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It’s been a while since I’ve done a “What You’re Searching For” Post, where I pull out items from my blog’s stats, the keyword searches that bring people to this site – the common, the uncommon, and the strange.

From most frequent to least frequent (leaving out the boring and obvious stuff like “lean blog mark”). Toward the bottom, some of these are a single person searching, not necessarily indicative of any trends. The search terms are in bold, my comments after the dash.

top healthcare administration books - I hope there’s more interest in Lean nowadays (my list for lean)

lean and nurses – another good topic (my posts on nursing)

non essential workers - it must be hard to hear that term associated with your job. High search term means more companies are looking into furlough days?

long supply chain - this is in reference to firms shipping goods from China, long supply chains = slow supply chains. with cheap labor, sometimes comes poor customer responsiveness.  See this link and this one for alternatives.

cleveland clinic and lean - a great organization that uses lean and other methods for process improvement

outlearning the wolves blog - a reference to this book, apparently: Outlearning the Wolves: Surviving and Thriving in a Learning Organization – any one read it?

what companies closed after lean – uh, oh. Ironically, the top google result for me is this post about the “best lean companies” (presumably those who do NOT shut down after using Lean).

Toyota facebook comments about managers San antonio – hmmm, what’s the story behind this one?

lean is not mean – amen.

the doublespeak of sigma six - interesting search term.

taylorism starbucks - Hopefully the Lean efforts at Starbucks are involving the staff, as opposed to having process improvement done TO them.

for dummies series stupid name – I normally hate the term “dummies,” but the Lean For Dummies was surprisingly good.

monty python health care cow catapult – I used to be a Monty Python fan, but what is the relation to healthcare?

lean healthcare conference 2010 - one that I’ll be involved in will be put on by the Lean Enterprise Institute in June, for more info sign up on this page.

why isn’t canada using quality management in hospitals – There’s actually quite a lot of Lean activity in Canada.

Other Posts That May Add Value:

• Reader Quiz - Guess the Lean Blog Global Readership
• University of Michigan and other hospitals in the news
• And the #2 Lean Blog Reader Country Is...
• The Lean Library
• Rebuilding US Manufacturing

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By ROBERT LASZEWSKI Just when you thought you couldn’t be more cynical about the health care bill. As I have said before, there wasn’t a lot of hope the same administration that ignored the rule of law in granting unions...

A team of British, Italian, and American scientists has been looking into a technique that uses an ophthalmoscope and fluorescent markers to detect cell apoptosis in the retina. Because retinal apostosis is directly related to cell death within the brain, the technique should provide a diagnostic modality of gauging the status of Alzheimer's and other neurological diseases. In this study, we use spectrally distinct, well-recognised fluorescent cell death markers to enable the temporal resolution and quantification of the early and late phases of apoptosis and necrosis of single nerve cells in different disease models. The tracking of single-cell death profiles in the same living eye over hours, days, weeks and months is a significant advancement on currently available techniques. We identified a numerical preponderance of late-phase versus early-phase apoptotic cells in chronic models, reinforcing the commonalities between cellular mechanisms in different disease models. We showed that MK801 effectively inhibited both apoptosis and necrosis, but our findings support the use of our technique to investigate more specific anti-apoptotic and anti-necrotic strategies with well-defined targets, with potentially greater clinical application. The optical properties of the eye provide compelling opportunities for the quantitative monitoring of disease mechanisms and dynamics in experimental neurodegeneration. The technique uses fluorescent markers that attach themselves to the relevant cells and indicate the stage of cell death. The retina is then observed using a customised laser ophthalmoscope. Until now, this kind of technique has only been used in cells in the lab, rather than in live animals. This research is therefore the first ever in vivo demonstration of retinal nerve cell death in Alzheimer's Disease. Professor Cordeiro, UCL Institute of Ophthalmology, said: “The death of nerve cells is the key event in all neurodegenerative disorders – but until now it has not been possible to study cell death in real time. This technique means we should be able to directly observe retinal nerve cell death in patients, which has a number of advantages in terms of effective diagnosis. This could be critically important since identification of the early stages could lead to successful reversal of the disease progression with treatment. Image: Retinal images of a living 14-month Alzheimer Triple Transgenic mouse (a) compared to an aged control living mouse (b). Many more retinal nerve cells are in the early phase of apoptosis (green spots) in the Alzheimer mouse. Press statement from University College London: How an eye test could... Michael

In observance of Martin Luther King Day, FierceHealthIT will not publish a newsletter on Monday, Jan. 18. We instead will publish on Tuesday, Jan. 19.

Transcatheter aortic and pulmonic valve replacements are shaping up to become attractive alternatives to open heart surgery, as we have seen with products such as Melody Pulmonary Valve and Edwards Sapien Aortic Valve. But the same cannot be said of mitral replacements. The mitral valve has a complicated anatomy, as well as a precarious intracardiac left AV position that's difficult to access. Then there is also the issue of a complex etiology of mitral regurgitation, such as ring dilation, chordae rupture, or cusp damage. So the transcatheter MVR development has seen its share of failures and difficulties. Now CardiAQ of Winchester, Massachusetts thinks that it has developed a novel percutaneous solution for mitral regurgitation patients that doesn't use a radial force to attach the artificial valve, overcoming the main problem of performing mitral valve replacement. To help move the company's Transcatheter Mitral Valve Implantation (TMVI) forward, the firm just finished a $6.5 million 'Series A' fund raiser, giving us hope that we might be seeing this technology in cath labs within a short period of time. 1. INSERTION. A catheter carrying the replacement valve is threaded through the femoral vein and up into the right atrium of the heart. It is passed through the intra-atrial septum, into the left atrium, and down through the mitral annulus. 2. POSITIONING. The valve is partially expanded to engage the ventricular side of the annulus and establish the proper position. While the valve is now functional, it can be recaptured and adjusted prior to final deployment, if necessary. 3. ANCHORING. With the valve in position, the sheath is retracted fully. Foreshortening of the frame creates a clamping action that anchors the valve above and below the annulus. Company page: CardiAQ... Press release: CardiAQ Valve Technologies (CVT) Closes $6.5 Million 'Series A' Funding for Its Novel Transcatheter Mitral Valve Implantation (TMVI) System... More from MassDevice...... Michael

We typically don't profile individual components that make up the insides of medical devices, but when we see a tiny novel motor come to market, we get excited of its potential to miniaturize all kinds of gadgets. New Scale Technologies out of Victor, NY has released the ultrasonic SQUIGGLE RV motor system that is only 2.8mm wide and can drive a shaft at 10 mm /sec. And it does this at .5μm resolution (that's half a millionth of a meter). It seems that where small size and precision are key, such as in invasive medical devices, a motor so small could open new possibilities in angio interventions, laparoscopy, drug delivery, and therapeutic systems. From the product announcement: The NSD-2101 accepts direct 2.3 VDC to 5.5 VDC battery power and uses patented full-bridge switching technology to create the ultrasonic motor drive frequency. The IC also has patent-pending smart drive features built in that optimize motor performance while minimizing power consumption over a broad range of operating and environmental conditions. The NSD-2101 requires only DC battery power and digital I2C control commands to achieve unrivaled miniature motion control performance. The SQL-RV-1.8 motor achieves forces in excess of 50 grams and high resolution to 0.5 micrometer. It can run at speeds greater than 7 mm/sec with power consumption of less than 350 mW when moving under typical loading conditions. This corresponds to a DC current of only 120 mA for a typical 3 VDC battery. Its unique self-locking design means that zero power is needed to hold the motor position, providing additional power savings. New Scale's TRACKER™ NSE-5310 linear encoder, the world's smallest linear position sensor, can be integrated with the SQUIGGLE RV system for high system repeatability with submicron resolution. Some ideas for medical applications of the device: Robotic surgical devices. SQUIGGLE motors and TRACKER position sensors can be used for everything from robotic grippers and retractors to miniature mobile robots for minimally invasive surgery. Endoscopes. Small enough to fit inside the head of a standard endoscope, SQUIGGLE motors and TRACKER position sensors can add more capabilities: focus a lens, manipulate a scraper, collect a sample, dispense a liquid. Implantable devices. The SQUIGGLE motor would allow adjustment of implanted devices in situ, preserving optimal performance. Microfluidics. SQUIGGLE motors and TRACKER position sensors can be used to create tiny microfluidic pumps in handheld devices for POC testing, which promises faster results, improved... Michael

Recently, BIDMC and Atrius Health began a collaboration that required clinical data sharing and secure email.
I've described the clinical data sharing in a previous blog. Here's the approach we've used to secure email - SMTP over Transport Layer Security (TLS), which ensures all email is encrypted as it travels over the internet.
Configuring TLS varies with the gateway that you are using. We use Proofpoint Protection server as our primary MX servers. Proofpoint makes it very simple to enforce TLS between sites. There is a configuration option that allows you to specify what domains you want to enforce TLS with. (as a default we have opportunistic TLS turned on for every site). You simply add the domain you want to enforce and specify always use TLS.
The advantage of this approach is that it does not require any client side certificates or complex server side certificate management. No special software is needed at the desktop and the encryption is invisible to the user.
Secure email that is as easy as a setting on a gateway - that's cool.

By Matthew Holt In developing countries, (and here too) counterfeit drugs are a mega-big problem. Essentially fraudulently labeled drugs in the supply chain are often not what they say they are, with potentially devastating consequences. But there’s no really easy...

This article from Detroit’s Crain’s Business Journal (“Lean machine: Health care follows auto’s lead, gears up for efficiency”) highlights a growing lean healthcare movement in my home state of Michigan, one that, ironically, traces its origins back to Toyota General Motors. Seriously… General Motors.

Featured in the article are Dr. Jack Billi and the University of Michigan Health System, active participants in the Healthcare Value Leaders Network, co-facilitated by the Lean Enterprise Institute.The article discusses how GM helped hospitals last decade and how hospitals are increasingly hiring people from the auto industry (including my former consulting colleague, Ken, who came from Ford and gets a mention in the article.

The UM Health System was one of the first hospital systems in Southeast Michigan to adopt the auto industry’s lean principles, Billi said.

For six of its first eight lean projects, lean engineers from GM’s Global Manufacturing System helped refine UM’s lean philosophy. From 2004 to 2008, GM’s lean team helped to reduce auto recalls by 85 percent.

There are examples and quotes from University of Michigan and a number of other hospitals and systems.

Some of the key points include:

• Every employee should be involved in improvement and problem solving (University of Michigan)
• It’s possible to double the percentage of time that nurses spend with patients by eliminating waste (William Beaumont Hospitals)
• Hospitals should focus on end-to-end patient flow, not just departmental projects
• Lean is not just about cost, it’s about improving quality and the patient experience
• Lean should be a cultural transformation, not just a program or projects (St. Joseph Mercy)
• Lean shouldn’t be used to drive layoffs, or it kills the employee involvement that’s so critical to lean

It’s great to see that progress in Michigan! I wonder if there’s more “lean healthcare” in the Detroit area than there is in Boston?

Other Posts That May Add Value:

• Porsche Drives Hospital Down Lean Road
• Lean Healthcare in Toyota's Backyard?
• University of Michigan Health System and Lean
• What You're Searching For, January 2010 Edition
• Reducing Medication Waste for VA Patients

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Many hospital staff have friends and family in Haiti. It may not seem obvious that IT can make a difference, but here's what we're doing at BIDMC to support the Haitian community.
We are diligently working to install phones that enable direct calling to Haiti and public internet kiosks in several campus public areas so that all staff, even those without a work computer, can get personal email and internet access as they attempt to contact their friends and relatives.
I highly recommend that all IT Leaders ask their staff how they can support the effort to bring comfort and assistance to those who need voice and data connectivity to Haiti.

By Matthew Holt Trying to figure out how Facebook's permissions work in embeddable videos. Can you comment if you can see this hot three way of Matthew in bed (yes really!). Or not (and also let me know if you...

By Matthew Holt Last year I was a judge in the MS-HUG award for the HealthVault applications category. The quantity and standard of the entries was pitiful. I think that a few sales reps rounded up a few entries at...

Frimley Park Hospital NHS Foundation Trust has gone live with surgical, anaesthesia, recovery room and critical care software solutions from Picis.

A hospital doctor accused of accessing the Emergency Care Summary records of high profile politicians, footballers and BBC journalists will not be prosecuted, Scotland's Crown Office has decided.

A post on Dan Ariely's Predictably Irrational draws our attention to Google as a source of data for all sorts of research into human emotions. Dan Ariely, the James B. Duke Professor of Behavioral Economics at Duke University, believes that by using drop down suggestions in Google, we can gain insights into "what people might care the most about concerning a given topic. When people search a particular political leader, what are their main concerns? What are people secretly guilty about? For better or for worse, Google's obsession with collecting and refining data has given us a window into each other's fascinating and telling curiosities." But we think that this argument can go some additional distance. When it comes to medicine, this kind of data insight could be used to formulate and implement well designed public policy initiatives. If properly searched and defined, the data could be stratified according to sex, social class, age, etc. Using Dr. Ariely's example, shown above, we gain a look at sexuality issues of young people. But the same technique, for example, can help us take a look at how the elderly understand diabetes. The other side of the same coin, as we have argued before, is Google's responsibility to deliver accurate and responsible medical search results. Even though some might argue that what is delivered in search results is not Google's responsibility per se, as these reflect the conversations on the internet, nevertheless we do think what Google suggests in the drop down menu is indeed Google's responsibility. According to a discovery by PZ Myers, Google has a mechanism to control the drop down suggestions. We hope that with Google's help in balancing the forces of responsibility and transparency that we can harness the implicit data that exists when millions of people are trying to learn more about their health.... Michael

Here’s something new to try — a way of giving away a copy of my book Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction.

What percentage of Lean Blog readers are from the U.S. (or at least a U.S. server)?  What country is #2 in readership? Come take a guess…Take your best guess using the poll box below and see what others are guessing. Answer will be revealed on January 18.

View Poll

To have a chance to win the free copy of my book, leave a comment on the blog (with your email address) with your guess as to the country who is #2 in readership. I thought just guessing the U.S. percentage might not be a good contest in and of itself since the voting might lead to the right answer. The contest to guess the #2 country. I’ll reveal that and the U.S. percentage on the 18th. Note: if more than one person picks the #2 country correctly, I’ll do a random drawing of those people to choose one winner.

In an ironic twist, if you’re outside the U.S., I will send you $40 in an amazon gift certificate or via PayPal. International Shipping is outrageously expensive for a book!

Other Posts That May Add Value:

• And the #2 Lean Blog Reader Country Is...
• What You're Searching For, January 2010 Edition
• Dr. Gawande & Checklists Featured on NPR
• Lean Hospitals Book Update - Aug 12
• Notes on a Talk by Eric Ries (@ericries) at MIT on "Lean Startups"

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ClearCount Medical Solutions out of Pittsburgh, PA is finally releasing its RFID-based sponge tracking products that won FDA approval back in June of 2007. Medline Industries of Mundelein, IL has been named as the soul distributor of the SmartWand-DTX and SmartSponge System. ClearCount's technology tracks the history of every sponge or towel during a procedure, and guarantees that nothing is left behind by using dime sized RFID chips sewn into the fabric. We're not aware of the price of the system, but it'll probably cost a pretty penny once you add up the extra time maintaining the system and managing it during operations, all to chase a relatively rare problem that's typically solved by an old fashioned nurse's count. Conceptually, the process is a little like finding a coin on the beach with a metal detector, but much more high-tech and precise. Each sponge has its own ID number coded in its RFID tag. The SmartSponge System can read and record the unique ID number of each sponge as it comes out of its packaging in the OR, as it is used in the patient, and as it is removed and disposed of. Both the SmartSponge and SmartWand-DTX count multiple sponges and read through blood and tissue, and they can locate a missing tagged sponge using radio waves to signal the RFID tag to identify itself. Both systems also use the same RFID-tagged consumables, providing hospitals for the first time with a choice of devices to best address the unique conditions of each OR. System provides sponge counts and sponge detection No line of sight is required for RFID tags to be read Intuitive graphical interface provides a quick "In/Out" view of reconciliation Reduced handling of soiled sponges minimizes biohazard exposure Different sponge types and towels can be tracked and counted at the same time Uniquely identified sponges prevent the system from ever counting the same sponge twice SmartWand scanning provides quick detection in event of non-reconciliation SmartMat ensures the SmartWand is within range and ready for patient scan Data can be exported to your Hospital Information System (HIS) in standard HL7 format Printer option is available to document case Non-intrusive RFID tags are smaller than a dime and do not contain a battery Medline to Distribute Only FDA-Cleared System to Both Count and Locate Surgical Sponges Left in Patients Product page: SmartSponge System Flashbacks: There's an RFID in... Michael

Gunshot wounds can cause severe bleeding that is not subject to typical control measures like pressure application and bandaging the site. Most of the torn vessels are way below the skin, and so external methods to stem the bleeding don't address the real problem within, especially in the trunk. CardioCommand out of Tampa, Florida has developed the TourniCath device that is actually inserted into the wound along the bullet's path and then inflated to apply pressure directly to the insides. At over a foot in length and half an inch in diameter before inflation, the device is designed for quick and intuitive application by emergency responders. More from CardioCommand: The balloon is made of two walls of material: the outer wall is nylon coated on the inside with polyurethane; the inner wall is a layer of soft polyurethane. The design makes the balloon resistant to punctures from sharp objects, like shrapnel, that might be inside the wound. The balloon will also conform to the shape of the wound and compress it. Similar balloon devices, used mostly in operating rooms, "stretch when inflated, but they want to take their 'natural' shape, and do not therefore contour to fit the wound track," says Ramsey [Maynard Ramsey, CEO, CTO of CardioCommand]. The CardioCommand device was developed for areas where conventional tourniquets cannot be applied, such as the groin or shoulder. But even tourniquets have drawbacks because they can't be left on for more than 30 minutes and can cause secondary tissue damage. The new device was also made for puncture wounds too deep and severe for traditional methods of treatment. Video of Maynard Ramsey demonstrating the device after the fold:... Michael