The Health Information Technology Platform Meeting

Today at Harvard Medical School, Zak Kohane and Ken Mandl assembled 100 folks to discuss "Substitutability" - the notion that EHRs of the future will be more modular and more iPhone app-like, possibly with common Application Programming Interfaces.Some of the speakers at the conference were Mitch Kapor (Lotus founder), Sean Nolan (Microsoft), David McCallie (Cerner), Alfred Spector (Google), Rob Kolodner (formerly of ONC), David Liss (New York Presbyterian), Charles Friedman (currently at ONC), Mark Frisse (Vanderbilt), Clay Christensen (HBS), David Kibbe (Senior Advisor to AAFP), Aneesh Chopra (US CTO), Todd Park (HHS CTO), and Regina Herzlinger (HBS)I served on the opening panel called Open or Closed Platforms? One or More Platforms.Here are a few of the key points.I suggested that standards...

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Reality Show on Food Allergies

The next two videos from Children's Hospital in Boston are in. My heart skips a beat every time I watch one of these because I think "Oh, we're getting close. We're getting closer to finding a cure!"In this video installment, Ming Tsai, chef and owner of Massachusetts restaurant, Blue Ginger, and father of a son with food allergies talks about life with food allergies at home and at work. He talks about "what a pain in the rear it is to travel with food allergies". Yup, we can relate. He also talks about how eating in restaurants is an important part of every child's life and that's why he has made a committment to create a safe restaurant. "I have moms crying tears of happiness when they watch their food allergic children eat a safe meal in my restaurant," Tsai says. I know, priceless...The...

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Preparing for ICD-10

In 2013, CMS will require the use of ICD-10 for coding of diagnoses in billing/administrative transactions. The code set allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant expansion of the 17,000 codes available in ICD-9. How can we best prepare for this transition?1. Improve electronic clinical documentationThe granularity of ICD-10 requires precise clinical documentation. Unstructured paper-based notes are unlikely to enable coding beyond the most general code for each diagnosis. ARRA incentives require ambulatory EHR implementation with structured problem lists, medication management, and clinical documentation as well as hospital CPOE use. These electronic systems will provide the foundation for the detail needed...

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Food Allergy Twitter Party This Friday

Have you attended a food allergy Twitter party yet? They're fast, furious and fun. The next event is this Friday, October 2, from 9:30-10:30 PM, Eastern time (EST). Friday night's theme is everything Halloween. Come with your questions and your favorite Halloween tips. Here's what you need to do to get into this social event of the year:Sign up for a Twitter account if you don't have one. It's free.Register for the party.Friday night at 9:30 PM EST go to Summize and type in "#foodallergy". Then click the search button. This will take you right to the party. Another way in is through Tweetgrid or Tweetdeck. Tweetdeck needs some advance plannning as it needs to be downloaded.During the party, use the hashtag "#foodallergy" whenever you type something. That ensures your comments will be seen...

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Building the Nationwide Healthcare Information Network

I describe interoperability as a set of business partners with aligned incentives who exchange data to enhance efficiency, reduce costs, and improve coordination of care. Generally healthcare information exchange is local - hospitals, labs, pharmacies, clinician offices, and public health in a region exchange data for a specific purpose. Privacy and data use concerns are resolved locally. I do not believe that an architecture that requires a monolithic central database in the basement of the Whitehouse is going to be acceptable to stakeholders.So what is the Nationwide Healthcare Information Network (NHIN) likely to be?It will be a federated network of networks based on a common set of policies and data standards, enabling local, regional and domain specific (VA, DOD, Children's Hospitals)...

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Nomads- Wandering Women of The Whitewater Tribe

Nomads, my award winning documentary film, is about three women kayakers who give back to a small village in Uganda. It has been an official selection in over 30 film festivals world wide. Runtime 20 minutes $19.99Available now on www.trademe.co.nz http://www.trademe.co.nz/Browse/Listing.aspx?id=244681799&ed=t...

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Cool Technology of the Week

As clinicians implement electronic tools to achieve meaningful use, it's likely that a diversity of approaches will be used in 2011 - some comprehensive EHRs, some hosted Software As a Service applications, and some modular applications. What are modular applications? Imagine that a clinician assembles a collection of iPhone apps and hosted interoperability services (Surescripts, Quest, Emdeon) to achieve e-prescribing, lab viewing, quality reporting, and administrative data exchange with payers. Such an approach would fall under CCHIT's notion of modular certification. Think of it as a "Project" rather than "Product" certification, ensuring that the collection of applications has the capabilities needed to achieve meaningful use.This week, Quest introduced a six month trial of its...

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Anti-Viral Medications for the Flu

There are two anti-viral medications that are used to treat both the seasonal flu and the H1N1 strain. Relenza® is an inhaled medication that has caused issues in some people with asthma. Relenza® does contain lactose from dairy. Talk to your doctor if there is a dairy allergy diagnosis. Tamiflu is an oral medication used to treat the flu. It does contain corn starch and gelatin.Check out the ingredients in both medications before you or your child may need th...

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How I Eat

It's time for a Thursday blog where I turn introspective an examine my life experience.I've written about what I eat and where it's from but not about how I eat.What do I mean?In the US, meals are often considered a meat-based main dish plus sides or trimmings i.e. we're having chicken for dinner.Taking a lesson from Japanese cuisine, there is no main dish to any my meals. I typically have 4-5 or five small plates that include salad, soup, rice, and vegetables.Here's tonight's dinner1. A bowl of Coconut Barley Pilaf with Corn, Tofu and Cashews (I replaced the chicken in the recipe with tofu) 2. A bowl of Braised Yuba and Bok Choy from our...

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How You Can Make a Difference

How you can make a differenceMaking a difference begins with you. For you to make a difference in your community and the greater world you first need to give to yourself.� Make time for yourself � Sign up for that class you have always wanted to take: yoga, Aerobics, spinning, art, dance, doing something just for you will bring more joy, calm and peace in your life and you will have more to give to others. When you feel good it rubs off.�Slow down, take a walk, breathe and notice the beauty around you.-make a conscious effort to bring more joy into your life -do something nice for you!� Go on a negativity diet � Avoid negative people, negative news and TV shows; keep negative comments and gossip to yourself. Focusing on what�s good in the world and your life will create more good. �Write...

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Meaningful Use for Specialists

I was recently asked how specialists, such as pediatric surgeons with few Medicare or Medicaid patients, can participate in ARRA and implement EHRs with meaningful use.First, let's review how ARRA stimulus payments work:MedicareMedicare incentive payments are capped at 75% of allowable Medicare charges, up to $18,000 for the first payment year. Incentive payments are reduced in subsequent years: $15,000, $12,000, $8,000, $4,000, and $2000. For eligible professionals in a rural health professional shortage area, the incentive payment amounts are increased by 10 percent.Physicians who do not adopt/use a certified EHR will face reduction in their Medicare fee schedule of -1% in 2015, -2% in 2016, and -3% in 2017 and beyond. ARRA allows HHS to increase penalties beginning in 2019, but penalties...

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iPhone App for Gluten Free

I don't own an iPhone, but I can't help being amazed by all the useful apps users can get. There are applications for working out, traveling, making dinner and managing your money. We're talking thousands of apps. Now, for those who need to avoid gluten, ZEER has announced the glutenScan app. For a monthly fee, subscribers can get help with grocery shopping, while grocery shopping. Simply by typing in a name or UPC number, users get information about whether a product contains gluten. It even recommends gluten-free alternatives.Now, if they would only come up with an app that does my work-out, handles the grocery shopping and makes my meals...I...

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Guidelines and Protocols

I'm often asked about decision support capabilities in the BIDMC inpatient and outpatient EHR. I've previously written about our general principles of decision support and our priorities for implementing electronic guidelines and protocols.I thought it would be interesting to show you the screens from our self-built Provider Entry System. I've included the protocol for Complex antibiotic ordering per protocol, our protocol for Heparin Dependent Antibodies, our Hydration Protocol to minimize risk of Iodinated Contrast Neprhropathy, Red Cell ordering, and TPN ordering.I've also included an overview of our web-based ambulatory EHR, called webOMR. You'll see all the meaningful use features - vocabulary controlled problem lists, medication management (including medication reconciliation,...

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HER Success and Independence

Yesterday I had a phone interview with HER Success and Business Magazine http://www.hermagazine.co.nz.I am feeling very grateful to have the chance to talk about Flair Films and my mission to inspire millions of people thru my films. Getting interviewed is a great opportunity to get even more clear with my mission and saying it out loud makes it come to life.Also, giving examples of the people I know that have been inspired still brought tears to my eyes.Here's just a couple of examples of inspired viewers:A highschool age girl saw Nomads, and told me she had always wanted to play rugby in Canada and never thought it was possible, and now she is going to!A South Island medical school student went to volunteer with SOFT POWER HEALTH in Uganda after seeing NomadsA 14 year old boy in Massuchusetts...

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Monday Review: Earth Balance

This Monday Review is sponsored by Earth Balance natural spreads. Finding a "non-dairy butter" for baking and spreading is no easy feat. It was important to me to find something our entire family liked. As a matter of fact, I wanted a product that would fool everyone. My non-dairy chocolate chip cookies needed to taste just as good as anyone's cookies. The butter on my table for our dinner rolls needed to taste just like any other butter. Our non-dairy butter would be my little secret.Well, I found the right product and I can't keep it a secret. I've used Earth Balance spread for years, ever since my son outgrew his soy allergy. Our local grocery...

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To Wait or not to Wait?

I'm often asked by clinicians and hospitals if they should wait to purchase an EHR because of the uncertainty regarding meaningful use and certification.I tell them to move forward now.Meaningful Use is complete for 2011 and you'll find the finished matrix online.Although the HIT Policy and Standards Committees only make recommendations/advise the Office of the National Coordinator and HHS, I believe that the regulations issued in the next few months will follow the spirit of the Commmittee work.Here's my understanding of the events of the next few months:1. In mid December, CMS will issue a Notice of Proposed Rulemaking (NPRM) regarding meaningful use, then provide a 60 day public comment period. A final rule on meaningful use will be issued in the Spring.2. In mid December, the Office...

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Guidelines for H1N1 Vaccine and Egg Allergy

The American Academy of Allergy Asthma and Immunology has come out with their guidelines regarding H1N1 vaccine and those with egg allergy.I'm really torn about how to proceed with this. My son recently underwent an egg challenge in the allergist's office. It was not successful. Looking over the AAAAI guidelines, it appears that he would need several skin pricks (which he hates) and then if we proceed, he may require 5 vaccines at 15 minute intervals. If a medical issue arises, we face a shot of epinephrine and perhaps inhaled steroids. Ugh! And that's just the H1N1 vaccine. This whole procedure is repeated for the seasonal flu vaccine. For the past few years, the rest of the family has received the seasonal flu vaccine. I get mine this afternoon. Our egg allergic son has not gotten the vaccine....

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Cool Technology of the Week

The recent work by the HIT Standards Committee requires the encryption of patient identified data on mobile devices (laptops, USB drives) to ensure confidentiality is protected. This is already required by the Massachusetts Data Protection Regulations.At BIDMC, we use McAfee's Endpoint Encryption as our enterprise solution for encrypting mobile devices.Though the product is good for the enterprise, there are alternatives for the home user (taking into consideration factors such as usability, supportability, performance, cost). For personal use, PGP Whole Disk Encryption is my cool technology of the week.PGP Whole Disk Encryption provides continuous disk encryption for Windows and OS X, enabling data protection on desktops, laptops, and removable media.The PGP Whole Disk Encryption engine...

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Traditional Japanese Clothing

This is another entry in my series about Kyoto.Although I wear black in the office, at home I wear season appropriate traditional Japanese clothing. Kyoto is a wonderful place for traditional crafts including fabric weaving, dying, and clothes making.Here's a few of my experiences:Samue - The most incredible fabrics and Indigo dyeing is done by Ken-ichi Utsuki, owner of Aizenkobo workshop, a traditional Japanese natural indigo dying and textile firm. He and his son fitted me with a Samue (Japanese workclothes for Zen monks and tradespeople). Indigo naturally repels mosquitos, and imparts a wonderful feel and odor to the fabric. I wear my samue while gardening, doing weekend chores, and while playing the Japanese flute.Geta - Remarkable Japanese wooden sandals made from Kiri wood and...

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Free Training - Medical Reserve Corp

The Crater Medical Reserve Corp provides free training such as CPR and First Aid to its volunteers. Click HERE to register. Watch the video below for an important announcement from the Secretary of Health and Human Services, Kathleen Sebeli...

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The Draft FY10 IS Clinical Systems Plan

Every year, BIDMC IS leadership gathers input from all our governance committees to produce an IS operating plan. The Clinical Systems area is the most challenging since we need to balance limited resources with ever increasing demand. Here is the draft FY10 IS Clinical Systems Plan based on the priorities of all our stakeholders. You'll notice an emphasis on projects which support meaningful use criteria for 2011 and 2013, accelerate national standards implementation, and provide increased interoperability.Inpatient/CPOE/Pharmacy* Implement pharmacy, charging and other revisions to support Pharmacy 340B requirements.* Complete implementation of CPOE for NICU* Complete implementation of CPOE for ED* Implement outpatient pharmacy for oncology/chemotherapy* Enhance inpatient applications...

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Children's Hospital in Boston

I recently posted videos from Children's Hospital in Boston where they are conducting a milk desensitization study. The latest installment is a grocery shopping trip with the mother of 11 year old Brett who is participating in the study. Brett has 15 different food allergies, his brother has 16- Yikes! People often say to me, "How do make food without dairy, nuts and eggs?". I've gotten to the point where it's pretty easy to avoid those foods, but when I hear about people needing to avoiding beef, chicken, turkey, nuts, eggs, soy, and so on...well, wow! Where do you begin to find good protein sources with all those restrictions? The shopping trip shown in the video takes place at a Whole Foods Market. Take a look, you may learn a few things. I learned that Rice Dream®, a non-dairy alternative...

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The Latest Deliverables from the HIT Standards Committee

Today, the HIT Standards Committee received the latest deliverables from its workgroups.The Quality Workgroup presented its updated matrix of measures, data types and recommendations. Of the 29 measures listed, 17 are measures of quality which are being retooled by quality measure authors to be based on data elements captured in an EHR. Two are privacy/security related (Full compliance with HIPAA Privacy and Security Rules, Conduct or update a security risk assessment and implement security updates as necessary) and 10 are related to the adoption of EHR function (i.e. % of orders for medications, lab tests, procedures, radiology, and referrals entered directly by physicians through CPOE). The actual data standards needed to measure quality and the implementation guidance for these standards...

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Food Allergy Family Fun Event and Expo

North Wales, PA, just outside of Philadelphia was the location for a fantastic event for families with food allergies. Yesterday's Expo featured singer Kyle Dine along with vendors, raffles, coupons and lots of free allergy friendly food. The highlight of my experience was watching my food allergic son and his non-food allergic sister enjoying chocolate lollipops they got from Premium Chocolatiers. Priceless. It felt so freeing to move among vendors where our WHOLE family could enjoy the samplings. Some of the vendors we visited yesterday:Whole FoodsEnjoy LifeCherrybrook KitchensAllergyFree FoodsPamela's ProductsSunbutterCookies for Me?So Delicious...

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Security for Healthcare Information Exchange

In my role as vice-Chair of the HIT Standards Committee, I join many of the subcommittee calls debating the standards and implementation guidance needed to support meaningful use. Over the past few months, I've learned a great deal from the Privacy and Security Working group.Here are my top 5 lessons about security for healthcare information exchange.1. Security is not just about using the right standards or purchasing products that implement those standards, it's also about the infrastructure on which those products run and policies that define how they'll be used. A great software system that supports role-based security is not so useful if everyone is given the same role/access permissions. Running great software on a completely open wireless network could lead to compromise of privacy.2....

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Food Allergy: Truths and Lies

A post on Food Allergy Buzz got me thinking about common misunderstandings about food allergies. It's up to the food allergy community to set the record straight. I wrote an article for Suite 101, Food Allergy Myths. Did I get it right? Did I miss any? We can work together to get the right messages out the...

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Reflections on 9/11

My schedule for the next few days includes flights to Denver, Las Vegas, San Francisco and Washington.I spent all of Thursday afternoon in Logan airport waiting for a delayed flight to take off.What happened and what was the root cause?My 2:45pm flight was originally reported on time. Then it became slightly delayed to 3:15pm because of a late departure of the inbound aircraft. Then it became indefinitely delayed due to a "mechanical failure" that occurred in flight. The only information given was that the plane would land, mechanics would diagnose the problem, and then propose a departure time based on their findings.At 4pm, they announced that the problem would require a spare part to be flown in from Washington, which would arrive at 5pm and be installed by 6pm. A go/no go decision...

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In Praise of Japanese Food

When you think of Japanese cuisine, what foods come to mind - sushi, sashimi, teriyaki?Remember that Japan has long embraced Buddhism, a philosophy that includes vegetarian specialty foods.When I think of Japanese cuisine here's what comes to mind:Okara - to make tofu, soybeans are boiled and then ground to make soymilk which is then turned into tofu by adding nigari coagulant that produces "soy curds". The leftover ground soybeans are okara. It's a great dish served cold with mixed vegetables.Yuba - when soy milk is boiled, a film appears on the surface, which can be served fresh or dried into sheets. This soymilk film is called yuba. It's...

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HITSP's Next Priorities

Today I led a HITSP Board meeting and we discussed the work being done in collaboration with the HIT Standards Committee. On September 15, the HIT Standards Committee and its workgroups will release the finished 3 matrices documenting the chosen standards for Clinical Operations, Clinical Quality and Security/Privacy including certification criteria and implementation guidance.There are very few standards gaps for 2011, but there is work ahead for 2013 and 2015 standards, including ensuring all the necessary content standards and vocabularies are ready for ordering labs, reporting summary quality measures, and representing consumer preferences for care and consent.The HITSP work ahead is focused on 3 waves as outlined in this Powerpoint Presentation.Wave 1Quality MeasuresCommon Data TransportNewborn...

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Flu Vaccine- Get it or Not- That is the Question

The flu vaccines have hit doctor's offices in our area. This is the seasonal flu, not swine flu or H1N1. The H1N1 vaccine is expected in limited quantities in the US in mid-October with more vaccine available each week. There is still discussion about how many H1N1 shots will be recommended in the US.It's a personal decision whether to get the vaccine- seasonal or H1N1. Parents will also need to decide what is best for their children. Remember that both vaccines are cultured in chicken egg. Those with egg allergies should talk to their allergist about the possibility of getting the flu vaccine in slowly increasing amounts to avoid an allergic reacti...

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Replacing a Stolen iPhone

Yesterday my daughter's 32 GB iPhone 3GS was stolen. She set her purse down for a moment while walking with a friend in a park and when she looked back it was gone. It contained minimal cash, no credit cards, but it did have a $299 iPhone 3GS 32 GB. We filed a police report and searched the web for the possibilities, finding much contradictory information. What should you do? Here's my experience:1. The credit card we used to buy it does not offer purchase protection - no luck.2. Our home insurance deductible is larger than the iPhone price - no luck3. Apple Care does not cover stolen iPhones - no luck4. Apple and AT&T do not offer replacement insurance on iPhones - no luck5. We stopped by the Apple store and found out that the retail price of a 32GB iPhone is really $699,...

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Kyle Dine Tour Dates

I've posted about Kyle Dine before. He wries music about food allergies. Seriously. Have you heard "Epi-Man"? Hilarious!He's coming to Philly Sept. 13 and our family is going to his concert. Check out his other tour dates to see if he'll be near your hometown. Kids With Food Allergies is sponsoring the Sept. 12 event. Should be great f...

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Cool Technology of the Week

Before I became the CIO of Beth Israel Deaconess, I was the Executive Director of the CareGroup Center for Quality and Value, responsible for dashboards and business intelligence for BIDMC and several other hospitals. Building dashboards is challenging. Data must be acquired from multiple sources, cleaned up, normalized, and analyzed. Displaying data in a form that is actionable takes talent, such as per the work of Edward Tufte Analyzing community health data provides policymakers with guidance to prioritize funding and public programs. The Healthy Communities Institute has developed a set of visual dashboards that are my cool technology of the week. Check outSan Francisco Marin County Sonoma County San Bernardino County Whatcom County and click on See all Indicators.You'll find...

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The Experience of Tea

This is the first of many Thursday blogs about my recent trip to Japan. That trip was an exploration and appreciation of Japanese traditions. Some of my favorite traditions are tea (cha-no-yu), incense (Kodo), Japanese textiles (Samue and Farmer's jackets called Noragi), Zen cuisine (Shojin Ryori), and music (Shakuhachi).Today's blog is about tea. While in Kyoto, I spent an afternoon with Nagahiro Yasumori, owner of Horaido Tea on the Teramachi shopping street in Kyoto. I traveled to the oldest tea store on the planet, Tsuen, located next to the Uji River bridge for the past 850 years. I also walked the hillsides of Uji (photo above) to...

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Use Expired Epi-Pens®

Show Grandma, new classroom teacher, soccer coach, or scout leader how to use an Epi-Pen®. Use those expired pens and demonstrate (or better yet, let someone else try) how to discharge the unit in a lemon, orange or grapefruit. After carefully inserting the Epi-Pen®- needle end first- into it's storage tube, drop it off at your allergist's or family doctor's office for proper disposal.Do a little gratitude dance that the Epi-Pen® didn't have to be used to treat an allergic reaction and pat yourself on the back for teaching someone else to use ...

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Snow Leopard is Up and Running

Over the weekend, I purchased a family 5 pack of Mac OSX 10.6 Snow Leopard and upgraded my wife's Macbook Pro, my daughter's iMac and my Macbook Air.Although I did the simple automated upgrade for my wife and daughter, I used the opportunity to return my Macbook Air to its original factory settings and start from scratch - call it a technology spa day.Over the past year, I've added many applications to my Macbook Air including HP printer drivers (which are often unstable and buggy), Office 2008 with Entourage (Entourage is always unstable and buggy), and several versions of Citrix/Webex/Gotomeeting etc.The end result of adding many applications, many upgrades and many configuration changes during my Mac learning curve resulted in less than optimal performance. Thus, I backed up my important...

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