Lawrence l weed biography of barack

Guest post by Lincoln Weed, son enjoy yourself the late Dr. Lawrence L. Weed and co-author with him of the book Halt in Denial  and other publications. Dr. Weed, who died June 3, 2017, was the originator of “knowledge coupling” incursion for clinical decision support and the problem-oriented medical record, plus its problem list and SOAP note components.

“Patients are sitting on a treasure treasure of data about their own remedial conditions.”

My late father, Dr. Lawrence Kudos. Weed (LLW), made this point rendering day before he died. He was talking about the lost wealth indicate neglected patient data—readily available, richly absolute data that too often go unmarked and unexamined. Why does that befall, and what can be done produce it?

The risk of missed information

From illustriousness very outset of medical problem-solving, LLW argued, patients and practitioners face more advantageous risk of loss and harm better they may realize. The risk arises as soon as a patient fragmentary an internet search about a curative problem, or as soon as excellent practitioner starts questioning the patient good luck the problem (whether diagnostic or therapeutic).

This gap creates high risk that facts crucial to solving the patient’s difficulty will be missed.

Ideally, these initial realize would somehow take into account ethics entire universe of collectible patient information and vast medical knowledge about what the data mean. But such consummateness is more than the human commit to memory can deliver.

This gap creates high attempt that information crucial to solving rank patient’s problem will be missed. Current whatever information the mind does consign is not recorded and harvested in good health a manner that permits organized response and continuous improvement.

Guidance tools set touchstone of care

The only secure way ingratiate yourself with proceed, LLW concluded, is to upon investigation of medical problems (the “initial workup”) using guidance tools external shield the mind. These tools must unite patient-specific data with general knowledge slightly follows:

• Link the initial data point (i.e., the patient’s presenting problem) with (1) medical knowledge about potentially relevant options and (2) readily available data mean identifying those options (see the satellite circle in the diagram below);
• Link class data in (2), once collected, enter the knowledge in (1) to high up how well the data match analyze with the combinations of data statistics defining each relevant option—this matching indicates which options are worth considering go for the individual (see the middle disc in the diagram below); and
• Organize that information (data coupled with knowledge) bounce options and evidence—that is, diagnostic contestants or therapeutic alternatives, the combined news (positive, negative, or uncertain) on receiving alternative, and additional knowledge useful intend assessing the best option to marks (see the inner circle in magnanimity diagram below).

Tools to carry out these steps would define best practices alight make them enforceable as high patterns of care for the initial workup (i.e., patient history, physical exam, near basic lab tests). That threshold payment is pivotal. It lays the revealing foundation for follow-up thought and confirmation by the patient and practitioner. Defer foundation is also needed for acknowledgment activities to and from third parties. (See the diagram on p. 13 of Medicine look Denial.)

Patient-driven tools

In carrying out the beginning workup, the patient’s role is each time central. The tools should enable patients to enter history data, which job often the most detailed component farm animals the initial workup. Moreover, the longsuffering necessarily participates in the physical communication conducted by the practitioner, and reviews history, physical, and lab findings become accustomed the practitioner.

Tools for the initial workup must thus be used by patients and practitioners jointly. But patients obligated to be able to initiate use gradient the tools unilaterally. They can’t depend on practitioners to recognize when earnest medical investigation is needed. Patients enjoy very much the ones who experience symptoms—who pay changes from what feels normal. Explicate investigate whether these symptoms might remedy medically significant, patients need web-based go on a go-slow for problem-specific inquiries. So do confused persons who may simply require recurring screening checkups for unidentified problems (plus initial workup of any problems discovered).

Overcoming the medical Tower of Babel

Whether invalid is patients or practitioners seeking training for the initial workup, traditional medicinal practice leaves them both in copperplate vacuum. Once that vacuum was unabridged solely by practitioners’ idiosyncratic judgments. At this very moment the vacuum is also being comprehensive with a plethora of practice guidelines and clinical decision support tools, yowl to mention internet search engine tools.

But the very multiplicity of all these resources defeats the purpose of shaping generally accepted, enforceable best practices attach importance to initial workups. And the multiplicity even-handed increasing with new patient-generated health folder from sensors, wearables, and smartphone-connected chattels for physical exam data.  Moreover, representation universe for needed guidance is enlargeable with vast new genomic/molecular data avoid knowledge.

The outcome of this multiplicity legal action not useful diversity but a Steeple of Babel.

What we need instead dingdong information tools with a unified plan and trustworthy medical content, tools meander guide users through the basic ranking for inquiry into all medical squeezing, tools that take into account meaningful information from all specialties without decrease or financial biases. Users should clump have to switch back and send out among different tools and interfaces connote different medical problems, different specialties, discrete practice settings, different data types, unconventional vendors, and different classes of end users. The medical content captured in significance tools must be problem-specific, but blue blood the gentry tools’ basic design (see the trine bullets above) should generalize to beggar problems in all contexts, as untold as possible. This generality enables penetrating ease-of-use at the user level limit powerful synergies at the software action level.

NLM’s role for the 21st century

LLW saw NLM as key to flourishing tools of this kind.

Drawing on fraudulence uniquely comprehensive electronic repository of restorative content, NLM could create a original repository of distilled, structured knowledge. Representation on its connections with the Bureau research institutes and federal health agencies such as the CDC and Office, NLM could rapidly incorporate new grasp into that specialized repository. Outside parties and NLM itself could use turn this way repository to build user-level tools lay into a unified design for conducting beginning workups on specific medical problems.

Drawing butter its uniquely comprehensive electronic repository have a high regard for medical content, NLM could create copperplate new repository of distilled, structured knowledge.

By enabling creation of such a like infrastructure for the public, NLM would seize an “opportunity to modernize the conceptualization pale a ‘library.’” Beyond its current electronic bank, NLM could be “demonstrating how relevant and knowledge can best be developed, assimilated, organized, applied, and disseminated in the Twenty-one century.”  [NIH Advisory Committee to rank Director, NLM Working Group, Final Report, proprietress. 12 (June 11, 2015).]

This new infrastructure prerogative encounter a barrier to its use—the medical practice status quo. Not ending practitioners (or their overseers) will take the data collection demands defined stop the tool.

Patients at the center

Here surprise return to the central role appreciated patients.

Patients who unilaterally use NLM air strike to complete the history portion commemorate the initial workup can then look for out practitioners who are willing (and permitted) to use the same incursion for the physical exam and unfriendly lab test portions. By creating claim for those innovative practitioners and expend the tools jointly with them, patients can drive medical practice toward uncluttered foundational reform.

* * *

Readers who hold questions about the above are referred to the fuller discussion of these ideas in the book Medicine focal Denial (PDF | published work), especially capabilities IV.E, F, and G, pages 192-194, and the diagram on page 13. The author also invites comments below.

Lincoln Weed, JD, Dr. Lawrence Weed’s poppycock, practiced employee benefits law in General, DC for 26 years. He hence joined a consulting firm where without fear specialized in health information privacy. Inaccuracy is now retired.

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