Open Wiki Style Medical Decision Making

The pace and expanding scope of medical information growth increasingly challenges the ability of doctors to keep up to date. A shortage of health care workers also necessitates that these doctors do more with less time. These two trends combine to increase the risk of less than optimum medical decisions and practice.

Extending an open innovation approach to the medical decisions space may offer a way to mitigate the impact of this problem and achieve new gains. Medical records could be placed anonymously on a web site along with doctors decisions. Visitors to the web site could then review the patient information at their leisure and suggest better diagnosis or treatment options while citing the research that supports their position. It would be somewhat like a wiki of diagnosis and treatment with a means to present conflicting views and allow consensus building.

Patients and their doctors could then review the wiki. Patients could look at it as often as they wish while doctors may want to be alerted only once certain thresholds are reached in terms of consensus on differing diagnosis and treatment and the significance of the difference. Such thresholds could help ensure that the time that doctors spend on this new task is likely to have significant value.



This sort of approach would also allow insight into the most common errors by doctors which could be used as basis for a national effort to communicate best practices to physicians.


Key Challenges

Increased patient interaction with inexpert health commentary could lead to unnecessary further taxing of health care resources as these patients seek to present to their doctors such commentary. Thus it may be necessary to restrict patient access to the wiki in some way if it is found that patients report to their doctor with wiki information that is of no value and based on anecdotal evidence or poorly understood personal experience.

The popularity and success of wikipedia and other open innovation platforms may not transfer to a wiki of medical decision making because of some clear differences. First and foremost perhaps is that the "experts" are already over tasked so this program would likely not be able to piggy back off of their efforts, particularly MD's. It may be that Ph.D.'s involved in medical research may have sufficient expertise to quickly and efficiently review and contribute to medical records with characteristics within their scope of expertise. These experts may be more inclined to exam medical records.

Novices face larger hurdles to making good contributions than with Wikipedia. Where for Wikipedia one could find several pieces of corroborating information and include them in a relevant article with an intuitive sense of their significance, the experience with a wiki of medical diagnosis and treatment would be different. The diversity of medical conditions and their presentations make it much harder for a novice to first understand enough to evaluate the information and then know when they know enough to suggest a differing diagnosis or treatment path. It would seem feasible that, for a great many conditions, after the novice has command of human physiology not much more than is often covered in high school health classes, they may be able to work their way through a diagnosis or treatment decision tree when presented with such a tree and with access to resources like wikipedia within a handful of hours or days. This claim seems worth evaluating.

A second key difference between this sort of wiki of medical decisions and say wikipedia is that persons with a limited scope of interest or expertise may find it more difficult to find patients with the conditions they are expert in particularly if their aim is to ensure proper diagnosis and seek out misdiagnosis. It would seem easy enough to make records searchable by physician diagnosis, but making symptoms, lab work, and certainly diagnostic imagery effectively searchable seems a much more difficult task.

Bank Brand Differentiation with Interest Donation Programs

Banks could promote accounts where the interest is contributed to charity. This could be a helpful way to sneak cash out of our hands that we want to give up in light of God's Word so we can rely on Him and not so much ourselves, but cash that we won't so easily give up because of the weakness of our faith. With interest rates low so is interest on bank deposits so it's likely that many could manage this sort of contribution without financial harm even if they aren't even remotely hoping to live off the daily bread God gives instead of a masterfully orchestrated IRA.

All that said it seems to be consensus thinking among those I've heard that saving for retirement or future reasonably expected needs doesn't contradict God's call. I'm confident that's true for some. I just got a funny feeling or maybe just a funny calling...who knows:-) God has plans for each of us.

An End to Rational Public Discourse: Wasn't Politics a Dirty Word?

I seem to recall that claiming someone was "playing politics" used to be a common method of attack on elected officials so much so that the very word "politics" carried a negative connotation. Now it seems that times have changed. Major news organizations have decided they want to be known for "politics." MSNBC's proudly proclaiming itself as "the place for politics" with it's tagline often placed on the frame of it's programming. CNN joins in with "CNN = Politics" as it's frequent banner. Fox News, the ratings leader, uses no such tagline and seems to focus more on policy with a "fair and balanced" approach but compensates by incorporating the (feigned or sincere seems up for debate) fringe fanaticism of Beck and the unbridled, overly simplified partisan perspective of Hannity in it's lineup.

So what does MSNBC, for one, seem to mean by politics. With Rachel Maddow, Keith Olbermann, Ed, and Chris Matthews as evidence, MSNBC defines politics as viewing Washington as a soap opera where Democrats are the heroes and policies matter to the extent that they cause contention and personality and party conflict. They have become the reality soap opera shows.

While the lack of helpful information on policy debates from MSNBC (and all the most popular media for that matter) is troubling, particularly given the amount of time that issues like health reform have been center stage, Fox News Beck takes troubling to a whole new level. Beck seems to want to be the Art Bell of politics, with his penchant for conspiracy theories. At the same time, with his tone and perpetual and emphatic call to action, Beck seems to want to be the pastor of politics. That later would seem to be much more dangerous to a weary people searching for a purpose in life that should come far from tea parties, DC marches, and excessively charismatic pundits who know the ratings power of entertainment and intrigue. Such a purpose of course is found only in humbly seeking the will of our ever present and working Maker.

It's an interesting course of events that Fox's most absurd show host in Beck also happened to preside over one of the most helpful discussions on health care yet to make it to the mainstream media. Several days ago Beck filled a room with about 40 doctors and med students who he questioned about health reform. Surprisingly the diversity of their opinions and comments suggested they weren't preselected for conformity with Becks "health reform is Obama's way to subject the masses" perspective.

So there you have it. News organizations want to be the next Guiding Light and an American anti government version of Hugo Chavez, in terms of his concept of reason and truth, is the person to look at for a reasonable policy discussion on health care. That is, of course, in between his rants about a new fascism and how the president is a racist seeking to rule your existence.

Note: This article was written with it's own degree of simplifying slightly entertainment seeking rhetoric. In my mind, Beck and all other individuals mentioned are children of God and seem to be genuinely good people.

Fixing Health Insurance Is A Small Part of the Solution

The following was my post (with a little simplifying rhetoric) in response to an indication that the health insurance industry doesn't have the largest profit margins amongst all industries: Insurers should be paying us to hold our money. A 3.3% "profit margin" becomes a bigger deal once you realize that insurance fundamentally is little more than a shared checking account. People pay in and they pay out. Who would use a bank that takes 3.3% of all money you deposit?

But that's not even half of it. The profit margin is after expenses. So it may be closer to having a bank that takes 10% or 30% of all the money you deposit.

All that said, there's a larger problem. Even if we find a way to educate insurers on how to deposit and write checks for less expense than 30% of the check, that only represents maybe 4 years of health care inflation and may do little to slow the rapid pace of cost increases.

It may be a sad testament to our democracy, after months of headline coverage, the following fundamental issues have gotten only a glancing survey by the major media sources. First off regardless of competition among check writers (insurance), competition amongst the actual health providers is fundamental to obtaining the benefits of the "free markets" everyone talks about. Health consumers need access to cost and quality information so they can purchase health care rationally. Then innovation at the care level will be properly valued and stimulated because better providers will get higher profits.

Second, while the health industry is far from market driven, the principles of supply and demand can't be overlooked particularly with all the evidence of a health care system on the brink in terms of capacity with rushed physicians and long lines at ERs. Health care supply must be increased. Perhaps this means automating processes now carried out by doctors and finding ways to do more with less training. Care would likely improve with software making decisions based on information in a nationally updated best practices database rather than doctors, particularly in primary care, who have an impossible task of keeping up with all relevant advances in medicine.

Insurance is certainly a more conceptually accessible issue but the heart of the matter lies elsewhere after we train insurers how easy it is to write checks:) These fundamental concepts of stimulating innovation and increasing supply do happen to be addressed in the current health bills but their approach merits debate because after all these are the measures that will actually impact the rate of cost increases. A failure to recognize this is either a surrender to the notion that patients can't be rational consumers and properly choose providers no matter what help they're given (which is certainly worth debate right?) or a simple intellectual error that could literally cost trillions.

Utility Bill Analysis to Direct and Encourage Efficiency Measures

Utility Bill Analysis to Direct and Encourage Efficiency Measures

Utility bills in a community are reviewed to determine what houses use the most energy and water per person or per square foot. Those with excessive utility use will be informed and given suggestions on how to be more efficient. This information could also be given to relevant and screened contractors with or without (if all information is public domain) consent who would then approach the owner offering solutions. Credit mechanisms could be arranged to help finance improvements where the expected annual utility savings exceeds the annual cost of the loan.

Data Collection:

Utility bills are often public information. Ideally this data could be obtained in digital form. House statistics should be available from the government offices responsible for assessing property values for tax purposes. There may be some error in assessor information. Perhaps checking building license approvals would also be helpful. Obtaining an estimate of the number of occupants might be possible by checking number of bedrooms or by collaboration with state or federal agencies.

Efficiency Score:

Properly comparing diverse households to determine which ones would likely most benefit from cost effective interventions could be a challenge. Perhaps the easiest method might be determining resource utilization per square foot of dwelling space. If occupant data is available a per occupant ratio may also be used. The causes and magnitudes of error with these calculations seem potentially significant and should be evaluated.

Competition to Drive Results and Innovation

Informing households that they are among the least efficient would likely be a motivation to change. Another motivator could be obtained through a time limited competition. A household resource efficiency competition could be had where households that are the most efficient at the end of some specified time win some sort of prize. The challenge would be in structuring the competition in a way that nearly all households can have a chance to win and therefore are motivation to try. For example someone could spend hundreds of thousands of dollars installing solar cells and a water capture and filtering system so that their house uses no utilities. This would be an unwelcome outcome if it caused those who could not afford those modification to abandon the effort.

Other potential factors to consider in competition design include the following:

verifying residence of individuals and number of household occupants during competition period
efficiency strategies that involve transfer of costs like more use of public bathrooms and power outlets, use of generators, more use of cars for power and accommodation
unhealthy attempts like maintaining unsafe temperatures in summer or winter, not washing hands and items as thoroughly, using fuse boxes frequently to cut power to appliances.

After the competition, participants would be encouraged to share their strategies for trying to win the competition and thereby potentially motivate and reveal new ways to save resources.

Changing the Culture of Consumption with Bank Brand Differentiation by the Social Benefits of Lending Practices

Banks could measure their impact on the community and use that data to differentiate them from the competition in relation to depositors. Banks get an increasing amount of their revenue from fees depositors pay. This factor could increase the potential benefit of this sort of brand differentiation.

Perhaps the most significant social impact banks have is through their lending practices. The events of financial crisis of 2008/09 shows the harm that can come from poor loan practices but it is also clear the substantial economic gain that can come from good behavior. Business expansion can be funded, homes can be made more energy efficient or accommodated for occupant disabilities, and educations can be funded.

Loaning behavior could be rated on how well they match the financial ability of borrowers to repay. Loans could also be evaluated by whether they are spent in ways that meet needs and contribute to the common good or are spent on luxury and entertainment that fits more with worldly hedonism.

A successful implementation could change borrower behavior and motivate them to consider the overall benefit of their borrowing and change their approach to obtaining loans from any bank. Perhaps they would seek to expand their business instead of their homes or they would realize they don't need a shiny new car just because the neighbors bought one.

While this type of promotion seems to offer banks that implement it a competitive advantage a third party rating system could also achieve the social benefits. One roadblock to third party ratings would be access to loan data. Information on general categories of loans might be available but these categories likely don't differentiate a home equity loan used for a 3 month around the world trip versus one used to widen doorways and put in a first story bathroom for someone confined to a wheelchair.

Banks with the best records in these measures and the means to obtain and share in aggregate this sort of data could benefit from participation in this sort of third party rating system. With the proper branding of the rating system it could offer prestige and bolster the bank brand all while achieving the social benefits.

Increasing School Revenue with After Hours Use of Facilities

Our schools have vast amounts of space that, for the most part, are used for less than a third of a day and remain wholly unused during summer months. This is a wasted resource. Finding ways to utilize this space in socially and economically valuable ways can reduce the hardships facing school budgets and offer new opportunities to area communities.

Some ideas for productive after-hour use of this space include the following:

1. After-hour childcare

2. Leasing to area businesses – most consumer activity occurs outside school hours anyway. This sort of leasing could reduce the cost for startups. Multiple businesses would allow the school to become, in effect a local mall.

3. Community events

4. Adult education and degree programs

5. Local government public meetings for increased participation

A number of challenges exist to enable this course. First is the actual mechanics of daily implementation. While gym space is often available, classrooms space is most underutilized. Using classrooms may require moving desks and other classroom materials to make space. This moving creates a setup time and increases the risk of damage to the desks and materials. Public access to classrooms increases the risk of thefts and disruption of materials so systems would have to be established to manage these risks.


Depreciation of the facility would occur at an increased rate for parts of the facility like bathrooms, doors, floors, and moved materials. This increased depreciation would have to be accounted for in lease pricing and evaluation of potential uses.

Legal liability risks would have to be accounted for as well. Exposer to the errors of leasees and occupants would have to be limited. This could involve clear distinctions and notices that use of school facilities by other organizations does not constitute endorsement or verification of leasee practices by government or the school.

Solutions to US Economic Woes with Christian Evangelism

A cause of much of the trouble now facing the US economy is the effort by many to seek from material goods and services the joy and peace that can come only from a right relationship with God. We need bigger faster more esteemed cars, bigger houses, prettier faces, lots of travel, and too much food. We seek to be respected intellectually, socioeconomically, and physically by those just as confused about what truly matters in life.

Hearts surrendered to God free themselves from these bondages. They become free to do what is good and to love without concern for what matters not in the least. With these freedoms also comes freedom from debt obtained in the pursuit of vain things and freedom from the sense of burden to accumulate even more wealth merely for wealth's sake.

Seeing for the Blind Using Moble Device Web Tool

Those with visual difficulties could carry a camera phone for taking and sending pictures of items and situations for which they would like a visual interpretation along with a message describing their specific inquiry. This information would then be sent to a web site where people answer the questions about the images. The answers are then sent to the camera phone as a message or through live conversation.

Volunteers could be motivated to interpret more images by prizes and drawings where the odds of winning increase with more interpretations. Interpretations would also be rated by the client to help eliminate bad actors.

Gaming of the system could also be discouraged by requiring a credit card during registration. Volunteer integrity could also be increased by restricting recruiting to churches with churches agreeing to staff the site at certain hours. With sufficient volume multiple interpretations could be made available to the client and volunteers could rate other volunteers' responses.

Volunteer participation could be made easier by allowing inquiries to be sent to and replied from volunteers' phones. This functioning may need to be restricted to those inquiries that don't require high resolution viewing.

Dialogue with Muslim Extremists - A Starting Point for Results?

Perhaps the Muslim extremist movement could be deflated by a direct theological/values discussion. Young men may choose to join these movements for a number of reasons but one component seems to be that they believe they are serving God. The Taliban in Pakistan desire to instill sharia law. Perhaps a motive for this is that it will allow better devotion to God and eliminate temptation and sin.

This particular motive is one the nation and particularly the church can offer agreement. Emphasizing that we also desire a society with less lust and prideful vain ambitions could open discussion on the means towards this end. We could then argue that killing innocent people is not the best way. We could show how people in the US are living holy lives even while women are given equal rights to dress and work as they are called.

We could even offer assistance and collaboration for living lives free from sin. This could include counseling and advertisement. It could include assistance countering pornography and prostitution and it could emphasize using wealth for the benefit of the poor and countering greed.

Perhaps this effort would seem too religious for the US government to undertake. If this is the case perhaps the Vatican or some association of churches could take this tact.