#1. A aspirin…my son agrees.
#2 C My son says CAD…we’ll go with that
#3 B My son says B
#4 My son says A
#5 D

My 11 year old son: “For number four: all of those answers are ridiculous, they’re all Pointing to SPECIFIC things so therefore are not the answer.” ( He typed that)

Unfortunately I cannot come to your cardiology fair, but it sounds FUN. I wish I could. I especially wish I could learn more to help my sisters kids who have Friedereichs Ataxia. Her kids are so incredibly fun and will likely both suffer from cardiac disease as their Ataxia becomes worse. Most do. My cousin Stephanie has lived to a ripe old age 48 with FA and has suffered relatively minor cardiovascular complications considering what most people suffer, but unfortunately was put on hospice and is dying now. I remember Stephanie when she was a teenager and on a date. My cousin and I ran outside taunting her, and her date. I remember what she was like back then, and her life has been cut so short by FA. The good cardiovascular news for my nephew last week is that despite FA, the cardiologist said his heart is great condition and he has started physical therapy for motor skills. My sister took him to Snowbasin to go skiing last week. Nice to think of these days when he can still walk, ski, and play. She doesn’t like to take him with my son because it’s hard to watch his cousin manuever the jumps and the runs with no problems, and go at lightning speed. Tomorrow I will take my son to his cousins 12th family birthday party though where they will wrestle as equals. Most males with FA die of cardiac disease in their 20′s. Females tend to live longer, so I can have this hope for my niece with FA. I hope they can find a way to get frataxin? into the cells and find a cure for this terrible disease and find a way to manage the cardiac complications. I had hoped there would be a Valentine blog on how to manage some of these complications of the heart. Oh well….guess I can’t complain. I walked into work on Valentines day and there sat a dozen long stemmed red roses next to my office for ME! WOW! He also got me a necklace, and got us almost front row tickets to Lady Antebellum!! and a letter. He wrote me a letter! Who ever writes letters anymore? At least heart disease can’t steal love.

I recall this idea from my time in the military. The patients (the generals) thought it was a great idea because they’d get preferred service from “only the best doctors.” The higher-ranking physicians loved it because they got to hobnob with the top brass.

The only problem was that it wasn’t very good care. As you correctly pointed out, the most up-to-date, yet experienced, doctors were the field-grade officers, mainly the majors and lieutenant colonels. In truth, the physicians who were most attentive to details were the interns and residents. Yet none of these “lesser doctors” were allowed to get close to the military’s higher echelon. If the generals had simply turned their care over to the young captains and majors like everyone else they would have had the same exceptional care military medicine is known for.

Thankfully, this idea was eventually put to rest, but probably more because of its intrinsic public relations message than the fact that it was poor care. The generals of 2012 probably wish they had the extra perks the executive medicine program offered, but they’ll live longer under the current, more egalitarian system.

Thanks for your comments.

Dr. VDG

By the time I came on active duty as an intern in that same hospital, Congress had disbanded the Executive Medicine program. I came to realize an irony as I learned the ropes of that massive hospital. The best doctors were not the colonels. They had long ago shifted their career emphasis from the practice of medicine to the pursuit of rank advancement. The best doctors were in fact the young majors! The Executive Medicine program was all about perception.

I love this post–it makes me want to sneak a few pieces from the box I’m saving for my wife’s Valentine’s gift. You know I’m a fan of chocolate (see my own post at http://www.blogalegent.com/index.php/2009/chocolate/) and I’m happy to recommend it for all my heart patients. Thanks for the info.

Dr. VDG

And I understand the vision and the value in never losing sight of what’s *really* the goal in all of this as a solution. It remains a “be patient” chore in the meantime, while us behemoth vendors continue to scramble to keep our existing customers less angry & more certified, and to keep our prospective customers knocking at the door.

If it makes you feel better, I, too, look at a pinnacle in design (and the metaphor meets with your aspirations for voice recognition…I just have my holy grail in typed form). On your google calendar….the quick add….you just type in whatever to represent an event (details in any order), and it gets it right…..puts it on your calendar, you’re done. The same logic will be what’s behind your future-state voice-driven system. Healthcare delivery has more moving parts than a calendar appointment at least one hundred-fold, but we’ll get there.

….I thought I recognized that guy headbanging to “Blinded by the Light” in rush hour the other day……

Cheers
-designer

As I went through the design process of several large scale systems, one of the most difficult parts of the process was getting accurate, consistent, de-conflicted input from the users on what the system had to do. And additionally, since these systems were in the educational records, payroll and accounting areas we had to be aware of the myriad federal regs that govern so much of this. I cannot imagine the vast list of government based requirements that medical software must meet. Glad I am not in that arena. I offer this simply as another view. Your requirements are all valid and I would think that a reasonable developer would love to have someone like you as the “inputter” of requirements for system design. And since commercial systems many times are aimed at such a wide variety users they try to make everyone happy with one system and that can result in suboptimal systems for all users.

I love your blog and I love your comments. I just hope your desires can be met in a reasonable period of time because I see great value in EMR systems. The last time I visited my cardilologist he asked if I knew when my last blood work had been done. I wasn’t sure of that date but knew my internist, also in the Alegent system, had done tests recently. Dr R was able to quickly access that data, see the results and save the time and cost of more blood work. I know that is a very puny example but to me that was very helpful as well as my internist being able to see all of Dr R’s results from my exam. Hang in there and keep pushing the system to be the way you want. But also be patient with us geeks. We want to help I promise.

Thank you for taking the time to write your lengthy response to my recent blog post. I appreciate the input of an expert on the other end of this dilemma and your demonstration of the appropriate use of sarcasm in crafting your rebuttal. I take no offense at the tone of your comments, especially in light of the fact that I set the stage by taking pot shots at your profession (I am obviously not one who should be casting stones–I nearly failed a Fortran class in college).

While I can appreciate your arguments about how simplistic my “wish list” must sound, I would like to share one observation. Years ago, when my best friend and I were in high school, tooling around in his 1969 Camaro, we used to crank the tunes of the day with the windows down in an attempt to lure all the hottest foxes in the school. For our playlist we’d take our collection of LPs and dub them to a mix-tape with supplemental songs recorded off the radio (we were too cheap to actually purchase all the music we listened to). That way we could cruise to the sounds of 38 Special, Bob Segar, Aldo Nova, and Foreigner, all loaded onto a small collection of cassettes.

These days I often reminisce on my experience as i spin through my iPod’s massive playlist. The device connects wirelessly to my car’s stereo system so that I have the entire 70s and 80s at my fingertips as I cruise down the road with my foxy wife. If there is a song I don’t have it only takes a moment to take my eyes off the road, download the tune, get it started, and panic as I swerve to miss a gaggle of orphans in a crosswalk before I can continue on, enjoying the choruses of “You’re As Cold As Ice.”

If I were to go back in time to 1982 and tell a room of computer programs about a “wish list” I have for car audio (“instant access to any song on the planet”) I would be laughed out of the room and face a barrage of pocket protectors hurled in my direction. Their excuses might just even sound like the criticisms you offer in your rebuttal. The fact remains, however, that, 30 years later, we now have the technology to do something no computer programmer in 1982 thought possible.

If you’ve read Steve Job’s biography you’ll note that his career consisted of programmers telling him that what he envisioned wasn’t possible. He simply disagreed and pressed on with his “pie-in-the-sky” ideas, then he and his experts made the impossible come to fruition.

Mr. DeSigner, I’m not asking for you to create my dream EMR today. I just want to remind you that we need to keep the big picture in mind as we move forward with our technology. We can’t let today’s technological limitations steer the course in this journey. We need to keep our ideals front and center as you and your colleagues assemble the ones and zeros.

Thanks again reading my blog and sharing your comments.

Dr. Van De Graaff