Wednesday, December 27, 2006

James Brown – The Slippery Scale of Good vs. Bad

This is a shout out to James Brown, who died today of pneumonia and heart failure at the age of 73. His death today left me with mixed emotions. On one hand, I have listened to his music my whole life. I consider his legacy to be his musical genius, which is a major contributor to genres of music today. His funky music always makes me want to move my body. At the Experience Music Project, there was a Funk motion simulator ride that was based on James Brown. I am very thankful that we experienced the ride several times before they buried it. On the other hand, he is convicted woman abuser, who had a very difficult time recovering from substance abuse. He was not kind to his wives or family. No one is all good or all bad. For the New Year, I hope I can try to concentrate on the goodness in people.

Saturday, December 23, 2006

Scaling the Tower of Babel – The Slippery Slope of Scale

One of the first obstacles to a successful Google global health URL is language. I will refer to this obstacle as the “tower of Babel idea” (Adam Bosworth). All the stake holders speak different languages. This is one of the major reasons that the second-generation EMR applications are failing. In my opinion, this lack of communication is found at every intersection of computers and humans.

From applications within education to EMRs for private clinical practice, developers in general do not understand the interactions of the end-users with the interfaces they design. Add in the languages of consumers, administrators, fiscal managers, nurses, medical researchers, radiologists, psychiatrists, HIPAA, and vendors, and we now have an insane tower of Babel.

I spend most of my days trying to scale this slippery tower by translating between stakeholders. I go into meetings, I try to learn as much of the alphabet soup that I can for each stakeholder, then I try to map one language into another to all at the table are referring to the same constructs.

To illustrate, I will describe a small unrepresentative sampling study. Several family members, friends, medical doctors, psychologists and office staff members were asked what the word SCALE means, that is, how would they describe scale to someone:

Who They Are

“What they Said”

Mother, 73

Something you stand on to weigh yourself

Son, 22

I do not know what you mean. Do you mean conveying the information to … (no answer, playing PSP)


Something you use to measure something


Something used to measure a concept

Friend, 15

Climbing up the side of something - to climb

Me, Ph.D.

A unidimensional set of items used to measure a defined concept


To allow an application to work with small or large amounts of information. Go from development to large-scale dissemination

Thursday, December 14, 2006

Shout Out to Dan Savage – I am so Damn Proud of YOU!


You totally rock and you are my HERO!

In my opinion, you always have been a proponent of truth (truthiness) in your writings about gender, sexual orientation, alternative sex positive communities, and sexual and mental health education. You are one of the best sex educators I have ever had the joy to experience. I know you will probably never see this post, but I just saw you on The Colbert Report 12/13/06. One of my life’s ambitions has been to be on either John’s or Steve’s shows. Your book The Commitment is incredible, one of the few books I actually purchased this year.

I have followed your career since your first column in The Stranger. You probably do not remember, but you and I used to chat many years ago. I used to go to gay bingo with my family. You were a bingo caller. I loved you then and I love you now. I am so thankful for you! You are really a great icon. Thanks for the book and thanks for looking so gorgeous on TV. TRUTHINESS ROCKS!

Sunday, December 10, 2006

How Walgreens Helps us and Hurts us at the Same Time – the Slippery Scale of Customer Satisfaction

Speaking as a private citizen and not as an employee, I can be quite opinionated. So please forgive me in advance.

This word: Xifaxan (rifaximin) – I have difficulty pronouncing it J

This antibiotic has recently been found in a few small RCTs (randomized controlled trials) to provide benefit to people with one of the three types of IBS (Irritable Bowel Syndrome) whose symptoms are not controlled or entirely controlled by diet, exercise, and stress factors. My excellent stomach doctor prescribed this medication for my stomach that is usually given to people to treat diarrhea that is caused by bacteria from food you eat “traveler’s diarrhea”.

However, he prescribed rifaximin at a much higher dosage than is usually used to treat “traveler’s diarrhea. Please see: - {First GOOGLE suggested site without refinement by subtopic}. It is so expensive, that my doctor gave me a $30 rebate coupon so the company that markets Xifaxan (not yet available in generic form) can collect lots of information on me, and send me advertising email “newsletters.”

When I went to my local Walgreens (it IS as cheap as COSTCO) to get my diabetes meds (medications) and fill this new script (prescription), the Pharm Tech told me “there is a drug warning that the dosage is way too high and/or their may be an interaction with your other medications.” The pharmacy technician did not really want to give me that information. I had to probe with a couple of questions to get the information.

Once I got the information about why the computer was not letting them fill my order of three different medications, I told them, this is GREAT! The system worked the way it should. I am very impressed! Perhaps, my university faculty doctor made a dosing mistake. However, lingering in my mind was the nagging feeling that he did NOT give me the wrong dose, but the right dose for my diarrhea type IBS. He gave me an “off-label” or not yet totally approved by all the powers to be dosage for an indication (another disorder) other than the one the FDA approved the drug for (bacteria diarrhea). However, I like people to err on the side of safety, so I did not mind Walgreens pharmacy’s decision not to give me ANY of my medications (a FAIR thing to do) and told me to come back the next day after they talked to my stomach doctor.

A woman who was sitting in the waiting area at the pharmacy for at least the 25 minutes it took me to complete my transaction, spoke up at this point. She told me she was waiting there for 45 minutes for the pharmacy to talk to HER doctor (it is now 5:30 pm). No surprise, they are gone for the day. The problem is, SHE HAS TO HAVE HER MEDS because she is on insulin, so they cannot get rid of her as easily as they get rid of me. The pharmacist now has to try heroically to call the MDs after-hour service, whose employees probably just got to work. It is sad, but it will probably take over an hour and a half to work this all out so she can just get her medications. Diabetes treatment REQUIRES constant changes in dosages at least 3 medications. A system that has to make you wait days or hours to pick up your meds is NOT GOOD.

I returned the next day at about 5 pm and was told that I could not have the rifaximin yet (A BAD THING) because my insurance would not pay for it [Uniform Medical Plan – State of Washington (fee for service)]. I left from my SECOND Walgreens visit, without all my meds. I got home and the ironically GOOD thing was that they had left me a phone message (at home???) that my meds had a problem and to call in. Ironically, I do not stop home before I do my errands after work. I do not believe most people do. The good thing is, at least some type of warning was there and the routing to another phone would be very easy.

Now 3 days later, unbelievably, I am still trying to get my Xifaxan! I called the pharmacy the next morning (a Saturday). After waiting so long on hold that my call became new again, the patient pharmacist explained the situation to me. She also said, the MD and the pharmacist would have to appeal the decision of the insurance, and that would require the MD to fill out “over-ride” type papers that are faxed to the MD from the insurance company at the request of the pharmacy. This would take 2 days to 2 WEEKS. IS THIS PROCESS INSANE?

I would love to see GOOGLE HEALTH design interfaces that are based on patterns of actual usage, and simplicity rather than trying to make ONE SIZE FITS ALL computerization. That will not work in HEALTH CARE information processing. What we really need is the zero install application model that can be accessed everywhere like the Web. That is why I believe that the model proposed by Adam Bosworth seems a logical starting point for this new wave of health care information in the age of infinite content to link health information in real time.

Here is a HORRIBLE thing about Walgreens retail prices; they cheat customers with poor vision, absentmindedness or those who do not read well! While I was there, I was tempted by a couple of products that had big stickers on them saying boldly - 2 / $5.00 or something like that. I did not give it much thought and I grabbed two very different items and went to the cashier. When I got back to my car, I realized my bill was too much $. They had charged me about fifty cents more on each item. In very small, 4 point font, it says “$3.00 each.” I could not read the font without my glasses!

This Walgreens store primarily serves the elderly and poor people receiving public assistance and living in the public housing communities across the street. I talked with the very young and smug manager, who told me it was “corporate policy” and he had no control over that. I believed him. I thought, wow, instead of just feeling angry, gosh darn it, I can blog this! Maybe someone who matters in Walgreens could find this posting, maybe using DIGG, bring it to awareness of us people for who $1 matters.

My truthiness is that, Walgreens is not ALL good or ALL bad; it does some good things and some not so good things. The free Diabetes magazine I pick up there with my meds is GREAT, even though it is funded by the pharmaceutical industry. Who cares? Not me, its good bathroom reading. However, the way the retail marketing misleads us, and then over charges the people with the least money to spare, is not a nice thing. Walgreens I think you can do better.


Friday, December 8, 2006

I Finally Woke Up to Smell the BRIIE - BLOG RSS-Type Intellectual Information Exchange (BRIIE)

Welcome to my first posting.

I am exploring the new world of GOOGLEs’ mind-blowing array of free products. I feel humbled and overwhelmed by how many different products GOOGLE is offering me, now that I have started using GMAIL. I have been so insanely busy that I have not taken time to learn any new non-work related apps is quite a while. I am having a blast!

The GOOGLE engineers seem to jump right out at you from the basic setup as inidividuals, and theyfeel very humanistic and caring to to the user. This is in strict contrast to installing proprietary software, which needs to only be done by IT experts. GOOGLE makes every level of instruction seem so nurturing, forgiving, polite and full of options for customization and your individualization as a person. It even tells you that it "understands that change is difficult." I think that is awesome!!! It is great to have supportive software in this world.

The permutations of information seeking programs like DIGG, style setting templates, people to link to, and feeds to choose, approaches infinity. People can dog paddle or Olympic style crawl in the ocean of the WEB using GOOGLE products and the links that GOOGLE supports, which are also free. Free to the end user is a very good model.

I also really enjoy the subtle way GOOGLE gives the user hints. I was typing, and in the bottom out of the way is permanently written hints for control keys. That IS very useful AND it IS NOT annoying.

MS 2003 software is TOO helpful. It is just too aggressively helpful by constantly telling you what it THINKS you mean. Moreover, it does not always give you help when you need it or give you suggestions you could readily apply. Hints about shortcuts or options that could actually improve your performance are given in GOOGLE space, but not in MS apps.

I know I am probably ignorant, and would appreciate being told how to turn off all those horrible helping suggestions [auto-format or that terrible little lightening bolt that you can’t move away from your view] and other annoying characters. I am also bothered by the waste of a huge column of space on the right side of the screen, which you need to click off each time you open WORD.

I just love how nicely the end user is treated with in the WEB space of GOOGLE products. It feels very therapeutic, welcoming, and billowing with information potential. Overall, I cannot think of a better product with a better worldview from what I have come understand about GOOGLE at this current time using BRIIE. Ironically, of course, since GOOGLE controls all the content of GOOGLE Space, they can certainly control the information about GOOGLE that hits the WEB.

The amount of information that is accessible within this new BRIIE is totally making me rethink some of my measurement models. My Tivo is totally backed up, because I am exploring the BLOG RSS-Type Intellectual Information Exchange (BRIIE) people and places instead of watching episodes of my favorites of soon to be cancelled TV shows. My WMC HD is also backed up with many episodes of shows, which were cancelled,

I listened to Adam Bosworth, Vice President of GOOGLE say many interesting things about the models behind and functionality of RRS-1 and RRS-2. From my naive end-user POV, Bosworth’s arguments seemed to correlate with my experiences using both the first and second version of the GOOGLE READER.

I am waking up after many years in a self- and academia- induced masochistic coma, and finally realizing (2 years too late) that a new form of communication had totally developed under my sleeping brain. I am ignorant about its usage, but am learning at a rapid speed. This really sucks. This does not happen often. I am an innovator end-user. I was one of the first people in my set of peers to have a PC, to use Email, the IRC, Metacrawler, SPSS, GOOGLE, Readers, etc.

Once I understand BRIIE, and I love good cheese, I will then try to use this medium to talk with like-minded individuals about my favorite topic, health care, and in specific mental health care.

Thank you for taking the time to read my first post.