Comments on: New Tech Signals http://www.overcomingbias.com/2009/03/new-tech-signals.html Overcoming Bias is economist Robin Hanson’s blog, on honesty, signaling, disagreement, forecasting, and the far future. Sun, 12 Feb 2012 01:09:57 +0000 hourly 1 http://wordpress.org/?v=3.1.3 By: Chase Johnson http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385786 Chase Johnson Mon, 30 Mar 2009 16:57:26 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385786 Unsupervised: The failure modes you discuss have an easy workaround: print out the records. Any reasonably well-designed electronic system can easily fall back on non-electronic methods. At that point, you have no advantage from the electronic system, but in time it would be limited to special cases. As the sophistication of EMR systems grows, compatibility between different hospitals will become less of a problem. Individual EMR products will gain increased ability to translate between different document formats. Check out a piece of modern word processing software. The format reading and writing options are staggeringly numerous, because compatibility is an important component of the word processor's job. Unsupervised: The failure modes you discuss have an easy workaround: print out the records. Any reasonably well-designed electronic system can easily fall back on non-electronic methods. At that point, you have no advantage from the electronic system, but in time it would be limited to special cases. As the sophistication of EMR systems grows, compatibility between different hospitals will become less of a problem. Individual EMR products will gain increased ability to translate between different document formats. Check out a piece of modern word processing software. The format reading and writing options are staggeringly numerous, because compatibility is an important component of the word processor’s job.

]]> By: Dan http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385785 Dan Sat, 28 Mar 2009 15:04:32 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385785 There are two stages to the adoption to any new technology: the assisting phase and then the integrating phase. In the first phase, the new technology is used to improve existing designs and processes. For example, the Romans used iron instead of bronze for swords and spearheads, but the basic conduct of war remained the same. IN the digital age, early on improvements were made because of things like not having to send a clerk down to the file room to get records, they could be pulled up nearly instantaneously on a terminal. IN the second phase, new processes and designs are created that could not have been achieved using the old technology. For instance, iron swords became longer, narrower, and for their size lighter, making them more easily used on horseback, and thus the medieval knight was born. IN the example of electricity, it wasn't until new tools were developed that took advantage of the ability to place the power source within the tool itself (replacing the system of belts and pulleys powered by a steam engine or water wheel) that the productivity gains were achieved. With computers and information now medicine is just beginning to move into the second phase. In order to truly achieve the gains from EMRs and other new technologies, the very process of medicine is going to have to change. What form that will take, I don't know, and anybody who says they do is either a fool or about to get very rich (possibly both). There are two stages to the adoption to any new technology: the assisting phase and then the integrating phase.

In the first phase, the new technology is used to improve existing designs and processes. For example, the Romans used iron instead of bronze for swords and spearheads, but the basic conduct of war remained the same. IN the digital age, early on improvements were made because of things like not having to send a clerk down to the file room to get records, they could be pulled up nearly instantaneously on a terminal.

IN the second phase, new processes and designs are created that could not have been achieved using the old technology. For instance, iron swords became longer, narrower, and for their size lighter, making them more easily used on horseback, and thus the medieval knight was born. IN the example of electricity, it wasn’t until new tools were developed that took advantage of the ability to place the power source within the tool itself (replacing the system of belts and pulleys powered by a steam engine or water wheel) that the productivity gains were achieved.

With computers and information now medicine is just beginning to move into the second phase. In order to truly achieve the gains from EMRs and other new technologies, the very process of medicine is going to have to change. What form that will take, I don’t know, and anybody who says they do is either a fool or about to get very rich (possibly both).

]]> By: Adam Nelson http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385784 Adam Nelson Thu, 26 Mar 2009 21:54:00 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385784 On the technology/productivity angle, I always thought it was interesting that the most efficient firm I've ever seen was Wal-Mart and their in store inventory system was a single terminal that still had a green screen all the way up to 2001, but unlike any other store, everyone knew our could quickly find out how our sales were doing compared with the prior week/month/year last year for each product in their department. I think their overall IT budget was about 2% of 10 year average profits, but one study attributed a huge % of the nation's productivity to their gains alone. On the technology/productivity angle, I always thought it was interesting that the most efficient firm I’ve ever seen was Wal-Mart and their in store inventory system was a single terminal that still had a green screen all the way up to 2001, but unlike any other store, everyone knew our could quickly find out how our sales were doing compared with the prior week/month/year last year for each product in their department. I think their overall IT budget was about 2% of 10 year average profits, but one study attributed a huge % of the nation’s productivity to their gains alone.

]]> By: Unsupervised http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385783 Unsupervised Sun, 22 Mar 2009 21:55:29 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385783 It's so easy to say we need a nationwide electronic medical record system. Sounds so easy and quick. And cheap, too, I'm sure. And whose version of the Electronic Medical Record (EMR) will you be using? The VA's? City hospital of wherever's? University-of-whatchamacallit's? What's to ensure my EMR from my ER visit in Maine when I was on vacation will match with my EMR at my local hospital or doctor's office? Who will decide on the encryption for transmission via Internet circuits? The doctor's office uses a MAC-based EMR. The university a locally-developed LINUX one. My hospital uses a Windows-based system. I doubt if there's a common database structure. How about the Military's AHLTA system of outpatient electronic medical records? As of this writing, AHLTA isn't compatible with MAC, LINUX or VISTA, only XP Service Pack 2 (not even Service Pack 3). And you can't use any Internet Explorer version newer than 6 (not IE7, not IE8, and I'm not even going towards the non-Microsoft ones). It's a dog. (but the government developed it, so it's gotta be good, right?) It’s so easy to say we need a nationwide electronic medical record system. Sounds so easy and quick. And cheap, too, I’m sure.
And whose version of the Electronic Medical Record (EMR) will you be using?
The VA’s? City hospital of wherever’s? University-of-whatchamacallit’s? What’s to ensure my EMR from my ER visit in Maine when I was on vacation will match with my EMR at my local hospital or doctor’s office? Who will decide on the encryption for transmission via Internet circuits? The doctor’s office uses a MAC-based EMR. The university a locally-developed LINUX one. My hospital uses a Windows-based system.
I doubt if there’s a common database structure.
How about the Military’s AHLTA system of outpatient electronic medical records? As of this writing, AHLTA isn’t compatible with MAC, LINUX or VISTA, only XP Service Pack 2 (not even Service Pack 3). And you can’t use any Internet Explorer version newer than 6 (not IE7, not IE8, and I’m not even going towards the non-Microsoft ones). It’s a dog. (but the government developed it, so it’s gotta be good, right?)

]]> By: Richard Pointer http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385782 Richard Pointer Fri, 20 Mar 2009 03:59:48 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385782 Dr. Hanson, Would Self-digitizing my medical records help me? Having some sort of implanted, readable chip be of use? Dr. Hanson,

Would Self-digitizing my medical records help me? Having some sort of implanted, readable chip be of use?

]]> By: MZ http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385781 MZ Thu, 19 Mar 2009 16:44:23 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385781 Carl Shulman said: <em>My main interest in electronic medical records has been the potential to produce big datasets to study treatment effectiveness, risk factors, etc.</em> It's funny that you mention that. I published a <a href="doi:10.1016/S0003-4975(00)01293-5" rel="nofollow">paper in 2000</a> on how risk factors affect the longterm outcomes of endarterectomy procedures. Well, I didn't really publish it, I got my name on it, but I didn't most of the grunt work. I was a undergraduate at the time and a group of doctors needed someone to cull through their patient records and collect data on what turned out to be 41 "clinical and angiographic" factors (things like lifestyle, patient history, family history, etc). In all, 254 records were included, although I had to go through at least twice as many more, so maybe >700 to get that data. I spent ~15 hrs a week for 4 months in the medical records room, and half that time was spent pilfering through the stacks of records, trying to find the right files. I probably could have cut the workload in half if the records were computerized. Carl Shulman said: My main interest in electronic medical records has been the potential to produce big datasets to study treatment effectiveness, risk factors, etc.

It’s funny that you mention that. I published a paper in 2000 on how risk factors affect the longterm outcomes of endarterectomy procedures. Well, I didn’t really publish it, I got my name on it, but I didn’t most of the grunt work. I was a undergraduate at the time and a group of doctors needed someone to cull through their patient records and collect data on what turned out to be 41 “clinical and angiographic” factors (things like lifestyle, patient history, family history, etc). In all, 254 records were included, although I had to go through at least twice as many more, so maybe >700 to get that data. I spent ~15 hrs a week for 4 months in the medical records room, and half that time was spent pilfering through the stacks of records, trying to find the right files. I probably could have cut the workload in half if the records were computerized.

]]> By: davidc http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385780 davidc Thu, 19 Mar 2009 16:06:43 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385780 Is there much evidence about the use of technology in education? What i can find seems to point to it having negative consequences http://www.slate.com/id/2192798/pagenum/all/ Is there much evidence about the use of technology in education?
What i can find seems to point to it having negative consequences
http://www.slate.com/id/2192798/pagenum/all/

]]> By: Grant http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385779 Grant Thu, 19 Mar 2009 14:21:44 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385779 Aren't outcomes going to be extremely varied? Why not simply let some practice and hospitals switch when they want to (i.e., do nothing)? It seems to me that some doctors, nurses and aids have the computer skills necissary to take good advantage of new technology, while it may only befuddle others. I know some doctors who have to have every latest gadget, and others who can scarcely use a computer. Julian, couldn't people make their medical records public (or semi-public) if they wanted to? If the benefits were there I could see some people using a system like that. Aren’t outcomes going to be extremely varied? Why not simply let some practice and hospitals switch when they want to (i.e., do nothing)? It seems to me that some doctors, nurses and aids have the computer skills necissary to take good advantage of new technology, while it may only befuddle others. I know some doctors who have to have every latest gadget, and others who can scarcely use a computer.

Julian, couldn’t people make their medical records public (or semi-public) if they wanted to? If the benefits were there I could see some people using a system like that.

]]> By: TGGP http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385778 TGGP Thu, 19 Mar 2009 04:06:54 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385778 <a href="http://caseymulligan.blogspot.com/2009/03/porters-reap-gains-from-specialization.html" rel="nofollow">Casey Mulligan</a> has a recent NYTimes post where he says studies show that highly specialized doctors "make better diagnoses and fewer mistakes". That would have been precisely the sort of factor I would have assumed was more about status-affiliation than effectiveness, rather than technology. My own company primarily serves businesses just now getting into the technology of the 80s and ditching pen & paper for computer systems. I'm told we drastically increase their productivity and reduce their costs, but I'd expect my employers to say that regardless. Casey Mulligan has a recent NYTimes post where he says studies show that highly specialized doctors “make better diagnoses and fewer mistakes”. That would have been precisely the sort of factor I would have assumed was more about status-affiliation than effectiveness, rather than technology. My own company primarily serves businesses just now getting into the technology of the 80s and ditching pen & paper for computer systems. I’m told we drastically increase their productivity and reduce their costs, but I’d expect my employers to say that regardless.

]]> By: TGGP http://www.overcomingbias.com/2009/03/new-tech-signals.html#comment-385777 TGGP Thu, 19 Mar 2009 04:01:33 +0000 http://prod.ob.trike.com.au/2009/03/new-tech-signals.html#comment-385777 This blog began in late 2006, so a better comparison might be what Robin writes about Obama starting in 2014 (assuming he wins the next presidential election). This blog began in late 2006, so a better comparison might be what Robin writes about Obama starting in 2014 (assuming he wins the next presidential election).

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