Five IT skills every doctor should learn and master

IT is not a very sexy term for doctors' ears despite having potential to boost productivity and clinical skills. I find it hard to convince my colleagues that IT could be one the hopes for battling rising costs and burden of modern healthcare. Productivity and effective work is the one most important factor today - a doctor who is highly educated and trained is a much too valuable resource to be seen wasting time fighting a computer or software. Computers are everywhere today and can't be dodged - we are practising desktop medicine instead of bedside medicine. Same goes for the information tsunami, you have to ride it instead of being drowned in it. So I would like to share with you what IT skills I think every doctor should learn and master.

1. Touch type writing

Doctors write text all day long and no single skill is as underestimated as writing fast, many doctors picking the keyboard with one finger for same typing speed as Stephen Hawking.

Words per minute:
Stephen Hawking 15
Slow writer 20
2-3 days training 60
Professional writer 90
Reading aloud 150
World record 216

Training for 2-3 days will give you 300% gain in writing speed - such a number in the NNT world would normally be a breakthrough article in the medical journals!

2. Google Docs (Drive)

I have surrendered to my brain and admit that however I try I will not be able to remember everything. My brain is a powerful processor of information but for organizing and storing it I need an online, easily accessible notebook. Google Docs is exactly that and has become an indispensable tool in daily clinical work. Everything I have learned the years - tips, links, references, quotes, statistics - I have noted in a well organized collection of text and images for easy retrieval bedside or at computer.

Besides being a huge personal notebook, Google Docs will forever change the use you approach information and data - ultimately leading to the 'mobile, paperless office', essential for organizing and accessing your work from wherever you are.

# A vodcast/post about Google Docs in clinical practice is just around the corner - stay tuned! #

3. Social media

Social media for doctors is essentially
1) Great educational material coming online (and free) through blogs and related technologies.
2) Communications platforms (Twitter, Google+ etc) for expanding your contact network - where your colleagues sharing their most valuable learning points and lessons.

Learning to use social media is not about any one technology, like starting Twitter, it is a new lifestyle. It may not be for all but for those who master it I can promise doors opening to a completely new world of e-learning, yielding clinical skills not possible before. Almost every day I find my self implementing something learned from my social media network to patient care. Learning ultrasound would have been impossible for me without social media as it has provided me with teaching material to support me.

4. The web browser

Software installed locally on your hard drive is becoming a thing of the past as data cloud and web-applications take over. The heart of this revolution is the web browser and it is the one software you really have to know inside and out. Tabbed browsing, using the Omnibar (for Chrome), knowing the keyboard shortcuts, working with text (special copy & paste functions), synchronized preferences etc... Mastering these will give you maximum performance while doing your work. And for a busy doctor, productivity is everything!

5. Genuine interest!

Just as the best doctors are those who are genuinely interested and active in their field - the same goes for IT skills. Strive to always become better and have open eyes for improvements, acknowledge that your way of doing things today may not be the most efficient one. Most of your daily tasks involve IT in one way or another and you will find lots of colleagues, especially younger ones who're born with IT at their hands, who are willing to teach you and help you.

An everyday example of IT in use!

Finally, an example from work - a serbian patient who repeatedly came to the ED with mostly non-compliance based problems because he didn't understand his medication list. Problem solved with a simple IT tool, Google Translate!

Being a tech competent physician is key to productivity and efficiency at work, a win:win situation for you and your patients. In the menu above you will find a list of some 10+ posts about technology, IT and social media for doctors. I highly encourage you to check it out!

The ultimate Google+ widget for microblogs - help needed!

Ok this is a medical blog, so what is this discussion doing here you will ask? Well - many visitors here are (medical) bloggers and this is a very practical scenario that needs to be solved. So I'm asking the blogger community for advice, stay tuned and you'll learn some!


So you have a blog and you are using social media also for microblogging - ultrashort comments for quick interactions with your community, "Twitter" style. You want these microblogs to appear on the side bar of your blog - we have all seen the Twitter widget streaming recent tweets. Great for the small stuff that you don't feel like making a lengthy blog about but still want to share with your followers.

Well Twitter is all great but being minimalistic I want everything under the same roof and for me that's Google. I prefer using Google+ for microblogs because of convenience - no extra login or external website to browse to as everything is easily done from the Gmail interface or via my Android. Besides, Twitter is limited to a frustrating few 140 characters and Google+ provides for an excellent platform for professional networking and communications. Twitter is lacking for me.


So a Google+ widget is needed to display these microblogs. That's where the issues start, let me explain.

Google+ is based on Circles which are primarily thought as a layer of privacy. You can post something privately to your colleagues through a "Doctors' only" Circle so that your other friends and family members don't read that. It's tempting to think of Circles as a "channel" or "group" feature - a little like #hashtags are used to categorize posts - but first and foremost it is for privacy. Thus, your Circled posts are not open to the Internet as Public posts are and there is and will never be any RSS stream from these, it would simply defy the function of Circles.

A hack might be to use email forwarding; add an email to the doctors only Circle so that the post is forwarded to some service which adds it to a stream. Sounds good but the details are fuzzy - I will have to work on this. IFTTT might be the platform providing this.

So why not just post Public all the time and stream that to a widget? Well that's no good either - my blog followers would never want to read my non-medical posts. And vice versa - posting Public all the time on Google+ would drown my other followers in topics they are not interested in. Public posts using #hashtags seems like a nice intermediary solution but again I would be overflowing my followers as a whole and there is no way to make a stream from hashtags in Google+.


So I started a Google+ Page as a social-backend for my blog. All posts there are public and thus easily streamed to a widget. There are two major drawbacks with  this way;
1) Notifications on Google+ Pages cannot be forwarded to my personal Google+ or email. I'm too lazy to login to Page just to check for notifications. I like to follow up posts through comments and it's too cumbersome from a seperate Page. Remember a Page is designed to be managed by one or more individuals.
2) How do I choose if I should post a microblog with my personal Google+ profile or the blogs' Page? My  'librarian oriented' brain cannot have my posts disseminated all over in an unsystematic way!


Best of all thus would be if I could post on my personal profile and these then were forwared to the Google+ Page as a public post from where it is then displayed on the gadget. Again I'm looking into the email forwarding possibility but it seems to me there are no options currently available.



So a call out to 'bloggers united' - do you have any suggestions?

Why Google+ is better than Facebook as a professional social media platform

From the battle of social media platforms have come three giants we all know; Twitter, Facebook and Google+, all very likely to stay for a while. Twitter, restricting posts to 140 characters, has a different approach and has turned out to be an excellent medium to discover new, interesting information. It's also good for making new contacts but minimal profile information and communication features makes it limited for anything more than that. And thus it isn't even considered to be a competitor to the other two giants, Facebook and Google+.

Many have said that Google+ is nice but it isn't making the expected impact and I see most my colleagues ignoring Google+ because it lacks the critical mass of users to have any power. I think this is a pity since Google+ has some powerful tools and features and in my opinion is a much better network for professional networking, unlike Facebook which still today has reminders of it's roots in a network for college students. As I learn more about Google+ I find my self leaning more and more towards it and actually stepping away from Facebook as it is becoming just too much nonsense. Let me explain why.

Google+ enters the scene and breaks records

Facebook has been around for years while Google+ is the new kid on the block but it has Google's enormous back-end with complimentary IT tools- and services not to be undermined. Integrated with Gmail, Picasa and Google Docs (now Google Drive) amongst others it is so much more than just another social media platform and has many tools to be more than an entertainment platform. This along with excitement, as people were eager to see Google's implementation of a social media network, made Google+ welcomed as it was launched in July 2011. Records were broken in just a few days as users flocked in to try it out but the sunshine story faded as most users didn't return. What else was there to expect, it was like coming to a banquet full of food but with only a few attending. Google+ newbies got lonely.

Facebook is not a professional playground

Facebook was started as an online network for college students. Nobody could have foreseen the tremendous growth Facebook was to go through in the coming years but this growth spurt has also turned out to be Facebook's Achilles heel. As a network for college students, privacy was never an issue - the kids wanted to see their classmates doing heroic or stupid things and seeing someone dead drunk in a bush on the schoolyard was simply cool. Posts were open to everyone and as Facebook opened to the rest of the world this non-privacy approach lived on until new users started crying out, asking for fixes. Major issues were plastered and privacy settings introduced but too complicated for users to grasp. Still today, the average user has no idea how much of his or her posts are visible to other contacts or even rest of the world through the search engines. The fact remains; on Facebook, you mostly read everything from everyone. Not only is it a privacy concern but also you are easily overwhelmed by useless information like 'Joe just ate a meatball yesterday' and 'Jane Liked it'. A little like a kids playground if you ask me.

Google's approach: Circles

This is not the kind of media I want as my professional platform (nor for private purposes!) and Google was smart as they recognized the problem and came up with a solution: Circles. For each friend (contact) you add on your Google+ account, you define what circles your friend should belong to. A little extra work compared to Facebook's way of just adding a friend, but this way yields a high ROI (return of investment) as you, through your Circles, define not only who can read your posts but also what you want to read on your wall (called Stream in Google+). So when I want feedback from my emergency medicine colleagues I will post that post only to that circle and if it's personal family photos my colleagues will not have to read that. It is very important you understand this is not only a major leap for privacy but also a way to have your wall fed only with what you are interested in, you will not read about your friends Like-ing the meatballs somebody else ate.

To Facebook's defence, they have actually added the 'Lists' feature to try to achieve the same results and even a mute button for individuals - but these were introduced too late. Nobody has time or energy to go through their hundreds of contacts and group each and everyone to a list. Google+ does this right from the beginning and even does it with an intuitive and graphical drag 'n drop interface to make the task of circling friends an easy one to do, almost fun even.

Hashtags for discovery

Social media is a great tool for discovering new content, you can do that either by watching posts from your contacts or follow a particular channel. The hashtag (#) is a simple technology for the latter; using #emergencymedicine as a search pattern on Twitter or Google+ will show you in real-time what people or posting, relating one way or the other to emergency medicine.
You can also save hashtag searches (Google+ calles these Sparks) for fast access later (your saved searches also affect what is displayed on your main Steam ('wall'). This is yet another feature to minimize the clutter you are confronted with on your wall (said a little rougher; cut the bullshit) as you can easily select what 'channel' you want to read from. So when I don't feel in the mood to be fed with random clutter I click the Emergency Medicine Doctors and read only posts from these. Or I click #Linux and read only what's going on in the Linux world. It's a feature you will love once you've met!

Facebook lacks this feature and actually returns a rather awkward, cluttered list of search results if you search 'emergency medicine' without the hashtag. Google+ returns a more intuitive list of results and even attempts to prioritize them to fit your interests.

Google Hangouts for easy video-conferences

Many have tried to provide for a decent interface for video-conferencing and most have failed, succumbed to technical challenges or just lack of users (in todays competitive climate you literally have to give gold to attract users). With Google+ the Hangout was introduced as a easy and quick way to start a video conversation with up to 10 users simultaneously. This is a tool companies would have paid thousands of dollars for only few years ago and is now available for free.
Add to this how easy it is to discover and contact interesting people on Google+ and you should realize the potential. Online discussion panels or debates about hot topics in emergency medicine... and you can participate from your living room - how awesome is that!

Other small stuff I like about Google+

• Google+ integrates very nicely with the mothership, Google's search engine, for smooth and easy publicity of your posts on the Internet (if you wish so). Defining posts as public or confined only to your selected circles is very intuitive and hard to do wrong. Facebook has had years of criticism for this as the settings were introduced late and are cumbersome to use. 
• Your posts can not only be deleted if you regret but also edited, something that Facebook amazingly doesn't allow.
• Google+ is tightly integrated with Picasa, Google's excellent photo & album manager. With Google+ you can instantly edit and arrange your photos stored on Picasa and those you add through Google+ are instantly accessible through Picasa. With the Android app (I don't know about the iOS or Win versions, anyone?) you can ask for all photos to be automatically uploaded to your Google+/Picasa account, sparing you the hassle of plugging the phone to a computer to get your photos. 
• On Google+ you don't get the feeling that you are a puppet being used to create treasure for money makers in the market. Advertising is minimal and I don't expect Google+ to disgust me with the idea of asking for money for prioritized status updates as Facebook has just introduced.
• Finally, this is what had me come back repeatedly to Google+ for good laughs and inspirations: animated GIFs. Just try the #GIF channel for yourself, be warned - you are going to have a hard time stepping away from your computer!

Further reading

• Google+ is better than Facebook - and this is coming from PC Magazine, a journal that usually promises Microsoft products above all
• Graphical Google+ features intro
  Great introduction to the major features of Google+
• Quick guide to Google+ basics (aka Help / Welcome Kit)
  From Google+ users to newbie Google+ users!
• This Is Why You Fail At Google Plus
  A popular and well written article for Google+ newbies wanting to learn from others' mistakes.
• The difference between Facebook and Google+
  Facebook helps you keep in touch with the people you already know, Google+ helps you get in touch with the people you want to know.
• KevinMD: Why doctors should embrace Google+
• Automatically posting to Twitter from Google+

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Choosing the best technology platform

The Commodore Amiga story is one I like to tell to examplify that even the best technology will sometimes succumb to market (money) power. The Amiga was introduced in 1985 and was at the time a technological breakthrough as it could easily display colorful, animated graphics and play high quality sound while PCs (and even Apple) at that time were black & white and had one single speaker that could only beep. It's operating system was cleverly designed and handled windows and multitasking (like playing music and writing text simultaneously) with a breeze while PCs at that time were playing hangman with you on a green DOS screen.
The Amiga was geniously designed by brilliant engineers, incorporating clever and advanced technology so that it was way ahead of it's competitors and thus jaw-dropped everyone who saw it in action, below is one of the first demos showing of Amiga's capabilities


Despite technological advances, the Amiga was elbowed out of the market mostly because the public's attention was where the money was and vice versa, so IBM, Microsoft, Apple and the big giants won with their inferior products.

For me, like many, this was a sentimental battle. Not only did I love my Amiga but I felt the world could gain so much with it's advanced technology. The revolution came finally but only many years later as the PCs finally caught up and the IT boom set off and changed the world as we know it forever. Still today I wonder what had been if the Amiga had had the impact it was designed to have?

Today I feel pretty much in the same way about some technologies being in the shadow of others enjoying the spotlight without really having done so much to deserve it. Now you may say I am arrogant but let me remind you I've been using computers almost since infancy and I've tried many different technologies so that what I use today is the result of many years of trial and error. I have made dramatical u-turns when I feel there is another technology which fulfills my needs better -  like when I switched to Linux after having been a Windows fan for more than 10 years.

For this reason I get irritated when the world seems to believe there is only one gadget existing like Apples' i-products. Physicians are head over heels about iPhones and now iPads but what most of them haven't done is to actually compare them to the alternatives. I have done this and for many reasons (open source software, USB connection, high configurability just to name a few) I prefer Android to iPhone.

The Linux vs Windows one is a no-brainer, Windows is a totally overvalued piece of software that exists today only because of the power of money (you could start with asking yourself why it is almost impossible to buy a computer without Windows pre-installed). Read my above mentioned blog-post to find out why.

Then there is the Google Apps vs MS Office debate. I was an Office fan too and I found Google Docs to be a lousy product in it's beginnings. But it has advanced a lot and today it is one of the most important IT tools I have and has dramatically changed the way I work and stay organized both as a physician and family man with three children.



The message? Be critical, open-minded and picky about your technologies. Don't just buy a product because the word of the street says it's the best. There is no thing such as 'one size fits them all' when it comes to software and gadgets - decide what to purchase based on what your needs are and what you are going to do with it. There are plenty of blogs and IT magazines out there to do some home-learning!

Windows vs Linux story

You have been warned, although mostly emergency medicine related, my blog is also about IT. To the heart of my IT experience is converting from Windows to Linux, the best decision I have ever made.

I like collecting stories about why this is good. I've just read an interesting article from PC World where IT geek Tony in 30 days tries out one of the Linux flagships: Ubuntu. I will not go into his incomprehensible approach of installing it inside Windows and expecting to get a Windows clone which completely defeats the purpose of his experiment... But reading through the comments has revealed to me some very good Windows to Linux conversion success stories and learning points which I'd like to collect here.

Take home point: "... but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer."

ricegf Mon Jun 06 06:55:52 PDT 2011

"@blamblam: What are some concrete examples of things that you cannot do with a Windows computer that you can do with a Linux machine

Excellent question. Though I'm not the original poster, I'm a libre software advocate based on hard-won experience, so I appreciate the opportunity to point out some practical implications for free vs proprietary software. I'll do so with first-hand anecdotes, and leave you to draw general conclusions.

I helped Mike (a friend), whose hard drive had crashed, to install a new one. When we reloaded Windows, the software refused to accept the 40 character authentication code (a pain not inflicted on Linux folk), deeming it invalid. We spent 30 minutes on the phone with 3 different people at Microsoft while they decided if we would be permitted to use the software he'd bought or would be required to purchase a new copy, since his machine might be considered "new" because of the replaced hard drive - the End User License Agreement (EULA) didn't define "new", leaving its interpretation at their discretion. In the end we were "permitted" to use the product for which he'd paid (via a new 40-character code), but this was the wake up call that caused me to begin my Linux transition.

I've received two physical letters from the Business Software Alliance (BSA) asserting their right to enter my home and "audit" our personal computers at their convenience to see if any of my applications are improperly licensed. They claim their members' EULAs grant them this right (the specific EULAs are not identified). I would certainly deny them access to my Linux computers, however, since they run no EULA-impaired software at all (the Gnu GPL is not a EULA).

I helped my daughter build a desktop, and purchased a retail copy of Windows XP so she could run certain games. After it was overrun by malware, we reloaded from CD - but the authentication code was rejected as "pirated". Unable to convince Microsoft that we'd purchased an original CD, unable to obtain a refund for an "opened product", and unwilling to continue buying new copies for the same hardware, we acquired a copy via different means to get the machine operating again (though it won't accept any non-security updates).

I have more stories, but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer.

From another perspective, I'm able to upgrade any of my computers to the latest or any older version of Ubuntu, Fedora, Mint et. al. at any time, to share any of these systems and all of my apps freely with friends, and to run as many copies as I like in my virtual machine system (Windows most common EULA limits use to 3 copies total on the same hardware). I can run and publish benchmarks and comparisons (which was prohibited by Microsoft's EULA last time I checked). I also have confidence that the software isn't siphoning off information without my knowledge: I haven't checked personally, but independent people that I trust have - and have found that some proprietary software (not Windows) does indeed send personal info back to corporate headquarters without the user's knowledge or consent (instances occasionally pop up in the trade press, in case you follow it).

From a practical perspective, I've found Linux software to be generally better than Windows for my needs. New versions of Microsoft Office, for example, often require reformatting of complex documents while OpenOffice.org (which uses an ISO-standard file format) does not. Of course, we can (and do) use the same software on the Windows computers in the house, which illustrates another advantage of libre software - it typically has been ported to all systems! You can even find mainstream libre software on quite obscure systems such as Haiku and Plan 9, while many proprietary Windows apps won't even run on a Mac.

Speaking of apps, installation and maintenance (which is centralized through an "app store") is certainly far better under Ubuntu than any competitor I've tried (except perhaps the late unlamented Lindows) - Microsoft plans to address this at last with an app store for Windows 8. The Linux system is also far more useful out of the box (which you concede), and obviously is far less expensive to set up from a licensing perspective.

The biggest practical barriers to a Linux transition are for Photoshop users, those dependent on certain Windows-only vertical market apps, and for those with a large investment in DRMd media (Linux generally doesn't support DRM, since given source code DRM is trivial to defeat - though no DRM system has survived very long in the wild even on Windows).

Overall, my personal experience with proprietary software has been quite negative, because power corrupts and the BSA members seek near-absolute power over their customer's computing devices as the above anecdotes illustrate. My experience with libre software has been uniformly and overwhelmingly positive, and I'm far more productive - and certainly more free - than I was on Windows.

I speak only for me, your mileage may vary, but I hope this gives you some food for thought.

JoeAnotems5445 Wed Jun 29 05:53:34 PDT 2011

"The author missed the most important thing. With Ubuntu or Linux Mint, you don't use AV and you don't get infected. Microsoft gets infected with viruses, botnets and has many other security issues. Microsoft Windows cannot operate without AV, ever. Microsoft never had secure source code, and with millions of lines, it's unlikely they will go back and fix it. Linux has open source (freely available to anyone) source code and security is designed into every line. It's been that way since version 1 in 1991. Android is Linux.

I've used Linux for over 8 years without any AV and with absolutely no infections. Linux Mint is based on Ubuntu but has many extra codecs for playing Microsoft media and playing and recording DVD's - right after the install.

I've never seen the problems with arrogance from Linux users on the help posts the author mentions. If he is a Microsoft user, he is probably not familiar with the terminal commands that are commonly used when someone is trying to help. These commands have to be typed in exactly as described or they will not work. It can be frustrating and overpowering to a new user.

Also, Microsoft enjoys a large market share that has been developed over the years, even through some monopolistic practices.

Linux was never meant to be a copy cat of Windows. The authors' approach is to treat it like a Windows wanna-be. Remember, almost all Microsoft programs use a proprietary function called Active-X or Direct-X. Over the years, this has been responsible for a tremendous amount of security issues. Linux does not use Active-X. Neither does Firefox or Google Chrome. That's why they are becoming so popular, people are getting increased security using them with Windows instead of Internet Explorer.

Linux Mint is the #2 Linux OS in popularity. It's absolutely fantastic. I'm using the 64-bit version on a dual core HP with 2GB of ram. I have an ATI 2GB graphics card with a custom ATI driver meant for Linux. I use FireFox4 and Google Chrome 64-bit, both with Ad-Block Plus. I installed Google Earth, Google Picasa, TrueCrypt, FileZilla, K2B CD-DVD burner, Scribus publishing, Google DNS, Youtube-dl among others. Also, Mint comes with LibreOffice office suite that parallels Word, Excel, Access, and PowerPoint. It also comes with Gimp, which is a multi-layer photo editing program similar to Photoshop.

There are over 33,000 free applications that can be installed from a repository with a couple of clicks using the Software Manager. All you have to do is Google for the Linux equivalent of the Microsoft program you want, and you can usually find it. For example if you Google Microsoft Publisher, you get Scribus and Lynx, which can be installed for free.

For me, Linux installs in about 8 minutes with no product keys, WGA or DRM to contend with. I can't even imagine my family or I going back to any MS product. If you are a Windows user dealing with one or two computers, AV and infections seem to be manageable. If you're responsible for 20 or 30 computers, Linux requires virtually no maintenance and gives you your life back."

@AndreCostaubn:

"Windows is a lot harder to install than Ubuntu. People usually don't care because it's preloaded on new computers (as well as bloatware).


I have to remove all the viruses/trojans from my Mom's windows computer everytime I go visit my family. I installed Ubuntu on her laptop so that she stops complaining about it being slow. She was doing fine after that.

Windows doesn't just work, or else I'd be still using it."

Why I Google

The Google applications are a core component of my online life and thus are mentioned a lot in my blogposts. Here I will explain why exactly so that you don't think that I am bought by Google!
You might also be interested in my rant about choosing the right technology platforms.

Most of you have used Google search and very likely Gmail but not everyone is aware that those two are just a small part of the bigger Google application suite, a plethora of powerful online tools for productivity and creativity. If Google Apps is new to you, I highly recommend this short introduction to this toolset which can seriously boost your productivity.

Alternatives

It is but fair to tell you that there are alternatives to Google Apps, indeed there are thousands of them but none that I know of that has the broad spectrum of application types as Google has. For Google Docs I could mention Zoho and Office 365, commonly compared to Google Docs. Remember The Milk is a nice todo-list application. To read about the others you could check this article.

Why Google apps?

Google Apps is a prime example of web-applications - they run from the browser and use the data-cloud, providing you with easy access to your data wherever you are and a fully automated backup. They are therefor the core component of my online, mobile office - as long as I have a decent web-browser running my office is up and running, ready to untap my productivity. I have previously written a post about web-applications and the data cloud and why you should seriously consider converting to these, here I will rationalize why Google Apps are my first choice.

Single login to all apps, all data in one place

Sitting in the cockpit of a 747 is very much how I feel when I have logged into Google - I have all controls within the reach of my fingertips. With a single login account I have about 30 different applications before me and only one password to take care of. Even with only a few different web-apps, it would be a hazzle to login to every single one and major treshold to start working and getting things done.

Not only are the apps interconnected but so is their data. On the surface you will not notice it but under the hood all your data within the Google apps is pooled in a single database, just showing up differently within the different applications. This means that each and every application can access your different data pools, for example Blogger and Google Docs can easily grab photos from your Picasa account, your Gmail contacts are accessed with Google+ and vice versa. Seeing is believing - from Google's dashboard you can see how your data is stacked within the different apps.

All eggs in one basket?!

Now some will feel violated by privacy issues - the fact that a private company stores so much of your personal data and there are tons of articles and discussions wiggling this issue back and forwards. This is of course a double sided coin; there are indeed companies that will use your data to personalize your ads and some might even abuse your data but if you trust your company there is so much to gain. Consider for a moment how big Google is and that their existence relies on public opinion - they simply cannot afford violating your data in evil ways, one false move and they could go down the drain over a night. Besides, whether you like it or not, in Google's huge data-cloud, you are just an ID number and your data is handled by robots who don't give a damn about what you do or don't do, like or don't like, for them you're just a bunch of binary 1s and 0s! Some think that Google's employees have fun reading emails in the Gmail database, wake up - that's just as silly as claiming that doctors sit and read patient journals for fun. If you still feel insecure, I think you should consider leaving the Internet altogether and start using paper and pen again. This is the era of Web 2.0 tools where storing personal data online is the prerequisite for them to work. That is not unique for Google, it's just the way it is today. Google is well aware of these issues and provides you with an easy way to take out all your data if you should want to close down your account - Google takeout (also an excellent tool if you want to have an extra backup of your data on a local hard drive).

If you want a 3rd party solution there is Backupify. No need to worry!

Actually it makes me sleep better in the night to know that a corporation with pockets full of money and enormous muscle power is keeping my data safe. Should Google go bankrupt or be hijacked, your personal data is the least problem of all since that scenario would be a major event touching not only individuals but corporations, countries and even the whole world. You can be sure someone with greater interests will already be working on this before you even have had time to say "ouch"!

Google is also offline

Since the start of the Internet, downtimes have occured in all major services and Google is no exception but it is so rare and short that in effect you would barely have time to have a cup of coffee while it is being fixed.
A more likely scenario is that you are without Internet connection e.g. while flying or sitting on the train. This is yet another reason to choose Google Apps as they are very well aware of the possibility and have been eager to implement offline options to most of their applications. Their current technique is based on HTML5, an universal standard not likely to disappear over one night and since HTML5 support is growing even on smartphones, you will not have a problem with this on your Android or iPhone. Google Docs for example allows you to mark which documents should be available offline and they will be downloaded and synced automatically without you having to do anything but just enjoy.

Simplicity is power

Ever since Google's search page appeared, simplicity has been Google's style. Wether it's Google Docs, Picasa or Blogger - everything is easy to setup and work with, yet providing the most important features needed. Thus the Google Apps are easy to learn and use, you can start working in minutes.

Constantly updated

Google is eager to provide you with the best tools and state of art technology. I have used Google Apps for almost five years now and the features have grown enormously. Almost every month something new is being added and I feel that Google is listening to their users, adding the features most requested. As web-browsers become better every year we can expect even better features in the future. On the Google OS blog you can follow all additions as they are being implemented.

Android integretation

It should not come to a surprise that the Android operating system has great support for the Google applications, they are after all the brains behind this great OS. With the Google Docs app for instance, it's easy to search, read and even edit your documents and recently offline support was added - this literally means that your online office is available whenever and wherever you go. A technology most would have though to be impossible only several years ago.

Totally free

Last but not least - the Google Apps are totally free, for up to 1gb of storage. Despite having every single document of mine and 10 years of emails there, I've still only used 25% of my quota. In time, I will upload my 50gb or so of photoalbums to Google's services for an online backup and I have no problems with paying $20/year for their 80gb additional storage, if you ask me - the price is ridiculously low, it's just a fraction of the price of a hard drive.

A success story for me

A few years ago I uploaded every single document from my hard drive to Google Docs. My laptop now has no hard-drive installed (runs much faster off a 4gb SD memory card with Linux installed), backup and working with different versions of the same document are a things of the past. With Google's Chrome installed on a USB chip I can start my office up from any computer in the hospital in just seconds and the IT department won't have anything to say about it since I'm not opening any security threats to their in-house network. With my Android I can easily access all my online data and I use it every day for better patient care and to steepen my learning curve in emergency medicine. I am a happy Googler.

Please check out my post about the online, mobile office if you wan't to know the details!

Finally - the disclosure

And now you should understand that my choice of Google for almost everything in my online life is not just a sentimental one, it is truly the one tool that helps me the most for my productivity and creativity. I have nothing to disclose; I have no affiliation in any way with Google or related services and my choice to use their tools tools is utterly my own and solely based on years of "trial and error" with various solutions. There was even an era in my life where I had almost grown roots into the flagships of Microsoft, Windows and Office - but I woke up one day and found out there were better ways to achieve my goals.

More on this topic

• I've been Googled
  A blogger describes how Google grew on him from being a search engine only to his complete online Swiss army knife and why Google's applications are growing fast in the small/medium sized business world.
• Google Privacy: 5 Things the Tech Giant Does With Your Data
  Mashable e-magazine explains in a user-friendly way what the Google privacy issues are really about. As it turns out, a lot of fuzz out of nothing...

Picking the right social network, storing your 'read articles' collection

I am currently updating my PEA blog as it was an aesthetic disaster. I have dwelled deep into Blogger's infrastructure and found a way to almost completely takeover the HTML code which allows for much more advanced layout. That along with CSS and jQuery has the potential to make it an awesome interactive site. I will post more details about this later.

I am now having the dilemma of choosing the one social network to "mini-blog" on the side column. Running the feeds from Twitter, Facebook, Google Plus (and even more!) is too much, my readers will end up with a randomized chaotic nystagmus.

Until now Twitter has been the obvious choice but with Google Plus on the rise as a highly advanced and professional (FB for me is the personal network) social networking tool I am tempted to use it not only to mini-blog but also to store all my favorited articles, read on the Internet.

Previously it was easy to do with Google Reader's Shared items function whereas you could mark each favorited item (article) in your subscriptions and export this as a special RSS feed. That way widgets and gadgets could grab that feed and display it on your blog aka 'I am now reading:' list in a box on the sidebar. Well in nov 2011 Google made a unpredicted and very unpopular decision to remove this feature (previous items fortunately are found through Google's Dashboard and can even be exported). Most probably their intentions were benign and to have the crowd use Google Plus instead which is not a bad idea considering it is their main social media platform. But as we speak, half a year after Google Plus entered the scene, there has been none official RSS export function introduced [april 2012: this function is now available through a 3rd party solution!]. There are hacks but the only way to be sure it will continue working tomorrow and the day after tomorrow is to have an official version from Google and thus I have not used these.

Now why do I want to obsessively pin my online readings and share this way? Actually sharing is a lesser important feature, I can live without it, but I have repeatedly found my self going back to my previous readings to find again "just that great article" I read some months ago (like this great piece of work on things that will more likely kill you than sharks).  This commonly happens while writing a blogpost or just having a gust of inspiration to kill the writer's block. I am aware there are other options for this like Evernote and StumbleUpon.com but they are not Google services and thus require another sign up and login which is against my idea of minimalism and one key to all doors. Besides I want smooth integration with Google Reader which despite all is still my favorite RSS reader. I am sure you will eyeball my decision but this is my choice after years of trying different services, loosing data and trying to port data between them, an awkward waste of time.

Wanting the Google Reader integration I have found a relatively painful new way for pinning by creating a special "Pinned articles" circle in Google+ and using the G+ share function in GR, it allows the pinned circle to be selected specifically (and is remembered next time as default choice). You can then decide if you want to invite your friends to this circle or just keep it publicly readable for everyone. This is an ok solution to the problem but I really miss an RSS export feature to create some magic from my feed, eg displaying it on the blog.

The search will continue - please comment if you have any thoughts!

Of Android, e-readers and tablets

I have decided to loosen up a little and do more of spontaneous think-a-loud on my blog. Since I started blogging I have always had the feeling that I should stick to facts and facts only and skip personal opinions and thoughts. After all, my readers - mostly emergency physicians I believe - are constantly short of time. What I have found out is that this format makes me nervous and stiffens my fingers, leaving a dozen of unfinished or drafted blogposts because I feel 'they don't meet the right format'. From now on, I will never again force my self to separate the left and right side of my brain!


Therefor, you will in the future see more of personal thoughts from my daily life of information technology and emergency medicine. With a dash of uninhibited ideas from the right hemisphere and without the expectations of a scientifically correct format, they will be the perfect IT-EM-rants. Phew... I feel unrestrained already!!

I love my Android and have found lots of use for it in my daily EM work, most importantly easy access to Google docs where I have all my notes and books in a electronic book-shelf. I thought I would never need a tablet computer but now that I am reading almost everything electronically (see my post about Crocodoc, the perfect tool for your PDF/article collection) I really feel the need for a bigger screen. For highlighting and annotating my books or documents the small-screen Android keyboard just doesn't do it. Although I have very small 10" netbook, speedy and snappy with Linux installed, it feels clumsy and noisy and so the urge to try a tablet has grown. And it won't fit into my pockets at work.

Today I stumbled upon an Android e-reader which also has a highlight feature - something that has been missing until now and kept me away from the e-reader buzz. It's the Mantano reader and judging from the online reviews I've found it seems to be welcomed by the market. In the same review you will see the Moon+ reader also providing highlighting/annotating features but it doesn't support PDF files which in my opinion makes it unusable.

However, being a minimalist, I suspect I will continue to use the online Crocodoc (and patiently wait for Google to implement highlighting feature to Google Docs), after all it's free, incredibly featured and has the same look and feel wether accessed from a mobile or tablet device or a computer. Besides, all notes and highlights will be saved in the cloud so that they are still there when I login next time from somewhere else.

So once again, I prefer the power of web applications instead of local applications. Running Crocodoc on a tablet has thus become a dream, let's see if we can find a juicy plate to try out,BRB!

Addendum:
The Moon+ reader is for me a fail since it doesn't read (and highlight) PDF files, that's 99% of my electronic book shelf! That leaves Mantano as the winner.

Ask a friend - the universal EM questions experiment

My emergency program here in Lund (Sweden) is one of the first in Scandinavia and for that we are proud of. Our ED is a well functioning one with ambitious residents. There is no doubt we have had enormous help from modern IT and social media, especially since we are a totally on our own whereas the program is only 10 years old. I am not sure Joe Lex understands what an impact his Free emergency talks has had for our group, giving us opportunity to listen to the great talks from the big conferences - that was how it all started.

The problem is still that we haven't got so many to ask when our group is exhausted. But that doesn't silence the hunger for an answer, in the opposite the frustration just grows.

I am sure there are other colleges out there, in dark corners - having exactly the same problem. So I decided to start an experiment to see if we can relief the frustration with modern crowdsourcing. Therefor I have started a Google Docs document, open for everyone to edit, with a few questions from our group to kickstart this project. Michelle Lin (UCSF) has previously had experience with Google docs crowdsourcing and has a huge interest to in EM academics so I asked her to help me and she even has a question on the list, waiting for a clever EM physician to answer. Should this go well I am prepared to take it a step further and develop a better platform but currently I think Google Docs this is the easiest way to start. Remember if you have a Google account the document will reside as shared on your GD home page and be bolded everytime there is a new question/answer.

Alright, everything is set and we are ready to go. The magic link then is
https://docs.google.com/document/d/1oDFuaYJrOT5UJolsmgudVfdLSkeYvuTsMkmVpz7d9Ds/edit

ADDENDUM feb 2012

Judging by Blogger statistics this post has had very many readers so I assume the idea must be something my colleges are interested in. As I had suspected the text based format is not the best one if this is to roll on, for example there is no way to "upvote" a the best answers and just pushing answered questions further down is no good way of archiving old questions.
In the meantime I have discovered Quora which seems to fulfill all our needs of an easy, web-based Q & A tool for asking and answering EM questions by the community. Although not locked or restricted, it's tagging and grouping system would make it incredible easy to use for the EP community and being a modern social-web based tool (for example using Facebook login credentials) it has the potential to become the true tool I was looking for. The one thing we need is more EPs to sign up and start using it and as such I suggest you all go there and start following the Emergency medicine group.

IT for emergency physicians - the esoteric talk

In september 2011 I was at the 6th MEMC, an international emergency medicine conference held in the small greek island of Kos - the birthplace of Hippocrates. I was given the opportunity to talk about my IT experiences in my life as an physician.

The thought of a first first time talk on international ground was comfortably stressful until the day before when I decided a trip to an Irish karaoke-bar would stabilize my nerves. And it did but the irish bartender spotted my Acchiles' heel and managed to sneek more beer on my table than I had planned for, fiddling most of my cortical senses and spinal reflexes the day after.

There was a silent nervous breakdown going on and standing in front of tens of ED docs, masters of spotting obfuscate symptoms, it was a little hard to give "the perfect talk". A faux pas for martians even. Fortunately the content of my talk was of more interest than performance and it seemed the audience forgave me stuttering words with a mixture of esoteric swedish, icelandic, english-wannabe pronunciation. I even had a short-lived crowd gathering afterwards asking for my name tag and email which I like to think was a positive sign.


And now, I give to you a "home edited" version of the same talk, with the same esoteric pronunciation for you only to feel the atmosphere of the real talk...

Keep in mind I was limited to 20 minutes and to dissect a broad topic as IT in such a short time would be utterly impossible. Instead, I give you a few eye-openers and ideas for you to step onto the IT-wagon yourself and I welcome you to follow my blog for the details.

Please feel free to ask any questions you have in the comments and I will happily reply. If you find an urge to discuss with me karaoke as stress-relief therapy, you are welcome to contact me - you will find contact info in the introduction post.




IT for emergency physicians from David Thorisson on Vimeo.

Where has Google body browser gone?

A little shocking news has arrived from the Google complex about the future of an all-time favorite, the Google body browser. Now that many physicians have just discovered this amazing application it is frustrating to find out that this project is being discontinued. Or is it really?

UPDATE jan 2012:

All is good and well, Body browser is back online but now as "Zygote body"!
http://googlesystem.blogspot.com/2012/01/google-body-browser-is-now-zygote-body.html

It seems by digging into this news that it isn't at all, rather it is part of Google's decision to stop the Google Labs project and move on all projects within to a finite application but in the hands of other developers. Which should mean that projects that have been in a standstill for years are now pushed to faster development, a win-win situation for everyone.

The same goes for Body browser which will now go to a private company, Zygote media group, which has promised to offer it for free in the future. Their connection to GBB is their ownership of the underlying 3d body model. The viewer itself will also be taken over by the open source community.

Reading all this I've also learned about another similiar 3d project, the BioDigital Human. It seems theirs is even more advanced, for example allowing real-time dissection for. Competition is always good for end users and so with news seemingly sad news we actually should cheer out loud.

Web applications are the software of the future

We all remember those days when Microsoft Office was installed from some 25 or so diskettes and once setup up it was a permanent version not to be updated for a few years. With the Internet, updating became a little easier but you still had to manually download and install. Now that the web-browsers are becoming ever more powerful the software world is being taken over by web applications. Don't be thrown off by the scary term, you most likely are already using web-apps already. Google Docs, Facebook and Twitter are one of many examples. A web application is not installed on your computer since it runs on the web. Instead of opening it from the Start menu you go to a URL and you have it up and running. With a login, it remembers your customized settings and content and hardly any data is written to the hard disk of your computer. You never have to bother if the application is compatible with your operating system or type of computer you have, the browser takes care of it all.

And so we are seeing more and more of web-applications and the classic software you remember installing from diskettes and CDs are now web-based. With the latest web-technologies such as HTML5 and 3D graphics inside the browsers a new era has started and there are no technological barriers for running almost any kind of software as a web-app. Recently audio and video editors have been appearing and Google's body browser (update: now Zygote body browser) is a pioneer for 3D applications as web-app, showing a glimpse of the future. Not even programmers would have believed five years ago that this would ever be possible!

Combined with "cloud computing", this is a gigantic leap in the IT evolution which will completely change the way we work with data. Your data and "software" configuration is accessible wherever you are as long as you're connected to the Internet and even if you're house burns down you can go to the neighbour and continue working with your documents. I like to call this the "mobile office" since you literally have your office desk with all it's tools and papers but in a virtual, electronic format which you can take with you anywhere you go or just open your documents on your mobile. Actually, since you do more than just editing documents and updating your calendar - it's more like having your desktop computer in your pocket. That is true IT power and can save lots of time and effort for the physician. I will later on write more about the mobile office concept and how I use it my self.

Ok, enough of this hallelujah web-app rant, you most likely are asking yourself what does this have to do with the emergency physician?

First of all, you are not any more dependent on a specific operating system. As said earlier, the web-browser is now the most important factor between you and the software (and this is why I hate hospitals that are slow to upgrade the web-browsers, for me it's literally like being forced to work with Windows 3.1). This gives you the opportunity to throw out old habits (I'll be less obscure, stop using MS Windows!) and give way for alternatives. Did you know for example that Linux is a well-established operating system which is free, more secure and stable than Windows  and uses considerably less resources like memory and CPU power - ultimately meaning a faster system. Since Linux is free of virus vulnaribilities it will give you that 10-15% of your CPU which antivirus software normally takes and you will never have to be afraid of crashing your computer because you accidentally pressed that "wrong button". There are many Linux variants but Ubuntu is in my opinion the best one for newbies and has amazed many previous Windows users. It takes only 10 minutes to install and if you're afraid of killing your other OS you can install it parallel to your Win/Mac and choose from the boot screen which one you prefer.

Secondly, your browser is now the bread and butter of your computer and you should really see over if you're having the best one and know how to use it properly. It is beyond the scope of this post to discuss the best browser out there but I can tell you that after years of trying out most of them, Google's Chrome is in my opinion leaving the competitors in smoke. It is fast, stable and incredibly easy to use, yet having very advanced powers under the hood. It's self-updating so you will never have to worry about compatibility or security issues. Add some extensions, you've got a F22 Raptor in your parking slot.

Finally, your valuable documents, pictures, videos and every single information you have collected through the years can now be electronic instead of heaps of papers in the shelves of your office. Imagine having all your articles you've read through the year in a single place, readable from home, work or even your mobile on the train while commuting. With an electronic marker-pen you've highlighted and made notes in those articles that have had the most practicable value to you and in only seconds you can have it back on your screen, just as you left it last time. Having all your emails and documents in a "electronic heap" means it's easily searchable... with a single click you can search through everything you've read or written for the past years. A lost login to the local EMR system, your impersonality notes about ECG reading or just the number of your bank account - it's all right there at the tip of your finger!

You want to relax after work and listen to David Bowie's soothing 80s music? Listen to it at Grooveshark.com and you can search through terabytes of online music and play it right from your screen. If you've created an account you can even play that "dinner playlist" you just created the other day to bring up good memories. You have an ECG which needs to be edited to erase patient ID and resize. Open pixlr.com - an insanely amazing photo-editor which does most if not everything that Photoshop does, completely free of use! You always wanted to try a 3D editor? It's yours if you just click this link! Oh and you have a video that needs the final touch but don't have your laptop with you? Don't worry, you have several to choose from. Oh and they're also free! If you need to create a video-tutorial of something you are doing on your computer, say using your local EMR - guess what, there's a webapp for that too! And if you ever get suspicious, you can even run a viruscheck from a website!!


You get my point. Start building up your collection of web-apps, it is the true beginning of being an IT competent doctor. This post hopefully inspires you, the rest is up to you. In my next posts I will tell you about the Google Apps and the importance of simplicity aka "cockpit approach" to web applications. For me at least, it has stepped up my learning curve more than any other modality.


Still confused? Check out these ultra short videos about webapps:

What a wonderful (IT) world

Last night I lay comfortably in my bed, not being able to sleep. I plugged the miniature headphones to my Android and listened to Scott Weingart's EMCrit podcasts on treating the severe asthma patient. After that Amal Mattu's EM Cast about a 2 year old lethargic child with fever and that's when I Mr. Mattu started to echo and I found my self drifting away into the world of jumping sheep.

Earlier this week I was asked to have a short clinical case for my colleges in the hospital and as preparation time was essentially none I picked three excellent 5-minute videos from HQMedEd, all presenting a clinical scenario where the ultrasound in the ED saved the patients life (walkin and talkin!). I had even prepared to show Vanderbuilt's ultrasound video collection to show my ED colleges that learning to use ultrasound in year 2010 doesn't require an expensive international course - just a comfortable sofa with your laptop/mobile and some interest in the field!

Then, preparing for an exam next week - the insanely great Lifeinthefastlane has provided me with invaluable texts on everything I ever wanted to know about ECG, arrhythmias, electrolyte disorders (and other lab-abberancies), intoxications and ED medicines like Magnesium in acute asthma. It's so much more than just a blog. Of course I have my dear Tintinalli resting quietly in the book-shelf, just in case - but LITFL has simply provided me with everything I need to know. It's a true emergency medicine website; written by emergency physicians for emergency physicians - just the facts. The cream of the cake. The brass of the music.
With all this knowledge at the top of my cortex I was prepared for that unconscious patient the other day presenting with a new LBBB which I correctly diagnosed as hyper-K induced. After some insulin+glucose, a new ECG revealed a normal sinus rythm and a resource-draining trip to the angio-lab was spared.


And I haven't told you all the useful things I've learned by reading through my RSS subscriptions... oh my oh my...

Discussion forum for emergency physicians - hot or not?

I guess most of you have participated in some kind of discussion forum as there are thousands of them out there. They are a convenient form of communicating with other internet travellers. The discussions are archived so that you can browse or search through earlier topics and usually you can see more information about the other users on the forum. This is to compare with an early invention of the Internet - the good and old (email) postlists which are still pretty common today. I still remember a trauma postlist I was a member of. It had very interesting discussions, for example the classical one about whether or not to insert a needle into the 2nd intraclavicular space in traumatic cardiac arrest. Having the  most eager trauma specialists of the world on board meant it was a heated but professional discussion. This level of activity has never been reached in a good emergency medicine forum.

Well forums in general maybe don't have a good reputation as well intended and professional arguments tend to be killed in the end by emotional havoc, leaving the forum participants angry and irrational (since we are talking arguments, there is one that is so funny it will unwind your intestines... Monty Pythons argument clinic!). Then there are those that only want to stir up emotions, the net trolls. Still there are quality forums out there and it seems that the longer they have lived the better they get, probably as the members get to know each other better.

So I have often wondered why on earth we emergency physicians have not got a decent forum for our community? Almost every day I have a question of some kind and am burning to have it answered; a ECG riddle, clinical decision point or whatever. Every now and then I wonder "how do they do this in other countries" as comparing treatments between continents often has it's interesting pearls of wisdom. In my emergency department in Lund (Sweden) we are a very young specialty and we are very commonly hitting the walls of other specialties. So often I would like to learn from the experience of my colleges abroad who have been there and know how particular obstacles were solved. A common discussion forum is a perfect place for this.

I have to mention BMJs very interesting experiment, they have a recently launched sub-site called Doc2Doc which has the goal of "connecting doctors worldwide". It is the best try I have seen yet and they seem to be aware of the net troll problem as only doctors can register and each and every registration is processed manually. Which means they actually check if you are a legitimate doctor in your country. Impressive! There are lots of features within Doc2Doc such as the ability to start your own blog in there - all in all it is a light weight social networking site like for example Facebook - but for doctors only. I did try this out and must say I am impressed but I have not touched it for a while now as I was overloaded by information that I did not need. I am only interested in emergency medicine, the best training centers for GPs in UK or treating acromegaly surgically or medically does not touch me at all. And so I put it on ice but I will be keeping my eye on this interesting experiment.

Besides that, there are several websites having the same idea and I will not delve into them here since I have not found any with an active EM group. It all comes down to one point - we want it simple and familiar. We don't have the time or energy to try out yet another website which may or may not be worth our time. Doctors are really lazy and impatient when it comes to getting to know new websites. Then there are already thousands of passwords and web addresses we have to remember at work and every new login to remember has to be for a very good reason.

So what about the social networking sites we already know, have a login with and are familiar with? Facebook, Google groups and LinkedIn are the ones everyone knows and all of them have tools for easily creating a discussion group. Most of us already have a login at some of these sites and starting a forum for emergency physicians is really easy to do. I did a quick search of "emergency medicine" in all of these sites and well there were a few hits but none of them very active or rich of members.

I must say, I really don't understand why someone in our tech-savvy EM group hasn't been there and done this. Now that the technology is there, easier then ever before and completely free - it makes me wonder if there is some other hindrance? Could it be that physicians are shy to share their thoughts in front of colleges? Or afraid of revealing some gap in their medical knowledge? Or just find new technologies scary? I really don't know! What do you think?