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Tag: Frank Meissner

The Case for Case-Based Reasoning

flying cadeuciiCase-based reasoning has been formalized for purposes of computer reasoning as a four-step process[1]:

  • Retrieve: Given a target problem, retrieve cases from memory that are relevant to solving it. A case consists of a problem, its solution, and, typically, annotations about how the solution was derived.
  • Reuse: Map the solution from the previous case to the target problem. This may involve adapting the solution as needed to fit the new situation.
  • Revise: Having mapped the previous solution to the target situation, test the new solution in the real world (or a simulation) and, if necessary, revise.
  • Retain: After the solution has been successfully adapted to the target problem, store the resulting experience as a new case in memory.

The complexities associated with programming and implementation of a knowledge management system based on case histories is both non-obvious and difficult, but ironically this is the actual process that an expert physician uses in his day to day clinical work.

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The 5 Stages of EMR Acceptance (With Apologies to Kubler-Ross)

                                                   DENIAL  

                 I can’t believe they are making me use this system!

                                                 ANGER

                I CAN’T BELIEVE THEY ARE MAKING ME USE WHAT 
                     THEY LAUGHINGLY CALL A SYSTEM!
                                                BARGAINING 

‘Look if I agree too willingly and cheerfully use this system, can you ask for and fund these change orders, add these features, re-engineer this screen…..blah! blah!  Blah!, etc. ‘
                                               DEPRESSION 

I can’t beeeelieeeeeeve (sob, sob, sob, sob) theeeey (sob, sob, sob) are making meeeee (pouring tears from both eye tear wells) use this system!’ 
                                             ACCEPTANCE 

           I believe they are making me use this system.
                                         (Resigned Sigh) 
And just as in the original Kubler-Ross model, our only release from EMR agony is death……. an eventuality that I used to accept stoically as inevitable, but now positively look  forward to its release (as do my carpal-ly tunneled wrists!). Continue reading…

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