Content: Now, that I have reached this blog site, I want to make comments about this course and the three lectures so far as well as additional issues for which I elicit comments from all of you. Lecture 1, which was essentially an introduction, sets the plan for this course. It is clear that Kanal is a creative guy with an ability to think on his feet. Perhaps, one of the most valuable aspects of this course will be to see how he approaches problems and their solutions in an innovative way. As an example, determining hand washing with lasers, etc. was neat. One of the most useful concepts in learning is to apply what you are or have learned. This consolidates the material and makes it more than just rote learning. This is why the assignment and choice of projects related to 5 areas of critical content is very useful. I am sure that no one will approach any single topic in the same way, in no small part due to the varied background within this class. Topics, like this, when chosen generate a need to use and integrate content from a variety of sources. I suspect that these topics will provide the basis for individual research foci of members of this class. One thing that would be particularly useful, though, is to have a schedule of the lecturers for this class. I may have missed this, but I would like to have this. In Lecture 2 by Valentin, there is an introduction to databases with particular emphasis on Entity attribute value modeling. This, certainly, is the preferred means for entrance of genetic data, but accessing the different sources of metadata. The clarity in simple terms of this type of database versus conventional databases was part of the lecture. However, the lecture assumes working knowledge of databases. For those of us who are software engineering compromised, more basic information is needed also. The posts by Kanal of some database references are useful, but a more general lecture or several on databases to compliment the EAV lecture is needed. Just as clinical topics may be repetitive for some, this may be repetitive for others, but is essential. I, personally, want to take a database course and learn to program and construct databases both conventional and EAV. Eric has provided me with a linkage to some background in Access, but if this is an important and useful database software, I would like a lecture on this. In the 591 Statistics Course, we have lecture as well as computer application. Is it possible to have a component of this for this course, which is a methods course. In Lecture 3, we have heard from Dr. Greenes, a whole concept of research and the approach within the field that is complimentary to Dr. Shortliffe's lecture. As I mentioned in class, decision support is of some interest and the references on this would be useful. Determining that there will be a course on decision support in the Winter Semester is advantageous. We will also have more in 501. The framework provided from the Greenes lecture is very useful, but I would like in this lecture and this course, to have a series of several questions. These questions would promote thinking about the content of the lecture and applying it. This is the way to learn the concepts and how they can be used. I am not interested in making more work for all, but I am interested in learning how to use the content, on daily basis with each lecture, in addition to the project that we all are doing. With regard to this lecture, I posed the question about guidelines and how these should be utilized in taking quality care of patients. I am in agreement that guidelines are just that and do not supplant clinical experience and judgment. Documentation, as promoted by Dr. Shortliffe, is also very useful and this is where efficient electronic records that have optimal human interfaces are essential. I would be grateful for some of your comments on guidelines, medical records, and clinical care. This is a suitable forum to also bring up a question that I put to Dr. Shortliffe about our own personal experience with electronic health records and the current legislation. It is clear that finally due to the efforts of Biomedical Informatics Community, that we finally have funding for improvement of health care with informatics, including direct application and grants. The problems in instituting this are extremely complex. Unfortunately, the money is present, but the means for implementation of the protean problems are not at all clear for all aspects. Even the basis for increased funding to save costs but to provide care for the uninsured is unclear because it is unknown the actual uninsured numbers, as per Dr. Johnson, and then getting the uninsured to seek this care. One drawback of the current funding and legislation for electronic health records is the predicament that we have with the company using these inducements and government certification to promote the use of another EHR program with its new attendant costs for those like myself that have an existing EHR upon which the clinical care of all of patients revolves. Given the fact that new more expensive software does not have the capacity to migrate my templates and clinicial data, What is the use of a monetary inducement by the government for me to migrate if I can not take care of patients due to the lack of prior information. Jeff has suggested that the migration can be accomplished using other vehicles despite what the company may be saying. As such, given the methods nature of this course, I would like to have several lectures on the electronic health record, their components, and the issues. If not part of this course, then perhaps in the next methods course. Also, maybe there should be a separate mini-course on this. I would like some of your opinions on this and also on EHRs and legislation. I will await all of your input and will be reviewing other content from all of you to get a idea of the different approaches that are given from the myriad of different backgrounds.

Stuart

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