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Health informatics pioneer Larry Weed dies at 93

Lawrence L. Weed, M.D., a pioneer in the world of health informatics and organization of patient information, has died at the age of 93. Weed passed away in Burlington, Vermont, on June 3 after a fall two weeks earlier, his son Lincoln said.

Weed created the who created the problem-oriented medical record (POMR) and the subjective, objective, assessment, planning (SOAP) format of progress notes that became ubiquitous. He had advocated for what now is known as clinical decision support for at least 60 years, talking often about “coupling” patient problem lists with medical knowledge that changes often.

“The unaided mind does not know what data to collect, and does not see many of the significant relationships buried in whatever data are collected,” Weed said in a 2004 story I wrote for Health-IT World, a former spinoff of Bio-IT World. Thus, according to Weed, paper records were inferior to computerization — and they were half a century ago.

While at the University of Vermont in 1976, Weed co-developed an early electronic medical record called the Problem-Oriented Medical Information System, or PROMIS.

In 1991, the Institute of Medicine report, “The Computer-Based Patient Record:  An Essential Technology for Health Care,” (revised 1997) said that the problem-oriented medical record “reflects an orderly process of problem solving, a heuristic that aids in identifying, managing and resolving patients’ problems.”

In a seminal 1968 article in the New England Journal of Medicine, Weed wrote:

Since a complete and accurate list of problems should play a central part in the understanding of and management of individual patients and groups of patients, storage of this portion of the medical record in the computer should receive high priority to give immediate access to the list of problems for care of the individual patient and for statistical study on groups of patients.”

To this end, Weed developed a system of “problem-knowledge couplers,” and founded PKC Corp. in 1982 to market his idea. The company landed a series of government contracts, but struggled to catch on in the public sector. Weed was forced out by investors in 2006, and PKC was sold to consumer health company Sharecare — founded by WebMD founder Jeff Arnold and TV doctor Mehmet Oz, M.D. — in 2012.

Weed described the framework of problem-knowledge couplers in a 1994 article in the journal Medical Interface.

A true Renaissance man fond of quoting Francis Bacon, Tolstoy, Copernicus, Galileo and other celebrated philosophers, Weed was known as a brilliant educator, deep thinker and an engaging speaker. At the age of 89, he commanded the stage for a good 75 minutes at the HIMSS13 Physicians’ IT Symposium, and received two standing ovations.

“The worst, the most corrupting of all lies is to misstate the problem. Patients get run off into the most unbelievable, expensive procedures … and they’re not even on the right problem,” Weed said during that memorable presentation in New Orleans.

“We all live in our own little cave. We see the world out of our own little cave, and no two of us see it the same way,” he continued, explaining the wide deviation from standards of care. “What you see is a function of who you are.”

Lincoln Weed lamented that health IT companies have not always paid attention to these ideas. “The informatics community hasn’t really caught up to my father’s work,” the son said. “It’s not about technology. It’s about standards of care.”

The problem-oriented medical record is a standard for organizing information in a record. Couplers are standards for collecting data to generate recommendations based on the ever-changing body of medical knowledge, according to Lincoln Weed.

Some of Larry Weed’s ideas did catch on, notably, the SOAP note. However, some have recently rethought that format for the digital age, swapping the first two and last two element to create the APSO note. Weed defended his approach in 2014.

Weed stayed active up until his last day alive, according to Lincoln Weed. The day Larry Weed died, he discussed a poorly adopted National Library of Medicine personal health records project with sons Lincoln and Christopher. Lincoln recalled that his father said the NLM tool needs to let patients enter their own health data.

“I’m hopeful that the NLM is close to jumpstarting that process,” Lincoln Weed said. “Dad died with more optimism than he had had in a long time.”

Indeed, it could be argued that Weed was a founding father of patient empowerment. Back in 1969, Weed wrote a book called “Medical Records, Medical Education, and Patient Care.” In that, he said, “patients are the largest untapped resource in medical care today.”

Lincoln Weed said that the late Tom Ferguson, M.D., who founded the journal Patient Self-Care in 1976, “thought Dad was one of the originators” of the empowered patient movement.

With patient-generated data and now genomic information making its way into clinical practice, a system for organizing medical records is more necessary than ever, Lincoln Weed said. Equally important, he said, is a computerized system for matching the patient problem list with all known, relevant information to address specific problems — couplers.

“I’m glad Dad has left me with these things to work on,” said Lincoln Weed, a retired attorney who co-authored “Medicine In Denial” with his father in 2011.

Weed, who earned his medical degree from Columbia University in 1947, is survived by five children, a sister, two grandchildren and two step-grandchildren, according to the Burlington (Vermont) Free Press.  He was preceded in death by his wife, Laura, a physician herself who died in 1997.

Weed’s public memorial will focus on his lifelong love of classical music. His children are planning a memorial concert on Sept. 17 at 4 p.m. Eastern time at Charlotte Congregational Church, 403 Church Hill Rd, Charlotte, Vermont, according to the Burlington Free Press.

Here is a video of Weed from a well-known grand rounds he presented in 1971. It was unearthed by a Weed disciple, Art Papier, M.D., of clinical decision support vendor VisualDx.

June 18, 2017 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

A new focus: How to become empowered patients

Attention, kind readers. After years of doing this blog in fits and starts — particularly the two-year gap while I was essentially prohibited by a full-time employer from writing about health IT here or anywhere else but that company’s site — I have decided to refocus on healthcare consumers rather than industry insiders.

The “Meaningful HIT News” name itself has become dated, given that the Meaningful Use program from which this blog takes its name has evolved and kind of fallen out of favor. For those not up on the lingo, “meaningful use” is the standard healthcare providers must meet to qualify for Medicare and Medicaid bonus payments for use of health information technology and/or avoid penalties for not being “meaningful” users of electronic health records.

The program came about in 2009 with the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a bipartisan part of the very partisan American Recovery and Reinvestment Act (ARRA); ARRA was President Barack Obama’s $831 billion stimulus legislation. Despite what you may have read elsewhere, Meaningful Use was not part of the Patient Protection and Affordable Care Act, the 2010 bill that’s come to be known as Obamacare.

Meaningful Use was largely successful in getting hospitals and physician practices to adopt electronic health records, which was the goal of Stage 1 (2011-13, give or take). But it started to fall apart in Stage 2 (2014-16), which required participants to share data with other healthcare organizations. Now we have reached Stage 3, in which hospitals and doctors are supposed to prove that they are able to provide better, safer, less costly care with the help of their electronic records.

While all this was happening, Congress got impatient about the $35 billion in incentive money that has been distributed to date and passed legislation at the end of 2015 that changed how physicians are paid for treating Medicare patients. Long story short, Meaningful Use Stage 3, at least for doctors and other individual practitioners, is now part of a bigger calculation that pays for outcomes rather than for simply providing more services. The Meaningful Use program remains unchanged for hospitals.

I won’t bore you with any more details, but I think it’s time to look at the bigger picture, namely the rights and responsibilities patients have in making their own care better. Stay tuned for real patient stories and advice in the next few days. In the meantime, check out the post that represented a shift in my thinking, after my dad passed away nearly five years ago.

I want to help you become empowered patients. That, to me, is what is really meaningful.

I’ll categorize every relevant post as “The Patient Journey” so you can find these stories in the future.

 

March 30, 2017 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Join me for some upcoming speaking gigs

Hey all. I bet you thought I abandoned this blog when I took the job with MedCity News in April. I kind of did, because this is a health IT blog, and the people who pay my salary want me covering health IT exclusively for them. However, I’m allowed to promote myself, so promote I shall. As a bonus, all of what I’m about to tell you is related to health IT, which is why you came here in the first place.

I’ve got several speaking gigs coming up next month. Some are open to the public, others are not.

  • Oct. 1, I will moderate a panel discussing trends in patient engagement as part of the kickoff event for the new Chicago chapter of Health Technology Forum. RSVP here for the event, which starts at 6 pm CDT at SAS Institute’s Chicago office, Two Prudential Plaza, 180 N. Stetson Ave., Suite 1600. Panelists TBA.
  • Oct. 7, I will be at the Surescripts 2015 Customer Forum in Alexandria, Va., on a panel hosted by Surescripts CEO Tom Skelton. I’ll be joined by my friends Mandi Bishop of Dell and Shahid Shah, a.k.a. the Healthcare IT Guy, to discuss interoperability. That session runs 8:30-9:15 a.m. EDT.
  • Oct. 26, I am scheduled to be on a panel called “The Intersection of Digital Health and Patient Centricity,” alongside Sean Katz, CIO of the Vitality Group, and Maryam Saleh, director of member experience at health technology incubator Matter. That’s hosted by marketing firm APCO Worldwide, and starts at 5:30 p.m. CDT in the Wacker Room of the CME Building, 10 S. Wacker Drive, Suite 1200, Chicago.

Perhaps I’ll see you at one or more of those.

September 18, 2015 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Loudmouth patients, in their own words

The video from the Digital Health Summit session, “Loudmouth Patients: Making Noise and Making Change,” that I moderated in January has been posted. It was a lively, fascinating discussion involving: empowered patient Hugo Campos; Donna Cryer, CEO of the Global Liver Institute (and a liver transplant recipient herself); and Greg Matthews, group director of  interactive and social media at WCG.

Unfortunately, one long-winded questioner from the audience took up all the Q&A time (and I initially mistook her for Bettina Experton of Humetrix), so some things went unanswered. If you have any questions for the participants, post them in the comments below and I will attempt to get the panelists to answer.

This discussion took place Jan. 8 at the Digital Health Summit at International CES in Las Vegas.

In case you missed it, here are some post-session interviews with Campos, Matthews and myself.

February 13, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Digital Health Summit videos: Loudmouth patients

As I noted last week, I moderated a panel at the Digital Health Summit at International CES on “loudmouth patients.” Aside from a slight technical glitch in which the “Seinfeld” clip I shared here didn’t play during the presentation and me misidentifying an audience questioner, it was, IMHO, one of the best sessions of the two-day conference. As the moderator, I owe that to my panelists.

Hugo Campos and Donna Cryer told their compelling stories, while Greg Matthews discussed some new research he did, looking for patterns in online physician-patient interactions.

Afterward, video producer Tim Reha pulled each of us aside to chat on camera for “Digital Health Summit Live” interviews. I talked, possibly awkwardly, about what the other panelists said during the session, then they told their own stories in far more detail and precision than I could offer. I have to say I deftly positioned myself as an empowered, loudmouth patient myself. My physicians, consider yourself warned.

 

Here’s Campos discussing his compelling story:

 

And Matthews explains his research:

If any video of Cryer surfaces, I will be sure to add it.

January 13, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Patients raise their voices at CES

I’m about to escape the frigid winter blast in Chicago, a.k.a., Chiberia, for the relative warmth of Las Vegas (it will be below 40 degrees Fahrenheit at night, so it’s not exactly tropical there either) and the Digital Health Summit at International CES. On Wednesday afternoon at 4:10 p.m. PST, I will be moderating a panel called “Loudmouth Patients: Making Noise and Making Change.” Panelists will include: well-known empowered patient — and pain in Medtronic’s behindHugo Campos; Donna Cryer, CEO of the Global Liver Institute (and a liver transplant recipient herself); and Greg Matthews, group director of  interactive and social media at WCG.

I’m giving just a short intro since the session is only 30 minutes long, though I do intend to give a condensed version of the story of how I had to raise my voice in support of my dad, who was rendered unable to speak by a rare disease as he was dying — and being badly mistreated — in an ill-equipped and poorly run hospital less than two years ago.

Hopefully soon we can all speak up to our healthcare providers without being blacklisted like Seinfeld’s Elaine back in the 1990s (h/t Brian Ahier).

Speaking of patients getting a look at their medical records, I’m also working on a story for U.S, News & World Report about the pros and cons of the OpenNotes project. Stay tuned for that one hopefully later this month.

January 6, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.