Archive for January, 2012

Stupid Cancer Humor

January 26, 2012 2 comments

Some Cancer Humor

I saw a patient today who presented with a large vaginal cancer.  I was discussing her care with my intern, and that it would make a big difference if the cancer were localized or if it had already spread to the lymph nodes.  Based on her exam, I thought there was a pretty good chance it had already spread.

“The toothpaste is already out of the tube”, said the intern.

I replied “I suppose… but usually we say ‘the horse is already out of the barn‘   After all, like cancer, the horse wants to leave the barn and run.  The toothpaste doesn’t want to leave the tube.  It will stay there forever until you squeeze it out.”

A look of understanding hit the intern’s face…. then puzzlement.

“But Dr. Fogelson, it seems like its a lot easier to put a horse back into the barn than it is to put toothpaste back into the tube.  If cancer was like the horse it would be much easier to cure once was spread.”

So there you have it.

Cancer acts like a horse at first, but then becomes toothpaste.

Categories: Fun Stuff Tags: , , ,

A New “Model” for Electronic Medical Record Systems

January 14, 2012 10 comments

As a physician formally trained in computer science, I have the opportunity to look at today’s computerized medical record systems both from the perspective of a end user and as a software designer.  It is perhaps because of this that I have been so persistently disappointed with the current state of clinical record software.  

I am disappointed because despite all the fancy hardware and expensive software, our clinical records systems aren’t that much better than paper.  We would think that a patient could go to any doctor and present their medical records the doctor could read them, but they can’t.  We would think that it would be easy for me to get a CT scan report that was done at an outside hospital, but no.  It actually has to be printed out and faxed, requiring not only human intervention and time, but if reentered into the receiving provider’s system actually converts a digitally stored report into a picture of a piece of paper, completely breaking the idea of an electronic record system.  While information can be digital in one system, if it ever is passed on to someone working in another system, it becomes just another piece of digital paper.  The sad truth is that despite our incredible investment in EMR systems, we have only created a massive collection of information silos, and have almost no way to transfer information between them – a system little better than the paper charts we sought to eliminate.  And sadly, because these silos are hard coded and massive, innovation is stifled.

There is a very specific reason why our system operates like this, and it is that EMRs as a whole lack a common way to represent information.  Each system represents medical records in its own proprietary format, and thus lack the ability to speak to each other.  An thus no matter how wonderfully a EMR system represents information to its users, if information has to get out of the system, it can only be through pictures of pieces of paper.

So is there a solution to these problems?  I would argue yes.   But it requires a fundamental change in our paradigm – a change to a common “Model” for representing data.
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Categories: Business of Medicine
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