Re: amazing and appalling at the same time

[David Farber <dave () farber net>]

Begin forwarded message:

From: "John S. Quarterman" <jsq () quarterman org>
Date: December 5, 2008 6:16:47 AM EST
To: dave () farber net
Cc: "John S. Quarterman" <jsq () quarterman org>
Subject: Re: [IP] amazing and appalling at the same time

> From: David de Bh=E1l <david.debhal () v-practice com>
> Date: December 5, 2008 1:15:53 AM EST
> To: dave () farber net, "'ip'" <ip () v2 listbox com>, Bob19-0501 () bobf frankston com
> Subject: amazing and appalling at the same time
> Reply-To: david.debhal () v-practice com
>
> I have been involved in the provision of online medical records in
> Australia.
> My colleagues, by-and-large, shun check boxes, check lists, drop-down
> boxes which discretely capture high quality information from a system
> which mimics closely the clinical method and retain this presenting
> the latest summary of this information, attributable, in an ongoing
> fashion. It has been almost impossible to gain traction except in a
> few small facilities in Australia while in Singapore it is like rocket
> science.

Hm, would be interesting to compare countries that actually do this
with some measure of physical well-being.

> My personal feeling after years of frustration is that electronic
> records and checklists will only be adopted by the colleagues when not
> doing so impacts on their income.

Perhaps if it impacted their income by lawsuits if they don't do it.
Or if it impacted their hospital's bottom line by not being able
to get insurance if they don't do it.

Now that last may well be one reason medical personnel don't want to  
do it.
They've had enough of insurance companies telling them 15 minutes per  
patient,
etc.

Nonetheless, if for example an incoming government adminstration were
serious about fixing a problem like this and was revamping the medical
insurance system anyway, requiring insurers of hospital liability to
take communication within the hospital into account could help.

And that might even lead to a problem interesting enough to get
CS people to work on it.  What kind of connectivity and measurement
system would produce appropriate data to be used in this way?

When I previously posted about iatrogenic (physician-caused) illness,
I noted that a lot it was lack of communication: nurses often don't
communicate across shifts, and don't even read charts within shifts.
Multiple doctors prescribe drugs without bothering to look at what
other doctors already prescribed, or ignore side effects even when
they're pointed out, or prescribe drugs such as statens for blood
pressure when diet and exercise often can solve the same problem
with fewer side effects.

This issue of lack of collection of data from machines is part of
the larger issue of lack of communication in the medical profession.
It seems to mostly still be run like it was in Napoleon's hospitals,
where each doctor was a deity and there were no other methods than
voice and paper.

Remember the seriousness of the problem:

One study shows 11% iatrogenic death rate in a dept. of internal  
medicine:

http://linkinghub.elsevier.com/retrieve/pii/S0953620507001094

A study from 2000 estimates 98,000 deaths a year in the U.S. from  
iatrogenic ca
uses:

http://www.deathreference.com/Ho-Ka/Iatrogenic-Illness.html

"This number slightly exceeds the combined total of those killed in
one year by motor vehicle accidents (43,458), breast cancer (42,297),
and AIDS (acquired immunodeficiency syndrome, 16,516)."

There's another possible way to motivate CS students and other people.
Cancer research gets quite a bit of grant money.  What if medical
communication were treated similarly?

> David de Bh=E1l

-jsq





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