“They are just mad Obama won” so they don’t agree what he is doing now. Well, that pretty much goes owhtiut saying. You act like it was a popularity contest. They didn’t agree with his views and policies or they would have voted for him. So yeah, obviously, they aren’t going to be in agreement with a large part of the changes he will propose?!And the fact that Oklahoma won’t allow write in’s or 3rd party votes is just fundamentally wrong. We have the freedom to vote for who we want to be president……as long as its one of these two dolts we allow you to choose from? Just asinine.Just a thought, would your father have wanted the government to tell him how much he could/couldn’t sell his medicine for? Or that he had to sell for less to certain people..etc. Those things which would have affected how you grew up (income). What these people are saying is no one should. It is just the choice of a government or a big business run world? How about being responsible for ourselves.

The idea of an integrated alarm system sounds to be a fine display of ingenuity combined with the obvious- advancement in technology as should be appropriate for the year 2012… When you mention that other fields such as aviation already have such systems, in comparison the world of healthcare technology does seem to be living in the past a bit.

Definitely food for thought.

OK, how did that get mis-replied? Maybe it was the Johnny Walker Black

https://thehealthcareblog.com/blog/2012/02/23/why-can’t-the-icu-be-more-like-a-cockpi/comment-page-1/#comment-180346

It’s available on Amazon, and I continue to discuss it depth on my REC blog.

OK, Medicine in Denial, page 37:

“Policymakers recognize that transformation requires more than technology. Accordingly, certification and “meaningful use” of electronic health records (EHRs) are required to receive subsidies to purchase EHRs under the 2009 economic stimulus legislation. But the requirements for certification and meaningful use as currently conceived are primitive. They fail to incorporate or even consider most elements of the problem-oriented medical record (POMR) standard (the subject of part VI), which became prominent four decades ago. Since that time, the quality of medical records has declined. Use of the POMR standard has receded, and the clinical purpose of the medical record has been compromised.”
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Or…

“Patients must be educated in the use of tools such as the problem-oriented record and computerized POMR so that there is some concrete instrument for expressing and capitalizing upon their own motivation. If the patients are not motivated enough to use the tools effectively, then we should get over the illusion that those same patients are accomplishing much with twenty minute visits to providers or that they are complying very precisely with directions from those providers, except in those instances where a normally healthy individual gets specialized care for a self-limited problem from the appropriate specialist, e.g. a broken leg.

The Power Of The Right Tools:
Tools extend our muscles, our senses, our memories, and our analytical capacities. Extending our muscles and our senses with automobiles, power tools, telescopes, etc. are commonplace. Extending our basically chemical and electronic minds with electronic computers is becoming more commonplace.

For patients who, up until now, have had little exposure in school or elsewhere to the use of the medical record as a powerful tool in their own health care, the particular form of this tool will be of little consequence so long as it is clear to them and usable by them. A computerized problem-oriented record will not be any newer or more confusing to them than traditional paper records since they never had either record in the past.

Physicians, nurses, and other providers have been trained with a whole set of habits and notions about medical records and their availability to patients. It is difficult for some of them to switch to electronic tools that provide specific guidance for solving problems within the context of patients’ other problems. Some not only do not want to switch to an electronic record system, they still do not recognize that the record should be a tool the patient’s use as much as a tool for their own use.

Therefore:
In health care, patients and very inexpensive paramedical people who are already a permanent part of a community must be taught to use the problem solving guidance in their own records and eventually in computers. After all, rescue squads with remarkable skill in heart and lung disease have been developed all over the country, and people with only a high school education or less have been taught to do sophisticated medical work. Surely we all can learn to deal with many of the less life-threatening disorders such as sore throats and body aches if we have our records and the right guidance tools. Expensively trained medical professionals should be reserved for specialized tasks that we cannot master and cannot do for ourselves. They also should be used to build the guidance in the tools and to monitor occasionally our records and behaviors to make sure that we are behaving in a disciplined and reliable manner…

…Physicians and other providers often make time the constant and achievement the variable with patients. They try to do everything for the patient themselves and even keep all the records to themselves and instruct the patients hurriedly over a series of timed appointments. They do not have the time or money to give the necessary time to those who need it; on the other hand, they also have patients who return for repeated office visits that are unnecessary because those patients understood their situation at the first visit and can manage their own affairs. In such medical practices the patient is not only being denied his essential role as an informed participant. in his care, he is also being denied the basis to form an accurate judgment about the quality of health care he is purchasing.”[Medicine in Denial, pp 261-2, 264]”
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Or,

“The massive scope and intricacy of our increasing knowledge, and its infinitely variable applicability to individuals, make it increasingly obvious that the minds of highly educated physicians cannot be relied upon to recognize the patterns that define unique individuals and their medical needs. In that environment, we will heed Bacon’s warning not to “falsely admire and extol the powers of the human mind,” and we will embrace the use of external tools to empower the mind. Both the mind and external tools use language to reference clinical concepts. Lack of precision and consistency in the use of language has long been recognized as an obstacle to semantic interoperability among disparate health information technologies, particularly electronic health records. Accordingly, major efforts have been underway for many years to develop standardized medical terminology, taxonomies of medical concepts and corresponding coding systems. These efforts, however, valuable as they are, leave unresolved the problem of unstructured clinical judgment by physicians. For example, using standardized terminology to record the results of an initial workup does not assure that the contents of the initial workup will be complete or accurately coupled with medical knowledge. Assuring those goals requires some form of knowledge coupling tools as described above. Standardized terminology and coding is pursued most fruitfully when it is driven by needs that arise in developing knowledge coupling tools and using those tools in medical practice.” [Medicine in Denial, pg 192]

Bobby, just a plain reference to that book, without any further explanation, is about as valuable to the discussion as “nana nana boo boo”.

Pronovost is out there and he too, has ignore the lack of safety accountability of the EHRs and their vendors.

Paper checklists work cause they are simple. EHRs and CPOEs kill patients cause they are poorly usable.

Gawande’s and Pronovost’s point re checklists is not that you can replace clinical thinking with checklists (or pilots with computers), but rather that in appropriate instances (procedures like central line insertions) a checklist can prompt appropriate infection control measures to bring down the rate of infections – with well-designed trials to back up those assertions.

A good analogy between clinicians and information tools like checklists could be in the ‘rifleman’s creed’. You wouldn’t replace soldiers with guns to win a war like WWII, but putting soldiers in unarmed (or with poor guns) should be viewed as being vastly inferior than giving them the right, well-designed tools.

IMO, for clinicians those tools for the most part simply don’t exist today.

No argument there. And, Lawrence Weed is not optimistic that things will change for the better anytime soon.

Then turn on the computer and leave the pilot at home. Want to ride?