Disqus - Latest Comments for nickdawson

Re: More on glycerin and psoriasis

Nick — Fri, 01 Jan 2021 21:24:20 -0000

@Michelle Arbeau I'm so glad you are finding success with glycerine. Truth be told, I've also enjoyed a 10 year remission and as a result I haven't thought much about this post or that Inspire discussion in quite some time. I'll admit, I'm glad this page is still up and providing some help to people.

What I recall from the very limited research is that glycerin has an effect on the way our skin cells replicate.

One of the most disappointing things I remember was the research scientist (Dr. Bollag) saying she couldn't get funding so the research never continued. That's infuriating! I tried for a bit to see if we could find some funding through the Society for Participatory Medicine. I still think a good peer reviewed article, even if it is simply on observing the effects, would be a game changer!

Re: Getting your NVMe SSD working on macOS Sierra 10.12.2

Nick — Sat, 22 Jul 2017 16:04:22 -0000

great post! Helped me get my NVMe set up a few weeks ago. Now, it seems, I put off updating from .4 to .5 so long that it went ahead an auto-updated (or maybe I clicked Update Tonight) by mistake.

Regardless, now my system won't boot.

I still have a working 10.12.4 install on an SSD and was able to patch it to recognize the NVMe drive too.

I'm trying to figure out if I can somehow patch that NVMe drive for 10.12.5 while it's mounted in a .4 install. Any ideas? Can I just copy the kext for .5 into /Volumes/NVMe/System... ?

Re: Why patient engagement is so challenging to achieve

Nick — Thu, 25 Feb 2016 16:06:22 -0000

Loved the visuals!

Re: Why patient engagement is so challenging to achieve

Nick — Tue, 23 Feb 2016 21:07:18 -0000

I really appreciate the spirit of this post. I like how you lay out the complexity of the healthcare system some of the different entry points people may have. However, I'm commenting in the spirit of collaborating to make healthcare more human. Specifically, I'm writing to share the industry's version of patient engagement -event the term -misses the mark widely.

First, I've never met a patient who wants more engagement, or who is asking to be engaged in the first place. I've certainly never met one who wanted to be managed. The terms convey the lens through which our industry views patients - as the commodity. We can manage a supply chain or engage our vendors. But I'd like to see us broaden our understanding of what it means to be a patient at all.

First, it's not some different state that other people assume. Perplexingly, we are not —despite popular rhetoric —'all patients'. But for those who experience sudden illness, trauma or live with a chronic condition, patient-hood is not defined by a desire for more engagement. Instead, it's often defined as an opportunity cost against living better days, it's defined as having to trade dignity for treatment and for sacrificing control and agency to someone else (however willfully or unwillfully that exchange occurs).

I like the idea of asking how exchanges might be more patient-centered and how the interactions of patients differ from those of caregivers. And, arguably shopping on an exchange is the closest any of us gets to a true consumer-like experience in healthcare today. But I worry, when executives and managers get together at places like HIMSS, ACHE, HFMA, SHSMD, etc and talk about 'engagement', they are really conflating customer service and loyalty with marketing and retention.

Let's move past those understandings of our market value and, instead, ask how we can be part of a system which helps everyone, in any community, live their best days. Let's look for ways to treat patients (the end user of our system) as equals, or better yet, drivers instead of second class citizens (how many patients or caregivers where their at HIMSS compared to attendees who's livelihood affords or dictates their attendance?). And better yet, let's value patients, caregivers and communities as equal team members in the design of systems, services and tools.

I'm not seeing anything in this post to suggest you might not agree, so I hope this comment doesn't feel like an attack. On the contrary, I know IBM has a growing understanding of human-centered design and I know it's one of the few companies poised to fundamentally change the power dynamic in healthcare to on of patient-centeredness and health, through the decimation of knowledge and decision support. I'm looking forward to seeing that unfold!

Re: More on glycerin and psoriasis

Nick — Thu, 11 Dec 2014 12:20:23 -0000

Topazmoon11 - I am so glad to hear glycerin has worked well for you. It was certainly helpful for me.
There's a whole community of patients on the Inspire site who are also experimenting - might be worth your time to check out. https://www.inspire.com/gro...
Best of luck!!

Re: Improving community health with more people and less cost

Nick — Wed, 03 Dec 2014 16:52:47 -0000

Sounds like your group is doing the right kind of work Leigh Anne - kudos!

Re: Improving community health with more people and less cost

Nick — Mon, 24 Nov 2014 15:18:27 -0000

Clarke - I think you are on to something. There's a need for a different kind of care at different times. Trauma isn't the same as cutting your finger making dinner.

Re: More on glycerin and psoriasis

Nick — Thu, 26 Jun 2014 17:32:57 -0000

Any drug or grocery store - also several options on amazon

Re: How a $4 internet cure saved me from chemotherapy and hundreds of dollars

Nick — Thu, 29 May 2014 12:08:15 -0000

Bill - thanks for the comment.
I appreciate your skepticism. With the exception of the purposefully quack-sounding title of the post, I hope the rest doesn't come off as quackery. I've got no vested interest in selling glycerine or anything else for that matter. As a career-long healthcare administrator focused on innovation and quality improvement, my dog in this hunt is to call attention to the research problem. Glycerine seems to work for some— certainly did for me —and yet there's no peer-reviewed research.

Re: Build a health care system based on community values

Nick — Wed, 23 Apr 2014 07:45:10 -0000

This is nothing short of inspirational.
"Customer-owners are in control of how the system is designed and their individual health care needs. Providers gain a better understanding of how a customer-owner’s community influences their overall health."

As other traditional providers struggle to make the shift towards population health and ACO models, it sounds like Nuka has embraced the true essence of being a community provider.

I'm also impressed with the attention to staff happiness and support.

Wow!

Re: Cut down on unnecessary patient visits

Nick — Tue, 22 Apr 2014 13:52:35 -0000

I love this flip. There are some really powerful things embedded in the Symcat idea. In particular, the idea of computer-aided diagnosis seems like something we should be actively working towards. To that end, I'd challenge us all to think about some assumptions and goals.

First, are we still putting the onus on the wrong resource?

"An overwhelming number of patients visit the emergency room each year for conditions that could have been handled elsewhere." - I challenge the idea that an emergency room is an inappropriate place for some levels of care. Why not build ERs which can handle all levels of care, with appropriate resources and costs? Patients chose the ER because its represents a 'desire path'. It's open 24/7 and it doesn't require an appointment.

Setting aside the ER example, we still need to consider if we are giving patients a complete toolkit. Put another way, is it reasonable to think most people will consult an app to figure out which healthcare delivery options is best for them? Telling me I should go to my primary care doctor is well and good, but doesn't do anything to reduce the burden of getting in to see that doctor (online scheduling, long wait times, lack of appointment options, etc). That's just another way of making patients fit the existing system. Why not build a system which can respond timely and appropriately to any need?

Least I sound too "yes but...", I wholeheartedly believe in the inevitability of computer-aided and computer-automated diagnosis. I'd posit, if we are to proverbially skate where the puck is going, we need to accept the idea that apps, sensors and in-home devices will make it possible for most people to diagnose at least common illnesses entirely on their own.

There are commercial products coming to market this year which provide in-home rapid strep testing which is every bit as reliable as what is used in doctors' offices.

Once a service like Symcat, or similar, can reach the same level of accuracy as a physician, doesn't that start to truly flip the model? Then you come your provider not seeking a diagnosis, but seeking a consult on treatment options. That's a massive savings in time, steps and arguably cost. I can imagine Symcat collecting patient data and offering a reasonable, accurate diagnosis to both the patient and the provider in real time. Then a provider says "yep, I agree, here's the eScript for the appropriate med." There'd be no need for an office visit at all and the entire process may not take more than 5-10 minutes from both parties.

Pie in the sky? Could never happen because legal/HIPAA/management/etc? Ask a record store, travel agent or mailman about their businesses.

So my take is a resounding "yes!" this is something which not only should work to reduce costs today —particularly in the pragmatic ways outlined in the post —but is a harbinger of what will inevitably come in the next ten years. And that future vision is the kind of thing that really flips the relationship, the visit, and the clinical experience.

Re: What if medical records worked like Wikipedia?

Nick — Mon, 14 Apr 2014 09:53:58 -0000

"Here's a news flash: most of us barely have time to pull up and review old records on a patient."

And that's certainly a huge problem too...but arguably its a separate problem (albeit one which needs critical and earnest attention).

Though, one may make the argument, if patients are allowed into the walled kingdom they may be increasingly self-supporting and 'empowered' and thus need less time from —or make better use of the time with —their providers. Win/win?

Re: What if medical records worked like Wikipedia?

Nick — Mon, 14 Apr 2014 09:51:31 -0000

Great point - in a collaborative platform, the UI should probably delineate who made the contributions. This would also include data contributions from connected devices, non-traditional providers, lab results, etc. On the other hand, does knowing the source allow for too much attribution bias? Might providers discount something relevant because it was a patient contribution?

Re: What if medical records worked like Wikipedia?

Nick — Mon, 14 Apr 2014 09:48:08 -0000

Sure it is!
And, it's frequently one of the top three results patients are likely to find with researching symptoms or a diagnosis. Arguably, its already a significant part of our medical culture, even if we don't acknowledge it as such.

Re: What if medical records worked like Wikipedia?

Nick — Mon, 14 Apr 2014 09:46:40 -0000

"This would be a medico-legal disaster unless the simple act of allowing this kind of access, automatically excludes patients from making any legal claims whatsoever."

That's where an audit logging and revision history feature is critical, right?

Re: What if medical records worked like Wikipedia?

Nick — Mon, 14 Apr 2014 09:45:50 -0000

"Still, I don't think patients should be able to edit medical staff notes, no matter how inaccurate the notes may be."

What if it is a non-destructive edit? Meaning, what if the original note remains and can be reverted? And/or, the patient's edits and additions are store separately, so neither the patient nor provider can clobber each other's contributions to the records?

Re: What if medical records worked like Wikipedia?

Nick — Mon, 14 Apr 2014 09:44:09 -0000

"I wonder if it would work in other industries for example healthcare consulting? "

I'm not a consultant, per se, but I love this idea! Certainly makes sense to me to share and co-edit a work product one is paid to advise on.

"If it isn't, why not, and why would we start experimenting with this approach with something as medically and legally sensitive as a medical record?"

Certainly, its not new for workgroups to share common documents everyone can edit - look at the up take of Google Docs and shared editing platforms like Office 360. And a lot of sophisticated project management tools, like Base Camp, allow vendors to invite clients into a shared space. I'd argue this is pretty much the de facto way to operate on most work projects today. And I love your idea of looking at what works in those platforms and what we might learn from collaborative editing suites!

Re: What if medical records worked like Wikipedia?

Nick — Mon, 14 Apr 2014 09:40:24 -0000

The short version is: yes, the wiki platform can do those things. But the longer answer is that this is an allegory and not a direct proposal to implement wikimedia as an EMR platform. The point is that today, its extremely expensive and difficult to get even limited interoperability between the same EMR platform across two different organizations, let alone any user/patient contributed data. And that's absurdly antiquated considering that, yes, a free open source knowledge base has solved that problem for 10+ years. If we desire empowerment, we cannot build and maintain a walled kingdom.
And, frankly, the VA has done this with Vista, it's open source, free EMR....pretty good model, and they are incorporating the OpenNotes standard to allow shared record editing. So yeah, it can be done in a cost effective, product way.

Re: What can health care learn from Amazon?

Nick — Wed, 26 Mar 2014 09:27:57 -0000

Margalit,

Thank you for your passionate comments. As the author of the article, I take a few exceptions. If I've misinterpreted you, please let me know.

First, I'll preface this by suggesting the Amazon example is allegorical. With the exception of hinting that Amazon might one day offer just-in-time medication delivery, I'm not earnestly suggesting we'll all go to Amazon.com for our healthcare needs (though stranger disruptions have happened). Rather, I'm suggesting what Amazon is doing with 'big data' and predictive analytics should be an inspiration for our whole industry which has notoriously lagged in its use of data.

To some specifics:

1) not to sound like an Amazon apologist or healthcare defeatist, but...while Amazon may not care if it makes anyone bankrupt, healthcare certainly does not care. Medical expenses are still the number one cause of bankruptcy in the US. http://www.investopedia.com...

2) Amazon, or the folks at its helm, may also not care if the products it sells kill you. Then again, we unintentionally harm between 210,00 and 440,000 people through medical errors every year: http://www.npr.org/blogs/he...

3) For me, at least, Amazon is hardly a mindless experience. I can look for a product, find it in seconds and very quickly see cost and quality information. I can see how many people bought X versus Y. I can read about their experiences with the product. Ask the average healthcare seeker to shop a procedure in the same way. We cannot easily find out how many procedures one doctor has done versus another, or what their outcomes are, or what the cost is. I think that's a lot more mindless than my Amazon experience.

But what I really take exception to is your concern that learning from Amazon's predictive analytics is about "maximizing convenience-based exploitation of all people with a nickel in their pocket, whether healthy or sick."

In fact, the post proposes exactly the opposite. We don't have a healthcare "system" today. Systems function in a predictable order, and in concert with individual components. We have a fragmented which has become too big to fail. Provider organizations are scrambling to secure narrow profit margins to maintain the expensive, complex and faulty infrastructure that we've built over the past 40-60 years. That's not a system.

A system would do what's best for the health, comfort and wellbeing of individuals and populations. Predicting those health needs should be a basic tenant of a system. That's not a money making endeavor, in fact, if done correctly it would simultaneously reduce costs while providing people what they need in a more satisfying, human-centered way. I'd much rather my provider (or rather, their computer system) pick up on nascent trends in my geographic and DX population, couple that with specific data from me and know I may need an intervention long before symptoms present and I need something more costly, painful or complex.

I welcome this dialogue. You point out the best and most nobly desirable traits a provider can have - compassion, care for the sick, intention to heal and concern for cost and quality. I'd invite you to re-read the post and consider that we share the same ideals - does that change your perspective?

And finally, if we want to get critical about something, lets both be concerned that modern EMRs are multi-million dollar implementations and don't currently do any of this predictive, proactive management. That's almost criminal.

Re: TEDMED #GreatChallenges: Meaningful Minutes: Reinventing the Clinical Visit

Nick — Wed, 12 Mar 2014 10:54:56 -0000

Wonderful recap, thank you for writing and sharing this!

Re: What if there was an EMR built on Wikipedia?

Nick — Mon, 03 Feb 2014 11:14:45 -0000

Susannah, I really like this dialogue. I think most folks would accurately suggest I'm talking about a PHR (personal health record), but I really dislike that term too, its take a pejorative stance. EMR isn't much better, is it?

I like the idea of a new term, something that isn't defensive, but rather implies a positive "life graph".

Great thoughts from Esther Dyson on that topic - thanks for sharing!

Do you think we can reasonably get to something more positive and proactive? I'd imagine the positive contributions - eating well, fitness data, positive mental health observations - would greatly outweigh the things in which providers are traditionally trained to intervene (maladies, injuries, illness...). So we'd have to also re-think who the right players are. Fitness trainers, dietitians, caregivers, teachers, etc might actually get more benefit out of a 'positive record' than healthcare providers would. Can you imagine?!

Is anyone doing anything like this?

Re: Amazon.com as a delivery model for population health

Nick — Wed, 29 Jan 2014 09:23:22 -0000

Penny - wonderful to hear from you. I think about you and you work in this space often!
I'd love to hear more - you should publish!

Re: Evernote Is My EMR And Its Better Than The Rest

Nick — Mon, 27 Jan 2014 12:06:09 -0000

Thanks Tyler - was thinking about Mint specifically when I asked the question. You read my mind.

Re: Evernote Is My EMR And Its Better Than The Rest

Nick — Mon, 27 Jan 2014 11:52:01 -0000

Great insight Lauren - thanks for adding those important details about security!

Re: Evernote Is My EMR And Its Better Than The Rest

Nick — Mon, 27 Jan 2014 11:51:25 -0000

To build on David's question - is prime connecting to MyChart via an API, or does it emulate a user's web calls? Asking out of nerdy curiosity, not to suggest one way is better than the other.