The study reviewed 3,291 patient records and looked at both procedural (incomplete, unclear medication orders) and clinical (e.g. wrong dose, wrong drug) errors, and rated the potential severity of the errors (minor to serious). The researchers found that procedural prescribing error rates fell by more than 90 percent, and the most serious prescribing errors declined by 44 percent.

German Hörrohr

“The study provides persuasive evidence of the value of commercial e-prescribing systems to significantly and substantially reduce a range of prescribing errors,” said study leader Professor Johanna Westbrook, from UNSW’s Australian Institute of Health Innovation.

The 60 percent reduction was far beyond anything anticipated, Professor Westbrook said. Previous attempts to reduce prescribing error rates in hospitals - such as the introduction of a standardized National Inpatient Medication Chart - had resulted in an improvement of only around four percent.

“Prescribing errors are among the top hazards faced in a hospital setting,” said Ric Day, a Professor of Pharmacology who helped implement a commercial e-prescribing system at Sydney’s St Vincent’s Hospital. “From a clinician’s point of view this is an incredible result given the prevalence and the intractability of the problem. It’s even more significant given that we expect to see greater reductions once user support is added to the systems.”

Australian hospitals are only now starting to make multi-million dollar investments in e-health technologies. “Most of this technology was developed in the US with the big medical centers designing their own customized systems. Hospitals in Australia can’t afford to do that, so they’re taking commercial off-the-shelf systems. We set out to see whether these systems are as effective as the home-grown ones,” Westbrook said. She stated more research was required to ensure the new technologies were both effective and safe. Despite the significant improvements, the study found that the new technology - which demands changes in doctor, nurse and pharmacists’ work practices - also introduced new errors.

“e-prescribing systems can be very effective, but we need to monitor them closely,” Westbrook said. “They can unwittingly introduce system-related errors such as a clinician accidentally selecting the wrong drug name from a drop down menu. Systems are most useful when they provide user support to guide clinicians in their decision making. The systems we examined had very limited decision support and thus we would anticipate that, with support added over time, even greater reductions in medication errors can be achieved.” The findings were first published in the magazine PLoS Medicine.

Medical technology has come a long way from the early stethoscope (a German Hörrohr dating back to the 19th century is shown in the illustration). Computer based electronic prescribing technology or e-Rx can reduce errors between 58 and 66 percent, new research conducted in Australia shows. Illustration: Meyers Lexicon/Public Domain

“This is the biggest annual growth we’ve seen for this market since 2008,” said Colleen Graham, research director at Gartner. “Pressures to optimize costs and efficiencies in a heterogeneous IT environment are driving organizations to turn to MDM as a more efficient way to manage and maintain data across multiple sources. In addition, the increasing governance, risk and compliance regulations are forcing organizations to focus on MDM to support these initiatives.”

From a regional perspective, North America and Europe will drive the demand for MDM, and both regions will grow at a steady pace to reach the billion-dollar mark, in 2013 for North America and in 2015 for Europe. In 2013, MDM software revenue will see faster growth in Asia/Pacific, where revenue will increase by 30 percent from 2012 to reach $209 million. “MDM has become a critical discipline required for dealing with the challenges of social data, ‘big data’ and data in the cloud,” Graham said.

Within the overall MDM market, more than half the revenue is driven by products from small and best-of-breed vendors, as the market continues to favor specialized solutions over "generic" offerings. However, the overall MDM market is dominated by three major players - IBM, Oracle and SAP.  “In the next four years we expect larger vendors will continue to acquire for this specialization while smaller vendors will acquire each other to build market share and increase the functionality within their portfolios,” said Chad Eschinger, research director at Gartner.

However, the variety of technologies that can be applied to an MDM initiative leaves the door open for the entrance of data integration and data quality providers, in particular. As more midsize organizations adopt MDM in the course of the next four years, they are demanding lower prices and more flexibility from vendors. As a result, many new MDM vendors and offerings capturing this market will be focused on areas such as open source, as well as cloud computing/software as a service.

The largest domains are MDM of customer data and MDM of product data, each of which is predicted to more than double in size over the next four years. MDM of customer data helps an organization cross-sell and cross-market, as well as retain customers and provide a consistent high-quality customer experience. The market for MDM of customer data is expected to reach $644 million in 2012 and to exceed $1 billion in 2015. The market for MDM of product data, which helps an organization store product-related master data, metadata, or both, is projected to reach $688 million in 2012 and to surpass $1.1 billion in 2015.

“The increased demand for more effective decision-making and a focus on improving the timeliness and accuracy of business decisions makes MDM paramount for organizations,” said Graham. “MDM supports these goals by ensuring the high quality of key data needed at the point of decision, removing uncertainty and increasing confidence.”

"This has the potential to shift the arms race regarding censorship to be in favor of free and open communication," said J. Alex Halderman, assistant professor of computer science and engineering at U-M and one of Telex's developers. "The Internet has the ability to catalyze change by empowering people through information and communication services. Repressive governments have responded by aggressively filtering it. If we can find ways to keep those channels open, we can give more people the ability to take part in free speech and access to information."

Today's typical anticensorship schemes get users around site blocks by routing them through an outside server called a proxy. But the censor can monitor the content of traffic on the whole network, and eventually finds and blocks the proxy, too.

"It creates a kind of cat and mouse game," said Halderman, who was at the blackboard explaining this to his computer and network security class when it hit him that there might be a different approach, a bigger way to think about the problem.

Halderman envisions that user could download Telex software from an intermittently available website or borrow a copy from a friend. Internet Service Providers (ISPs) outside the censoring nation deploy equipment called Telex stations. When a user wants to visit a blacklisted site, he or she would establish a secure connection to an HTTPS website, which could be any password-protected site that isn't blocked. This is a decoy connection. The Telex software marks the connection as a Telex request by inserting a secret-coded tag into the page headers. The tag utilizes a cryptographic technique called "public-key steganography."

"Steganography is hiding the fact that you're sending a message at all," Halderman said. "We're able to hide it in the cryptographic protocol so that you can't even tell that the message is there."

The user's request passes through routers at various ISPs, some of which would be Telex stations. These stations would hold a private key that lets them recognize tagged connections from Telex clients. The stations would divert the connections so that the user could get to any site on the Internet. Under this system, large segments of the Internet would need to be involved through participating ISPs.

"It would likely require support from nations that are friendly to the cause of a free and open Internet," Halderman said. "The problem with any one company doing this, for example, is they become a target. It's a collective action problem. You want to do it on a wide scale that makes connecting to the Internet almost an all or nothing proposition for the repressive state."

The researchers are at the proof-of-concept stage. They've developed software for researchers to experiment with. They've put up one Telex station on a mock ISP in their lab. They've been using it for their daily web browsing for the past four months and have tested it with a client in Beijing who was able to stream YouTube videos even though the site is blocked there.

Turning the whole web into a proxy server could make it virtually impossible for government to block individual sites or services such as YouTube, for example. Today's typical anticensorship schemes are more like a game of chess, allowing users to create a uncensored route through an outside proxy until the censor catches up. Photo: www.imagine-your-world.com

"End-user application development (EUAD) is nothing new, but the risks and opportunities it presents have become much greater in recent years," Ian Finley, research vice president at Gartner, says. "In the past, EUAD posed limited risks to the organization because it was typically limited to a single user or workgroup. However, end users can now build departmental, enterprise and even public applications. While this change enables organizations to empower end users and releases IT resources, it also heightens the risks of EUAD."

IT organizations need to adapt to the new realities of EUAD and build a citizen developer support program, the company recommends. While the potential for end-user application development is great, the risks to the business of poorly managed (or unmanaged) EUAD can be severe. Gartner predicts that by 2014, at least a third of enterprises without formalized citizen developer governance policies will encounter substantial data, process integrity and security vulnerabilities.

"EUAD is being transformed by several converging forces, including changing workforce demographics, the mass customization and maturation of service-oriented architecture, simplified tools for new development and the power of cloud computing for delivering IT capabilities to end users with no IT assistance," said Eric Knipp, research director at Gartner. "Fighting these forces is a losing battle, but a citizen developer program can reduce the risks and unlock potential in EUAD."

IT leaders should work with the business to identify just-enough governance to enable and protect citizen developers and mitigate risks such as the reproduction of similar applications, inadequate application life cycle management (ALM), the delegation of responsibility for failed projects to the IT department and the ignorance of best practices in security, performance, etc.

"If end-user developers are ignored, and they build applications without help or knowledge from the IT organization, then there is a real risk that they will fail miserably and create an unplanned burden for IT," Knipp said. "When an application is mission-critical - as often is the case with unmonitored tools used in business areas - the pain for the IT staff is even more acute. IT leaders must be proactive in managing citizen developer initiatives by providing tools that enable transparency in monitoring, change control and analytics. Even if IT is not at the wheel, it should keep a close eye on the dashboard."

IT organizations should manage the inherent risks of EUAD by educating citizen developers where they must tread lightly, and offer platforms with the "sharp edges" removed.

NVMM technologies, such as phase-change memory, hold great promise to replace conventional dynamic random access memory (DRAM) in the main memory of computers. NVMM would allow computers to start instantly, and can fit more memory into the same amount of space used by existing technologies. However, NVMM poses a security risk.

Conventional DRAM main memory does not store data once the computer is turned off. That means, for example, that it doesn’t store your credit card number and password after an online shopping spree. NVMM, on the other hand, retains all user data in main memory even years after the computer is turned off. This feature could give criminals access to your personal information or other data if your laptop or smart phone were stolen. And, because the data in the NVMM is stored in main memory, it cannot be encrypted using software. Software cannot manage main memory functions, because software itself operates in main memory.

“We could use hardware to encrypt everything,” explains Dr. Yan Solihin, associate professor of electrical and computer engineering at NC State, describing hardware encryption system called i-NVMM, “but then the system would run very slowly - because it would constantly be encrypting and decrypting data. Instead, we developed an algorithm to detect data that is likely not needed by the processor. This allows us to keep 78 percent of main memory encrypted during typical operation, and only slows the system’s performance by 3.7 percent.”

The i-NVMM tool has two additional benefits. First, its algorithm also detects idleness. That means any data not currently in use is automatically encrypted. This makes i-NVMM even more secure than DRAM. Second, while 78 percent of the main memory is encrypted when the computer is in use, the remaining 22 percent is encrypted when the computer is powered down.

“Basically, unless someone accesses your computer while you’re using it, all of your data is protected,” Solihin says. i-NVMM relies on a self-contained encryption engine that is incorporated into a computer’s memory module – and does not require changes to the computer’s processors. That means it can be used with different processors and different systems. “We’re now seeking industry partners who are interested in this technology,” Solihin says.

The paper, “i-NVMM: A Secure Non-Volatile Main Memory System with Incremental Encryption,” will be presented June 6 at the International Symposium on Computer Architecture (ISCA) in San Jose.

Advanced Credit Cards with smart-card capabilities use an embedded chip to compute cryptographic algorithms. Photo: www.imagine-your-world.com