Why I might not follow you (back) on Twitter

Twitter.. This is really an interesting space on the Internet. Millions of people, chatting into space, connecting, sharing, reading... opening their sometimes private thoughts for the world to view. Yes, it's essentially a blogging site, but easily searchable and even indexed now by search engines.

Most people join because they're curious or already know it's an invaluable source of real-time updates on pretty much any topic. Others join in an attempt to spam.. The most active Twit'rs (besides Celebs, I would say), want followers so they can spread their message, corporate, public service, personal, or otherwise.

I joined Twitter for a couple of the above reasons (hint: not spam), and I constantly find myself in a quandary about something... Who I should follow.

I haven't yet subscribed to the courtesy of following people who follow me. I follow those people who I'm interested in hearing what they have to say, or semi-interested and they don't post too frequently (up to maybe 10 posts/day). I do this because I read *every* post of the people I follow. There are apps which allow me to filter out posts and ignore people I chose to follow. But, honestly, why would I follow someone if I don't even read their posts?! It is purely a courtesy to follow someone back when you don't read their posts, and that just doesn't make sense to me. I choose to do this even though it's detrimental to my follower count. Tell me, how am I supposed to read everyones' posts if I am following 500 or 1,000 or 20,000 people? If I want information on a specific topic, I will search for it, and very possibly find someone new to follow.

My choice has nothing to do with the person... I just try to keep the topics in my stream pertinent to my life, usually professional, but sometimes personal or just plain funny.

On a final note...

Qwitter is now telling me who un-follows me, and so far, it has been people I didn't follow back. I would say I'm sorry to those people, but really, why'd you follow me in the first place?

Filed under  //   Social Networking   Twitter  

NCAA in San Jose-se

Downtown San Jose is full of life tonight... College hoops fans are in town to see the NCAA tournament at HP Pavilion. It's New Mexico vs Montana, but it looks like the NM fans brought the numbers.

It's great to see this liveliness in Downtown. Sure, we get to see some life here when the Sharks are playing at home, but you've got to agree that College fans are WAY different from Pro-Sports fans. They're so full of pride and hope for their respective teams! I do have to admit, however, that Sharks fans are a very PROUD and PASSIONATE bunch, and the Shark Tank is always sold out.

It's too bad we don't have this excitement Downtown on a more regular basis.. Maybe that will change if/when the A's come to town. Then it'd be year-round!

Not a Cloud in the sky today

It's a beautiful day in the Bay Area.. Nothing but sunshine. I don't see a single Cloud. When I think of Clouds, the words "cold", "stormy", "windy" come to mind... We've had a lot of Clouds this Winter. Don't get me wrong of course, there are times when I welcome Clouds. When it's too hot or when we need some rain because of a drought, Clouds are great. Most days, however, I much prefer a nice, clear, Cloud-less day.. even if it's a cold day.

Now that I think of it, the very best days are those mostly clear days with a few Clouds to bring on a little shade and coolness. On those days, I really welcome them. That's the thing about Clouds... While they're not the preference for everyday (we all want some sun, right?), they definitely have a place and a purpose. I just wouldn't want all Cloud all the time...

Filed under  //   Cloud   SF  

SkyClub

Here I am at SFO. This was a familiar place last year, where I departed on flights totaling around 90,000 miles. These trips took me to more international destinations in one year than I had ever been in any year prior, and I'm not even including Canada. A total of 3 countries outside the US- the UK, Philippines, and China. All places I had never been before. All places I knew I would visit sometime in my future. Who knew they'd all happen in 2009, a year that will probably be looked back on as a more negative than positive period in history.

During all those trips however, I never stepped foot in the SFO Delta SkyClub, a club I am free to visit because of my Amex Delta Reserve Card. I'm not going to tell you if the card is worth it ($495/year), but if you have the option of visiting the SkyClub, it's a great way to spend your stay at the airport. For some reason, I had low expectations of the SFO club. Perhaps it's because the Delta terminal at SFO is a second-rate terminal. United has a great terminal, obviously, but even Virgin America is moving to the currently-being-renovated Terminal 2, which should be pretty slick when it's done. The Delta terminal is this hob-bob of old gates with shiny "high-tech" gate numbers, unfamiliar chain stores, and some smoothie place at the very end. So, you can see why my expectations for SFO SkyClub were low...

Well, I'm happy to say, my expectations are exceeded. Don't get me wrong. This place is not the Tokyo SkyClub, which served sushi and variety of other snacks and drinks, but it is clean and has a wide variety of drinks. Plus, it's got decent Internet access, which is what I'm using right now. The only other unusual thing abou this SkyClub is it's outside the terminal, before you go through security... Maybe that's the only way it can stay away from the ugliness that is Terminal 2, Delta.

If you get a chance, check it out, grab a drink, and use the private restrooms before that long flight.

Filed under  //   Delta   Kerio   SFO  

Austin, Day 1

Just got back from a work trip to Austin and Dallas, Texas. I gotta admit, Texas is much better than I expected, but also less than I expected in certain aspects.

I landed in Austin on Tuesday evening and was picked up by Peter in his relatively new, white Honda Accord. We were both hungry so we decided to immediately grab some Tex-Mex food at Guero's. This place, as well as South Congress, really got me into the local scene of good food, good looking people, and cheap eats, and all with this cool, low-key vibe. I had Queso for the first time, but this was no ordinary Queso. This Queso had chorizo and green onions in it. Amazingly good with the tortillas and freshly made chips. My dinner consisted of chicken and steak tacos. Both were tasty, but I got sort of full from the Queso.

Another really cool thing on South Congress was the "Trailer Eateries". This is a little trailer park, but the trailers were actually walk up restaurant-trailers with such places as Hey Cupcake! and The Mighty Cone! (yes, both places have exclamation points in their names). We didn't stop here as most of them looked closed for the evening. Our night, however, did not end at Guero's.. I got a quick tour of all the greatness known simply as 6th Street. Say "6th Street" anywhere in Texas, and probably anywhere west of the Mississippi, and people immediately know what you're talking about. The blocks on and around 6th contain something like 250 bars and music venues.. Wild! 6th (East of Congress, that is) has many of the bars, while the Red River District has some of the most well known music venues. I think this East 6th area is often referred to as "Dirty 6th". As you head West on 6th and cross Congress, 6th becomes a little more foo-foo. A little nicer bars, furniture stores, and a crazy Whole Foods supermarket. I say "super" because that thing took up a whole downtown city block! I was told this is the corporate headquarters as well, so it makes sense.

We ended the night at this amazingly cool bar called Lustre Pearl. Oh. My. God. This place was frickin cool. Wish I had the chance to see it on a weekend night. This was Tuesday. It still had a really cool vibe... Chill. Cheap drinks. Fun people. Ping Pong. Hoola Hoops. This place was a converted home that must have been built in the late 1800's or early 1900's. It had that old home charm, but was a bar with full indoor and outdoor areas to hang out. Really cool. Really hot. The neighborhood, though, is weird. House across the street is boarded up. A couple houses down is a beautiful example of the original architecture. Then empty lots with overgrown weeds, grass, dirt, and some abandoned vehicles.  In San Francisco, realtors might call this an "up and coming neighborhood".. (sarcasm).. And then... Lustre's sister location, more upscale bar- Clive Bar. We just went to see it because it opened a couple months ago, but wow! I am impressed! Clean. Streamlined. Comfortable. Warm. This is a place, along with Lustre, I would definitely take people visiting, or looking for something different. Similar formula as Lustre with Indoor and Outdoor areas, built from a converted, old house, but you can feel the dial move from casual to "pop your collar". It's interesting because Clive doesn't feel pretentious or overdone, but you can feel the simple opulence around you. From the white, leather bar stools to the clever Patron tequila bottle chandeliers, Clive does a great job making you feel special being there. I just hope the neighborhood finds its identity. Seems like its at a crossroads of high rise condos, old school beautiful homes, run down lots, boarded up homes, and these two bars. I guess we'll see in the near future since I plan on making a visit to Austin at least once per year.

Filed under  //   Austin   Bars   Kerio   Travel   Work  

SF Friday Night

While Chris is in Vegas working (partying), I wondered to myself what I should do after work today. It has been a long and stressful week as usual with some "wins" peppered throughout. I didn't feel so drained at the end of the day, but I didn't feel like going out. Tonight was the first night I took a walk by myself in San Francisco. Usually I am with with other people or at least the dogs. It was a cool, breezy night and on the quiet side. There were some folks walking around, having dinner at Amici's, fishing in Mission Bay and hanging out at the yacht club facility. I didn't walk far, just up until I caught view of the Bay Bridge. It's a sight to take in - the bridge in the backdrop, the water and the many sailboats docked close by. It felt very refreshing and I think I should take the 45-60 minutes sometimes to simply look around without the cell phones, laptops, and constant "buzz" we're always surrounded by. Sometimes people think that it's not worth it to give time to themselves or that they can't spare a few minutes to do it, but it really does soothe the soul. 

WFH - working from hotel

This morning flew by for me. I was sitting in front of the computer working away when I suddenly felt faint. I looked at the clock and it was way past 1pm already. Time for some lunch! I decided to brave the crowds and go out to grab some food. After walking to Citibank to get some cash, I roamed around the streets wondering what I should eat. Hmm, I don't want to sit down by myself so I try to find a quick and easy takeout spot. I find myself near the Times Square mall where there was a booth for "Hot crispy sandwiches" so I go over there to grab one. They are hot pocket-like sandwiches in the shape of fish! I get a bacon, tomato and mushroom flavored one. I eat that while I continue to walk the streets and almost squirt tomato sauce all over myself. LOL. I'm still hungry and the famous quote of "Do something that scares you everyday" repeats itself in my head. I go over to one of the vendors and say "HI!" really loudly. I point to the chicken wing and rice dish and say "TOGO". She says "TAKEOUT?" and I say "YES!". I have to say this loudly since it's so noisy out on the streets with people walking/whizzing by on each side. I wait while they cook it up. They give it to me and I am so happy and proud of myself! I go over next door for a drink. Hmm, what shall I order. Milk tea in a bottle? Score! I trek all the way back to the hotel to devour my lunch, but first I have to share with the whole world my small accomplishment of the day. Now, time to eat!