See One, Do One, Teach One

Having “open” electronic medical records (EMR) is absolutely ridiculous.

ReadWriteWeb believes that we should be able to control and transfer medical records personally. However, this is felt impossible because health care is “controlled by big business and government.” Furthermore, they state that “decentralizing this network and giving the power for each American to control their own medical record could ensure higher reliability, less poor diagnoses, and can handle scale.”

Wrong. Wrong. Wrong.

Yes, our current medical record system needs to change. As a practicing physician, I frequently see test duplication and delays in diagnosis due to our current closed system. Doctors at one hospital will likely not get results from other hospitals in a reasonable amount of time. Even if a physician knows to request the records, often the physician may not know specifically what to request. Worse yet, these records are usually faxes from one hospital to another.

With these problems, the brainstem reflex is to let each person control his or her own medical history. Let me, the patient, control who and what accesses my medical records. It is romantic. It is crazy and flawed.

Actually, if the patient was always YOU, then an open EMR might work. You are probably not crazy. You probably do not abuse the system, drugs, or your body. But you are the same person who actually accurately keeps up with medical history now. Any medical record system works well for you.

Let me a take common ICU admission for you. Young lady found down unresponsive and barely breathing. Maybe by searching her house or testing her urine we can estimate that she has overdosed. Maybe she has been in the hospital before and we know that she has been depressed or has a history of overdose. Maybe she also has a rare disease like adrenal insufficiency that can be fatal if not also concurrently treated.

Assume that we fix this lady up and forward her medical records to her EMR carrier of choice. If it is truly open, she can forward it to anyone. Perhaps she forwards it to a “lockbox” carrier who promises to keep it hidden from other systems. Her physicians will never know about her suicide attempt or her potentially life threating illness. Perhaps she forwards it to a “edit” carrier who promises to sanitize or grossly edit the medical record for her. She pays a little extra so her medical record will now show that she has a crippling pain syndrome and requires narcotic pain medications.

Open is open. An open medical record system is an untrustworthy medical record system. Now, I agree that people should have the ability to view and make comments about their personal medical records. Doctors and tests are not perfect, and a patient should have the right to make his/her opinions known.

Luckily, this is not complicated. Just get the EMR companies to come together a establish a universal document standard and communication API. The government would host and secure the common database that would store all the information. Patients could log in and make comments to clarify the record, but information could not be removed or edited.

Medical records are as essential as legal records. Should legal records be open too? Frequently life and death decisions are based upon these documents. A truly open EMR system allows for manipulation and abuse. A universal medical records system will save money and lives. It is vital and essential to insure that the record is inclusive and precise. In this circumstance, being “open” is not the solution.

I will be glad to detail and debate further issues in the comments below.

Technorati Tags: emr, open emr, electronic medical records

I have been weeding through my feed subscriptions. Seeing “links for” is an instant unsubscribe…

This shows why Microsoft has outgrown itself. This January 23, 2007 kbfaq support document from windows is supposed to tell the user how to print a folder listing on a windows machine.

Read this garbage…

To print a listing of files or folders, you can copy an image of a My Computer or Windows Explorer window to the Clipboard, paste it into an image editing or word processing program, and then print the image.To create and print an image of a listing of files or folders using Microsoft Paint, follow these steps:

1. In My Computer or Windows Explorer, open the folder you want to print, and then press ALT+PRINT SCREEN to copy an image of the active window to the Clipboard.
2. Click Start, point to Programs, point to Accessories, and then click Paint.
3. On the Edit menu, click Paste, and then click Yes to display the image.
4. On the File menu, click Print.
NOTE: If there are more files or folders than can be displayed in the My Computer or Windows Explorer window (in other words, you must scroll to see all the files or folders), you must scroll to view these files, and then repeat steps 1-4.

So Microsoft wants the user to actually print a screenshot from explorer to print a directory/folder listing? Crazy.

The way a real person would do it…

1. Drop to a terminal / command prompt window
(Run -> cmd.exe)

2. Navigate to the directory/folder you wish to list

3. dir > folder.txt

4. Open folder.txt in whatever application you wish to edit it or print it.

Today I discovered one of the weaknesses of badges, gadgets, and embeds. Users who are behind restrictive web filters may never correctly see a web page that contains an “include” from a blocked site.

On my XP machines at work, the Facebook Badge does not time out in a graceful manner. This has been the source of my thinking that my blog has not been working incorrectly. Today I installed firebug and yslow for firefox and noticed the following…

The site was stuck on waiting for the facebook badge — eternally. This is likely because of the websense restrictive filtering policy of the hospital. If I try to directly visit facebook, that never resolves either. I receive an eternal “Waiting for…” message in the tray in both IE6 and firefox.

Eventually, IE6 just quits waiting for the badge and never renders the rest of the page. After a minute or two, firefox gives up and does render the page; however, it is such a long delay most people would give up ship and move to another page.

Certainly, you can complain about the way the browsers handle timeouts on javascript. However, the more important point is the following:

How many users are we missing because we are using these embedded objects?

The huge spikes in internet traffic during the work portion of the week suggests that a large majority of internet traffic is from people at work. People at work often have some type of internet filter between them and the rest of the world. It makes sense to me, then, that these hot new embeddable objects may be making many web pages inaccessible to many users.

If a browser fails to load an image, it fails gracefully. If a browser fails to load a gadget, the rendering of your entire page may choke.

Hey, multi-piercing shumck with the SO with fake red hair:

If somebody is sitting behind you, it is rude to recline the seat.

Done. That’s it.

I don’t care if you are 8 feet tall and dying of sleep deprivation. Reclining the seat is basically saying that you are going to claim 6 in X 30 of my space. If you recline your seat, it practically impossible for me to work on my laptop because your headrest is almost directly above the entire portion of my tray.

Of course, it’s a one hour flight and you are not trying to sleep anyway. You are just a tool.

(And I know her red hair is a desperate attempt to hide her premature graying… even if you stopped paying attention long ago.)

I guess I have now seen it all. ABC is blog spamming my site.

They posted the comment to this completely unrelated blog post — The PR Pain — Blog First, Test Later. That blog post is only a year old, btw.

The comment and my email response back to them are quoted below.

The blog comment –

Lauren | talkback@abcnews.go.com | abcnews.go.com/technology/talkback | IP: 192.195.66.48

ABC News in New York would like to extend an opportunity for your video comments to air on our program and be posted on our website.

ABC News Now’s “Healthy Life� wants you to ‘Talk Back’ about using generic brand drugs. Which do you use — generic or name-brand? Why? Generic drugs are cheaper than name brands — but do they provide the same relief & results? Have you had any problems with generic brands?

Tell us your story on-camera! Send in your video comments by Friday, August 17th at 9 a.m. EDT and it could be aired on ABC News Now!

It’s easy! Here’s HOW:

ABC News is specifically requesting 15-45 second video comments or photos.

HOW TO SUBMIT VIDEOS:
1) Via cell phone
Record a clip and email it to: icaught@abcnews.go.com

2) Via the web:
http://abcnews.go.com/Health/TalkBack/story?id=3478601

We look forward to hearing from you & thanks again for your participation. Should you have any questions about this project, email us back at this address: talkback@abcnews.go.com.

Best,

- The ABC News “Talk Back� Team

My email response –

Lauren:

I realize that some mainstream media journalists may not familiar with proper etiquette on blogs. However, posting unrelated comments on a blog post for the sole purpose of driving traffic/attention to your site is considered poor form.

I would appreciate a response.

Best,

Davak

Author of See One, Do One, Teach One
http://blogs.tech-recipes.com/davak/

Imus is an idiot. He is so isolated that he has no clue where the line between humor and insult lives. Slamming girls who have worked tirelessly to become the best they can be. Pitiful.

Most of us understand the issue to that point, and then the wheels fall off. The main stream media is slowing eating itself. Good riddance.

TV talking heads are chomping to slam rap artists who use derogatory terms toward females. Heck, you can’t get more degrading than “It’s Hard Out Here for a Pimp.” This part of the “Hustle & Flow” Soundtrack was part of the Academy Awards Ceremony.

The CNN/MSNBC/FOX “journalists”and bloggers are now shocked that society rewards rappers and fires shock-jocks for the same language. Are you kidding me?

A song author must use the language that fits the environment of the song. If you are trying to accurately portray the life of a pimp, you are not going to be Mr. Goodie-Goodie with your language.

It is not wrong to sing about pimping out women; it is wrong to do it. Taking a picture of a crime is not the same as performing the crime. Art is sacred. Recording an experience through song, photography, essay, whatever… it’s all art. It must be geniune.

As a shock jock, Imus could also claim that his “humor” is his art. Indeed, the humorists will be the next ones to feel the slippery slope. Who will be brave enough to attempt racial humor now? Is every comedian, sports announcer, journalist, and shock jock just one bad joke away from unemployment? Yes, the damn cliche works… you can’t define where funny stops and insult starts, you just know it when you see or hear it.

Maybe the I-Man should have just gone to rehab; however, he did not play the game correctly. Imus is unemployed and silenced.

If Imus were internet-based, he might have less advertisers now, however, he would still have a voice. He could still publish on a daily basis through podcasts, audio streams, or blog posts. Instead, he has been destroyed by the main stream media… the same media that is destroying their own freedom of speech.

Art is art. Sometimes it is ugly and painful.

Imus is an idiot. Ditto.

Apple won over a new generation of mac users through their easy iPod interface.  People figured if the iPod is that easy, then OS X must be too.

Conversely, Apple is shooting itself in the face over iTunes.  iTunes for windows is one of the most worthless pieces of software ever created.  It’s pain equals the crap that is the AOL-redo version of winamp.

I perfectly believe that Apple does this on purpose.  People try to do iTunes-on-Windows-thing when they purchase an uberpopular iPod.  When it does not work well, Apple hopes that people will consider buying an Apple box instead.

Microsoft isn’t a saint here either.  Microsoft actively neglects Office for Mac which is undoubtably more bugging on OS X than on a windows box.

So most OS X users that try office think that the buggy office suite on windows is what the typical windows user experiences.  Most windows users trying iTunes assuming that the shiny apple software sucks on OS X too.

Apple should learn from the iPod.  If you give users slick, pretty things that work well… then users will assume that everything you do works well. 

Physician friends of mine who make quick flights across the state frequently comment on the massive fields of pig farms.   Around the cotton farm I worked as a kid, there were small pig farms; I thought I appreciated the visual and olfactory insults that are associated with porking farming.  I think I was wrong.  This is completely different.

In 1992, when a worker making repairs to a lagoon in Minnesota began to choke to death on the fumes, another worker dived in after him, and they died the same death. In another instance, a worker who was repairing a lagoon in Michigan was overcome by the fumes and fell in. His fifteen-year-old nephew dived in to save him but was overcome, the worker’s cousin went in to save the teenager but was overcome, the worker’s older brother dived in to save them but was overcome, and then the worker’s father dived in. They all died…

The Rolling Stone article, Boss Hog, continues with six pages of brutal attacks against the pork industry, much of which is located in North Carolina.  I will not repeat the article’s documentation of the pork industry’s defilement of the environment.  The read should be essential for anybody who lives in this area.

I am not a political blogger.  In fact, the only political blogs I read are those of local bloggers.  I read those to keep up with the local blogging community more than the poltical one.

Why is this issue not discussed more frequently?  Is pork farming (and the jobs it provides) just too important of an industry for that part of the state?

The N&O received a Pulitzer in 1996 for discussing this topic.  Boingboing  has an amazing array of pig-farm-hating resources relating to this article. 

Boingboing also helped out with a google maps picture of one such farm.  Here are more in that area – another and another.  But once you learn to see them on google maps, you can zoom out and start to see them everywhere. 

For example, this area between Clinton and Newton Grove seems very dense — just scroll north and sound to see a ton of them.  I believe I have marked a few here… (click for a larger pic)

I am just glad that these waste pools are spill-proof because I then I would never be able to find a google map of what looks like a flooded one.

Evidently, NBC-17 has sent out listening tour invitations to a ton of local bloggers here in the triangle…

We would like to invite you to our groundbreaking Blogger Ascertainment. We recognize the contributions bloggers are making to their readers and would like the opportunity to make a lasting connection with your important voice.

This meeting will be dedicated to finding out more about the important issues in your community, and suggestions on how we might be able to serve them better.

The mainstream media in a respectful manner reaches out to local bloggers. These are bloggers who have all ten typing fingers on the pulse of the community. These bloggers represent many groups who are trying to get their ideas expressed. The local media is reaching out to communities of writers who are typically trying to find unique ways of reaching out themselves.

And how does the “local blogging community” respond?

I. Lighthearted - Paul Jones: “I’m sure you mean well, but geez TV guys — Geeks want drinks! And those start after 5. Doncha know, we bloggers are still in our PJs at noon? ”

b. Snarky - Coturnix: “I’d like to ascertain you instead of being ascertained. I’d like to know more about what you want and what are you offering us….”

iii. Uppish - Brian Russell:

7. Be very honest early on about what you want from Bloggers. We are not free labor.

8. Most important: Treat bloggers as equals and with respect. The era of consumers and passive viewers is over. Put links to us on your website…

Before we start making recommendations, should we at least sit down with them first? This is like trying to figure out who gets the kids in the divorce before the first date.

As clumsy as it may be, NBC-17’s invite should be embraced within the local blogging community. It is an excellent opportunity from both sides.