elegation's posterous

el·e·ga·tion: being highly effective, yet simple

Visual Thinking, Metaphors, and Inspiration to Improve Electronic Medical Records (EMRs)

Visual_thinking_for_design

I would like to share with you one of the most inspiring books for me.


Perhaps you have heard of it?  Its by Colin Ware, "Visual Thinking for
Design", a free preview can be found on google books:

http://books.google.com/books?id=WBlUgKhMbdsC&lpg=PP1&dq=visual%20thinking%20for%20design&pg=PP1#v=onepage&q=&f=false

I draw inspiration from the book.  One is the idea that most humans are at a basic level fundamentally designed to receive and interpret visual information in the same manner.  The steps higher up in cognition, such as "what" is that object, what to "do" with the object can be different for different people.  Due to these similarites, products and interfaces can be designed and optimized for human use.  Elegant design by an engineer can help decrease mental workload and make a task actually more enjoyable & effortless.  The current hospital environment and design of EMRs have loads of room for optimizing workflow, visualization of data, and for distributing workload between humans as well as human-computer.  Specifically, the tasks for which the computers are able to accomplish (data storage, continuous monitoring, information retrieval, and communication) can be interfaced with the human's strength (prioritization, problem solving, decision making, interpretation and adding meaning to data).  The interface can provide a powerful end product (see computer/device alerts in the critical care setting for when a patient is getting ill, the amount of data
the cllinician is able to review on a daily basis during "rounds", or the human maintaining a medical problem list for a patient).

Clinicans, when combined with elegant design of computerized systems is safer and more effective than the clinician without any tools.  Dr. Friedman's "Fundamental Theorem" of informatics elegantly describes this idea:
http://www.jamia.org/cgi/content/full/16/2/169/FIG1

A current problem in health care that much of the electronic medical record (EMR) is not objectified.  Humans evolved and succeeded in their environment due to the ability to manipulate objects.  It can even be an enjoyable experience (see the iPhone).  The difficult to use interface and navigation of clinical data that is commonplace in the currently availabe EMRs has much room for improvement.  Coln Ware's book offers a reference to my other academic hero, Dr. George Lakoff.  page 62-63, "Even when we talk about abstract, inherently non-spatial ideas, phrases such as connected to, built on, contained within, are so common that we do not even think of them as metaphoric.  According to Lakoff, these kinds of spatial analogies are fundamental to human reasoning, which is ultimately grounded in human experience gained by interacting with the environment."  In other words the lower levels of visual processing are fundamental and fixed, but the higher levels offer for a much more malleable situation.  The human is "programmed" via narratives and metaphors.

One feeling I get in engineering these days is that conceptual models can be very complex, and I wonder if they could be simplified a bit.  One possibility would be if these models could actually be tied more directly to some of the fundamental metaphors and narratives for which many of us are familiar.  Perhaps these ideas and concepts which are written on papers and journals are essentially in "the cloud".  I wonder if there is an opportunity to bring it back to earth, to the world in which we live, to be more applicable to our everyday lives.

CMS Proposed 2010 Payment for Procedures

Proposedcmscharges

 

While the previous table tries to demonstrate stability in fees, this table shows that charges for the same procedure and care delivery net a 10-30% decrease in charges for 2010.

Does this mean that physicians will receive a 20-30% pay decrease?

Likely not, as the Wall Street Journal reports.

The issue goes back to a law passed in the 1990s that was supposed to ensure that the amount Medicare paid doctors for each beneficiary grew no faster than the overall economy. That didn’t happen. (The law created something known as the “sustainable growth rate,” or SGR, in Washington jargon).

So now there are two different worlds. There’s the official world, in which doctors are scheduled to get a 21.5% pay cut from Medicare next year under SGR. And then there’s the real world, where Congress will intervene at the last minute to block the pay cut, as it’s done time and again in recent years.

There have been calls for Congress to fix the situation, but doing so would wreak budgetary havoc: It would require admitting that payments to physicians are way higher than the government officially expected.

2010 Proposed Medicare Changes

Proposedcmschanges

Very Interesting.

Culled from the latest 1100+ page document on (pages 716 & 717).

As you can see, the CY 2010 Changes pay less for Cardiology (-11%), Interventional Radiology (-10%), Nuclear Medicine (-13%), Radiation Oncology (-19%), Radiology (-11%).

Specialties with the highest increase in funding include Ophthalmology (11%), Family Practice (8%), Geriatrics (8%), Physical Medicine (7%), Internal Medicine (6%), Anesthesiology (6%), Interventional Pain Management (6%).

Personally I'm a bit confused as to why ophthalmology got such a huge bump, as did anesthesia, interventional pain management, and even orthopedic surgery all enjoy an increase in reimbursement.  Meanwhile cardiology, radiology, and related radiologic service get pretty deep cuts.  

Meanwhile GI, dermatology, emergency medicine, hold steady.

Looking at the graph, its easy to tell that it truly is a zero sum game.  The combined impact nets 0-1% overall changes in funding, meaning that cuts in one area of medicine could be linked to increases in others.

The Bonfire Called Living [inspiration]

From my grandmother's blog..  She was ahead of her time.


[E]nergies we create with our minds as well as our bodies.  These thought waves can be measured electronically so we admit that there is actual use of energy with each thought.  In our society, as in most social structures, we are carefully programmed to accept certain thoughts as correct, simply because they are repeated over an over in action as well as words.  Ideas are as contagious as the common cold, and when they are accompanied by fear and worry, many mistaken ideas are accepted as truths.  These thoughts become deeply rooted in our minds, our bodies and our future.  When I stated in a previous column that today we are creating our tomorrows, I was referring to just that.

 
Liken your mind to a television set. Now turn off the old obsolete ideas of dreading and fearing the future and change the channel to ones called hope, anticipation and wanted plans for the future.  What you will be doing is directing your energies to the things you want instead of what you don’t want. Fear, dread and worry burn up precious body energies that could be converted and used to kindle the fires of creativity, love and joy.  How about adding your kindly thoughts to our wonderful bonfire called LIVING.

In Pursuit of Elegance [book]

Elegancebook

I read In Pursuit of Elegance: Why the Best Ideas Have Something Missing by Matthew E. May last week while on Vacation.

It started slow, but the ideas captured my attention, and the theme came together nicely by the final chapter.  I continue to see the concepts throughout my daily life, including symmetry, seduction, subtraction, and sustainability.

Unintended Consequences in Health Care Reform

Unintended

Atul Guwande in the New Yorker via Sean Khozin 

 
Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check [Guwande]

Gawande likes the idea of having integrated healthcare delivery systems, like the Mayo Clinic, where salaried physicians work in multidisciplinary teams and there is fair amount of collective thinking. As the CEO of the Mayo Clinic told him, “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing.” [Khozin]

The current system drives some absurd behaviors and incentives.  I hope any upcoming reform builds within it, a way for continuous change.  Any future changes will have unintended consequences.  Fortunately, the fixes don't have to come all at once.  Unfortunately it is very difficult to drive any positive change in the current system.

photo via docksidepress 

Bon Iver: Blook Bank

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Bon Iver, of Eau Claire, Wisconsin.  A mood altering/enhancing performance.  The folklore surrounding his album For Emma, Forever Ago is sometimes a guiding narrative of my current stage of life.  A coming of age story, starting to accept pains from the past and moving forward, stronger than before.  Each listening session seems to build on the previous and continues a journey of self improvement and simultaneous self acceptance.