Tag Archives: Kent Bottles

Quis custodiet ipsos medici?

Internet security is in a position similar to that of safety in the medical industry. Many doctors have an opinion like this one, quoted by Kent Bottles:
“Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.” And she says, “I don’t even bother checking the results anymore. I just quietly push the reports under my pile of unread journals, phone messages, insurance forms, and prior authorizations.”

Meanwhile, according to the CDC, 99,000 people die in the U.S. per year because of health-care associated infections. That is equivalent of an airliner crash every day. It’s three times the rate of deaths by automobile accidents.

The basic medical error problems observed by Dennis Quaid when his twin babies almost died due to repeated massive medically-administered overdoses and due to software problems such as ably analysed by Nancy Leveson for the infamous 1980s Therac-25 cancer-radiation device are not in any way unique to computing in medicine. The solutions to those problems are analogous to some of the solutions IT security needs: measurements plus six or seven layers of aggregation, analysis, and distribution.

As Gardiner Harris reported in the New York Times, August 20, 2010, another problem is that intravenous and feeding tubes are not distinguished by shape or color: Continue reading

Trust the Doctor, or Trust the Doctor’s Report Card?

What can be done about the huge medical error fatality problem Dennis Quaid identified when his baby twins were almost killed? Electronic medical records (EMR) are a start. Then as Kent Bottles suggests, let’s use those records to improve physician care:
“Dr. Kim A. Adcock, the radiology chief at Kaiser Permanente Colorado, created a system that misses one-third fewer cancers on mammograms and “has achieved what experts say is nearly as high a level of accuracy as mammography can offer.” At the heart of the program was his willingness to keep score and confront his doctors with their results. He had to fire three radiologists who missed too many cancers, and he had to reassign 8 doctors who were not reading enough films to stay sharp.”
We could use more report cards for physicians, including firing ones with failing grades, and maybe even paying the really good ones more, or at least getting them to teach the others.