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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.

Video: AliveCor’s AI launch, plus $30M investment from Omron and Mayo

I did a video interview this week with AliveCor COO Doug Biehn about that company’s launch today of a physician-side artificial intelligence platform for mining ECG readings for signs of atrial fibrillation, a key early marker of stroke risk. AliveCor also announced it has closed a $30 million Series D investment round, led by Omron Healthcare and Mayo Clinic.

You can read my recap on my Forbes page, but here’s the full video interview.

I goofed in one spot as I was editing the video after midnight: I was in Chicago, not Silicon Valley, as you might be able to tell from the artwork behind me. The error is sorta fixed if you’re watching on a desktop computer, but YouTube annotations don’t show up on mobile devices. (In fact, YouTube is phasing out video annotations this month for that very reason.)

Your feedback is always welcome.

March 16, 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.

Back from CES, and ready to, um, laugh about digital health

I got home from the Digital Health Summit at International CES in Las Vegas late Thursday night, and have spend most of the time since them just catching up on things. Among important news I missed was that Stephen Colbert took on health apps on Wednesday, specifically Doctor on Demand. Colbert joked that the app is going to “revolutionize medicine.” (“Why waste time getting an exam when you can just shoot your doctor an emoji of your shattered femur?”)

Ah, yes, revolutionary health apps. It has to be a joke, right?

“Clearly, app-based healthcare is the future of medicine,” Colbert continued, before introducing one of his own, from “sponsor” Prescott Pharmaceuticals.

The Doctor on Demand part starts around 3:30, but the earlier part is pretty funny, too. Some might be offended by this segment.

I will have more on the Digital Health Summit on MobiHealthNews and right here on this blog later this week.

January 12, 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.

So many types of telehealth

Here’s a short video (720p HD) I put together from the just-concluded American Telemedicine Association’s annual conference in Austin, Texas. No wonder it’s so hard to get a real sense of the size of the telehealth and telemedicine market when there are so many components and so many different definitions. This is a row of banners outside the meeting rooms highlighting the various types, not to mention some of the ATA’s constituencies and important topics at the conference. I did the voice-over at 1:30 in the morning.

May 8, 2013 I Written By

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

Video: My interview with Phytel’s Steve Schelhammer from Health 2.0

Last fall, I conducted one of the “3 CEOs” interviews at the 2012 Health 2.0 Conference in San Francisco. For my interview, I drew Steve Schelhammer, CEO of Phytel, a population health management technology provider. Aside from a little technical glitch — one that got edited out of this clip — with Schelhammer’s earpiece microphone not working, I think this went very well. The most amazing part is that this was the first session of the morning and not only was I on time, I was awake and alert.

February 20, 2013 I Written By

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

ICD-10 explained in a minute and a half

It’s Sunday, so it’s time for something light.

University of Utah Health Care put together this handy little video that explains ICD-10 to physicians as well as their role in making the transition. There is one footnote I’d like to add: the compliance deadline has been delayed to October 2014 since this video was made.

 

Thanks to the HIMSS social media team for pointing this out to me, via their Facebook page.

October 21, 2012 I Written By

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

Skype for ‘redneck telehealth’?

Kudos to Barbara Duck of The Medical Quack blog for coining a new term: “redneck telehealth.”

A friend of hers had an outbreak of gout while getting ready to board an overseas flight. “He had called his doctor who was not set up with any of the new telehealth programs and software that is just now becoming available so I said ‘get your doctor on Skype and put your foot up there for him to see,’” Duck explained in a post over the weekend. “Obviously this is not a perfect situation for either side for a real diagnosis, but as the old saying goes a picture is worth a 1000 words and that’s what this would do.”

Actually, I’ve heard that because a picture is worth 1,000 words, a video is worth 1 million words. Since laptops tend to have built-in webcams these days and a lot of 3G smartphones can transmit live, mobile video (hey, even some 2.5G phones can do so over a Wi-Fi connection, like you might find in say, an airport), why not fire up Skype or FaceTime or similar videoconferencing program and show your foot to your doctor? If you don’t like the term “redneck,” just call it a video call or an ad-hoc network.

Or are we expecting far too much by assuming that the doctor would one, be available on short notice, and two, voluntarily share his/her mobile number or Skype screen name with a patient?

May 16, 2011 I Written By

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

Video: Overview of mobile healthcare technologies

I haven’t done much with my YouTube page since I launched it last month, but here’s some new video of me, courtesy of Nuesoft Technologies. Nuesoft hosts a podcast series, and they recently invited me, along with Health Data Management Editor-in-Chief Greg Gillespie to discuss mobile healthcare technologies. We all had webcams, so the result is this YouTube video.

In a bit of serendipity, Gillespie happened to be looking for freelance help with HDM’s HIMSS Microsite, a collection of articles previewing HIMSS11. My first story should be up within the next hour.

February 3, 2011 I Written By

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

Can you handle Extormity’s truth?

Just a couple weeks after I launched my own YouTube channel (still sparsely populated), fictional EHR vendor Extormity has done the same. Coincidence?

Here, Extormity senior executive Frederick “The Colonel” Youngblood testifies before a panel investigating EHR implementation practices. Gotta love movie parodies!

Seriously, though, if Extormity is such a profit machine, how come this video isn’t even available in high quality, much less high definition? Even I have an HD camera.

January 20, 2011 I Written By

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

Welcome to my YouTube channel

First came blogging, then podcasting. Now I’m venturing into vodcasting with my very own YouTube channel.

Here’s my first short video, with me cleaning out my filing cabinet and riffing on the evolution of the health IT industry over the last 10 years, focusing on Physician Micro Systems. The company, which dates to 1983, changed its name to Practice Partner and later was bought by McKesson.

The video is in HD, thanks to my new Kodak PlaySport ZX3 camera (no, I didn’t get the purple). I may be a bit hard to hear when not looking at the camera because the microphone is built into the camera. At least there’s not a lot of background noise. I’m learning, and the videos will get better.

So, without further ado, here is my short video.

Now, who wants to teach me how to embed ads in the videos so I can make a little money with it? The blog and the podcasting sure don’t produce much income.

January 4, 2011 I Written By

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