Tag Archives: communications

Academia, Health Care, Technology

Information Theory in Health Informatics

Contemporary information theory has its roots in the development of telephony. During the middle of last century, an engineer at Bell Telephone Laboratories, Dr. Claude E. Shannon, innovated information theory by extending the mathematical observations of Boltzmann, Szilard, von Neumann, and Wiener in the area of physics, quantum mechanics, and particle physics (Weaver, 1949). Dr. Shannon, however, applied the theory to communication technology, introducing entropy to the theory (Nelson, 2002; Weaver, 1949).

Weaver, who worked at the Sloan-Kettering Institute for Cancer Research, adopted Shannon’s technical message transmission observations and adapted them with his understanding of the semantics of a messages meaning (as cited in Nelson, 2002). Shannon and Weaver’s Information and Communication Model details both the components of a message and the requirements of delivery. An example, as it would relate to health care informatics, would be when a nurse charts a patient’s medical history by encoding it via a desktop client application and the same data is viewable by the same nurse at other computer terminals, other nurses, and the treating physician. The data is also stored along the communication pathway for future retrieval and delivery when the patient presented again. Though this example satisfies Shannon, if the intended recipient were blind, the information shown on a computer screen would be meaningless, according to Weaver, and would indicate a limitation to overcome.

Evaluating hospital information systems developed, in part, from the Shannon and Weaver model, Bruce I. Blum (1986) conducted analysis of object (data, information, and knowledge) processing in both hospital and ambulatory care settings. He concluded that system designs should reflect the artificial delineation between these three types of objects and that these systems will benefit practitioners and patients by improving the overall health care process. Blum (1986) called for the “integration of existing systems with medical knowledge and knowledge-based paradigms” (p. 797) in order to have a positive impact on health care delivery in the coming decades.

Information theory is concerned with the adaptability of a message through a particular channel for optimum transmission. In health informatics, as Blum (1986) points out, information theory can be a benefit by improving “[1)] structure — the capacity of the facilities and the capacity and qualification of the personnel and organization, [2)] process — the changes in the volume, cost and appropriateness of activities, [and 3)] outcome — the change in health care status attributed to the object being evaluated” (p. 794). The major challenges, however, would be initial implementation and acceptance (Blum, 1986).

References

Blum, B. I. (1986). Clinical information systems. The Western Journal of Medicine, 145(6), 791-797. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307152/pdf/ westjmed00160-0055.pdf

Nelson, R. (2002). Major theories supporting health care informatics. In S. P. Englebardt & R. Nelson (Eds.), Health care informatics: An interdisciplinary approach (pp. 3-27). St. Louis, MO: Mosby.

Weaver, W. (1949, September). Recent contributions to the mathematical theory of communication. Retrieved from http://academic.evergreen.edu/a/arunc/compmusic/ weaver/weaver.pdf

Academia, Health Care, Technology

Implementing an EMR system

Electronic records streamline the flow of many of the components of patient care. EMRs and ePCRs are very useful in lowering costs, simplifying business processes, and increasing patient safety, as well as overall efficiency, if implemented correctly (Smith, 2003).

Currently, I work as a critical care paramedic providing patient care in acute settings, whether prehospital of interfacility. Within this capacity, I also teach classes to other health care providers, including first responders, emergency medical technicians, paramedics, nurses, physicians, and allied health personnel. I am familiar with the concepts of electronic patient care reporting (ePCR) and the importance and utility of electronic medical records (EMR); however, the only means of electronic reporting available in my capacity as a paramedic is poorly developed ePCR software coupled with intermittent network connectivity, so I still choose to utilize paper reporting. My part-time job with a local municipal ambulance provider relies on a widely available third-party ePCR system that seems to work well. I do utilize this ePCR system when working for this provider.

I have also gained experience with information technology and object-oriented programming concepts while developing platform-independent, client-server distributive applications designed for the internet and intranets. I also have experience with Windows and Unix/Linux platforms.

References

Smith, P. D. (2003). Implementing an EMR system: One clinic’s experience. Family Practice Management, 10(5), 37-42. Retrieved from http://www.aafp.org/fpm/2003/0500/p37.html

Academia, Clinical, Culture, Emergency Medical Services, Health Care, Politics, Public Health, Society

Physician-assisted Suicide

I have always maintained that the best thing that I have ever done for a patient was to hold their hand as they died; however, there are few scenarios that I can posit where I would ever cause the death of another, and I would never do it in my capacity as a medical professional. In the State of Connecticut, assisting a patient in their suicide is illegal (Kasprak, 2003; Saunders & Smith, 2010). Saunders and Smith (2010) describe the use of “semantic ploys” (para. 3) in arguing for physician-assisted suicide and how the court deemed the “issue rests with the legislature, not with the court” (para 4).

Two states have laws permitting physician-assisted suicide, Oregon and Washington (Death with Dignity Act, 1997; Death with Dignity Act, 2008). The other 48 states either have laws forbidding assisted suicide, such as Connecticut, rely on common law, or have no laws permitting or forbidding the practice (Kasprak, 2003). Personally, my thoughts on the matter are clearly reflected in my opening statement. More compelling, however, is a recent discussion on the discontinuation of implanted cardiac devices in patients with a desire to “refuse continued life-sustaining therapy” (Kapa, Mueller, Hayes, & Asirvatham, 2010, p. 989). Many of the respondants to this study viewed the discontinuation of pacemakers akin to physician-assisted suicide, whereas less felt the termination of cardioverter-defibrillator therapy was an ethical issue. Oddly, lawyers indicated less problems discontinuing therapy than did physicians.

There are conditions that are so intractably painful and wrought with suffering that I would not even consider thinking less of a person suffering such a malady who took their own life. Death, for many people, is a fear beyond fear, and for a person (of considerable sound mind) to choose death as a viable alternative to such suffering, I commend their bravery and choose not to judge them negatively. No physician or other health care provider should cause the death of a person directly, but acknowledging the patient’s will to die is another matter. In lieu of providing a chemical means of ending life, a physician could, in my mind, counsel a patient on the means and methods that might be viewed as more effective and humane than other means which might result in unwanted suffering. I do believe that a person has the right to choose an alternative to a surely painful and agonizing death, regardless of the presence of depression. If a person is suffering from depression because of a terminal illness that is causing physical suffering, it is hard to imagine this person will resolve the depression before succumbing to the causal disease process. In these cases, the person has the right to choose a more dignified death. For those cases where the person is incapacitated and cannot make health care decisions, I feel that any friend or family member, or a consensus of available friends and family members, should be able to make the decision to continue or discontinue life-sustaining measures. Even if the decision is wrong for the patient, most of the time the decision is for the benefit of the family and friends and lacks medical relevance aside from resource management, though there are spiritual, emotional, and moral considerations that the next of kin may face which are no less relevant.

Personally, I grant any person permission to end my life if they see me engulfed in flame or if taken on the battlefield by an enemy known for public torture. Beyond these two circumstances, I will always choose to live so long as I have my thoughts. I have heard some people intimate that they would wish to die if they were conscious but perpetually paralyzed (i.e. locked-in syndrome); however, I am not so sure that I would want to die just for lacking the ability to communicate with others. I would want to view the world, though, perhaps by television or radio. I am too curious as to what comes next for the world. As we interfere with the dying process, it does make sense that we address the morality in which we do this. It does not seem right to have brain dead patients connected to ventilators and feeding tubes forever. It’s Orwellian.

References

Death with Dignity Act of 1997, O.R.S. 127.800 et seq. (1997).

Death with Dignity Act of 2009, R.C.W. 70.245 (2008).

Kapa, S., Mueller, P. S., Hayes, D. L., & Asirvatham, S. J. (2010). Perspectives on withdrawing pacemaker and implantable cardioverter-defibrillator therapies at end of life: Results of a survey of medical and legal professionals and patients. Mayo Clinic Proceedings, 85(11), 981-990. doi:10.4065/mcp.2010.0431

Kasprak, J. (2003, July 9). Assisted suicide (OLR Research Report No. 2003-R-0515). Retrieved from http://www.cga.ct.gov/2003/olrdata/ph/rpt/2003-R-0515.htm

Saunders, W. L. & Smith, M. R. (2010, June 21). Assisted-suicide advocates fail in Connecticut. National Review Online. Retrieved from http://www.nationalreview.com

Technology

Innovation of Technology

Any expansion of the core infrastructure has historically driven technological growth spurts. From the advent of fire, electricity, and assembly-line manufacturing, there has been huge growth in technology following these cataclysms, but what is truly impressive is the exponential growth when these technologies are combined.

The telephone is a great example of this growth. Telephone systems evolved from the telegraph when Alexander Graham Bell combined his expertise of acoustics and oration to his knowledge of electricity. Bell, at the time, was attempting to perfect a multi-band telegraph, or a musical telegraph (Casson, n.d.). I feel that Bell’s contribution to the telephone and others succeeding in the field resulted in his lifelong dream of the musical telegraph being realized as he meant for it to be, unfortunately well after his death. The computer modem is such a device using multiple tones in quick succession to communicate with other computers with modems. The same concepts have been applied to promulgate broadband technology which most of the world now relies upon.

Whenever an innovation of technology occurs, it allows more people more opportunity to expand on it. With this in mind, I feel the biggest benefit of Internet2 and IPv6 would be the spark of innovation that is sure to come soon after acceptance.

References

Casson, H. N. (n.d.). The History of the Telephone. Electronic Text Center, University of Virginia Library. Retrieved on 22 June 2009 from http://etext.virginia.edu/etcbin/toccer-new2?id=CasTele.sgm&images=images/modeng&data=/texts/english/modeng/parsed&tag=public∂=1&division=div1

Emergency Management, Technology

Wireless reliance

Wireless information appliances will improve overall performance and communications, but will also have an adverse impact as we see today with Blackberry devices. Many people who work with Blackberry devices disregard them during off hours as they become bothersome. This is detrimental as the instantaneous notification is usually expected to be answered immediately. We will see more of this affect towards these devices. On the other hand, those people who welcome the ability to be connected and available at all times will be more accessible and therefore viewed by others as in a better light, perhaps. These people will become the “go-to” people and increase others perception of them on the network. This will lead to reliance on in-house electronic social networking to promote the usefulness of improved connectivity. Realistically, organizations must be clear on the expectations of the responsibilities of having increased connectivity with these and other wireless information appliances.

Another issue with increased connectivity is the increase in the opportunity of exploitation. As Metcalfe’s Law states that a network becomes exponentially more valuable as the user base increases, the inverse of Metcalfe’s Law should also hold true in that the network becomes increasingly vulnerable with a significant risk in membership and the connections themselves. Security becomes exponentially important as the network becomes more valuable.

Whenever I talk about network security, I try to relate it to the brick-and-mortar world: Homes in rural areas with unlocked doors are more secure than the dead-bolted homes of the urban environment.

Emergency Management, Emergency Medical Services, Public Health, Technology

Communicate Clearly – Streamlining the Communication Process

In my current profession, I am tasked with responding to disaster areas and treating the afflicted and displaced. I must communicate my intent and direction clearly and with a presence of authority. Understanding the various communication modes and methods that different people utilize and respond to, perhaps across cultures or socio-economic backgrounds, will allow me to streamline my communication processes to directly impact the most people in the most efficient manner possible.

Previously, I stated that I only have one long-term personal goal: leave a positive mark on the society in which I live. My attention to this goal is unwavering and will never change. Technology being what it is today, effortless communications across lines previously drawn is paramount in improving society. I value improving the lives of others: individuals and society as a whole. I feel I have already met the outcome objective of Walden University which is one of the reasons why I chose to enroll here. Apparently, others share many of the same goals.

In college, I have found a chance to interact with a variety of people from a variety of backgrounds without ever really knowing who they are. Not unlike a double-blind study, the results of the discourse are authentic to the environment. I found this to be quite interesting and attempted to hone my communication skills in such ways as to be a benefit for as many of my classmates as possible. I will never know if I have succeeded in this, but I feel the intent and the experience will stay with me far longer than the results. Being able to communicate clearly with yourself, however simple a task that may seem at first, allows one a clearer understanding of one’s needs and allows for the development of a plan for attaining those goals that meet these needs. That is being true to one’s self!

Technology

Communications Violations

I have been involved in the internet community for many years, starting pre-internet with running a bulletin board system. Throughout this time, I have always tried to encourage the use of proper “netiquette”. Though I am mindful that not everyone understands the concept initially, those that choose to continuously utilize networks for communication should strive for proper, clear and concise methods.

One of the biggest violations of “netiquette” that I see frequently is the use of all capitalized letters. THIS IS THE ELECTRONIC EQUIVALENT OF SHOUTING. Though useful at times, it is very difficult to read and adds a confusing tone to the message. As I have stated before, it is so difficult to transmit emotion via electronic means, the assumption of stress placed on messages such as these only complicates the matter.

That being said, the single worst violation in communication is the sending of messages that the recipient has no desire for. We have all dealt with the person who feels it their place to tell about their woes to anyone who will listen (or, better stated, to anyone who will stand there and pretend to listen). Most of us have received “cold calls” from marketing firms. And, those with email accounts are very familiar with SPAM, or unsolicited email messages. These messages are disruptive to the audience and to society as a whole, costing time, money, and causing frustration.

There are many instances of good and bad netiquette occurring daily, and though I have only mentioned two bad examples, I find the various modes of network communication to be positive, helpful and efficient means when used appropriately. In this age of technology, many of us are forced to communicate at a distance which makes network communications essential. Users of this technology should have an idea of the appropriate use of each, and each puts unique responsibilities on the user.

Cell phones are a great example of this. A cell phone should be used at any time synchronous communication is preferred or if the message is large and requires immediate feedback. Using a cell phone, though, places responsibility on the caller to ensure that they are free from distraction and will continue to have proper battery and signal strength during the entirety of the call.

Instant messaging and text messaging are by far the least formal modes of communication and should be used when the message units are small and the overall message is easy to comprehend. Instant messaging and text messaging are interchangeable, though with text messaging, the users tend to be more mobile which creates a social responsibility to be mindful of safety. Text messaging should never be done while driving or operating other machinery.

Email is the new postal service. Many of the formal requirements of email are being shed for ease of communication. In times past, a person would write a letter, but now, they write an email. Email is the chameleon of network communications. One may send simple one-line notes to friends and family and use the same mode to send a very formal budget proposal to their Chief Financial Officer. The use of email demands that the user takes responsibility for ensuring that the message is formed in such a way as to be appropriate to not only the intended recipient but the information enclosed in the message. Email should never be used when the delivery of the message needs to be guaranteed or is so time-sensitive that its immediate delivery is paramount.

Most importantly, keep the recipient’s needs in mind when choosing a mode of communication. The recipient will usually make clear the modes of communication that they prefer.