Re: amazing and appalling at the same time

[David Farber <dave () farber net>]

Begin forwarded message:

From: "Bob Frankston" <Bob19-0501 () bobf frankston com>
Date: December 4, 2008 5:08:12 PM EST
To: <dave () farber net>, "'ip'" <ip () v2 listbox com>
Subject: RE: [IP] amazing and appalling at the same time

Thirty five years ago I was in the Clinical Decision making group at  
MIT so I'm not at all surprised at the ad-hoc approach to care. More  
recently my son worked at a local hospital and was surprised to learn  
that using computers was not the norm and that paper was the preferred  
medium for information. In doing software for a researcher he was told  
that the results were to be printed out so they could be gathered and  
tabulated from the paper.

I do appreciate the importance of capturing and sharing procedures and  
if checklists are a start then they are valuable. But the larger  
question is why don't we have the understanding and tools to make it  
easy to do so much more.

This gets to the heart of the point I was trying to make when I posted  
my comments on GENI -- http://frankston.com/?Name=IPGeni2 -it's not  
about the network -- it's about what we (don't) do with networking.  
Why does someone have to go down the floor to check whether the  
machines are connected just right -- why aren't they self-checking.  
I'm not saying that we can automate the process -- just the opposite.  
It's not about automation -- it's about not being gratuitously dumb.  
Of course we can't capture all the nuance and we shouldn't have blind  
trust in the technology.

It's not just about clip boards but the idea that we still define  
information relationships using wired logic with isolated devices and  
machines that have to be wired together or else have their information  
copied on clipboards. It's a problem at the physical interconnection  
level and with information relationships and interpretation.

What makes this so frustrating is that this is so mundane that even  
using a clipboard is an advance. Telemedicine should be too boring to  
write about. Sending a digital image of rash should be the norm before  
you have to use expensive resources for an office visit.

We should also be able to assume connectivity without having to have a  
billing relationship every step of the way and without having to  
depend on a third party to fix "dead spots" (bad pun?). Instead I  
should able to expect my wrist health monitor to be connected most of  
the time. Not necessarily all the time -- we do need resilient design  
-- but often enough that I can be monitored if need be while retain  
mobility.

And, yes, we get back to telecom policy because as long as we assume  
someone has to communicate for us and as long as we tolerate  
gatekeepers then something as simple as telemedicine is as hard as ...  
well, I'd say brain surgery but that's another topic.

PS: I notice my Walgreens pill container does have a barcode but my G1  
doesn't recognize it. I wonder what's on it. Why can't I use it to get  
information about the medicine? Is it that complicated. What would it  
take to use my personal scanner (what some people call a phone) to  
read the information and compare with my other medicines? How hard can  
that be?

-----Original Message-----
From: David Farber [mailto:dave () farber net]
Sent: Wednesday, December 03, 2008 16:34
To: ip
Subject: [IP] amazing and apalling at the same time



Begin forwarded message:

From: mo () ccr org (Mike O'Dell)
Date: December 3, 2008 1:01:20 PM EST
To: dave () farber net
Subject: amazing and apalling at the same time

Checklists - ask for them by name!

http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande?printable=true

      -mo




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