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Informatics Pioneer Says Healthcare Needs Better Systems

Dr. Lawrence Weed continues his longstanding advocacy for computer-aided healthcare and revamping medical education.
"We don't have a system," Weed said about healthcare. There is a transportation system that works because the knowledge is in the system, not in someone's head, and because parents teach their children how to interact with it.

"Medicine is a 2 1/2 trillion-dollar industry with no accounting system, and it's killing us economically."

Businesses standardize accounting systems, Weed noted. "The scandal in business, at Enron, there was an accounting system and they corrupted it. The scandal in medicine is there's no accounting system. We don't know [all that] actually goes on," he said. "There would be a scandal in travel systems if California had different stop signs than New Jersey. I mean, let's get things standardized. Let's move knowledge through tools."

Some have touted evidence-based medicine as a way of improving healthcare, but Weed has long dismissed that concept as being too reliant on probabilities, not the patient's actual problems. "We start thinking statistically," said Weed, who advocates the "coupling" of medical knowledge to problems with the help of computers.

"The patient isn't interested in what's probable. They're interested in what's wrong. And if it's highly improbable, they expect you to find it," said Weed, who received two standing ovations in the 75 minutes he commanded the podium.

Weed formerly ran a company called PKC -- which stands for "problem-knowledge couplers" -- that has roots stretching to 1982. He was fired in 2006 because of a conflict with management he had brought in several years earlier. Sharecare, an Atlanta-based health and wellness social network founded by TV host Dr. Mehmet Oz and WebMD founder Jeff Arnold, bought PKC last year.

Despite the ouster, Weed still believes in the power of couplers. Knowledge couplers eliminate typing, document cases and lead to automatic outcomes studies. "You realize when you see something like that, we're in the dark ages about moving information," Weed said. "Never move it through heads." Instead, let computers do the work, he said.

Ever the Renaissance man, Weed has a fondness for quoting literary and historical greats. "The cause and root of nearly all evils in the sciences is this -- that while we falsely extol and admire the powers of the human mind, we neglect to seek for its true helps," is one of his favorite lines. It was written by Francis Bacon. In 1620.

"We keep talking about artificial intelligence as if intelligence is the standard," Weed quipped. "If you've got a big pile of dirt in your yard, and you can't shovel it all out, you get a bulldozer. We don't call a bulldozer an artificial arm. We don't call telescopes artificial eyes," he explained.

"The mind is a very dangerous instrument," Weed added.

Weed also had some choice words for the President's Council of Advisors on Science and Technology (PCAST) health IT report, released in December 2010. That report called for the White House and the U.S. Department of Health and Human Services to work together to develop metrics for measuring progress toward a national health IT infrastructure and for federal officials to designate a "universal exchange language" for sharing health data.

Weed quoted from the report: "We believe that any attempt to create a national health IT ecosystem based on standardized record formats is doomed to failure."

"That's what people in the profession, from the universities, are saying to the president of the United States," he added, somewhat incredulously, then compared health IT infrastructure to the Interstate Highway System.

"They didn't say to Eisenhower ... 'any reason to standardize the national transportation system is doomed to failure,'" Weed said.