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INSIGHTS

Erik Gfesser

Erik is a Sr. Technical Architect at NVISIA LLC.

Recent Posts

What is Big Data?

on 11/6/14 6:07 PM By | Erik Gfesser | 0 Comments | Big Data Data Management
Quite recently, I overheard a project colleague of mine having a discussion with someone on the phone. Somewhat abruptly, he covered the mouthpiece of the phone and whispered a question to me: "Erik, are we doing big data on this project?" My short answer, without thinking too much about whether the term is a verb or a noun, was that, no, we were not. The immediate reply: "So what is big data?" In response, I gave the best concise answer that I have ever heard: "Big data is when the size of the data itself becomes a part of the problem."
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Final definition of “meaningful use”?

on 10/14/14 11:07 AM By | Erik Gfesser | 0 Comments | Software Development Executive Insights
On December 30, 2009, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services issued proposed regulations on the definition of “meaningful use” and the initial set of standards, implementation specifications, and certification criteria for EHR technology. This announcement was made in conjunction with the publishing of two separate documents and a request for public comments: Health Information Technology Initial Set of Standards, Implementation Medicare and Medicaid Programs; Electronic Health Record Incentive Program
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Patient-Centered Research

on 10/14/14 11:06 AM By | Erik Gfesser | 0 Comments | Healthcare Tech Executive Insights
Continuing our review of the recent special report on healthcare and technology in the April 18, 2009 issue of The Economist magazine, the writers further their discussion of patient empowerment and the bottom-up approach to tackling healthcare by looking at patient-centered research, which according to Gregory Simon of Faster Cures, an advocacy group in Washington, is “the key” to bigger things beyond the movement of patients to the center of the medical system, now just in its infancy.
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HIT or Miss

on 10/14/14 11:06 AM By | Erik Gfesser | 0 Comments | Architecture & Design Healthcare Tech Executive Insights
In its recent April 18, 2009 special report on health care and technology, The Economist magazine offers a nice high-level summary of both the progress and struggles that have taken place in this space, and concludes that the digitization of medical records is getting closer through health information technologies (HIT) such as electronic health records (EHRS). While the terminology in this space is still evolving, the article entitled  “Hit or Miss” in this report defines EHRS as “digitized versions of all the bits of paper usually kept in files by all the doctors a patient sees regularly”, and EHRS as “all the hardware, software, and other kit needed to make sense of the data and to give remote access to them”.
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Patient Search Cycle Time

on 10/14/14 11:05 AM By | Erik Gfesser | 0 Comments | Healthcare Tech Executive Insights
During a recent project engagement, my client stressed his observation that physicians often have unique expectations associated with process flow.  Of the examples shared, one worth noting was associated with a frequent physician need to minimize the time needed to search for patient records.  While practitioners of the five steps of the Six Sigma process, DMAIC, might view this as a typical cycle time problem, the situation here has a bit of a twist in the sense that total cycle time of the process flow for patient record search was not the concern.  The concern that my client communicated was solely focused on the time needed by the physician themselves to perform this particular process activity.
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Examinations and Usability

on 10/14/14 11:05 AM By | Erik Gfesser | 0 Comments | Healthcare Tech Executive Insights
A study not yet submitted for publication that was conducted by resident physician Yehonatan N. Turner, concluded that the inclusion of patient photographs alongside digital radiographic examinations should be routine due to the apparent positive effect this practice had on the performance of radiologists.  This study was presented earlier this week at the Radiological Society of North America conference along with 4,000 other studies.  Much attention is being given to this particular study, however, because it focuses on the radiologist-patient relationship rather than traditional radiology training.
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ICD-10 - The future of the Medical Coding System

on 10/14/14 10:49 AM By | Erik Gfesser | 0 Comments | Healthcare Tech Executive Insights
This past week, The Wall Street Journal reported on the plan of U.S. government regulators to overhaul the aging coding system, the International Classification of Diseases (ICD), that physicians and hospitals currently use to bill insurers. The new system, called ICD-10, to which most of the world’s developed countries have already adopted, is expected to result in a 10-fold increase in the number of codes for ailments and procedures. One extreme example from the current system is the single billing code for angioplasty, which will grow to 1,170 billing codes to provide more detailed descriptions as to the locations and devices involved. The new system of 155,000 codes consists of both diagnosis and medical procedures codes, and while hospitals use both types of codes, physicians use only diagnostic codes from the current system. Use of 9,200 codes from the American Medical Association (AMA) that were created in the 1960s are still being relied upon for procedure codes. The current coding system is simply no longer expandable. From a business perspective, several potential pros and cons are associated with a move to the new ICD-10 medical-coding system: Pro: Increase in patient detail. Pro: Increase in payments. Con: Increase in cost. Con: Increase in errors. Con: Existing hospital systems must be upgraded to to handle ICD-10
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Upgrading Open Source Frameworks – Part II

on 10/14/14 9:51 AM By | Erik Gfesser | 0 Comments | Java Open Source Software Development
In the first part of this series of blog entries, we discussed Spring Framework and Hibernate upgrades, and an XDoclet migration, all of which were performed for a recent client to decrease time-to-market, increase maintainability, maximize system lifetime, and maximize framework lifetime. In this second part, we start taking a more detailed look at the implementation details behind this architecture effort.
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Upgrading Open Source Frameworks – Part I

on 10/14/14 9:48 AM By | Erik Gfesser | 0 Comments | Architecture & Design Java Software Development
Just recently, I created a series of proof of concepts for a client that concentrated on making components of a system available across the enterprise. The route chosen for these proof of concepts was Web Services, and the SOAP stack used was Apache CXF v2.1.3. In addition to the introduction of Web Services, upgrades of several open source frameworks were also performed, most notably Spring Framework v1.2 to Spring Framework v2.5.6, and Hibernate v3.0.5 to Hibernate v3.3.1. In addition, a migration from XDoclet v1.2.3 to XDoclet v2.0.6 (Codehaus) was also performed.
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Commercialized Open Source

on 10/14/14 9:40 AM By | Erik Gfesser | 0 Comments | Open Source Software Development
One nontrivial area of decision making that is of increasing import in recent years involves the choice between open source and commercial products.  If you have not yet noticed, a fair number of open source software products have been acquired by commercial firms, and much open source has the backing of commercial entities, which has a number of implications, including the fact that when the choice of one of these products is made, one often has the choice whether to obtain support for a fee.
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Open Source Code Navigator

on 10/14/14 9:31 AM By | Erik Gfesser | 0 Comments | Software Development Modernization
Faced with a complex system that you need to understand better in order to enable effective maintenance or modernization?  During a recent project, I decided to use a freely-available source code analysis tool called Code-Navigator after testing several other similar tools.  Many of the open source tools available in this space are unfortunately specific to Java analysis, and I needed a tool that could analyze about 1200 legacy COBOL programs across 7 functional areas that were understood to be compartmentalized into functional-specific subsystems.  And more detailed information about the system was just not available since the technical staff was relatively new and the documentation either contained discrepancies or was out-of-date.
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Truth - Part I

“A single fact can spoil a good argument.” – Anonymous One of the responsibilities of an enterprise data architect is to understand fact, or “truth”. There is a subtle difference between these two terms, at least when used here. There may be multiple facts that lead to something undisputed, but those facts, although true, are true within a specific context. Multiple facts about something may be referenced by a software application, but at an enterprise level when all software and business processes are taken into account, it is often the case that those facts provide a limited, or slightly different, perspective.
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