text:
Softsoap Moisturizing Body Wash Coconut Scrub
48 reviews
89% would repurchase
Package Quality: 4.0
Price: $$
Package Quality: 4.0
Price: $$
INGREDIENTSWater , Sodium Laureth Sulfate , Acrylates Copolymer , Cocamidopropyl Betaine , Fragrance , Apricot Seed Powder - Prunus Armeniaca , Titanium Dioxide , Glycol Distearate , Sodium Chloride , Laureth-4 , DMDM Hydantoin , Sodium Hydroxide , Tetrasodium EDTA , Citric Acid , Hydrogenated Jojoba Oil , Coconut Oil - Cocos Nucifera
on 9/27/2015 3:14:00 PM
Age: 25-29
Skin: Dry, Fair, Cool
Hair: Brunette, Straight, Medium
Eyes: Hazel
This is a really great product. I'm kind of a product snob, I don't really purchase ''cheap'' drugstore products, and I thought that Softsoap felt in this category. However, I was wrong, and buying something that is not expensive doesn't mean that it's cheap and this product is the proof of that. This body wash smell super nice (a soft, vanilla-coconuty smell, but not sunscreen coconut), lather nicely, is lightly exfoliating without being irritating for my sensitive skin, and leave it moisturized and not striped away and tight.
All-in-all, it's definitively worth 5 lippies.
on 5/11/2015 6:25:00 PM
Age: 36-43
Skin: Dry, Fair-Medium, Neutral
Hair: Grey, Wavy, Medium
Eyes: Brown
When I think of softsoap, I always think of the BIG huge bottle of hand soap at Costco, so I never thought to try of their body wash product. However, I saw a buy 1 get 1 deal at Target a few months ago and decided to try it. Blew me away, not only does it smell great, the scrub is very smooth and feels really moisturizing after. LOVE it and will stock up on this if I see this goes on sale again :)
on 4/26/2015 9:37:00 PM
Age: 18 & Under
Skin: Oily, Fair, Not Sure
Hair: Brown, Other, Other
Eyes: Hazel
I love this! It lathers well, smells amazing and leaves my skin feeling super soft!
on 12/23/2014 11:38:00 PM
Age: 19-24
Skin: Combination, Fair, Neutral
Hair: Brunette, Curly, Fine
Eyes: Brown
This is my favorite body wash. The scent is amazing. The texture and consistency is quite thick and creamy. It lathers nicely, and gently exfoliates. Leaves my skin clean, super soft and moisturized! Doesn't dry my skin out at all. And it's pretty cheap! Love it!
on 12/4/2014 2:32:00 PM
Age: 30-35
Skin: Dry, Medium, Neutral
Hair: Blond, Straight, Fine
Eyes: Hazel
I run out of my usual Suave - Creamy Almond & Verbena body wash, and wanted to get something new. I saw SoftSoap Body Butter that is body wash and scrub. Sounds great, I actually wanted to get a scrub so much but I noticed that there are only about 3 body scrubs in the market, most of them are gels. And for $2.99 at Walmart, I had to get it.
So far I really like it. It cleanses well, the scent is nice (but it does not remind me of coconuts though) although the little beats are too small and too less. I fell that it does not exfoliate very well. But I guess that's way it's better for people with sensitive skin.
It does contain sulfates but.. which body wash doesn't? I am not sure I would re-purchase it because it is good but nothing that wows me.
on 12/1/2013 4:45:00 PM
Age: 36-43
Skin: Dry, Medium, Not Sure
Hair: Brunette, Other, Other
Eyes: Brown
I ran out of the body wash I use from the European Wax Center which I love but it's 20 for 8 oz. I was expecting this to be a bit more gritty but I still love it overall because it is very moisturizing and still leaves my dry skin soft. I will still buy my usual body wash which exfoliates better but I won't use it every day as this suits me great if I don't need a lot of exfoliating. For the price you can't beat it and I love the consistency of it, very thick and creamy. I love the scent of anything coconut which makes this a perfect match to my Organix Brazilian Keratin shampoo and conditioner. Dont need too manyscents going on! I will definitely be repurchasing this!
on 11/2/2013 1:35:00 AM
Age: 19-24
Skin: Combination, Fair, Not Sure
Hair: Brown, Other, Other
Eyes: Other
I wouldn't really call this a scrub, it is a body wash. It's creamy formula leaves a fresh scent, cleans well without stripping, and moisturizes. It doesn't leave that soap scum feeling that so many other products do. Love it and have repurchased several times. I have dry skin.
on 5/27/2013 12:46:00 AM
Age: 18 & Under
Skin: Sensitive, Fair-Medium, Warm
Hair: Other, Straight, Fine
Eyes: Brown
Skin background: dry and sensitive. THIS IS NOT FOR PEOPLE WITH SENSITIVE SKIN. IT WILL BREAK YOU OUT EVERYWHERE.
Results: I noticed an 100% increase in back acne and even chest acne which I never had before. After using this, my neck, shoulders, back, and chest broke out intensely. Left me with countless scars. I thought it was hormonal but I never struggled with acne in my shoulders, neck and chest. I got acne after using this product.
Do not let the pleasurable smell and cheap price lure you into buying this product if you have sensitive skin.
on 5/13/2013 5:51:00 PM
Age: 25-29
Skin: Combination, Fair, Cool
Hair: Blond, Straight, Other
Eyes: Green
I never used Softsoap body products only because I feel like it's suppose to be a hand soap line. I saw this at CVS, the creamy color with the crushed like coconut beads caught my eye plus it was on sale for under $4. I smelled it, read the ingredients and purchased it...
and now I love it! It's gentle yet exfoliates well and moisturizes.
It's now a staple in my shower!
on 9/7/2012 10:59:00 AM
Age: 25-29
Skin: Dry, Fair, Cool
Hair: Brunette, Wavy, Fine
Eyes: Brown
I used this at my sister-in-laws house and smells great. It also is gentle and soft on your skin with mini microbeads to exfoliate. It is a creamy, silky body wash.
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National TV horror host, Svengoolie, has never had any trouble attracting long lines at C2E2 (Chicago Comics & Entertainment Expo) and this year would be no exception. The only notable difference was the time of his appearance; earlier than previous years and conflicting with the photo op time tickets I had for Stan Lee. Fortunately C2E2 is a well-oiled machine and despite missing his arrival I was still able to get to him rather quickly…though hardly alone.
Tag Archives: Svengoolie
The 2015 Hearse Show was quite a ride!
On Saturday June 13th I headed up to Lombard, Illinois to attend a Hearse Show. Not only did the event promise a collection of automobiles specifically designed to deliver you to your final destination but also live music and a visit from national horror host Svengoolie. As someone who firmly believes that Halloween is much more a state of mind rather than just a date on the calendar, an occasion such as this was just too darn fun to pass up! Joining me for the ride was my friend, Susan, a gal who also enjoys the macabre. Continue reading
The Terror Daves visit Svengoolie at the Studio Part 2!
Dave: Doug Scharf (a.k.a. Doug Graves) arrived at the studio and this was a big deal to me. I'd watched him accompany Svengoolie during his musical numbers since I was eight years old as well as participate in various skits and viewer mail segments. He settled in and I was particularly happy to see that he'd brought his horn with him which meant I'd get to see him play two instruments for two different numbers! As soon as he arrived, he and Sven hunkered down Sven to discuss their segments.
The Terror Daves visit Svengoolie at the Studio Part 1!
On Friday March 27th, we headed out to Chicago to do something we'd dreamt of doing since first becoming Terror Daves five years ago; being present for a Svengoolie taping at the studio! I'd been there before back in 2013 and had the honor of throwing chickens at him during the beginning & end sequences of The Leech Woman and Dracula along with getting to see some of my favorite props such as Tombstone, Durwood, & Kerwyn. At the time, the studio rules were pretty strict and I wasn't allowed to share that experience on social media nor on this site which was pretty painful since I was so excited about it that wanted to shout it from the roof tops. Happily, I've now been given permission to do so as well as share our experiences during this visit (provided we waited until those shows aired and didn't give anything away in terms of content). Here are some shots from my first visit in 2013…
Lions, Tigers, Bears…& Metaluna Monsters: Svengoolie appears at Brookfield Zoo!
After enjoying an afternoon seeing the animals at Brookfield Zoo, we headed over to their Discovery Center where my AAZK (American Association of Zookeepers) Chapter was hosting its annual Vital Ground fundraiser. It's an all-you-can-eat spaghetti dinner with the money raised to be used for obtaining property out west in grizzly bear country. The buildings or lots purchased are then converted back to their natural state so the animals can use them for travel and aid in finding mates, food, etc. I've been going to these dinners long before I joined AAZK because they also feature an appearance by my favorite horror host, Svengoolie…the man indirectly responsible for bringing us Terror Daves together in the first place.
Nightmare on Chicago Street: Chaos & Cosplay!
As sun went down, the energy level rose and everyone knew that Elgin's Nightmare on Chicago Street had officially begun. One of the featured acts, "The Rocking Dead," took to the stage as the streets were soon filled to capacity.
Twas a "Nightmare on Chicago Street!"
Hey gang, I hope everyone enjoyed their holidays and are looking forward to another year of horror, science fiction, super heroes, and monsters! I'm gonna kick off 2015 with a series of posts on an event that took place during the last Halloween season. Okay I know that isn't very "New Year-ish"but I felt this story deserved to be looked at carefully and required some time that my Christmas (or Krampus had I been a local here in Elgin) season just didn't allow. So let's enjoy these 'dead of winter' days (with Dead being the operative word) and discuss an occasion that, while always amazing, is unique each year. Just curl up and forget those sub-zero temps that are plaguing a good portion of the US right now and go back to a much warmer evening WAY back in 2014.
Ah, it seems like only yesterday…

subset: commoncrawl


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Bombono DVD
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Arsenal Training Session and Press Conference
Wojciech Szczesny of Arsenal during a training session at London... News PhotoArsenal F.C.,Club Soccer,England,Event,London Colney,Soccer,Sport,Sports Training,St. Albans,UK,Vertical,Wojciech SzczesnyPhotographer Stuart MacFarlaneCollection: Arsenal FC 2013 The Arsenal Football Club PlcST ALBANS, ENGLAND - OCTOBER 21: Wojciech Szczesny of Arsenal during a training session at London Colney on October 21, 2013 in St Albans, England. (Photo by Stuart MacFarlane/Arsenal FC via Getty Images)


text:
Don't let the Cubs fans sour your view of Chicagoans, Erica. They're generally snotty frat guys and trust fund kids who think the world revolves around Lakeview (the actual name for the area known as "Wrigleyville"). Next time you're in Chicago, make a foray to the South Side, where the people are a lot more genuine and appreciative of life beyond the trendy bars and getting drunk.
A newly minted Milwaukeean in Chicago
Moving to a new city requires a lot of explanation - at least, it has for me. »Read Full Blog Post
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Most people that live in "Chicago" live in the suburbs anyway.
Gotta love someone who tells people not to stereotype an entire city and then goes ahead and stereotypes an entire region of that city. Believe it or not, adam, not all people living on the North Side (or in Lakeview) are rich and spoiled frat boys. Some of us work for a living, but prefer to live on the North Side, as it's closer to our native Milwaukee.
wonderful observation Erica. Full of wide-eyed wonderment. I have an idea for your next entry: "isn't it weird how in Milwaukee the sun rises in the east and sets in the west, just like in LA!!!???"
Having lived in Chicagoland recently (1994-2004), I can say that most Chicagoans like Milwaukee and enjoy coming here, particularly for the outdoor fests and tailgating at Miller Park. Chicagoans like the values here, the lack of traffic, the friendliness (like Milwaukeeans appreciate Chicago's variety, bustle and world-class urbanity). Don't let sour denizens of Wrigleyville influence you too much; you'd be surly, too, if you waited 62 years (and counting) for one lousy trip to the World Series...
I used to "date" a girl who lived on Addison and Lake Drive with a great apartment overlooking Lake Michigan. She had nice girl friends, and they all had plenty of money from daddy which they used to pay for everything when we went out. It was great!
Don't feel bad about liking Wrigley Field, even though you're from Milwaukee. It's a great place to see a ballgame and one of a handful of special sports venues (like Lambeau). Cub fans are a separate issue. Like Packer fans, there are reasonable, enjoyable ones and boorish, obnoxious ones. As for the Chicago/Milwaukee relationship, I think it's common that the big city that's down the road from the little one often has a superiority complex component. I was vacationing in Maine this summer and heard that the people who live "Down East" there call the people who vacation there "Massholes," very reminiscent of the "FIB" designation here. I think the Chicagoans you ran into in Wrigleyville just can't fathom why you'd live so far away from what they consider civilization.
Look at it this way, Milwaukee is a cute little city with an easy to access airport, a great airline, a magnificent lake, some decent restaurants and a housing marlket where your $$$ will go farther than anywhere in Chicago (city or suburbs). It is alo affliected with many big city problems (poorly performing schools, crime, poverty, etc.) and a serious inferiority complex that in the 30 years I've lived here keeps getting worse.
But strangely enough, it is an addictive place to live especially as I get older and less tolerant of long lines, crowds, etc. If I were still in my 30s and living in the midwest my first choices would be Lincoln Park or Bucktown in Chicago and then Minneapolis because of their vibrant economies and great social and professional opportunities that seem to me to be lacking in MKE & in WI. But I'm not in my 30s any longer and MKE works just fine for me.
Cubs fans hate everyone, especially themselves and their team, so you're temporary Milwaukee address has little to do with their animosity. Was this the same game Zambrano attacks his own fans?
I can't for the life of me understand why people would choose to live in Chicago. It's a nightmare of a city to navigate.
If I were you I would have changed spots and not have even entertained those chi-town guys. There are a lot of great places to live and where ever you are it is what YOU make it. Thanks for realizing this and embraseing MKE for it's own great qualities.
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Gifted and Talented (Paperback)Wendy Holden
Paperback Published: 12/09/2013
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It's the new university term among the dreaming spires. The start of a whole new life. Meet Isabel, beautiful, clever, shy - and leaving home for the first time. Meet Olly, recently graduated, idealistic and a little hopeless, a man whose heart leads his brain and for whom opportunity just hasn't come knocking - yet. Meet Amber, the It girl who is soon partying with the fast set - and no-one is faster than Jasper de Borchy, glamorous leader of the notorious Bullinger club. Meet the grown-ups: Diana, recently divorced mother-of-one, newly arrived in town to take up a post as college gardener - and Richard, the new college head, a widower, a scientist, and as lonely as some of the specimens he captures in his science lab. The rich, the poor, the shy, the extrovert, the givers, the takers. Meet the Gifted and Talented.
Publisher: Headline Publishing Group


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Submit Content | Media Center | NCAA.COM
Oklahoma's national championship-clinching victory capped a record-breaking 26-0 season.
The star pitcher could have turned pro immediately after high school but chose a partial scholarship to Stanford instead. Decades later, he says he would make the same decision again.
The former Brown University basketball player had a lifelong dream of being a college athletics administrator. That dream has been fulfilled – he now works as Stanford's athletics director.
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Get the latest news from Wolves delivered for FREE to your inbox.
19:40 14th July 2013
Short scheduled downtime on Tues/Weds
Wolves are making fans aware that they will be unable to purchase tickets online between the hours of 5.30pm on Tuesday, July 16 and 9am on Wednesday, July 17.
This short period of overnight, scheduled downtime is to enable essential IT maintenance work to be completed.
The Club would like to apologise for any inconvenience and hopes the advance notice gives supporters the opportunity to arrange any online ticket purchases around these hours.
All Wolves' other websites – including wolves.co.uk – will be operating as normal.
Click here for all the latest ticket news.
News of fixture changes
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7 of 11 people found the following review helpful
Highly Disappointed,
Verified Purchase(What's this?)
This review is from: Clarks Men's Stinson Wallabee Chukka Boot (Apparel)
I was soo excited to receive my package to give to my boyfriend,but I was not pleased to see that the shoes looked like they were pre-worn. Both shoes were scuffed all over and I am unhappy that I waited so long to receive the item, only to my disappointment that they were less than appealling. What's more disappointing is that I have gotten better products from sellers,and to see the terrible condition that Amazon sold these shoes at is degrading. I will be returning these shoes!
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Tuesday, October 6, 2015
Please Join me for #NHITWeek Tweetchat Thu Oct 8 at 3pm ET #connectedPatient
HIMSS15 The Year of DigitalHealth, Interoperability and Security
Friday, May 29, 2015
Healthcare Technology need to include Patients
and patient engagement rank among the top priorities for CIOs. In fact, they rank above improving care coordination, streamlining operational efficiencies, and achieving Meaningful Use.
The tides are clearly changing. We've all been talking about what the shift to a value-based care model means for healthcare organizations. What we haven't been talking about is how this shift is transforming our patients into "prosumers."
There's a saying, "To a worm in horseradish, the world is horseradish,"
meaning we are predominantly aware of that which we are surrounded by on a daily basis. Health IT, in all its intricacies and expansiveness, has become hyper focused on making sense of its nebulous infrastructures, working hard to prepare healthcare organizations for next new wave of regulations. Our world, while not horseradish, is composed of goals and milestones that are 100 percent contingent upon these systems.
But, as yet one more unintended consequence of this pursuit, we have become myopic. The business of healthcare is no longer simply confined to a hospital or an IDN site map.
Patients are reaching for their phones, not to call their doctors, but to research their symptoms. They're educated buyers, looking up reviews before seeing a new specialist, just as they would before buying the latest gadget on Amazon. And, as we enter the era of the Internet of Everything (IoE), they want their wearable devices to meaningfully connect as simply as when they use their phones to play songs from the playlist on their laptop.
It becomes a challenge of sustaining the momentum of the moment. As the wearable trend continues to grow, it is not merely enough to count steps or measure the amount of UV rays absorbed. That won't keep patients engaged. We need statistics and personal health trends that can be used to foster a richer, ongoing dialogue between patients and their physicians.
Consider the positive health implications for patient who receives a treatment plan from her doctor, which is entered into the EMR during the visit and connected to a three-question daily check-in for three months via a mobile device. The patient could provide a thumbs-up, thumbs-down, or neutral rating (think Pandora playlist) on how the treatment is working, with perhaps an option to enter free text should she choose to expound upon her responses. These daily reports could be aggregated into trends and reviewed by a clinician to make adjustments to the treatment plan as needed, extending patient care beyond confines of the four walls and the 12 minutes of an office visit.
Connectivity and personalization is the zeitgeist. CIOs know this. We are all unique snowflakes, and as more and more people submit their genes for analysis and mapping, we're proving the increased drive for individuality. While the industry is pushing for population health (a laudable vision indeed), patients are looking not to be considered in aggregate, but to be treated with the same personalized attention they experience when they go to a favorite restaurant where the wait staff recalls their usual order or when they go to a website that remembers all their previous preferences. It's about not starting from square one every time.
Patients aren't going to tolerate the disconnect in healthcare forever. And as digital natives,some generations won't tolerate it at all. The day is coming where a patient will ask her doctor, "Did you notice that that my headaches seemed to lessen on those days I go to the gym? I'm wondering if there's a connection?" If her physician isn't paying attention to her, she will find a physician, or perhaps even an intelligent medical assistant, who will.
This post originally featured on HISTalk
Saturday, May 23, 2015
Memorial Weekend - Be Happy
This memorial day is a good time to reflect and give thanks - in fact this visual gives a great sense of the sacrifices of so many for our freedoms and life today
Original from Facebook
Here's one for the SHARE button. A truly powerful image that tells it like it is.
Posted by Madison Rising on Thursday, October 30, 2014
So while thinking about how lucky we are we should try hard to be happy as Bobby McFerrin suggested: "Don't Worry, Be Happy" So in the spirit of focusing on happiness which is well proven to improve your life this piece in Time Magazine: Happy Thoughts: Here Are the Things Proven To Make You Happier choked full of great ideas and principles - starting with Gratitude which
Showing gratitude for the good things you have is the most powerful happiness boosting activity there is....which seemed a perfect match for today. But there are many other elements starting with
Doing what you are good at - no matter what that might be as often as possible - Starving Artists are happier with their jobs which goes a long way to explain the power of Regina Holliday and her amazing presence and power in medical advocacy (She's just a published her first book "The Writing on the Wall" which should be required reading and would definitely be on Oprah's book list if that were still thing)
As for you time - spend it with the people you like - the happiest people are social with strong relationships and that describes much of the online community around Healthcare and Patient advocacy that i consider myself very lucky to be part of. There have been some studies that suggest a causation between happy social networks influencing others and helping them to be happier (I know could just as easily be correlation but either way Happiness is infectious)
Money can help but is not essential to happiness and it is not good to focus on money or the desire for it.
Well known that giving is better for happiness than receiving - notable during the holiday that the giving of gifts is more satisfying than receiving. Interestingly striving for ambitious goals has a positive effect and being optimistic (even bordering on delusional) has positive effects but it is this list of "big life regrets" that is worth highlighting
- I wish I'd had the courage to live a life true to myself, not the life others expected of me.
- I wish I didn't work so hard.
- I wish I'd had the courage to express my feelings.
- I wish I had stayed in touch with my friends.
- I wish that I had let myself be happier.
and as someone pointed out - no one says as they near death - I wish I had worked much harder and spent more time at work.
Relish the time off, enjoy your life, family and friends, savor the positive experiences and do so frequently even in small doses.
Wednesday, April 15, 2015
MasterChef in Healthcare: Integrating Social Media
Social Media is rapidly becoming an integral part of our lives. Despite the pervasive nature of the communication channel healthcare remains a technology laggard. This presentation from HIMSS15 Wednesday Apr 15) will offer insights to help understand why healthcare professionals should join the community, participate in the discussion and how can do so successfully.
I presented this topic at HIMSS15 on Wednesday Apr 15 - you can find the listing here. As promised I am posting a summary of the points as well as a link to the Slideshare for that presentation
- 68 percent of patients bring a list of questions to each doctor's consult;
- 39 percent have checked WebMD or another online source in advance; and
- 20 percent bring personal health data from outside monitors.
- It's a conversation, not a lecture
- It's an extension of everyday interaction
- It's group driven, not top-down
- It's messy, disorganized & hard to control
- It's a tool, not an end-point
- But most of all…
- What you have read that you want to share with others
- When and where you are speaking
- Something you post on your blog
- A link to a Web site that you find interesting
- Listen to conversations happening online using keywords (hashtags, lists and searches) – learn from your colleagues, friends and patients
- Befriend people – and then earn their trust by solve problems, answering queries, helping and providing useful information
- Share information, valuable content with them
- Questions and Requests for information and help – crowdsourcing answers
- At a minimum – Lurk, Listen and Learn
What Not to Do
- Social Media for Physicians is a Game Changer
- Social media, when effective, will establish a physician's brand and connect him/her with those in need of their services
- With increased deductibles, more consumers will "shop" using social media sites.
- Social Media will Expand the Physician's Role with Patients
- Social media is shaping patient encounters with physicians and that impact is expected to increase significantly
- Extending the patient experience will foster existing patient relationships and improve patient outcomes, especially for long-term chronic conditions.
Friday, April 10, 2015
HIMSS15 The Year of DigitalHealth, Interoperability and Security
First off - download the HIMSS Mobile APP that now comes with GPS intelligence which hopefully will start to provide keen insights into activities and opportunities that are nearby as you move around Chicago, the convention center and beyond
Download and print (I know not very environmentally friendly but there is a lot to absorb) the HIMSS Conference Guide (72 Pages) - or if you are feeling really clever send it to you iDevice, Pocket, Kindle or some other reading device
Or use the online version of the HIMSS of the guide - here
For the physician centric guide - head on over to this living breathing dynamic Google Document - put together by Wen Dombrowski (@HealthcareWen)
For the HIT Centric Guide from John Lynn (@TechGuy)
For the latest and greatest news be sure to follow the #HIMSS15 hashtag, and others linked to the conference including #DrHIT
And your best option for keeping up with the latest and greatest from Symplur tracking system on #HIMSS15 and that page features additional topics and tags worth following and tracking
And of course follow your Social Media (#SoMe) Ambassadors can all be found in this list on twitter
Tuesday, March 24, 2015
Digital Health Technology Trends from SXSW
Health and fitness apps, smart devices and connected products are making us more aware of our own health—and more active participants in our efforts to stay healthy. At the same time, health providers are looking to technology for smarter ways to deliver quality care, whether we are in the hospital or at home.
- Wearable technology - 80% of consumers would benefit from the use of wearable technology
- Connected devices - Using remote monitoring to reduces readmissions
- EHRs - 71% of physicians now use EHRs and 85% meeting current meaningful standards
- Telehealth 70% patients comfortable communicating with their doctor using digital technology vs hauling themselves in to the officer
- Predictive analytics - More than 80% of standard tasks (BP, glucose etc) and even complex testing (e.g. genomics) will change the way we deliver care as described by Eric Topol in "The Patient Will See You Now"
- Population health management - 70% of providers reporting patient care benefits from population health initiatives
- mHealth apps - 71% of want providers to use mobile apps not least of because they do...going where everyone else is
- Data security - rightly ranked as a major issue among consumers given the ongoing debacle of healthcare related security breaches (Premera and Anthem Blue Cross, the HHS wall of shame)
- Partnerships - increasing healthcare companies entering new healthcare partnership - Tenet seem to be the latest
- Cloud-based technology - importantly seen in conjunction with "Data Security" expect this to grow at a staggering 20% rate and heading to $5.4 billion in annual revenue.
Saturday, March 14, 2015
The intersection of Science Fiction, super-pi, and technology innovation
Here's to those who choose to defy reality and instead envision a future world – a world that ventures beyond even Mr. Spock's wildest dreams.
Monday, March 2, 2015
Would you swipe left on a healthier you?
It's always comical to watch movies from the 1980s, not only for the distinct style choices that typified that decade, but to see the type of technology most of us can still recall using. It's nearly impossible to believe we used to happily lug around three pound mobile phones with antennas and back-up battery packs, but they offered a convenience the likes of which we had never seen before. While heading to the 2015 Mobile World Congress (MWC)
one of the most prominent tradeshows in the tech industry, I couldn't help but think about the pace of change and get excited about the digital health innovations that will be showcased.
We tend to take for granted the conveniences and time-saving effects such innovation has on our lives. Prior to the pervasiveness of mobile technology, if you were walking down the street and you saw someone collapse, you would need to find the nearest store or phone booth to call for help. In fact, most of us probably knew which corners on our daily commute had pay phones. Now, even if you've left your phone in the car (an unthinkable these days) you can comfortably rely on the fact that someone nearby will have theirs in the case of an emergency.
Is your heart in it?
From a healthcare perspective, the interconnectivity of devices is fascinating and holds a lot of potential for engaging patients and improving health outcomes. Innovations such as smart watches, which are being outfitted with fitness trackers and heart rate monitoring sensors, can alert the wearer he has achieved 10,000 steps that day or that a runner has reached her target heart rate
While innovations such as these are always exciting, the bigger picture is about creating a healthier population. According to the World Health Organization, cardiovascular disease is the number one cause of death in the world today. Factors such as poor diet and lack of physical activity are some of the main contributors to the disease— and they are also elements most of us struggle to balance. In other words Lifestyle is the biggest contributor to your health as you can see in this video
Wearable devices designed with intuitive interfaces hold the possibility of helping us maintain that balance, remind us of our inactivity, track our daily caloric intake, remind us of how many hours, minutes, and days it has been since our last cigarette (even Spock spoke out against smoking)
When smart watches and fitness bands are tethered to mobile devices, we can layer on more practical applications for personal health management. What if you were walking down the street and your wearable could sense you were having a minor heart arrhythmia, send a signal to your phone, and have it call for help or advice? Or, perhaps, much like our phones can now alert us to poor traffic for our daily commute, what if your wearable, knowing you are diabetic, could sense low blood sugar, sync this data with your phone and tell you some appropriate restaurants and grocery stores nearby? They will be able to translate personal health data into steps and actions we, as patients, can take to better manage our care and keep ourselves healthier.
Engagement ROIThe benefits of an engaged patient population are numerous. Not only will people be healthier, but consider the above World Health Organization cardiovascular disease statistics and the associated costs of care, medication, and lost productivity, not to mention the personal impact on each of us. For coronary heart disease alone, the U.S. spends $108.9 billion. If people were more dialed in to their health— tracking, monitoring, and being rewarded by insurance companies for adherence to healthy lifestyle activities— imagine the savings both in lives and dollars. And with the pervasiveness of health IT innovation, we are seeing more consumer-facing health apps, such as Sharecare's AskMD, becoming standard features on mobile devices. People can now use these apps to walk them through their symptoms, offer guidance on managing chronic conditions, and remind them to check in with their doctors.
We've come a long way from the shoe-box sized mobile phones of the '80s and it will be interesting to see a glimpse of our future technologies, widgets and devices on display at CES 2015. One thing is certain: whether you're a physician or a patient, we're all still consumers and our expectations for efficiency and conveniences on mobile devices will play a large role in the next phase our health evolution. In fact, I imagine the current wearable will be considered clunky and dated in as little as 10 years. We might find our lives equipped with even more svelte tools integrated with all of our healthcare data and real-time advisors, apps or avatars that coach, coerce or cheer us on through daily choices to keep our lives and health on the ideal track.
The original article appeared in WhatsNext
Saturday, February 28, 2015
Honor Spock's Logic - Follow the Science
Like many I was saddened to hear the loss of one of my heroes growing up - Leonard Nimoy was Spock to me as he was to many others. He epitomized the value of science and logic in the resolution of problems
As my good Friend Jane Sarasohn-Kahn highlighted in her tribute on Healthpopuli: Learning from Mr. Spock and Leonard Nimoy about living long and prospering. Her selection of this iconic moment with Spock were right on target - from one of the great movies from the franchise - Wrath of Khan
Spock: "Do not grieve, Admiral. It is logical: the needs of the many outweigh…"He spoke out on smoking - something that in the end killed him before his time in this tweet from January 2014:
Kirk: "The needs of the few…"
Spock: "Or the one."
I quit smoking 30 yrs ago. Not soon enough. I have COPD. Grandpa says, quit now!! LLAP
I quit smoking 30 yrs ago. Not soon enough. I have COPD. Grandpa says, quit now!! LLAP
30% of people will suffer serious Chronic Obstructive Airways Disease (COPD) as a result of smoking - and that's just one of a slew of diseases inextricable linked to smoking. Smoking while in decline in some countries is on the rise in others and this major health risk remains one a negative impact on personal health
— Leonard Nimoy (@TheRealNimoy) January 30, 2014
You can explore WHO data in this interactive chart from who here
But don't limit the application of science to health and smoking - you can put Vaccines in the same category of Science and Logic. Jimmy Kimmel captured the sentiments aptly in this segment featuring real doctors
So much of your health boils down to Lifestyle choices that was so elegantly captured by Brigitte Piniewski, MD in this chart
Where would you rather be - fun or no fun
Spock the Hero with Super Powers
We may wish for the seriously cool vulcan Nerve Pinch
But we don't need the vulcan nerve pinch. He and his character have taught us that science while not infallible has been working for us for millennium. We have started to tap into the power of science and the opportunity offered to our health and well being.
When it comes to science and healthcare Doctors are your trusted advisor - the relationship may be changing from the paternalistic role to a collaborative role as Eric Topol so eloquently describes in his latest book - The Patient will See you Now. But as captured in this piece by this Trauma Surgeon (@DocBastard) on the Daily Beast: Why You Trust the Internet More Than Your Doctor
...for god's sake don't think that you know as much as a doctor because you Googled something. Medical training takes up to a decade or longer (depending on the specialty), so a 0.452 second Google search does not substitute for consulting with an actual physician whose only interest is your health.We are only at the beginning - what comes next and in our future is unimaginable. Our innovation, inventiveness and abilities continue to expand our universe and our understanding. Science wins- every time. Be logical with that splash of human emotion and honor his legacy - open your mind, analyze the facts and apply the science. As Jesse: Yeah, Mr. White! Yeah, science!
On a side note - if you are interested in the history of the Spock Vulcan Salute - Live Long and Prosper you can watch his explanation of his Jewish Origins here (derived from the Hebrew letter shin and the first letter of several hebrew words Shaddai (god), Shalom (hello/goodbye/peace) and Shekhinah (feminine word for god) - How Fascinating!
Monday, January 26, 2015
Will 2015 be the year your watch teaches you about your health?
There is no known medical condition that enables an individual to predict the future. While such an ability would be extremely useful for myriad reasons, we have, instead, learned to hone and leverage our analytic skills to deduce what might occur, relying on the data we cull and parse to help forecast the future. So, when it comes to predicting the year ahead, we should consider the one we just had.
Consumer technology is often a good indicator of what type of capabilities and functionalities might be in store for health IT. This past year, we saw major players in the tech space announce their forays into healthcare. While this will not be without its challenges, it does not diminish the underlying fact that there is a need and want for better technology in healthcare— regardless of whether you are a patient looking to effectively manage your weight or a physician struggling to juggle patient care and administrative duties.
In the last year, we saw a wave of next-generation wearable devices flood the market, and as a result, we, as patient consumers, now have streamlined access to information such as our daily step count and average heart-rate on our watches. We know that ease-of-use, understandability, and some level of gameification:
are vital to maintaining engagement.
I believe this is the beginning of something much larger, a groundswell movement that will result in patients wanting more information about their health data, and, more importantly, craving a better understanding of what all these numbers actually mean and how to positively impact them. Achieving this level of engagement demands a simpler intelligent interface that doesn't require a learning curve, but is one that consumers can just use. Clever user interface designs can only go so far, particularly given the small visual real estate available on wearable devices, and the addition of capabilities such as intelligent voice assistants will be an integral part of this explosion of personal health management.
Having a heart-to-heart about your heartTechnology holds the potential to create clinical synergy, bringing patient consumers (who have become professional health IT consumers, or health prosumers) better intelligence about their personal health data and outlining the proactive measures they can take to become better partners in their own health. The average patient consumer may not have a reaction to the phrase
"Your Protime this week is 3.3," but for someone with a heart condition, this number is very important and indicates how fast her blood is clotting. The data, while extremely useful to a clinician, is only helpful to the patient if she understands what it means and how she can take the right actions as a result.
The future is about patients managing their own care and working alongside clinicians to drive better outcomes. To the woman who has a Protime of 3.3, access to these results supplemented with clinical guidelines would mean that she wouldn't need to wait for her physician to call with diet recommendations, she would know her blood is clotting too slowly and that she might have an inadequate protein consumption or might need to increase her vitamin K intake. If the number required that her Coumadin dosage be adjusted, this would be the point where her physician would reach out to her to discuss.
Although a basic example, it is one that has endless permutations when it comes to building a more engaged patient population. There is no one more invested in your health than you, and the person who cares the next most about keeping you well, is your physician. I believe that clinical synergy will be driven by both patients, who want to actively manage their chronic conditions and take meaningful preventative care measures, and physicians who want to empower their patients to better understand how the choices they make have significant health implications. Technology is the connective fiber that can enable the transmission of this important data, and help translate it into wisdom. And that truly is the crux—the data flowing between patient and physician must be relevant and meaningful. That ability for technology to determine the relevancy of health data information is just around the corner and soon our wearables will be able to notify our health information data that deviates from our personal "normal" results.
Approximately 75 percent of U.S. healthcare expenditure is related to chronic care management, imagine the impact this level of clinical synergy will have on driving a healthier population while reducing cost. I'm ready, are you?
This post originally appeared on WhatsNext
Tuesday, January 20, 2015
CES 2015 - Turning a techie into a modern-day Odysseus
While it was interesting to see all the fitness and consumer health apps, I found myself spending extra time looking at non-healthcare related technologies, drawn in one direction or the other based on the "oohs" and "ahhs" of crowds marveling at incredible and unfettered innovation. I made countless stops along the way, and spoke to many different creators about the potential healthcare implications of their products, and I quickly realized that the future of health IT innovation will be a combination of various consumer technologies that are carefully sutured together.
Internet of Healthcare Things (IoHCT)The interconnectivity of devices has been a growing trend in the consumer world, but it is one that has not really made its foray into healthcare. When it does, the potential will be astounding. I spoke with La Crosse Technology,
They collect data from weather systems, such as temperature, humidity, etc. They have developed the ability to leverage this data to adjust home heating and cooling systems according to the current weather conditions. Practical and money-saving for sure, but it is easy to extrapolate the benefits of such technology to patient consumers.
Imagine the impact this could have for someone suffering from chronic respiratory issues or severe asthma: they could receive guidance on what is going on outside and perhaps take extra medication to cope with poor air quality.
Additionally, such data could be used to send important reminders to help patients better cope with their medical issues, for instance, a virtual assistant that says "Heavy snow is on the way for the next three days, and I noticed your drug supply was down to two days, you should refill today so you don't run out while the weather is bad and traveling is difficult."
I also met with Butterfleye
a company that develops in-home monitoring systems.
Although there were many players in the home-monitoring space, I found this one compelling as it was easy to install and designed to learn, adapting to daily occurrences and routines as opposed to being programed. Imagine the value of setting this device up in the home of an elderly patient or loved one and using it not for security purposes, but for peace-of-mind, to make sure there is activity and movement and to learn of a fall or worsening condition more quickly.
Because the system is able to learn, it can discern the difference between a dog or cat roaming about the house and a person, so if there was an incident, a pet won't "trick" the system into thinking the individual is actually walking about the room. While personal alerts are helpful if the individual is conscious and is wearing a medical alert device, a system such as this could help identify more severe life-threatening health conditions, and, with an intelligent virtual assistant, could ask residents if they are okay and call for help, if they get a negative or no response.
A Modern-day Techie OdysseusThose familiar with the story of Odysseus know that he spent seven years sailing the seas trying to return to his homeland, Ithaca. What started out as a point A to point B trip, became a journey that forced him to see things differently. He was drawn in by all sorts of alluring (and not so alluring) options along the way, and when he finally returned home, he did so a wiser man. Meandering through the labyrinth-like CES showroom floor, I saw everything from robots that attach to windows
Solving that challenging problem of dirty windows on the outside
And clean the outside, to alluring bionic sensor
Technology that allows users to control devices via subtle muscle movement from behind their ears.
A Nod to 3-D Printing3D printing is taking off and I saw multiple exciting innovations of the technology on the show floor that included developments around materials and the ability to print metals and food. As you can see from this Geek Beat clip we are heading for a reality of the Star Trek Replicator
Healthcare is just scratching the surface and you can get a sense of some of the excitement in this piece by Dave deBronkart (ePatientdave): The Future Is Leaking In: "The Patient Will See You Now" Is 3D Printed Reality
Health and Fitness Apps Get a MakeOverAs my colleague Rebecca Paquette pointed out in her post on CES we are getting people to talk to things more naturally.
Chances are if you're into staying fit, you're into tracking all of the data that goes into keeping you happy and healthy. But tracking that data shouldn't be a workout unto itself. The amount of time we spend logging meals, activity and sleep could be much better used burning more calories, or, if you're like me, getting more shut eye (I forget to log it, then scramble to get it in before I fall asleep).This consumer health prototype app on the Samsung Gear S from Nuance turns the process of interacting with these devices on its head as featured in this interview at CESLive
But the best thing about wandering the show is that it makes you see things differently, helps you think about things in a new way. It's about pushing the limits, finding new use cases, new possible technology partnerships to create an even more robust, more powerful solution to address what people need.
Healthcare impacts many different types of people, from patients and clinicians, to administrators, coders and compliance officers— just to name a few. The common denominator, regardless of who you are, is that we all seek the best possible health outcomes. Having the opportunity to not only see, but experience, all different types of technology with untapped healthcare potential was incredible. It wasn't about finding the health-specific applications and devices that would magically solve any one challenge, but about seeing the copious options available to consumers en masse, and talking with innovators about the potential cross-over and blending of technologies to advance healthcare today and in the future
This post originally appeared on WhatsNext
Tuesday, January 6, 2015
CES 2015 - The Year of Digital Health and Wearables
CES attracts 150,000 visitors (all looking for the same cabs so I'm willing to bet that Uber is not going to work as well), occupies 2,000,000 sq ft of space (35 football fields - American or the rest of the world soccer) and includes 3,500 companies
This year the DigitalHealthCES meeting runs concurrently and I believe is in its 4th year. Further evidence of the merger of health, consumer and the engaged patient equipped with mobile technology and wearables.
As my friend John Lynn said in his post Initial CES 2015 Observations. He sees the top trends as
- 3D Printers
- Drones, and
- Wearables
The first two not closely linked to healthcare (except perhaps this recent recent student suggestion of an Ambulance drone to deliver help to heart attack victims).
Wearables are front and center and John cites the Amstrip company with a band aid style monitoring concept. I expect clothing and in particular sports to lead this charge with the initial interest in optimizing training and athletic performance as we saw from the World Cup last year and the miCoach system from Adidas that was in use by the winners Germany.
Needless to say others are joining the fray with clothing brands such as Asics, Under Armour and Ralph Lauren now offering clothes to monitor all sorts of parameters
This year may see the emergence of more from the Internet of Things (IoT) - or the new term the Internet of Everything (IoE).
Everything connected and controlled through a consumer friendly hub which will include the wearable and monitoring concepts.
This is as simple as ceiling fans and cooling systems and thermostats but with healthcare making this even more interesting and the learning potential of these intelligent systems and their Artificial Intelligence offering insights into our lives to help turn unhealthy behaviors and activities into healthy choices.
So much of our healthcare expenditure is related to chronic care management, imagine the impact this level of synergy and motivation will have on driving a healthier population while reducing cost.
I'm ready, are you?
Wednesday, November 12, 2014
Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology
This is an exciting time for mobile devices and while we know there is a discrepancy in the accessibility of mobile technology (I'll be participating on the panel Bridging the Patient Digital Divide) some of this divide in access can be linked to the complexity of this technology.
With ubiquitous technology comes ubiquitous complexity - adn this is especially true for doctors who face challenging User Interfaces - captured here in this post: How Bad UX Killed Jenny. As doctors we feel we are loosing touch with the Art of Medicine
Which for many of us was the reason we started on the journey to being a healer. Physicians don't go to medical school because they want to document and code clinical information. Doctors choose their path because of their compassion and desire to deliver care to patients in need. There are increasing physician frustrations with technology and their struggle to keep the focus on patients and not data entry.
Medicine is part science, part art. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding but is followed by focusing on the patient not the technology. I will be presenting our prototype "Florence" that combines artificial intelligence and speech recognition to offer innovative new speech technologies that help capture and understand not just what the clinician says but what they mean. With new tools that speech enabled systems we simplify access and empower clinicians to capture information and thoughts as they occur. Through the innovative use of natural language tools, context awareness and the generation of high-value clinically actionable medical information clinical systems become efficiently integrated into care delivery process offering the opportunity for doctors to return to the Art of Medicine and focus on the patient.
Here's a video showing off Florence
Tuesday, November 11, 2014
Bridging the Digital DIvide
Melody Smith Jones
and includes
Lauren Still
Nick Genes
The session was put together by Melody to take on the oft talked about but perhaps poorly understood "Digital Divide". Patients spend less than 1% of their time with doctors - the balance of our time represents (lost) opportunity to interact with people helping them live fulfilling healthy lives and making the best possible choices.
On average, patients only spend 1% of their time in the clinical care setting. Traditional medicine has focused upon patient engagement during that eight minute doctor visit. Yet, it is the other 99% of the time, when patients are at home, at work, at school, and in their communities that matters most. It is outreach to patients while they are living, working, and playing that determines how their overall wellness is managed.We have seen a plethora of technologies that attempt to address this area with everything from diet and fitness apps to specific applications designed to address long term health issues.
But there is variability with access in the community to information technology preventing access and knowledge and skills necessary to derive the value from these tools. Melody has addressed this divide specifically focusing on apps doe Low-Income Mothers in her recent post: 3 High Health Apps for Low-Income Moms. Check out Melody's top 3 picks for low income mothers - some great apps focusing on the Food stamps including clever use of Bar code scanning technology to check eligibility of food and the nutritional value and a novel use of simple text messaging to improve maternal and newborn health <----- approach="" font="" love="" of="" simplicity="" the="" this="">----->
As she points out many of us make assumptions about accessibility to technology in lower social economic groups- as she puts it
Many make an assumption that those with low income or low education levels would not have mobile technology to use in the first placeBut despite the budgetary restrictions we see a very high level of adoption of mobile technology - this is true worldwide as demonstrated by the statistics of mobile phone in the world: More People Have Cell Phones Than Toilets, U.N. Study Shows.
Out of the world's estimated 7 billion people, 6 billion have access to mobile phones. Only 4.5 billion have access to working toilets.
In one of my personal areas of passion - Africa that is replete with examples of successful use of technology to impact the health of the population at levels that we can only dream of here in "the West". Here in this study: Text message reminders improve healthcare practice in rural Africa
and this piece in the Atlantic: Medicine by Text Message: Learning From the Developing World
It might seem counter intuitive to spend money on what some might consider a luxury or discretionary spend - but for some this is the only means of communication replacing the plain old telephone line (POTS) and these devices come with capabilities and a reach that was pervasively unavailable to many in our society. The statics suggest as many as 80% of low income consumers own a mobile device.
But despite this opportunity the technology and apps are often times targeted at the higher income who already have fitter healthier lifestyles. Some of this is because of the existing developer community (higher social economic group) who develop for the problems they perceive and the harsh economics - this is where the money is (or at least we think it is). Despite Malaria being such a big killer there is limited investment in prevention and treatment of the disease as it affects the poor nations with limited capacity to buy any solutions that are developed despite significant progress and the impact of World Malaria Day
This was covered eloquently by J.C. Herz at wired in this piece: Wearables Are Totally Failing the People Who Need Them Most. We are awash with wearables, new devices and new apps and buckling under a Tsunami of data but:
...developers continue flocking to a saturated market filled with hipster pet rocks, devices that gather reams of largely superficial information for young people whose health isn't in question, or at risk. It's a shame because the people who could most benefit from this technology—the old, the chronically ill, the poor—are being ignored. Indeed, companies seem more interested in helping the affluent and tech-savvy sculpt their abs and run 5Ks than navigating the labyrinthine world of the FDA, HIPAA, and the other alphabet soup bureaucracies.There are some economic reasons for these current trends, some social aspects of the development community but these may be based on false belief of the economics when you consider the opportunity exists to shake up the $2 trillion annual cost of chronic disease….!
I'm with Kabir Kasagood, director of business development for Qualcomm Life who said
Go from the children's table to the grown-up table...If you're serious about this, embrace the FDA. Learn how HIPAA works... move away from fitness and go hardcore into health. That's where the money isAround 45% of US adults are dealing with at least on chronic condition and picking on one Diabetes and look at the market opportunity of $6.3 Billion spent on blood glucose strips gives you a sense of the economics of this market. These are motivated people for whom the quantified self can mean the difference between an (expensive) admission to hospital or managing and improving at home.
At some point, you've got to ask yourself whether it's just the friction created by health-industry regulation—the HIPAA security rules and FDA approval (or waiver) process and the hassle of integration with legacy systems. Or is it too daunting for a twenty-something engineer to develop technology for people who aren't like them at all? An obese diabetic on a motorized scooter? Or a frail old lady with memory loss? Or her caregiver? Someone who's three bus transfers away from a doctor's office?We plan to address these issues in our panel - if you can't join us maybe you can join the conversation using the hash tag from the conference #Med2 here at Symplur
Monday, November 10, 2014
Dunkirk Spirit: How physicians support patients overcoming adversity
One in eight U.S. women will develop invasive breast cancer over the course of her lifetime. In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed. That's approximately 808 cases per day.
But these statistics don't matter. Whether it's one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers. It immediately becomes a reality to you. We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post "When 1 in 8" was no longer just a statistic to me."
As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you've done it before. We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news. We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.
What never ceases to amaze me, however, is the strength of the human spirit. Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term "Dunkirk Spirit," that inner strength that helps patients and their families overcome tremendous adversity.
|Dunkirk Spirit
It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.
Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives. As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care. We don't just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.
Technology can help in healthcare, but it is not the goal nor should it ever be the focus. Yet, in some cases, it has detracted from our ability to provide care and compassion. To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.
To learn more about the role technology plays in the Art of Medicine, read: "There's no room in technology in end-of-life care decisions"
Monday, October 27, 2014
The #EMR, #Ebola and #Bigdata - what Can We Learn
A thoughtful piece that drilled in to the detail of events surrounding the arrival and subsequent consultations, admission and treatment of Thomas Eric Duncan
who sadly died on October 8 succumbing to the ravages of the Ebola virus
As the authors state
The mishandling of US Patient Zero is receiving widespread media attention highlighting failures in disaster management, infectious disease control, national security, and emergency department (ED) care.....also brought decision-making vulnerabilities in the era of the Electronic Health Record (EHR) into the public eyeMuch of the commentary generated "fear, uncertainty, and doubt about the competence of our health care delivery system" and while there were problems I agree with the authors that this is a "teachable moment" and a chance to identify the missed opportunities and key issues that we can learn from
The authors used the publicly available documents and testimony in their quest and it is important to note that they did not have access to the full record, the EMR used or indeed all the pieces of the puzzle and made up for this in some areas with educated guesses.
It is interesting to note that in the first visit to the ED the patient's temperature spiked to 103 degrees accompanied by pain described by the patient as 8/10 in severity.
|This from a Malaria Study but typical of the Spike in Temperature found with this disease
He was diagnosed on initial discharge included sinusitis but "but that CT scans of "head and abdomen" ordered during the ED visit showed no evidence of sinusitis" and perhaps with more attention and importantly time made available to the clinical staff would offer them the opportunity to focus on the history and examination and less on high tech investigation. In many cases clinicians are forced into their use not by clinical practice but rather to meet the production pressures - as the authors put it
A host of system-related factors detract from optimal conditions for critical thinking in the ED, leading clinicians to lose situational awareness. These include production pressures, distractions, and inefficient processesThe upshot was a discharge and subsequent return days later at and even then:
even after the second ED visit which led to hospitalization, strict Ebola isolation precautions were not followed for 2 days, until the diagnosis was confirmed by the CDCOffering a window into the events that is made so much easier with the benefit of 20/20 hindsight
The authors offer some learning opportunities that are worth highlightingTop of the list in would be working with software developers to improve EHR usability
As this case illustrates, EHR-based clinical workflows often fail to optimize information sharing amongst various team members, leading to lapses in recognizing specific clinical findings that could aid in rapid and accurate diagnosisAs an interesting addition none of the systems (or incentives) have any form of feedback loop built in to allow clinicians to learn from their actions.
As for the process of information capture - we have lost site of the information that is relevant in the fog of billing and regulatory driven template driven charting.
Condition-specific charting templates, drop-down selection lists, and checkboxes developed in response to billing or quality reporting requirements potentially distort history-taking, examination, and their accurate and comprehensive recording.. Clinicians also tend to ignore template-generated notes in their review process; often the signal-to-noise ratio in these notes is low. EHRs can lead to less verbal exchange, which is all the more needed and more effective when dealing with complex tasks and communicating critical informationRight on except to say this does not "potentially distort history-taking" - it does distort history-taking and
not "EHRs can lead to less verbal exchange" - EHRs do lead to less verbal exchanges
The data entry requirements place an enormous burden on our clinical professionals
who are tasked and measured not on clinical practice and the delivery of great care but on specific content of documentation that is mandated to capture clinical information in specific ways determined by the reimbursement, coding and regulatory system.
Other factors, such as heavy data entry requirements and frequent copy-and-paste from previous notes, detract from critical thinking during the diagnostic decision-making process... For EHRs to be most effective, they need to be able to automatically sort through patient data, identify the pertinent findings, and present them in an easy to understand manner. Computer algorithms could combine patient-specific information with the latest evidence-based clinical knowledge to help clinicians reach the correct diagnosisThis is the next frontier of Healthcare technology and in particular clinical documentation - we know we can sort through patient data, identify the pertinent findings - focused in these examples on quality of care and evidence based guidelines and we know computer algorithms can use patient specific information combined with evidence based knowledge to help
Technology can help but there are some fundamental flaws in the design and management of healthcare that are fed by the current incentives. Many initiatives attempting to improve patient safety and value-based purchasing but don't focus on accuracy and timeliness of diagnosis and in particular Outpatient reimbursement policies do not reward diagnostic decision-making, teamwork, or quality time spent with the patient in making a diagnosis.
What you incent is what you get and this needs to be changed as well.


text:
- Name:
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Updated more than 6 months ago | Claim This Business| Report Incorrect Data
Kent Home Improvements was established in 1989 as a specialist plastics and pvc product supplier offering quality:
uPVC Fascias, Plastic Guttering, Plastic Roofing Sheets, PVC Skirting Boards
We now have Home Improvement and DIY store branches in Bristol and Hereford too and have broadened our product range to include low maintenance and finishing products made from a wide selection of materials.
Keywords:Double Glazing, Pvc Products, Upvc Fascia, Plastic Roofing, Pvc Skirting Boards
ProductsuPvc Fascias, PVC Soffits, Plastic Guttering, PVC Decking
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As a local Property Developer I have used Kents Building plastics for the last 10 yrs and can highly recommend them, I found them very helpful with design options and there time from ordering on High quality windows and doors to delivery was on Average 2weeks, I found their same day delivery on Guttering down pipes and facials and skirting board to be second to none.
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Jardins de Inverno
Idéias para utilizar plantas em espaços internos e criar belos jardins de inverno.
Jardins de Inverno
- 65 Pins
Related Boards
sacada com deck!
Cities Patio, Rooftops Gardens, Balconies Gardens, Dreams, Decks, Balconies Design, Hepfer Design, Outdoor Spaces, Cities Living
Great outdoor space in city
this would be my dream.
Charming rooftop garden
City patio
Anne Hepfer designed balcony garden {via desire to inspire}
@Kerry Nelson you are only allowed to move to Washington if your place has this deck and view.
Anne Hepfer - desire to inspire - desiretoinspire.net
In My Dreams, Balconies Spaces, Balconies Design, Interiors, Breakfast, Patio, Outdoor Spaces, Balconies Decor, Flower
small balcony designs and patio ideas
love idea of little breakfast nook
Nice little outdoor space :)
In my dreams.
Interior inspirat... - Bloglovin
Gardens Ideas, Succulents Garden, Succulents Planters, Rotisserie, Plants, Vertical Gardens, Pvc Pipes Projects, Gardenidea, Hanging Gardens
Vertical succulent planters, planting ideas, indoor plants, air plants, colorful, easy to care for
Succulent garden ideas
Happiness Crafty: PVC PIPE PROJECTS ~ 11 GARDEN IDEAS Clever idea for succulent planting
amazing hanging garden idea.
Stunning corner: For the Garden!
Cactos são ótimas plantinhas para animar o ambiente e manter tudo com um ar mais clássico.
Cactus Plants, Home Interiors, Window, Indoor Gardens, Interiors Design, House, Delicious, Design Home, Indoor Plants
BRICK HOUSE : indoor plants. I need more cactus plants.
home inspiration - succulents, cactus plants
Home #interior house design #home design #hotel interior design #design bedrooms #architecture interior design
BRICK HOUSE : indoor plants, window
Indoor Garden. I love the window design too.
Jardim de inverno de cactos!
Interior Design, Happy Carts, Urban Jungles, Carts Inspo, Bar Carts, Cool Bars, Jungles Barcart, Cacti Gardens, Carts Display
cool bar cart concept with a nice tray
cacti garden
Happy cart.
bar cart display.
urban jungle barcart
bar cart inspo
Cacti on display: The taste of Petrol and Porcelain | Interior design, Vintage Sets and Unique Pieces www.petrolandporcelain.com Urban Jungle bar cart.
look! pimp your room: Von Monsteras und Monstern
Jardim dentro de casa!
Itsy Bit, Bachman Spring, Indoor Gardens, Ideas House Parts, Succulents Gardens, Succulents Towers, 2013 Bachman, Spring Ideas, Indoor Plants
Looks like a store display rack, and it's ideal for this succulent garden. Per: Itsy Bits and Pieces: see more ideas from the 2013 Bachman's Spring Ideas House...Part Two
Itsy Bits and Pieces: More From the 2013 Bachman's Spring Ideas House... A SUCCULENT TOWER!! I love it!
Indoor plant section -- 26 Mini Indoor Garden Ideas To Green Your Space, garden indoors, container gardening, succulents
Vertical Indoor Garden Itsy Bits and Pieces: More From the 2013 Bachman's Spring Ideas House...Part Two
Jardim de fadas!
Gardens Ideas, Tiny Gardens, Tired Swings, Fairies Gardens, Minis Gardens, Adorable Fairies, Fairies House, Trees House, Miniatures Gardens
Indoor Fairy Garden with a tire swing! : Mini garden by ninimakes, via Flickr
Adorable fairy garden- probably my favorite one that I have see. A little tree house and everything! Toy car tire swing.
Adorable fairy garden. I am fascinated by these tiny gardens in little pots and I'm going to try to make one this spring.
fairy garden inspiration. miniature garden.
Fairy garden ideas- tire swing
Quem disse que não dá pra ter sua hortinha em casa?
Gardens Ideas, Decor, Green Thumb, Gardens Inspiration, Terracotta Can, Indoor Gardens, Mud Rooms, Plants Tables, Indoor Plants
Mix Home & Garden Ideas| Serafini Amelia| I Love This Spaces Indoor Plant Table
green thumb
love this indoor plant table // Encontrado en apartmenttherapy.com Indoor Garden Inspiration: Bring In The Terracotta! Apartment Therapy Terracotta is one of the most quintessential materials of Spring. And while it looks lovely in the garden, it looks inspired when brought indoors and used in groups. Instant indoor garden!
Open Shelving Design Ideas, Pictures, Remodel, and Decor - page 13 Wall Color***
Mud room
Indoor Garden Inspiration: Bring In The Terracotta!
Plants Terrarium, Africans Violets Terrarium, Houseplants Africans Violets, Google Search, Glasses Jars, Small Gardens, Terrarium Ideas, Indoor Plants, Houseplantsafrican Violets
glass jar
unique terrarium - Google Search
[With a tiny violet, could do this in a small jar] African Violet Terrarium
jar plant terrarium lovely creative idea
Small garden under glass
Dá pra fazer um jardim de inverno só cm xícaras! Fica uma graça!
Plants Can, Gardens Ideas, Teacup Herbs, Growing Herbs, Gardens Teas, Teas Cups Planters, Coffee Cups, Teacup Gardens, Herbs Gardens
teacup garden I love the idea of this for growing herbs
Teacup garden or coffee cup garden.. thebowerbirdstories.typepad.com
british tea cup planter sets
For my cilantro plant, vintage repurposed coffee cup plant pot!
Teacup herb garden.
Garden Tea Party.
Herb garden idea
Vasinhos suspensos são os clássicos jardins de inverno.
Succulents Garden, Hanging Plants, Vertical Gardens, Design Sponge, Black Fence, Hanging Succulents, Hanging Planters, Hanging Gardens, Hanging Pots
DIY Hanging planter via Design Sponge
DIY hanging garden on Design Sponge
DIY hanging succulent garden - design sponge
Hanging plants
Hanging pots for a very stylish vertical garden proving you don't need oodles of space to give nature a home #homesfornature
black fence + hanging pots
DIY Project: A Simple Hanging Succulent Garden | Design*Sponge
Não precisa ser um vazinho chique e caro para começar sua horta. Latas velhas servem muito bem e quando customizados!
Gardens Ideas, Teacher Gifts, 24 Creative, Creative Gardens, Gardens Container, Tin Cans, Tins Planters, Tins Cans, Planters Ideas
So many cute planter ideas here
For Herb in the window sill instead of plastic! Tin Can Planters There are always an abundance of tin cans, and they make for cute gifts! I like this idea as a teacher's gift. You could...
Garden ideas
Tin planters
These would make a lovely little centrepiece. 24 Creative Garden Container Ideas | Tin can planters!
24 Creative Garden Container Ideas (with pictures)
Jardim de fadas dentro de casa!
Jardine, Ideas, Miniature Gardens, Fairies Gardens, Minis Gardens, You, Mini Gardens, Miniatures Gardens, Flowerpot
different types of plants that make a great miniature garden ~> From the Mini Garden Guru blog
fairy gardens or miniature gardens can be made just about anywhere. Great use of a conifer to bring it all together
Love this idea of using a larger pot and creating a miniature garden around a larger plant.
mini jardin dans le pot d'une plante
.Não tem desculpa para não ter uma plantinha em casa!
Shewr Work, Work Studios, White Pots, Victoria Bc, Shewring Work, Leslie Shewring, Tours Leslie, Delicious, Indoor Plants
Tour Leslie Shewrings Work Studio In Victoria, BC
Tour Leslie Shewring's Work Studio In Victoria, BC. succulents, succulove, sempervivum. #succulents #succulove
indoor plants in white pots
Tour Leslie Shewring's Work Studio In Victoria, BC
Vazinho pequeno, vaso grande, dá pra montar um lindo jardim na varanda ou na janela.
Plants Can, Green Home, Green Thumb, Inspiration Urbanjungleblogg, Met Planten, Plants Urbanjungleblogg, Flower, Indoor Plants, Gardens Pots
when in drought. / sfgirlbybay - indoor plants in terracotta pots planters
when in doubt flowers
Pimpelwit : plants - table - inspiration #urbanjunglebloggers
green home
Décoration intérieure avec des plantes #urbanjunglebloggers
10x creatief met planten
Potting Plants
garden pots
when in drought. / sfgirlbybay
Até nas paredes podem se formar jardins!
Woods Pallets, Green Wall, Design Interiors, Outdoor Patio, Floral Decor, Hotels Interiors, Interiors Design, Interiors Ideas, Indoor Plants
Floral Decoration
green wall
Indoor plants Decor8 Blog
flower #interior house design #interior ideas #architecture interior design #hotel interior design| http://hotelinteriordesign.blogspot.com
shopruche: Wood pallet obsession.
Que tal reutilizar espaço e materiais velhos?
Diy Ideas, Gardens Ideas, Rustic Gardens, Plants Stands, Pots Holders, Gardens Tools, Shovel Head, Flower Pots, Plants Holders
how cool. The stuck shovel heads into a pole and use it as a flower pot holder.
Old post + old shovel heads = rustic garden shelves. Me: LOVE IT! Could even do little succulents withOUT a pot :) I think I would have this come straight out of my fence post :) ...it's even a cute idea for shelving garden tools (gloves, hook hose over bottom piece, a rake could hang a few hand tools)
Old post + old shovel heads = rustic garden shelves. Would look great with hanging flower baskets. #garden #ideas
Old shovel head as a plant stand. 1 of 18 diy ideas / http://www.topdreamer.com/18-creative-and-useful-popular-diy-ideas/
Shovel head plant holders
Old post + old shovel heads = rustic garden shelves. or just set a post in concrete and use it for different height handing flower pots
Mini vasos para alegrar!
Plants Can, Pink Flower, Pots Gardens, Container Gardens, Flower Pots, Outdoor Shelves, Gardens Design, Dreams Gardens, Flowerpot
terra cotta pots with pretty, pink flowers
Beautiful. Flower pots on ladder - @Meri Vincent Leggott
Container #garden decorating #garden designs| http://modern-garden-design-986.blogspot.com
Great use of space for potted plants!!! Bebe'!!! Great container garden!!!
Dream garden by TheCupcakeConfessions
outdoor shelves. Ikea Lerberg shelf unit would work
Jardim e conforto!
Gardens Ideas, Small Balconies, Balconies Gardens, Vines, Trellis, Plants, Small Spaces, Ark, Canopies
Since we've been looking for ways to maximize the use of a small balcony or outdoor area (see here, here and here to catch up) we've run across a lot of the same kinds of ideas: tier plants, keep it clutter free, make sure you have a comfy place to sit, etc. But never would we have thought of this idea for growing a canopy of vines on a balcony:
Balcony Garden - a small space with some great ideas that maximize privacy - vine trellis (PVC & bamboo) I love the idea of having a canopy made of plants!
Arched trellis, great idea for a balcony garden
Curved Small Balcony Garden Idea
A varanda com jeito de jardim é exatamente o que a moradora deste apartamento queria: aconchegante, com plantas e temperos frescos sempre à mão.
Diverso Vaso, Ems Caixa, Wood, You, Estrutura De, Célia Weiss, Ever-Living Garden, Balcony, Flowerpot
A paisagista Claudia Muñoz, da Línea Paisagismo, recebeu carta branca para transformar esta varanda de 35 m². A única exigência da moradora era manter o pé de romã, um presente de família. "Plantei a romãzeira em um vaso de zinco e construí ao redor uma caixa de cumaru para destacá-la", diz. Segundo ela, como são feitas sob medida, as caixas são recomendadas porque possibilitam conseguir uma área maior de plantio
Jardim em caixas
diversos vasos
XX (Foto: Célia Weiss)
Na varanda do apê também pode ter vaso grandão! Ao lado do banco de madeira, o vaso de barro tem planta Sete-Ervas e a caixa de madeira tem manjericão. Piso com pedriscos e pisadas de madeira pínus de reflorestamento. Projeto do paisagista Roberto Riscala
Horta em apartamento
Que tal um jardim vertical? Ótimo para espaços menores e que merecem um toque de verde.
Gardens Ideas, Pallets Gardens, Living Wall, Outdoor Living, Pallets Planters, Living Plants, Vertical Gardens, Herbs Gardens, Plants Wall
Pallet garden #gardens #gardening #ideas
Pallet Planter Idea ~ love the vertical garden idea, too!
diy outdoor living plant wall #vertical #garden
Take each herb garden label up a notch with a living wall. Here's How to: Make a DIY Outdoor Living Plant Wall. Visit http://www.kincaidplantmarkers.com/.
How to: Make a DIY Outdoor Living Plant Wall » Curbly | DIY Design Community- A gardening idea for our highrise balcony in korea
Uma varanda não fica completa se não tiver uma plantinha.
Varanda Dos, Bem Decoradinha, Consoles, Ideia Varanda, External Area, Showcase, Banco Varanda, Candles Holders, Urban Gardens
área externa - débora - Álbuns da web do Picasa
varanda - console de madeira...combina com a arandela esses suportes de velas e pode ter vaso com folhagem
Banco varanda
Ideia varanda da sala
Candle holder
Varanda varandinha... bem decoradinha...
aparador varanda
Pequenos detalhes grandes diferenças: Dicas fáceis para manter uma horta em apartamentos!
Gardens Ideas, Green Thumb, Container Gardens, Gardens Tomatoes, Growing Vegetables, Growing Tomatoes, Vegetables Gardens, Tomatoes Plants, Small Spaces
Many people who have smaller gardens believe they just don't have the space to grow vegetables. This is fortunately not true! Anyone can grow vegetables in their garden; you just need to think outside of the box. There are many container gardening options which will allow you to grow your own veggies, such as potatoes or carrots. These are ideal for small spaces as they take up minimal space.
Growing tomatoes in small spaces.
container gardening ideas pictures | Container Garden Tomatoes 239x300 Container Gardening
Container garden tomatoes. I can put two or more tomato plants together and share staking and watering.
Container Vegetable Garden Ideas http://gardeningly.com
Hortinha vertical também vale!
Gardens Ideas, Herbs Pots, Pots Shelves, Gardens Herbs Ladder, Vertical Gardens, Herbs Gardens, Step Ladder, Plants Shelves, Ladder Plants
Potting shelves
step ladder plant stand
Plant shelves
nice for my herb pots...
herb garden idea
Vertical Gardening
Para quem tem uma área que tem bastante luminosidade, os vasos aéreos são lindos para decorar e encher o ambiente de verde.


text:
We stayed as part of a group of friends (18, with 10 adults and 8 kids) in three of the connected villas in the Arwana Estate (Villa Sam, Villa Joe and Villa Arwana, each self sufficient with their own pool). They are beautifully designed and perfect for a big group. This was ideal as it allowed us freedom to be together or enjoy some quiet time/privacy.
The staff are extremely helpful and welcoming, handling all our needs with big smiles and enthusiasm. Easy for Seminyak and a great holiday.
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com, Expedia, Hotels.com, Travelocity, Low Cost Holidays, Odigeo and Agoda so you can book your Arwana Estate reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.


text:
Business Owner ? Response
Alberta Co-op Taxi Line Ltd10538 114 St NW, Edmonton, AB T5H 3J7
- 780-425-2525
- Get directions
- Website
I dont know why i keep taking this cab. They are always late!!!! Even when i call ahead of time. The dispatch people are always so rude and dont care. The drivers are even worse! Because none of them speak english! Be warned dont use co op taxi for your transportation service.
called at 615 didn't come till 7 and was late for work don't know how they stay in business glad there's other cab companies out there
I caled at 8 and was answered right away. Was told my can would be right away to 20 min. Ok, sounds fair. But 40 minutes later when I called back, after being on hold for 15 minutes, all I got was 'we were down' as if that is supposed to make me feel better. She was angry and mad at ME instead of being sorry and apologetic that I am suffering as a result of their service failing. I don't care what happened but basic customer service is more important!
After being on hold for 5 mInutes I called another company, and left with them before these guys answered the phone. Id have not given any stars but one is the minimum. For a company supposedly oriented on customer service, I received none, not evn bad service, just none.
Nothin but the best to say


text:
Ski School Rates
|Group Lessons (minimum 3 people)
|1.5 hour
|2015-16 rates coming soon
|Private Lessons
|1.5 hour
|2015-16 rates coming soon
|Semi-Private Lessons
|1.5 hour
|2015-16 rates coming soon
|Beginners Package
|Includes Lift Ticket, Equipment Rental and Lesson
|2015-16 rates coming soon
*All program classes are subject to a minimum 3 participants.
If you wish to book any of these please email email@example.com with class desired plus name, age and whether you want ski or snowboard lessons.
Payment is required in advance and can be by check payable to White Pine Ski Resort, or we can process Visa/Mastercard payments.
Please send checks to PO Box 190, Pinedale, WY 82941 or call the White Pine office at (307) 367-6606