tag:blogger.com,1999:blog-8434050931789572015.comments2023-08-30T22:42:22.226-04:00DirkMD - CMIO PerspectiveDirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.comBlogger156125tag:blogger.com,1999:blog-8434050931789572015.post-88666429109377867392023-08-27T16:23:55.788-04:002023-08-27T16:23:55.788-04:00#6 is SO IMPORTANT! The mistakes I made early in ...#6 is SO IMPORTANT! The mistakes I made early in my career, both in my work and academic careers. After you learn better, you do better!Debra B. Grahamhttps://www.blogger.com/profile/05998494509766077849noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-35202978226730014022022-06-18T16:42:33.124-04:002022-06-18T16:42:33.124-04:00Hard part is step 2….recognizing need for applied ...Hard part is step 2….recognizing need for applied informatics.Paul Seville, MD, MBI, CPHIMShttps://www.blogger.com/profile/11893638802577247269noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-69728081273816844932022-06-16T18:29:51.896-04:002022-06-16T18:29:51.896-04:00Excellent article on your journey. This helps me ...Excellent article on your journey. This helps me to understand the details and dependencies of the various elements involved in workflows and change management.Paul Seville, MD, MBI, CPHIMShttps://www.blogger.com/profile/11893638802577247269noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-1700900711431792772022-06-03T20:03:48.350-04:002022-06-03T20:03:48.350-04:00This comment has been removed by the author.DrManchesterhttps://www.blogger.com/profile/16065051674922382766noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-4015018164785459192022-06-01T13:33:14.979-04:002022-06-01T13:33:14.979-04:00What? No asparagus tongs? We'll need to rede...What? No asparagus tongs? We'll need to redesign (But I don't have time to do that, you can work with my admin).Anonymoushttps://www.blogger.com/profile/08095803103008656151noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-50063444821870808922021-11-04T03:41:20.493-04:002021-11-04T03:41:20.493-04:00Hi Dirk,
Great article! Just discovered your blog...Hi Dirk,<br /><br />Great article! Just discovered your blog. I agree completely that integrating and communicating different areas and functions of a healthcare system is critical to optimization. As in SOAP noting, thought processes of the writer's assessments and plans must be integrated with the plain data of the patient's situation.<br /><br />I had the privilege of working with Larry Weed back in 1985-87 as Director of R&D at Presbyterian/St. Luke's Medical Center in Denver. We worked on integrating my AI research into his PKC system (Problem-Knowledge Couplers), an early AI based clinical diagnostic and treatment helper for MDs that automatically integrated the latest clinical diagnostic and treatment concepts, providing an automated decision tree "assistant" for the MD. He was also one of the keynote speakers at my 1986 National Conference on Innovation in Health Care held in Denver. Great to know you knew him!<br /><br />As in your Standardized Index of Healthcare, the PKC concept faced the challenge of updating all the new research and recommendations that are published each and every day, and communicating it effectively to the providers.<br /><br />Technology back then (and in the 1990's, when DARPA funded an effort to use PKC for battlefield medic Just In Time diagnostic and treatment headsets) was not up to the humongous amount of input, processing, storage, and output (IPSO) power necessary to make the system useful in real time.<br /><br />The current level of IPSO today is finally robust enough to support such an effort. My research is working on this problem (along with many others), and hope to have something to show in the near future.<br /><br />As for creating and maintaining the framework, I have come to believe that the Cloud-based SAAP (System As A Platform) will evolve as the only realistic approach. This would allow a large investment in R&D and maintenance by a central vendor or consortium, with subscriptions spread out among thousands of customer healthcare organizations. Local authors (within an organization) would contribute content to the cloud-based dynamic framework.<br /><br />Every employee would be able to modify and contribute, in a modified Wikipedia model. A relatively small dedicated group with the organization would coordinate and shepherd both the intranet's organization and content.<br /><br />Both the Wall Street FinTech sector and the US government (especially the Pentagon via their new Thunderdome system and others), both first movers in advanced systems, have been evolving in this direction in the last year or two. Healthcare can do well to track and follow their leads.<br /><br />Cheers,<br />Mark<br /><br />Mark Casey<br />Miyian.com<br />mark@miyian.com<br /><br />markboulderhttps://www.blogger.com/profile/10273005917568495566noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-3854686059423447402021-11-03T23:53:47.740-04:002021-11-03T23:53:47.740-04:00Hi Dirk,
Great article! Just discovered your blog...Hi Dirk,<br /><br />Great article! Just discovered your blog. I agree completely that integrating and communicating different areas and functions of a healthcare system is critical to optimization. As in SOAP noting, thought processes of the writer's assessments and plans must be integrated with the plain data of the patient's situation.<br /><br />I had the privilege of working with Larry Weed back in 1985-87 as Director of R&D at Presbyterian/St. Luke's Medical Center in Denver. We worked on integrating my AI research into his PKC system (Problem-Knowledge Couplers), an early AI based clinical diagnostic and treatment helper for MDs that automatically integrated the latest clinical diagnostic and treatment concepts, providing an automated decision tree "assistant" for the MD. He was also one of the keynote speakers at my 1986 National Conference on Innovation in Health Care held in Denver. Great to know you knew him!<br /><br />As in your Standardized Index of Healthcare, the PKC concept faced the challenge of updating all the new research and recommendations that are published each and every day, and communicating it effectively to the providers.<br /><br />Technology back then (and in the 1990's, when DARPA funded an effort to use PKC for battlefield medic Just In Time diagnostic and treatment headsets) was not up to the humongous amount of input, processing, storage, and output (IPSO) power necessary to make the system useful in real time.<br /><br />The current level of IPSO today is finally robust enough to support such an effort. My research is working on this problem (along with many others), and hope to have something to show in the near future.<br /><br />As for creating and maintaining the framework, I have come to believe that the Cloud-based SAAP (System As A Platform) will evolve as the only realistic approach. This would allow a large investment in R&D and maintenance by a central vendor or consortium, with subscriptions spread out among thousands of customer healthcare organizations. Local authors (within an organization) would contribute content to the cloud-based dynamic framework. <br /><br />Every employee would be able to modify and contribute, in a modified Wikipedia model. A relatively small dedicated group with the organization would coordinate and shepherd both the intranet's organization and content.<br /><br />Both the Wall Street FinTech sector and the US government (especially the Pentagon via their new Thunderdome system), both first movers in advanced systems, have been evolving in this direction in the last year or two. Healthcare can do well to track and follow their leads.<br /><br />Cheers,<br />Mark<br /><br />Mark Casey<br />Miyian.com<br />mark@miyian.com<br /><br /><br /><br />markboulderhttps://www.blogger.com/profile/10273005917568495566noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-88383225328033697572021-10-09T14:20:27.908-04:002021-10-09T14:20:27.908-04:00Thanks for sharing your experience and insight. Th...Thanks for sharing your experience and insight. This was a fascinating read. Best wishes from Northern Ireland, UK.Carlyhttps://www.blogger.com/profile/13776090585920376605noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-77562574004113189342021-06-23T18:48:55.727-04:002021-06-23T18:48:55.727-04:00Both excellent, see my previous commentsBoth excellent, see my previous commentsebrauerhttps://www.blogger.com/profile/06469776486419483281noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-11100467753639382942021-06-23T18:48:17.809-04:002021-06-23T18:48:17.809-04:00Excellent. I would like to discuss this with you i...Excellent. I would like to discuss this with you in detail.<br />I am a Critical care Physician and work mainly in a NeuroIntensive Care unit and I am a Epic Physician builder.<br />Ernesto Brauer, MD<br />ernesto.brauer@gmail.comebrauerhttps://www.blogger.com/profile/06469776486419483281noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-10830224468002624282020-10-29T22:12:28.979-04:002020-10-29T22:12:28.979-04:00Thanks Karim! Thanks Karim! Dirk Stanley, MD, MPHhttps://www.blogger.com/profile/09568427937893548660noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-71790624059305591922020-10-26T19:12:08.673-04:002020-10-26T19:12:08.673-04:00Hello Dirk,
Great thread! From a peds perspectiv...Hello Dirk,<br /><br />Great thread! From a peds perspective, also need to consider LP’s done as an “add on” while the child is in the OR or getting a procedure done. Or for intra thecal chemo. This is usually done by the oncologist. There needs to be communication between the OR and the oncology team for both scheduling and notification. And then for the correct labels to be printed and sent to the lab. <br /><br />Great work. <br /><br />Dr. Karim Jessa<br />CMIO Sickkids karimhttps://www.blogger.com/profile/17911884745083980537noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-71161703441680853282020-10-03T17:11:13.932-04:002020-10-03T17:11:13.932-04:00Hi! Its really informative content for me. The tip...Hi! Its really informative content for me. The tips you mentioned above are very helpful for me. I also used guide. This guide is very informative and i recommend you if you want to get more knowledge. I will wait for your new article. Thank you<br />jameshttps://www.blogger.com/profile/00903264519434567721noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-52423775658260361332020-08-23T15:51:56.156-04:002020-08-23T15:51:56.156-04:00Dr. Stanley - Your thoughts are very true. The nee...Dr. Stanley - Your thoughts are very true. The need to identify and appropriately compartmentalize the terminology within our EHR hierarchy both granularly and in the specificity helps drive for better decision support through analyticsAmarhttps://www.blogger.com/profile/02711214983012150705noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-7292072315359502262020-08-13T12:00:58.487-04:002020-08-13T12:00:58.487-04:00Dirk, I appreciate your analogies. How would you...Dirk, I appreciate your analogies. How would you approach personalized filters in these scenarios? For example, there is a system-wide "box of fruit" that can be filtered based on the type of fruit, the color of the fruit, size of the fruit, etc. These parameters can be individually set based on the user's needs. This way, you do not need to have multiple boxes with lists or dropdowns that are inefficient and potentially risky to navigate.Sgermanmdhttps://www.blogger.com/profile/02031116055163205078noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-74916172266098774402020-07-20T06:52:36.595-04:002020-07-20T06:52:36.595-04:00Thanks for sharing. The diagnosis code in the firs...Thanks for sharing. The diagnosis code in the first position on the claim form drives a lot from the billing perspective (waiving out of pocket costs), particularly for commercial carriers. <br /><br />Great summary on how complex this stuff can get. <br /><br />MaxAnonymoushttps://www.blogger.com/profile/06248735248982117105noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-28780224315651010272020-06-30T09:53:00.720-04:002020-06-30T09:53:00.720-04:00Dirk, excellent summary-as always.
Dirk, excellent summary-as always.<br />Sgermanmdhttps://www.blogger.com/profile/02031116055163205078noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-18955536698895495722020-06-24T17:13:20.479-04:002020-06-24T17:13:20.479-04:00Thanks for the informative EHR walkthrough (as wel...Thanks for the informative EHR walkthrough (as well as clinical)!Dbhttps://www.blogger.com/profile/14973818018457380552noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-59221664284150129302020-02-23T16:44:35.052-05:002020-02-23T16:44:35.052-05:00Love this post. The vast majority of organizations...Love this post. The vast majority of organizations on't think about communication strategy at all, and so don't take the necessary steps to ensure that critical organizational communications—policy changes, work flow changes, etc.—are not just distributed, but received and understood, as well. SteveODhttps://www.blogger.com/profile/13093630701417497173noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-16454611974247366382020-02-08T05:45:48.368-05:002020-02-08T05:45:48.368-05:00This is one of the best descriptions I have ever r...This is one of the best descriptions I have ever read related to ways to design communications in a clinical setting. Brilliant!Radwomanhttps://www.blogger.com/profile/06175180239164946600noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-81672853253732957282020-01-16T21:34:45.122-05:002020-01-16T21:34:45.122-05:00This is really helpful, I'm one of the founder...This is really helpful, I'm one of the founders of a provider communication app. Signal to noise is very true, making providers easier to reach also means potentially more noise. One of things we are doing actually is decreasing noise from the ancillary stuff by making their other care providers easier to reach (rather than text the attending you know in surgical, you can text the resident) or automation around escalations (if someone doesn't read the text, it goes to the attending). Anyways, very insightful tidbits with great reasons on why communication happens! Albert Taihttps://www.blogger.com/profile/17489526557878239165noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-40739043971881725352020-01-06T16:35:11.073-05:002020-01-06T16:35:11.073-05:00As always Dirk, concise, to the point, enlightenin...As always Dirk, concise, to the point, enlightening, engaging, and spot-on accurate.Sgermanmdhttps://www.blogger.com/profile/02031116055163205078noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-88343361874546003112019-12-30T15:18:33.485-05:002019-12-30T15:18:33.485-05:00There are two diagram I will send you from Shortli...There are two diagram I will send you from Shortliffe and Cimno's Book Biomedical Informatics 2014. That also are good to frame the terminology.John Poikonen, PharmDhttps://www.blogger.com/profile/03597435301999332159noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-71133433200867865492019-11-20T14:59:09.185-05:002019-11-20T14:59:09.185-05:00Thanks for the laugh Dirk. It is a nice reminder ...Thanks for the laugh Dirk. It is a nice reminder of the world I left behind!Ralph Johnsonhttps://www.blogger.com/profile/03531616130388095715noreply@blogger.comtag:blogger.com,1999:blog-8434050931789572015.post-77231781719893396852019-11-08T13:35:37.142-05:002019-11-08T13:35:37.142-05:00Hilarious... thanks for a great Fri afternoon laug...Hilarious... thanks for a great Fri afternoon laugh. John Poikonen, PharmDhttps://www.blogger.com/profile/03597435301999332159noreply@blogger.com