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By Bill Elmore ·
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Microsoft preaches the gospel of Exchange

by Bill Elmore In reply to Blogging IT One Word at a ...

<p class="MsoNormal">Microsoft paid a visit last week; not the entire company,
mind you, but a couple of disciples to spread the good faith. They worked in a pre-sales capacity and one
had the ominous title of Messaging Specialist.
Messenger, disciple ? what?s the difference, right? Anyway, you?ve probably guessed they were
here to tout the coming of Exchange 2007, explain the added benefits, and get a
pulse for our readiness to upgrade.
Given the fact we are just completing the final stages of an upgrade
from Exchange 5.5 to 2003, I explained that this discussion was a bit
premature. Then they offered us some
water to drink, which we accepted, but discovered it tasted strangely similar
to Kool-Aid.</p>


<p class="MsoNormal">Exchange 2007 should arrive sometime in the first quarter of
?07, not by the end of this year like you may have heard but didn?t quite believe
anyway. I?d like to know when Service Pack
1 will be available because that is more likely the first time we will begin to
consider another upgrade of our messaging system. Let someone else discover the problems usually
found in the release of a new software version.</p>


<p class="MsoNormal">The meeting was brief and not filled with much ?meat? as it
was largely meant to answer questions about Exchange 2007 and build excitement
about its impending release. The latest
version will continue Microsoft?s trend of attempting to be your one source
solution provider. And while I can?t
dive into much technical detail in a short blog entry, I can opine my thoughts
on some of the new features being hyped.</p>


<p class="MsoNormal">Unified Messaging.
Much is being made about the UM integration in the next Exchange
system. I have to admit that I like what
I?ve read and heard to this point about integrating voice and fax access with
my email (pause as I sip my drink).
Sure, aspects of UM have been available before now thanks to third party
vendors who filled in functionality gaps left by previous Microsoft releases. Companies like <a href="http://www.gfi.com/">GFI</a>
or <a href="http://www.castelle.com/">Castelle</a> offer unified fax solutions,
and there are many companies like <a href="http://www.adomo.com/">Adomo</a>
that offer unified voice mail solutions.
But now (through various company acquisitions, of course) Microsoft can
offer the total solution. Their vision
is to have total voice and data collaboration.
Couple Exchange with Microsoft Live Communications Server and you also
can include VoIP to make your unified messaging experience complete (sip).</p>


<p class="MsoNormal">Security. Microsoft
has rightfully taken a public beating in recent years about the security holes
and deficiencies in their OS releases and other core products. This is a good thing. They are making huge strides to improve
security, and Exchange 2007 is another step in the right direction. If you take a look at the latest published <a href="http://www.microsoft.com/technet/prodtechnol/exchange/2007/productevaluation/features.mspx">feature
list</a>, the first and largest section displayed is the one listing numerous
built-in security enhancements. A
significant number include ant-spam and antivirus capabilities. And there is now a new Exchange component
called the Edge Transport server which sets in your company?s DMZ and acts as
the first line of defense for outside facing mail flow. By default, all intra-organizational mail
flow is encrypted. Regulatory compliance
is even addressed through support for Information Rights Management and message
transport and storage rules-based encryption and retention (sip).</p>


<p class="MsoNormal">Management. Microsoft
is well known for ?wizardizing? every common IT task that can be
automated. Maybe it ?dumbs? down the
average IT pro, but I tend to appreciate a good wizard tool to make my job
easier and faster. Have you ever
suffered through a horribly long and complicated math homework problem only to
be told by your teacher the next day that there was a two-step shortcut? Sure you have. Microsoft sympathizes with your plight (sip)
and has made managing Exchange (almost) entirely possible via the new Exchange
Management Console which happens to be based on the new MMC 3.0. And for those that need to manage from the
command line, there is the Exchange Management Shell. Everything that can be done from the
Management Console, and more, can now be done within a script.</p>


<p class="MsoNormal">There are many more new features and enhancements (sip)
bundled with the next Exchange release, and I don?t have room to cover them
all. For instance, it is a native 64-bit
application which will increase memory and processor efficiencies and improve
disk I/O. It also offers improved data
replication and search capabilities (sip).
But I digress. From what I?ve
seen so far, Exchange 2007 has much to offer.
Whether it has enough to warrant another upgrade in the near future may
be a different story. My cup is now
empty. I?m done.</p>

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Microsoft preaches the gospel of Exchange

by br123456 In reply to Microsoft preaches the go ...

<p>I would be interested in whether or not the disaster recovery steps are still as much an incomprehensible mess as it is with all the other Exchange versions.  I would gladly trade each and every new feature they have in Exchange 2007 if they could just make disaster recovery 1) quick and 2) easy.  No matter what role the server has which exchange is installed on.  No matter what type of hardware the recovery server has.  No matter if it is a mailbox store, a mailbox, a public folder store or a public folder.  Forget about Recovery Groups, which is more a cludge than anything.  It didn't really fix the problem.  Disaster recovery in Exchange is a nightmare.  Now that MS is integrating faxes, phone messages and other things into the system, rapid and simple disaster recovery is that much more critical.  As it stands now, I would <em>never</em> want Exchange responsible for these new roles if I knew that the disaster recovery mechanisms are still as slow, cumbersome and fraught with peril as they always have been.</p>

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Weighing the benefits of electronic medical records

by Bill Elmore In reply to Blogging IT One Word at a ...

<p class="MsoNormal">I recently read an opinion column from Dr. John Halamka, a practicing
physician at a teaching hospital, which discussed the pros and cons of
converting from paper to electronic medical records. I found the article to be very interesting
and happened to agree with most of what was written until the final few
paragraphs. He stated that the hospital
where he practiced was going to give patients the option to choose between
having their records stored electronically and storing as traditional paper records
? their choice. What? How can this possibly be something that a
patient can make an informed decision about, and more importantly, why offer
the option in the first place?</p>


<p class="MsoNormal">Dr. Halamka?s main reason for giving patients their choice
of record storage method stemmed from the publicity of recent data
breaches. He reasoned that though it was
relatively easy for someone, authorized or not, to walk around a hospital and
swipe a handful of patient records, one electronic data breach can compromise
the integrity of thousands of records.
While he makes a valid point that the total number of patients at risk
for identity theft is higher using electronic storage, you shouldn?t just
transfer such an important matter to a person who probably doesn?t understand
the far reaching implications of their decision. And my guess is, if they are ill enough to be
at the hospital, they probably have more pressing topics on their mind than
what format their medical record is kept.
If you?ve been to the hospital recently, you probably remember how many
papers are placed in front of you to sign ? insurance authorization, privacy
rights, acknowledgment of treatment risks, etc.
</p>


<p class="MsoNormal"><i>Please sign beside the
X here, here, here and here.</i> </p>


<p class="MsoNormal">Yes, whatever you say.
Just let me see the doctor. I?m
sure everyone reads and understands all of the paperwork placed in front of
them, right?</p>


<p class="MsoNormal">The benefits of converting to an electronic medical record
system are many. Complete records can be
viewed anytime from anywhere, and records can be accessed concurrently by other
hospital staff. Any location with a PC,
proper authorization and access to the hospital network can be used to view an
electronic medical record (EMR). Faster
access from more places means medical staff can make quicker and better informed
healthcare decisions. Greater
coordinated care can be achieved by interfacing the EMR system with hospital
clinical applications, resulting in a more complete care assessment and reduced
critical errors. Improved hospital
workflow efficiencies can result in greater physician productivity and patient
care. Audit logs showing who accessed
which record and when can be maintained by system administrators. The ability to comply with HIPAA and other
government compliancy regulations can be achieved. The list goes on and on.</p>


<p class="MsoNormal">Likewise, paper records can only be checked out to one
person at a time and must be picked up in person or sent for. This can result in delays in patient care and
potential errors in critical decisions.
Also, many times the paper medical record remains incomplete, even
through follow-up reviews, while it takes time for various labs, x-rays and
tests to make their way into the paper chart.
Access audit logs are often not available.</p>


<p class="MsoNormal">Besides the above pros and cons, when a person becomes a
patient at a medical facility they grant a certain amount of trust to the
institution to make decisions about how best to provide a safe patient care
environment. In other words, I don?t
need to see everything that goes on behind the big red curtain. There are certain decisions best left to
trained professionals and not second guessed by the average lay man. If the hospital you are seeking care at spent
the money to research and implement an EMR system, you are indirectly opting to
have your medical record stored electronically.
In fact, a decision to install an EMR system is not made as an IT
decision, but requires heavy buy-in from physicians. If your preferred physician practices at a
hospital utilizing EMRs, it is likely that he or she bought in to the benefits
at some point; otherwise, they?d probably be practicing elsewhere.</p>

<p class="MsoNormal">I?m all for empowering people to make decisions concerning
their own welfare, but certain decisions are best left to trained
professionals. If patient care truly is the
hospital?s number one goal, storing electronic medical records as opposed to
paper records is an easy choice to make.
It pains me to see knee jerk reactions to media reports of data breaches
that could compromise patient care. Hospitals
should make a decision and stick by it.</p>

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Weighing the benefits of electronic medical records

by Jaqui In reply to Weighing the benefits of ...

There are drawbacks, besides the security breaches mentioned.<br />like the DHS' right to any records so stored from any company with an office in the US.<br /><br />when the local medical services plan contracted with a us based data storage firm to store all medical records for them, they put themselves in violation of the federal privacy laws.<br / yup Oz, BC Medical Services is in violation of F.I.P.P.A. ]<br /><br />

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Weighing the benefits of electronic medical records

by Nathank In reply to Weighing the benefits of ...

You hit the nail right on the head Bill, when you walk into a hospital the last thing you want to worry about is data fraud. Paper records have worked well in the past, however it is very easily for a data-hungry employee to just meander through the cabinets looking for data to steal or memorize. HIPAA has done what they can thus far to protect patients and their data, however the moral issues beyond it are what are costing people their medical records these days. You trust hospitals with your life, let's hope hospitals figure it out so that you can <a href="http://www.essentialsecurity.com/Documents/article3.htm">trust them with your data</a> as well. 

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Weighing the benefits of electronic medical records

by David_W In reply to Weighing the benefits of ...

<p>Of course we all know that a sharable file of your health records in your hospital is a 'good thing' but given the state of the National Health Service  (UK) project to automate records and bookings I am very sceptical when someone says  "trust me, I'm a professional"  for two reasons.</p>
<p>1- The quality of data security is poor because of staff turnover is faster than IT know about</p>
<p>2- Of course the media should react...knee jerk or any other kind of jerk...that is why they exist. They also keep the pressure on 'professionals' to act instead of going into denial.  We have a duty of care and have to be ready to explain what we do and why.</p>
<p>But then of course we don't have the level of damages and law suits in the UK as compared with the USA...yet !   Till then we must do our best to help the medical staff do their job....The big benefit is that on a computer screen they can read the history instead of struggling with illegible hand writing....</p>

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Weighing the benefits of electronic medical records

by Derek_R In reply to Weighing the benefits of ...

<p>This is a no-brainer. Notwithstanding that there have been security breaches, well-publicisized ones, no one has suggested that banks revert to the paper-based client account systems of 25 years ago. The benefits too far outweigh the risks; it would be a silly idea and everyone knows it. </p>
<p>So it is with Electronic Health Records (EHR). EHR will finally bring the management of clinical care into the modern world -- and about time, too. I've heard it said, as an argument against EHR (oddly), that people care more about their health records than they do about their financial records. That statement doesn't apply to me; personally, I would be more upset about disclosure of my bank information than I would about a breach of privacy of my medical records. That said -- I care WAY MORE about receiving professional, competent, timely, efficient healthcare than I do about convenient banking. </p>

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Weighing the benefits of electronic medical records

by Master Meng In reply to Weighing the benefits of ...

<p><span>Ya ay yah yah.... the thing is we all like tech, and rely on it daily, but some of us don't seem to be able to control our selves when it comes to a new convenient techie way of doing thins. This reliance on tech is the number one way identity thieves get our info...just stop o think about it, please.<?xml:namespace prefix =" o" ns =" "urn:schemas-microsoft-com:office:office"" /></span></p>
<p class="MsoNormal"><o><font face="Times new roman" size="3"> </font></o></p>
<p> </p>

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Weighing the benefits of electronic medical records

by Master Meng In reply to Weighing the benefits of ...

<p><span>Ya ay yah yah.... the thing is we all like tech, and rely on it daily, but some of us don't seem to be able to control our selves when it comes to a new convenient techie way of doing thins. This reliance on tech is the number one way identity thieves get our info...just stop to think about it, please.</span></p>
<p class="MsoNormal"><?xml:namespace prefix =" o" /><o><font face="Times new roman" size="3"> </font></o></p>
<p> </p>

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Weighing the benefits of electronic medical records

by john In reply to Weighing the benefits of ...

<p>EMRs are a no-brainer.  The evolution of all business operations to an electronic infrastructure is inevitable.  Computerization of operations in the bloated and ridiculously inefficient medical industry is long overdue.  I am sick of paying over $300/mo for insurance, $3/pill for Rx and then see that nobody in my Dr's office can even figure out the last time I was in there.</p>
<p>My favorite way to pass the hour or more I sit in the waiting room is to stand at the front desk and read the open paper files of other patients that I see laying all around the office.  I am not convinced that Dr's or anyone else in the industry are so concerned about privacy.  I think they are all just scared of knowledge and technology that they do not understand and have not spent a decade in school to learn.</p>
<p>Now, that said, I am concerned about DHS's need to ignore the privacy of medical or any other personal data.  I would recommend that any data storage service employed by any business that keeps private data be used post encryption.  Any discussions about DHS and personal data storage?  Any technologies that can encrypt data at a stage that is immune to the prying eyes of big brother?</p>

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