The KHIT Blog: WHAT? "Boil Water order" for NOLA?

Sunday, March 3, 2013

WHAT? "Boil Water order" for NOLA?

OK, I'm here in the press room at HIMSS13, about 10:30 a.m., sitting in a cube and, just saw a tweet:

Boil water order issued for east bank of N.O. after water pressure drops

WWLTV.com

NEW ORLEANS - A precautionary boil water advisory has been issued for all of the east bank of Orleans Parish, after a loss of water pressure Sunday morning, city officials said.

"Sewerage & Water Board officials are still determining the cause of a loss of water pressure at the S&WB Power Plant," said a statement from the city, about two hours after initial reports of the problem from residents.

S&WB recommends that customers boil their water for one minute and let it cool down prior to consumption (including drinking, cooking, brushing teeth, bathing or preparing food).

"This boil water advisory will remain in effect until further notice for customers in the affected area. The Sewerage and Water Board will notify residents when the advisory is lifted." said the city's statement...

Uh, OK... I brushed thoroughly this morning...

Well, if we have to boil water, we might as well boil some crawdads while we're at it.

TRIP TO THE RESTROOM

Lovely.

What about, uh, washing your hands in the lav?

MOVING RIGHT ALONG

Michael L. Millenson is all over it. By way of Maggie Mahar:

The Health IT Scandal the NY Times Didn’t Cover

As health information technology honchos gather for the annual HIMSS trade show and schmoozefest, it’s a safe bet the industry “scandal” the New York Times placed on page one recently will breed more bored yawns than buzz. The real scandal in health IT involves the customers, not just the vendors, but that’s a topic for quiet conversations journalists can’t cover.

In case you missed it, the shocking news was that health IT companies that stood to profit from billions of dollars in federal subsidies to potential customers poured in – well, actually, poured in not that much money at all when you think about it – lobbying for passage of the HITECH Act in 2009. This, putatively, explains why electronic health records (EHRs) have thus far failed to dramatically improve quality and lower cost, with a secondary explanation from athenahealth CEO Jonathan Bush that everything would be much better if the HITECH rules had been written by Jonathan Bush of athenahealth...

Even those hospitals that adopted EHRs rarely bought, or bought and then didn’t turn on, clinical functions related to drug-drug interactions and infection prevention. “Computerized medical records” were used to better document all the small details of care that boosted payment in a fee-for-service world. Salt Lake City’s LDS Hospital used computerization to reduce the adverse drug reaction rate below the theoretical minimum of the Harvard Medical Practice Study and its innovation diffused precisely nowhere. One hindrance, some doctors whispered softly, was that infections resulted in more care, more revenue and more profit for the hospital...

Now we come to the behavior that really should inspire the outrage. We as a nation paid out billions in bribes because so many physicians simply refused to believe they could benefit from an EHR that the hospitals dependent on those doctors for admissions refused to buy computerized records no matter what the evidence. The vendors, aiming to ease the transition when hospitals did buy, designed clumsy interfaces based on provider habits and inefficiencies from the paper world. When the market finally changed, all the bad stuff got baked in: difficult interfaces and missing functionality that frustrated physicians; poor customer service from vendors puffed up with profits; absurd flaws – a medical record less searchable than a ten-year-old PC – that were never corrected while piled-on new features created a kluge-job catastrophe.

Then there were the unintended consequences that occur when any innovation is taken to scale. Is it any surprise that academics focusing on efficiency and clinical improvement were blindsided by sharpies who focused, instead, on how EHRs could help game the reimbursement system to make more money?...

The problem with health IT isn’t the politicians and lobbyists, easy targets though they may be. It’s us, in health care. It’s the doctors, hospitals, vendors and researchers among us who are not held accountable when our behavior delays and distorts innovation, hurts patients, costs money and impugns our own industry’s credibility.

THCB has the post as well. The comments are interesting, as always.

HEALTH INNOVATION BROADCAST CONSORTIUM

Just ran into Dr. Salber and Gregg Masters. They're doing a cool thing here at HIMSS.

About
We’re an independent association of professional journalists, producers, bloggers and activists who have joined forces to organize and produce coverage of the HIMSS 2013 Conference and Exhibition. We’re laying the foundation to make HIBC.tv a sustainable, independent resource, so we appreciate your support. Founding members include Open Affairs Television, The Doctor Weighs In, ACOwatch (XanateMedia) and crowdfunders Medstartr and Health Tech Hatch. Coverage of the conference and the ‘innovation conversation’ begins on Sunday, March 3 2013 with “HIMSS’13 Highlights” and continues through the end of the conference Friday, March 8th, 2013.

A partial list of the experts we have secured include Pat Salber (@docweighsin), Gregg Masters (2healthguru), Nate DiNiro (@unclenate), Neil Versel (@nversel), Jane Sarasohn-Kahn (@healthythinker), Regina Holliday (@ReginaHolliday), Dave Chase (@ChaseDave), Matthew Holt (@boltyboy), Leah Carey (@thehealthmaven), and others to be announced as they come aboard. Our conservative estimates put potential targeted audience reach at over 250,000 daily viewers...

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WORKSHOP C:
BEST PRACTICE (METHODS AND TOOLS) FOR CLINICAL WORKFLOW ANALYSIS

OK off to Great Hall A. I think it's in a different ZIP code.

CODA: EVENING RECEPTION

Walter Wolfman Washington and his band. Lots more shots. Too tired to post tonight, though. Big day tomorrow.
__

Up at 6...

Nice. A good day. The big stir starts today (Monday).

I'll have to have my cognates aligned so I can fully absorb all of the Seamless Sustainable Interoperability Solutions I'm gonna hear about. There will be a plethora of End-to-End Solutions that Span the Medical Device Connectivity and Clinical Informatics Spectrum.
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More to come...

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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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Sunday, March 3, 2013

WHAT? "Boil Water order" for NOLA?

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