September 12, 2013

One of these EMRs is not like the others

Filed under: Health, Software Blog, Usability — marcstober @ 10:58 pm

winner-thumb healthhub-thumb runner-up-thumb

Above are three thumbnail screenshots of prototype medical applications.

One of them is the winner of a White House competition, winning thousands of dollars and influencing the EMR of the huge VA medical system.

One is a problem-oriented medical record and the runner up.

One is a prototype I designed as part of an Innovation Team project while working at Partners. (We didn’t win a White House award. I guess we were ahead of our time.)

June 7, 2010

When food hurts – The Boston Globe

Filed under: Allergies, Food, Health, Personal Blog — marcstober @ 1:00 pm

It remains a mystery why, in some people, the immune system responds like a fly swatter to a food allergen while in others, the cavalry is summoned, cannons blasting.

via When food hurts – The Boston Globe.

The “fly swatter” resonates with me. It is indeed a confusing mystery as to whether some itch or tingle is an allergy, something else (which still wouldn’t explain the positive allergy tests), or just me being overly sensitive. Or God forbid, a warning of a worse reaction, which I’ve never had but is in my family history. It’s just good to see the popular media acknowledge this. Everything you find online (including from the food-allergy advocacy groups, unfortunately) tends be along the lines of “kids can die from food allergies; and if it doesn’t kill you, you’re just making it up.”

My only issue that this doesn’t cover is trying to keep kosher but ordering the steak because who knows what combination of nuts and seeds the veggie burger will be fortified with (and I don’t really want to go into it all with the server).

May 26, 2010

My Job, on TV!

Filed under: Health, Personal Blog — marcstober @ 9:29 pm

Well, not my job, but the people on the front lines of my organization:

Dear Colleagues,

As many of you know, film crews from ABC News spent several months at the MGH last year documenting the experiences and perspectives of staff, patients and families. By the time the crews finished filming in May 2009, they had captured more than 2,500 hours of footage, showcasing the poignant stories that unfold inside our hospital walls each day.

After a year of cutting, editing, polishing and refining, the result is “Boston Med,” an eight-part series that will air this summer, beginning Thursday, June 24 at 10 p.m. Locally, “Boston Med” will be shown on Channel 5, and it will appear on other ABC affiliate stations across the nation and beyond. In addition to the stories about the MGH, the series will feature pieces from Brigham and Women’s Hospital and Children’s Hospital.

I thought the MGH community would be interested in seeing the series trailer, which was just posted on the ABC website at I look forward to watching the compelling stories and outstanding caregivers who will be highlighted on Thursday nights throughout the summer. Thanks to all who helped make this very special prime-time opportunity possible. We will be sending you additional information about the series as we get closer to the premiere.

Peter L. Slavin, MD
MGH President

Should be interesting!

November 24, 2009

Two Weeks on a Vegan Diet

Filed under: Allergies, Food, Health — marcstober @ 12:06 am

At the urging of a health care provider, and armed with a new copy of Veganomicon: The Ultimate Vegan Cookbook, I tried an essentially vegan diet for two weeks. This means no mean, poultry, fish, eggs, or dairy. It also means no cream in my coffee, and rules out most commercial baked goods, which usually contain some egg or dairy ingredient.

How did it work out? I feel great! Then again, I expected I would; for whatever reason, I’ve never particularly enjoyed a lot of meat in my diet. I feel more relaxed and energetic, and may have even started to lose a little weight.

Of couse, I can’t tell if I’m actually reducing my risk of diabetes or cancer, as Colin Campbell claims of no-animal-protein diets in The China Study. I’m not sure anyone can conclusively prove that one long-term diet is better than another, and discern its impact from genetic and other factors that cause disease. But it seems right, and it doesn’t make sense to ignore reasonable evidence when it’s impossible to have a conclusive proof.

I feel that the whole exercise was a bit of a Trojan Horse. For two weeks, I did a lot of cooking from scratch, ate more and better vegetables and less junk food, and rarely ate from restaurants. I think I would have been healthier than usual on that plan even with a piece of fish or even a hamburger added in.

This experience did cement in my mind the uselessness of an ovo-lacto vegetarian diet. There was a period in my early 20’s when I primarily ate “kosher dairy” that included fish, dairy products (lots of cheese), and eggs. I don’t think this is particularly healthy, especially as it’s pretty easy to follow such a diet eating processed junk foods (which was its appeal to me at the time. 🙂 And, from a moral perspective, did your egg-laying hen really have a better life than its cousin in the oven? And does not eating them maybe acknowledge them a little less?

(I should mention that I don’t have a moral or ethical desire to be a vegan to not harm animals. I do make some efforts at keeping kosher, out of respect for God and what He’s created; and as a very general moral principle don’t want to leave a larger “footprint” on the planet than I have to. But I consider humans eating meat just part of the whole circle of life.)

So, do I continue? I timed the suggested two-week trial period to fit in between two trips out of town. Yesterday, the two weeks up, I put some cream in my coffee when I was out of the house, rather than taking it black. Then, I decided to cook a chicken that had been in my freezer for at least two weeks, but I let the rest of the family eat it and didn’t have any myself. This is the hard part: it’s great to eat a plant-based diet when I can cook at home, but I don’t always want to have to cook at home, or seek out special food everywhere. I want to be able to travel and eat meals with people in restaurants or as a guest in their homes (plus, I still need to worry about foods I’ve tested allergic to). I expect I’ll keep putting soy milk in my coffee and trying to bake without eggs at home, but I’m not sure I’ll avoid Dunkin Donuts completely.

November 6, 2009

New York Times Magazine on Dr. Brent James and Health Care Innovation

Filed under: Health — marcstober @ 8:51 am

For those of you who know about the Innovation project I did at work last year, this is a lot of what we researched. These are the ideas that will actually reduce costs (hopefully after we’ve achieved coverage reform nationally, as we already have in Massachusetts). While they only briefly mention computers in the article, just as in any industry, predictable, better organized, more measurable care will in large part depend on IT.

The health care debate of 2009 has had so many moving parts that it has sometimes seemed impossible to follow. The crisis behind the debate, though, is about one thing above all: the scattershot nature of American medicine. The fee-for-service payment system — combined with our own instincts as patients — encourages ever more testing and treatments. We’re not sure which ones make a difference, but we keep on getting them, and costs keep rising. Millions of people cannot afford insurance as a result. Millions more have had their incomes pinched by rising insurance premiums. Medicare is on a long-term path to insolvency. The American health care system is vastly more expensive than any other country’s, but our results are not vastly better.

via Magazine Preview – If Health Care Is Going to Change, Dr. Brent James’s Ideas Will Change It –

September 1, 2009

Health Care Reform and the American Dream

Filed under: Health, Politics — marcstober @ 8:52 pm

Here is my recurring nightmare version of the American Dream:

1. Have an idea for the next .com, Web 2.0, etc. success story.

2. Decide I need to leave my job and start my own company to develop the idea properly.

3. Hire Cheryl on to manage the business.

4. The company grows successfully yet organically, remains a small family-friendly concern, and we are able to offer our employees health insurance.

5. One of our employees, or worse, someone in the family gets cancer, it metastasizes and requires intensive chemotherapy.

6. Our insurance company, directly through rescission or effectively by raising our rates, drops our coverage.

7. I die homeless wandering the streets of Boston.

At step 3 I am taking on extra risk by putting all the family’s financial eggs in one basket (but that’s why it’s a dream). And thankfully, things could turn out better in Massachusetts thanks to an individual mandate and non-profit institutions committed to their mission (but it’s a nightmare, too). Admittedly, I might never start my own company, but small companies like this really do exist–I’ve worked for a couple of them before my current large-organization job.

Republicans say health care reform is bad for small business. But doesn’t the current system penalize small businesses that actually provide health benefits?

Don’t we get insurance to protect against just this sort of bad luck in the first place? How can anyone (unless they’re on Medicare, and selfishly care for no one but themselves) not wish for change–and not expect their representatives to be working constructively toward it?

July 9, 2009

Food Allergies Unsimplified

Filed under: Allergies, Food, Health, Personal Blog — marcstober @ 1:34 am

A few months ago I was diagnosed with some food allergies. These days people tend to associate food allergies with children, but food allergies have always impacted me, since my mom is allergic to peanuts and some other things. Reading labels on food packages and worrying at restaurants has always been part of my life.

Here are the foods I’m avoiding, along with the allergy test results and some comments.

Sesame seed (Skin prick test reaction. In hindsight, this was probably a main source of problems for me, as I can recall several incidents of mostly mild but disturbingly unexplainable irritation in my mouth, face and lips after eating hummus [with tahini – Trader Joe’s now has a tahini-free version!], Asian sesame dressing, sesame seed bagels and Kashi cereal.)
Sunflower (Skin prick; surprisingly, this was my most severe skin prick test reaction for a food.)
Hazelnut (Skin prick, class 3 RAST [blood] test reaction.)
Almond (Skin prick.)
Walnut (Skin prick.)
Peanuts (Negative, but avoiding them anyway based on family and personal history.)
Cherry (Skin prick, class 2 RAST.)
Peach (Class 2 RAST.)
Apricot (Class 2 RAST.)
Plum (Negative test, but had an episode of severe itching at the back of my throat to eating a fresh plum a few years ago, and in the same family as the above 3 foods.)
Nectarine (Not in the doctor’s orders, but similar to plum and peach, so I’m avoiding it.)
Apple (Class 2 RAST and an equivocal skin prick test – I’ve definitely eaten apple, although I’ve never enjoyed whole apples much, maybe that was a sign.)
Black bean (Class 1 RAST – I’ve definitely eaten them so this test is equivocal, but why not eat pinto beans instead?)
Corn (Class 1 RAST – although it’s nearly impossible to avoid corn as an ingredient, I’m going to avoid whole corn; corn-on-the-cob always sounded better than it was anyway. Heavy cornmeal coatings like on the bottom of some bread or used as breading seems to irritate me a bit.)
Green beans (Skin prick – again, never enjoyed them much as compared to other vegetables – these days we tend to do more broccoli, cauliflower, or sometimes squash.)
Lobster (Skin prick, haven’t eaten in years for religious reasons anyway.)
Clam (Ditto.)
Eggs (Negative, but I have a long history sensitivity of some sort that results in gastrointestinal symptoms rather than throat/mouth reactions, as confirmed by increased avoidance over much of the past year. Still eating them as an ingredient but avoiding whole eggs and mayonaise, although I’ll still order a tuna salad sandwich sometimes [at home I make it without mayo now, though].)

I also was tested for environmental allergens by a skin prick test. I was also tested for these as a child, so I pretty much knew about these, and for the most part had much larger reactions to these than to the food allergens:

Grass (Various types.)
Dust mite
Cat pelt (Nothing personal, Molly and Pepper!)
Aspergillus mold
Hormodendrum mold

(I didn’t clearly react to dog, which I did as a child. I’m not sure if this means we can get a dog.)

The earlier diagnosis of environmental allergies and oral symptoms to food seem consistent with something like oral allergy syndrome although I don’t exactly fit the plant/food pairings (no problem with tomatoes!) and don’t want to diagnose myself on Wikipedia.

What made me go to an allergist? In addition to personal and family history, I felt my environmental allergies had been getting worse over the past few years, and that it included stuffy noses and sore throats that didn’t really follow any allergy season. (This site suggests that could be a mold allergy, which probably explains some of it, and why I’m allergic to damp basements.) I sometimes had irritation around my lips and the roof of my mouth that wasn’t consistent with benign effects such as from salty, spicy, or acidic foods, but couldn’t pinpoint the offending food. Also, Hannah has been tested for allergies several times starting with a concern raised at day care when she was 1, with consistently inconclusive results.

Results have been mixed. I’ve been avoiding foods and taking non-drowsy over-the-counter antihistamines (Claritin or Zyrtec, or more likely the store brand) on a regular basis with good effect. Along with a medication for migraines prescribed by my primary care doctor, I’m feeling better than I have in years. I really feel “clear,” like on the Claritin and Zyrtec TV ads. With the exception of corn, which is an ingredient in everything but I’m barely allergic to it, all of the food allergens are pretty easy to avoid. Essentially, I have some environmental allergies and some fortunately mild food allergies, and I can feel better by avoiding the foods but probably won’t have any bad reaction if I somehow consume one from cross contamination.

However, I have a lot of anxiety now. My allergist prescribed an EpiPen, which I was told I’d probably never need. I should think of it like a life insurance policy, that I don’t often think about and can relax knowing I have it, but it serves more as a reminder that there is a small but clinically significant chance I could die from this. I’ve had a panic attacks that were most likely caused by my (psychologically) overreacting to some insignificant, non-allergy itch, like one time when my tounge felt itchy after eating some salty pretzels. I may have even been reacting to general stress–the incident with the pretzels happened during a particularly stressful time at home and work. Unfortunately, taking Benadryl, which can be indicated for a real allergic reaction, can make you jittery, hypertensive, and unable to concentrate all at the same time; in other words, it makes a little panic attack much worse. Rationally, my anxiety is out of proportion to the reality of the allergies, but that’s not how it feels sometimes. So, I take a deep breath, remind myself that I’m not having trouble breathing, and that there are people around who would take me to the hospital or call 911 if I needed it.

I write this in the hope that it will explain to friends and family (who might see me picking at food, etc.) what’s going on; and also in the hopes that it will be useful to someone else with similar issues out there on the Internet. (Note: This is a partial description of my patient experience; feel free to compare notes but more importantly get advice from a good doctor.) Plus, it’s a good way to deal with the issues in my head. There is more I want to write: about what I eat; social/political issues of food allergies; allergies vs. kashrut and other physically and spiritually healthy ways to eat; and maybe even some recipes. But I so rarely get a chance to write as it is, so I’ll save rest for some other time.