Dec
16

Cost Disease

By kconover Posted in Tutorials | Comments Off on Cost Disease

The Cost Disease is both the name of a book, and the economic theory espoused by this book.Total health expenditure, % of GDP

The theory is relatively simple at its base. There are two segments to our modern economy, the progressive and the stagnant.

The progressive sector makes rapid improvement in efficiency. Examples include manufacture, particularly of items such as computers and cellphones.

The stagnant sector, including healthcare, education and live entertainment, due to dependence on human-human interaction, does not improve its efficiency rapidly.

Thus, the fraction of our GNP (and your paycheck) spent on the stagnant sector will increase. Continously.

Note that I said the fraction.

This may seem depressing. But the authors point out that, in real terms, our society, globally, is becoming richer. Therefore, despite the increasing fraction we will spend on the stagnant sector, we will be able to afford it. We will be able to afford more and better healthcare, education, and live entertainment.

Nonetheless, we need to do what we can to make the stagnant sectors more progressive. They give examples in the book of how healthcare, in particular, can become more progressive.

It is apparent that there will be an excellent ROI in healthcare by maximizing the efficiency of our healthcare personnel. Some big projects like RHIOs will contribute to this, but at a massive cost. But think – how much of our healthcare personnel’s time is spent using – or cursing at – computers?  Given the sad state of usability of our medical software, we will get a lot better ROI by simply making simple changes to our software to make it more usable. The cost of these changes is small compared to a RHIO, but the incremental benefit is huge. Thus, this website.

[asa]0300179286[/asa]

Nov
29

Model T

By kconover Posted in Tutorials | Comments Off on Model T

An article in the New York Times points up some of the shortcomings of the push for meaningful use of electronic medical records (EMR): it’s vulnerable to fraud. The Department of Health and Human Services is shocked, just shocked, that perhaps some physicians and hospitals may have not been entirely accurate in self-reporting how well they’ve converted to an EMR, just to get a few million dollars.Model T Ford

But the part of the article that got my attention was this quote from Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago:

We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup.

The reason I love this aphorism is not because I am shocked at the poor HHS oversight of the meaningful use process. To that, I say “duh.”

But it encapsulates where I think we are in terms of usability of medical software. Even our best software and hardware – iPhones and Android phones, Google search, Google Maps, and the like – are still barely beyond the Model T phase. Our medical software, far behind these market leaders, doesn’t even make it to the Model T level. Maybe its to the “pileup of Model Ts” phase.

We don’t need Model Ts, we need something like the Tesla Roadster.Tesla Roadster

Jul
10

Menu

By kconover Posted in Tutorials | Comments Off on Menu

Faced with a long dinner menu, it’s hard to decide what to order. (Even with a medium-sized menu, my wife always says “You go ahead and order, I haven’t decided yet.” But that’s extreme.)Chinese Menu

It’s not just an urban legend. There are scientific studies that demonstrate it.

The study When Choice is Demotivating by Sheena Ivengar of Columbia University showed this:

In a grocery store, set up a jam-tasting station.

First, put out four different jams, and let people taste, and if they wish, buy.

Four out of ten people who stop by will taste some jam. Of those people who stopped to taste, three out of ten will buy some jam.

Next, put out twenty-four jams.

Six out of ten people will stop to taste. But of those who taste, less than one in ten (3%) will buy. Read the rest of this entry »

May
07

Contact

By kconover Posted in Tutorials | Comments Off on Contact

As of 2012, a new metric for ED throughput is physician contact time – with the caveat that assigning a physician name on a tracking system, or the time of the first orders, is not adequate to measure this. Surprised? Some docs put their name on the patient as soon as the patient arrives in their pod; after all, they will be seeing the patient.  Sistine Chapel CeilingOthers only put their name on the patient’s tracking board entry after they’ve physically seen the patient. If and when they remember, that is. Some figure that the time from “arrival in room” to “seen by physician” time is most important – and indeed, that may be what they’re being graded on. Others figure that the time from “seen by physician” to “admitted” or “discharged” may be most important – and indeed, that may be what they’re being graded on.

But now that CMS has said

“Our ED physicians “Assign” themselves to patients using the tracking board function of EHR. Does documentation of the date/time “assigned” qualify as Provider Contact Date/Time? Otherwise, the earliest documentation of contact with the patient would typically be the first order or the first LIP progress note. Are those acceptable forms of documentation for these data elements?”

“No, this would not be sufficient documentation of provider contact. You would need to use documentation that supports the time of the first direct, personal exchange between an ambulatory patient and a physician or institutionally credentialed provider to initiate the medical screening examination.”

–Quality Insights of Pennsylvania

I predict three things:

(1) ED directors will try to persuade docs to only put their name on the patient at the instant they actually see the patient,

(2) this will be a miserable failure that fails to generate accurate data and causes much friction, and that

(3) passive tracking (using RFID smart badges that track when you enter a room) will suddenly be of great interest to many EDs. May be a good time to invest in these products.

 

Mar
27

Speech Recognition

By kconover Posted in Tutorials | 1 Comment »

In the Beginning: VoiceEM

Back in 1988, Ray Kurzweil came out with speech-recognition software, including something called VoiceEM. It was an emergency medicine physician charting application; there was also VoiceRAD for radiology. These were DOS programs that ran with that typical DOS 80 character x 25 character text screen. In addition to having a medical-specific vocabulary, VoiceEM had another advantage over the retail shrink-wrap Kurzweil Voice: you could access your voice profile (what the program learned about your particular voice, and the new words you had taught it) from any PC on the network. And, as it learned more about your voice, and as you taught it more words, these were saved back to the server, so you could access this updated “profile” from the network when you started up at the beginning of the next shift. VoiceEM alsom allowed electronic signature, saving your charts on the server and sending them through an interface to an electronic medical record (EMR) system.

VoiceEM employed a speech recognition engine developed by Kurzweil and his engineers. It was advanced for the time but crude by today’s standards. It only recognized Kurzweil Voice

one

word

at

a

time.

The recognizer wasn’t all that good, but if you gave it a choice of just a few words, it could figure out pretty easily what you said. It was even quite good at discriminating between fifty or a hundred words.

To leverage this, Kurzweil added Applied Intelligence. (Applied Intelligence is Artificial Intelligence, only with more engineering and less hype.) They analyzed ED charts, and created templates for the most common presentations.

Let’s take, example, a “chest pain” template. (I’m grossly oversimplifying so it has only a passing acquaintance with the real template, which appears in the screenshot of VoiceEM’s successor Clinical Reporter, but bear with me, it’ll work for an illustration.) Read the rest of this entry »

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