tag:blogger.com,1999:blog-3503957686158274288.post4029734488962464429..comments2024-03-12T12:32:15.598-05:00Comments on On Health Care Tech & Policy: Health IT and the Carob TreeMargalit Gur-Ariehttp://www.blogger.com/profile/08777722834145614546noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-3503957686158274288.post-58268401646088161302011-02-01T07:14:44.513-06:002011-02-01T07:14:44.513-06:00Generally, 15 grams of carob powder is mixed with ...Generally, 15 grams of carob powder is mixed with apple juice for children. Adults should take at least 20 grams per day. The powder can be mixed with mashed potatoes or sweet potatoes. John, drink lots of water. Note that the diarrhea is controlled pediatrician proper hydration and electrolytes is essential for high acute diarrhea.hyperhidrosishttp://www.stopsweat.com/hyperhidrosis.htmnoreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-51780750353291272652010-12-28T15:03:01.851-06:002010-12-28T15:03:01.851-06:00Hi David, thank you for the kind words and by all ...Hi David, thank you for the kind words and by all means feel free to link this, or anything you else you like.<br /><br />I did mean superset, with the intent of sharing less not more depending on the context. That said, I can see how advances in genetics, for example, could lead to a need to expand the superset. I can also see how eventually, advances in computational technologies may make expanding the superset to include every piece of data, and distilling contextually relevant information on the fly, almost trivial (that's the 70 years program :-)).<br /><br />I find it both interesting and telling that the Netherlands, which are considered to be very advanced in this field, are actually creating special summaries to be shared through the national hub. They do not share the full record as is. I like the Dutch approach. I also like the CCR/CCD/CDA and HL7 in general, which seems to be globally accepted, and I don't know why we need to reinvent the wheel....Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-67283608801481867852010-12-28T14:41:06.992-06:002010-12-28T14:41:06.992-06:00Hi Margalit,
Very thoughtful post. I find you one ...Hi Margalit,<br />Very thoughtful post. I find you one of the most interesting bloggers out there. Sometimes in the medium of the written word it's not always obvious where irony is intended, but I think I have it figured out in your Carob tree analogy. I'd like to link to your blog from my "Harmonious Health IT" blog where I just wrote some recent thoughts on a related matter.<br /><br />The "superset" (actually I think you meant "subset") lies behind the clinical summary concept started with CCR then CCD and currently enthroned in MU. While I don't disagree with the items you mentioned in the general case, how much will clinicians want to rely upon this least common denominator, vs. wanting more intelligence based on their context, sort of "personalized medicine" with personalization here applying to the combination of patient, provider, and encounter. I realize that the perfect shouldn't be the enemy of the good, and don't want to imply a 70-year carob tree though.<br /><br />Thanks,<br /><br />DavidDavidhttps://www.blogger.com/profile/13251393010554964308noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-13500720776378012722010-12-28T10:24:31.114-06:002010-12-28T10:24:31.114-06:00I'd like to add in response to the comment by ...I'd like to add in response to the comment by Elad Gross that I think there's a different mentality when it comes to health care. Financial records have traditionally been a person's perogative to keep, both in the days before people trusted modern banks to safely hold their money (see Margalit's other excellent <a href="http://onhealthtech.blogspot.com/2010/08/ehr-circle-of-trust.html" rel="nofollow">post</a> comparing finance and HC) and even now in the days of electronic banking. People view their finances as their responsibility to keep up with. Wheras in health care, the record keeping has traditionally been the doctor's responsibility. People just don't think about them in the same way, and it will take time for that kind of mental paradigm to change.Michelle Whttp://www.occampm.com/blognoreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-81075660334291970262010-12-24T13:57:26.569-06:002010-12-24T13:57:26.569-06:00Thanks Dr. Vaughn.
Funny you mention productivity....Thanks Dr. Vaughn.<br />Funny you mention productivity. I often wondered what exactly does that mean. My mental picture has always been of a frazzled pcp rushing through weary patients who have spent a long time in a crowded waiting room already. EHRs are poorly equipped to solve this particular problem. <br />The "other" productivity could indeed stand some "losses" and hopefully EHRs will be able to help a little when they become a lot more than a data collection tool.<br />7 years sounds right....Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-14935983438439860212010-12-24T06:51:44.976-06:002010-12-24T06:51:44.976-06:00Provocative essay Margalit. Hopefully the EHR caro...Provocative essay Margalit. Hopefully the EHR carob tree will be mature in 7 years and not 70. I think you might have mentioned that there is still little evidenced based medicine to 'encourage' with CDS and that places like Intermountain Health use EHR as part of the EBM discovery and distribution process. And finally, referring to decreases in productivity when that productivity includes less than ideal care and a lot of unnecessary care is counterproductive. Thanks for pointing out that the common comparison to financial services (ATMs) is a really unfair. Health care will never be as simple as arithmetic.rvaughnMDhttps://www.blogger.com/profile/09958728840526322073noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-72064874711234936832010-12-24T00:17:39.183-06:002010-12-24T00:17:39.183-06:00First, most medical records in this country are on...First, most medical records in this country are on paper. Unlike financial data, which is mostly numeric, medical records have been historically a narrative, thus significantly harder to digitize.<br /><br />Yes, there is a potential for someone(s) to make a boatload of money by creating a Mint for health care, and this is why there is such a great push to coherently digitize medical records.<br /><br />Yes, incentives are misaligned. In order for data to exist in an electronic format, which is a prerequisite to a Mint style solution, someone must input it into the computer. The individual(s) who need to do the data entry (i.e. clinicians) have very little to gain from their efforts. Data entry is not reimbursable and, from a physician point of view, it reduces productivity, which has a negative impact on the bottom line.<br />Furthermore, there are no definitive studies showing improvement to patient care when current EHR tools are used.<br /><br />The financial benefits of EHR will accrue in the future and will accrue to those who pay for health care, not to those who provide health care services. The immediate financial investment on the other hand, has to be made by service providers. Government is proposing to help some, but the incentives cover only a small fraction of projected costs.<br /><br />Yes, everybody has a price, but so far the "reserve" hasn't been met.Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-45187189700292865332010-12-23T13:19:48.187-06:002010-12-23T13:19:48.187-06:00Health care isn't a new issue, so why do you t...Health care isn't a new issue, so why do you think no private sector solution, like those you mentioned in the area of finance, have emerged to simplify personal health records?<br />We have WebMD and other self-diagnoses/advice sites, but nothing like a Mint for health. Wouldn't it make sense (and a good amount of money) for someone to put together a platform not unlike online banking for health, where reminders can be set up (texts to take meds, go to the doctor), online scheduling can occur between compatible doctor/home-use platforms, patient journals can be kept, etc?<br /><br />And why does this have to take such a long time to do? The technology is already there. And there should be incentive for SOMEONE (more likely A LOT of people) to collect all of this data on people for use in medical studies.<br /><br />In short, what's stopping the market from streamlining medical information? Are incentives misaligned? Does current government regulation guide funds to less efficient products? Is the private sector itself broken?<br />Everybody's got a price, including "greedy" providers.Elad Grosshttp://www.eduexchangecorps.orgnoreply@blogger.com