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In hacking healthcare I talk about "the incredible bandwidth of paper". That's still true. Without really first world software and hardware in a very modern phy

In hacking healthcare I talk about "the incredible bandwidth of paper". That's still true. Without really first world software and hardware in a very modern physical setting it is difficult if not impossible to solve medical problems better than pen and paper can. In the practice of medicine pen and paper are really adequate tools to deliver quality care. It is in the business of medicine where large scale data necessitates and benefits from electronification.

russnewcomer 6y ago
Thanks for that perspective. Helps me understand why their use case ( my friend talked about multiple nurses needing to have about 20in of records organized in binders and then coordinate between the nurses in case Nurse A saw someone in Place 1 but then Nurse B saw them in Place 2 a month later...) is helped by the computerization (along with the record keeping they needed to provide for grants/funding), but people working clinical settings that I've talked to are not really interested...
breck 6y ago
I 100% agree and am going to start using your "the incredible bandwidth of paper" quote (awesome!). Even in the first world, I want an EMR system that treats paper as a first class medium, and it's easily doable.
- dreamer7 6y ago
  Hi could you please elaborate on how this would work? There have been several attempts at treating paper as first class - scanning reports, using a digital pen etc. But none of these solutions is convenient. How would you interface paper with software?
  - breck 6y ago
    My hypothesis—and I could be wrong—is that via innovations around 2-D programming languages, you could invent languages that are natural for casual users to write with pen and paper, that are identical to what a programmer would type. You'd never get a casual user to write {"weight": 145} on paper, but you could teach them to write: weight 145 And then it is really quite easy to write DSLs that parse things like that in a type checked way. Or, to put it another way, instead of trying to teach people JSON, why not teach programmers something new? One thing we picked up on quickly when talking to doctors and nurses in the field is that most of them come up with their own short-hand dialects for scribbling notes (for later data entry, sometimes). Why not make it easy to scan these microDSLs as is, and even define them formally and cheaply, at the last mile that then compile into a more common tongue for ingestion into bigger EMRs? Epic I guess has something somewhat along those lines, but not taken to the extreme.
    - dreamer7 6y ago
      I'm not convinced that we can try to enforce any sort of format on blank paper for doctors. They fill templates also in weird and unexpected ways. They will write info out of order, in different orientations, outside the margins, etc. I would be interested in discussing this in more detail. Let me know if I can mail you.
      - breck 6y ago
        It's a good point. From what we learned each one had their own style, but the key thing was they all had a consistent style. If they are weird but consistently weird, should be okay. And we added things like anyfix to handle out of order. Sure anytime. email is in profile.

russnewcomer 6y ago

Thanks for that perspective. Helps me understand why their use case ( my friend talked about multiple nurses needing to have about 20in of records organized in binders and then coordinate between the nurses in case Nurse A saw someone in Place 1 but then Nurse B saw them in Place 2 a month later...) is helped by the computerization (along with the record keeping they needed to provide for grants/funding), but people working clinical settings that I've talked to are not really interested...

breck 6y ago

I 100% agree and am going to start using your "the incredible bandwidth of paper" quote (awesome!). Even in the first world, I want an EMR system that treats paper as a first class medium, and it's easily doable.

dreamer7 6y ago
Hi could you please elaborate on how this would work? There have been several attempts at treating paper as first class - scanning reports, using a digital pen etc. But none of these solutions is convenient. How would you interface paper with software?
- breck 6y ago
  My hypothesis—and I could be wrong—is that via innovations around 2-D programming languages, you could invent languages that are natural for casual users to write with pen and paper, that are identical to what a programmer would type. You'd never get a casual user to write {"weight": 145} on paper, but you could teach them to write: weight 145 And then it is really quite easy to write DSLs that parse things like that in a type checked way. Or, to put it another way, instead of trying to teach people JSON, why not teach programmers something new? One thing we picked up on quickly when talking to doctors and nurses in the field is that most of them come up with their own short-hand dialects for scribbling notes (for later data entry, sometimes). Why not make it easy to scan these microDSLs as is, and even define them formally and cheaply, at the last mile that then compile into a more common tongue for ingestion into bigger EMRs? Epic I guess has something somewhat along those lines, but not taken to the extreme.
  - dreamer7 6y ago
    I'm not convinced that we can try to enforce any sort of format on blank paper for doctors. They fill templates also in weird and unexpected ways. They will write info out of order, in different orientations, outside the margins, etc. I would be interested in discussing this in more detail. Let me know if I can mail you.
    - breck 6y ago
      It's a good point. From what we learned each one had their own style, but the key thing was they all had a consistent style. If they are weird but consistently weird, should be okay. And we added things like anyfix to handle out of order. Sure anytime. email is in profile.