This Blows Me Away
Today in the mail, there comes a letter from the new Chair of the Department of Medicine at the medical school where I did my residency in 1963. That’s a long time ago. There was frequent contact with the department during my years of practice but never a letter from the department head asking for the opinion, the thoughts and experiences of former Department of Medicine house officers. Spell that grunts or residents, like on ER. I doubt he expected an answer from a crapped out bush pilot.
A new age is dawning, however. Not only is this a hint of bottom up management, but also a request for Information to flow by Internet and from what must be a very diverse and very large constituency. What seems to be significant is the lack of authoritarian, top down medical information but a suggestion that some kind of quality might derive by information flowing the other way, and indeed, it might.
Group intellect is obviously greater than individual. The problem has always been with the committee effect, wherein the whole seems to come out less than the sum of the parts. Size has tended to have an adverse effect, the larger the group the greater chance for confusion. The Internet seems to change that. It is curious, thousands can respond but in the bloggesphere, the opposite seems true. The numbers improve output exponentially; the more input the wiser the level of discourse. Furthermore, the intelligence is networked not just with one respondent but a network of endlessly interconnected contributors.
Part of the rapid growth of the Internet and of technology resulted from the sharing of data on the Internet. This would have great potential for health care. One of the problems, however, lies with obtaining clean data from the clinics and rural offices where the vast amount of pathology is treated and where insurance considerations distort the data.
Offering my thoughts to this high ranking and respected academic, however, is a scary matter. Ranting in a blog is one thing, writing the head of a Department of Medicine with 500 full time faculty and with a 600 volunteer clinical faculty is quite another matter. I look at the list of specialists and shudder.
The thing that fascinates me, however, is what really got me into the geek thing in the first place. I had a fascination with the computer as it applied to my practice. There were certain things the computer could do and many that it simply could not or at least not without endless fiddling around. Like with a typewriter the productivity was immense. I saw the productivity of my business office grow. The computer combined the journal with the ledger, and again with a jump in efficiency. What I wanted was for it to save me time and write a better patient record and a more accurate record. There remained great amounts of wasted time posting laboratory results, writing prescriptions, confirming dosages and drug interactions and looking up foolish diagnostic codes, foolish because of the archaic nomenclature and convoluted numeric coding. I knew spread sheets and used them from the time Lotus put theirs on the market. The spreadsheet was two dement ional in those days but there was a new relational database that could do more interactively. There may have been multiple renditions of the principal, but I was off on Philip Kahn’s version, called Paradox. I joined the user’s group. The idea was to have multiple inter connected lists that could relate in multiple dimensions, and Philip was into what he called a dashboard that simplified entry. I bought the program and started experimenting with its application to a patient record system of nearly thirty thousand charts. It required help, but I was able to relate a list of patients with a list of diagnoses, with a list of complaints, with a list of findings, with a list of treatments, with a list of drug interactions and finally with a list of accessible references for each. The system was incomplete and focused on every day encounters such as bronchitis. By picking the items from each list, one assembles a report that describes the patient encounter in a problem-oriented format with diagnosis, and optional treatment selected from a dropdown menu. The printed report included the prescription eliminating a potential source for error and a plain English version for the patient to take home. This multi dimensional database was very compact. The same narrative was not repeated over and over again for multiple patient records but only the selected content for the report for that one patient. The endless series of reports were stored and recalled like any other file but none of the content was unique. There was a file for narrative but that was not usually needed. A file in the Review of Systems might list an organ system as a field and symptoms as rows in that field. These terms apply to Paradox but may vary with other database systems many of which can achieve this virtual, multi dimensional, actually digital, appraisal of a multi dimensional clinical encounter. Such an interactive database supplying accurate and confirmed data to statisticians, researchers and epidemiologists can have significant benefits. Well I sent it off anyway; we’ll see what happens.
A new age is dawning, however. Not only is this a hint of bottom up management, but also a request for Information to flow by Internet and from what must be a very diverse and very large constituency. What seems to be significant is the lack of authoritarian, top down medical information but a suggestion that some kind of quality might derive by information flowing the other way, and indeed, it might.
Group intellect is obviously greater than individual. The problem has always been with the committee effect, wherein the whole seems to come out less than the sum of the parts. Size has tended to have an adverse effect, the larger the group the greater chance for confusion. The Internet seems to change that. It is curious, thousands can respond but in the bloggesphere, the opposite seems true. The numbers improve output exponentially; the more input the wiser the level of discourse. Furthermore, the intelligence is networked not just with one respondent but a network of endlessly interconnected contributors.
Part of the rapid growth of the Internet and of technology resulted from the sharing of data on the Internet. This would have great potential for health care. One of the problems, however, lies with obtaining clean data from the clinics and rural offices where the vast amount of pathology is treated and where insurance considerations distort the data.
Offering my thoughts to this high ranking and respected academic, however, is a scary matter. Ranting in a blog is one thing, writing the head of a Department of Medicine with 500 full time faculty and with a 600 volunteer clinical faculty is quite another matter. I look at the list of specialists and shudder.
The thing that fascinates me, however, is what really got me into the geek thing in the first place. I had a fascination with the computer as it applied to my practice. There were certain things the computer could do and many that it simply could not or at least not without endless fiddling around. Like with a typewriter the productivity was immense. I saw the productivity of my business office grow. The computer combined the journal with the ledger, and again with a jump in efficiency. What I wanted was for it to save me time and write a better patient record and a more accurate record. There remained great amounts of wasted time posting laboratory results, writing prescriptions, confirming dosages and drug interactions and looking up foolish diagnostic codes, foolish because of the archaic nomenclature and convoluted numeric coding. I knew spread sheets and used them from the time Lotus put theirs on the market. The spreadsheet was two dement ional in those days but there was a new relational database that could do more interactively. There may have been multiple renditions of the principal, but I was off on Philip Kahn’s version, called Paradox. I joined the user’s group. The idea was to have multiple inter connected lists that could relate in multiple dimensions, and Philip was into what he called a dashboard that simplified entry. I bought the program and started experimenting with its application to a patient record system of nearly thirty thousand charts. It required help, but I was able to relate a list of patients with a list of diagnoses, with a list of complaints, with a list of findings, with a list of treatments, with a list of drug interactions and finally with a list of accessible references for each. The system was incomplete and focused on every day encounters such as bronchitis. By picking the items from each list, one assembles a report that describes the patient encounter in a problem-oriented format with diagnosis, and optional treatment selected from a dropdown menu. The printed report included the prescription eliminating a potential source for error and a plain English version for the patient to take home. This multi dimensional database was very compact. The same narrative was not repeated over and over again for multiple patient records but only the selected content for the report for that one patient. The endless series of reports were stored and recalled like any other file but none of the content was unique. There was a file for narrative but that was not usually needed. A file in the Review of Systems might list an organ system as a field and symptoms as rows in that field. These terms apply to Paradox but may vary with other database systems many of which can achieve this virtual, multi dimensional, actually digital, appraisal of a multi dimensional clinical encounter. Such an interactive database supplying accurate and confirmed data to statisticians, researchers and epidemiologists can have significant benefits. Well I sent it off anyway; we’ll see what happens.
posted by Clancy Hughes | 6/28/2005 01:01:00 AM
0 Comments:
Post a Comment
<< Home