With healthcare reform requirements, massive merger and acquisition initiatives and a growing need to manage the health of the patient population, healthcare providers face some daunting challenges and opportunities. Two truths seem clear: 1. the operational and clinical provider landscape will remain to some extent uncertain and 2. healthcare providers need a platform to modernize their data centers that will provide unmatched agility, speed, cost effectiveness, security and scalability.Combined with that as federal Electronic Health Records policy continues to evolve, technology initiatives have become critical to basic healthcare requirements from the smallest doctor’s office to the largest hospital. More so than ever, organizations trying to meet complex new federal mandates and adopt improved technology solutions find that their goals are a constantly moving target. On one hand, healthcare providers must accomplish more with less, yet effective care is increasingly dependent on a wide variety of increasingly complex and infrastructure intensive products and systems.The list is extensive: in addition to core EMR systems, organizations are using building automation systems, picture archiving and communications systems (PACS), computerized physician order entry (CPOE), clinical decision support systems (CDSS), closed circuit television (CCTV), real-time location-based systems (RTLS) and even interactive patient education systems. And this isn’t taking into consideration business apps like accounting, administration, learning management, workflow and process automation, intranet, logistics and even ERP. These are a few of the challenges and associated solutions that we’re looking forward to discussing with our customers and partners at HIMSS 2016.Chad Sakac and I took the opportunity to talk about these topics with customers at the Monday night VCE Users Group here at HIMSS.Challenges and OpportunitiesDealing with the frenetic rate of change in healthcare standards and application support required by today’s healthcare organizations means that scalability and forward thinking are critical to healthcare CIOs. As IDC reports, CIOs are being asked to reduce costs, consolidate resources, and produce and deliver higher quality services to support patient care more quickly than ever. At VCE, we’ve been able to optimize our Converged Platforms designs to accelerate IT transformation and dramatically simplify IT operations while mitigating risks. With VCE, healthcare organizations are able to shift resources to focus more on innovation and less on maintenance. The industry has thus been able to reduce costs, accelerate the return on investment and really reap the benefits of having state-of-the-art technology, optimized applications which enables improved patient care.Customers Realize the Benefits of Converged InfrastructureChad Eckes, EVP and CFO of Wake Forest Baptist Medical Center, turned to converged infrastructure as an effective technology to manage change without sacrificing strategic priorities.Wake Forest purchased and deployed three Vblock Systems: Vblock 720, Vblock 540, and Vblock 340 to provide the infrastructure for its new software-defined data center, Wake Cloud. The environment was designed to support not only the medical center’s upgrade to Epic 2014 EMR, but also more than 750 other applications.“Our first Vblock System was launched specifically to manage our very large imaging files. We were able to set up the entire Vblock System environment within two days—a process that had taken six weeks in the past,” Eckes says. “The implementation proved the financial case, and our governance’s response was, ‘How can we speed up the rest of the deployment?’”Chad Eckes spoke on the first HX360 panel of the day. He took time to emphasize the importance of an agile infrastructure when it comes to enabling innovation.With the implementation of the VCE Vblock System infrastructure, Wake Forest has been able to standardize, consolidate and converge technologies to simplify its IT environment and significantly reduce both its physical and management footprints. It also has successfully moved away from its previous project-based application delivery model—which resulted in an IT stack for each new solution—to a VCE-based enterprise hybrid cloud, service-based model.But system complexity isn’t the only challenge in healthcare. We’re increasingly witnessing regulatory concerns emerge as one of paramount importance to healthcare organizations. Since 2015, the HITECH act has made it essential for healthcare organizations to not only demonstrate meaningful use but also pay massive penalties that are assessed as a result of data breaches. Our customers consistently tell us that trusted converged infrastructure is key to enabling their organizations to centralize and control organizational data by leveraging unified management, enhanced security features and complementary technologies such as VDI to provide anytime access to medical systems while not allowing patient data outside the data center.Mark Braidwood, Director, Infrastructure Technology Architecture and Services, Interior Health relies on the MEDITECH electronic health record solution to help it provide efficient and more effective patient care. As the facility upgraded to the latest version, it chose to move to a converged infrastructure to answer MEDITECH’s expanded server, storage and networking requirements. Since choosing Vblock System Interior Health has seen improvements to MEDITECH’s performance and has enabled its IT support teams to focus on business enablement and training instead of reactive networking tasks.“By running MEDITECH and other applications on the same converged infrastructure, we’ve seen application performance improvements and efficiencies. This will go a long way in helping clinicians increase their productivity and responsiveness to patients. Ultimately, the Vblock System has helped IH deliver a better clinician experience, which leads to improved patient care,” Braidwood says.Choosing the Right Converged Infrastructure for YouThe maturity of the converged solution selected is an important aspect of garnering maximum value and business benefit from converged or hyper-converged infrastructure systems. In addition, the types of workloads running on these systems are critical in determining the best converged platforms. VCE ranks the strongest in both these categories as validated by both our customers and industry analysts.Source: Gartner (August, 2015)Gartner in their most recent Magic Quadrant analysis ranked our vision and ability to execute combined as the highest in the industry. The choice of Blocks, Racks and Appliances enables organizations of all sizes to flexibly and cost-effectively deploy converged and hyper-converged infrastructure systems that match their specific needs.For larger deployments, a variety of Vblock and VxBlock (VMware NSX ready) converged infrastructure systems are available depending on customer requirements. For the most extreme-scale projects, VCE offers the VxRack, a full rack hyper-converged system that collapses compute and storage into the same physical device and accommodates hyper-scale workloads. And finally, for small organizations or branch offices, the VCE’s hyper-converged infrastructure appliance, VxRail enables the most cost-effective scalability and ease of use while maintaining centralized management and configuration features available on larger systems.VCE’s Vision software unifies all of these systems separately or together into a single unified management framework, which is further augmented by the Solutions Exchange online portal which offers pre-built applications and connectors to other network management tools accelerating time to deployment and facilitating ease of management.Tyler Fisher, the CIO of Gordon Memorial Hospital summed up his experience selecting VCE converged infrastructure this way: “When I finished my presentation to the hospital board, the chairman said that it would be foolish not to purchase the Vblock System. That’s how clear we felt the decision was.”We remain committed to the healthcare industry and I’m excited by the opportunities ahead in delivering the industry’s richest, enterprise-scale, Converged Platforms customer experience.Join us at HIMSS 2016 at Booth #1921 on the Exhibit floor to hear more about EMC and VCE solutions in healthcare IT.
Billing: Our profession’s not-so-hidden shame Alan G. GreerEvery year throughout America, law firms alike repeat the same ritual with our brand new associates: We teach them about the business practices of being an attorney and by doing so, whether we realize it or not, we set the tone for the rest of their legal careers.One of the very first of these lessons is the importance of tracking hours so that their work can be billed to clients. We tell these fresh new lawyers-to-be that the principal commodity they have to sell is their time. And, by the way, if they expect to be successful attorneys in this firm they had better bill those clients between 2,000 to 2,500 hours each and every year. As the icing on the cake, we add that if they exceed these requirements there will be a nice year-end bonus for them as well.As a result, we preordain the outcome. Instead of these young lawyers faithfully recording the actual time they have worked on client matters — be it a total of 1,500 or even 1,800 hours in their first year of trying to learn the craft of lawyering — they will almost inevitably write down on their time sheets the compulsory 2,000 to 2,500 hours.Why do they stretch their billable hours? Because we have clearly let them know that, if they don’t bill the right number of hours, they will lose their highly paid associate positions. We have confronted them with a moral dilemma in their young lives that most of them can only solve by buckling to our pressure.As their very first lesson in the practice of law, we — their mentors and teachers-in-the-law — have taught them how to cheat the same clients that we have taken an oath to faithfully serve. doing so, we set in motion a process of diminishing ethical and moral values in our new lawyers that appears to have no end.Our new associates perceive that we have condoned the practice of cutting corners and padding time in order to meet our own self-created financial needs. This begins a downward spiral of professionalism that allows more and more lawyers to justify to themselves a lower level of ethical conduct in the name of their own personal wants — be they financial or emotional.As you read this, I can just imagine many of you grinding your teeth and muttering, “But they can put in that many hours. It only takes 50 hours a week, 50 weeks a year to do it. That’s just 8.33 billable hours a day, six days a week. No sweat. Besides, everyone bills this way, so why shouldn’t we?”No snowflake in an avalanche feels responsible when the avalanche it is riding wipes out everything in its path. Well, for lawyers, it is our clients who are in our paths, and what we are wiping out is their confidence in our ethical values, our professionalism, and the justice system in general.So, let’s go back to those 50-hour weeks with their 8.33 billable-per-hour days. If we are honest with ourselves and our young associates, we have to admit that it is almost impossible to do that every day, six days a week, 50 weeks a year. People have to eat lunch, have bathroom breaks, deal with staff problems, read inner-office memos, answer non-billable phone calls, get their teeth fixed and their hair cut — plus carry out a thousand other tasks and activities that cut into that time, week in and week out.And what’s worse is that by predetermining how much time has to be spent to meet the firm’s billing requirements, we teach our young lawyers to expand the work they do on any given project, ensuring that those 8.33 hours are billed — even if the same job could be efficiently concluded in less time if the lawyers were not focused on time sheet totals.No matter, you respond. The clients will take our word on how much time was needed for each task, since for them it’s like shooting craps over the phone when we hold the dice. If we say boxcars turned up on the roll, when it was really snake eyes, how are they to know?But we know the truth, and so do our young lawyers. The recorded hours expand to fill the allotted volume of time. And whether we admit it or not, each time we pad those numbers it diminishes us in our own minds and hearts. We give up little bits of our professional pride and honor till they all but disappear, leaving only a hollow shell of professionalism we hide behind like a mask.What we have brought about is to consciously or subconsciously dull our associates’ consciences in the same way our ethical sense has disappeared. After all, when the money is rolling in and everything else feels great, the one thing that hurts is our conscience.A friend of mine whom I will call Sarah recently recounted a story to me with a shake of her head. She was co-counseling a case with a much larger out-of-town firm. The client had decided that the casework would be equally divided between the two firms. About six months into the case, she got a call from her lead co-counsel who, after hemming and hawing, said, “Sarah, I’ve seen your bills to our client. You have got to bring them up. You’re making us look bad.”There were no questions regarding why Sarah’s firm could do the same amount of work for the client much more efficiently. Instead, there was just the conscience-dulling suggestion to bill more hours so the lead firm wouldn’t have to reduce its numbers.This little tale seems to define one of the central ethical dilemmas of the modern practice of law: When professionalism comes up against profit, it is profit that wins more often than not.Let’s not put our young associates and ourselves in the ethical position of Watergate defendant Jeb Magruder, himself a relatively young lawyer, when he said, “I know what I have done, and Your Honor knows what I have done. Somewhere between my ambition and my ideals, I lost my ethical compass.”Instead, we should heed the thoughts of Mark Twain: “Morals (and ethics) are an acquirement like music, like a foreign language, like piety, poker or paralysis. No one is born with them.”So, let’s try harder to teach our young lawyers some positive lessons. Instead of educating them on how to predetermine the billing outcome to the financial detriment of our clients, let’s focus them on doing each task as efficiently as possible — and let the total amount of our time consumed on our clients’ behalf be judged by that standard. Let’s forsake the practice of setting associate bonuses based on the amount of gross time they have charged our clients and examine how much they have accomplished as lawyers without respect to the billable hours involved.There is an old saying that each of us has to live with ourselves, so we should see to it that we always have good company. Let’s try to keep our own consciences sharp and alive. In doing so, keep in mind that it is far easier to prevent bad habits than to break those already acquired. Let’s not force our young lawyers into the same bad habits we older lawyers struggle against.And let’s not forget the words of Oscar Wilde, “No man is rich enough to buy back his past.” Alan G. Greer is currently serving on the ABA’s Standing Committee on Professionalism. He is a senior partner with Richman, Greer, Weil, Brumbaugh, Mirabito & Christensen, a Miami and West Palm Beach firm. Greer is certified in civil trial law practice by the National Board of Trial Advocacy and The Florida Bar and is Florida Bar board certified in commercial litigation. This column first appeared in the ABA’s The Professional Lawyer , and is reprinted with permission of the ABA. Billing: Our profession’s not-so-hidden shame April 1, 2002 Regular News
Lagonero, meanwhile, was detained in thelockup facility of the Hinigaran municipal police station, facing charges./PN The 13-year-old victim from Barangay 4,Hinigaran, sustained injuries on the head and the body, a police report showed. According to police investigators, thevictim was accidentally hit by a delivery truck driven by 61-year-old MikelLagonero of Barangay Kabulacan, Sta. Catalina, Negros Oriental around 3 a.m. onMarch 6. The victim’s cadaver was brought to alocal mortuary. BACOLOD City – Crossing the road turnedfatal for a girl in Barangay Pilar, Hinigaran, Negros Occidental.