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November 28, 2005

New additions to Medlogs.com

So it's been a while since I've added to medlogs.com.  Here are a few standounts from the 20-or-so recent submissions that I added today.  If your blog was submitted but it doesn't yet appear in Medlogs - chances are that you don't have a valid RSS feed (blogmd.net, msspnexus blog, etc) or that our editorial board (me) decided that the weblog has commerce as a primary goal rather than the sharing of information.  Some blogs are on-the-edge of this (such as drjohnlapuma.com) and have been added to the "more"section. 


  • Christina's Considerations focuses on "workplace effectiveness, regional health information exchanges and health information technology, and healthy children and families."  She recently posted a sample RHIO executive director job description. 

    RHIOs are all-the-rage these days - and our area is no different.  Trouble is - no one can agree on what a RHIO should be.   My concern is that the primary goal of a RHIO - to improve the care of the patient - is often secondary to more selfish goals of an orginazation.  Unless the providers ina  community cal really agree on the basic principles - a RHIO is not likely to succeed. 
  • Dr GNU is a podiatrist and has interests in open-source software.  Not many posts yet ...
  • The Fat Doctor.  'nuf said?  Excellent.
  • Cosmic Watercooler is a nurseblog:
        "I am an RN and I don't know why.
         I like it, but the pay sucks.
         I have a wonderful family and that's all that matters."
  • The Healthcare IT guy and Neil Versel's Health IT Blog are about .. um .. healthcare IT.
  • And of course .. there is a new bird flu blog.
There are many more .. and as always - the resident/student blogs offer some of the best ..

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November 26, 2005

Web Host Trouble

The Web host that provides services for Docnotes.net and medlogs.com has had some difficulties recently.

About 10 days ago (as you may have noticed) the server was down for about two days.  This is because one of their servers (srv2) needed to be replaced. they moved all of the clients off of that machine and onto new machine (srv3). 

Today's difficulties are described in their response to the trouble ticket pasted below.

Unfortunately, they made no mention of this on their web site - and the whole thing bothers me enough that I think it might be time to move to new Web host that offers some redundancy or just move it to one of the servers that we host ourselves.  Originally, we were on a very inexpensive plan with this host, and "you get what you pay for" was understood and accepted.  At this point, we are paying $30 per month in light of the band with required to support medlogs.com.

I think for that much, a little redundancy would be in order. 

----------------------------

Here are the details for any one bored enough to be interested: 

 

 ---11/26/2005 4:29:59 PM---
(Apologies for the cut/paste response, but we are attempting to keep everyone up to date on this issue as quickly as possible) Earlier this morning srv3 stopped responding to requests. After attempts to gain access to the server remotely were uneffective, a reboot of the server was attempted via our APC remote switch, but the server still would not come back online. A tech at the datacenter was dispatched to investigate the issue and we are currently awaiting word back from them as to the cause of the issue and a solution. As soon as we have more information we will continue to update all open tickets on the issue.

---11/26/2005 6:55:10 PM : CLOSED ---
Apparently the cause of this mornings srv3 failure turned out to be a faulty RAM chip, which caused a kernel panic and the machine to freeze up.  When we attempted a remote reboot and the system did not come back online immediately, the tech who was sent to investigate discovered that the machine had encountered another kernel panic during the boot up process, and begun the process of diagnosing the root of the problem.

Ultimately replacing both sticks of RAM in the server with new ones, the machine would successfully boot up, but wanted to perform a full fsck of the drives to ensure no data-corruption had occured.  The technician allowed this process to run it's course (which took a couple of hours) and made note of any files that appeared to have been corrupted by the unclean shutdown of the server.  The bulk of the corrupt files were not of consequence (temporary files in /var/tmp mostly), but a few were mySQL datafiles belonging to client websites.

The tech then proceeded to bring the machine up fully after the fsck was complete, but did not bring up the multi-user processes (apache, mySQL, etc) until after he could run mysql rebuilds on the affected database files.  (In order to ensure that no client data was lost from the databases).

At this time the mysql repairs are complete, and all services (web, mysql, email, etc) on srv3 are back up and running.

As a safety precaution the tech is still running some diagnostics and digging through some logs on the machine, but nothing that remains to be done should require taking the server offline.  This process may cause the machine to be slightly slower then usual for the next hour or three, but should not have any other side effects.

---

As a few clients who experienced last weeks srv2 failure have already asked, let me take a moment and assure everyone that we do not believe srv3 is "on it's last legs" or anything of that nature.  Srv2 was a much older piece of equipment then srv3, and prior to today srv3 had an uptime of roughly 180days, it's last reboot having been during a kernel upgrade six months ago, so no, I don't believe that srv3 is "dying" on us, I simply think it's a combination of a dying ram chip (which we have seen before), and incredibly bad timing considering the events of last week. :(

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November 25, 2005

VOIP in Healthcare - Version 1.0

Since my post about 5 weeks ago on the SwitchVox PBX .. lots has happened .. including at least one patient who decided to leave the practice because our phone system was broken .. and many more who were frustrated .. and a sleepless night or two for me.

The story will be told - but I don't have the time (or the typing skills to tell it now). 

Short version:

  • VOIP has a rolein healthcare are and will improve patient care and service.
  • SwitchVox is good software. Not great (yet) but quite good.
  • Four Loop Technologies (developers of SwitchVox) is an excellent company and their tech support is extraordinary.  Even with good software - there needs to be good support.
  • Time Warner Telecom has very good 24 x 7 tech support.
  • After several weeks of post-live troubleshooting  (after weeks of beta testing) ... The SwitchVox team determined that the Time Warner Telecom hardware  was sending out-of-spec ISDN messages to the PBX.  Since SV is based on Asterisk - this problem would occur in any environment running Asterisk.  Our problem was that the system would disconnect calls.  At first it seemed random - but eventually we figured out that it was happening only on outgoing calls that went through the IDSN PRI circuit.  So I routed all outgoing calls through VOIP providers for a few weeks while we sorted things out.  Brian, from SV's tech support team, was able to log in to our server, log the errors and then patch Asterisk so that it ignored the out-of-spec messages coming in from the Time Warner hardware.  (and that's the short version!)

November 22, 2005

Swikis

A Swiki is a search that the searchers modify.  Huh? 

Well .. it's kinda interesting .. I made one for "otitis media" .. here is it is: (once you get to the search result page - click the "promote and "demote" links to teach the swiki.

 

November 21, 2005

links for 2005-11-22

November 14, 2005

links for 2005-11-15

November 10, 2005

links for 2005-11-11

November 08, 2005

links for 2005-11-09

November 07, 2005

links for 2005-11-08

November 01, 2005

links for 2005-11-02

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