Remembrance of Larry Weed

Berner, Eta S eberner at UAB.EDU
Wed Jul 12 19:01:58 UTC 2017


I believe the way that problem knowledge couplers were envisioned was that they required data on an exhaustive amount of signs and symptoms to be entered, but that the patients (with non-physician assistance) would enter the data prior to meeting with the physician, so the MD did not spend time entering data.  However, the list of suggestions was also intended to be rather exhaustive, which did take time to for the physician to review.   Most diagnostic decision support programs (for good or ill)  assume that a knowledgeable clinician is entering the data, and that data will be filtered by that clinician’s  knowledge, so it would be less exhaustive than PKC requires.  In addition, there are algorithms to shorten the potential list of diagnoses, based on some estimate of likelihood.   Larry Weed objected to that approach and felt that the PKC approach that he termed “combinatorial” rather than “probabilistic” was better.

*********************************************
Eta S. Berner, Ed.D.
Professor, Graduate Programs in Health Informatics
Director, Center for Health Informatics for Patient Safety/Quality
Department of Health Services Administration
School of Health Professions
Professor, Department of Medical Education
School of Medicine
University of Alabama at Birmingham
1716 9th Ave. S. #590J
Birmingham, AL 35294
Phone: (205)975—8219
Fax:       (205)975-6608
Email:   eberner at uab.edu<mailto:eberner at uab.edu>
www.uab.edu/HI<http://www.uab.edu/HI>
www.uab.edu/shp/hsa/research/chips-q<http://www.uab.edu/shp/hsa/research/chips-q>

From: Mark Graber [mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG]
Sent: Wednesday, July 12, 2017 8:39 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Remembrance of Larry Weed

Its interesting to consider how different our world might be if the Apkon article hadn’t put a big stake in the heart of Weed’s decision-support tool.  It seems like interest in decision support for diagnosis took a major nose dive as a result of this publication, and ultimately the use of ‘problem-knowledge couplers’ never caught on.

Although they selected 24 different quality metrics in evaluating the impact of Weed’s PKC’s, none of these directly evaluated the most important outcome of interest, the accuracy of diagnosis.

Mark L Graber MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University
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From: David Meyers <dm0015 at ICLOUD.COM<mailto:dm0015 at ICLOUD.COM>>
Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, David Meyers <dm0015 at ICLOUD.COM<mailto:dm0015 at ICLOUD.COM>>
Date: Wednesday, July 12, 2017 at 8:45 AM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] Remembrance of Larry Weed

Harlan Krumholz reflects on Dr Weed’s legacy.

http://healthaffairs.org/blog/2017/07/11/what-larry-weed-understood-about-the-medical-profession-a-remembrance/

David
David L Meyers, MD FACEP
Listserv Moderator/Board member
Society to Improve Diagnosis in Medicine
Save the Date: Diagnostic Error in Medicine, October 8-10, 2017, Boston, MA

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