Thread by @brandontoner

I can’t shake the idea of a networked database of medical knowledge and a companion interface for the delivery of patient care.

Feels so possible and so powerful.

When most people think about advancements in healthcare information technology, they think big. Very big.

Connect all the information, in all the centres, from all the sources.

And that’s a compelling vision.

But I don’t think it’s next.

Even WITHIN a single practice site (e.g. pharmacy), the possibilities are powerful.

There are “classes” of information that all have features or properties.

And this information is used in different processes.

Entities:
- Patient Details
- Health Metrics
- Medical Conditions
- Medications

Each of which have a (reasonably) finite number of properties — or conventions

Then there are sources of information:
- Medical Research & Trials

That populate what we know about those entities.

Then within the delivery of care there are a bunch of well-conventioned processes and summaries:
- the case presentation
- progress notes & documentation
- the care plan

And these all have sub-components or properties.

And parts of the knowledge database are relevant here..

E.g. a care plan might include monitoring parameters which could be more effectively assembled using suggestions from “what could/should be monitored while managing X condition or Y medication”.

Important to note these should be *suggested* and *presented* rather than auto-pop.

As I complete lectures on clinical topics, all I see are taxonomies.

All I see is how this could all be filtered into a database that would be a permanent reservoir of knowledge.

Each slide deck dissected into its respective parts.

It’s all systematic. Already.

Yet I can’t grab it!! I can’t build the thing I can imagine.

I can see it. But I just can’t find the fluid workflow.

It’s there, though.

https://twitter.com/brandontoner/status/1338181844894937090

The key is going to be in defining or discovering the important taxonomies, how they can interact and relate, building funnels for population of data, and building workflows for its retrieval, use and presentation.

https://twitter.com/brandontoner/status/1336547560786423810

The structure of the data is key.

Once that is established, the population is easy.

It can be opportunistically populated.

This is a front-heavy project.

https://twitter.com/brandontoner/status/1293710481744683009

Populating the content can be expedited though existing libraries, through community, through opportunistic population, or random generation of #[[not-populated]] data to fill in missing blanks.

Prioritizing more frequently used content.

https://twitter.com/brandontoner/status/1332736013119213570

Then when dealing with individual patients. The purveyance of care.

You’d start with a “blank slate” at the beginning of the care relationship, then gradually populate and update the various fields as data points were missing or in need of updates.

These patient metrics and data points would interact with the knowledge repository...

With the ability to highlight important differences or deviations from a standard.

Status of condition, possible issues or drug therapy problems, overdue monitoring parameters, etc

Perhaps a documentation environment for progress notes should more closely resemble the flow of a daily notes page... dates with suggestive templates based on the patients status and missing/out-of-date parameters, reason for referral or chief complaint.

AoTs for care...

And the ability to link contents of the assessment and interaction to the patients growing database of clinical interactions.

Slowly, but steadily building a well-referenced and data-rich “story of health”

I believe this direction would begin to empower true patient-centredness, as evidence-based shared decision making would become more efficient.

Integration with a patient-facing interface could facilitate an asynchronous care relationship, enabling more detailed exchanges.

There are countless nuances at every turn of this thread. A large number of them I’ve considered deeply though practice experience and contemplation.

This is possible. And it’s important.

It could transform healthcare.

I won’t stop until I see it.

And upon realizing a basic model of this, there are infinite other futures that are unlocks. Bigger and more impactful problems and opportunities.

We’re in the first inning. Status quo healthcare is not healthy. There is dramatic room for improvement.

All that I do with exploring tools for thought, is indirectly exploring this future.

Understanding the constraints and possibilities available with technology, arms me with the knowledge to do justice to the articulation of this vision.

There are not many in the specific interface between healthcare expertise from a “systems of care” and “philosophy of care” perspective — and technology and tools for thought.

That’s the intersection of skills and knowledge that’s necessary here.

To carve the right nuance.

Cycles of growth, learning, expansion and exploration.

Followed by distillation, simplification, application, and practice.

The bearing feels right. Hopeful to continue progress in conceptualizing this possibility — finding the others along the way.

For some context of pharmacy practice, here’s a brief thread:

https://twitter.com/brandontoner/status/1339300887580323841