What a Wonderful Christmas

Well, the hustle and bustle of Christmas is over, and I must say that this was a GREAT year. The boys had a wonderful time and REALLY like this whole Santa thing.

Wesley loves his new train that he has already learned to operate on his own (he really likes the whistle). In addition, Wesley is having a great time with his new truck. He has been the proud chauffeur to Cameron as they parade around the yard finding trees to run into and mud holes to get stuck in :)

I have been really fond on my new Garmin Nuvi GPS which has been a wonderful upgrade for my ancient Garmin that I was using from way back in the day. The new model includes a color touch screen, bluetooth for my phone, changeable vehicles (that is fun) and options to change the voice as well. It will take me a while to get everything programmed into the unit, but I am very pleased and want to say a big thank you to Santa for knowing that is something I would really enjoy. I hear that my dad had one as well... apparently it was the year of the GPS for the Crisler men.

Stephanie and Greg had a very nice Christmas dinner which I was very thankful for. It was great not to have to worry about food in the middle of all of the festivities. The food was wonderful and it was great to share gifts in a nice family environment. I also should note that Greg and Stephanie have done a great job on their house-- it is really taking a new look with a new roof, landscaped yard, beautiful grass (I am jealous) and LOTS of space.

Christmas 2009 -- A BIG HIT, and a nice culmination to a great year.

Santa Clause is Coming To Town

It has been a great year and I cannot wait to see the look on the boy's faces when they receive their visit from Santa. This year I believe that Wesley is really going to enjoy Christmas and really remember what the fun that surrounds the season. I know that I have been enjoying his curiousity as well as his learning Christmas songs.

"Jingle Bells, Jingle Bells. Have fun. Have fun. Hey" That is his version :)

Windows 7

After many years of resisting change and always picking the 'Classic' options when available on a new Windows setup, I have taken the plunge.

Microsoft has definately come up with a winner in my book. While it certainly takes a little getting used to the new GUI and there are some frustrations with the 64 bit OS not being compatible with some of my hardware, overall this was a very smooth install and I am pleased with the results.

I am enjoying my web server with sql 2005 with windows 7 ultimate. The speed is fast, the built in options with Windows 7 are good (I really like movie maker), and the GUI makes it easy to navigate (after a while of figuring things out)... I also will say that it is nice that Microsoft did not criple Windows 7 features like they have in previous Windows versions. That has been another nice surprise with the upgrade and my utilization of some less than standard features of the OS.

The other really nice bit I will say is that disk defrag now will allow scheduling of multiple drives easily without creating funky tasks and setting each drive to run at a given time with some guarantee of no overlap. The new system is MUCH enhanced over that.

The down side... There are still a lot of security pop-ups. I get tired of authorizing software that I clicked on. It is too bad they cannot distinguish between software that is programatically initiated and software that is initiated by clicking directly with the mouse. For those software started programs, I actually appreciate the security warning, however, for things that I click with the mouse, the extra window takes time and has no true value.

ASP System Login Working

YEAH!!! After a long time struggling with my ASP.NET configuration I have finally completed a working connection between the server and my website.

Thus, the site now allows for authentication which I will utilize to increase the content available and restrict certain content to those authenticated at certain levels. I will also be able to allow friends to create an account such that I can know who they are and have conversations.

Now on to the next phase of development with the login! Slowly but surely I am getting all of this working!

Website Overhaul

After many months of the same thing, I am working to overhaul the site. You will note some changes. While things are not 100% the way that I would like them and they way they will likely stay, the site is quickly becoming more user-friendly, easy to administer, and more up with the current times of web development.

The new site features aspx menu driven content, breadcrumbs, template utilization, and most importantly is built on the principles of utilizing cascading style sheets to allow for rapid adjustment to the site as needed.

Hope you like it!

Potty Today

Parenting just got better! Yesterday Welsey crossed a real milestone. It was the first day of perfect potty. Wesley not only went pee pee but also poo poo and more importantly started to tell me when he needed to go. I was so proud of him I couldn't begin to express it.

Now the real trick will be to build the sustainability and to get ready for the frustration of constantly looking for a potty while we are out and about-- it was all worth it though. The cat and mouse playing stubborn and waiting him out finally paid off. I thought it was never going to work.

Fast Track a Go

After months of work and numerous headaches, we are T-minus 2 days for the start of the new Fast Track program.

I am really excited about this program as it truly is the right thing to do. The plan: manage low acuity patients in a low acuity setting and infrastructure. This allows us to charge lower rates which are reasonable for the conditions that patients are presenting with.

Although this is not going to be a positive impact for the bottom line, the hospital should be applauded for doing the right thing.

Now on to the fun-- we have to get the TAT for this venture to 60 minutes. More on that after the roll-out!

Server Online Again

My old server finally bit the dust. After being held together with a new power supply stolen from another machine, some memory to replace the worn out memory, two new hard drives, and a few other modifications to hold it together a few more months, my computer is officially dead.

I have replaced the old machine with another Dell (the last one held together really well). The new machine has 1.5 terabytes of storage so I should have no issues with the pictures and videos that I will want to share and it has a number of other great features that I have been missing since I have been working from a machine that was from the stone ages in computer time.

It is amazing to see what improved processing speed, faster hard drive, 6x more RAM and a good video card will do!

I am back online and all content should be uploaded within the next day or two to the new server. Please be patient. I am having to recover the files from my old drives since the number computer only uses SATA and all previous equipment was IDE.

*** Cameron is One ***

I have learned a lot being a father of two, and it is my great pleasure to be the father of another wonderful boy over the age of one!

Cameron had his birthday on Friday and we had a great time. He is into trains and so, of course, he received a number of trains for birthday presents. Cameron was very excited about these gifts and has been playing with them non-stop. I have enjoyed watching him grow and learn as he plays with these toys.

As an added treat to the birthday celebrations, Cameron is also now starting to walk. This has added a little extra spice to the occasion. Currently we are having a bit of balance trouble, but he is able to manage a good 3-5 steps before falling back to a crawl.

HAPPY BIRTHDAY CAMERON. I love you!

September 20 - The Swine Flu

Well it has been a few weeks since the start of the swine flu pandemic here in Memphis and I can say that I have lost a LOT of sleep over it.

Things were plodding along well as they were supposed to and then all of the sudden I get a call while on vacation in Pigeon Forge saying that the bottom has falled out at the hospital and patient volume is rising to never before seen levels.

I was supposed to attend a disaster planning session for 2 days after returning from my vacation, however, I was told that things were too crazy at the hospital and that I needed to report back to work ASAP.

After reporting back to work, it was clear that we were in uncharted waters. We were seeing >350 patients per day peaking around 420 in an emergency department that is staffed and budgeted to handle about 180 patients per day. It was clear that our current system was unsustainable.

After struggling with options and plans, it was finally determined that a flu screening tent would be utilized to manage the volumes and I, along with a few others, were charged with making this happen. Immediately we began preparing for the tent and within 12 hours of the decision, we had developed a protocol for medical screening, trained our first medical screeners, erected a 40x66 tent, placed porta-potties in the parking lot, created a screening form, and started to decompress the emergency department.

After another few sleepless nights working to ensure that the process was working and after a few new appearances, we are beginning to see the true benefit of the work that we are doing. Patient wait times have dramatically improved, patient satisfaction is at very high levels, total turnaround times are improving significantly and these things are all happening with never before seen levels of volume.

I cannot begin to say how proud I am of the great team that I work with which has made this happen. The RNs, RRTs, Medics, PCCs, and everyone else that has played a part in making the tent a success truly are heros! I never thought that it would come to providing care in a tent at a major metropolitian emergency department, however, I have to say, it is working very well!

Bulldozer

Today was the big day at Stephanie and Greg's to have some more of their dozer work done. Greg called in the AM to confirm that the work was going to take place and then we started the process of getting everyone ready to go.

At around 9:30 we made it to their house and Wesley was certainly excited. He came outside to check out the preparations to get the dozer going. After topping off the hydraulic fluid and greasing lots of places, the dozer finally cranked up and Wesley was there watching all the way. He was offered the chance for a short ride before the work started, however, Wesley declined by saying 'Dooooo' :)

The sun was high and hot, so we retreated to watching under the shade tree. There Wesley decided it would be fun to learn how to operate a 4 wheeler. With instructions from Greg, Wesley learned to start the engine. I am not sure that was such a good thing for him to learn, but there is no turning back now!

The real tough question for the day is not whether or not Wesley had fun because that is obviously be his grin and how dirty he is... the real question is whether he liked the dozer or the 4-wheeler more. I think the dozer scared Wesley a bit because of how loud it was. In either case, we had a great time.

As a side note, Stephanie and Greg's yard is really starting to look nice. They are working hard and it is paying off!

July 7, 2009 - Sliding for Fun

Well today was a great day for swimming. After work, I enjoyed coming home to a wonderful dinner and then heading to the pool for a nice evening swim. Wesley has decided that he no longer needs swimmies and so he ditched those and has moved to simply utilizing the lifejacket. In addition, he has decided that he is capable of doing all of the things that big boys do... like jumping off the ledge, going down the waterslide, etc. Wesley started off the evening with the waterslide and was having a blast. Then Julie joined into the fun for the first time since we opened the pool and seemed to also have a great time. Of course, as a big kid myself, I have been having fun on the slide since we got it :)

I had a great time watching the whole family enjoy the pool that we worked so hard to get ready... and now it is ready and LOTS of fun.

I should also note that Julie harvested the biggest squash out of the garden today that I believe I have ever seen. It was a monster.

July 4, 2009 - Enjoying the Holiday

What a wonderful day. There was a great breeze, the skys were a bit overcast helping to keep the heat down a bit. It was the perfect day to celebrate Independance Day.

Wesley, Cameron and I went to Albert's for his traditional get-together which was fantastic. There is nothing like some good BBQ chicken along with all the fixins. Although Julie had to work, she will get the opportunity to enjoy some ribs via rain check. This was a wonderful event.

Tonight, we will be going to shoot a few fireworks over the pond which will hopefully be fun. It is yet to be seen if Wesley and Cameron will like fireworks or if they will be scary. We will see...

July 2, 2009 - Vacation Planning

It is rapidly approaching that time! I haven't taken a true vacation where the plan was to relax and there were no side agendas for other events etc in a very long time and I cannot tell you how excited about the upcoming week of vacation that I am going to take with the family-- it is going to be great.

We are planning our trip to Dollywood, Splash Country and then we will enjoy some fun around Gatlinburg and relaxation in the mountains.

To help make the relaxation better, Julie helped to find the perfect cabin-- and I think she found it. She managed to find a place that has two bedrooms, two bath, WiFi access, is close to the resort pool, has a hot tub, jacuzzi in the master, kitchen, laundry, and many other fun perks for less than what the hotel was going to cost. I am proud of her for finding us this gem which makes me look forward to the trip even more-- too bad we can't leave immediately :)

More to come on the trip...

June 27, 2009 - Healthcare Reform

Why don't they get it?

The problems with healthcare are obviously a very complex; however, there are a few things that are at the heart of many of the issues.

It is time that the payers are removed from the beds of the hospitals and providers. Competition is stymied because providers are not forced to compete with one another, but instead they complete for the best contract with the insurers.

In addition to the issues created when competition is stymied, costs soar when the complexity of the payment system requires entire departments to manage. In the new healthcare model (the efficient model), the cost of care should be the cheapest for the person that has cash up front at the door and most expensive for the person with insurance that has very complex payment requirements.

Note that my push to change the model of payment does not mean that I do not support improvements in quality. Pay for performance and other concepts to force providers to have excellent outcomes and practice evidence based care. These are good things.

What I am really suggesting is that we must overhaul the system such that receiving payment for services provider as suggested by your physician should not be a complex issue. Submit the claim, get the payment, close the case.

So, how do we manage utilization in a system like this? That should be the responsibility of the individual insured party. When they contract with the insurer to provide coverage, information should be provided showing clearly what is covered and what the max payments for these services are. While I do not believe that insurers should contract with providers, it would be fine for insurers to note that a specific provider has a charge structure that is approved. This, however, should never be a negotiation. In the event the insured chooses to seek services which exceed the cost of their insurance coverage, the provider can agree to accept the insurance coverage as payment in full or the insured will be responsible for the balance of the bill.

I sincerely hope that we focus on FIXING healthcare rather than simply adjusting a few statements and increasing the complexity of the system. We aren't going to have a cheaper healthcare system by simply leveraging more technology.

June 24, 2009 - Jackson Paramedic Students

Today I went with Kaye and Sherrie to teach PALS to Jackson State Paramedic students. I was very impressed with their knowledge and skill level. These students asked a lot of great questions and were all eager to learn. The area around Jackson is very lucky to have such a great group of students coming out of the program. I wish all of these students the best of luck to pass their paramedic national registry exam and I hope to be working with these professionals soon. Every now and then it is fun to get back into the clinical mindset :)

June 23, 2009 - A Day Without a Cell Phone

It was the best of times. It was the worst of times!

Today I left my cell phone at home. Never did I believe that not having my cell phone would be considered a catastrophe; however, I found out today just how attached to technology that I have become. I depend on my phone to wake me up in the morning, guide me through my schedule throughout the day, inform me of new important (and sometimes uninportant) information that becomes available during the day, and to provide a communications link to me wherever I am and whatever I am doing.

That really is starting to sound more like a ball and chain than a cell phone, but that is what I depend on it to do for me. A day without it was quite a challenge.

On a different note, I wanted to also say a special thank you to Julie, Wesley and Cameron today for the wonderful Father's Day gift of shoes that I received. My feet appreciated a nice pair of shoes all day... and I am sure I will get many more days of good wear. Thank you!

June 21, 2009 - Father's Day

Today I am the proud father of two great boys, but I am especially proud of Wesley. After working for the past few weeks to teach him to swim and be comfortable in the water, Wesley took off in the pool today.

With his swimmies on and his life-jacket donned, Wesley proved that he had learned what his daddy taught him. I tossed the ball into the water and he jumped in, began kicking his feet and working his hands taking him straight to the ball where he grabbed it and brought it back. The game of fetch was on!

Wesley played the game of fetch until I was tired and we went inside together to share in a bottle of gatorade and a bag of cheetoes. I don't know who had the bigger grin-- me or Wesley, but we both had great fun.

I got the best father's day ever-- a whole day with the boys!!! I am so proud to be daddy to Wesley and Cameron. They are great boys and I look forward to seeing what they learn each day. They are growing so fast.