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There is a well-known concept in computer science called Garbage In, Garbage Out (or GIGO for short). You need not be a brain surgeon to figure out what it means. If you enter bad data into a program or an algorithm, you’ll get bad data as output. No duh. Seems self-evident to me. That said, I’m not sure everyone has adopted the GIGO way of life, and it’s making me sad.
As many of my readers know, I used to work for a software company which is based near Madison, WI that makes a popular electronic health record (EHR). I won’t name the company to help protect their privacy. I practiced primary care pediatrics for many years before moving over the vendor side, so the ways of a large corporation were foreign to me in many aspects. While this might sound odd, what follows is a true story.
I recently read an article in Wired magazine about what sound design is with respect to information technology (IT) and why sound design is so important. I admit that I’ve rarely thought about this field of software development, but it really is important. What exactly is sound design? The author introduces the concept this way: “How do you know whether Siri heard you? Just as in human interaction, good communication is about the flow of conversation, the ongoing exchange of information.” Sound designers try to ensure that the two-way communication between humans and technology works, intuitively and naturally.
The electronic health record (EHR) problem list is . . . well, it’s a problem. I’ve worked with many of the leading EHR vendors and their tools, and no one has solved this quandary. While I haven’t met a physician (or any clinician for that matter) who doesn’t want a well-maintained and curated longitudinal problem list for their patients, I have met many doctors who don’t want to take on the responsibility. “I’m just the specialist” or “I’m in the ED” are common statements, but one might argue (I might argue) that these are the very folks who benefit the most from an up-to-date list of patient issues and concerns.
I recently attended the second annual KLAS Arch Collaborative meeting in Salt Lake City. If you’re not aware of the Arch Collaborative, it’s a group of hospitals, healthcare systems, and clinics which survey their clinical users about the technology they use to do their jobs. The Collaborative members then benchmark against peer institutions to see how they’re doing. Some crazy Arch Collaborative findings:
In my last post, I described the Last Mile Problem in healthcare information technology (IT). To summarize: The Last Mile Problem originated with supply chain and delivery. It is relatively easy to get a manufactured good from the factory to close to the purchaser (note the word relative!). That last mile – from the post office or local storage depot – is by far the most difficult. Are the roads big enough for the truck? Will the driveway support heavy equipment? Will the customer be there when you deliver? Will the object fit through the door? You get the picture.
I was recently speaking with a friend about a new endeavor that he is exploring, and he commented that no one has solved the Last Mile Problem – that’s what he’s working on. If you’re not familiar with the concept, the Last Mile Problem describes how it’s relatively easy and cheap to get a product from a far-away factory to very close to a consumer’s house, but getting that delivery to the front door of the purchaser takes a lot of effort and costs a relatively large amount of money. Even though the distance from a local distributor to a home may represent 2% of the journey, the costs may consume 25% of the potential profit.
Recently, WBUR posted an article about a parody Twitter account that satirizes one of the biggest electronic health record (EHR) software vendors: Epic. When the reporter reached out to Epic to ask them if they had any response or reaction to the parody account, Epic replied, “We do not.”
I’m a big fan of fellow pediatrician blogger Bryan Vartabedian’s 33 Charts. While I spent a few years at Texas Children’s Hospital, our paths never crossed, and that’s a shanda because Dr. V says smart things in an entertaining way. If you don’t know his work, you should.
I recently read an article in the New York Times titled “The Joy of Standards: Life is a lot easier when you can plug in to any socket.” The authors begin by diving deep into the topic, discussing standards around the size, consistency, and design of the 8-by-16-inch concrete block. From there, we learn about standards-producing organizations and how they interact with governmental agencies. The article ends with a reminder that society needs a strong base upon which to build: “In an age of breathless enthusiasm for the new and “disruptive,” it’s worth remembering the mundane agreements embodied in the things around us. It’s [the] very ordinariness and settledness of standards that enable us to survive, and to move ahead.”