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.