c: 2017-06-27

• US EHR “market failure” - “Systemic, not communal”, “need government standard” – government intervention
• “Free isn't cheap enough” Kocher - on Wellpoint's free computers to California doctors
• “Shovel ready”
• p14 “You never want a serious crisis to go to waste” Rahm Emanuel COS to Obama

c: 2017-07-06

• Larry Weed Emory: SOAP 1970s
• Mayo clinic executive screening story - cellophane tape
• Southwest airline “relational coordination”
• information vs knowledge
• Paul Chang: “We have to go beyond isolating ourselves and concentrating on messages in a bottle”
• Radiology & PACS - prescient for other specialties?

“Doctors are conservative and hate change”

“We would have to use a mixture of seduction and coercion”

Delbanco p.176

“Patients possess a body of knowledge about themselves that we can never hope to master, and we have a body of knowledge about medicine that they can never hope to master”

p.173

Parasuraman automation quote p.135

“We failed to remember the Google Mantra that it is much more important to solve a small problem incredibly well than a big problem 80% of the way.”

p.186 Roni Zeiger

Personal health record - needs to be really simple for consumer

Santa Barbara Health Information exchange failure

• no private money interested in rare public good.

hx - 2017-07-19

• fewer hospitals and inpatients
• change consults and records
  • EHR in cloud? how about curation?

“Reaching the ideal future state will depend on government assuming its proper role: the meaningful - and limited - use of its vast powers.”

p.266

• 2017-08-08

2017-07-27 p.201

Roni Zeiger & Giles Frydman - Smart patients website

Ch 23 Meaningful Use

• HiTECH Stages 1-3 Blumenthal
• “Experience hath shewn that even under the best forms of government, those entrusted with power have, in time, and by slow operations, perverted it into tyranny”
• David Brailer: “Bureacracies don't retrench,” he said. “When a bureaucracy that starts as the candy man runs of out candy, it goes dark and turns into regulatory man.”

c: 2017-08-08

What do you call a 99-1 vote of the medical staff? – a tie

p 244 Paul Krugman: “Productivity isn't everything, but in the long run it is almost everything.”

Brynjolfsson 1993: “the second machine age” , “productivity paradox”

• “a shortfall of evidence is not evidence of a shortfall”
• The need to redesign work with introduction of IT

“If the doctor thinks there might be even the tiniest bit of incremental value, why wouldn't she reorder the test?”

p 248 Julia Adler-Milstein

“Culture eats strategy for lunch”

Drucker

Wachter, R. M. (2017). The digital doctor: Hope, hype, and harm at the dawn of medicine’s computer age. McGraw-Hill Education.

• 2017-08-08 created on index card
• 2020-08-10 transcribed to dokuwiki