Health record and museum

A good health record system will have many similarities to a museum.  if the generalized definition of a museum is a thing that preserves important things for people, then a medical record could do likewise.  the 'things' and how they are preserved are different in a museum than in a warehouse.  there is a pride in the things, there is an attention to detail in how they are presented, how they relate, the intrinsic value of the things themselves is evident.

so what of health records? they are with us from the time we are born, our APGAR scores, they chronicle our great failings, and often our great successes.  they store images of our hidden inner anatomy, there are abstract, and sometimes beautiful functional studies.  they chronicle our fears, our goals,  but they do so in a similar fashion to a warehouse.  they are utilitarian without even succeeding in this capacity, being haphazardly put together.  the logic of data granularity is missing, the power of intelligent design is lacking.  there is no pride in the things, there is minimal attention to detail on how or even if they are presented, and the intrinsic value of the things that are preserved is most certainly not evident.  no wonder we as patients don't see inside this thing, if we are ever given the keys.

obviously redesigning this system is valuable, that is why we are doing so, not just for these reasons, but for so many others.

another bit that came to mind is how various galleries offer different experiences at different times.  there are visits to the art museum that doesn't include any modert art, and there are visits where there is nothing but.  each gallery has it's treasures, it's great works, both as historical phenomena, but also as personal statements of an individual speaking through a particular medium.  so should our health record system be, an organized space, offering various ways to experience and learn about an individual, and the complexities of their bio/social being.  data visualization, and each model thereof, becomes a work, in a gallery, in an instance, of an individuals museum.

And what happens when that individual dies, will they open their treasure to society, to their family, or will they have it destroyed?  time will tell, but this story will change our culture, and if we choose to work towards an honest human outcome, we will create something incredible for future generations.

Multimedia arts and end of life

multimedia public service announcement

Last week i was taking care of an old patient who was dying slowly in the hospital, which i do regularly.  the patient was  what we call comfort care (kind of like being in hospice).  it reminded me of my time spent in the ICU, rounding on patient after patient on life support machines.  these patients are immobilized and sedated with a cocktail  of drugs, and or physical restraints.
The point is that these people are exposed to whatever multimedia, usually auditory in nature, that the hospital staff chooses.  patients who have the good fortune to have family members who are sensitive to this phenomena will select the audio environment, and give note to the nurses etc.

We all need to be aware that this may befall us.  some of us couldn't care less, but those of us that may be sensitive to this should document, and prepare for this possibility.  quite frankly it scared me, and could very well be a disturbing way to move to the next phase of being.
carry on.

first week exploring multimedia integration with my patients.

Last week i began using a multimedia system with my patients.  with this system we look at our bodies together using video, audio, and a structured light scanner.  my first insight was with a patient who was tired and quite frankly not taking very good care of themselves.  this younger individual was disgusted when viewing the ear canal.  upon reflection i wondered about this response which was very different from all other patients who i used the system with.  most of us have some wax in our ear canals, but everyone else was more fascinated by seeing this aspect of their body than disgusted.

clearly one individual is only one individual but there is a difference between looking at a number like blood pressure, or lab results and seeing ourselves, becoming body aware.  will being confronted with more of our real bodies have an effect on us? will exploring our health through multimedia be more beneficial to certain individuals as we attempt to move towards greater health?  how can this be used to our collective advantage?  i'm curious to see.

Current medical record software is really quite horrible to use as a human.  Another physician compared it well to the model T, which functional, lacked the comforts of current vehicles.  Data entry should use more than just fingers, voice and free gesture should be optional elements.  designing a system for physicians and health care staff is unique in that this group of users has a long history of memorizing lists of information.  this could be used to design a flow through a physical topography, or tree diagram where nodes or branching points are memorized freeing the physician to move away from the screen and still enter data.
flexible sensors on the back of fingers could allow quick access to arrays of four data points.

Electronic medical records

What i envision is a state coordinated record that has many layers of access.  As a patient i can fill my personal spaces, selecting images, describing my personality, documenting my relationships, cataloging my interests, and chronicling life events.  As a physician i can enter physiologic, biochemical, and genetic data, describe health events, prescribe medication, and chronicle treatments.  The state can enter educational, and legal data and events.  A relationship with this database would begin in elementary school, and follow through the individuals life.
Fundamental to any electronic record is the ability to abstract it's data to find patterns.  The patterns should help guide society toward increasing the overall health of it's citizens.  It goes without saying that this database would be abused by certain individuals; this is inherent in human culture.

unifying reality

in physics there has been great human effort put into the search for the unifying theory of physical reality. i, and a great number of others have been looking for a similar unifying view of humanity. is it attainable? can human behaviour be reduced to a meaningful statement.

but say i had accomplished a feat, what next. what is the ultimate goal of searching through our experiences and the catalogs of others aware minds. clearly it is the process of discovery itself that is beautiful, the engagement with reality, the savouring of phenomena, so full.

but say i, you, of they had finished with the unification process. most likely there would be a rush of excitement, and then the urge to communicate the finding to others. would it be to let other sentient creatures know that it had been accomplished? that it was now available for their use? then what? would that ever be enough, would all others stop their searches and happily use this new finding, it seems unlikely.

there would be endless discussion on the merits of such a device. in the closed parts of our personal being not much would changed.

does this mean that spreading the good news of God is a waste of energy? at times it probably is. under the wrong motives it has clearly done damage over the centuries.

is love the final goal for a human; a reciprocating love. is making love with your wife, and engaging with her on as many levels of your self as possible, the highest state of being. i believe it is.

the magic art of numbers

i love science, i love quantitive view of reality, i love being a physician; but there is a great disconnect between science and healing. this is nothing new. but as i continue to practice and am faced with patient after patient it's difficult to reconcile my scientific conscience with my practice patterns.

there are countless studies of varying quality on numberous subjects, but the patient in front of me is unique. i have to offer advice to this person, who for the most part, will follow it. but how do i know that this drug, or this data range are meaningful, and healthy for this patient. in the short run there is less confusion, physiology adjusts with the medications most often. but in the long run who really knows, i don't. there is no way to find the probability that this person in front of me fits into a given study. i can guesstimate a probability, but, BUT it's just a hunch, educated true, but a guess. or is it a hypothesis, is this my own, our own science experiment, on you the patient, where we allow greater latitude where the probability of seriously negative outcome is lower. i guess it is.

i wonder if the clinics that have the highest probability of following evidence based medicine have the longest patient retention, or if they are university, or residency based centers with high turnover. i wonder if being able to adhere to guidelines makes you feel more comfortable, it does me.

the doctor patient relationship can't have changed much over the centuries in-spite of our current technology. being with this other person, with certain expectations, and assigned roles in place. how did we prognosticate on the seemingly healthy person in days gone by, or did we. not much has changed with regards to indulgences of the flesh; too much and we increase the probability of negative health consequences.