Begin forwarded message:
From: David de Bhál <david.debhal@v-practice.com>
Date: December 5, 2008 1:15:53 AM EST
Subject: amazing and appalling at the same time
Reply-To: david.debhal@v-practice.com
I have been involved in the provision of online medical records in Australia
My colleagues, by-and-large, shun check boxes, check lists, drop-down boxes which discretely capture high quality information from a system which mimics closely the clinical method and retain this presenting the latest summary of this information, attributable, in an ongoing fashion. It has been almost impossible to gain traction except in a few small facilities in Australia while in Singapore
My personal feeling after years of frustration is that electronic records and checklists will only be adopted by the colleagues when not doing so impacts on their income.
David de Bhál
From: David Farber [mailto:dave@farber.net ]
Sent: Friday, December 05, 2008 8:33 AM
To: ip
Subject: [IP] Re: amazing and appalling at the same time
Sent: Friday, December 05, 2008 8:33 AM
To: ip
Subject: [IP] Re: amazing and appalling at the same time
Begin forwarded message:
Date: December 4, 2008 5:08:12 PM EST
Subject: RE: [IP] amazing and appalling at the same time
Thirty five years ago I was in the Clinical Decision making group at MIT so I'm not at all surprised at the ad-hoc approach to care. More recently my son worked at a local hospital and was surprised to learn that using computers was not the norm and that paper was the preferred medium for information. In doing software for a researcher he was told that the results were to be printed out so they could be gathered and tabulated from the paper.
I do appreciate the importance of capturing and sharing procedures and if checklists are a start then they are valuable. But the larger question is why don't we have the understanding and tools to make it easy to do so much more.
This gets to the heart of the point I was trying to make when I posted my comments on GENI -- http://frankston.com/?Name=IPGeni2 -it's not about the network -- it's about what we (don't) do with networking. Why does someone have to go down the floor to check whether the machines are connected just right -- why aren't they self-checking. I'm not saying that we can automate the process -- just the opposite. It's not about automation -- it's about not being gratuitously dumb. Of course we can't capture all the nuance and we shouldn't have blind trust in the technology.
It's not just about clip boards but the idea that we still define information relationships using wired logic with isolated devices and machines that have to be wired together or else have their information copied on clipboards. It's a problem at the physical interconnection level and with information relationships and interpretation.
What makes this so frustrating is that this is so mundane that even using a clipboard is an advance. Telemedicine should be too boring to write about. Sending a digital image of rash should be the norm before you have to use expensive resources for an office visit.
We should also be able to assume connectivity without having to have a billing relationship every step of the way and without having to depend on a third party to fix "dead spots" (bad pun?). Instead I should able to expect my wrist health monitor to be connected most of the time. Not necessarily all the time -- we do need resilient design -- but often enough that I can be monitored if need be while retain mobility.
And, yes, we get back to telecom policy because as long as we assume someone has to communicate for us and as long as we tolerate gatekeepers then something as simple as telemedicine is as hard as ... well, I'd say brain surgery but that's another topic.
PS: I notice my Walgreens pill container does have a barcode but my G1 doesn't recognize it. I wonder what's on it. Why can't I use it to get information about the medicine? Is it that complicated. What would it take to use my personal scanner (what some people call a phone) to read the information and compare with my other medicines? How hard can that be?
-----Original Message-----
From: David Farber [mailto:dave@farber.net]
Sent: Wednesday, December 03, 2008 16:34
To: ip
Subject: [IP] amazing and apalling at the same time
From: David Farber [mailto:dave@farber.net]
Sent: Wednesday, December 03, 2008 16:34
To: ip
Subject: [IP] amazing and apalling at the same time
Begin forwarded message:
From: mo@ccr.org (Mike O'Dell)
Date: December 3, 2008 1:01:20 PM EST
To: dave@farber.net
Subject: amazing and apalling at the same time
Checklists - ask for them by name!
-mo
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