[PLUG-TALK] About the medical software you see in your physician's office

Rich Shepard rshepard at appl-ecosys.com
Sun Dec 23 06:07:34 PST 2018

On Sat, 22 Dec 2018, Keith Lofstrom wrote:

> Providence and Legacy, the two largest medical systems in Portland, both
> use Epic (I don't know about Adventist and Kaiser).

   My PCP is part of the Legacy system and I know they have Epic installed.

> If you don't enter the birthday as well as the name, you can get the wrong
> patient record. If there are two James Smiths with the same birthday,
> watch out.

   In my Army basic training company there were two William B. Williams; I've
no idea of their birthdays. This caused the DIs fits until they assigned one
as William1 and the other as William2.

> Providence used to issue little time-coded security dongles to limit
> access. They failed too often, at the wrong times, and sick patients
> weren't treated on time. So, Providence got rid of the dongles. Now anyone
> with a username/password can get in. A nurse trying to save your life. Or
> a blackmailer. Security and speed are opposites.

   Yet both are critical for a medical records system.

> The last time I looked, Providence and Legacy could not transfer patient
> records between systems. Too customized. They say that if you've seen one
> instance of Epic, you've seen one instance of Epic. I hope it is better
> now.

   Isn't this the main point: too many standards? As it has been said, "Yes,
we have standards. Pick one."

> One story in Robert Wachter's excellent book "The Digital Doctor"
> describes a doctor who inadvertently used doses instead of milligrams for
> a pediatric prescription - the unit field is an obscured dropdown in the
> UCSF hospital customization of Epic. The automated prescription-filling
> robot dutifully filled a basket with hundreds of packets of pills. The
> unsupervised floater night nurse (senior nurses get day shift) in the
> pediatic ward kept feeding the kid pills until he had a seizure and nearly
> died.

   What an ordeal for all involved! With consolidation in all industries,
including the health care industry, what are pragmatic options to resolve
some of these serious issues?

> American Automobile Assn. research shows voice-assisted navigation is a
> dangerous distraction. Radar sensors on cars are hugely expensive to
> repair properly, increasing total accident costs.

   I don't know if there are differences between the GPS navigation systems
now built into new vehicles and the Garmin NUVI I use, But, about 10 years
ago there was the situation where a couple driving from Mountain Home, ID,
to Elko, NV (a really nice ride through Owyhee Canyon part of the way) were
directed by their in-vehicle GPS to an unmarked Forest Service road where
they got stuck. Husband went for help; wife was rescued alive a few days
later. Husband's body was discovered a year latter by hunters in the
Jarbridge Mountins.

   The Garmin wants to direct me (and others, I assume) on one route) even
when I know where I'm going and it's a different route. On US25 29 miles
north of Winnemucca, there's a turnoff to NV 140 that leads to OR 205 and
Hines. That's where the Garmin keeps telling me to go. But, in the area
around Fields, OR, the open range cattle like to lie on the highway so I
prefer to take 95 north to OR 78, then turn west to Burns. It takes the
Garmin 12 miles before it gives up trying to turn me around to take NV 140
and accepts that I can continue on 95 to 78. I've seen the same issue
locally. Don't trust the GPS; know in advance how you want to go and let the
GPS let you know when turns come up.

> Besides a huge spike in distracted-driving accidents (Portland is in the
> top 5th dangerous driver percentile), lack of human medical advice is also
> adding to the death toll. The US death rate mostly went down between 1930
> and 2015. It increased in 2016 and 2017, and is expected to increase again
> after 2018 data becomes available.

   Do the numbers reflect an aging population?

> The sorta-good-news is that OpenEMR is an open source electronic medical
> records system. My wife used it. Portlander Tony McCormick maintains it
> for doctors, and contributes code. Being free, there's no boil-the-frog
> subscription price increases like EPIC uses to ensnare and then trap
> doctors (or drive them into bankruptcy). The bad news is that OpenEMR is a
> spagetti-code kludge of PHP and twisty little databases all different.
> OpenEMR could use a LOT of TLC from the rest of the open source community,
> but we are too busy monetizing consumers.

   Looks like an ideal use case for Django, Python, and Postgresql.

   I knew that you would share valuable insights with us, Keith. Thank you
for doing so.

Happy holidays,


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