*I promised I’d share Toronto physician blogs if I found them, so here’s a GREAT one: Dr. Greiver’s EMR. She’s a family doc in North York and was recently featured on the CBC for her > 4 year documentation of the peaks and valleys of running with the Nightingale EMR (one of the ones subsidized by the Ontario government).

Today’s post is inspired by Dr. Greiver and a lifetime of paper-love.

There’s just something about paper. You can’t get rid of it.

A few examples:

• I start reading many books on the computer and subsequently quit for a hard copy from the library.
• Lifehacker polled its readers for the Five Best To Do List Managers, ostensibly looking for applications, and guess what came out on top? “Pen and paper.”
• Stats Canada: “paper consumption has doubled over 20 years even as Canadians adopt new technologies”.

I think it’s safe to say that the paperless office/home is a myth.

Now, as EMR, EHR, PHR proliferate, there’s even more evidence that paper just persists…

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The success of electronic medical records (EMR) depends on much more than the EMR itself, but intuitive, smart software is still important. In this post (Merry Christmas!), I will talk about one tough issue in particular, the search problem, and why a “finder” like Google Wave (June, November) might be a good idea.

Larger electronic record projects may show us what’s needed.

Yesterday, I read an article (National Post) on MyLifeBits, a kind of Electronic “Life” Record. Since 1998, Gordon Bell, a principal investigator at Microsoft, has led a project to “go paperless”, essentially scanning, recording, logging every single thing in his life.

The motivation?:

I’m not cluttered with having to remember any of this stuff. I just have to remember that it’s in there, and that I’ve looked at it.

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How about this for an analogy?

On reading that the Senate’s health reform bill has swapped the controversial “public option” for a “buy-in” Medicare option + two national private insurance policies (Washington Post), I immediately had a giddy vision of the diagram on the left from Bruce Alberts’ Molecular Biology of the Cell.

This diagram describes how post/co-translational protein folding works.

1. On-Pathway: slowly moving along as a molten globule, trying out different combinations until it finds the correct conformation.

2. Off-Pathway: somehow turned into a not-so-good conformation, so chaperone proteins can help get it back on track.

3. “Irretrievable Accidents”: are ubiquitinated and chewed up by the proteasome.

Will health care reform become an “irretrievable accident”?

It’s been an interesting journey for me to learn about the American health system as a Canadian, so let this be my disclaimer that I’m definitely not an expert. However, it seems to me that the original objectives are getting more and more convoluted as this debate continues.

President Obama gave the “buy-in” option his approval, calling it “a creative new framework”. But given the choice, would “creative” be my favourite word I’d want to use to describe my health care?

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Facebook, Twitter, RSS, etc. may have changed the way I communicate, but in some arenas, the mere acknowledgement of social media still moves at a glacial pace. Naturally, I was surprised to see that the local hospitals’ notice boards had been outfitted with colourful new posters. Privacy tips, they were entitled.

The first one I came across went something like this:

Privacy Tip #14

Post wisely…

Cut detail when posting on Facebook, Twitter, or blogs.

Patients can be recognized without their names.

The social media triad grabbed my attention. After all, the other tips were well established truisms on shredding patient information at the end of day and not gossiping about cases in the cafeteria. This was addressing social media explicitly, which to me is an acknowledgement that the institutions are aware of the new technologies and feel some kind of need to rein in early adopters. An important step forward, I think, despite the not-exactly-rah-rah tone, because a time without rules is an exciting time, but it’s also a dangerous time.

I don’t need to tell you why privacy is one of the major minefields in medicine 2.0.

It’s clear that lines need to be drawn, though no one knows quite where. Many health care bloggers post with excellent objectives: to share their love of medicine, to discuss new technology, to give a public voice to physicians in the health care reform debate – in general, to give participatory power to the reader in the form of shared information. But who are the readers and what will they do with the information? Really, the only control the blogger has over the spread is to censor himself in the first place.

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Update Jan 26th, 2010: Thanks to Dr. Ves (@DrVes) for suggesting this post on Clinical Cases and Images: CasesBlog!

Let’s face it. The last two weeks of gently fiddling with Google Wave (effy [dot] han [at] googlewave.com) really weren’t all that gentle. From painful slowness on Firefox to the most awkward reply structure ever (someone please explain this to me!) to extensions that would barely load let alone function – Wave was more of a rollercoaster than the idyllic sea that its name was probably meant to evocate. I’m still just as excited about Wave in health care as I was in July, but there is plenty more to consider now that many of us have gotten our hands wet. Is our ideal feasible?

A health information system built on Wave could take patient empowerment to the next level.

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