Comments on: Don’t forget the patient when using algorithms in their care http://www.kevinmd.com/blog/2010/02/forget-patient-algorithms-care.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Medical Quackhttp://www.kevinmd.com/blog/2010/02/forget-patient-algorithms-care.html#comment-139343 Medical Quack Sat, 31 Jul 2010 23:48:30 +0000 http://www.kevinmd.com/blog/?p=42296#comment-139343 Algorithms, one of my favorite topics and yes there's both the good and bad side and balance is needed so reliance with information available doesn't forget there's a patient to be treated in the picture too:) One item to also keep in mind are "user friendly" algorithms too. Almost every hospital today is feeling the crunch with around 55% operating in the red and we now have both private equity firms and venture capitalists entering the picture to also come in and try to make things more efficient and profitable and the balance there on how this will play out remains to be seen.When it comes time in hospitals for the insurance end of things which is totally algorithmic scoring formulas, it gets to the point of how do you comply with some of these algorithms?http://ducknetweb.blogspot.com/2010/02/hospitalists-peer-committees-and.htmlI stuck the word "algorithm" and it's definition square in the center of my blog a couple years ago as I have seen the ups and downs, good implementations and bad implementations, and so on. On the payer side of things they have invested in the highest levels of intelligence and data systems (too bad some can't secure them any better though) and they score and do risk management on everything walks and talks, so think that includes us:)The bushiness intelligence they use would be relative to going to battle with machine guns, and the rest of us, well we kind just have some sword and daggers. The analytic end of everything is growing and I we need balance and also that growing awareness of what would be called "rogue" or "dirty" algorithms in healthcare today. We still need to treat people with respect and find out all the information from the human side too and hopefully the balance will come around, I hope:) I've written enough algorithms in my time to see both sides of the coin and I'm almost to the point of saying for some, analytics could also stand to be the next 12 step program in the works as we do see some some rather strange stuff out there along with the useful and fact based information that helps us. Analyzing should not be done just for the sake of analyzing either. One thing that somewhat gets over looked too with those reviewing information after the fact is that they were not there interacting with the patient either and how decisions were made based on what was occurring at those moments. Algorithms can be helpful with delivering information but we still need the balance and wisdom of a human doctor. Algorithms, one of my favorite topics and yes there’s both the good and bad side and balance is needed so reliance with information available doesn’t forget there’s a patient to be treated in the picture too:)
One item to also keep in mind are “user friendly” algorithms too. Almost every hospital today is feeling the crunch with around 55% operating in the red and we now have both private equity firms and venture capitalists entering the picture to also come in and try to make things more efficient and profitable and the balance there on how this will play out remains to be seen.

When it comes time in hospitals for the insurance end of things which is totally algorithmic scoring formulas, it gets to the point of how do you comply with some of these algorithms?

http://ducknetweb.blogspot.com/2010/02/hospitalists-peer-committees-and.html

I stuck the word “algorithm” and it’s definition square in the center of my blog a couple years ago as I have seen the ups and downs, good implementations and bad implementations, and so on. On the payer side of things they have invested in the highest levels of intelligence and data systems (too bad some can’t secure them any better though) and they score and do risk management on everything walks and talks, so think that includes us:)

The bushiness intelligence they use would be relative to going to battle with machine guns, and the rest of us, well we kind just have some sword and daggers. The analytic end of everything is growing and I we need balance and also that growing awareness of what would be called “rogue” or “dirty” algorithms in healthcare today.
We still need to treat people with respect and find out all the information from the human side too and hopefully the balance will come around, I hope:) I’ve written enough algorithms in my time to see both sides of the coin and I’m almost to the point of saying for some, analytics could also stand to be the next 12 step program in the works as we do see some some rather strange stuff out there along with the useful and fact based information that helps us.
Analyzing should not be done just for the sake of analyzing either.
One thing that somewhat gets over looked too with those reviewing information after the fact is that they were not there interacting with the patient either and how decisions were made based on what was occurring at those moments. Algorithms can be helpful with delivering information but we still need the balance and wisdom of a human doctor.

]]> By: Joseph F. Sucher, MD FACShttp://www.kevinmd.com/blog/2010/02/forget-patient-algorithms-care.html#comment-124990 Joseph F. Sucher, MD FACS Wed, 10 Feb 2010 07:43:50 +0000 http://www.kevinmd.com/blog/?p=42296#comment-124990 The title is right on track, but the text that follows is nearly meaningless to me. Taking care of patients follows an algorithm of thought and process. This is the foundation of medical practice. In fact, one of the best texts in surgical practice is "Surgical Decision Making" by Robert McIntyre, Gregory Van Stiegmann, Ben Eiseman. This book is, in practice, a series of algorithms that include thought processes and pathways that organize the surgeon's ability to better sift through what could otherwise be complicated decisions.In other words, many physicians focus on the ubiquitous negative visceral reaction to the idea of "cook-book" medicine. The truth is, good medical practice is based on logical algorithms applied to individuals with specific problems. Local practices can appropriately influence these logical algorithms, thus making them difficult (if not impossible) to apply broadly. This, in turn, is one of the reasons why negative perceptions continue to surround algorithms and pathways. Pathways need to consider the local factors that can influence the usefulness or appropriateness of their application.In my opinion, we need to get the argument on track. Pathways and algorithms can be very good for patient care, and in fact, if adopted widely can help us better identify how well we are treating our patients. Without standards of care broadly applied and tracked, we continue to struggle with understanding what is truly good care, and what isn't. JF Sucher, MD The title is right on track, but the text that follows is nearly meaningless to me. Taking care of patients follows an algorithm of thought and process. This is the foundation of medical practice. In fact, one of the best texts in surgical practice is “Surgical Decision Making” by Robert McIntyre, Gregory Van Stiegmann, Ben Eiseman. This book is, in practice, a series of algorithms that include thought processes and pathways that organize the surgeon’s ability to better sift through what could otherwise be complicated decisions.

In other words, many physicians focus on the ubiquitous negative visceral reaction to the idea of “cook-book” medicine. The truth is, good medical practice is based on logical algorithms applied to individuals with specific problems. Local practices can appropriately influence these logical algorithms, thus making them difficult (if not impossible) to apply broadly. This, in turn, is one of the reasons why negative perceptions continue to surround algorithms and pathways. Pathways need to consider the local factors that can influence the usefulness or appropriateness of their application.

In my opinion, we need to get the argument on track. Pathways and algorithms can be very good for patient care, and in fact, if adopted widely can help us better identify how well we are treating our patients. Without standards of care broadly applied and tracked, we continue to struggle with understanding what is truly good care, and what isn’t.
JF Sucher, MD

]]> By: David Allen, MDhttp://www.kevinmd.com/blog/2010/02/forget-patient-algorithms-care.html#comment-124930 David Allen, MD Tue, 09 Feb 2010 00:54:20 +0000 http://www.kevinmd.com/blog/?p=42296#comment-124930 It happens with stroke pathways too. How often does a stroke nurse ask me 'did patient x have a TIA?' It is such a simple question, but it isn't always clear. I may never know if patient 'X' had a TIA. Indeed, I may feel that partial simple seizure or migraine phenomenon is more likely, with TIA being a distant third. Yet the stroke pathways, with request for my signature, keep showing up the chart. It is surprising to me how easy patients, administrators, and even nurses feel diagnosis is. It happens with stroke pathways too. How often does a stroke nurse ask me ‘did patient x have a TIA?’ It is such a simple question, but it isn’t always clear. I may never know if patient ‘X’ had a TIA. Indeed, I may feel that partial simple seizure or migraine phenomenon is more likely, with TIA being a distant third. Yet the stroke pathways, with request for my signature, keep showing up the chart. It is surprising to me how easy patients, administrators, and even nurses feel diagnosis is.

]]> By: The Mind Relaxerhttp://www.kevinmd.com/blog/2010/02/forget-patient-algorithms-care.html#comment-124906 The Mind Relaxer Mon, 08 Feb 2010 14:41:23 +0000 http://www.kevinmd.com/blog/?p=42296#comment-124906 Agree, check and recheck before diving into the treatment. Agree, check and recheck before diving into the treatment.

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