We can also greatly enhance and streamline the entry of running notes in the medical record. These notes are usually structured as a list of “items”, where each item corresponds to a type of data, or a clinical sign or symptom. The actual selection of which items to use depends on why we’re seeing the patient, as expressed through the “type of contact” (or “problem”). The content (value) of the items, however, is free text, but usually limited to a few variations only. These, the system can learn and present.
While creating referrals in a record system, the workflow is fairly predictable. For any particular kind of problem, there’s only a relatively limited range of referrals you are going to write, so we can let the system record which ones we use and pop up a list of last used referrals the next time we see a patient with the same problem (“type of contact”).
When you’re seeing a patient, it’s very often useful to do a search for diagnostic and therapeutic guidelines, medical articles, regional or institutional recommendations and so on. These searches need to be restricted to appropriate sources, not just the wild internet. Once you’ve done a search and found some useful information, you’d probably want to save a reference to it and be able to locate it again the next time you see this patient, or another patient with a similar problem.
As I see the structure of medical knowledge and its application to patients, there are three levels:
- Biological science, pathology, EBM, epidemiology, etc. In other words, everything we know about human biology and pathology in the large, not at the individual level.
- Applications and methods that apply biological science to the individual patient, and methods using the history of the patient to search for applicable science.
- Knowledge about a particular patient, signs, symptoms, treatments and diagnostics that have already been performed. In short, the individual patient history.
Each of these three levels correspond to particular processes and methods, and computer applications also fit one or more of these levels. For instance, IBM Watson sits squarely in level 1, while current Electronic Healthcare Record (EHR) systems are fully in level 31.
As I already mentioned, the Mac Pro 2008 (10.10.5) I’m running the Retrospect server on, dropped its network connection for the first time in nine years (that I’m aware of) after installing Retrospect. Since then, it’s happened more than ten times, three times just during the last 24 hours.
While setting up Retrospect, I ran into a number of problems, most of which I think I solved. I’m just noting some of them here, so I can find them again. Or so you can find them, perhaps. I’ll add to this post as I encounter more oddities.
Now that Crashplan for home is gone, or at least not long for this world, a lot of people will need to find another way of backing up their stuff. It’s tempting to get angry, and there are reasons to be, but in the end you have to forget about all that and move on. Even though you may have months, or even a year, before Crashplan stops working, there is another reason you have to get something up right now, namely file histories.
I just discovered that Parallels v12 has a really nice feature, namely to stop Windows from doing updates except for a predetermined period. Brilliant! It’s also a sad testament to what Microsoft has done when it comes to respect for the user’s time and work.
When applications are in “quarantine” on OSX after being downloaded, they are run in a kind of sandbox; they’re “translocated”. You don’t really see this, but weird things then happen. For instance, Little Snitch won’t let you create “forever” rules on the fly, claiming your app isn’t in “/Applications”, which it clearly is if you check in Finder.
The problem is that the extended quarantine attribute is set, and needs to be reset (at least if you trust the application). Too bad Apple didn’t provide a GUI way of doing that, so here goes the magic incantation (assuming WebStorm is the problem in the example):
First check if the attribute is set:
Then if you see that it is, reset it:
xattr -d com.apple.quarantine /Applications/Webstorm.app/
…and there you go. Life is good again.
I have this 2008 Mac Pro running 10.10 connected to two networks, one from each interface. Now, number 1 is connected to a slower WAN, but is the route I need to take to cross a VPN tunnel to a customer site. Number 2 should be used for everything else.