"A huge thing"

A recent comment on this blog observed that Community's intention to join with Upstate "is a huge thing" and employees "have every right to be scared."

It is a big deal, and not only for employees, but for the medical staff and for the community-at-large. It's a big deal in response to the big changes affecting all health care providers. There is an ongoing, significant consolidation in health care.

Look at what has happened to doctors in our community. A number of medical practices have merged, some doctors have left practice, and some groups have been acquired by hospitals. These changes over a number of years have consequences on services available at hospitals and on how much it costs hospitals to provide the services.

Add to that the higher costs of running a purchase cialis (hospitalists, for example); the higher cost of mandates (such as electronic medical records); the cost of new technology; the restrictions, rules, the cost containment we have seen (and will continue to see) in Medicare and Medicaid, (and the limited ability of insurers and employers to make up the difference) -- these forces are inexorable, and they make the financial situations of stand-alone, community hospitals very difficult indeed.

We have seen this coming for a number of years. As I pointed out in my remarks before the Central New York Health Systems Agency (CNYHSA), the Syracuse hospitals have been considering mergers and consolidations since the 1990's.

I used the slide (above) to remind the CNYHSA about the various studies and reports that have recommended that Syracuse hospitals consolidate. You can find my full presentation here (click on "Tom Quinn's PowerPoint").

Community General cheap cialis is part of this industry-wide consolidation, and I expect such consolidation to continue, even increase, among New York's hospitals in coming years.

The question is not whether we can avoid such consolidation. The question is, given the massive changes in health care, what is best for our community and for the health care people caring for our community?

That’s why Community has sought a merger partner, first with Crouse Hospital and ultimately with Upstate Medical University. That is our Board’s responsibility – to assess the situation and, given the changes and the realities, to determine how Community General should best serve the community-at-large in the future.

There are and will be many technical and legal issues affecting the Community General combination with Upstate. All these issues have not yet been resolved. I believe our path with Upstate makes the most sense for our community, for Community’s employees, and for the medical staff.

We are working with Upstate to assure that Community’s mission, services and jobs continue as part of Upstate's larger organization and purpose. Let me call attention to the guiding principles, developed by Community and Upstate (available here), in which the importance of the existing workforces is recognized at both organizations. Upstate is a fair and honorable partner for Community, and I have confidence that the combination will ultimately be in the best interests of Community's employees.

For the most up-to-date information regarding affiliation and workforce issues, please see the Q&A section of the Community-Upstate website.

Tablets, the Clipboard of the 21st Century

We shouldn't be surprised at the appeal the iPad, as the first mass market tablet, has encountered.  Many of us have had touch screen smartphones for over a year or more now.  My Samsung Instinct, other's iPhones or Android phones are really nothing more than mini-tablets.  The iPad, and the many order cialis that will follow it to market really just give us more real estate on which to work.



The iPad is aimed as a media consumption device.  You read books, magazines, web sites, and watch videos easily on it.  It hasn't really been pushed for any kind of business setting, although many are using already at work.



I have been thinking about how every job that needs a clipboard can benefit from a tablet.  The most obvious is a doctor's office or hospital.  My doctor walks into the examining room and immediately sits at the computer and pelting me with questions.  After the exam, he sits down again at the computer.



When I was last in the ER (ice, parking lot, head on pavement, no worries), the doctor walked into the examining room with a laptop on a nifty rolling cart.



When I last visited someone in the hospital, I found their doctor having just come from their room, awkwardly writing up his notes in her chart, while standing.  Those notes I assumed would get entered into a computer somewhere by someone other than he; a point of failure if ever their was one.



Imagine a doctor roaming around with an iPad?  The hospital or office setting is a highly controlled environment so wi-fi coverage is simple to arrange.



They pull up a patient's record on the way to their room, see nursing and medication notes since their previous visit.   During the visit, if the doctor needs to check medication interaction, or even look up something in their old text book, it is right their on their tablet.  Any changes to treatment, they can enter in right there, and it is sent to a central system for archiving, and sent out as a "work order" of sorts to a nurse's tablet.



The Washington Post talks about this, and more, including pulling up x-rays and other test results right on the iPad.



The iPad isn't that readable in sunlight, but other screen technologies are.  I can see cheap cialis designed for daylight useful to Auto Shops.  As the in-take person walks around the car with the owner figuring what is needed, he enters it on tablet.  Again, work orders appear on base stations in the repair bays.



Coaches can have a ready catalog of plays, stats on performance, scouting reports, etc. all on their magical clipboards.  They can make notes during practice and more.



Walk onto a car lot, and the salesperson can check stock for your needs right there in the lot.



Touch user interfaces, whether on tablets, phones, or dedicated units are going to change a lot of our already rapidly changing world.