Reading a few books on

Reading a few books on the trip:

Reality Coldfusion MX is an interesting book in "real world" application development with Coldfusion MX and Flash MX.  It's making a compelling case for using Flash as a rich client.  I hadn't been convinced .. but I'm warming up to the idea.  We'll probably try some experiments with Oncalls next week.  The hospital operators don't use a mouse.  Their hands are always on the keyboard.  If they are going to use Oncalls to look up who is on call .. they can't use the website.  So the website is good for the physicians .. and for the schedulers ..but not for the operators.  We've got two choices for the telephone operators:  A Flash MX client, or a Windows .net application.  So far, the .net application is winning. 

Flash MX Actionscripting.  Not so easy to read as Forta's book (but with fewer editing errors!)   This book provides the cake tot he "reality" book's icing.  It's the meat on how to do actionscripting.  I never really took the time to learn.  ActionScript is like Javascript .. so it's not too hard, but the whole "movie" metaphor is hard for me to adapt to.  Born as a programmer in the early 1980's (BASIC, Pascal) .. I still have a hard time with object-oriented programming.  Taking it up another level to think of my program as a series of "frames" in a "movie" is tough.  I understand that it makes sense when I'm making an animation .. but it's hard to think of a web form as a movie. 

.net user interfaces with C#  I'm not a C# programmer.  Not sure I'll ever be one.  Dave works for me.  He's a C# programmer.  I need to uderstand what he's doing.  I can't manage his work if I haven't a clue what he's doing.  

I have a friend who is a manager at General Electric.  He manages a team that develops turbine engines.  He's a fluid mechanics engineer.  He manages fluid mechanics sngineers.  He and I were discussing the "joys" of management recently, and I observed that there is a high turnover of IT management.  He wasn't surprised.  "F=MA" He says.  I get it.  The domain isn't a moving target in mechanical engineering.  IT managers have to keep up on technology.

A big day today. (yesterday)I’m  in San

A big day today. (yesterday)I'm  in San Diego at the AAFP conference.  4700 family physicians.  I'm one of a handful of folks who are staffing the computer "zoo" at the conference.  It's an area on the exhibit floor where folks can go to learn about software and hardware.  Lots of traffic today in the "PDA Chat Room" where folks came to learn how to use their Palm OS devices.  Not many folks using WinCE. 

Heard in the chat room:

"what is the essential software that should I load on to my PDA?"

Common answers:
Epocrates, 5 Minute Clinical Consult , Shots

"Is there software that I can use to help me write progress notes really easily?"

Um … no

"How do I check my e-mail?"

The concept of the "zoo" is a good one.  The exhibit hall is a good place for folks to see software and hardware that many vendors are promoting .. but it's not a good environment to USE the software or speak with knoledgable folks about the products.  Exhibitors are salespeople.  In the zoo .. we try to provide folks with unbiased guidance.  There are 30 computers loaded with software from many of the vendors.  People can sit down and try the software.  No one breathing down their neck.

And they can check their e-mail too.

Sam and I are building

Sam and I are building a tree House in the back yard.  We've been spending time at … A picture named DCP_0098.JPG

Turns out that you don't need a building permit to build a tree House.

But things can get out of hand sometimes ..

We're keeping ours simple.  Yet elegant  😉

I just finished the taxes.  

A picture named DCP_0109.JPGI just finished the taxes.   NEXT year I'll do them on time .. 😉

Last week, I was asked why I write "docnotes."

Easy answer.  I write it for myself.  Doogie Howser wrote that little diary at the end of every day …

Bookmarks to interesting medical stuff .. and .. yes .. diary entries.  You're welcome to read it too.  These days there are a few hundred people who stumble in here every day.  I hope you find something useful.

Information Storage – Medical Knowledge

In a post on Dave Winer's Scripting News today, Dave brings up the issue of information storage.  He seems to be discussing hierarchic thinking.  Dave has written outlining software for years.  He's added complesity to the outliners  . beginning with More in the dinosaur ages .. and forward to Frontier and Radio.   I don't think that we all function so well with outliners.  Not everyone THINKS that way .. even if one can DESCIBE what we're doing in a hierarchy.

So what?

I teach at a medical school.  So I teach medicine.  I also teach Medical Informatics to physicians.  And I study medicine.  And I study Medical Informatics.

These topics are vast.  Many (?most) searches on the internet are related to medical information.  In the early days of the internet, many "directories" were created to help people find the informationthat they were looking for. Yahoo was one of the first, of course .. and it was successful because it was well implemented.  Medical Matrix was a great early resource for medical information — for both physicians and patients.  Yet in the practice of medicine, the information resources are so vast .. and the temporal pressure to find the RIGHT information NOW is so great that a directory simply falls apart.

My pal Dave Kauff came up with a hypothesis a few years ago .. he recognized that physicians don't really use the internet to find medical information very often .. even if they know that what they are looking for is "out there" somewhere.  If I learned about a certain condition from a certain book when I was in medical school and I know that the information I'm looking for is on the page on the left-hand side about 2/3 of the way tthrough the book in the chapter on such-and-such and the book is on the bookshelf on the 3rd shelf up on the right hand side of my desk. …. then .. that's where I'll find it 1st.   So Dave K says .. "if the docs can put the books on the bookshelf .. then maybe they can organize links to the data that they want if we make it easy for them.

So we teach people to use "MYHQ" .. which is STILL the best URL/Bookmark utility on the internet, and still free free free.

It works well, but not everyone likes it.  Not everyone thinks that way. 

Where am I going with this? 

Dave Winer can superimpose a hierarchy of thoughts on how many people organize their homes.   So long as we learn good searching strategies . (yes .. hierarchies again .. I hear you coming, Dave!) .. and maintain good search engines . it doesn't matter at all.  We physicians have strugges for years to develop nomenclatures that describe medicine.  ICPC, SNOMED and ICD-9 are all examples of such attempts.  ugh. 

I guess today's post is a work-in-progress.  We'll see if I can make more sense of all of this later.

medpundit

From Medpundit:

"A patient is seen and treated in the office. The doctor submits the bill to the insurance company, which, according to the contract it has with the doctor, is supposed to pay the bill within a certain number of days, say 30. On the thirtieth day the doctor doesn't get a payment. Instead he gets a form from the insurance company claiming they need more information about the visit. Was it for a pre-existing a condition? To make it even more difficult, the letter doesn't specify which diagnosis for that visit it has concerns about, and sometimes it doesn't even state the day of service. So, if a patient saw the doctor for two things – say an ear infection and to have his blood pressure medicine renewed, or if he's been to the office twice for two separate problems, the doctor's staff has to call to clarify things, a process which can take minutes to days. Then, the form has to be mailed back to the insurance company. They won019t accept the information by phone. This happens even if the condition is clearly not a pre-existing one. In fact, I see it most frequently for office visits that have been for an acute problem such as an ankle sprain or an ear infection. The only reason the insurance company has for doing this is to delay payment by another couple of months."

ugh.  This is my life.  Well put, "medpundit."