The KHIT Blog: Up next...

Friday, October 5, 2012

Up next...

www.Health2con.com

I'll be schlepping my camera gear, notepad, and laptop (above, some of my archived shots I've stashed on my wife's Powerbook in iPhoto, edited and tweaked a bit). Gonna give it the HIMSS12 treatment, and represent the REC POV.
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5:45 pm, all set to go.

First up, on Sunday, 1 pm:

Health Law 2.0

Health 2.0 has created a pre-conference session entitled Health Law 2.0 that addresses the pressing legal issues for both large and small Health 2.0 companies. We have identified several key legal issues that face companies in the regulated world of health care and created two tracks of programming — one focused on Patient/Consumer Legal Issues and the other focused on Legal Issues with Providers, Plans and Life Sciences.

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Much more to come. Gonna be a great week.
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SATURDAY ERRATA

Okee Dokee... I waltzed into town on Virgin America, clueless, only to learn that there are: a 3-day Bluegrass festival under way over in Golden Gate Park ("Hardly Strictly Bluegrass") , America's Cup Race heats going on in the bay, US Navy Fleet Week in port (replete w/ Blue Angels overflight performances), SF Giants and 49'er games, Arizona at Stanford football, and UCLA at Cal Berkeley.

Shot this from the Sausalito ferry in 2009

And Health 2.0, among other things. A quiet weekend in SF.

My foray into downtown from Walnut Creek on BART to the pre-conference events tomorrow ought to be interesting.

Late afternoon, relaxing amid the quiet before the storm, view to the west.
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“A well person is a patient who has not been completely worked up.”

Interesting THCB post, "The Art of Diagnosis"

...“clinical algorithms can be useful for run-of-the-mill diagnosis, distinguishing strep throat from viral pharyngitis, for example. But they quickly fall apart when a doctor needs to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact. In such cases — the kinds of cases where we most need a discerning doctor — algorithms discourage physicians from thinking independently and creatively. Instead of expanding a doctor’s thinking, they can constrain it.”If the doctor attends to the patient in front of him, not just by listening to him, but by observing him–perhaps even laying hands on him– he may realize that the patient just doesn’t fit on the tree...

...When a patient visits a doctor complaining of symptoms, he expects the doctor to diagnose what ails him. If he doesn’t, the patient is likely to view the visit a failure.

For his part, the physician presented with a patient in pain quite naturally wants to solve the problem. His medical training has taught him that the resident who names the disease wins the gold star. Thus, both patient and doctor conspire to “insist” on a diagnosis.
If the doctor cannot find a satisfactory answer, or the patient does not respond to treatment for the diagnosed disease, the physician may become testy–and ultimately blame the patient...

"Dia" - "gnosis"... "this, not that." Binary, differential choice of what is deemed to be causal in the search for remediation and cure. Decide this, to the exclusion of countervailing conclusions.

A nice THCB cautionary tale via which to reflect upon the glitterly enticements of "wellness apps," "big data" and "comparative effectiveness research."
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SUNDAY MORNING:
CHECKING MY OFFICE EMAIL FROM WALNUT CREEK

FROM THE WESTERN UNION HEAD OFFICE DEPARTMENT REPUBLIC OF COTE D'IVOIRE. You have been awarded with the sum of $100,000 US dollars by our office Western Union head office department. As one of our customers who use Western Union in their daily business transaction.

This award has been selected through the internet, where your e-mail address was indicated and notified. Please provide Mr. Okffi Abass with the following details listed below so that your certificate of the winning award and also the fund to be remitted to you through our office Western Union. Here is the winning award number: WUS-2018236171/42-CI Note that we have a list of beneficiaries that are claiming there funds, So our office will not be held for any impersonation or wrong payment so you are advised not to disclose your winning number to anyone until your claims has been made and your payment made to you. We hope you understand.

GET BACK TO US IMMEDIATELY WITH THE BELOW INFORMATION

(1) Name:-----------------------

(2) Address---------------------

(3) Country ---------------------

(4) Phone Number--------------

Contact person: Mr. Abass Okffi

Thanks Mrs Mariam Ahmed, Western union staff

To think what I might have missed...
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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Friday, October 5, 2012

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