NEWSWIRE
February 25 2017

For months, a bug in CloudFlare resulted in malformed pages spraying uninitialized memory. This uninitialized memory contained anything that passed through CloudFlare: passwords, cookies, HTTP headers, HTTP content, even internal cloudflare TLS certificates.

NEDOCS is not affected, and NEDOCS users need not take any action. You may be affected, however, if you have used many of the popular internet sites.

Please take a look here at the originating story: https://bugs.chromium.org/p/project-zero/issues/detail?id=1139.

Take a look here at a partial list of affected sites: https://github.com/pirate/sites-using-cloudflare.

We suggest all users to change ALL passwords you may have with these websites. As a simple security measures we always advise our users to change their password periodically. We also always advise our users to use separate passwords for each app.
October 4 2016

NEDOCS Hospital Badge With Emergency Codes

The hospital badge for the 21st century is here. Now you can touch your codes.

Activate and communicate emergency incidents with one click. Upload a picture and complete your profile.

Secure, and encrypted messaging one on one is here. Messages are private to the users.

Upload pictures - emergency data is more than just numbers, and chatter. Now you can upload pictures directly into the timeline as chatter.

Soon, doors can be opened up, and meds will be dispensed using your NEDOCS hospital badge.
May 11 2016

A new bug was introduced last week which prevented some users from receiving Apple Push and SMS notifications for NEDOCS updates. We’ve resolved the issue and active subscribers to APNs, and Text messages should receive them.

If you’re still not receiving notifications, please reach out to support.
May 3 2016

We’ve been hard at work, and you’ve been feeling the shakes and hearing the cranks. We apologize, again, for the outage on April 13th. The May Day weekend changes will help avoid these issues for good.

While at first it may not seem like we’ve made much progress - and that’s because most of the changes are under the hood. But with a better engine, we’ve also rolled out some aesthetic changes.

First, we’ve made changes to our authentication system. You can now have passwords up to 2048 characters, which will allow us to use certificates in the future. This change will also allow us to have BASIC AUTH based API. Coming soon.

Second we’ve made major javascript restructuring. We’ve moved around calls, and added nifty little things to make the user experience better. Like the shake on invalid logon? Also bugs, and errors related to adding checklist items, notifications, and sending updates should be resolved with this restructuring. Goodbye IE 9.

:: Paging The Doctor ::
Who still uses pagers? "I’ve paged the doctor”, said the charge nurse notifying everyone. There are some reasons still to have the airway pagers, but the internet is obviously the way to go. So now you can page on NEDOCS. Pages are one way short messages beginning and ending with :: ::. The page sends out the notification, and also adds a team update. Free, unlimited pages. Supports Apple Push Notification, and SMS.

We sent out close to 6000 text messages last month. We’d like to receive that many too - so go ahead and talk back.

Besides this, we’ve restructured navigation to make better room for new things coming. iPhone app now supports all the analytics, and user profile settings.
February 15 2016

Now users can belong to multiple facilities. No more email aliases, and multiple accounts per user. Now you can switch between hospitals from your single user account.

How does it work?
First, a user must already be an active user at a hospital. Then, they can be invited like a new user - by an admin at the new hospital.

The user must sign in to accept this invite. Once accepted, the user will be added to the facility's team.

Switch between hospitals using the drop down arrow on the front page. Notifications will carry over from your first hospital, and can be managed per hospital.
December 25 2015

We suffered an outage on December 24th for at least four hours which prevented hospitals from entering data. The cause is resolved, and all operations are back to normal. We apologize, and are working to ensure this fault does not happen in the future.

Some users were not able to successfully activate their invites. We've resolved this bug and all invites are now able to create their accounts.
November 19 2015

Building your team just got easier. Now any Admin can invite users and have them sign up with a snap.

Send a direct sign up link to another user. Click the envelope icon under Team - and enter the target user's email address.

That user will receive a special link in their inbox. User simply chooses a password and boom - they're on NEDOCS.

No two step verification process - instant user sign on once invited.

Create an account will no longer be available starting November 21st, 2015.
October 8 2015

Automate NEDOCS - get the NEDOCS to Epic interface. Now free and standard for all customers. Interfaces not just with Epic, but with any EMR or patient flow system.

We have well working Epic interfaces, and encourage everyone to start this process. The Epic interface process is streamlined, and well understood by application analysts.

Forward this technical document: NEDOCS Interface Overview, and contact us to start the project.
September 14 2015

How long does it take to get an ED bed on average in the USA? 22 minutes - as of right now.

Over seven years ago we launched NEDOCS.org with a very simple and clear mission: To track hospital overcrowding. We've registered over 300,000 NEDOCS scores since then, and helped over 2000 hospitals track hospital overcrowding globally.

We've been sitting on a large pile of very important data - some of which we've shared with you over the last few years. But we've never just wanted to be a simple data dump - we really want to publish and provide data that mean something. So we've always been looking to share our data with you in new and meaningful ways. And we're doing that again with the Statistics page: NEDOCS.org/stats.

We're now sharing the average ER wait times, and average ER admit times on our statistics page in a real-time basis. These are data collected from subscribing hospitals which include world-class academic, non-profit, and private facilities.
August 25 2015

Some users lost the ability to add scores, and experienced a distorted layout in IE 9 without compatibility mode since Thursday August 20th.

Change was due to a minor upgrade in the NEDOCS layout. We've resolved the issue and users can continue as normal with IE 9 native mode.
July 14 2015

Text me Status to get back your hospital's current NEDOCS status. You must have your your phone number in your notification preferences for this command to work.

More commands on the way. Remember, you can always text NEDOCS anything, and it will be executed it as a Team Update.

We've also resolved an issue which prevented some users from receiving text messages.
July 7 2015

NEDOCS calculator was unavailable and not responding to new scores between 6/7/2015 Midnight PST and 1100 PST.

We've resolved the issue, and are looking at the root cause. We sincerely apologize, and are working hard to ensure NEDOCS is available at all times.
May 14 2015

Text me both ways. Add your number in your account settings under Devices.

Set notifications to SMS as you would to your Email or iPhone. You can text me back too. Your message will be executed as a team update.

So save my number. And call me maybe?
March 8 2015

On Tuesday, March 3, 2015, researchers announced a new SSL/TLS vulnerability called the FREAK attack. It allows an attacker to intercept HTTPS connections between vulnerable clients and servers and force them to use weakened encryption, which the attacker can break to steal or manipulate sensitive data.

NEDOCS is not at risk. Learn more at Tracking Freak Attack.
March 6 2015

Sometimes it feels like technology is stagnant, and lifeless. We know it can have strong impact. And impact sometimes takes time. These success stories reaffirm our belief in working for a purpose.

Making technology is hard, and it would be nearly impossible if you didn't find it useful.

Thank you Kirk, Medical Center of Plano, and HCA North Texas for sharing your story.

-- Kirk Bradford at Medical Center of Plano --

The Medical Center of Plano began calculating NEDOCS (albeit a crude version of it) back in March of 2014. Adoption and compliance with timely calculations of scores was, at best, challenging. As our ER staff became more familiar with the calculations, compliance was better. This calculation was completed using a Microsoft Excel spreadsheet and was not readily accessible to most of our leadership here at MCP.

I was fortunate to come across your NEDOCS application and immediately saw the benefits. The simple fact that ‘real-time’ communication of the NEDOC Scores made a huge impact on our ability to act and intervene in a more timely fashion. Our entire leadership from all departments of our hospital have become keenly aware of the capacity issues facing our Emergency Department, because they now have the scores and see the trends in real-time and get notifications to their mobile devices.

I want to thank you for making the implementation process so easy and for your responsiveness to our questions and needs.

Here is our data for the past year (I think it’s pretty impressive):
FYI – The month of January 2015, MCP has seen record admissions and both of our overflow admit units have been open and full because of house capacity.


-- End Story --
March 6 2015
API

The NEDOCS API is a restful interface accessible securely via the internet. It's a key to make different applications work together.

We've always had the API wrapped up in the NEDOCS core, and have used it internally - but for the first time ever, we're ready to interface with developers in the hospital.

Hospitals can now begin submitting NEDOCS scores automatically. The notifications will be sent as they always have been.

Watch the API page for more interfaces: nedocs.org/api. Goodbye HL7.
March 6 2015

The checklist items can now be on or off. Corresponding alerts of Activated or Deactivated will be appended to the alert.

The analytics overview page now loads 7 days by default.
November 19 2014

The timeouts have been changed for iPhones. You should see a 12 hour timeout without any activity. You only need to open the app once every twelve hours to stay logged in. After 12 hours it will take you to the login page. We're working to increase that timeout limit even longer for just the iPhones.

Duplicate entries in the surge plan no longer happen. You will also notice a confirmation box before deleting a surge plan item.

The NEDOCS logo has been replaced by a Home button on the iPhone app when logged in. We've also made the icons a bit bigger to help with big fingers.

The team update box is now at the bottom of the screen on the iPhone app. When you click it, the screen will zoom in. Enter the text, pinch to zoom out, and click the green arrow button to send the team update.

We're working hard to meet the mobile demands, and you'll see lots of new changes to the iPhone app in the next few weeks. Android plans are also in the works, with go-lives in December.
November 14 2014

Over the last couple of weeks you may have noticed service interruptions. There were three outages, lasting from a few minutes to two hours.

We’ve investigated, and concluded the root cause to be an abrupt change in the Apple’s policy to discontinue SSL support for push notifications. As per the earlier advisory we made to you regarding POODLE, Apple switched to TLS only quietly: https://developer.apple.com/news/?id=10222014a.

This change caused NEDOCS iPhones notifications to break, and making vibrations in the rest of the system. This created a connection leak, which caused our infrastructure’s more than sufficient pool to fill up.

As of 100 HRS PST we’ve resolved the issue. Push notifications are flowing through to iOS devices, and the infrastructure is once again stable.

We’ve had virtually zero downtime in 2014, and we take this one to heart. We admit we were caught a bit off-guard by Apple’s short notice. We apologize for the outages, and renew our promise for working hard to minimize downtime for this mission critical app.
October 16 2014

A number of news sources, corporations, and the OpenSSL team reported on October 14th 2014 that version 3 of SSL is vulnerable at the protocol level.

SSL plays a key role in securing your data transmission from your computer to our servers. We are advising our customers to upgrade to TLS to mitigate the situation.

This vulnerability is an industry-wide issue, and not limited to NEDOCS. We support the TLS protocol, and clients can immediately begin migrating to secure infrastructure. Since most of our clients still use Windows XP, and Internet Explorer - we will still continue to support SSL.

Even though this is an industry-wide vulnerability, it is not considered a high risk. An attacker must be on your local network, and make a large amount of calls for a successful attack.

We've found the following resources to be of high interest to our customers.

Microsoft Security Advisory 3009008

Apple Discussion Board

Google Security Blog
August 27 2014

Email notifications will now be sent via messenger@nedocs.org, instead of the user's email address. Emulating the user's email has been one of the most creative and used features of NEDOCS, but has become unsustainable with our growing user base.

Users now have a simple Reply button at the end of the notification. Simply log in to the app, and add your team update to reply to the event.

NEDOCS updates are no longer visible on the timeline, and the team update has changed icons from the bull-horn to balloon-callouts.

We're hard at work to streamline messaging as it becomes our core feature. Reliable, quick, and clear communication is the key to improving patient flow.
June 9 2014

Benchmarks are here.

See how you rank compared to your peers. Now you can see wait times, and admit times against hospitals in your health system, and all others on NEDOCS.
May 21 2014

Each user is now subscribed to black, red, and orange alerts by default. They'll receive notifications for all of the events: NEDOCS, Team Update, and Checklist.
May 18 2014

The IP and the ED bed values will now be automatically pulled into the new calculator window.
May 18 2014

Certain characteristics can be changed for your hospital. These are model specific values.

We've added a new section under Settings, called Model. Under this menu you can modify the definitions for each variable, and what you label each color.

We've also updated the alert settings to be based on the color, so your labels can work independently. The colors of the scale will always remain the same, and will be the basis of the level specific settings.
April 24 2014

All of the NEDOCS variables are measured at the time score is calculated.

ED Patients
The total number of patients in the ED. Includes all patients who have walked in the door, but have not been discharged. Includes patients in the waiting rooms, and waiting admits in the ED.

ED Beds
Total number of gurneys, chairs, and other treatment benches in use, or staffed. Includes hallways and chairs that are opened up. Do not include un-staffed beds, such as beds in closed areas at night, or un-staffed beds at slow times.

ED Admits
Count all admits waiting for a bed in the ED. Patients moved away from ED to inpatient holding areas should not be counted. Count all ED admits/rollovers/holdovers waiting in ED care for an inpatient bed.

IP Beds
Count all inpatient beds regularly staffed. Can differ from licensed IP beds, if some licensed beds virtually not staffed, or staffed in disaster. Count holding beds, including observation beds.

Last Door to Bed Time
Door to bed time for the last patient to receive a bed. For example: if you’re measuring at 1300 hrs, and the last patient to be placed in a bed was at 1255 hrs, count that patient’s door - bed time. When measuring NEDOCS at 1400 hrs, count the person who received the bed last, between 1300-1400 hrs. If no one was placed in a bed during 1300 and 1400 hrs, count the patient who received bed at 1255 hrs. Always count the most recent patient’s door-bed time.

Longest Admit
Count the longest holdover, admit waiting for an inpatient bed in the ED. If four patients are waiting for an inpatient bed, count the patient waiting longest. Time to admit starts upon decision to admit. Decision to admit typically a joint decision between ED and admitting physician.

1:1 Patients
Count the number of patients in 1:1 care. Includes ventilators, ICU admits, critical care patients, trauma patients, and sometimes includes psych holds. Typically a site specific variable, which should include all patients who require a one-to-one nurse care.
April 21 2014

There were some critical issues of late, and some old ones. We've worked hard to fix all known issues in the last few days.

There's been a lot going on both in the front of the store and the back. Here are some of the issues we've fixed, and changes we've made.

Time interval values for Longest Admit and Last Bed Time
The interval values for these values were pulling back wrong values. Some users experienced an hour being added to the value.

Heatmap showing wrong colors
In some cases, the heatmap was showing the incorrect color.

Wrong timestamps
The server was recording a timestamp 13 minutes earlier than the actual time of the event.

Daylight savings time
This was an old bug which passed two seasons of DST changes. Fixed.

Some users experienced some slowness, especially on loading. We've added a lot more horsepower, and changed lots of things under the hood. We've also taken away the maps, which added extra time to load for some users.

All issues and bugs vary in difficulty, and depth. Keep reporting any issues you find. We'll be more diligent in reporting current, and known issues.

As always, we apologize for the bad experiences. We sincerely appreciate your patience.
April 20 2014

No heartbleed found here.

Security is paramount at NEDOCS. From your device to our servers - everything is encrypted via SSL. We don't use OpenSSL, and therefore not affected by the bug.

As standard practice, we frequently change the SSL certificates. Current bit strength is 2048.

We do remind you to change your password frequently as well. Security is a team effort. So stay safe, keep your password to yourself.

We'll always be in touch about serious security threats.
October 29 2013

Can NEDOCS predict TAT for dropping off ambulance patients? Yes it can.

The NEDOCS score may be predictive of ambulance offload delay in the ED and should be further investigated as a potential marker for EMS systems. The NEDOCS score should be calculated in busy EDs and could potentially be utilized during EMS determination of the most appropriate destination, or as a tool for hospital EDs to initiate, and terminate ambulance diversion.

117 Can NEDOCS Score Be Used to Predict Ambulance Offload Delay?
D.R. Cooney, S. Wojcik, N. Seth

Annals of emergency medicine 1 October 2011 (volume 58 issue 4 Page S217 DOI: 10.1016/j.annemergmed.2011.06.144)
October 28 2013

Alessandra Revello

University of Pittsburgh Medical Center uses NEDOCS for surge response. Presentation by Tom Gronow, VP of Operations at UPMC Mercy.
October 28 2013

Sandro Pertini Hospital in Rome is constantly overcrowded, there is a frequent use of surge plan, and a conflict between ED and the Hospital. Dr. Revello has used NEDOCS to objectify the problem and highlight inefficiencies.

Alessandra Revello

Dr. Revello has championed a movement in Italy to reduce overcrowding. She has used NEDOCS since the launch of our website in 2008. She was instrumental in bringing everyone together at the national overcrowding congress in Rome in 2011.

This is her presentation at the NEDOCS Summit 2013 in San Francisco, which discusses the latest progress with hospital overcrowding in Rome, and Italy.

Presentation: NEDOCS in Rome, Italy.
October 24 2013

UCLA Ronald Reagan Medical Center
NEDOCS is a measure for the entire hospital, not just the emergency department. We will always see the hospital as a whole, and create technologies that seamlessly bring together the thousands of things that need to connect to run a medical center efficiently.

We also love art, and instead of boring and static colors, we decided to show off the beautiful side of hospitals.

Our current background images are of the UCLA Ronald Reagan Medical Center. On the top left you can see the helipad, on the bottom left you can see the ambulance approaching, and the twilight time brings out great colors.

We'll change the photos from time to time, as we get new subjects. All art is the creative work of NEDOCS LLC.
October 24 2013


NEDOCS BrowsersNEDOCS IE Users

Over ninety percent of users access NEDOCS via Internet Explorer (or IE). Over ninety percent of those IE users are on either IE 7 or IE 8 (split evenly).

NEDOCS works and looks great in Google Chrome, IE 9 and above, and now we've rolled out some major upgrades that make it work even better IE 7 and IE 8.

We're officially lowering our minimum browser requirement to IE 7. All primary features will now work in IE 7 and IE 8, however we strongly advise you to upgrade your browsers, or work with your IT to install Chrome.
September 24 2013

Hello, world! We've finally created a blog, and we're coming to the party with a gift for you.

NEDOCS has been online since 2008. At first it was just a wiki, intended to share information on patient flow, and NEDOCS. Then we created online tools at NEDOCS.org and NEDOCSCalculator.com to help help you measure your NEDOCS scores. Hospitals from around the world responded, and began using the score to operate more efficiently.

*Update*
We're sorry, the dataset is no longer available for download.

Those that did download the dataset, and are considering publishing a study: You must refer to NEDOCS.org in your publications.

Thank you!