I still beleive in paper notes. The cure for illegibitly is called a dictaphone and a typist. Typing onto paper. Or a printout.

FOR 20 years, I practiced pediatric medicine with a “paper chart.” I would sit with my young patients and their families, chart in my lap, making eye contact and listening to their stories. I could take patients’ histories in the order they wanted to tell them or as I wanted to ask. I could draw pictures of birthmarks, rashes or injuries. I loved how patients could participate in their own charts — illustrating their cognitive development as they went from showing me how they could draw a line at age 2 and a circle at 3 to proudly writing their names at 5.

Now that I’ve been using a computer to keep patient records — a practice that I once looked forward to — my participation with patients too often consists of keeping them away from the keyboard while I’m working, for fear they’ll push a button that implodes all that I have just documented.

We have all heard about the wonderful ways in which electronic medical records are supposed to transform our broken health care system — by eradicating illegible handwriting and enabling doctors to share patients’ records with one another more easily. The recently passed federal stimulus package provides doctors and hospitals with $17 billion worth of incentive payments to switch to electronic records. The benefits may be real, but we should not sacrifice too much for them.

The problem is not just with pediatrics. Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room — making that crucial connection between doctor and patient.

via Op-Ed Contributor – The Computer Will See You Now – NYTimes.com.

This is a must read article. And confirms my reasoning for keeping my records on paper.

And ignoring the hospital approved forms. The traditional notes work. Read the whole article.

The root of the problem I experienced with health information systems is a very bad data model. Evidence supporting my claim includes these observations:

Incoherent database design isolates patient information from one department to the next and from one organization to the next. This wastes time and increases errors because medical personnel must enter patient information into a unique view of the system that corresponded to user identity and department – this prevents one medical professional from seeing patient information input by another medical professional.

Patient information is easily lost inside the electronic records system

Hard copy patient information becomes dissociated with the electronic record

A healthcare professional’s work pattern is not reflected in either the system design or data model – people spent considerable time searching and data reentry

No master data management MDM in evidence – Production of a consistent record of me as a patient required the ICU nurse to copy data from multiple database views into the in-patient record

Admitted in-patient records are treated differently by the system than out-patient or ER record only patients – no information about my medical history gathered during a prior visit to ER was available to my doctors or nurses.

Nurses and doctors do not have ready access to listings of pharmaceuticals which wasted much time while they searched for information about my daily medications – lists of medications in the system are limited to those at the hospital pharmacy.

No support existed for recording allergies differently than to ambient source and foods – Lists of allergies were not in drop down menus although these are well known by allergists and drug companies.

The root cause of these problems is the failure by information technology IT system architects to correctly capture business requirements. There also is evidence that no one ever produced a reliable conceptual data model. The problem commonly occurs. Too often, system architects simply gather lists of requirements then they ask their favorite vendors to quote a product. This is non-architecture and system non-design. Rarely do architects request information architecture.

Fault also rests with independent software vendors ISVs whose products fail to support end- user requirements – real doctors, nurses, technicians, and pharmacists. Rather they build products to a marketer’s or a developer’s best guess about end-users’ requirements. It is easier to rush a product to market that “looks good” to IT people but horrifies end-users.

via Analysis from the Bottom Up | The Data Model That Nearly Killed Me.

I can clearly recall the enviromentalists arguing against hydro power in my youth, and in the last year they have argued against wind power (in Otago) and are starting to argue against more dams..

I think the greens function as druids, but are not prepared to think through the theology of this. The Druids subsumed all to nature — to the point of bonefires. It takes talent and practice to habitually disgust the Romans… who exterminated this religion because of the evil they saw it doing.

We live in an energy hungry world. We are moving from fossil fuel to solar/wind/hydro: this is doable if (like in the US) you exploit your deserts. There will be a cost: here always is.

The SunZia transmission line that would link sun and wind power from central New Mexico with cities in Arizona is just the sort of energy project an environmentalist could love — or hate. And it is just the sort of line the Interior Department has been tasked with promoting — or guarding against.

If built, the 460-mile line would carry about 3,000 megawatts of power, enough to avoid the need for a handful of coal-fired plants and to help utilities meet mandated targets for use of renewable fuel. “We have to connect the sun of the deserts and the winds of the plains to places where people live,” Interior Secretary Ken Salazar said recently.

But the line would also cross grasslands, skirt two national wildlife refuges and traverse the Rio Grande, all habitat areas rich in wildlife. The graceful sandhill crane, for example, makes its winter home in the wetlands of New Mexico’s Bosque del Apache National Wildlife Refuge, right next to the path of the proposed power line. And much of the area falls under the protection of the Interior Department’s Bureau of Land Management (BLM).

via Renewable Energy’s Environmental Paradox – washingtonpost.com.

Now if you think that this is too much, can I suggest you choose to live a neolithic lifestyle, and accept the drudgery, the sexual dimorphism in tasks, the maternal and child death rate, and the shortened life this entails. I prefer to live in the 21st century.

Ascribe means an active choice to worship: to give honour.

Ascribe to the LORD, O families of the peoples,

ascribe to the LORD glory and strength.

8 Ascribe to the LORD the glory due his name;

bring an offering, and come into his courts.

9 Worship the LORD in holy splendor;

tremble before him, all the earth.

10 Say among the nations, “The LORD is king!

The world is firmly established; it shall never be moved.

He will judge the peoples with equity.

via PC(USA) – Devotions.

Karl is writing about traffic and cyclists. I prefer to cycle, run and walk… alone. It gives me silence, a very good thing.

And (apologies to Cactus) he misses the big source of error when doing any of the above on a road: wearing a walkman or ipod. You literally cannot hear the car that is going to hit you.

It’s useful here to distinguish between different sub-species of cyclist. There’s cyclistus zealotus – typically a Greenie who is ideologically committed to cycling as a way of life, detests motor vehicles and will assert his or her right to occupy road space because it’s a matter of saving the planet.

Then there’s cyclistus pelotonus, who – unlike the Greenie – drives a car most of the time (and often an expensive one at that) but at weekends likes to dress up in lycra, climb on a flash racing bike and join his or her cycling mates in a peloton – that’s French for a bunch of riders – on a group ride.

These people, who are generally not too concerned about saving the planet, assert their right to occupy a lot of road space because … well, because there’s a big group of them, they’re often soaked with testosterone and they know motorists will make way because no one wants to end up in court charged with careless driving causing death.

Cyclistus pelotonus has a remarkable ability to irritate non-cyclists even when not on the road. A friend of mine bridles at the way they arrogantly swagger (his words) into the cafés they occasionally stop at on their rides.

I can afford to sound self-righteous here because I belong to a third sub-species, cyclistus solitarius. I ride on my own because I value the solitude and the silence. Because I don’t have any companions to make conversation with, I can keep well to the left and not hold anyone up.

If I’m on a narrow road approaching a blind bend and I sense a car stuck behind me, I signal as soon as soon as it’s safe for the car to overtake. And when motorists behave considerately toward me, as they often do, I acknowledge it with a wave.

via Karl du Fresne.