The Balkans


On a bitter cold December day in 1982, I fired up my sedan and drove my fifty-three-year-old father from his home in Bloomington, Indiana to Cleveland, Ohio.

Our destination was the Cleveland Clinic, then basking in the glory of having recently performed coronary bypass surgery on King Khalid Ibn Abdul Aziz of Saudi Arabia.

My father had had a series of fainting (loss of consciousness, syncope in the medical lexicon) the cause of which had eluded providers from Bloomington to Indianapolis.

The Cleveland Clinic seemed the next logical step up in search of what was going on.

A Drag on Our Wing


The health care industry has never seen information technology (IT) as a way to improve patient outcomes. Instead, IT in healthcare has always been a back office affair where computers are used to schedule and to bill patients (and their payers).

Not to hold their medical records, much less disseminate those records to places where the records could do the patient the most good.

What the machines are telling us


When Air France 447 crashed into the ocean off of Brazil, the cause was human diagnostic failure. At the time of the crash, every important mechanical and electronic system onboard was functioning normally. And every primary flight instrument was screaming the same thing: the aircraft’s nose is too high. It’s requiring more power from the engines than they are capable of delivering to maintain level flight.

The solution was simple: Push the stick forward. Lower the nose.

That solution wasn’t implemented. Because the humans at the controls failed to diagnose what the machine was telling them. Diagnosis had to wait for the forensic investigation.

My late wife, Sophia, died in the same way. Despite the all machines’ information, no accurate human diagnosis was made. Not until the post-mortem forensic investigation.

Also known as her autopsy.

Why is innovation so hard?


What is wrong with the implementation of information technology systems within the health care system?


Let’s start with application. Traditionally IT within the industry has been concentrated in three major areas: support for research and development (e.g. gene sequencing, advanced imaging, etc.), interfaces and control for clinical medical equipment, and administrative tasks (billing, scheduling, etc.).

What that means is that within a typical practice, clinical environment, hospital, etc. the only people routinely in contact with IT systems have been administrative personnel and technicians. Providers themselves traditionally have had little need or use for information technology while patients have been just simply left out in the dark altogether.

The Forest and the Trees


It started like this...

Your doctor knew you. He (and it was a "he") knew your family, your community, your history. That knowledge was stored in his head in narrative form where he understood your life, and thus your health history, in a longitudinal context annotated and detailed by the environment, events, and behaviors that defined you as an individual.

In other words, he understood your health history as a story, full of qualitative information running longitudinally through time.

As our nation grew so did the domain over which an individual physician roamed. Pressures, including professional and economic, drove doctors and their staffs to see more patients and to spend less time with each.

All This Machinery


Years ago I was part of a forum discussing the use of technology in navigation. A question came up: what technology did we panelists think contributed most to modern navigation?

This was in the early 1990s and many of my colleagues weighed in about the wondrous new technology of the Global Positioning System (GPS) with its sub-yardstick accuracy. When it came my turn to speak I said simply “The Marine Chronograph.”

In other words, a clock.

From Failure to the Future


There are two trends in our industry. One trend towards, one trend away. Towards patient involvement and empowerment, particularly in the collection of biometric data critical for accurate diagnosis. And away from the encounter-based model, where patients and providers encounter each other only in discreet events – office visits, with little to link the events and little to no contact or outreach between events, and a sea of amnesia tenuously holding it all together.

About Gregory Travis

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I’ve a bit of experience in the technology field, having written my first computer program (in FORTRAN, naturally) for the CDC 6600 computer in 1976 (I was twelve). Between then and now, I developed one of the first social networking programs, Note (it has a Facebook page) in 1979, a UNIX distribution (ISRNIX) in the early 1980s, and helped start a data warehousing company (DPSI) in the early 1990s, a travel management software company (Cornerstone) in the mid-1990s, and a health care software development company (SGC) in the mid 2000s.

My experience in the health care field is both professional and deeply personal. I lost my father, suddenly, to an aortal dissection when he was 53. I lost my first wife, suddenly, to cardiac amyloidosis when she was 46.

These experiences have given me the opportunity to see the health care system in the United States in a rare and special way, a way that informs my approach to problem solving, makes me acutely aware of the challenges, and gives me an understanding of the people, processes, and institutions within our industry. That understanding is one of care and insight into the lives and careers of people who, like me, only want to serve and serve well.

My intention with this blog is to write candidly and honestly about things as I have seen them and as I see them in our industry. I hope that some of the subjects I cover here will be a catalyst for a robust discussion of where we are and where we might go.
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