New Office in Chennai

26 06 2012

by Anthony Subbiah

Click to see more photo’s of our new offices.

This is a great milestone for our organization. Finally a nice office for our Chennai team. I am sure a lot of effort went into making this move happen with minimal business interruption; and significant effort to build it out.

This brings back the memories of 2007/08 and working conditions in New Delhi as well as Chennai. Even in those days, New Delhi had a decent office. I guess Rahul always makes sure of that!!!!!!!!!!!!!!!! Chennai, those days was a different story. Two small apartments, couple of desks and sofa which used to convert to bed…………………. which I used to the maximum. With Nanda, Andy and Hareesh and all the Dosais, Idlis, etc……. and early morning visits to restaurants.

This was in 2008; not too long ago. And we have come a long way since then. If I remember correctly, Rahul and team were working on the EDI engine and all the good stuff. We probably had 3 or 4 clients then.

Journey has been certainly interesting; its truly a joy to work with a team that’s passionate. And I am inspired by many in our team.

This is certainly a milestone; many more to come.

Congratulations to all.

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An old article on state of healthcare and how it applies to ACO and MSSPs

16 08 2014

“The Cost Conundrum” This article was published in The New Yorker and authored by Atul Gawande.
“What a Texas Town can teach us about health care”

This is a great article and to read more click

http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum

Some excerpts:

“McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.

McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”

This article was published in 2009.  Managing more than a handful of ACOs, we get to understand this is an understatement – knowing fully well, in some geographies with renowned hospitals, the cost is closer to $20,000 per life on an average per year.

We tend to agree with our President’s comments:

“The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

The author goes on to state:

“I was impressed. The place had virtually all the technology that you’d find at Harvard and Stanford and the Mayo Clinic, and, as I walked through that hospital on a dusty road in South Texas, this struck me as a remarkable thing. Rich towns get the new school buildings, fire trucks, and roads, not to mention the better teachers and police officers and civil engineers. Poor towns don’t. But that rule doesn’t hold for health care.”

Author goes on to transcribe a conversation about the high cost of healthcare in this town:

One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

Interesting article published in 2009.  Many of these challenges are overcome by empowering Primary Care Physicians to coordinate care and also be paid for the performance through ACOs and PCMH Incentives.  To read more about this please visit http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum





Outage at Facebook and our Rahul Diwan’s reflection………….

4 08 2014

Recent service disruption to Facebook’s services brought about anxiety to many of Facebook users; it goes on to prove how Facebook and social media have become an integral part of our lives. So much so, that even a 3 hour outage creates panic among the loyal users.  Rahul, EHI’s Chief Architect, reflected on this incident and reproduced verbatim:

“Facebook also went down due to technical issues and the whole web was full of stories indicating the world is coming to an end. Below is the official notification from facebook, interesting part is the section which i have marked in bold. This is quite similar to a challenge we have faced once. Web servers and others servers connected to a database server network create tonnes of queries every second. When the DB service goes down and you try and bring it back up, you will face continuous slowness for a extended period of time. The only solution is what Facebook guys did, put your traffic generators down (put the web servers down), so that the DB can come back to normal processing state and then switch on the web servers sequentially to let the DB server adapt to the sequentially growing demand and then auto adapt to full load. There are other ways also to do this, but this a proven method to get back things up in the shortest possible time”

Facebook’s communication was detailed and honest:

More Details on Today’s Outage

Early today Facebook was down or unreachable for many of you for approximately 2.5 hours. This is the worst outage we’ve had in over four years, and we wanted to first of all apologize for it. We also wanted to provide much more technical detail on what happened and share one big lesson learned.

The key flaw that caused this outage to be so severe was an unfortunate handling of an error condition. An automated system for verifying configuration values ended up causing much more damage than it fixed.

The intent of the automated system is to check for configuration values that are invalid in the cache and replace them with updated values from the persistent store. This works well for a transient problem with the cache, but it doesn’t work when the persistent store is invalid.

Today we made a change to the persistent copy of a configuration value that was interpreted as invalid. This meant that every single client saw the invalid value and attempted to fix it. Because the fix involves making a query to a cluster of databases, that cluster was quickly overwhelmed by hundreds of thousands of queries a second.

To make matters worse, every time a client got an error attempting to query one of the databases it interpreted it as an invalid value, and deleted the corresponding cache key. This meant that even after the original problem had been fixed, the stream of queries continued. As long as the databases failed to service some of the requests, they were causing even more requests to themselves. We had entered a feedback loop that didn’t allow the databases to recover.

The way to stop the feedback cycle was quite painful – we had to stop all traffic to this database cluster, which meant turning off the site. Once the databases had recovered and the root cause had been fixed, we slowly allowed more people back onto the site.

This got the site back up and running today, and for now we’ve turned off the system that attempts to correct configuration values. We’re exploring new designs for this configuration system following design patterns of other systems at Facebook that deal more gracefully with feedback loops and transient spikes.

We apologize again for the site outage, and we want you to know that we take the performance and reliability of Facebook very seriously.





Enable Healthcare Inc (EHI) achieve Meaningful Use Certification for Phase II – MU II

2 08 2014

Enable Healthcare Inc. MDnet V6.0_Complete Ambulatory Compliance Certificate 2014 Edition Rev-15May2014

Team EHI is proud to announce the achieving of Meaningful Use Phase II Certification and thank the Certification Body Drummond Group for a exciting and educational certification process.

This was not an easy process with the levels of complexities involved.   It again goes on to prove, the power of Team EHI and what they can achieve when they put their mind to any task.  There were many members of the team who had successfully completed their deliverables while also taking care of day-to-day operational responsibilities.

A great, well executed project by the entire team led by Rahul, joined by Sandeep, Andy and several others playing important roles.  A true testament to team work.

Congratulations to all involved.





24 Hours – A Reflection!

30 06 2012

by Anwer Qureishi

“Warp speed ahead, Mr. Spock” — Capt. James T. Kirk of starship Enterprise

It was late last night and I was driving. As usual my mind started wandering and after a while it rested on thoughts of human achievement and then as I glanced at the clock it said 11:59 PM. The first thing that came to mind is that we have just 24 hours left on the Mission: Small Business. With a team effort EHI has qualified as a contender in the challenge and we are leading in the healthcare category for the grand prize of $250,000. We were not only able to exceed our required 250 votes but also support our partner VIP Doctors & Patients in this round.

Our minds are an amazing creation (and I choose to use the word “mind” intentionally “ instead of “brain” – that’s different discussion altogether).

What can you do in the next 24 hours  to make a difference? Click on image to visit EHI on Facebook

So getting back to my drive, my mind finally rested on the thought of human accomplishment and specifically examples of feats accomplished in a 24 hour period. For the last two hours I have been immersed in looking up and reading on incredible feats accomplished by individuals and teams alike. When it comes to accomplishments Guinesss World Records is an obvious place to start. (Note, the word “book” is now missing from its name): http://www.guinnessworldrecords.com/Search.aspx?q=24+hours

  • Jeff Ondash, 51, of Canfield, Ohio, has embraced the Valentine’s Day spirit faster than anyone before, giving 7,777 hugs in 24 hours, raising money for the American Heart Association, and setting the new world record for the Most Hugs Given in 24 Hours.
  • The Women’s world record on Track is held by Mami Kudo (JPN) who ran 254.425 km/158.126 miles in Taipei, TAIWAN Dec. 2009.
  • The most push ups completed in 24 hours was 46,001 by Charles Servizio (USA) in Fontana, California, USA, on 24-25 April 1993.
  • The greatest distance covered under sail in 24 hours is 766.8 nautical (1,420.1 km; 882.4 miles) by the 36.5-m (120-ft) maxi catamaran Orange II captained by Bruno Peyron (France), during the fastest crossing of the Atlantic between 2-7 July 2006. The average speed was 31.95 knots ( 59 km/h or 36.7 mph).
  • The most tattoos in 24 hours by a single artist is 801 and was achieved by Hollis Cantrell (USA) at Artistic Tattoo in Phoenix, Arizona, USA, on 16 November 2008.
  • The most trees planted in 24 hours by a team of 300 people is 611,137 and was achieved by the District Administration of Dungarpur (India) at village Khemaru, village panchayat Gadamoriya, Dungarpur, India, from 11 to 12 August 2009. Beginning at 7:15 p.m. on 11 August, participants dug holes for the trees through the night and began planting at sunrise at 6 a.m. the following morning. The trees planted were of species native to the region, mostly fruits and vegetables for consumption by the local population.
  • The most “likes” on a Facebook page in 24 hours was 2,047,058 by Farmers Insurance (USA), on 22-23 June 2011.  Farmers Insurance ran a promotion with Zynga. Throughout the day this promotion ultimately resulted in 6 million views.
  • For the auto racing fans amongst us LeMans is an amazing race of endurance. The person that won Baja 1000 in 1967 took 28:48 and 2011 winner took away the trophy in 14:14:25.

Then there are other significant events in history that changed the course of the world for example, D-day on June 6th 1944 and the list goes on. If there is an example you’d like to share please post it as a comment below.

Anyhow, as you look through the list some may appear mundane and you may say “WHY would anyone even attempt it?” or “it’s ridiculous or stupid” or “I could have done that!” However the point is that it was important enough for someone to pursue despite the odds they may have faced.

There is a common underlying theme in all accomplishments whether they were completed in 24 hours or a lifetime. PASSION is the key to success which leads to human achievement, ignites the fire within us  and serves as a conduit to PERSEVRANCE and ultimately SUCCESS.

LIVE a passionate life!





“VIP Doctors & Patients” Enhancing Patient and Doctor Communication!

25 06 2012

A guest post by Jeffrey R. Darna, DNP(c), APN of VIP Business Solutions LLC

Given all of the stressful situations life brings, communicating with your health care provider should not be one of them. VIP Doctors & Patients streamlines the communication between doctors and patients. The resources provided include personal health record management, online appointment bookings, and prescription refills. Further, once joining VIP Doctors & Patients users can access lively discussion boards about various health issues and health tips. VIP Doctors & Patients improves the connection between health care providers and patients allowing users to access health information anytime, anywhere.

The site is divided into two entities.

VIP Patients caters to the needs of patients allowing them to book appointments and monitor their personal health records.

Click on image to visit VIP Patients, JOIN, it’s FREE

VIP Doctors caters to the needs of physicians and their practice such as monitoring doctor referrals and accessing medical records.

Click on image to visit VIP Doctors

VIP Patients Personal Health Record tools thoroughly and effectively monitor patients’ medications, emergency contacts, allergies, medical history, surgical history, hospitalizations, immunizations, health care providers, vitals, and insurance information. For those with hypertension, diabetes, and high cholesterol, VIP Patients offers easy to use tools to manage these long-term illnesses, especially between doctor visits. Patients can log their vitals using the management tool and compare results over time. This information can be shared with a healthcare provider to optimize the patient’s medical management.

There is no wait to book an appointment online with VIP Doctors & Patients – it is quick and simple. Patients can search by doctor or aliment and view appointment openings. Refilling a prescription is just as easy. Patients simply select their pharmacy and enter their prescription information.

Doctors can use VIP Doctors to make their practice more efficient. Instead of calling various offices for patient information, everything pertaining to each patient’s medical history will be in one place, saving time and money.

Enable Healthcare (EHI) enables physicians to provide patient centric care through effective use of Health IT. Together EHI and VIP Doctors & Patients provide a connected interface for EHR management. These services are growing and accelerating the adoption of EHR. This interconnected interface has everything a practice needs in one place.

Together EHI and VIP Doctors & Patients and YOU can make a difference. Help us gain the recognition by VOTING for us in the Mission: Small Business – JP Morgan and Living Social Challenge.

We appreciate those of you who have already VOTED for VIP Doctors & Patients. For those who have not VOTED, please follow the instructions below:

Click on the image to vote for “VIP Doctors & Patients”

  1. Click on ‘Login and Support’ Button on lower right corner
  2. Login with your Facebook credentials
  3. Enter ‘VIP Doctors & Patients’ in the Business Name box
  4. VIP Doctors & Patients will appear on the top of list
  5. Click to SUPPORT
  6. Like VIP Doctors & Patients on Facebook at http://www.facebook.com/vipdoctors

Your SUPPORT is much appreciated. Thank You!





Social Media is powered by Trust!

22 06 2012

by Anwer Qureishi

Click to vote for EHI on Mission: Small Business

If you’re on any of the hundreds of social media tools including Facebook, LinkedIn or Twitter etc. and haven’t read “Six Pixels of Separation” by Mitch Joel – you owe it to yourself to pick up a copy. It is an excellent book to integrate digital marketing, social media, personal branding, and entrepreneurship in a clear, entertaining, and instructive manner that one can understand and apply.

Social media and advances in technology have changed the way we connect and it enables us to have direct access to decision makers and influencers. I am not referring to celebrities that general public flock to in the millions but people that are in the forefront of thought including Guy Kawasaki (@guykawasaki), Gary Vaynerchuk (@garyvee), Tony Hseih (@zappos), Dr. Kevin Pho (@KevinMD) or Farzad Mostashari (@Farzad_ONC) etc..

What do all of these people have in common? Following traits create an environment of trust, foundation of any thriving community:

  1. Passion: They believe in their respective cause.
  2. Focus: Relentless focus inspires all around them.
  3. Commitment: It’s not a get rich quick scheme, takes time to prepare and execute. It’s a marathon as opposed to a 100 meter sprint.
  4. Communication: They communicate simply and directly without resorting to industry buzz words to impress others.
  5. Social Responsibility: They are genuinely willing to help, to give back and practice “Pay It Forward” thinking.
  6. Integrity: They are ethical in their business and personal dealings.

We, at EHI strive to uphold the highest standards and it was evidenced recently when we received requests from several small businesses to barter votes in the Mission: Small Business https://www.missionsmallbusiness.com/  challenge sponsored by JP Morgan Chase, Living Social and Facebook. Our team swiftly stepped forward and responded back to these contenders informing them that vote trading is not permitted within the rules and not in the spirit of competition in social media. It is a grassroots movement and every vote must be earned with your trust. The deadline to vote is June 30th 2012, so if you haven’t had a chance to vote yet please do so and share our message within your respective communities of friends, relatives, neighbors, classmates, colleagues etc.

Thank you!