Electronic health records, pyjama time and date night

According to a recent Clinical Psychiatry News article it seems physicians are beginning to call Electronic health record (HER) "Pajama time.” That’s the few hours physicians are spending every night finishing up their documentation, clearing out their in-box,”

University of Wisconsin researchers studying the impact of EHR systems on physicians’ workflow and lives looked at how often and when doctors were accessing their patients’ medical records. They found what many might think is obvious - doctors don’t have enough time in their days to finish their documentation, so they spend their evenings and weekends finishing up.

There is even a thing called “date night” which correlates with data showing this type of work being undertaken on Saturday nights. The same study “found that primary care physicians were spending 38 hours a month after hours doing data entry work.

At a session held in conjunction with the annual meeting of the Healthcare Information and Management Systems Society, Dr. Sinsky spoke about how electronic health records have not lived up to their promise of helping streamline patient care and instead have added hours and headaches to most physicians’ days. Here are a few of the reasons for this additional work.

1. It takes 33 clicks to order and record a flu shot. And in the emergency room, it takes 4,000 clicks to get through the day for a 10-hour shift.” Studies have shown that physicians are spending 44% of their day doing data entry work, [but] 28% of the day with their patient.”

2. Today’s EHRs have a workflow that doesn’t match how clinicians work.  Many clinicians are encountering these very rigid workflows that don’t meet the patient’s need and don’t meet the provider’s need.

3. Most EHRs lack a place for a photo of the patient and his or her family, and a place for the patient’s story, a deficiency that detracts from the value of the encounter.

4. Often, both a physician and a nurse or medical assistant need to add documentation to the EHR. Yet many systems are set up such that each party must log in, then log out, before another can contribute. 

496

We’re are all influenced by numbers psychology. The most basic is the notion of size. Our tendency to infer larger sizes or more of something from larger numbers. To downplay a 30-day service penalty, therefore, simply referring to it as a one-month suspension might help. Conversely, bigger numbers are used to convey increases in nutritional benefits (1,000 milligrams of fiber, not one gram) or mobile phone talk time (660 minutes, not 11 hours) to make us feel as though we are getting better deals.

But numbers are much more than that. There are a lot of important numbers out there. Some, like 42 had become popular among fans of the comic science fiction genre. You might recall in the radio series and the Adams’ first novel, a group of hyper-intelligent pan-dimensional beings demand to learn the Answer to the Ultimate Question of Life, The Universe, and Everything from the supercomputer, Deep Thought, specially built for this purpose. It takes Deep Thought 7½ million years to compute and check the answer, which turns out to be 42. Deep Thought points out that the answer seems meaningless because the beings who instructed it never actually knew what the Question was.

Later Adams was asked why he chose the number 42. Many theories were proposed, including that 42 is 101010 in binary code, that light refracts through a water surface by 42 degrees to create a rainbow, that light requires 10⁻⁴² seconds to cross the diameter of a proton. Adams rejected them all. In November 1993, he said “It was a joke. It had to be a number, an ordinary, smallish number, and I chose that one. Binary representations, base thirteen, Tibetan monks are all complete nonsense. I sat at my desk, stared into the garden and thought 42 will do; I typed it out. End of story.”

So I was saying there are many number of significance. Sure your girlfriend’s number is probably most important, but there are numbers and then there are numbers. Some numbers define our very existence. Some of these may well define the very workings of the universe. Consider for example Avogadro's number. This is the number of atoms in 12 grams of carbon, and is approximately six followed by 23 zeroes. The number of atoms can also be calculated using Avogadro's Constant (6.02214179×10²³) / one mole of substance.

Then there is Planck's constant. The universe packages energy in finite multiples of a smallest amount, much as the atomic theory proclaims that the universe packages matter in finite multiples of atoms. These small packages of energy are known as quanta, and Planck's constant, abbreviated h, tells us the size of these packages. The fundamental constant, equal to the energy of a quantum of electromagnetic radiation divided by its frequency, with a value of 6.626 × 10⁻³⁴ joules.

When we turn our attention to the history of the universe; There are really only two possibilities for the universe: Either it has always been here, or it had a beginning. It turns out that the universe is expanding; everything is flying apart. The relationship between the speed at which a galaxy appears to be moving away and its distance from earth is given by Hubble's constant. The constant H is one of the important because it may be used to estimate the size and age of the Universe. The Hubble constant is given by H = v/d.

Other important numbers include Boltzmann's constant, Schwarzschild radius, Chandrasekhar limit, Omega, Absolute zero, the speed of light.

The granddaddy of numbers, in my opinion is 496. This is most notable for being a perfect number, and one of the earliest numbers to be recognized as such. As a perfect number, it is tied to the Mersenne prime 31 2⁵ − 1, with 2⁴ (2⁵ − 1) yielding 496. Also related to its being a perfect number, 496 is a harmonic divisor number, since the number of proper divisors of 496 divided by the sum of the reciprocals of its divisors, 1, 2, 4, 8, 16, 31, 62, 124, 248 and 496, (the harmonic mean), yields an integer, 5 in this case. In 1984, Green and Schwarz realized that one of the necessary conditions for a superstring theory to make sense is that the dimension of the gauge group of type I string theory must be 496. Their discovery started the first superstring revolution.

Truth is stranger than fiction

“Truth is stranger than fiction, but it is because Fiction is obliged to stick to possibilities; Truth isn't.” 

Certainly a place I didn't expect to be for some 6 months. Photo taken in the mid 1990’s down at the Renison Gold fields mine; an underground mine located on the West Coast of Tasmania, Australia. Working on a system of bulk sampling for amenability to test commercial viability.

Our social brain

Humans are highly social beings. We like to be surrounded by friends and share our personal experiences with others. The recent appearance of various social networking tools, and their adoption at a virtually explosive rate, nicely illustrate the strong and fundamental human desire for social belonging and interpersonal exchange. I’ve been writing about the social brain for years – as well, our fascination with the celebrity subculture.

In most cases, this is perfectly natural. The social creatures in us live in an environment where it paid to pay attention to the people at the top. Celebrity fascination may be an outgrowth of this tendency, nourished by the media and technology. So a chance meeting with Peter Fitzsimons recently redirected my thoughts – asking myself what I’ve really learned about the Human psyche and what is arguably the most complex of systems – our cerebrum.

We know that evolutionary processes have favored the development of complex social behaviours in humans, along with the brain architecture that supports them. The Human brain is of course as compared to other primates and mammals of similar size. This is particularly interesting because the neocortex comprises many of the brain areas involved in higher social cognition, such as conscious thought, language, behavioral and emotion regulation, as well as empathy and theory of mind - our ability to understand the feelings and intentions of others. We are, so to speak, biologically hardwired for interacting with others, and are thus said to be endowed with a social brain.

Solving puzzles just for fun - Einstein's Riddle

There is no doubt that solving puzzles is fun. We enjoy solving puzzles; we have, after-all, an innate ability for pattern-finding, for trying to find meaning in things, for problem solving and trying to find innovative solutions. Our brain releases Oxytocin when we achieve something or receive praise. There is a sense of satisfaction and the release of the hormone makes us feel good.

We’ve also been taught that doing puzzles attenuate the negative effects of age on memory and perceptual speed tasks. Interestingly there is also some research suggesting mind puzzles may not be as beneficial as we assume. For example, a study examining crosswords and aging published in the Journal of Experimental Psychology (Volume 128 [2]. 1999, pp. 131-164) found no evidence to suggest that crossword puzzle experience reduces age-related decline in cognition

.

This said, and just for fun – here is an interesting puzzle to mull over. Over the years it’s had a number of different names including the zebra puzzle, and Einstein's Puzzle or Einstein's Riddle because it is said to have been invented by Albert Einstein as a boy. Many versions of the puzzle exist, including a version published in Life International magazine on December 17, 1962. It’s also suggested that only 2% of the population can solve it. Do you want to try…

Below, a list of fifteen clues is given that tell you about five houses, their inhabitants (each a different nationality), the colour their houses are painted, the beverages their inhabitants drink and also which cigarettes they smoke. From these clues you must deduce the following:

Who drinks water and where is the missing zebra? I’ve provided the solution at the end of this article.

The following version of the puzzle appeared in Life International in 1962:

1.      There are five houses.

2.      The Englishman lives in the red house.

3.      The Spaniard owns the dog.

4.      Coffee is drunk in the green house.

5.      The Ukrainian drinks tea.

6.      The green house is immediately to the right of the ivory house.

7.      The Old Gold smoker owns snails.

8.      Kools are smoked in the yellow house.

9.      Milk is drunk in the middle house.

10.   The Norwegian lives in the first house.

11.   The man who smokes Chesterfields lives in the house next to the man with the fox.

12.   Kools are smoked in the house next to the house where the horse is kept.

13.   The Lucky Strike smoker drinks orange juice.

14.   The Japanese smokes Parliaments.

15.   The Norwegian lives next to the blue house.

16.   Now, who drinks water? Who owns the zebra?

In the interest of clarity, it must be added that each of the five houses is painted a different colour, and their inhabitants are of different national extractions, own different pets, drink different beverages and smoke different brands of American cigarettes. One other thing: in statement 6, right means your right.

Assuming that one person drinks water and one owns a zebra, then it is possible not only to deduce the answers to the two questions, but to figure out a complete solution of who lives where, in what color house, keeping what pet, drinking what drink, and smoking what brand of cigarettes. By considering the clues a few at a time, it is possible to slowly build inferences that incrementally complete the puzzle's unique correct solution. For example, by clue 10, the Norwegian lives in house #1, and by clue 15, house #2 must be blue. The Norwegian's house therefore cannot be blue, nor can it be red, where the Englishman lives (clue 2), or green or ivory, which are next to each other (clue 6). It must therefore be yellow, which means the Norwegian also smokes Kools (clue 8).

Solution