Comments on: News 6/17/09

By: Alex Lifeson

Alex Lifeson — Mon, 22 Jun 2009 15:40:04 +0000

Hey, Henry In Vermont – I call your PR baloney right here. Sorry it took so long, I was on vacation.

What facts, exactly, did I get wrong? Where, anywhere, did I malign Epic and the success (real or not) of their install? How am I the “wrong hands?”

Fact: here’s the link to the big PR spread in the BFP from last week:
http://www.burlingtonfreepress.com/apps/pbcs.dll/article?AID=200990615028
Do you see the name of EPIC in there anywhere? Don’t you think that a little odd that a company receiving a $50m contract in that little state isn’t actually NAMED? Please, go back through the BFP and you’ll see that the other articles are the same: the vendor isn’t really named. In this day of farting-is-press-release-worthy, I see deliberation. I suspect it’s because of the Cult of IDX (and Allscripts) that pervades the town. Care to explain otherwise? Give us some facts instead of maligning me. I’m listening.

Fact: Epic is handing out proposals to local docs. I’ve seen them.

Fact: I made no comment about the quality of the implementation, whether people are happy or not, etc. This could be the single greatest EPIC installation in history, I don’t know. But I didn’t mention that.

Lighten up, Francis. Epic’ll still give you a paycheck no matter what someone says here.

By: skopjok

skopjok — Fri, 19 Jun 2009 20:46:14 +0000

I took the Nuance poll–kind of what they call a “push poll” during an election where the questions were obviously slanted to produce certain answers. That said, they have a point that is relevant to what HISJunkie is talking about–there’s data that can be tabulated and/or stored and displayed in an organized fashion, and HIT has been amazing for that. But that’s all based on deductive reasoning. Diagnostic medicine is done with inductive reasoning, which is much more of a wetware function that requires a narrative sequence to organize thought. Point and click EMR’s are useless for that–you need sentences and paragraphs with a story in them. You ask a good diagnostician how he got the answer, he’ll tell you a story and say it just fit.

By: Unfrozen Caveman CIO

Unfrozen Caveman CIO — Thu, 18 Jun 2009 20:56:29 +0000

Welcome to HISTalk’s UFC. We join the action…….

S Silverstein throws HITman to the canvas, wraps his legs around his chest.

Ouch. That’s gotta hurt.

HITman prepares his counterpunch……

By: S Silverstein

S Silverstein — Thu, 18 Jun 2009 16:59:26 +0000

Re: HITMan’s statement “I still think, however, that physicians think too highly of their own value and the quality of their EMR progress notes. Ask some nurses — they would probably have good insight about who really brings value to the health system equation. ”

Statements like this are why IT personnel have such difficulties being an accepted part of the healthcare provider team.

They are backed not by rigorous quantitative nor qualitative research or data (i.e., scientific approaches), but by personal opinion subject to the biases of the individual and “some” others.

Physicians, trained in a scientific manner, rightly see such approaches to truth as useless information.

By: HIS Junkie

HIS Junkie — Thu, 18 Jun 2009 16:40:38 +0000

HITman says:
“variation is the enemy of perfection and that by forcing physicians to deliver care in an evidence based-way (mon dieu!) and standardizing the care they deliver that we can improve the care that we deliver to our customers”
—————
Perfection…do you really think patient medical care can reach perfection?
Perfection assumes we KNOW what the final answer is…in medicine we are a very long way from that. I always have said – they don’t call it the ‘practice’ of medicine – for nothing!

80 /20 ? I would say it’s more like 60 /40. There is a big difference between procedural medicine and cognitive. The first you know what the problem is, and know from ‘practice’ what you need to do, the second you do not.

That’s why if you read a medical record you’ll see repeatedly the term R/O…rule out. Cognitive medicine is the process of elimination. Very time consuming and VERY costly, and not always consummated.

My view is that EBM can work well for procedural cases (till somebody comes up with a new procedure, or diagnostic tool) – which happens almost monthly as witnessed by all the medical / drug firms we have.
And we already use EBM for cognitive cases, again it’s called the R/O technique, which to really be effective must include some variation.