I’ doing a little guessing here and speculation from what I am reading about the latest article about the VA hospital in Phoenix.  You can read through and see the explanations of how a new scheduling system was making improvements and that I don’t doubt at all was rolling through a lot of hoops with trying toimage implement a new system and I am also somewhat guessing this is software that was brought in to work in harmony with the VA medical records system Vista.  We have layers of software today that we work with and making them all work together for the end result of better outcomes is a challenge.  When I read about the “secret” waiting list it some what says that these were patients that were in some kind of  a limbo stage somewhere along the line.

VA Hospital in Phoenix And The Secret Waiting List - Patients Are Victims Of A System Where Meeting Analytical Goals Trumps Any Sort of Ethics And Care-“The Grays” Where People Can No Longer Tell the Difference Between “Virtual” and “Real” World Values

You can get blinded too with implementing such systems here and there are all kinds of ways that measurements can be taken in or out of context too when it comes to quality reporting.  When I read about Dr. Foote, the whistle blower MD here I seem to think this is what he’s talking about because in such transitions, people do get lost in systems.  If you running a factory for example sure product gets lost in such transitions but here we have people’s lives, which is different than an inventory system of product. 

When it comes to the deaths of vets, well again sometimes when working a “system” and getting a patient in the system collide, well the real world has to step in here.  Sure it’s rocky and there’s not getting around it but when you have people who need immediate care, you have to sometimes change the system at least temporarily to get care for those vets.  In addition, I read here where the VA is limited on staff and needs more doctors.  I don’t care what kind of system you have there if you are down from 6 doctors to one, there’s no technology that’s going to solve that problem.  Sure there are efficiencies that can help but this is a math problem here that doesn’t add up with available clinicians to meet the needs.  It’s kind of uncanny that I wrote this post a few days before the VA story hit the news and it’s worth a read as when you watch the video the comments here relate to exactly what this post says, “there’s no ethics with machines in a working system” and again we come back to the collision of the real and the virtualimage world values. 

Limitations And Risks Of Machine Ethics (That Really Don’t Exist) - Abstract Basically Substantiating the Existence of What I Coined As “The Attacks of the Killer Algorithms”…

Will people out of frustration with safety goals hammering on them every day in a situation such think about trying to use a data system to make it not look so bad?  Happens all the time when the virtual world comes in and people want to see numbers and that seems like part of the problem here. I watched this video and the lack of “humanity” in their voices kind of bothers me quite a bit.  Sure you have the one doctor speaking and he gives his stand point which is good on what “he” has been able to handle.  Again it sounds like the math here with available clinicians versus those needing care is the real problem. 

Sure the system was starting to work with improving wait times but in the meantime you need to look at the “real” world and see who’s not getting in at the same time.  Nowhere do you hear that we saw some flaws that need immediate attention in the video and those things do occur.  Sharon Helman sounds very out of touch here with how her system is or was working.  The doctor describes the system improving appointments and that’s a good thing of course but again “the real world” comes calling in the midst of all of this and it’s a balance to stop the wheels in motion and make a left turn at times when people’s lives are in danger.  That’s what I see here is the fact that the “virtual appointment system” is making improvements again which is a good thing but there’s no sense of urgency here to catch what’s falling out the bottom in the process, in other words “The Grays” (link below). I wrote about that a short while back too and it’s everywhere. 

Virtual Worlds, Real World We Have A Problem And It’s A Big One With A Lot of Gray Areas Finding Where The Defining Lines Exist, Confusing Many With A Lot of Weird Values And Strange Perceptions…

Again the lack of concern here with Helman’s voice in the video is what disturbs me, the perceptions and the mention of “systems” over and over and her “perception” of the problem.  Meanwhile back at the ranch, the Office of the Inspector General is looking at “the real world” here with the bottom lines with patient safety and care. I wrote about this topic quit a bit with the implementation of “Healthcare.Gov” too in the fact that instead of sometimes looking at what was going on in the “real world” we just kept getting numbers over and over and over about how many had enrolled. 

That in itself is not a bad thing but when such stats are used to overshadow real world issues and difficulties? We had that and the news was like a bunch of magpies repeating stats over and and over.  I don’t know about you but when there are “real world” issues that need to be dealt with, it’s gets very old to not see more of those stories out there and we just get beat over the head with enrollments numbers all the time.  We need to hear both and not slide one under the carpet and I think this is relative here.  CMS is under this spell too with their recent “5 star hospital rating system”…we don’t need that but rather we need to know what hospitals are going to be available with the closure of so many, especially rural hospitals.  Time to take a serious look at what virtual and real world values are. 

CMS Plans To Begin Five Star Hospital Rating System - Add A Column For “Hospital Mortality Projections” Or Stop the Ratings All Together As Lack of Money Today Is More of a Determining Factor With US Hospital Inequality That Keeps Growing..

Again what is most disturbing to me about what I read and listened too was the lack of the “human side”.  Here’s a video clip that I have used a few times that somewhat says it all and if you like it, scroll on down to the footer and watch video #2 and see how virtual and real world financial markets have devastating results too when virtual values substantiate more “Gray” thinking.  You could say the patients are representative of the “oysters” if you will.  “With software you can do something about anything, you can modify and make the virtual world that you want”…

So anymore with the touting of “systems” you have to ask questions to find out what’s going on in the “real” world too and not just rely on data, as taken out of context, it can tell any story you want.  If you go back a few months you can also read where Bill Gates said “the internet will not save the world” so again maturity here with technology and where it can really benefit.  You can also take a look at this PBS report on Facebook, it’s a total “virtual” world so what’ more important here the number of” likes” you have or if you have a place to sleep and food to eat?  Again these are examples of where the virtual world values are on a collision course with the “real world” and that’s what I am seeing here with the VA sadly.  Dr. Foote is telling us about the “real” world of patients dying and the VA administration is tell us about “virtual” values..

Now we have the questions of Dr. Foote not voicing his concern before.  Well we all know what happens when that occurs while one is still working, the are the trouble makers.  A while back I had a couple doctors telling me about a situation they had at their hospital to where over and overimage they had voiced complaints about the anesthesiologists talking on their cell phones during surgery.  I heard that years ago and if they were to be whistleblowers, they wouldn’t be working today and it took years to get a situation like that resolved as it involved a long series of reports, getting a new group of anesthesiologists possibly, disciplinary action, etc.  So being a whistle blower is not an easy choice either. 

There were a number of complaints filed with the Inspector General by patients so if you follow the paper trails it somewhat says this was not a story just trumped up as people will talk when their voices can be heard without fear of retaliation.  It sounds to me that the transition from a paper based system into the electronic system was maybe the “fake list” we hear referred to and the inability to get people into the electronic system may be what is being referenced here. When I read that if a primary care doctor leaves that 1200 to 1400 patients are removed from the scheduling data base, well that’s a bit scary as they need to be reassigned and if there’s no available slots with under staffing and not enough primary doctors to see them?  60,000 unmet appointments in 2012, that’s a big number. 

The urology department which normally had 6 doctors was down to one, so I don’t care what kind of scheduling system one has has, this is the real world to where the number of patients needing care can’t be fixed with any kind of software model.  When you have to send patients all the way to Tucson and Albuquerque to make up for this shortage?  Outside the VA the US is having the same problem with “narrow networks” and maybe not as extreme with the number of miles but again doctors and hospitals are not available “in network”. 

Anyway, that’s my take here is that tight budgets and folks looking for ways to solve the math shortage of lack of primary and other doctors available for veterans receives a big “F” for fail and we need a much better awareness of the virtual and real worlds soon, and people need to understand the difference as deadly perceptions such as what occurred here will continue…Algo Duping and Killer Algorithm attacks as I call it. 

At the link below you can also read about a useless Nobel Prize winning algorithm for matching medical students to universities.  Medical students said it was useless as it only focused on the student and university as was not the slated full answer solution it was sold to be, not much different than a dating website.  Student has wife and kids, nothing about that as far as finding any solutions there which is the “real world” as student do have wives and kids that need to going along:)  See the correlation with what the VA was doing here perhaps with leaving out the affected humans?   BD 

Nobel Prize for Residency Match System Not Much Different Than What You Get From a Dating Site These Days– Flow Sheets And the Dangers of An “Algo Duped” Naïve Society That Gets Sucked In Too Often

A July e-mail exchange among employees at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix questioned whether administrators were improperly touting their Wildly Important Goals program as a success because it showed a dramatic reduction in wait times for patient appointments.

Hospital officials had claimed they wiped out a longstanding access problem for new patients, reducing delays that had sometimes lasted nearly a year to an average of just 14 days.

But, in the message string nine months ago that included Phoenix VA Health Care System Director Sharon Helman, an employee named Damian Reese complained the data were misleading.

Earlier this month, after allegations surfaced that wait times for Arizona VA patients were being falsified, Helman said it was news to her. However, that e-mail exchange nine months ago shows she was aware of the issue and concluded that the concerns warranted an internal ethics review.



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