The KHIT Blog: Refactored Day 2

Tuesday, May 14, 2013

Refactored Day 2

What a difference 30 minutes makes. Yesterday I left Walnut Creek at 6 a.m. and got to the Refactored Conference in an hour and five minutes. Today I didn't get off until 6:30 and it took an hour and 35 minutes.

Heard about this dustup the other day, and there's a news update this morning.

WASHINGTON (Reuters, David Morgan) - An Obama administration effort to raise private donations to help implement President Barack Obama's healthcare reform law came under fire on Monday from congressional Republicans who claim the action could violate the law.

As the Republican-controlled House of Representatives prepared to mount a new vote this week to try to repeal the law, House Energy and Commerce Committee Chairman Fred Upton asked the administration to identify the companies and organizations that have received fundraising calls from Health and Human Services Secretary Kathleen Sebelius.

The committee also sent letters to nearly a dozen healthcare companies asking if they have received solicitations from Sebelius. The list includes insurers Aetna Inc, Cigna Corp., Coventry Health Care Inc, Humana Inc, UnitedHealth Group Inc and WellPoint.

Meanwhile, Republican Senator Lamar Alexander called on Sebelius to end the fundraising, saying her actions could violate Congress' power to direct policy through appropriations...

Interesting question. Anti-ObamaCare obstructionist Republicans vow to throw tactical sand in the PPACA gears at every turn, given that they will never get the votes to repeal it outright (Rep Cantor's tiresome iterative posturing notwithstanding). By refusing to approve appropriations for the upcoming HIX deployment, they hope to help make the ACA health insurance exchanges the Cluster[bleep] they want it to be.

We shall see.

UPDATE

Uh, OK... Taking time out from her breathless warnings about the New Soviet Menace, I see. Her latest is that Obama is going to use the IRS to deny health care to Conservatives and "kill" them.

Is this a great country or what?

UPDATE2: Bachmann will have a cow...

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Off to witness far more interesting and value-adding stuff at Health 2.0 Refactored Day 2. to wit...

L to R: Adrian Gropper, Patient Privacy Rights, Arien Malec, RelayHealth, and The Bolty Boy

Health 2.0's Jess Goldband

Fred Trotter (center) and Laura Herzog (right) presented a searing session.

Fred Trotter is a Health Hack Badass. I've reviewed his work before.

Karen Herzog

Ryan Panchadsaram, White House Special Advisor. Another brilliant youngster.

Jess Jacobs, FDA

Karen Herzog

I am way behind in posting captions and narrative updates. They will probably have to await my returning from HIMSS California State HIT Day in Sacramento tomorrow. I have copious notes.

Didn't help that I spent five hours total today in heavy Bay Area commuter traffic.
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UI, UX, and U

Mike Cuesta, CareCloud

Sean Mehra, HealthTAP

Mike Cuesta moderated the Day 2 UI, UX, and U: Designing for Health session. Sean Mehra dazzled me fairly well with his eloquent HealthTAP presentation, which went through their design and coding proess for their product, written principally to agnostically accomodate iPhones, iPads, and Android product platforms (in addition to desktop web browsers) using combined HTML5 + JavaScript + CSS coding tools.

These kids are all really smart and into it.
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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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Tuesday, May 14, 2013

Refactored Day 2

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